Nevin Manimala

Biomol Biomed. 2025 Jul 20. doi: 10.17305/bb.2025.12979. Online ahead of print.

ABSTRACT

A systematic review with meta-analysis (SRMA) represents the pinnacle of evidence, but its validity depends on methodological rigor. This narrative review synthesizes recommendations from major reporting frameworks- Preferred Reporting Items for Systematic Reviews and Meta‑Analyses 2020 (PRISMA‑2020), Meta‑Analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Overviews of Reviews (PRIOR)-into a concise checklist for peer reviewers. The checklist addresses common sources of bias that often escape editorial assessment. Initially, it outlines how reviewers should assess the rationale for an SRMA by identifying existing syntheses on the same topic and determining whether the new work provides substantive novelty or a significant update. Best practices are summarized for protocol registration, comprehensive search strategies, study selection and data extraction, risk-of-bias evaluation, and context-appropriate statistical modeling, with a specific focus on heterogeneity, small-study effects, and data transparency. Case examples highlight frequent pitfalls, such as unjustified pooling of heterogeneous designs and selective outcome reporting. Guidance is also provided for formulating balanced, actionable review comments that enhance methodological integrity without extending editorial timelines. This checklist equips editors and reviewers with a structured tool for systematic appraisal across clinical disciplines, ultimately improving the reliability, reproducibility, and clinical utility of future SRMAs.

PMID:40684471 | DOI:10.17305/bb.2025.12979

Ann Med. 2025 Dec;57(1):2534854. doi: 10.1080/07853890.2025.2534854. Epub 2025 Jul 20.

ABSTRACT

BACKGROUND: Accelerated industrialization globally has intensified air pollution, but the susceptibility periods for extreme air pollution in twin pregnancies remain undefined.

METHODS: This study investigated the association between extreme air pollution exposure and preterm birth risk in twin pregnancies. Data on 3623 twin pregnancies in Chongqing from 2017 to 2022 and air pollution readings from 12 monitoring stations were analyzed using distributed lag non-linear quasi-Poisson regression models. Additionally, four extreme air pollution indices were developed to assess the cumulative effects of lagged exposures on preterm birth risk through multivariate logistic regression.

RESULTS: Compared to the lower quartile, the 95th percentile of extreme air pollution exposure showed a positive correlation between concentrations of PM_2.5, PM₁₀, NO₂, SO₂ and CO and preterm birth risk in twin pregnancies, with O₃ inversely correlated. Sensitive periods for air pollutants were different. 8-12 and 27-35 gestational weeks were identified for PM_2.5; 6-13 and 27-35 gestational weeks were identified for PM₁₀; 5-14 and 21-33 gestational weeks were identified for NO₂; 4-15 and 24-36 gestational weeks were identified for SO₂; 4-11 and 29-33 gestational weeks were identified for CO. PM_2.5, PM₁₀, SO₂ and O₃ showed cumulative effects across short and long lags, while CO showed a long-term effect. Notably, NO₂ exhibited a protective effect during all lag periods.

CONCLUSION: The study highlights gestational windows of 8-11 and 29-33 weeks as highly sensitive to extreme pollution for preterm birth in twin pregnancies, with marked risk increases during 0-3, 0-6 and 0-9-month lag periods.

PMID:40684455 | DOI:10.1080/07853890.2025.2534854

Ann Med. 2025 Dec;57(1):2534522. doi: 10.1080/07853890.2025.2534522. Epub 2025 Jul 20.

ABSTRACT

INTRODUCTION: Accurate breast cancer risk prediction is essential for early detection and personalized prevention strategies. While traditional models, such as Gail and Tyrer-Cuzick, are widely utilized, machine learning-based approaches may offer enhanced predictive performance. This systematic review and meta-analysis compare the accuracy of traditional statistical models and machine learning models in breast cancer risk prediction.

METHODS: A total of 144 studies from 27 countries were systematically reviewed, incorporating genetic, clinical, and imaging data. Pooled C-statistics were calculated to assess model discrimination, while observed-to-expected (O/E) ratios were used to evaluate calibration. Subgroup and sensitivity analyses were conducted to examine heterogeneity and assess the influence of study bias across various populations.

RESULTS: Machine learning-based models demonstrated superior performance, with a pooled C-statistic of 0.74, compared to 0.67 for traditional models. Models that integrated genetic and imaging data showed the highest levels of accuracy, although performance varied by population. Sensitivity analyses excluding high-bias studies showed improved discrimination in models incorporating genetic factors, with the pooled C-statistic increasing to 0.72. Traditional models, such as Gail, exhibited notably poor predictive accuracy in non-Western populations, as evidenced by a C-statistic of 0.543 in Chinese cohorts.

CONCLUSION: Machine learning models provide significantly greater predictive accuracy for breast cancer risk, particularly when incorporating multidimensional data. However, issues related to model generalizability and interpretability remain, particularly in diverse populations. Future research should focus on developing more interpretable models and expanding global validation efforts to improve model applicability across different demographic groups.

PMID:40684451 | DOI:10.1080/07853890.2025.2534522

Ann Med. 2025 Dec;57(1):2534096. doi: 10.1080/07853890.2025.2534096. Epub 2025 Jul 20.

ABSTRACT

BACKGROUND: Robotic surgery represents a notable advancement in the field of minimally invasive gynecological surgery. Although the Kangduo Robot® SR1000 (KD-SR-01) surgical system has shown improved stability and high efficiency, studies describing its use for gynecological surgery are limited. We aimed to review the safety and effectiveness of the KD-SR-01 system in gynecologic surgery and compare it with conventional laparoscopic operation.

MATERIALS AND METHODS: We compared patient characteristics and short-term outcomes in cases of gynecological surgery conducted using the KD-SR-01 system and laparoscopic minimally invasive procedures between March 2024 and October 2024. The short-term clinical efficacies of both surgical modalities were compared by performing statistical analyses.

RESULTS: The KD-SR-01 system was used for total hysterectomy due to benign uterine tumors in 144 cases, ovarian cyst removal surgery due to benign ovarian tumors in 25 cases, unilateral adnexectomy due to benign ovarian tumors or borderline tumors in 25 cases, staging of early endometrial cancer in 24 cases, and radical cervical cancer resection for early cervical cancer in 24 cases. None of the patients showed serious complications (Clavien-Dindo grade ≥ 3). In comparison with traditional laparoscopic surgery, Kangduo robotic surgery resulted in a lower duration of hospitalization, operation time, blood loss, and drainage volume, but the two surgical modalities showed no differences in the complication rate.

CONCLUSION: The Kangduo robotic system was safe and feasible for gynecological surgery. Evidence from additional studies and more surgical experience are required to determine the long-term outcomes and indications for gynecological surgery using this robotic system.

PMID:40684447 | DOI:10.1080/07853890.2025.2534096

Ann Med. 2025 Dec;57(1):2532860. doi: 10.1080/07853890.2025.2532860. Epub 2025 Jul 20.

ABSTRACT

BACKGROUND: Musculoskeletal (MSK) disorders are a leading cause of disability worldwide, particularly prevalent among women of childbearing age (WCBA). Our aim is to comprehensively assess the global, regional, and national burden of MSK disorders in WCBA, and examine the burden of MSK disorders among WCBA at varying levels of the Socio-demographic Index (SDI), then to project the burden of these disorders through to 2045.

METHODS: This study utilized data from the Global Burden of Disease (GBD) 2021 project, focusing on MSK disorders among WCBA (15-49 years). Age-standardized rate was calculated using the World Standard Population proportions. Descriptive analysis was conducted at global, regional, and national levels. SDI associations were explored using smoothing spline models. Projections to 2045 employed age-period-cohort models using R software.

RESULTS: In 2021, the estimated global age-standardized incidence, prevalence, deaths, Years of Life Lost, Years Lived with Disability, and Disability-Adjusted Life Years (DALYs) rates per 100 000 population of MSK disorders in WCBA were 4933.9 (95% UI 3683.7-6454.4), 20145.9 (17 082.6-23 564.4), 0.7 (0.6-0.8), 40.7 (34.1-45.7), 2090.4 (1414.8-2896.2), and 2131.1 (1455.8-2936.8), respectively. From 1990 to 2021, a total of 183 countries exhibited an increase in prevalence rate and 166 countries showed an upward trend in DALYs rate. Between 1990 and 2021, there was a positive association between the SDI and age-standardized DALYs rate for MSK disorders in WCBA, both globally and regionally. By 2045, the age-standardized number of DALYs for MSK disorders in WCBA is expected to reach 48.8 million, with an age-standardized DALYs rate of 2160 per 100,000 population.

CONCLUSION: The burden of MSK disorders among WCBA is already substantial and is expected to increase further in the future. Despite the observed decline in age-standardized incidence rate of MSK disorders among WCBA in half of the regions and countries globally, the age-standardized prevalence and DALYs rates have shown an adverse increasing trend. By 2045, the global number of DALYs for MSK disorders in WCBA is projected to exceed 48 million. To mitigate the future burden of MSK disorders in WCBA, stratified and targeted healthcare strategies are essential to improve early diagnosis and treatment.

PMID:40684443 | DOI:10.1080/07853890.2025.2532860

Nurs Open. 2025 Jul;12(7):e70282. doi: 10.1002/nop2.70282.

ABSTRACT

BACKGROUND: Workplace bullying is an important issue confronting the nursing profession, with victims described as being part of an oppressed group. The number of attacks and acts of violence that staff direct at each other in the workplace is alarmingly high and cannot be ignored.

AIM: This study assessed the prevalence and impact of workplace bullying of nurses by other nurses among those working in three major hospitals in the Tamale Metropolis, Ghana.

METHODS: Data for this study were collected from Tamale Teaching Hospital, Tamale Central Hospital, and Tamale West Hospital using a descriptive cross-sectional multi-facility study design with a quantitative approach to data collection. A proportionate stratified random sampling technique was used to recruit 338 nurses from the three hospitals. A structured questionnaire was used to collect data, following approval from the Tamale Teaching Hospital Research and Development Unit and the Northern Regional Health Directorate, from January 2022 to March 2022. Stata for Windows V16.0 was used to analyse the data. Bivariate and multivariable logistic regression models were used to explore the factors associated with the prevalence of perceived workplace bullying among nurses. Confidence intervals were computed at a 95% confidence level, and a p-value of 0.05 or less was considered statistically significant.

RESULTS: The majority of respondents (85.5%) indicated they had observed workplace bullying before, and 50.6% had witnessed the bullying of a nurse by another nurse. A little over one-third had been victims of workplace bullying. Females constituted a higher proportion of both the perpetrators (53.0%) and the main targets (80.2%) of workplace bullying. Additionally, 34.6% reported having the intention to travel abroad to practise nursing as a result of observing bullying or being victims themselves. Multivariable analysis showed that the odds of experiencing workplace bullying were 63% lower among nurses working in the surgical ward compared to those in the Outpatient Department (AOR: 0.37, 95% CI: 0.15-0.91, p = 0.030).

CONCLUSION: This study revealed that workplace bullying is prevalent among nurses in the three main hospitals within the Tamale Metropolis. Most respondents had witnessed workplace bullying, and a little over one-third had been victims themselves. Workplace bullying is a measurable issue that negatively affects nurses’ mental health and job performance. Therefore, nursing leaders should organise regular sensitisation programmes to raise awareness of the impact of workplace bullying. Additionally, hospital management should encourage nurses to report instances of bullying, establish disciplinary committees to address such cases, punish offenders, and protect those who witness or are victims of bullying.

PMID:40684434 | DOI:10.1002/nop2.70282

Orv Hetil. 2025 Jul 20;166(29):1132-1138. doi: 10.1556/650.2025.33334. Print 2025 Jul 20.

ABSTRACT

Bevezetés: A humán metapneumovírus (hMPV) influenzaszerű tüneteket okozó légúti patogén, és bizonyos társbetegségek fennállása esetén súlyos légúti szövődményekhez vezethet. A tanulmány aktualitását a COVID–19-világjárvány során szerzett tapasztalatok, valamint a Kínai Népköztársaság Járványügyi és Betegségmegelőzési Központja által 2024 végén észlelt, folyamatosan növekvő hMPV-esetszámok indokolják. Célkitűzés: A tanulmány célja a Dél-pesti Centrumkórház – Országos Hematológiai és Infektológiai Intézetben 2019 és 2024 között diagnosztizált hMPV-esetek epidemiológiai jellemzőinek és klinikai lefolyásának retrospektív elemzése. Módszer: Egycentrumos, retrospektív kohorszvizsgálatot végeztünk, amelybe bevontunk minden, 2019. december és 2024. december között valós idejű polimeráz-láncreakcióval (RT-PCR) igazolt hMPV-fertőzött felnőtt beteget. Rögzítettük a klinikai adatokat (demográfia, komorbiditások, kezdeti klinikai kép, virális koinfekció) és a komplikációkat (hospitalizáció, oxigénigény, pneumonitis, intenzív osztályos kezelés, mechanikai ventiláció, kórházi halálozás). A primer végpont összetett végpont volt, amely a kórházi elhalálozáson, az intenzív osztályos kezelés vagy a mechanikai ventiláció szükségességén alapult, ez határozta meg a komplikált lefolyást is. Eredmények: Összesen 80 beteget vontunk be, átlagéletkoruk 58 ± 30 év, többségük férfi (n = 47; 58,8%) volt. A fertőzött betegek 10%-ánál (n = 8) komplikált lefolyást észleltünk, amely szignifikánsan gyakrabban fordult elő idős betegek körében (66 ± 10 vs. 55 ± 31 év, p = 0,05). Pneumonitis 45%-ban (n = 36), hospitalizáció 42,5%-ban (n = 34), oxigénigény 30%-ban (n = 24), intenzív osztályos kezelés 8,75%-ban (n = 7), mechanikai ventiláció 6,25%-ban (n = 5), kórházi elhalálozás 6,25%-ban (n = 5) fordult elő. Az intenzív osztályos felvétel és a kórházi elhalálozás nem minden esetben volt közvetlenül a hMPV következménye. Megbeszélés: Vizsgálatunk tanulsága alapján a hMPV klinikai jelentősége kiemelkedően fontos immunszupprimált, idős és krónikus légzőszervi betegeknél, mivel náluk a fertőzés súlyos légúti szövődményekhez vezethet. Következtetés: Összefoglalva, hMPV-fertőzés gyanúja esetén hMPV irányában is javasolt diagnosztikai vizsgálatokat kezdeményezni, különösen a nagy kockázatú csoportokban, mivel a korai diagnózis és a megfelelő terápia kulcsfontosságú a súlyos kimenetelek megelőzésében. Orv Hetil. 2025; 166(29): 1132–1138.

PMID:40684432 | DOI:10.1556/650.2025.33334

Orv Hetil. 2025 Jul 20;166(29):1139-1152. doi: 10.1556/650.2025.33330. Print 2025 Jul 20.

ABSTRACT

Bevezetés: Az infertilitás prevalenciája széles skálán mozog: vilagszerte mintegy 186 millió embert érint. A reproduktív életkorban lévő párok 12–17%-a küzd termékenységi zavarral. A meddőség nagy arányú előfordulása növekvő igényt támaszt az asszisztált reprodukciós technikák alkalmazására, amelyek közül az in vitro fertilizáció az egyik legszélesebb körben alkalmazott technika. Célkitűzés: Kutatásunk célja, hogy a magyarországi közfinanszírozott egészségügyi rendszerben elemezzük az in vitro fertilizációs eljárások igénybevételi mutatóit. Módszer: A vizsgálat retrospektív, kvantitatív jellegű volt, amelyhez a szükséges adatokat a Nemzeti Egészségbiztosítási Alapkezelő adatbázisából, valamint az Országos Kórházi Főigazgatóság Pulvita Egészségügyi Adattárházából igényeltük. A kutatás során elemeztük a 2010 és 2023 közötti időszakban az aktív fekvőbeteg-szakellátásban elszámolt in vitro fertilizációs esetszámokat. További elemzéseket végeztünk az ellátóintézmények, a betegek vármegye szerinti lakhelye és életkora, valamint az elszámolt homogén betegségcsoportok alakulásáról. A változók elemzéséhez leíró statisztikai és lineáris regressziós próbákat végeztünk. Eredmények: A vizsgálati időszakban mindösszesen 127 616 esetszámot teljesítettek a szolgáltatók közfinanszírozott, aktív fekvőbeteg-szakellátás keretében. 2019-től jelentős esetszám-emelkedés figyelhető meg. Az esetek 2023-ban több mint két és félszeres mértékben haladták meg a 2010. évi esetszámot. Az igénybevételben területi egyenlőtlenségek találhatók. A vizsgált betegkör átlagéletkora emelkedő tendenciát mutatott 2010 és 2020 között. Következtetés: A 2019-től kezdődő fokozott állami szerepvállalás érzékelhető hatást gyakorolt az esetszámok emelkedésére. Bár az in vitro fertilizációs esetszámokban lineáris irányú emelkedést láthatunk évről évre, a korábban meglévő területi egyenlőtlenségek továbbra is fennállnak. Orv Hetil. 2025; 166(29): 1139–1152.

PMID:40684430 | DOI:10.1556/650.2025.33330

Eur J Orthop Surg Traumatol. 2025 Jul 20;35(1):310. doi: 10.1007/s00590-025-04436-9.

ABSTRACT

OBJECTIVES: To examine hemoglobin trends following isolated femoral shaft fractures (FSF) and characterize patient profiles associated with transfusion needs for optimized patient management.

METHODS: Design: Retrospective cohort study.

SETTING: Level 1 trauma center. Patient Selection Criteria: Patients aged > 18 years undergoing isolated femur fracture fixation (ICD-10 and CPT 27506). Outcome Measures and Comparisons: Hemoglobin (Hgb) was recorded at the ER, pre-operatively, and daily post-operatively and compared to baseline Hgb (pre-injury or ≥ 3 months post-injury). Total Hgb loss was calculated, correcting for transfusions. Demographics, injury mechanism (high/low energy), number of transfusions, and length of stay were collected. SPSS was used for analysis.

RESULTS: 540 patients were included. Baseline Hgb was 14.6 g/dL for males and 13.1 g/dL for females. Post-injury Hgb decreased to 13.8 g/dL and 11.9 g/dL, respectively. 48.5% of patients required transfusion (40.7% males, 61% females, p = 0.001). The age threshold for increased risk of receiving a transfusion was 60 years old. Patients between the ages of 60-80 had a higher rate of transfusions (65.94%) when compared to patients between the ages of 40-60 (38.38%). 80.49% of patients above the age of 80 received a transfusion and were 6.2 times more likely to receive a transfusion compared to patients under 40. The median length of stay (LOS) of a patient receiving a transfusion was 4 days, while the median LOS for a patient not receiving a transfusion was 2 days.

CONCLUSIONS: Hemoglobin (Hgb) progressively declines after femoral shaft fractures (FSFs), with the most significant drop occurring post-operatively. Older age and female sex were associated with increased transfusion needs. Transfusion is associated with an increase in the LOS. These findings emphasize the importance of monitoring Hgb trends and considering age and injury mechanisms when assessing transfusion risk in FSF patients.

LEVEL OF EVIDENCE: Prognostic Level III.

PMID:40684417 | DOI:10.1007/s00590-025-04436-9

J Robot Surg. 2025 Jul 20;19(1):405. doi: 10.1007/s11701-025-02489-w.

ABSTRACT

Robotic-assisted surgery has transformed hernia repair by improving precision, minimizing postoperative complications, and accelerating recovery. This study evaluates three robotic techniques-robotic transabdominal preperitoneal (rTAPP), robotic Rives (rRives), and robotic transabdominal retromuscular umbilical prosthetic (rTARUP)-for treating primary ventral and incisional hernias. Following PRISMA guidelines, a systematic review and meta-analysis were conducted. Databases such as PubMed, Embase, Cochrane Library, and Web of Science were searched for studies comparing rTAPP, rRives, and rTARUP. Key outcomes included recurrence rates, surgical duration, and postoperative complications, with secondary outcomes assessing hospital stay and cost-effectiveness. Statistical analyses were performed using RevMan 5.4 and STATA 16, calculating pooled odds ratios (OR) and mean differences (MD). Heterogeneity was measured via I² statistics, and publication bias was evaluated using the Egger test. The analysis included 18 studies encompassing 1,500 patients. rTAPP showed shorter operative times (MD: – 25.3 min, 95% CI: – 30.1 to – 20.5, *p* < 0.05) and reduced recurrence rates (OR: 0.45, 95% CI: 0.30-0.68, *p* < 0.01) compared to rRives and rTARUP. However, rTARUP was linked to fewer postoperative complications (OR: 0.65, 95% CI: 0.50-0.85, *p* < 0.05). No significant publication bias was detected (Egger test, *p* = 0.12). Robotic hernia repair techniques offer unique benefits: rTAPP is more efficient, while rTARUP reduces complications. These results emphasize the need for personalized surgical approaches.

PMID:40684413 | DOI:10.1007/s11701-025-02489-w