Tag: nevin manimala

Eur J Orthop Surg Traumatol. 2025 Mar 7;35(1):101. doi: 10.1007/s00590-025-04212-9.

ABSTRACT

PURPOSE: Shoulder stiffness is a common complication following rotator cuff repair (RCR) surgery. However, there is a paucity of literature on the short-term effects of postoperative stiffness on outcomes following RCR. The purpose of this study is to analyze the effect of postoperative shoulder stiffness on short-term outcomes following RCR.

METHODS: The Nationwide Readmissions Database (NRD) was queried from 2015 to 2020 for primary RCR patients. Stiffness was defined using International Classification of Disease Clinical Modification and Procedure Coding System codes for arthrofibrosis, adhesive capsulitis, stiffness, synovitis, or contracture of the shoulder. Patients were separated into stiff and non-stiff cohorts and a case-control match was performed based upon age, sex, and Charlson Comorbidity Index (CCI) for a total number in the control group of 358 and a total subject count of 489. Postoperative complications, reoperations, readmissions, mortality, and hospital cost metrics were compared between cohorts using t-test and fisher’s exact test.

RESULTS: Rates of complications, reoperation, readmission, and death were similar between the stiff and non-stiff cohorts and there were likely no clinically significant differences. Stiff patients were more likely to be discharged to home and less likely to be discharged to another type of facility (p = 0.007).

CONCLUSION: Postoperative stiffness was not predictive of increased complications, readmissions, or healthcare costs following RCR. These findings suggest that stiffness may not represent a significant clinical or economic burden, helping to guide patient expectations and management strategies. However, stiff patients were more likely to be discharged home and less likely to require facility-based care, suggesting potential differences in postoperative recovery or support needs.

PMID:40053210 | DOI:10.1007/s00590-025-04212-9

Eur J Haematol. 2025 Mar 7. doi: 10.1111/ejh.14407. Online ahead of print.

ABSTRACT

AIM: To assess the efficacy of continuous dasatinib in improving outcomes for adult patients with BCR::ABL1 ALL.

METHODS: The prospective, multicenter ALL/MRD2014 trial introduced a modified protocol compared to the MRD2008 trial, incorporating continuous dasatinib use and reduced chemotherapy intensity.

RESULTS: Among the 164 adult ALL patients enrolled (2014-2019), 61 were Philadelphia-positive (Ph+) (median age 50 years; 38 males, 23 females). Post-induction, 96.7% achieved complete remission (CR). The 3-year event-free survival (EFS) and overall survival (OS) were 51% and 76%, respectively. Patients undergoing allo-HSCT in CR1 had improved outcomes, with a 3-year EFS of 64% and OS of 87%. MRD-negative patients before transplantation exhibited superior survival (EFS: 71% vs. 29%; OS: 94% vs. 57%). Comparison with the MRD2008 trial revealed similar outcomes, with the MRD2014 trial achieving a 3-year EFS of 51% and OS of 76% vs. 52% and 84% in MRD2008. Although not statistically significant, the MRD2014 trial showed trends of increased relapse (CIR: 39% vs. 26%, p = 0.305) and reduced non-relapse mortality (NRM: 10% vs. 21%, p = 0.181).

CONCLUSION: The ALL/MRD2014 trial underscores the importance of MRD status and allo-HSCT in Ph+ ALL. Continuous dasatinib-based regimens offer favorable outcomes in MRD-negative patients.

TRIAL REGISTRATION: This study was registered with the UMIN Clinical Trials Registry (UMIN-CTR), number UMIN000012382.

PMID:40052397 | DOI:10.1111/ejh.14407

Eur J Clin Invest. 2025 Mar 7:e70021. doi: 10.1111/eci.70021. Online ahead of print.

ABSTRACT

BACKGROUND: Spontaneous bacterial peritonitis (SBP) is a frequent and life-threatening complication of cirrhosis, contributing to considerable morbidity and mortality.

METHODS: A cross-sectional derivation study was conducted to assess the diagnostic accuracy of two sepsis-related calcitonin peptide family biomarkers, mid-regional pro-adrenomedullin (MR-pro-ADM) and procalcitonin, in ascitic fluid for identifying bacteriologically confirmed SBP (BC-SBP). In a subsequent validation study, the diagnostic performance of the ‘SBP score’ was evaluated in an independent patient cohort using an absolute polymorphonuclear (PMN) leukocyte count threshold of ≥250 cells/mm³ as the diagnostic benchmark for diagnosing SBP.

RESULTS: In the derivation study, the concentration of MR-pro-ADM in ascitic fluid was significantly higher in patients with BC-SBP compared to those without BC-SBP (3.14 nmol/L [IQR, 2.39-6.74] vs. 1.91 nmol/L [IQR, 1.33-2.80]; p = .0002). Bayesian ANOVA indicated that MR-pro-ADM was highly discriminative for diagnosing BC-SBP, with a substantial Bayes factor (BFM = 2505), whereas procalcitonin exhibited poor discriminatory performance. Receiver-operating characteristic (ROC) analysis identified an optimal MR-pro-ADM cut-off of ≥2.50 nmol/L for diagnosing BC-SBP, with an area under the ROC curve (AUROC) of 0.746 (95% CI, 0.685-0.801; p < .0001). Multivariable logistic regression identified three independent predictors of BC-SBP, which were subsequently incorporated into the ‘SBP score’ (MR-pro-ADM ≥2.5 nmol/L, absolute PMN count ≥250 cells/mm³ and Child-Pugh score). In the validation study, the ‘SBP score’ demonstrated an AUROC of 0.993 (95% CI, 0.929-1.000; p < .0001) for diagnosing SBP.

CONCLUSION: MR-pro-ADM in ascitic fluid emerges as a promising biomarker for SBP diagnosis. Combining MR-pro-ADM with absolute PMN count and Child-Pugh score in the ‘SBP score’ greatly improves the diagnostic accuracy of SBP.

PMID:40052388 | DOI:10.1111/eci.70021

Cancer Med. 2025 Mar;14(5):e70757. doi: 10.1002/cam4.70757.

ABSTRACT

BACKGROUND: Black patients with non-small cell lung cancer (NSCLC) are more often diagnosed at a later stage and receive inadequate evaluation and treatment compared to White patients. We aimed to identify factors representing exposure to structural racism that mediate the association between race and NSCLC care.

METHODS: We queried Surveillance, Epidemiology, and End Results-Medicare for non-Hispanic Black and White patients ≥ 67 years diagnosed with NSCLC from 2013 to 2019. Our outcomes were localized diagnosis stage, receipt of stage-appropriate evaluation, receipt of stage-appropriate treatment, two-year survival, and receipt of “optimal” care, an aggregate metric comprising the first three listed outcomes. We estimated indirect effects of mediators on the association between race and outcomes.

RESULTS: Of 69,130 patients, 8.2% were Black. Medicare-Medicaid dual eligibility, a marker of individual-level socioeconomic status (SES), accounted for the largest proportion of mediating effects for most outcomes, ranging from 13.6% (p < 0.001) for localized diagnosis stage to 25.0% (p < 0.001) for two-year survival. Receipt of an influenza vaccine, a marker of health care access, had the second largest mediating effects on the associations between race and diagnosis stage (9.5%, p < 0.001), treatment (15.3%, p < 0.001), and optimal care (11.4%, p < 0.001). Neighborhood-level SES accounted for the third largest proportion of the effects of race on each outcome, explaining between 9% and 16% of the racial inequities at each phase (all p < 0.001).

CONCLUSIONS: Individual- and neighborhood-level structural factors partly explain inequities in NSCLC care, and their effects vary based on the phase of care. Interventions should be adapted to the phase of care.

PMID:40052387 | DOI:10.1002/cam4.70757

Turk J Pharm Sci. 2025 Mar 7;22(1):38-45. doi: 10.4274/tjps.galenos.2024.19947.

ABSTRACT

OBJECTIVES: This study aimed to explore the relationship between emotional labor, professional commitment, and self-efficacy among community pharmacists. Specifically, this study examined how self-efficacy influences professional commitment and the mediating role of emotional labor strategies in this relationship.

MATERIALS AND METHODS: A cross-sectional survey design was used to collect data from 396 community pharmacists. The study used a convenience sampling method and included standardized measures of emotional labor, professional commitment, and self-efficacy. Descriptive statistics were used to examine the levels of these variables among the participants. Multiple regression analyses were conducted to assess the interdependencies and mediating effects of emotional labor strategies.

RESULTS: General self-efficacy was positively correlated with emotional commitment (β=0.275, p<0.05) and continuance commitment (β=0.364, p<0.05), explaining 5% and 8% of their variances, respectively. A normative commitment was influenced by self-efficacy (β=0.464, p<0.05) and deep emotional labor (β=0.134, p<0.05), explaining 11% of its variance. Self-efficacy and deep emotional labor positively affected overall professional commitment (β=0.368, p<0.05), accounting for 15% of the variance.

CONCLUSION: The results highlight the crucial role of self-efficacy in managing the emotional demands of the pharmacy profession and in fostering stronger professional commitment. Enhancing pharmacists’ self-efficacy and emotional management skills can improve their job satisfaction and commitment to the profession. These findings have clinical implications for the development of training interventions aimed at supporting pharmacists in coping with the emotional aspects of their work and improving their overall professional well-being.

PMID:40052379 | DOI:10.4274/tjps.galenos.2024.19947

Otolaryngol Head Neck Surg. 2025 Mar 7. doi: 10.1002/ohn.1196. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine changes in trends of the incidence and characteristics of pediatric complicated rhinosinusitis with respect to the coronavirus disease 2019 (COVID-19) pandemic.

STUDY DESIGN: Retrospective cohort.

SETTING: Single tertiary-care center.

METHODS: A review of patients who presented to St. Louis Children’s Hospital (SLCH) with complicated rhinosinusitis from 2017 to 2022 was performed. Clinical and follow-up data were analyzed in association with COVID-19.

RESULTS: Eighty-three patients with complicated rhinosinusitis were identified and analyzed according to hospitalization before or after March 2020. No differences in demographic variables were found between the two groups. More patients had developmental comorbidities in the COVID-19 group (7 vs 1, P = .049). More patients with intracranial complications (55% vs 45%, P = .48) and Pott’s puffy tumor (78% vs 22%, P = .13) were observed in the COVID-19 era group; however, this difference was not statistically significant. In the COVID-19 group, more patients were found to have Streptococcus anginosus growth in their surgical cultures (67% vs 33%, P = .03). The incidence of complicated sinusitis correlated with the incidence of all viral cases at SLCH, particularly in 2021 and 2022, and increased following COVID-19.

CONCLUSION: Trends in complicated sinusitis vary before and after the onset of the COVID-19 pandemic. There was an increase in complications of sinusitis due to S. anginosus species in the COVID-19 era and trends towards increased intracranial complications and Pott’s puffy tumor. After an initial decrease, the incidence of complicated sinusitis per year increased following COVID-19.

PMID:40052376 | DOI:10.1002/ohn.1196

J Am Geriatr Soc. 2025 Mar 7. doi: 10.1111/jgs.19418. Online ahead of print.

ABSTRACT

BACKGROUND: Nonpharmacological pain interventions are effective but underutilized in people living with dementia (PLWD). Leveraging an implementation lens (i.e., the Readiness Assessment for Pragmatic Trials [RAPT] model) to scope the literature may reveal research gaps contributing to this underutilization. The purpose of this scoping review is to summarize the literature, map the studies to the RAPT model, and identify research gaps.

METHODS: Following Arksey and O’Malley’s framework and Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA- ScR) guidelines, two reviewers screened, collated, extracted, and mapped data from eligible studies to the 9 RAPT domains (implementation, evidence, risk, feasibility, measurement, cost, acceptability, alignment, and impact). We used descriptive statistics to summarize the studies and the extent to which interventions were mapped to RAPT domains.

RESULTS: Of 81 studies covering 24 interventions, 64% were in long-term care facilities (LTCFs), 66% reported unspecified pain, and 32% reported unspecified dementia. Of the interventions, the Tailored Activities Program had literature informing the most domains (6 domains), followed by exercise, pain education, and stepwise approaches (5 domains each). Most studies were mapped to the evidence domain (33 studies), few studies to feasibility (7 studies), acceptability (5 studies), and implementation (10 studies) domains, one study to cost, and no studies to risk or impact.

CONCLUSION: Despite the variety of nonpharmacological pain interventions studied, there is a notable lack of literature that aligns with the RAPT model. Furthermore, there is limited consideration of the specific pain and dementia conditions, as well as the diverse environments where PLWD reside and receive care. These gaps underscore the need for robust and holistic research to ensure pain interventions are effectively tailored and implemented for PLWD. Starting with acceptability and feasibility studies can establish a foundation for building robust evidence, ensuring practical and well-received interventions before larger-scale clinical trials.

PMID:40052350 | DOI:10.1111/jgs.19418

BJU Int. 2025 Mar 7. doi: 10.1111/bju.16694. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the perioperative outcomes of papillary versus non-papillary access in percutaneous nephrolithotomy (PCNL), which is the ‘gold standard’ for managing large renal calculi.

PATIENTS AND METHODS: In this prospective, randomised trial, 70 patients with de novo renal stones amenable to PCNL were allocated to undergo either papillary (n = 35) or non-papillary (n = 35) access. Primary outcomes included haemoglobin drop and the need for blood transfusion. Secondary outcomes assessed were: operative time, stone-free rates (SFRs; initial and final), the need for auxiliary procedures, incidence and grading of complication rates.

RESULTS: There were no statistically significant differences between the papillary and non-papillary groups in terms of perioperative haemoglobin drop (P = 0.971) or transfusion rates (P = 0.69). Although the non-papillary group had a shorter mean operative time (83 vs 92 min, P = 0.103) and a marginally higher initial SFR (88.6% vs 82.9%, P = 0.495), these differences were not statistically significant. Final SFRs were similar (94.3% vs 97.1%, P = 0.555). Both groups experienced low and comparable complication rates, including fever, sepsis, and prolonged urinary leakage, with no significant difference between them.

CONCLUSION: Both papillary and non-papillary access approaches in PCNL show comparable safety and efficacy. While non-papillary access was associated with a slight reduction in operative time and a higher SFR, these findings were not statistically significant.

PMID:40052346 | DOI:10.1111/bju.16694

J Med Econ. 2025 Mar 7:1-9. doi: 10.1080/13696998.2025.2477342. Online ahead of print.

ABSTRACT

AIMS: Migraine leads to substantial healthcare utilization and associated costs. However, much higher costs are attributed to lost productivity. The impact of effective migraine treatment on these costs, at the individual level, has not been well established. Even less known is the impact of treatment failure. The objective of this study was to assess lost earnings as a measure of migraine-attributed burden among triptan non-responders in Denmark.

MATERIALS AND METHODS: We used data from the Danish National Prescription Register and Danish Income Statistics Register over the 27-year period 1995-2021. We identified 4,979 triptan non-responders (85.9% female) and matched them for sex, age and region of residence with 14,292 continuing users of triptans (triptan responders) and 13,592 individuals from the background population (triptan never-users). We then estimated average annual individual earnings, and compared those among triptan non-responders, from three years prior to and ten years after their last triptan redemption, with those among their matched triptan responders and triptan never-users over the same periods.

RESULTS: Triptan non-responders earned significantly less than both their matched triptan responders and their matched triptan never-users. The earnings gap was evident even three years prior to the last triptan prescription (€4,344 and €4,356 respectively). This gap widened substantially over time, so that average cumulative earnings over the 14-year period of follow-up for each triptan non-responder were €93,684 less than those of responders and €99,485 less than those of never-users.

LIMITATIONS: There are uncertainties with regard to the reasons for triptan discontinuation (whether non-response or otherwise), and to lack of diagnostic confirmation of migraine.

CONCLUSIONS: Triptan non-response represents failure of currently available acute treatment options. It is associated with substantial and cumulative lost earnings, highlighting a disproportionate economic burden. These findings underscore the potential economic benefit of recognizing, and rectifying, unmet treatment needs in migraine management.

PMID:40052331 | DOI:10.1080/13696998.2025.2477342

Med Mycol. 2025 Mar 6:myaf022. doi: 10.1093/mmy/myaf022. Online ahead of print.

ABSTRACT

Scedosporium and Lomentospora species are emerging fungal pathogens capable of causing severe infections in both immunocompetent and immunocompromised individuals. Previous environmental surveys have suggested potential associations between these fungi and various soil chemical parameters, though the relative influence of human activity versus environmental factors has not been systematically evaluated. Here, we conducted a comprehensive survey of 406 soil samples from 132 locations across Taiwan, analyzing fungal abundance alongside soil physicochemical parameters and the Human Footprint Index (HFI). We recovered 236 fungal isolates comprising 10 species, with S. boydii (32.2%), S. apiospermum (30.9%), and S. dehoogii (14.4%) being the most prevalent. The highest fungal burdens were observed in urban environments (up to 1293 CFU/g), particularly in public spaces and healthcare facilities. Statistical analysis revealed a significant positive correlation between fungal abundance and HFI (r = 0.143, P = 0.005), while soil chemical parameters including nitrogen, carbon, pH, electrical conductivity, and various base cations showed no significant associations despite their wide ranges. These findings indicate that anthropogenic disturbance of environments, rather than soil chemistry, is the primary driver of Scedosporium and Lomentospora distribution in Taiwan. This understanding holds important implications for predicting infection risks and developing targeted public health strategies, particularly in rapidly urbanizing regions. Future studies incorporating more specific indicators of human impact may further elucidate the mechanisms underlying these distribution patterns.

PMID:40052326 | DOI:10.1093/mmy/myaf022