Tag: nevin manimala

J Am Acad Orthop Surg. 2025 Aug 28. doi: 10.5435/JAAOS-D-24-01181. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this study was to identify the incidence and risk factors associated with surgical site infection (SSI) after open reduction and internal fixation of bimalleolar ankle fractures. Bimalleolar ankle fractures are one of the most common subtypes of ankle fractures, accounting for 15% to 20% of all ankle fractures. Recent studies have shown that 4.37% of patients undergoing ORIF of ankle fractures develop an SSI postoperatively. The literature detailing the risk factors for the development of SSI after open reduction and internal fixation (ORIF) of bimalleolar ankle fractures is sparse. Therefore, the purpose of this study was to determine the risk factors that predispose patients to SSI after the index procedure.

METHODS: Patients who underwent bimalleolar ankle fracture repair between January 1, 2010, and December 31, 2021, were identified using the PearlDiver Mariner Database. Demographics and comorbidities between SSI and non-SSI cohorts were compared through chi-square analysis. Multivariate logistic regression was used to analyze risk factors for SSIs. A P value less than 0.001 was determined to be statistically significant.

RESULTS: The incidence of SSI after ORIF of bimalleolar ankle fractures was 3.1%. Age, sex, and a higher total Elixhauser Comorbidity Index were associated with an increased incidence of SSI (P < 0.0001). Risk factors for the development of SSI included male sex (OR = 1.17; P < 0.0001), chronic kidney disease (odds ratio [OR] = 1.233; P < 0.001), diabetes (OR = 1.27; P < 0.0001), drug abuse (OR = 1.22; P < 0.0001), fluid and electrolyte disorders (OR = 1.42; P < 0.0001), hypertension (OR = 1.29; P < 0.0001), peripheral vascular disease (OR = 1.62; P < 0.0001), tobacco use (OR = 1.25; P < 0.0001), and weight loss (OR = 1.25; P < 0.0001). Peripheral vascular disease was the most highly correlated risk factor for the development of SSIs in this study.

CONCLUSIONS: These findings underscore the importance of preoperative risk stratification and optimization to minimize SSIs in this population. This is the first study to delineate the risk factors for the development of SSI in patients undergoing ORIF for bimalleolar ankle fractures. Physicians can use these results to counsel patients before undergoing the index procedure to minimize postoperative infections.

LEVELS OF EVIDENCE: IV.

PMID:40907002 | DOI:10.5435/JAAOS-D-24-01181

J Am Acad Orthop Surg. 2025 Aug 28. doi: 10.5435/JAAOS-D-25-00371. Online ahead of print.

ABSTRACT

BACKGROUND: Current reliance on the expedited 510(k) approval pathway has driven rapid commercial availability of novel arthroscopic devices. Despite the low complication rates of arthroscopic procedures, products from this pathway are suspected to increase the rate of recalls and device malfunctions.

PURPOSE: This study aimed to characterize arthroscopic device recalls, analyze trends in recall incidence, and identify predictors of time to recall.

METHODS: A 20-year, retrospective, cross-sectional study was conducted using the Food and Drug Administration (FDA) Recalls database. Recalled devices approved under the FDA 510(k) pathway were identified and categorized by type, manufacturer, recall class, and cause. Statistical analyses included Poisson regression for trends and Cox proportional hazards modeling for predictors of time to recall.

RESULTS: A total of 124 recalls were initiated during the study period (average 6.2 recalls/year), with packaging and process control issues accounting for 50.7% of recalls. Recall incidence remained stable over time, although nearly half occurred in 2008, 2010, 2012, and 2019. Mean recall time was 491 days (95% confidence interval [CI], 444 to 539). Devices recalled due to material/implant contamination had markedly shorter times (HR: 3.73 [95% CI, 1.78 to 7.82]), whereas process control issues prolonged recall times (HR: 0.56 [95% CI, 0.31 to 1.00]). Manufacturer was another predictor of time to recall, with one manufacturer exhibiting substantially extended recall times (HR: 0.45 [95% CI, 0.22 to 0.92]).

CONCLUSION: Arthroscopic device recalls are largely caused by packaging and process control issues, emphasizing the need for stricter quality assurance during manufacturing. Although recall incidence remained stable over the past two decades, variability in recall times highlights opportunities for improved manufacturer accountability and FDA oversight. Increasing procurement scrutiny, enhancing FDA audit practices, and integrating recall data with clinical outcomes can minimize disruptions in arthroscopic surgery.

LEVEL OF EVIDENCE: Level III Therapeutic Study.

PMID:40906998 | DOI:10.5435/JAAOS-D-25-00371

Am J Public Health. 2025 Sep 4:e1-e9. doi: 10.2105/AJPH.2025.308225. Online ahead of print.

ABSTRACT

Objectives. To characterize the nature, burden, and trends of silicosis among California workers, including workers with engineered stone exposures. Methods. We conducted multisource public health surveillance and generated descriptive statistics, compared engineered stone cases to cases with other silica exposures, and examined the utility of various data sources for silicosis surveillance. Results. We received 1817 reports of possible silicosis for 648 individuals from 2019 to 2024 and confirmed 296 (46%) cases, including 243 (82%) associated with engineered stone exposures. Engineered stone cases were more likely to be younger, men, Latino, and from Los Angeles County than were non-engineered stone cases. Of engineered stone cases, at least 15 (6%) were known to have died, and 60 (25%) were referred for lung transplant, including 30 (12%) who received transplants. There was limited overlap between reporting mechanisms. Conclusions. Multisource surveillance was effective for identifying a large number of individuals with silicosis, including people exposed to engineered stone. Outcomes were severe, and many patients had advanced disease. Results illustrate that worker screening and silica exposure mitigation are essential to prevent morbidity and mortality in the engineered stone countertop fabrication industry. (Am J Public Health. Published online ahead of print September 4, 2025:e1-e9. https://doi.org/10.2105/AJPH.2025.308225).

PMID:40906995 | DOI:10.2105/AJPH.2025.308225

Issues Ment Health Nurs. 2025 Sep 4:1-11. doi: 10.1080/01612840.2025.2522229. Online ahead of print.

ABSTRACT

Sexting is associated with adolescent depression. This study aimed to expand provider assessment in Family Medicine and specialty settings in Appalachian Upstate South Carolina (AUSC) to include sexting and depression screening. AUSC depression rates are among the highest in the nation, highlighting disparities in the region. This nurse-led mixed-method, exploratory descriptive study included adolescents 11 to 18 years old and providers from an AUSC healthcare system, including nurse researchers, nurse practitioners, and physicians. Following education on sexting, depression, and screening, providers in Family Medicine and specialty settings administered the Intimate Images Diffusion Scale and PHQ-2 to adolescents at episodic visits. Concurrently, providers completed a survey on the barriers and facilitators to talking with parents/guardians (P/G) and adolescents about sexting with each participant, including provider comments. Providers also gave P/G a sexting education notebook to take with them. Surveys were analysed using SPSSv24 statistical software, and comments were analysed using thematic analysis. Over 50% screened positive for sexting, and over 40% of those who sexted screened positive for depression. Providers reported few barriers, with P/G (71.9%) and adolescents (81.3%) talking about sexting. The themes were P/G openness to conversations about sexting, P/G awareness of sexting risks, P/G concerns about sexting, adolescent openness to conversations about sexting, and provider facilitators and barriers to discussing sexting. Provider education and screening is a crucial first step in identifying adolescent sexting and depression. Screening in Family Medicine and specialty settings in rural, underserved areas may lead to earlier diagnosis and treatment and improved patient outcomes.

PMID:40906983 | DOI:10.1080/01612840.2025.2522229

Neurology. 2025 Sep 23;105(6):e214041. doi: 10.1212/WNL.0000000000214041. Epub 2025 Sep 4.

ABSTRACT

BACKGROUND AND OBJECTIVES: β-Amyloid (Aβ) likely triggers the spread of pathologic tau from the entorhinal cortex (EC) to the neocortex, but whether distinct Aβ levels exert differential influences on tau propagation beyond the EC remains unclear. We aimed to investigate the modifying effect of Aβ on the association of initial tau deposition with successive tau accumulation.

METHODS: A retrospective analysis was performed using data from 2 longitudinal observational cohort studies, the Alzheimer’s Disease Neuroimaging Initiative (ADNI) and the Harvard Aging Brain Study (HABS), both conducted in the United States. All participants underwent a baseline study visit that included amyloid PET scans, [¹⁸F]-flortaucipir PET scans, and at least 1 follow-up tau PET scan (amyloid positivity was not required). Linear mixed-effects models were fitted to examine the modifying effect of Aβ on the relationship between baseline EC tau levels and tau accumulation over time. The outcome variables included changes in tau PET in 6 regions of interest (ROIs): the entorhinal, inferior temporal (IT), inferior parietal (IP), meta-temporal (meta-ROI), Braak III-IV, and Braak V-VI regions.

RESULTS: This study included 434 older adults from ADNI (262 [60%] cognitively unimpaired [CU] and 172 [40%] cognitively impaired participants; mean age, 73 ± 7 years; 51% female; mean follow-up duration, 3.69 ± 1.98 years) and 200 CU participants from HABS (mean age, 72 ± 9 years; 61% female; mean follow-up duration, 4.33 ± 1.75 years). In ADNI, the 3-way interaction of baseline EC tau × centiloid (CL) × time was significant across all 6 ROIs (e.g., IT region: estimate = 0.00285, 95% CIs 0.00161-0.00408; p < 0.00001), as was baseline EC tau × CL² × time (e.g., IT region: estimate = -0.00002, 95% CIs -0.00003 to -0.00001; p = 0.00001). The negative quadratic term suggests that the potentiating association between CL and tau spread diminishes beyond a critical threshold. A similar pattern of findings was replicated in HABS.

DISCUSSION: Distinct initial Aβ levels seem to interact with EC tau deposition to affect successive tau accumulation in the rest of the brain. Interpretation should be approached with caution because causality cannot be inferred from this observational study.

PMID:40906972 | DOI:10.1212/WNL.0000000000214041

Chirurgia (Bucur). 2025 Aug;120(4):446-458. doi: 10.21614/chirurgia.3156.

ABSTRACT

Introduction: Radical cystectomy with ileal conduit urinary diversion (Bricker technique) remains the standard treatment for localized muscle-invasive bladder cancer (MIBC), as well as for high-risk non-muscle-invasive bladder cancer (NMIBC). Amid the transition toward minimally invasive techniques, comparing laparoscopic radical cystectomy (LRC) with robot-assisted radical cystectomy (RARC) becomes essential, particularly regarding perioperative morbidity and postoperative health-related quality of life. However, real-world data from Eastern Europe remain limited. Objective: To compare peri- and postoperative clinical outcomes and quality of life in patients undergoing radical cystectomy with Bricker urinary diversion via laparoscopic versus robotic approach. Materials and Methods: This is a retrospective, observational study conducted between March 2023 and March 2025 in two academic centers in Cluj-Napoca, Romania. A total of 37 patients diagnosed with MIBC were included and allocated into two groups based on the surgical approach: laparoscopic (n=22) and robotic (n=15). Clinical, biological, and surgical parameters were collected pre- and postoperatively. Quality of life was assessed at 3 months using the EQ-5D-5L and EQ-VAS instruments. Statistical analyses included t-tests, Mann-Whitney U tests, linear regression models, and correlation coefficients, with a significance threshold of p 0.05. Results: The robotic group demonstrated significantly better postoperative renal function (eGFR: 84.2 +- 5.88 vs. 66.55 +- 5.59 ml/min/1.73m²; p=0.041) and a shorter median hospital stay (7 days, IQR 6â?”8 vs. 9 days, IQR 7â?”13; p=0.045), despite a longer operative time (463 +- 25.4 vs. 415 +- 21.52 minutes). Severe postoperative complications were significantly more frequent in the laparoscopic group (54.5% vs. 6.7%; p=0.004). Preexisting urinary tract infections, more common in the LRC group (45.5% vs. 20%), were independently associated with decreased postoperative renal function (ò = -0.39, p=0.005). The mean EQ-VAS score was higher in the robotic group (84.93 +- 2.64 vs. 76.81 +- 4.42; p 0.01), despite a lower EQ-5D-5L utility index (0.52 +- 0.12 vs. 0.72 +- 0.05; p=0.02), indicating an overall favorable health perception despite objectively reduced functional outcomes. Postoperative complications were significantly correlated with decreased EQ-VAS scores (71.39 +- 20.49 vs. 88.37 +- 71.13; p=0.004). Conclusions: In the real-world clinical setting of Eastern Europe, the robotic approach to radical cystectomy with Bricker urinary diversion was associated with better preserved renal function, shorter hospitalization and a lower incidence of severe complications. Preoperative urinary tract infections negatively impacted renal function independently of baseline eGFR. Although RARC patients showed more pronounced functional impairments as measured by EQ-5D-5L, their overall health perception (EQ-VAS) was significantly better, suggesting the influence of technological expectations and postoperative satisfaction. These results support the implementation of robotic surgery in advanced urological centers and highlight the need for prospective, randomized trials with extended follow-up focusing on functional outcomes and quality of life.

PMID:40906957 | DOI:10.21614/chirurgia.3156

Chirurgia (Bucur). 2025 Aug;120(4):432-437. doi: 10.21614/chirurgia.3138.

ABSTRACT

Introduction: This study aimed to evaluate the resistance of anastomoses to mechanical traction in an ex vivo biomechanical experiment, to determine the most resistant manual suture for restoring digestive tract continuity after various types of gastric resection for cancer. Materials and methods: The tensile strength of different types of anastomoses was compared ex vivo using porcine esophagus, stomach, and small intestine. The test setup included a tensile testing device, which applied a controlled force on the anastomoses until they broke, which was recorded for each type of anastomosis and was expressed in N. Data processing and statistical analysis were performed in the GraphPad Prism program, using a paired T-test and ANOVA test. We considered the p-value 0.05 to be statistically significant. Results: Double-layer gastrojejunal (Roux-en-Y) and end-to-end esophagojejunal anastomosis presented the highest tensile strength. Double-layer anastomoses showed significantly higher tensile strength compared to monoplane ones. The results suggest that the double-layer suture technique offers better mechanical stability, which may reduce the risk of postoperative complications. Conclusions: Biplane anastomoses after gastric resections may reduce postoperative complications and improve patient outcomes.

PMID:40906955 | DOI:10.21614/chirurgia.3138

Am Surg. 2025 Sep 4:31348251371182. doi: 10.1177/00031348251371182. Online ahead of print.

ABSTRACT

BackgroundHealthcare disparities often cause rural BIG 1 TBI patients to be transferred to a higher level of care due to a fear of clinical decline.MethodsWe conducted a retrospective cohort study from 2020 to 2022 that compared patients with the principal diagnosis of BIG1 TBI who were transferred from rural critical access facilities in the upper Midwest to a tertiary care center vs those who were admitted directly to the same tertiary care center. The primary outcomes were cost and mortality. Statistical significance in mortality rates and length of stay was determined using Pearson’s Chi Squared and Kruskal-Wallis tests, with significance thresholds set at α = 0.05.Results62 BIG1 patients were examined in the study and 18 were excluded. Of the 44 patients studied, there were no deaths in either group, and length of stay was not significant (P = .36). Transferred patients also underwent more head CT scans when compared to directly admitted patients (mean 2.5 vs 2.1, P = .003). For in-network costs, the average cost of transferred patients was $13,956 and the average cost for direct admissions was $9216 (P = .0003). For out-of-network costs, the average cost of transferred patients was $20,041 and the average cost for direct admission was $13,789 (P = .02).ConclusionCompared to patients who are directly admitted, transfer patients have an increased cost of care while having no difference in clinical outcomes. Technological advances in telemedicine and protocolized care may assist with decreasing the cost while increasing efficiency of care for these patients.

PMID:40906907 | DOI:10.1177/00031348251371182

Hepatol Commun. 2025 Sep 5;9(9):e0803. doi: 10.1097/HC9.0000000000000803. eCollection 2025 Sep 1.

ABSTRACT

BACKGROUND: In Michigan, Asian Americans are disproportionately infected with HBV and HCV. As many infections are first diagnosed when patients present with advanced liver disease or liver cancer, HBV and HCV screening, awareness, and early treatment are critical to improving outcomes.

METHODS: Using a theory-informed approach, we administered a bi-level qualitative study to identify determinants of viral hepatitis and liver cancer care and treatment in Michigan Asian American communities. We conducted a focus group involving representatives from public health agencies, cancer coalitions, and Asian diaspora organizations across the state. We then completed 1:1 interviews with leaders from the communities. Groups and interviews were taped, transcribed, and used to identify common and distinct themes according to the National Institute of Minority Health and Health Disparities framework.

RESULTS: According to community leaders, language barriers, costs, and a lack of viral hepatitis education appeared among the top shared screening barriers between the 3 communities. Conversely, common facilitators included pre-existing health programs, interpretation services, and community partnerships. Such sentiments were also echoed by the stakeholder focus group. However, the communities also raised distinct concerns about medical mistrust and positive health messaging.

CONCLUSIONS: This qualitative report marks the first phase of a bi-level mixed methods study in Asian American Michigan communities to understand determinants of viral hepatitis and liver cancer care and treatment. This work lays the foundation for a quantitative survey that will gather data from community members to inform the development of a future intervention.

PMID:40906889 | DOI:10.1097/HC9.0000000000000803

Hepatol Commun. 2025 Sep 5;9(9):e0794. doi: 10.1097/HC9.0000000000000794. eCollection 2025 Sep 1.

ABSTRACT

BACKGROUND: The approach to appropriate risk stratification for metabolic dysfunction-associated steatotic liver disease (MASLD) is variable, and the adoption of non-invasive liver disease assessments in clinical practice is suboptimal. In this study, we implemented an electronic decision support tool for primary care patients with MASLD to assess its influence on linkage to care.

METHODS: We performed a prospective, before-and-after pilot study in which post-implementation providers were presented with an electronic decision aid automating non-invasive liver disease assessments with the Fibrosis-4 score and providing individualized, guideline-directed recommendations. Patients were included if attending an outpatient primary care visit with a study provider, had a pre-existing diagnostic code for MASLD, and had not established care with a hepatologist in the 3 years before the office visit. The primary outcome was linkage to care, defined as adherence to guideline-directed recommendations for the next step of care. A total of 503 encounters were included, accounting for 301 unique patients.

RESULTS: Provider adherence to guideline-directed clinical recommendations increased from 29.7% to 45.8% post-implementation (p<0.001). The effect of this intervention remained significant when controlling for patient age, race, sex, resident physician involvement in the clinic visit, and concomitant comorbidities of diabetes, hypertension, and hyperlipidemia (OR 2.11 [95% CI 1.42-3.14]; p<0.001). There was a modest increase in the number of referrals to hepatology post-implementation (2.3%-7.1%; OR 3.27 [95% CI 1.33-9.18]; p=0.014).

CONCLUSIONS: In conclusion, we present a novel, electronically integrated, innovative methodology for direct delivery of individualized guidance for the management of patients with MASLD that significantly enhanced the direction of care toward necessary guideline-directed liver assessments.

PMID:40906885 | DOI:10.1097/HC9.0000000000000794