Tag: nevin manimala

J Robot Surg. 2025 Jul 6;19(1):355. doi: 10.1007/s11701-025-02504-0.

ABSTRACT

This study aimed to evaluate the effectiveness of the RoSCo preoperative risk scoring system, which incorporates the RENAL Nephrometry Score, the Charlson’s Comorbidity Index, and body mass index to quantify surgical risk, in guiding individualized early mobilization protocols and to assess associated early postoperative recovery outcomes in patients undergoing robot-assisted partial nephrectomy (RAPN) for renal cell carcinoma (RCC). A prospective, randomized controlled study was conducted involving 82 patients diagnosed with RCC who underwent RAPN between October 2023 and October 2024 at the Department of Urology. Participants were randomized into an experimental group (n = 41) and a control group (n = 41). The experimental group received a RoSCo-guided personalized early mobility protocol, while the control group received conventional enhanced recovery after surgery care. Key postoperative recovery indicators, including time to first ambulation, time to first flatus and defecation, duration of hospital stay, and complication rates, were compared between the two groups. Participants in the experimental group demonstrated a significantly shorter time to first ambulation (18.94 ± 14.31 h) compared to the control group (36.56 ± 12.91 h, p < 0.001). The experimental group also exhibited significantly shorter postoperative hospital stays (5.34 ± 1.56 days vs 7.34 ± 2.98 days, p < 0.001), reduced duration of urinary catheterization (4.68 ± 1.94 days vs 6.00 ± 2.43 days, p = 0.008), earlier time to first flatus (19.99 ± 13.10 h vs 29.66 ± 23.82 h, p = 0.025), and earlier time to first defecation (65.12 ± 19.29 h vs 92.62 ± 39.98 h, p < 0.001). Additionally, the incidence of postoperative abdominal distension was significantly lower in the experimental group (2.44% vs 19.51%, p = 0.029). No statistically significant differences were observed between groups regarding the incidences of postoperative bleeding, urinary leakage, infection, lower back pain, or duration of drainage tube placement (p > 0.05). Preoperative risk stratification using the RoSCo score facilitates the development of personalized early mobilization protocols for patients undergoing RAPN for RCC. This approach is associated with improved early postoperative recovery outcomes, including earlier ambulation, faster gastrointestinal recovery, shorter hospitalization, and reduced catheterization duration, without increasing the risk of postoperative complications.

PMID:40619492 | DOI:10.1007/s11701-025-02504-0

Ann Surg Oncol. 2025 Jul 6. doi: 10.1245/s10434-025-17746-3. Online ahead of print.

ABSTRACT

BACKGROUND: Postsurgical hypoparathyroidism is a frequent complication in thyroid surgery. Visual inspection to assess parathyroid gland (PG) viability is subjective and inconsistent. Although indocyanine green (ICG) angiography can improve perfusion assessment, it introduces workflow disruptions and carries a risk of allergic reactions.

METHODS: This pilot study investigated the feasibility of incident dark-field (IDF) microscopy as a dye-free, real-time imaging method for assessing PG perfusion during thyroidectomy. Thyroidectomy patients were prospectively enrolled at a tertiary referral hospital. Parathyroid glands were visually identified and confirmed with near-infrared autofluorescence (NIRAF). Imaging was recorded using three techniques: gross inspection (GI), IDF microscopy, and ICG angiography. Perfusion status was evaluated and classified into three categories (devascularized, compromised, and well-vascularized) and reviewed by three independent, blinded observers. Statistical analyses included interobserver reliability and inter-evaluation correlation assessments.

RESULTS: Among 41 NIRAF-confirmed PGs, IDF microscopy demonstrated rapid assessment, requiring 2.41 ± 1.01 min per PG evaluation compared with 5.40 ± 1.53 min for ICG angiography. For PG viability evaluation, IDF showed higher correlation with ICG than GI (weighted kappa, 0.75 vs 0.60; both P < 0.001). Surpassing GI’s moderate agreement (weighted kappa, 0.44-0.47; P < 0.001), IDF microscopy exhibited moderate to substantial inter-evaluation agreement (weighted kappa 0.51-0.66; P < 0.001).

CONCLUSIONS: Incident dark-field microscopy offers a rapid, reliable, and dye-free method for real-time assessment of PG perfusion, demonstrating diagnostic performance on par with ICG angiography while providing notable workflow advantages. This technique has the potential to reduce hypoparathyroidism by enhancing PG preservation in thyroid surgery. Further studies are needed to validate these findings and refine quantification methods.

PMID:40619485 | DOI:10.1245/s10434-025-17746-3

Sci Rep. 2025 Jul 6;15(1):24134. doi: 10.1038/s41598-025-10217-5.

ABSTRACT

In dairy cows, the immune system is suppressed around calving, predisposing them to infectious diseases. This study investigated vitamin D levels and various immunological and oxidative stress markers in cows suffering from peri-parturient diseases compared with healthy cows. A total of 45 cows with peri-parturient diseases (including ketosis and uterine diseases) and 23 healthy cows were selected. For statistical comparisons, diseased cows were compared with healthy cows in various ways. To perform statistical comparisons, sick cows were categorized into different stages: first, those with various peri-parturient diseases; second, those with ketosis; and third, those with uterine diseases, for comparison with the healthy groups. Blood samples were collected at three time points: 7 days pre-partum, 7 days post-partum and 21 days postpartum. 25(OH) vitamin D (25(OH) D), interleukins 4 and 10 (IL-4, IL-10), interferon-gamma (INF-γ), immunoglobulin G (IgG), and haptoglobin amounts were measured via ELISA, while total antioxidant capacity (TAC) and malondialdehyde (MDA) amounts were measured spectrophotometrically. The Friedman test revealed significant time effects on 25(OH) D levels in both the healthy and sick groups (p ≤ 0.05). However, no significant differences were detected between healthy and sick cows at any sampling time. IL-4 levels significantly decreased in sick cows during the peri-parturient period, whereas IL-10 levels notably differed only after calving. IgG levels were significantly lower in sick cows than in healthy cows during the first week postpartum. INF-γ levels were significantly lower in sick cows, particularly one week postpartum. Haptoglobin levels were lower in cows with uterine diseases prior to calving. Although time influenced TAC and MDA levels, no significant differences were found between the groups. Overall, these findings indicate that 25(OH) D and certain immunological parameters may play a role in the health status of dairy cows around calving, warranting further investigation into their potential therapeutic effects.

PMID:40619462 | DOI:10.1038/s41598-025-10217-5

Sci Rep. 2025 Jul 7;15(1):24162. doi: 10.1038/s41598-025-08488-z.

ABSTRACT

This study evaluates heavy metal contamination in fish and its associated health risks, focusing on the implications for global public health. Fish samples were analyzed using advanced techniques, including Inductively Coupled Plasma-Mass Spectrometry (ICP-MS), Atomic Absorption Spectroscopy (AAS) with a hydride generator for arsenic, and a mercury analyzer. Results revealed significant contamination levels, with arsenic concentrations ranging from 0.9 ± 0.1 to 3.2 ± 0.2 mg/kg (mean: 2.24 ± 0.76 mg/kg), exceeding the WHO limit of 2 mg/kg in 75% of samples. Mercury concentrations (mean: 1.4917 mg/kg) surpassed the WHO limit of 0.5 mg/kg in all samples, while cadmium levels sometimes exceeded permissible limits. Statistical analysis indicated substantial variability in metal concentrations among samples, supported by Principal Component Analysis and Pearson’s correlation, identifying distinct pollution patterns and sources. Health risk assessments showed significant non-carcinogenic and carcinogenic risks, particularly for children. Arsenic, chromium, and mercury presented hazard quotients exceeding safe thresholds, with cumulative hazard indices confirming elevated risks (HI = 14.5 for adults, 44.1 for children). The findings suggest the pressing need for global strategies to monitor and manage heavy metal pollution in aquatic ecosystems.

PMID:40619450 | DOI:10.1038/s41598-025-08488-z

J Eval Clin Pract. 2025 Aug;31(5):e70188. doi: 10.1111/jep.70188.

ABSTRACT

BACKGROUND: Databases of reported adverse events after vaccination are used to detect alarming signals by qualitative methods (case series) and quantitative methods (the proportional reporting ratio).

OBJECTIVE: This methodological-empirical paper explores several key questions: How useful are these databases for detecting alarming signals? To which study design do they correspond? Which measure of association should be computed? Which key biases might operate, and what can be done to avoid or reduce them?

METHODS: A contemporary methodological tool-causal diagrams-was used to answer these questions. The analytical approach was demonstrated for three possible outcomes of Covid vaccines: Thrombosis with Thrombocytopenia Syndrome, Guillain-Barré Syndrome, and reported death.

RESULTS: A database of reported adverse events corresponds to a case-control study and should be analysed accordingly. The preferred measure of association is the odds ratio, not the proportional reporting ratio. Reporting bias operates to overestimate the true odds ratio, whereas control selection bias operates in the opposite direction (underestimation). As illustrated by three examples of reported death, the magnitude of the biases depends on the choice of the reference vaccine. However, extended methodological and empirical work is needed.

CONCLUSIONS: Databases of reported adverse events after vaccination are a rich source for quantitative research, provided that several methodological guidelines are followed. These databases should be analysed according to the principles of a case-control study, and the inference should be drawn on a case-by-case basis. It is crucial to estimate the reporting accuracy of a particular event by the type of vaccine, and only a clinical evaluation of a sample of records can provide this information.

PMID:40618408 | DOI:10.1111/jep.70188

J Eval Clin Pract. 2025 Aug;31(5):e70195. doi: 10.1111/jep.70195.

ABSTRACT

RATIONALE: Triage frequently fails to identify critically ill patients and needs improved methods. Limited understanding, or errors in multivariable models are likely to impede progress in service improvement.

AIMS: (1) to reveal a complex web of potential causal pathways stemming from nurses’ decisions at triage and patient flow. (2) to add to the understanding of, and research methodology for triage.

METHODS: Secondary data analysis of records from a 91 month convenience sample of all patients attending a general Emergency Department (ED) was used to pose new questions about the functioning of triage systems. A conceptual model of the impact of patient flow on triage decisions and subsequent events was developed. Directed Acyclic Graphs (DAGs) were constructed to assist in the understanding of results and future research.

RESULTS: Analysis showed a pivotal role for collection of vital signs data with far-reaching and surprisingly marked consequences. The response of triage nurses to time pressure revealed a complex ‘web’ of interactions and some unexpected findings. Safety and outcomes for patients were measurably affected and even the risky decisions some patients took to leave ED were influenced.

CONCLUSION: Triage is failing patients, ED staff and hospitals in complex ways and needs improvement. DAGs are useful for preventing mistakes in statistical analyses and improving research studies. By combining these with informal diagrams we hope to bridge communication barriers, since improving quality of care needs a multidisciplinary effort. Implications for the profession and patient care are outlined.

PMID:40618407 | DOI:10.1111/jep.70195

J Eval Clin Pract. 2025 Aug;31(5):e70153. doi: 10.1111/jep.70153.

ABSTRACT

OBJECTIVE: In this study, it was to evaluate the impact of diagnosis-related group (DRG) payments on hospitalisation costs, length of stay (LOS), and in-hospital mortality in Nanjing.

METHODS: A quasi-natural experiment was utilised. The intervention group consisted of patients enroled in the Urban Employee Basic Medical Insurance and Urban and Rural Resident Basic Medical Insurance programmes in Nanjing, while the other patients composed the comparison group. Interrupted time-series analysis and difference-in-differences combined with propensity score matching were employed in this study. The analysis was based on a case-level data set from a tertiary hospital between January 2021 and December 2022.

RESULTS: The introduction of the DRG payment caused a 13.5% decrease in hospitalisation costs per admission for the intervention group compared with the comparison group. Furthermore, the intervention group exhibited a slight reduction in the LOS of 0.75 days in comparison to the comparison group. No significant changes were observed in care quality, as measured by in-hospital mortality.

CONCLUSION: The DRG payment was effective in decreasing hospitalisation costs and length of stay. No compelling evidence was identified in terms of the changes in in-hospital mortality. The evidence from China may also be valuable to other developing countries considering the adoption of DRG payments.

PMID:40618405 | DOI:10.1111/jep.70153

J Eval Clin Pract. 2025 Aug;31(5):e70202. doi: 10.1111/jep.70202.

ABSTRACT

AIMS AND OBJECTIVES: To assess whether a workflow change introducing a third trimester pregnancy education guide would be associated with increased patient satisfaction regarding prenatal counseling.

METHODS: We surveyed pregnant patients between 34w0d-41w6d during a single prenatal appointment at one of two hospital-associated offices. We enrolled 49 ‘pre-guide’ patients March-May 2023 and 50 ‘post-guide’ patients October-December 2023, after a 4-month washout period. We performed t-tests and chi-squared analyses to compare the groups.

RESULTS: The cohorts had similar sociodemographic characteristics aside from lower education level in the post-guide cohort (p = 0.01). There was no significant difference between the groups and their reported satisfaction with third trimester and delivery counseling (p = 0.92). Those who received the guide were more likely to feel they were more adequately counseled regarding ‘pain management in childbirth’ (p = 0.01), but there were no other statistically significant differences between the groups. Of those who received the guide, 75% felt that it reduced their anxiety and stress about the unknown and 100% would recommend it to others.

CONCLUSIONS: We did not find that introduction of an informational guide about the third trimester of pregnancy significantly affected their satisfaction with their third trimester and delivery counseling or patient perception of the adequacy of counseling on specific pregnancy topics. All patients who received the guide noted they would recommend it to others.

PMID:40618398 | DOI:10.1111/jep.70202

Clin Exp Dent Res. 2025 Aug;11(4):e70170. doi: 10.1002/cre2.70170.

ABSTRACT

OBJECTIVES: To evaluate the oral, periodontal, and dental health of the elderly population of Iran.

MATERIAL AND METHODS: This was a cross-sectional study as a part of the second wave of Birjand Longitudinal Aging Study (BLAS), which is a community-based prospective cohort study. The comprehensive geriatric oral health assessment tool was used for data collection. Data was collected through clinical examinations.

RESULTS: Among the 1017 participants, the mean DMFT was 27.04. 67% (n = 681) were periodontally healthy, while mild to moderate periodontitis was diagnosed in 33% (n = 336) and severe periodontitis in 2.4% (n = 24). Xerostomia was diagnosed in 30% (305 individuals). 56.10% (n = 570) had removable dentures, among which 30.21% (n = 172) had poor retention, and 36.26% (n = 207) had poor stability. Red/white and exophytic lesions were diagnosed in 18.36% (n = 187) and 11.35% (n = 115), respectively. Tooth loss was prevalent, with 12.19% (n = 124) having mild tooth loss, 20.35% (n = 207) mild to moderate tooth loss, and 67.45% (n = 686) experiencing severe tooth loss.

CONCLUSIONS: Our study revealed significant oral health challenges among the elderly population. High DMFT and the prevalence of xerostomia, periodontitis, tooth loss and poorly fitted dentures underscore the need for targeted dental care interventions. Comprehensive strategies, including raising awareness and improving access to oral healthcare, are essential to enhance the quality of life and overall health of the elderly population.

PMID:40618396 | DOI:10.1002/cre2.70170

West Afr J Med. 2025 Feb 28;42(2):121-126.

ABSTRACT

BACKGROUND: Malocclusion is an abnormality of teeth alignment from interactions of hereditary and environmental factors, associated with stimuli present at the period of formation and development of the face and oral tissues.

OBJECTIVES: To determine the prevalence and determinants of malocclusion among preschool children in Maiduguri, Borno State.

METHODS: This study involved 239 pre-school children selected by systematic random sampling. The independent variables were ‘presence / absence of sucking habits’, ‘type of sucking habit’, ‘molar relationship’ and ‘nutritional status. The dependent variable was presence of malocclusion and ‘type of malocclusion. Frequency distribution of independent and dependent variables were presented. Association between the independent and dependent variables were obtained using Chi-Square test. Statistical significance was placed at 95% confidence intervals, p value ≤ 0.05. Data was analysed using SPSS for Windows (version 23).

RESULTS: Majority of participants were in the higher social class, (P=0.07), never had a dental visit (78.2%), P=0.08 and did not have any sucking habit (82.4%), P= 0.03. Most had mesial step (42.7%) or flush terminal molar relationship (37.7%), P=0.05. Prevalence of malocclusion was 4.5%, majority were cross bite (64.4%) SE=0.04. Distal step and flush terminal molar relationship were associated with prevalence of malocclusion (12.5% and 4.4% respectively), P=0.08.Fifty percent of those with digit sucking habit had cross bite, P=0.01.

CONCLUSIONS: Prevalence of malocclusion among preschool children in this study was low and majority had cross-bite. Digit sucking was significantly associated with cross bite. Children with distal step occlusion exhibited higher proportion of malocclusion. There is need for dental awareness on malocclusion among the population.

PMID:40618390