Tag: nevin manimala

J Voice. 2025 Mar 20:S0892-1997(25)00089-X. doi: 10.1016/j.jvoice.2025.02.040. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze the behavior of vocal nodules from childhood to postpuberty.

METHODS: Adolescents aged 15 years or older who presented vocal nodules in childhood were included and underwent the same evaluations performed in childhood. They answered a questionnaire about vocal symptoms, treatments, habits, and vocal abuse. They were submitted to videolaryngoscopy, auditory-perceptual, and acoustic vocal assessments.

RESULTS: In total, 31 adolescents (15-18 years), 23 boys, eight girls, mean age in childhood and postpuberty: girls (10.25 ± 1.85, 16.75 ± 1.3); boys (10.08 ± 1.34, 15.95 ± 1.87), without statistical difference between childhood and postpuberty (P > 0.05).

SYMPTOMS: four boys (12.9%) and three girls (9.67%) maintained dysphonia postpuberty. Videolaryngoscopy: nodules were not detected after puberty. Minor alterations: hyperemia (n-2), edema (n-1), posterior glottic cleft (n-1), and microweb (n-1).

TREATMENTS: vocal therapy (n-18), microsurgery (n-8), and no treatment (n-5). There was a significant difference in the acoustic (maximum phonation time, f₀, jitter, pitch perturbation quotient, shimmer, amplitude perturbation quotient, and Student t test) and acoustic perceptive parameters (Mann-Whitney rank sum test) between the moments (childhood and postpuberty). In the comparison between the treatments (Shapiro-Wilk and Kolmogorov-Smirnov tests) just for shimmer parameter, there was a statistical difference, being more significant in surgery and speech therapy.

CONCLUSIONS: After puberty, we observed a reduction in vocal symptoms, as well as an improvement in videolaryngoscopic findings and in auditory and acoustic perceptive vocal parameters. In the comparison between the treatments just for shimmer parameter, there was a statistical difference, being more significant in surgery and speech therapy.

PMID:40118659 | DOI:10.1016/j.jvoice.2025.02.040

Int J Geriatr Psychiatry. 2025 Mar;40(3):e70064. doi: 10.1002/gps.70064.

ABSTRACT

INTRODUCTION: The rise of mobile health interventions offers significant potential to improve the well-being of the aging global population, particularly individuals at an increased risk of dementia. To fully leverage this potential, it is crucial to evaluate the mobile health applications across different demographic and socio-economic landscapes. This study investigated the relationship between a country’s development status and the quality of dementia-focused mobile health applications, as well as the influence of developers’ medical expertise on app quality and perceived impact.

METHODS: This cross-sectional observational design study utilized the uMARS tool to evaluate the objective and subjective quality of dementia-related mobile health applications. Objective quality was assessed across engagement, functionality, aesthetics, and information domains, while subjective quality included user recommendations, anticipated usage, and perceived impact. A stratified random sampling method selected 17 apps for evaluation, and inter-reviewer reliability was confirmed (Kendall’s W = 0.143, p = 0.045). Data analysis involved descriptive statistics, independent sample t-tests, and Pearson’s correlation coefficients, with statistical significance set at p < 0.05.

RESULTS: Among the 51 dementia-related mobile health app analyzed, only one was developed in a low-income country. Additionally, this study found a linear correlation between the perceived impact of a mobile health app for dementia and the medical background of the development team, with a Pearson correlation coefficient of t = 3.708 (p < 0.001). Engagement was highly correlated with subjective quality (Pearson correlation coefficient r = 0.955, p < 0.001), and there was a strong correlation between the information provided by the apps and the perceived impact (Pearson correlation coefficient r = 0.884, p < 0.001).

CONCLUSION: The adoption of mobile health apps must be prioritized to assist individuals with dementia and their caregivers in low income countries. Future apps should focus on improving engagement and involving medical experts in development to increase credibility and utilization across socioeconomic levels and healthcare systems.

PMID:40118652 | DOI:10.1002/gps.70064

Kidney Int. 2025 Apr;107(4):602-605. doi: 10.1016/j.kint.2025.01.012.

ABSTRACT

In this issue, Schouten et al. report findings from a cost-effectiveness analysis of hemodiafiltration versus conventional high-flux hemodialysis using data from the Comparison of High-Dose Hemodiafiltration with High-Flux Hemodialysis (CONVINCE) trial. They found that the overall cost-effectiveness of hemodiafiltration is within the range of accepted willingness-to-pay thresholds in some countries, while near (but outside) the lower-bound thresholds of other countries. How decision-makers value treatment costs for additional years on dialysis and country-specific costs and willingness-to-pay thresholds influence the cost-effectiveness of hemodiafiltration.

PMID:40118588 | DOI:10.1016/j.kint.2025.01.012

J Am Board Fam Med. 2024 Nov-Dec;37(6):1014-1026. doi: 10.3122/jabfm.2023.230469R1.

ABSTRACT

BACKGROUND: At least 26 different fecal immunochemical tests (FITs) are available for use in the US. Liquid vial and card collection devices are available.

OBJECTIVES: 1) assess participant’s difficulties with and preferences for types of FITs; 2) assess whether errors in FIT collection were associated with FIT collection difficulty; 3) identify factors associated with difficulty with FIT stool collection.

METHODS: Prospective individuals scheduled for a colonoscopy were invited to participate in a study comparing test characteristics of 5 FITs. A product questionnaire asked participants about ease of collection and difficulties.

RESULTS: 2,148 participants; mean age 63 years; 63% females, 83% Whites, and 19% Hispanics. 1265 (61%) preferred use of a liquid vial versus 181 (9%) the card. 49% had no difficulty with Hemoccult ICT, and 66 to 70% had no difficulty with the liquid vials. Difficulties with Hemoccult ICT included: being messy (21%), collection window too small (19%), and getting sample on stick (8%). Difficulties with the liquid vials included difficulty probing or scraping the stool (5% to 8%) and unclear directions (3%). In a multivariable model, the perceived difficulty in FIT collection was significantly higher for Hemoccult ICT compared with OC-Auto Micro (adjusted odds ratio [AOR], 4.05), and it was significantly high for those with a FIT error (AOR, 3.90).

CONCLUSION: Participants strongly preferred a liquid vial compared with a card. Perceived difficulty was significantly associated with FIT errors and with FIT brand. Medical offices providing FITs should ensure that patients understand the task of FIT collection, so that errors are minimized.

PMID:40118555 | DOI:10.3122/jabfm.2023.230469R1

J Am Board Fam Med. 2024 Nov-Dec;37(6):1047-1054. doi: 10.3122/jabfm.2024.240059R1.

ABSTRACT

BACKGROUND: With the goals of improving health care delivery, patient outcomes, and creating a more engaged workforce, there have been consistent calls over the past 2 decades for increasing research capacity within the field of family medicine. Since 2014, the University of Minnesota Department of Family Medicine and Community Health (UMN DFMCH) has implemented strategies to enhance clinical faculty research capabilities while maintaining high-quality clinical care and medical education. This study reports changes in clinical faculty publications.

METHODS: Peer-reviewed publication data from 2013, 2016, 2019, and 2022 were analyzed for clinical faculty employed by the UMN DFMCH during those years. An annual research culture survey was administered via e-mail to clinical faculty in 2021, 2022, and 2023. The survey asked questions regarding Research Leadership, Culture, Training, Infrastructure, and Capacity.

RESULTS: While 2019 had the highest total number of publications with 99, 2022 had the highest proportion of faculty with at least 1 publication (50%). In 2023, 63.6% of survey respondents thought there were opportunities for them to participate in research, up from 41.0% in 2021. When asked about their research capacity and goals, 43.5% in 2023 responded positively, compared with 19.4% in 2021.

CONCLUSIONS: The efforts in our department to increase research capacity through investing in research infrastructure, faculty training and mentoring, and funding have led to notable increases in clinical faculty publications and positive perceptions of our research culture. These results provide additional evidence of the value of a model that harmonizes clinical care, education and research missions.

PMID:40118553 | DOI:10.3122/jabfm.2024.240059R1

J Neurosurg Pediatr. 2025 Mar 21:1-8. doi: 10.3171/2024.12.PEDS24542. Online ahead of print.

ABSTRACT

OBJECTIVE: Patients with advanced moyamoya disease have chronic cerebrovascular insufficiency with superimposed acute ischemic insults, leading to brain atrophy and cognitive decline. The outcomes of revascularization procedures in moyamoya patients with marked brain atrophy are not yet clearly known.

METHODS: This retrospective study used an approach based on the global cerebral atrophy scale to identify patients with severe brain atrophy from a single-surgeon series of patients with moyamoya disease undergoing revascularization from January 2015 to January 2024. Clinical outcomes (modified Rankin Scale [mRS] score, improvement in symptoms and cognitive function) and radiological outcomes (arterial spin labeling [ASL] perfusion) were studied and compared between direct and indirect revascularization groups.

RESULTS: Of 153 patients in the series, 16 (mean age 8.9 years) had severe brain atrophy (cortical atrophy score ≥ 8). The presenting symptoms were recurrent transient ischemic attack in 6 patients (37.5%), major stroke in 7 patients (43.75%), and seizure in 3 patients (18.75%). Fourteen patients underwent surgeries for both hemispheres and 2 patients underwent surgery for 1 hemisphere. Of the 30 hemispheres, 17 (56.7%) were treated with direct revascularization and 13 (43.3%) with indirect revascularization. The mean follow-up duration was 38.8 months. The median mRS score improved from 3 (preoperative) to 1.5 (last follow-up), with 11 patients (68.75%) showing improvement in mRS score. Thirteen patients (81.25%) showed improvement in presenting symptoms. Overall, 12 of 16 patients (75%) showed improvement in cognitive function at the last follow-up. The mean preoperative and follow-up ASL scores improved for the lower-perfusion hemispheres from 7.9 to 8.9 and for the higher-perfusion hemispheres from 9.6 to 10.45, respectively. Differences between preoperative and postoperative ASL scores for both groups were statistically significant. There was no significant difference in clinical and radiological outcomes between the direct and indirect revascularization groups. Clinical outcomes were comparable across patient groups based on the distribution of brain atrophy (unilateral/bilateral, predominant left/right side, predominant vascular territory involved).

CONCLUSIONS: Moyamoya patients with severe brain atrophy showed improvement in paroxysmal symptoms, cognitive function, and overall clinical functioning status, as well as radiological perfusion, after undergoing either direct or indirect revascularization. Comparative efficacy of direct and indirect revascularization in these patients needs further investigation.

PMID:40117668 | DOI:10.3171/2024.12.PEDS24542

J Neurosurg Pediatr. 2025 Mar 21:1-6. doi: 10.3171/2024.12.PEDS24418. Online ahead of print.

ABSTRACT

OBJECTIVE: Intrathecal baclofen (ITB) is commonly used to treat secondary generalized dystonia. Intraventricular baclofen (IVB) has been shown to be a safe alternative treatment with low complications. The objective of this study was to report the long-term effects of IVB.

METHODS: This retrospective analysis included patients who underwent IVB therapy from April 2005 to June 2024. The decision to use IVB and the surgical technique have been previously described. Data collection included sex, race, etiology of dystonia, Gross Motor Functional Classification System scores, Barry-Albright Dystonia Scale (BADS) scores, Ashworth Scale scores, medical and surgical management of dystonia, follow-up duration, and complications. Patients whose IVB pump was removed within 1 year and those with less than 1 year of follow-up were excluded.

RESULTS: Thirty-six patients with IVB were identified, and 27 patients (median age 12.9 years) were ultimately included. The most common cause of secondary dystonia was cerebral palsy in 21 patients (78%), followed by metabolic and neurodegenerative disorders in 4 (14%), infection in 1 (4%), and severe traumatic brain injury (TBI) in 1 (4%). The follow-up duration ranged from 1.2 to 16.7 years, with a median of 7.7 years and mean of 8.4 years. The baclofen dosage was twice as high in patients with metabolic and neurodegenerative disorders compared with those with cerebral palsy, TBI, and infection, with median dosages of 1455 μg/day and 725 μg/day, respectively. Both posttreatment BADS and Ashworth Scale scores showed statistically significant improvement. Complications included infection that necessitated pump removal in 1 patient (4%), wound dehiscence that was treated with wound revision and antibiotics in 1 patient (4%), and hydrocephalus that required CSF diversion in 4 patients (15%). In 2 patients, IVB therapy was ineffective at controlling dystonia and, thus, was discontinued after 1.3 and 2.7 years. One patient asked for the pump to be removed after 1.2 years due to “does not like the physical pump itself.” Four patients (15%) developed hydrocephalus, which required CSF diversion via a ventriculoperitoneal shunt in 3 patients and a lumboperitoneal shunt in 1 patient, with no further shunt or IVB complications.

CONCLUSIONS: IVB is well tolerated in patients with generalized secondary dystonia refractory to conventional medical therapy, ITB, and deep brain stimulation. Positive long-term outcomes were reported in this cohort, with significant improvement in dystonia and overall complication rates similar to those reported with ITB.

PMID:40117664 | DOI:10.3171/2024.12.PEDS24418

J Neurosurg Spine. 2025 Mar 21:1-11. doi: 10.3171/2024.11.SPINE24609. Online ahead of print.

ABSTRACT

OBJECTIVE: Previous research suggests elective surgical procedures performed later in the week have worse outcomes. This study investigated whether the day of the week on which elective anterior cervical discectomy and fusion (ACDF) surgery was performed impacts clinical outcomes.

METHODS: Using data from the Quality Outcomes Database, a nationwide, multicenter prospective registry, this study included patients undergoing elective ACDF for cervical spondylosis. Patients were categorized into groups based on the surgery day (early week, Monday and Tuesday; late week, Thursday and Friday). Analyzed outcomes included postoperative complications, readmissions, reoperations, and patient-reported outcomes. Statistical methods included the independent t-test, Pearson’s chi-square test, and multivariable logistic regression.

RESULTS: The study analyzed 19,818 patients, with 41.7% undergoing surgery early in the week and 36.9% later. There were no significant differences in 30-day mortality, readmissions, or reoperations between the two groups. Early-week surgical procedures were associated with a higher incidence of postoperative dysphagia requiring nasogastric tubes (0.6% vs 0.3%, p = 0.02) and a higher incidence of vocal cord paralysis (0.5% vs 0.3%, p = 0.01). The data indicate a surgical selection bias with more complex surgical procedures and higher risk patients typically scheduled earlier in the week, which likely contributed to the increased rates of dysphagia. Conversely, patients who underwent operations on Fridays were more likely to be discharged on the same day compared to those earlier in the week (p = 0.02), without a significant difference in length of stay overall. Surgical procedures performed later in the week were more likely to be performed at ambulatory surgical centers rather than inpatient facilities (p < 0.01), indicating a strategic selection of healthier patients for end-of-week procedures.

CONCLUSIONS: The day of elective ACDF surgery does not affect mortality, readmissions, or reoperation rates. However, early-week surgical procedures may see slightly higher rates of postoperative dysphagia and vocal cord paralysis, likely due to the scheduling of more complex cases or higher risk patients during these days. Overall, the authors’ data confirm that day of surgery does not influence overall patient recovery significantly. This information is useful for surgical planning and for providing patient reassurance that the day of the week does not significantly impact surgical outcomes.

PMID:40117661 | DOI:10.3171/2024.11.SPINE24609

J Neurosurg Pediatr. 2025 Mar 21:1-13. doi: 10.3171/2024.11.PEDS24322. Online ahead of print.

ABSTRACT

OBJECTIVE: The goal in this study was to retrospectively evaluate the safety and feasibility of purely neuroendoscopic removal of choroid plexus tumors (CPTs) in children using a monoportal or biportal technique.

METHODS: The clinical, radiological, and surgical data of all children with CPTs removed via purely endoscopic or microsurgical approaches in the last 12 years at two centers were retrospectively reviewed. Both centers were fully equipped with advanced neuroendoscopic technology, and surgical teams were fully trained in complex neuroendoscopic intraventricular surgical procedures.

RESULTS: The study involved 32 patients, divided into two groups: 13 undergoing endoscopic procedures and 19 undergoing microsurgical procedures. In the endoscopic group, the mean age was 2.11 years. Eight tumors were located in the lateral ventricles, and 5 in the third ventricle. The mean tumor volume was 6.59 cm3 (range 0.25-15.4 cm3); 9 patients had hydrocephalus at presentation. The monoportal technique was used in 9 patients, and the biportal technique was used in 4 patients. Gross-total removal was achieved in all patients-within a single procedure in 11 patients, and in a two-stage procedure in 2 patients. In the microsurgical group the mean age was 3.75 years. Seventeen tumors were located in the lateral ventricles, and 2 in the third ventricle. The mean tumor volume was 15.07 cm3 (range 1.2-84.35 cm3). The following microsurgical approaches were used: transcortical (n = 11), transcallosal (n = 5), and interhemispheric transprecuneal (n = 3). There was no statistically significant difference between the cases treated via microsurgical and endoscopic approaches with regard to CPT volume (p = 0.06), presence of hydrocephalus (p = 0.22), need for shunt surgery (p = 0.78), or complications (p = 0.06). Furthermore, a statistically significant difference was found in surgery time and blood loss: in endoscopic procedures there was significantly lower blood loss and a shorter surgery time (p < 0.005).

CONCLUSIONS: The present study conducted at two hospitals has demonstrated that neuroendoscopic removal of the CPT is a safe and feasible alternative to the conventional microsurgical procedure. The lower blood loss, lower rates of serious complications, and full resolution of hydrocephalus are the main points in favor of neuroendoscopic surgery to obtain gross-total removal of intraventricular CPT in infants and children.

PMID:40117660 | DOI:10.3171/2024.11.PEDS24322

J Neurosurg. 2025 Mar 21:1-9. doi: 10.3171/2024.11.JNS241896. Online ahead of print.

ABSTRACT

OBJECTIVE: Atypical intracranial meningiomas are characterized by brain invasion and faster growth than lower-grade counterparts. Surgery improves survival for patients with atypical meningiomas, and this study assesses the association between the timing of surgery and survival.

METHODS: Patients > 18 years of age with intracranial atypical meningiomas resected (2004-2019) and cataloged in the National Cancer Database were included. Descriptive statistics of sociodemographic and clinical characteristics were generated. Kaplan-Meier survival curves for each variable were generated. Cox proportional hazards models were developed to assess the association of time between diagnosis and surgery with overall survival, while controlling for age, sex, race, ethnicity, facility type, tumor size, comorbidity, resection type, adjuvant radiotherapy, and systemic therapy.

RESULTS: A total of 5452 patients were included; 17.81% of the patients were between 18 and 50 years, 66.89% were between 51 and 75 years, and 15.30% were > 75 years. Among the cohort, 55.98% of patients were female. The average time between diagnosis and surgery was 0.8 months; 63.33% of the patients underwent gross-total resection, 28.28% received adjuvant radiotherapy, and 0.92% received systemic therapy. Overall, 21.39% of the patients died during the study period, and the average follow-up time after surgery was 50.9 months. Bivariate analysis showed that the risk of patient mortality over the entire study period increased significantly for every additional month between diagnosis and surgery (hazard ratio [HR] 1.03, 95% CI 1.01-1.06; p = 0.01). On multivariable analysis, a longer time between diagnosis and surgery (HR 1.03, 95% CI 1.00-1.05; p = 0.02) remained a significant predictor of mortality after adjusting for age, sex, race, ethnicity, treatment facility type, tumor size, frailty, resection type, adjuvant radiotherapy, and systemic therapy. On subgroup analysis, delayed time to surgery was associated with increased mortality for those who received subtotal resection (HR 1.04, 95% CI 1.01-1.07; p = 0.01), but not for those who received gross-total resection (HR 1.02, 95% CI 0.97-1.06; p = 0.43). Patients who were female, Asian, treated at an academic program, and received radiotherapy were associated with significantly decreased mortality, whereas patients who were male, African American, had a tumor size > 60 mm, had more comorbidities, and underwent subtotal resection experienced increased mortality.

CONCLUSIONS: Additional time between diagnosis and surgery is associated with an increased risk of mortality after adjusting for confounders. The authors recommend surgery as soon as safely possible after diagnosis for patients with intracranial meningiomas with signs of atypia.

PMID:40117658 | DOI:10.3171/2024.11.JNS241896