Tag: nevin manimala

J Rehabil Med. 2026 Jul 17;58:jrm46016. doi: 10.2340/jrm.v58.46016.

ABSTRACT

OBJECTIVE: This review explores the use of implementation science theories, models, and frameworks in rehabilitation research by describing study characteristics and assessing how the applied theories, models, and frameworks align with study purposes.

METHODS: In the scoping review, peer-reviewed articles published in English between January 2010 and October 2023 were identified from 5 datbases. Eligible studies applied or were informed by implementation science theories, models, and frameworks in any rehabilitation cotext. Data extraction covered publication characteristics, target populations, setings, study designs, used theories, models, and frameworks, and study purposes. Descriptive statistics and deductive analysis were used to synthesize findings.

RESULTS: Of 2,277 citations, 121 articles met the inclusion criteria. Most of the articles focused on neurological and paediatric rehabilitation, with qualitative and mixed-methods designs predominating. A total of 34 theories, models, and frameworks were identified, mainly determinant frameworks and process models. Theories, models, and frameworks were primarily used to identify barriers and facilitators, evaluate implementation outcomes, and describe implementation processes. However, theories, models, and frameworks selection did not always align with the study purpose.

CONCLUSION: The use of theories, models, and frameworks in rehabilitation research is increasing but remains limited. Their systematic and purposeful application is needed to enhance the usability and transferability of research findings, thereby bridging the research-practice gap, sustaining evidence-based interventions, and informing policy.

PMID:42464854 | DOI:10.2340/jrm.v58.46016

Ginekol Pol. 2026 Jul 17. doi: 10.5603/gpl.104730. Online ahead of print.

ABSTRACT

OBJECTIVES: HPV vaccines have been proven effective against genital warts and various cancers, including cervical, anal, penile, vulvar, vaginal, and oropharyngeal cancers. This study aimed to evaluate the cost-effectiveness of including the 9-valent HPV vaccine in the Turkish National Immunization Program (NIP).

MATERIAL AND METHODS: The Papillomavirus Rapid Interface for Modeling and Economics (PRIME) framework was applied to project the potential financial and societal outcomes of introducing HPV vaccination into Türkiye’s 2024 national immunization schedule. Demographic data were obtained from the Turkish Statistical Institute (TUIK, Turkiye Istatistik Kurumu). The cost of vaccine was gathered from Ministry of Health. Epidemiologic inputs, treatment expenditure data, and additional modeling parameters were derived from previously published research sources. Model outputs included projected vaccination expenses, savings from avoided treatment, net costs, prevented cases and deaths, gained life-years, averted disability-adjusted life-years (DALYs), and estimated incremental cost-effectiveness ratios. Potential variability in model projections was examined through deterministic sensitivity testing.

RESULTS: At the national level, with the 9-valent HPV vaccination of a single age cohort in the base year, an estimated 772 cervical cancer cases and 369 related deaths could be avoided through implementation of the vaccination program. With an estimated US$13,754 per DALY gained, the 9-valent HPV vaccine fell within the acceptable cost-effectiveness threshold, defined as three times the GDP per capita. Sensitivity testing confirmed consistent outcomes across parameter variations, identifying the discount rate as the major driver influencing baseline estimates.

CONCLUSIONS: Findings from this analysis support the inclusion of HPV vaccination within the National Immunization Program (NIP) as a cost-effective public health strategy capable of reducing the burden of cervical cancer. Even when considering only cervical cancer, HPV vaccination proves to be cost-effective; when benefits against genital warts and other HPV-related cancers are included, the overall impact increases significantly.

PMID:42464849 | DOI:10.5603/gpl.104730

Ann Ital Chir. 2026 Jun 26;97(7):1308-1316. doi: 10.62713/aic.4538.

ABSTRACT

AIM: The surgical management of colonic Crohn’s disease (CD) remains controversial, with segmental resections possibly associated with a higher rate of recurrence and postoperative complications, while total proctocolectomy reduces recurrence but increases the risk of permanent stoma formation. This study compares surgical outcomes and complications in CD patients undergoing colonic resections (any colectomy with or without concomitant ileal/ileocaecal surgery) vs non-colonic resections (ileal or ileocaecal resections and/or small-bowel strictureplasties without colectomy), with particular emphasis on intra-abdominal septic complications (IASC), non-IASC events, and length of stay (LOS) in hospital.

METHODS: This monocentric observational study analysed consecutive adult patients with histologically confirmed CD who underwent intestinal surgery between January 2012 and April 2024 at Luigi Sacco University Hospital. Patients were divided into two groups according to the index operation. Group A included patients undergoing colonic resection, with or without concomitant ileal or ileocaecal resections and/or small-bowel strictureplasties. Group B included patients undergoing ileal or ileocaecal resection and/or small-bowel strictureplasties without any associated colonic resection. Outcomes included 30-day postoperative complications, LOS, and readmission rates. Statistical analysis was performed using chi-square, Wilcoxon rank-sum tests, and regression models.

RESULTS: Of 461 patients, 90 (19.5%) underwent colonic resections (Group A), while 371 (80.5%) had non-colonic resections (Group B). Overall, complications occurred in 36.2% of patients, with significantly higher rates in Group A than in Group B (48.9% vs 33.2%; p = 0.005). IASC were more frequent in Group A (18 out of 90 patients, 20.0%) than in Group B (37 out of 371 patients, 10.0%) (p = 0.008). The median LOS was 11 days overall, with a statistically significant difference between the groups (Group A: 12 days; Group B: 11 days, p = 0.012). In addition, we observed a significantly higher 30-day reoperation rate in Group A compared with Group B (14.4% vs 6.5%; p = 0.012). Thirty-day readmission rates were low and did not differ significantly between the groups (3.3% vs 1.3%, p = 0.365). Colonic resection, disease phenotype, and American Society of Anesthesiologists score were identified as independent risk factors for postoperative complications and prolonged LOS. There were no significant differences in the 30-day readmission rates among the groups, and no 30-day mortality cases were observed.

CONCLUSIONS: In this large single-centre cohort, colonic resections were associated with higher postoperative complication rates, increased IASC and longer LOS compared with non-colonic resections. These differences likely reflect greater baseline disease complexity and operative burden in patients requiring colonic resection, rather than a causal effect of the resection site alone, highlighting the need for individualised, phenotype-informed surgical decision-making. Further multicentre research is recommended to refine the surgical management of colonic CD.

PMID:42464844 | DOI:10.62713/aic.4538

Ann Ital Chir. 2026 Jul 10;97(7):1270-1278. doi: 10.62713/aic.4564.

ABSTRACT

AIM: The lymph node ratio (LNR) and the log odds of positive lymph nodes (LODDS) have been proposed as alternative indicators of nodal burden that may enhance prognostic stratification beyond conventional pN stage. This study aimed to evaluate the prognostic impact of LNR and LODDS on disease-free survival (DFS) and overall survival (OS) after curative resection for colorectal cancer, and to compare their performance with pN stage and total lymph nodes examined.

METHODS: This retrospective study included 154 patients who underwent curative-intent resection for stage I-III colorectal cancer between 2016 and 2022. Demographic, surgical, pathological, and follow-up data were analyzed. Patients were stratified according to pN stage, LNR, and LODDS categories. DFS and OS were evaluated using Kaplan-Meier survival analysis and Cox proportional hazards regression models. Receiver operating characteristic (ROC) analyses were also performed to assess the discriminatory ability of nodal parameters.

RESULTS: The median number of lymph nodes removed was 28, and adequate lymph node dissection (≥12 lymph nodes) was achieved in 94.8% of patients. During the follow-up period, 18 recurrences and 12 deaths occurred. In the DFS analysis, patients in the LNR 1-2 group showed lower 2-year DFS rates compared to the LNR 0 group (91.0% vs 96.6%). Cox regression analysis indicated a borderline increase in relapse risk in the LNR 1-2 group (hazard ratio (HR): 2.431, 95% confidence interval (CI): 0.963-6.135, p = 0.060). Although advanced pN stage was associated with lower DFS rates, statistical significance was not achieved in the regression analysis. LODDS was not significantly associated with DFS. In the exploratory multivariate analysis, the model including LNR and age showed the best discriminatory performance, and LNR remained independently associated with the risk of recurrence even after adjusting for age (HR: 2.535, 95% CI: 1.004-6.402, p = 0.049). For OS, increasing age was significantly associated with a higher risk of death (HR: 1.076, 95% CI: 1.006-1.150, p = 0.032). In addition, patients undergoing rectal surgery had a lower risk of death compared with those undergoing right/extended colectomy (HR: 0.178, 95% CI: 0.037-0.849, p = 0.030). Neither LNR nor LODDS showed a significant association with OS. ROC analysis showed limited prognostic discrimination overall, but the LNR demonstrated relatively higher predictive performance for DFS compared to pN stage and LODDS.

CONCLUSIONS: Among the lymph node parameters evaluated, LNR showed a trend toward improved prognostic discrimination for short-term DFS, whereas LODDS did not demonstrate significant prognostic value in this cohort. However, the overall discriminatory performance of all lymph node indices remained limited. Therefore, these findings should be interpreted with caution, particularly given the relatively low number of outcome events.

PMID:42464841 | DOI:10.62713/aic.4564

Ann Ital Chir. 2026 Jul 14;97(7):1146-1152. doi: 10.62713/aic.4590.

ABSTRACT

AIM: This study comparatively evaluates the efficacy and safety of contouring-assisted resection versus traditional fistula tract excision in the crus of helix cartilage region for the treatment of congenital preauricular fistula (CPF).

METHODS: This retrospective cohort study recruited 198 CPF patients who underwent surgical treatment at Ruijin Hospital between January 2018 and June 2024. Based on surgical technique, patients were divided into a contouring group (n = 98), who underwent contouring-assisted resection involving systematic dissection along the anterior and deep surfaces of the crus of helix cartilage while preserving the cartilage framework, and a traditional surgery group (n = 100), who underwent conventional fistula tract identification and excision. Baseline characteristics, recurrence rate, operative time, postoperative complications, and patient satisfaction were statistically compared between the two groups.

RESULTS: The recurrence rate was significantly lower in the contouring group than in the traditional group (2.0% vs. 18.0%, p < 0.001). Patients in the contouring group experienced significantly longer operative time (p < 0.001), while intraoperative blood loss did not differ significantly between groups. The overall complication rate was significantly lower in the contouring group (4.1% vs. 20.0%, p < 0.001), with a particularly reduced rate of incision-related infection in this group (1.0% vs. 8.0%, p = 0.044). Patient satisfaction scores were significantly higher in the contouring group (p < 0.001).

CONCLUSIONS: The contouring-assisted resection approach was associated with a significantly lower recurrence rate and higher patient satisfaction compared with traditional fistula tract excision, without an increase in specific complications such as chondritis, hematoma requiring intervention, or persistent sensory abnormality. These observations suggest this method is an effective and safe surgical option for patients with CPF in the crus of the helix region.

PMID:42464838 | DOI:10.62713/aic.4590

Ann Ital Chir. 2026 Jul 14;97(7):1172-1181. doi: 10.62713/aic.4529.

ABSTRACT

AIM: The cortical bone trajectory (CBT) screw fixation technique has been widely adopted in adult spinal surgery due to its minimally invasive nature and biomechanical advantages. However, systematic research on its anatomical feasibility and morphometric parameters in the pediatric lumbar spine remains lacking. This study aimed to evaluate the anatomical feasibility of CBT screw fixation in the pediatric lumbar spine, and to characterize the variations in screw dimensions and insertion angles across different age groups and lumbar levels, providing an individualized reference for pediatric lumbar surgery.

METHODS: This retrospective study included 80 pediatric patients aged 5-16 years without lumbar pathologies. Participants were stratified into four age groups (5-7, 8-10, 11-13, and 14-16 years, denoted as Groups 1, 2, 3, and 4, respectively), with 20 patients per group and sex-matched distribution (10 males and 10 females per group). Multiplanar reconstruction based on computed tomography (CT) images with 1 mm reconstruction was performed to measure the following parameters at each lumbar level (L1-L5): maximum screw length (MSL), maximum screw diameter (MSD), lateral angle (LA), and cephalad angle (CA). Statistical analysis was conducted using a mixed linear effects model to assess the influence of age, sex, lumbar level, and their interactions on each parameter, supplemented by analysis of variance (ANOVA) and post hoc multiple comparisons with Bonferroni correction.

RESULTS: MSL increased significantly with age and showed a level-specific pattern, generally rising from L1 to L3 and declining at L5. In the mixed-effects model, age group and lumbar level had significant effects on MSL, and a significant Group 4 × female interaction was observed. MSD increased progressively from L1 to L5 and was significantly affected by age group, sex, lumbar level, and age × sex interaction, with a particularly significant Group 2 × female interaction (estimate = 0.459, p < 0.001). LA generally increased with age and caudal progression of the lumbar level and was significantly influenced by age group, sex, and lumbar level. In contrast, CA decreased progressively from L1 to L5 within each age group and was significantly influenced by age group and lumbar level, whereas the age × sex interaction was not significant. Anatomical feasibility was assessed using a screw diameter threshold of ≥ 4.5 mm. The applicability rate of CBT fixation increased with both age and caudal lumbar level, with lower feasibility mainly observed at upper lumbar levels in younger children. At L1, applicability rates were 50% in Group 1, 70% in Group 2, and 100% in Groups 3 and 4; at L5, applicability reached 100% in all groups.

CONCLUSIONS: The anatomical parameters for CBT screw placement in the pediatric lumbar spine are significantly influenced by age, lumbar level, and sex. This study provides a systematic anatomical reference for CBT screw dimensions and trajectory angles across pediatric age groups. Anatomical feasibility, defined by a ≥4.5 mm screw diameter threshold, was higher in older children, whereas the use in younger children requires careful individual evaluation due to limited space and increased risk of cortical disruption, especially at upper lumbar levels. These findings offer supportive evidence for guiding patient selection and preoperative planning, though clinical applicability requires further biomechanical and outcome validation.

PMID:42464836 | DOI:10.62713/aic.4529

Ann Ital Chir. 2026 Jul 14;97(7):1232-1238. doi: 10.62713/aic.4499.

ABSTRACT

AIM: To assess the changes in biochemical indicators of nutritional deficiencies before and after bariatric surgery.

METHODS: This retrospective cohort study included 480 adult patients who underwent bariatric surgery between June 2016 and June 2019 at a tertiary care center in Saudi Arabia. Demographic data, comorbidities, and pre- and postoperative biochemical parameters, including hemoglobin, iron profile, Vitamin D, Vitamin B12, albumin, calcium, and parathyroid hormone levels, were extracted from the medical records. These biochemical parameters were used to assess micronutrient status and identify clinically relevant nutritional deficiencies based on established laboratory thresholds. Paired t– and McNemar tests were used to compare the pre- and postoperative values. Statistical significance was set at p < 0.05.

RESULTS: We found a high prevalence of pre- and postoperative nutritional deficiencies among patients. The mean hemoglobin decreased from 13.09 to 12.34 g/dL (mean difference -0.75 g/dL; 95% CI -0.89 to -0.61; p < 0.001). We observed a significant association between ferritin and gender pre- and postoperatively, which was lower in women than in men preoperatively and decreased in both sexes postoperatively. The prevalence of 25-hydroxyvitamin D deficiency was 88.0% preoperatively and 72.7% postoperatively in patients with available laboratory data.

CONCLUSIONS: A high prevalence of pre- and postoperative nutritional deficiencies was observed among patients undergoing bariatric surgery in Saudi Arabia. Although certain parameters improved after surgery, others remained prevalent or worsened postoperatively. These findings highlight the importance of structured nutritional assessments and regular biochemical monitoring before and after bariatric surgery.

PMID:42464830 | DOI:10.62713/aic.4499

Ann Ital Chir. 2026 Jul 14;97(7):1279-1291. doi: 10.62713/aic.4473.

ABSTRACT

AIM: To systematically compare the perioperative safety, early recovery, and mid-term clinical outcomes between on-pump and off-pump coronary artery bypass grafting (CABG) in very elderly patients (≥80 years).

METHODS: This single-center retrospective study enrolled 62 very elderly patients (≥80 years) undergoing isolated CABG from 2012 to 2022, assigned to on-pump (n = 22) or off-pump (n = 40) groups. Baseline characteristics, intraoperative data, and one-year follow-up outcomes were collected and compared. The primary endpoint was 30-day major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of all-cause death, stroke, and myocardial infarction. Secondary endpoints included the individual components of MACCE and key recovery metrics (duration of mechanical ventilation, intensive care unit (ICU) length of stay, and total hospital length of stay).

RESULTS: No statistically significant differences were observed between the two groups in perioperative mortality, incidence of major adverse cardiac and cerebrovascular events (including stroke and myocardial infarction), or one-year survival rates (p > 0.05). The off-pump group had significantly shorter median durations of postoperative mechanical ventilation (15 hours vs. 20.5 hours, p = 0.014) and ICU stay (3 days vs. 5 days, p = 0.007) compared to the on-pump group. However, there were no statistically significant differences in median total postoperative hospitalization (14 days vs. 15 days, p = 0.525) or in the time from ICU transfer to discharge (10 days vs. 9.5 days, p = 0.318). Analysis of postoperative complications revealed a high incidence of severe pulmonary inflammation, with no statistically significant difference between the groups. New-onset postoperative stroke was identified as a leading cause of early and mid-term mortality in this population.

CONCLUSIONS: In this exploratory retrospective analysis of selected very elderly patients, both on-pump and off-pump CABG demonstrated comparable survival and major adverse event outcomes. Although the off-pump group exhibited a statistically significant signal toward faster early physiological recovery (shorter ventilation and ICU stay), this observation warrants cautious interpretation due to baseline imbalances and should be considered hypothesis-generating rather than definitive. These preliminary findings highlight the need for future risk stratification tools and integrated care pathways, rather than prescribing a specific surgical technique based on recovery speed alone.

PMID:42464826 | DOI:10.62713/aic.4473

Euro Surveill. 2026 Jul;31(28). doi: 10.2807/1560-7917.ES.2026.31.28.2500916.

ABSTRACT

BACKGROUNDWhile bacterial sexually transmitted infections (STIs) have increased across Europe over the past decade, Poland continuously reported the lowest notification rates in the European Union/European Economic Area (EU/EEA), raising concerns about under-ascertainment and diagnostic gaps.AIMWe describe national STI trends in Poland from 2013 to 2024, temporal changes around 2020 and subsequent years, and demographic and geographic patterns relevant for STI control.METHODSWe analysed aggregated statutory surveillance data for syphilis, gonorrhoea and Chlamydia trachomatis infections, and calculated annual incidence rates overall and by sex, age group and voivodeship. Temporal trends were assessed using year-over-year per cent change and average annual per cent change (AAPC) estimated from log-linear models.RESULTSAll three infections increased modestly before 2020, declined in 2020 and increased markedly thereafter. Between 2013 and 2024, incidence increased 2.7-3.8-fold. It was highest among men, young adults aged 20-34 years and in urbanised regions. By 2023, syphilis incidence reached 7.92 per 100,000 population in Poland compared with 9.9 per 100,000 in the EU/EEA, whereas gonorrhoea and chlamydia incidence remained substantially lower. National AAPC estimates were not statistically significant, although they increased in several demographic groups and voivodeships.CONCLUSIONReported bacterial STI notifications in Poland are increasing, particularly among young adults and in urban regions. Persistently low gonorrhoea and chlamydia notification rates relative to EU/EEA levels probably reflect differences in diagnostic access and testing intensity rather than low transmission. Improving surveillance completeness, access to NAAT diagnostics, and testing coverage will be important to enhance detection and control.

PMID:42464818 | DOI:10.2807/1560-7917.ES.2026.31.28.2500916

Endokrynol Pol. 2026 Jul 17. doi: 10.5603/ep.111545. Online ahead of print.

ABSTRACT

INTRODUCTION: The C-reactive protein-triglyceride-glucose index (CTI) is an emerging composite biomarker reflecting insulin resistanceand systemic inflammation. Research regarding the relationship between CTI and risks of all-cause and cardiovascular mortality remainslimited and inconsistent.

MATERIAL AND METHODS: Data from 9,264 USA adults aged ≥ 20 years were obtained from the National Health and Nutrition Examination Survey (1999-2010). Mortality status was determined through linkage to the National Death Index through 31 December 2019. Hazardratios (HRs) for all-cause and cardiovascular mortality were estimated using weighted Kaplan-Meier methods, restricted cubic spline(RCS) models, and multivariable Cox proportional hazards regression models. Prespecified subgroup analyses and sensitivity analyseswere conducted to assess the robustness of the findings.

RESULTS: Over a median follow-up of 12.8 years, 2,644 deaths occurred, including 2,009 attributable to all causes and 635 to cardiovascular causes. After adjustment for potential confounders, each one-unit increment in CTI was associated with a 26% higher risk of all-causemortality [HR, 1.26; 95% confidence interval (CI), 1.15-1.38; p < 0.001) and a 25% higher risk of cardiovascular mortality (HR, 1.25; 95% CI,1.03-1.51; p = 0.021). Participants in the highest CTI quartile demonstrated a 33% higher risk of all-cause mortality compared with thosein the lowest quartile (HR, 1.33; 95% CI, 1.07-1.64; p = 0.010). RCS analyses indicated a nonlinear association between CTI and all-causemortality (p for nonlinearity = 0.018), with an inflection point at a CTI value of 9.25, whereas a linear association was observed for cardiovascular mortality (p for nonlinearity = 0.072). No statistically significant interactions were identified across prespecified subgroups. The results remained consistent after exclusion of early deaths (≤ 2 years) and after exclusion of participants with neoplasms.

CONCLUSIONS: Higher CTI levels were independently associated with increased risks of all-cause and cardiovascular mortality among USA adults. These findings suggest that CTI may serve as a clinically relevant biomarker for early identification of individuals at elevated mortality risk, with potential implications for risk stratification, targeted prevention strategies, and healthcare resource allocation.

PMID:42464808 | DOI:10.5603/ep.111545