Tag: nevin manimala

J Neurosurg Spine. 2025 Oct 31:1-11. doi: 10.3171/2025.7.SPINE25357. Online ahead of print.

ABSTRACT

OBJECTIVE: Enhanced recovery after surgery (ERAS) has demonstrated benefits across various surgical specialties. However, a significant research-practice gap remains, with fewer than half of spine surgeons incorporating ERAS principles into daily practice. A key barrier to ERAS implementation in spine surgery is postoperative compliance, as patients often express concerns about worsening pain. To address these challenges, the authors developed a standardized, delivery-focused ERAS clinical pathway (CP) for oblique lumbar interbody fusion (OLIF). This study prospectively evaluated whether ERAS-CP can improve postoperative compliance without compromising pain control compared with conventional ERAS.

METHODS: This prospective, randomized noninferiority trial involved 41 patients undergoing OLIF from July 2023 to February 2024. Patients were randomized to either the ERAS-CP group (n = 21) or the control (conventional ERAS) group (n = 20). The ERAS-CP comprised a CP system integrated into the electronic health record system, patient education manual, and dedicated medical personnel support. The control group (conventional ERAS) followed standard ERAS principles but lacked these structured compliance-enhancing interventions. The primary outcome was back pain at discharge measured by the numeric rating scale. Secondary outcomes included ERAS compliance, pain management, and patient satisfaction.

RESULTS: Demographics were similar between the groups. The ERAS-CP group demonstrated noninferiority in back pain at discharge compared with the control group in the intent-to-treat analysis (difference -0.1, 95% CI -1.4 to 1.1) and the per-protocol analysis (difference -0.3, 95% CI -1.6 to 1.0). The ERAS-CP group achieved earlier ambulation (median 2 [range 1-9] vs 3.5 [range 2-18] hours, p = 0.011) and longer daily ambulation times (mean 91.7 vs 68.2 minutes/day, p = 0.047). Nonopioid analgesic use was higher in the ERAS-CP group on postoperative days 1 and 2 (p < 0.05), with no difference in opioid use. Both groups reported high satisfaction with pain management (78%). No significant differences were found in complication rates, length of stay, or 3-month clinical outcomes.

CONCLUSIONS: The ERAS-CP for OLIF demonstrated noninferiority in pain management while improving adherence to key ERAS components. By reinforcing postoperative compliance through structured interventions, ERAS-CP may enhance recovery in lumbar spinal fusion surgery.

PMID:41172361 | DOI:10.3171/2025.7.SPINE25357

JMIR Res Protoc. 2025 Oct 31;14:e73201. doi: 10.2196/73201.

ABSTRACT

BACKGROUND: Heavy metals present in the environment, including lead, cadmium, and mercury, pose significant health risks to pregnant women and fetal development through food, water, and air contamination. Exposure to these metals has been linked to miscarriage, low birth weight (LBW), preterm birth, and developmental issues in children. The mechanism of oxidative stress, characterized by increased 8-hydroxy-2′-deoxyguanosine (8-OHdG) and malondialdehyde (MDA) levels, contributes to DNA damage, genomic instability, and adverse pregnancy outcomes. Additionally, DNA methylation changes induced by metal exposure may further exacerbate these risks. Certain micronutrients play a crucial role in heavy metal detoxification, and Moringa oleifera, a locally available plant rich in antioxidants and chelating compounds, has demonstrated protective effects against mercury (Hg), lead (Pb), and cadmium (Cd) toxicity in experimental studies. However, intervention studies on pregnant women remain scarce.

OBJECTIVE: The objective of this study was to evaluate the effect of M. oleifera supplementation in reducing heavy metal toxicity and oxidative stress biomarkers, 8-OHdG and MDA, in pregnant women exposed to high levels of heavy metals.

METHODS: A quasi-experimental, nonrandomized pre-post test design is used. Pregnant women with elevated heavy metal levels, identified through initial screening, will be included in the intervention group, receiving M. oleifera supplementation for 2 months. The control group will consist of women from similar geographical regions who will not receive the intervention. Primary outcomes will include changes in heavy metal concentrations, measured using inductively coupled plasma mass spectrometry (ICP-MS). Secondary outcomes will focus on reductions in oxidative stress biomarkers, measured via enzyme-linked immunosorbent assay (ELISA). Statistical analyses, including analysis of covariance (ANCOVA), will be used to adjust for baseline differences between the groups.

RESULTS: A total of 26 mothers for each group have participated. As of February 2025, the laboratory analyses have been ongoing, and the result is expected to be published at the end of 2025. The protocol anticipates that the intervention group will show a significant reduction in both heavy metal levels and oxidative stress biomarkers compared to the control group, suggesting the potential efficacy of M. oleifera in detoxifying heavy metals and reducing oxidative stress.

CONCLUSIONS: This study is expected to provide preliminary evidence on the potential effectiveness and safety of M. oleifera supplementation for reducing heavy metal toxicity and oxidative stress in pregnant women.

PMID:41172352 | DOI:10.2196/73201

JMIR Form Res. 2025 Oct 31;9:e78907. doi: 10.2196/78907.

ABSTRACT

Findings from a pilot randomized trial of 916 households indicated that outreach text messages were not an effective strategy to increase enrollment in the United States Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) among eligible households in Arizona.

PMID:41172350 | DOI:10.2196/78907

Plast Reconstr Surg. 2025 Oct 30. doi: 10.1097/PRS.0000000000012567. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer is one of the most common cancers diagnosed worldwide, with an estimated 2.3 million new cases in 2020. Breast reconstruction following mastectomy is crucial for the physical and mental well-being of patients. Therefore, the nipple-skin-sparing mastectomy (NSSM) technique has become a highly preferred surgical treatment option for breast cancer in recent years. Breast implants are placed above or below the pectoralis major muscle in single-stage procedures. This study aimed to elaborate on the inferior pedicled dermal flap technique, present the results of single-stage breast reconstruction following NSSM, and compare postoperative outcomes with those previously reported.

METHODS: Between 2014 and 2023, 420 patients who underwent nipple-sparing mastectomy and prosthesis repair in our clinic were retrospectively evaluated. Among these patients, 129 patients who underwent one-stage repair using an inferior pedicled adipodermal flap were included in our study. Patients were analyzed in terms of topographic features, breast size, amount of breast tissue removed, history of chemotherapy and radiotherapy, magnitude and types of postoperative complications.

RESULTS: A total of 129 patients with a mean age of 47.07 years (SD:8,02) were included in the study. Following the exclusion of breasts in which the NSSM technique was not utilized, 215 breasts were analyzed for outcomes. Postoperative complications were observed in 58 breasts (26.9%). These were categorized as major (n = 17; 7.9%) or minor (n = 41; 19.1%). Significant complications included total NAC necrosis, pillar necrosis, and prosthesis exposure. Minor complications included partial NAC necrosis, distal necrosis of medial and lateral pillars, loss of NAC grafts, local infections, and early postoperative seroma formation. Specifically, complications were distributed as follows: 30 breasts with partial NAC necrosis, 26 with pillar necrosis, 14 with complete NAC necrosis, 5 with graft loss, 15 with localized infections, and 26 with early seromas. Statistical analysis demonstrated a significant association between increased sternal notch-to-nipple distance and overall complication rates (p = 0.0027). Similarly, a significant correlation was found between higher breast volume (as indicated by resected tissue weight) and both total (p = 0.0035) and major (p = 0.0092) complication rates.

CONCLUSIONS: A common complication of single-session NSSM and implant reconstruction is areolar skin necrosis; therefore, double-layer repair is recommended to protect the circulation of thin skin flaps post-mastectomy. Autologous muscle and an inferior pedicled adipodermal flap as the second layer under the skin flap can be considered a more reliable technique for ptotic breasts.

PMID:41172344 | DOI:10.1097/PRS.0000000000012567

JMIR Res Protoc. 2025 Oct 31;14:e75501. doi: 10.2196/75501.

ABSTRACT

BACKGROUND: Youth of color who live in urban communities face disproportionate anxiety levels due to systemic inequities, including exposure to violence, economic instability, and neighborhood disadvantage. Despite increased need, these communities often lack accessible mental health interventions.

OBJECTIVE: This study presents a protocol for an anxiety prevention intervention developed through a community-based participatory approach that is tailored to urban youth of color using community-based participatory research methods.

METHODS: The intervention, co-developed with a community partner and guided by a youth advisory board, includes 5 structured weekly sessions on psychoeducation, coping skills, and role-playing exercises. Facilitators trained in social work or psychology will deliver the intervention, with at least 1 facilitator from the target community ensuring cultural relevance. Recruitment will occur through collaboration with a local high school, with counselors identifying high-risk youth. We will enroll a sample of 30 high school-aged youth at minimum (maximum 50 youth) into the study. Two cohorts of youth will participate in the study. The groups will be separated by sex (male and female). The primary outcome is reduction in anxiety, measured by the Generalized Anxiety Disorder-7 scale. Data will be collected at baseline, after the intervention, and during follow-up assessments (3 months after). Statistical analyses will include parametric tests (eg, repeated measures ANOVA and 1-tailed t tests) to compare anxiety reduction across groups.

RESULTS: This pilot intervention is a part of a larger study that began in September 2020 and ended in August 2025. Enrollment for the pilot intervention began in May 2025. The anxiety intervention is expected to reduce anxiety among a high-risk group of youth. Methods to improve facilitator fidelity to the intervention model are expected to support high fidelity to the curriculum.

CONCLUSIONS: This study highlights the development of a new anxiety intervention using a community-based participatory approach. Findings will be reported and used to scale up the pilot intervention into a larger clinical trial to serve a larger population of youth in the targeted community. In addition, the results will contribute to knowledge on improving mental health accessibility for marginalized youth. If effective, this model could be expanded to support youth in other underresourced communities.

PMID:41172343 | DOI:10.2196/75501

Br J Dermatol. 2025 Oct 31:ljaf416. doi: 10.1093/bjd/ljaf416. Online ahead of print.

ABSTRACT

BACKGROUND: Psoriasis is a chronic inflammatory skin disease associated with an increased risk of developing cardiovascular disease. Various environmental factors contribute to disease development in genetically susceptible individuals. Although infections have been associated with disease initiation and recurrence, the consequences of early exposure to infections, many years before disease manifestation, is unexplored.

OBJECTIVE: To investigate the effect of exposure to infections during formative years on the incidence of psoriasis through to early adulthood.

METHODS: ABIS is a large birth cohort in which parents of participating children have answered comprehensive questionnaires on exposure to infections and medication at different age intervals of the children. Information regarding psoriasis was obtained from the Swedish National Patient Register, while data on medication was obtained from the National Prescribed Drug Register. Statistical analyses were performed with custom-written R scripts.

RESULTS: Logistic regression analysis on one-year follow-up data revealed that influenza was associated with an increased risk of developing psoriasis later in life (OR 2.47, CI 1.32-4.39; P= 0.006). In line with this, at the third-year evaluation, we found that participants who had tonsillitis at least once during the first three years of life had almost three times greater risk of developing psoriasis into early adulthood compared to controls (OR 2.90, CI 1.46-5.56; P= 0.003). In contrast, at the eight-year evaluation, we found that psoriasis was less frequent in children who had experienced gastroenteritis episodes between ages six and eight, compared to controls (OR 0.42, CI 0.20-0.92; P =0.0028).

CONCLUSION: We demonstrate for the first time the effect of exposure to infections during the first years of life, and their role in the subsequent development of psoriasis extending into early adulthood. Our study indicates that early exposure to infections may influence the development of the adaptive immune system during formative years. This modulation is evidenced by the higher incidence of psoriasis observed in early adulthood, several years after the initial exposure.

PMID:41172339 | DOI:10.1093/bjd/ljaf416

JMIR Res Protoc. 2025 Oct 31;14:e78600. doi: 10.2196/78600.

ABSTRACT

BACKGROUND: Social media use among adolescents and young adults has increased exponentially over the last decade, with TikTok being one of the most popular platforms. In Spain, 61% of adolescents use TikTok, spending an average of 1.5 hours daily on the app. This phenomenon coincides with an alarming increase in the prevalence of self-harm and suicidal behavior among adolescents and young adults. Moreover, suicidal behavior is one of the leading causes of morbidity and mortality in this age group.

OBJECTIVE: The primary aim of this study is to evaluate the existing evidence on the association of TikTok use with self-harm and suicidal behavior in the adolescent population.

METHODS: This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines to ensure transparency, rigor, and reproducibility. Original studies that evaluate the impact of TikTok use on self-harm and suicidal behavior will be selected. The primary outcome will be the occurrence and prevalence of self-harm and suicidal behavior related to TikTok use among adolescents and young adults. Health science literature databases, including PubMed/MEDLINE, Cochrane, Web of Science, PsycINFO, and Scopus, will be searched. Two researchers will independently select studies that meet the predefined eligibility criteria, and they will extract data from each included study. The risk of bias and methodological quality of the included studies will be assessed using the Risk of Bias in Non-Randomized Studies of Interventions and Joanna Briggs Institute tools, respectively. The methodological characteristics, association measures, and qualitative conclusions of the reviewed studies will be analyzed, and a descriptive synthesis will be presented through tables and graphs.

RESULTS: This systematic review formally began in July 2025, although it has been planned since September 2024. The final systematic review will be performed and reported according to this protocol and the PRISMA guidelines. Initially, the search returned 6126 records, and 3664 records are currently being screened for eligibility. Data from the final included studies will be extracted, collated, and analyzed. The risk of bias and quality of evidence will be determined. A narrative synthesis will be used to summarize the results of the systematic review. When possible, statistical analyses will be presented using graphs and figures. The final systematic review is expected to be published in December 2025.

CONCLUSIONS: This systematic review will help to better understand the relationship between TikTok use and self-harm and suicidal behavior among adolescents and young adults. Our findings may support future research, recommendations, and policies in this field, emphasizing the need to incorporate the digital environment as a key factor in adolescent mental health.

TRIAL REGISTRATION: Open Science Framework MX5CJ; https://osf.io/MX5CJ.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/78600.

PMID:41172321 | DOI:10.2196/78600

Adv Gerontol. 2025;38(3):413-420.

ABSTRACT

A retrospective cohort study was conducted to evaluate the effectiveness of teledermatology in primary care for the diagnosis and treatment of skin diseases in patients of all age groups, with a focus on the population over 60 years. The study, conducted in Ufa from September 2023 to September 2024, included 1 590 patients over 60 years old with 3 214 registered skin lesions. The results demonstrate that teledermatology consultations allowed GPs to independently manage 67% of cases (2 153/3 214), minimizing the need for referral to a dermatologist. Indications for an in-person consultation with a dermatologist and biopsy were 42,80% (681/1 590) and 8,23% (131/1 590) of cases, respectively. The dominant diagnoses were seborrheic keratosis, solar lentigo, onychomycosis, melanocytic nevi, benign skin lesions, actinic keratosis, epidermoid cysts, leukoderma and viral warts. A statistically significant positive correlation was found between patient age and the incidence of skin malignancies requiring biopsy. Emollients were the most frequently prescribed group of drugs (30,90%, 275/890). The findings suggest the potential of teledermatology to optimize patient routing, reduce the workload of dermatologists and increase the availability of specialized dermatological care, especially for elderly patients.

PMID:41172315

JMIR Res Protoc. 2025 Oct 31;14:e66489. doi: 10.2196/66489.

ABSTRACT

BACKGROUND: Bioactive compounds, such as human milk oligosaccharides (HMOs), impact the development of the intestinal microbiome and immune maturation in early life. They have been shown to result in positive benefits, including improved gut health, reduced frequency of infections, and age-appropriate growth when added to infant formula. However, data supporting the added value of including these HMOs in early-stage infant formula is currently lacking among Chinese infants.

OBJECTIVE: In this double-blind randomized controlled trial including a nonrandomized reference breastfed group, we will test the efficacy of ready-to-feed infant formula containing 2 HMOs (2-fucosyllactose and lacto-N-neotetraose) on Bifidobacteria abundance, gut microbiome, gut and immune health, growth, and quality of life.

METHODS: Healthy infants will be enrolled between 3 and 14 days after birth at 5 sites in China and randomized to either the experimental group (fed ready-to-feed infant formula containing 2 HMOs) or the control group (fed the same ready-to-feed infant formula without the 2 HMOs), using a dynamic allocation algorithm with double blinding. Infants will receive trial formula until age 6 months and will be followed up until age 12 months. The breastfed group will serve as a reference. The primary end point will be Bifidobacteria abundance in fecal samples at 3 months, measured via quantitative polymerase chain reaction. Secondary end points will include fecal microbiome (including taxonomy, diversity, functionality, and metabolites), fecal markers of immune health, gastrointestinal tolerance, stooling patterns, immune competence (overall state of the immune system), sleep quality, growth, quality of life, medication use, and physician-reported adverse events. A 2-sided test at the 5% significance level will be used for statistical testing.

RESULTS: The study received ethical approval in March 2024 and will be completed by the end of 2026, which will be followed by a publication in a peer-reviewed journal.

CONCLUSIONS: The Starter Liquid Infant Formula Trial (STARLIT) will be one of the first to assess the efficacy of these 2 HMOs among Chinese infants on gut and immune health, in addition to clinically relevant outcomes such as quality of life, growth, and adverse events. This study should help to demonstrate that an increase in the growth of beneficial Bifidobacteria in response to intake of 2-fucosyllactose and lacto-N-neotetraose may have a broader impact on overall gut microbiome composition and infant gut and immune health.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06361719; https://clinicaltrials.gov/study/NCT06361719.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/66489.

PMID:41172301 | DOI:10.2196/66489

JMIR Form Res. 2025 Oct 31;9:e80654. doi: 10.2196/80654.

ABSTRACT

BACKGROUND: Approximately half of US veterans receive care outside of US Department of Veterans Affairs (VA) Veterans Health Administration facilities-a proportion expected to rise due to the Promise to Address Comprehensive Toxics Act and expanded use of VA-purchased community care.

OBJECTIVE: This paper describes the structure and impact of the Veterans Care Coordination in Community Settings (VetCoor) program. VetCoor was implemented in 2 non-VA community health centers, and we explored setting, staffing, and treatment targets to enhance veteran care and inform broader dissemination.

METHODS: VetCoor embedded a coordinator within community-based, non-VA health care settings to improve veteran identification and address unmet medical needs. Coordinators also connected veterans with VA and local resources addressing health-related social needs. VetCoor included training on veteran needs and military culture. It also held a monthly community of practice call where coordinators shared best practices and met with facility representatives to learn about VA services.

RESULTS: From May 2021 to September 2023, a total of 220 veterans participated, engaging in 773 sessions. Of these 220 veterans, 73 (33.2%) received VA enrollment assistance; 54 (24.5%) were referred for medical care; and 82 (37.3%) received care coordination, including medication reconciliation assistance. They also received assistance with transportation (46/220, 20.9%) nutrition and food access (42/220, 19.1%), housing and repair (42/220, 19.1%), and utility payment support (31/220, 14.1%). Common barriers to veterans seeking care were perceptions that enrolling in the VA took resources from veterans more in need and confusion regarding discharge papers required for enrollment.

CONCLUSIONS: VetCoor supported rural veterans’ health care and health-related social needs using dedicated coordinators. This model addresses resource gaps, fosters VA-community collaboration, and aligns with the VA’s expanding benefits under the Promise to Address Comprehensive Toxics Act.

PMID:41172298 | DOI:10.2196/80654