Nevin Manimala

Hernia. 2025 Jun 16;29(1):204. doi: 10.1007/s10029-025-03367-y.

ABSTRACT

BACKGROUND: The rate of incisional hernia (IH) at stoma site after ileostomy closure is controversial in the literature. We aimed to estimate the prevalence of IH at stoma site after ileostomy reversal and to determine its risk factors.

MATERIAL AND METHODS: We performed a systematic review according to PRISMA standards to identify studies reporting prevalence of IH after ileostomy closure. Meta-analysis was performed to estimate its rate. Heterogeneity was explained by meta-regression and subgroup analysis.

RESULTS: Twenty studies were included with 2629 patients. The pooled estimated rate was 13,7% with a 95% confidence interval (11-17%). The 95% prediction interval varied between 5,3% and 31,1%, which showed substantial heterogeneity. Meta-regression showed that ASA score III and IV increases IH rate (p = 0,02). Obese and elderly patients have a tendency for developing IH with substantial heterogeneity. Subgroup analysis for COPD, diabetes mellitus, smoking, laparotomy approach for the initial surgery, did not show statistically significant differences.

CONCLUSION: Prevalence of IH is higher than previously estimated in the literature. ASA score III and IV increases its rate. Prospective randomized studies focusing on the impact of prophylactic mesh implementation are necessary.

PMID:40522527 | DOI:10.1007/s10029-025-03367-y

Schizophr Bull. 2025 Jun 16:sbaf067. doi: 10.1093/schbul/sbaf067. Online ahead of print.

ABSTRACT

BACKGROUND AND HYPOTHESIS: To determine whether a tele-mentoring program increases clozapine utilization by improving prescriber knowledge and perceived competence in clozapine management.

STUDY DESIGN: In a cluster-randomized controlled design, we tested the effectiveness of an Extension for Community Healthcare Outcomes (ECHO) model-based intervention, consisting of 26 biweekly didactic and case-based tele-mentoring sessions, vs enhanced treatment as usual (eTAU), in which both conditions received access to a consultation phone line and a point of care device for on-site hematologic monitoring. Prescribers completed baseline and 12-month assessments of clozapine knowledge and competence, and prescription records were used to evaluate the effects of ECHO on prescribing and treatment persistence.

STUDY RESULTS: 266 prescribers from 43 mental health treatment settings throughout Maryland were enrolled. Prescribers randomized to ECHO demonstrated a significant increase in clozapine knowledge compared to eTAU (P < .001), and competence increased significantly in those who attended 14 or more tele-mentoring sessions (P = .017). ECHO did not increase the likelihood of clozapine prescribing during follow-up (P = .70). While there was a 17% lower hazard of clozapine discontinuation among patients of prescribers randomized to ECHO, this did not reach statistical significance (P = .72).

CONCLUSIONS: A statewide tele-mentoring program increased prescriber knowledge and competence in clozapine prescribing among those attending most ECHO sessions. Median time to clozapine discontinuation was double in the ECHO group, however, neither this nor rates of prescribing were statistically significantly different from control. Additional support is needed to motivate clozapine prescribing beyond providing education and increasing confidence in clozapine management.

PMID:40518551 | DOI:10.1093/schbul/sbaf067

Malar J. 2025 Jun 15;24(1):192. doi: 10.1186/s12936-025-05446-y.

ABSTRACT

BACKGROUND: The declining efficacy and widespread resistance to antimalarial drugs (AMD) pose significant challenges to global malaria control and elimination efforts. To enhance treatment efficacy, the World Health Organization (WHO) recommends the use of combination therapies. This study aimed to evaluate the therapeutic efficacy of chloroquine with primaquine (CQ-PQ) for the treatment of uncomplicated Plasmodium vivax malaria in the study area.

METHODS: The study utilized a single-arm, 42-day follow-up design to assess the therapeutic efficacy and safety of a treatment regimen in Northwest Ethiopia. Participants, all diagnosed with uncomplicated vivax malaria, received a 3-day course of chloroquine (CQ) at 25 mg/kg, followed by a 14-day course of primaquine (PQ) at 0.25 mg/kg. Participants were monitored with follow-up visits on days 1, 2, 3, 7, 14, 21, 28, 35, and 42. Data were double-entered into a standard Excel sheet by the WHO and analysed using SPSS v.26. Statistical analyses included Kaplan-Meier survival analysis, t-tests, and ANOVA, with statistical significance set at p < 0.05.

RESULTS: Of the 100 participants enrolled, 92% completed the study. The cumulative treatment success rate for CQ-PQ was 93.7% (95% CI 0.86-0.97) on day 42, with a 6.3% (95% CI 0.03-0.14) treatment failure rate. Asexual parasite clearance was rapid, with 97% achieving clearance by day 2 and full clearance by day 3 in all but one participant. Haemoglobin levels increased significantly from 12.3 g/dL at baseline to 13.5 g/dL by day 42, with 84.2% of mild anaemic patients and 85.7% of moderate anaemic patients showing recovery. Common adverse events included abdominal pain (8%) and diarrhea (5%), all of which resolved by day 7.

CONCLUSION: CQ-PQ therapy demonstrated high efficacy in clearing parasitaemia and improving haemoglobin levels in patients with vivax malaria. These results highlight the potential of CQ-PQ as an effective treatment option, with a favourable safety profile. Further studies are needed to explore long-term outcomes and the impact of this treatment on malaria control in different settings.

PMID:40518540 | DOI:10.1186/s12936-025-05446-y

Diabetol Metab Syndr. 2025 Jun 16;17(1):215. doi: 10.1186/s13098-025-01784-8.

ABSTRACT

BACKGROUND: The relationship between mixed metal exposure and metabolic syndrome (MetS) remains controversial, and the underlying mechanisms of this relationship are not yet fully understood.

OBJECTIVE: We evaluated the association between urinary metals and MetS and investigated the potential mediating effect of ageing.

METHODS: This study utilized National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2018 and included 11,541 adults aged 20 years and above. We explored the association between urinary concentrations of nine metals and MetS using weighted quantile sum (WQS) regression, grouped weighted quantile sum (GWQS) regression, and Bayesian kernel machine regression (BKMR). In addition, various methodologies have been used to assess biological ageing, encompassing the examination of cellular senescence through the evaluation of telomere length, as well as a comprehensive evaluation of overall body ageing through the determination of biological age. The contribution of biological ageing to the association between urinary metals and MetS was investigated in a mediation analysis.

RESULTS: After adjusting for confounders, the WQS and GWQS analyses found positive and negative correlations between metal exposure and MetS, and the main metals affecting MetS risk were cadmium (Cd) and lead (Pb), respectively. A positive relationship was found between exposure to mixed metals and the risk of MetS in the BKMR results. Mediation analysis showed that ageing biomarkers, including biological age and telomere length, mediated 68.43% and 12.05% of the association between metal exposure and MetS, respectively. Biological ageing may play a major role in the association between mixed metal exposure and MetS. Cd contributed the most to the positive association, indicating that priority control measures may be necessary to reduce the risk of MetS related to Cd exposure.

SIGNIFICANCE: The findings of this study could contribute to the advancement of targeted measures for metal precautions, ultimately mitigating the incidence of metabolic syndrome.

IMPACT STATEMENT: This research employed multipollutant models including WQS regression, GWQS and BKMR to evaluate the combined effects of various metal exposures on the risk of developing MetS based on a nationally representative large cross-sectional study. In addition, this research investigated biological aging by conducting a comprehensive assessment of biological age and telomere length. Our goal is to understand its potential mediating effect on metal exposure and the occurrence of metabolic syndrome. The insights gained from this study could provide valuable hints for future mechanistic research in this field.

PMID:40518538 | DOI:10.1186/s13098-025-01784-8

Int J Retina Vitreous. 2025 Jun 15;11(1):66. doi: 10.1186/s40942-025-00694-1.

ABSTRACT

BACKGROUND: The objective of this study was to establish a comparison between the vessel density (VD) and foveal avascular zone (FAZ) of patients with type 2 diabetes mellitus (T2DM) who lacked clinical signs of diabetic retinopathy (DR) and non-diabetic patients using optical coherence tomography angiography (OCTA).

METHODS: A cross-sectional comparative case-control study (unpaired) was carried out at two tertiary hospitals. All subjects underwent optical coherence tomography angiography (OCTA) examination (DRI OCT Triton Swept Source, Topcon, Japan). The average VD in the superficial capillary plexus (SCP) and the deep capillary plexus (DCP), the FAZ area (mm2) in SCP, and DCP were taken into analysis. The time since the diagnosis of T2DM was used to stratify patients with diabetes between 5 and 10 years and those with a diagnosis of more than 10 years.

RESULTS: Compared to non-diabetic controls, the parafoveal VD in both SCP and DCP was significantly reduced in the eyes of T2DM patients without clinical DR (p < 0.001). Additionally, the VD was also statistically reduced in T2DM diagnosed more than 10 years ago compared to T2DM cases diagnosed between 5 and 10 years ago (p < 0.001). The FAZ area in both plexuses was larger in T2DM eyes compared to controls (p < 0.001). The FAZ area was enlarged in DCP (p = 0.04), but there was no significance of FAZ area in SCP when comparing patients with T2DM diagnosed between 5 and 10 years ago to those diagnosed more than 10 years ago (p = 0.06).

CONCLUSION: In diabetic patients with long-term diagnosed disease, OCTA was shown to be capable of detecting preclinical microvascular foveal abnormalities prior to the development of clinically apparent retinopathy. According to our findings, OCTA has the potential to be a promising instrument for the early detection of vascular micro-abnormalities and the routine screening of diabetic eyes.

PMID:40518532 | DOI:10.1186/s40942-025-00694-1

J Orthop Surg Res. 2025 Jun 16;20(1):588. doi: 10.1186/s13018-025-06016-3.

ABSTRACT

BACKGROUND: Cage subsidence (CS) is a significant complication following oblique lateral interbody fusion combined with bilateral pedicle screw fixation (OLIF-BPSF) in patients with spinal degenerative diseases (SDDs). Identifying reliable predictors of CS is crucial for optimizing surgical outcomes.

METHODS: This retrospective cohort study included 314 SDD patients who underwent OLIF-BPSF between July 2019 and July 2023. Preoperative Hounsfield unit (HU) values and vertebral bone quality (VBQ) scores were measured. Statistical analyses included correlation matrices, Kaplan-Meier survival analysis, Cox proportional hazards models, restricted cubic splines, and receiver operating characteristic (ROC) curve analysis. Sensitivity analyses were performed to ensure robustness.

RESULTS: CS occurred in 13.38% of patients. Lower global (HR: 0.97, 95% CI: 0.97-0.99) and segmental (HR: 0.97, 95% CI: 0.95-0.98) HU values were significantly associated with higher CS incidence, whereas higher global (HR: 1.67, 95% CI: 1.29-2.16) and segmental (HR: 1.68, 95% CI: 1.30-2.17) VBQ scores were also significantly associated with increased CS risk. A nonlinear relationship was observed between the VBQ score and CS, with CS incidence significantly increasing when the global VBQ score was ≥ 2.67 or the segmental VBQ score was ≥ 2.49. ROC analysis demonstrated good predictive performance for HU values and VBQ scores, with segmental HU values showing superior incremental predictive value (AUC: 0.82). The findings remained consistent across various sensitivity analyses.

CONCLUSION: HU values and VBQ scores independently predict CS in SDD patients undergoing OLIF-BPSF. Incorporating these metrics into preoperative assessments may enhance risk stratification and guide personalized surgical planning.

PMID:40518511 | DOI:10.1186/s13018-025-06016-3

AIDS Behav. 2025 Jun 16. doi: 10.1007/s10461-025-04794-9. Online ahead of print.

ABSTRACT

While extant literature demonstrates that healthcare providers’ stigmatizing attitudes negatively impact care for people who use drugs (PWUD) and people with HIV (PWH), limited research has explored how these stigmas are interrelated. This study examines the relationships between multiple dimensions of stigma-including cognitive, affective, and role-based attitudes-toward PWUD and PWH. We operationalized these dimensions using two validated instruments. The Drug and Drug Problems Perception Questionnaire (DDPPQ) assessed five role-based dimensions of provider attitudes toward PWUD: role adequacy, role support, job satisfaction, role-related self-esteem, and role legitimacy. The HIV/AIDS Provider Stigma Scale (HPASS) measured three dimensions of HIV-related stigma: cognitive (stereotypes), affective (prejudice), and behavioral (discrimination). Canonical correlation analysis was used to examine multivariate associations between these subscales. The analysis included 128 healthcare providers from HIV clinics in Birmingham, AL, and Pittsburgh, PA. Participants were predominantly White (52.4%), cisgender women (70.3%), aged 36-47, with less than five years of experience working with PWH (35.8%) and PWUD (29.6%). The overall CCA model was statistically significant (Wilks’s λ = 0.579, F [15, 281.97] = 4.103, p < 0.0001), explaining 42.1% of the shared variance. Function 1 (rc = 0.615) accounted for 37.8% of the variance. Role-related self-esteem had the highest loading among DDPPQ subscales (β = 1.024), while prejudice (β = 0.778) and stereotypes (β = 0.546) were the strongest contributors from HPASS. Findings highlight the interconnection between stigmatizing attitudes toward PWUD and PWH. Subscale-level analyses suggests that providers with lower role-related self-esteem are more likely to hold prejudicial and stereotypical attitudes, reinforcing intersectional stigma. Addressing one form of stigma may help reduce the other, supporting more effective and targeted interventions in HIV care settings.

PMID:40518496 | DOI:10.1007/s10461-025-04794-9

Support Care Cancer. 2025 Jun 16;33(7):585. doi: 10.1007/s00520-025-09622-3.

ABSTRACT

PURPOSE: Urine drug testing (UDT) is recommended, yet underutilized, for patients receiving opioids for cancer pain. The primary aim of this study was to evaluate the impact of an embedded onco-palliative care clinic on UDT among patients with lung cancer. The number of patients tested, the timing of the first UDT, the incidence of unexplained UDT results, testing frequency, and substances detected on UDT were explored.

METHODS: This is a single-institution retrospective study of patients diagnosed with any stage thoracic malignancy who began urine drug testing 1 year before (pre-cohort) and 1 year after (post-cohort) implementation of an embedded thoracic oncology-palliative care clinic in Columbus, Ohio, USA, on September 5, 2018. Confirmatory UDT was routinely ordered for any patient receiving opioids prescribed by palliative care or via ad hoc testing by oncology providers regardless of palliative care referral status.

RESULTS: More patients completed UDT after implementation of an embedded onco-palliative care clinic (pre-cohort, n = 61; post-cohort, n = 182). Pre-cohort patients began UDT closer to death with median survival of 5.2 months after first UDT (post-cohort, 10.9 months; p < 0.0001). While a larger proportion of post-cohort patients completed > 1 UDT (pre, 26.6%, post, 46.7%; p < 0.01), there was no significant difference in the proportion of patients experiencing an unexplained UDT result (pre, 9.8% vs. post, 11.0%, p = 0.80).

CONCLUSION: Implementation of an embedded onco-palliative care clinic was associated with a significant increase in use and earlier initiation of UDT among patients receiving care in a thoracic oncology clinic.

PMID:40518470 | DOI:10.1007/s00520-025-09622-3

J Neural Transm (Vienna). 2025 Jun 15. doi: 10.1007/s00702-025-02970-8. Online ahead of print.

ABSTRACT

The role of neurodegeneration in essential tremor (ET) remains debated, particularly in patients with late disease onset. Neuropathological studies have identified structural changes in the Purkinje cells and its connections. Recent studies additionally suggested a role of cerebellar astrocytes. Increased levels of serum glial fibrillary acidic protein (sGFAP), an astrocytic intermediate filament, were found in various neuroinflammatory and neurodegenerative diseases. The objective of this case-control study was to investigate the role of sGFAP in ET focusing on early-stage late-onset patients. sGFAP was quantified by single molecule array at baseline and follow-up in 36 ET-patients (median follow-up period 5.3 years) and 36 age-matched healthy controls (4.9 years). ET-patients were assessed both at baseline and follow-up using the Fahn-Tolosa-Marin-Tremor-Rating-Scale. The ET group was stratified (1) by median age at onset and median disease duration in early-stage late-onset and early-onset/late-stage ET, and (2) by median sGFAP-level at baseline. Early-stage late-onset ET-patients had higher baseline-sGFAP than controls (p = 0.023) and higher follow-up-sGFAP and annual sGFAP-increase than both controls (p = 0.023; p = 0.007) and early-onset/late-stage ET-patients (p = 0.021; p = 0.024). Baseline sGFAP-level correlated with tremor severity at follow-up in the early-stage late-onset (r_s = 0.704, p = 0.011) but not in the early-onset/late-stage group. Patients with high compared to low sGFAP-baseline levels had later disease onset (p < 0.001) and sGFAP-increase was associated to tremor progression only in high sGFAP-patients (p = 0.041). ET-plus and pure-ET-patients did not differ in any of the sGFAP-parameters. sGFAP is elevated in early stages of late-onset ET and associated to tremor progression, substantiating the role of a neurodegenerative process in ET in this subgroup.

PMID:40518460 | DOI:10.1007/s00702-025-02970-8

Eur J Nucl Med Mol Imaging. 2025 Jun 16. doi: 10.1007/s00259-025-07368-y. Online ahead of print.

ABSTRACT

PURPOSE: Large B-cell lymphomas (LBCL) include diffuse large B-cell lymphoma, not otherwise specified (DLBCL, NOS), and subtypes such as transformed non-Hodgkin’s lymphoma (tNHL), primary mediastinal B-cell lymphoma (PMBL), and double/triple-hit lymphomas (DHL/THL). While metabolic risk scores based on metabolic tumor volume (MTV) have demonstrated prognostic value in DLBCL, NOS, their applicability to other LBCL subtypes remains unclear.

METHODS: Baseline [¹⁸F]FDG-PET/CT scans of LBCL patients treated with R-CHOP regimens at our institution were retrospectively analyzed. Metabolic parameters, including MTV, lesion dissemination (SDmax) and tumor surface volume ratio were calculated for each histological subgroup. Four metabolic risk scores-the international metabolic prognostic index (IMPI), MTV/WHO PS, MTV/SDmax and Clinical PET model- were applied to calculate progression risk in LBCL subtypes. Harrell’s C-index evaluated the prognostic performance. A multivariable model was developed for tNHL.

RESULTS: We included tNHL (n = 88), DHL/THL (n = 32), PMBL (n = 26) and others (n = 49), and compared them to a cohort of previously published DLBCL, NOS (n = 355). IMPI demonstrated the highest C-index amongst the metabolic risk scores in tNHL for progression-free survival (PFS), overall survival, time to progression and progression of disease within 12 months, but was outperformed by the IPI. For DHL/THL the highest C-indices were observed for MTV/WHO PS. For PMBL the clinical PET score showed the highest C-indices. SDmax improved prognostic predictions in PMBL and tNHL, but not in DHL/THL. Multivariate analysis identified independent predictors of PFS in tNHL, including IPI and SUV_mean.

CONCLUSION: Metabolic risk scores show variable prognostic value across LBCL subtypes. Subtype-specific metabolic models may enhance personalized risk stratification and guide treatment approaches.

PMID:40518458 | DOI:10.1007/s00259-025-07368-y