Tag: nevin manimala

J Obstet Gynaecol Res. 2025 Sep;51(9):e70068. doi: 10.1111/jog.70068.

ABSTRACT

AIM: This study aimed to compare short- and long-term surgical outcomes between robotic sacrocolpopexy (RSC) and laparoscopic sacrocolpopexy (LSC), performed with concomitant total hysterectomy, in patients with symptomatic pelvic organ prolapse (POP).

METHODS: This retrospective cohort study included 167 women who underwent RSC (n = 113) or LSC (n = 54) with hysterectomy for uterine prolapse at Kawasaki Medical University between March 2020 and December 2024. Perioperative parameters, complications (Clavien-Dindo classification), and POP recurrence were assessed. The POP-Q was used for anatomical evaluation. Long-term outcomes such as recurrence, urinary incontinence, and mesh erosion were monitored over a median follow-up of 30 (RSC) and 52.5 (LSC) months.

RESULTS: The patients in the RSC group were significantly younger and had a higher incidence of diabetes. RSC had longer operative times (median 175 min vs. 152 min; p < 0.01) but comparable blood loss, complication rates, and hospital stay. POP-Q showed greater cervical elevation in the RSC group at one month (p < 0.05). The long-term recurrence rate was low and similar between the groups (RSC, 2.7%; LSC, 3.7%; p = 0.71). Mesh erosion, urinary incontinence, and organ prolapse were rare and did not differ significantly between the groups.

CONCLUSIONS: RSC with concomitant hysterectomy is a safe and effective alternative to LSC with comparable short- and long-term outcomes. Despite longer operative times, RSC offers anatomical benefits without increasing the risk of postoperative complications or recurrence.

PMID:40922044 | DOI:10.1111/jog.70068

Int J Epidemiol. 2025 Aug 18;54(5):dyaf140. doi: 10.1093/ije/dyaf140.

ABSTRACT

BACKGROUND: Coinciding with the SARS-CoV-2 pandemic, malaria cases and malaria-related deaths increased globally between 2020 and 2022. However, evidence linking the pandemic to increased malaria burden remains ambiguous. We assessed the extent to which an observed malaria resurgence in Lambaréné, Gabon, can be associated with pandemic-related disruptions in malaria control programmes.

METHODS: Using observational data from two tertiary referral hospitals, spanning 2018 to early 2023, we applied autoregressive integrated moving average (ARIMA) models in an interrupted time series (ITS) framework to test for changes in trends and levels following the onset of the pandemic. The primary outcome is the monthly malaria diagnosis rate (per 1000 all-cause hospital diagnoses). As a sub-analysis, we focused on monthly maternal malaria incidence.

RESULTS: Following an initial drop (-47.32, P = 0.031), potentially due to risk-averse behaviours, the malaria diagnosis rate gradually and concavely increased (linear term: 7.32, P = 0.001; squared term: -0.19, P = 0.001) to a peak above pre-pandemic levels. Additional analyses suggest that this resurgence was likely driven by disruptions to malaria control activities and a waning efficacy of malaria control tools administered pre-pandemic. Conversely, a resurgence in maternal malaria incidence was not estimated.

CONCLUSION: Findings align with several national and global descriptive reports, but add a more detailed understanding of underlying dynamics, therefore reinforcing the importance of maintaining malaria control in the general population. The absence of a meaningful increase in maternal malaria provides some reassurance that malaria in pregnancy-specific control remained unchanged during the SARS-CoV-2 pandemic. However, observed peaks in post-pandemic maternal malaria incidence should raise concerns given the risks that malaria poses to this group.

PMID:40922028 | DOI:10.1093/ije/dyaf140

Radiat Oncol. 2025 Sep 8;20(1):139. doi: 10.1186/s13014-025-02719-3.

ABSTRACT

BACKGROUND: Stereotactic Body Radiotherapy (SBRT) has been proven to be a safe and effective alternative to surgery in patients with metastatic primary sarcoma. However, data describing tumor response in relation to the given radiotherapy dose is lacking. Therefore, this study aims at analyzing efficacy and dose-response relationship in a retrospective cohort.

METHODS: Patients with metastatic sarcoma treated with ablative SBRT and followed up at the Karolinska University Hospital between 2008 and 2021 were included. SBRT was delivered using an inhomogeneous dose distribution resulting in higher median doses within the planning target volume (PTV) than the dose prescribed. Local control (LC), progression-free survival (PFS), overall survival (OS), adverse events and dose-response relationship were assessed. Statistical analysis was performed to identify variables that correlate to outcome.

RESULTS: Forty-three patients with a total of 83 lesions were treated. The most frequent histology was leiomyosarcoma (44%). The most common site of metastases was the lung (84%), followed by the liver (11%). The median prescription dose was 45 Gy (range 30-56 Gy) delivered in 3 fractions (range 2-8) with a planned median CTV mean dose of 309 Gy in EQD₂ with α/β = 3 Gy. The local control at 1-year, 2-year and 5-year from SBRT treatment was 97, 93 and 84%, respectively. For tumors with a planned mean CTV dose above EQD₂ 278.8 Gy (corresponding to 60.3 Gy in 3 fractions) the 1, 2 and 5-year local control was 100, 100 and 93%, respectively. Tumors planned with a lower dose than EQD₂ 278.8 Gy (α/β = 3 Gy) had a 1, 2 and 5-year local control of 90, 70 and 52%, respectively. The difference in local control between the high dose and low dose groups was statistically significant (p < 0.001). The median OS for all patients was 43 months. When respecting dose constraints, there were only limited number of mild side effects.

CONCLUSION: In this analysis a strongly significant dose-response relationship with excellent LC rates and limited side effects for patients with metastatic lesions of sarcoma were seen. These results could be related to the inhomogeneous dose distribution of SBRT treatments utilized in this study.

PMID:40922018 | DOI:10.1186/s13014-025-02719-3

BMC Geriatr. 2025 Sep 8;25(1):687. doi: 10.1186/s12877-025-06244-6.

ABSTRACT

BACKGROUND: Hospital admissions occur frequently in nursing homes and are often preventable. Inappropriate hospitalisations due to nursing home-sensitive conditions pose significant risks to residents, place additional strain on emergency departments and hospitals, and thus lead to substantial healthcare costs. In light of demographic changes- characterised by an aging and increasingly multimorbid nursing home population- combined with ubiquitous lack of health care professionals, new strategies are urgently needed to ensure adequate medical care in nursing homes. Telemedicine presents a promising and innovative solution, particularly for rural regions, to improve access to timely medical attention. In this study, we evaluated whether the implementation of regular televisits, in addition to on-site visits, can help decrease unplanned hospitalisations.

METHODS: In 2021, a nursing home in rural Germany introduced televisits with a cooperating general practitioner. Data on unplanned hospital admissions was collected for the years 2021/22 and 2018/19, the latter serving as a pre-intervention comparison. Hospital admissions were then compared between the two time periods, as well as between residents of 2021/22 who did or did not receive regular televisits.

RESULTS: Baseline characteristics were comparable between residents of 2018 and 2021, as well as between residents in the telemedical care and the control group. Unplanned hospital admissions significantly decreased (P <.0001) after implementation of regular televisits. Furthermore, a significantly lower (P =.04) number of hospital admissions was noted among residents in 2021/22 who received additional regular televisits, compared to the control group of residents that only received regular on-site visits.

CONCLUSIONS: Implementing regular televisits in the nursing home setting reduced the number of hospital admissions. This is most likely due to more frequent medical assessment, enabling early detection and timely management of deteriorations. By preventing unnecessary hospital admissions residents were spared the physical and psychological burdens connected with emergency transfers and protected from hospital-associated risks. On top of enhancing quality of care for the residents, televisits implementation in nursing homes can contribute to decrease strain on emergency services and hospitals.

TRIAL REGISTRATION: Not applicable, as no health-related intervention, modifying biomedical outcome or health-related measures in patients, took place.

PMID:40922008 | DOI:10.1186/s12877-025-06244-6

BMC Pregnancy Childbirth. 2025 Sep 8;25(1):930. doi: 10.1186/s12884-025-08061-6.

ABSTRACT

BACKGROUND: A growing body of knowledge is questioning the timing of postpartum care (PPC) and suggesting a structural change. The primary aim was to evaluate individuals’ satisfaction with additional PPC, and the secondary aim was to identify different needs postpartum.

METHODS: This comparative study was conducted in six maternity clinics in Gothenburg, Sweden 2019-2020. A total of 1159 eligible individuals were enrolled. An intervention model of care was evaluated, where the intervention group received two postpartum care compared to standard care, one visit (seven weeks postpartum) to their midwives. The participants answered questionnaires in connection to all postpartum care visits and at one-year postpartum a follow-up questionnaire was sent out.

RESULTS: The data from a total of 958 of 1159 participants (82.7%) were analysed: 447 of 554 (80.7%) in the intervention group vs 511 of 605 (84.4%) in the standard group. The participants in the intervention group reported satisfaction with the early, additional visit 413/444 (93%); where primiparous individuals reported a higher appreciation compared to parous individuals; 223/233 (95.7%) vs 190/211 (90.0%), P = 0.051. The three-weeks postpartum visit was perceived as timely, 434/441 (98.4%). Participants attending the clinic situated in a low socioeconomic status area were less likely to report a preference for additional visits. Nearly half of the participants in the standard group 201/466 (43%) expressed a preference towards an additional and early visit and this was more common among primiparous, 127/254 (50%) vs parous 74/212 (34.9%) P = 0.001. Those in the standard group who expressed a need for earlier support reported a wish for discussing abdominal/vaginal problems and experience of giving birth. Primiparous 73/127 (57.7%) were more likely than parous individuals 28/74 (37.8%) P = 0.011 to express a need for additional support with breastfeeding.

CONCLUSIONS: The results demonstrate an increased need for early and additional visits among primiparous, and important topics were abdominal/vaginal problems, experience of giving birth and breastfeeding. Information for individuals in low socioeconomic status areas needs to be expanded.

PMID:40922006 | DOI:10.1186/s12884-025-08061-6

J Urban Health. 2025 Sep 8. doi: 10.1007/s11524-025-00999-4. Online ahead of print.

ABSTRACT

The food environment (FE) is the interface where consumers interact to acquire and consume their food. Over the last two decades, the FE has changed due to lifestyle changes, globalization, economic disparities, and supermarketization. In addition, research on the food environment has focused mostly on high-income countries. Our study shows the novelty of assessing the food environment using the market food diversity (MFD) in Nairobi, a rapidly urbanizing city. We assessed the food environment of three income regions of Nairobi-using market food diversity derived from the Minimum Dietary Diversity of Women (MDD-W) tool. In August-December 2023, we used the Global Positioning System (GPS) and a list-based questionnaire to map 3548 food vendors. Descriptive statistics show that informal vendors (86%) dominated across the three income regions compared to formal vendors (14%). The high-income region was characterized by the presence of more formal vendors (24.2%) compared to the other income regions. There were statistically significant differences in food group variations among vendors. The study shows that unhealthy foods remain dominant across the three income regions. Market food diversity was highest in the high-income (3.11) region compared to the low- (2.71) and middle-income (2.35) regions. Our results underscore the need for policy implementation that supports local food environments that promote access to healthier and more nutritious diets, particularly in rapidly urbanizing cities of low- and middle-income countries (LMICs) such as Nairobi. Distinguishing income regions highlights the need for local policy officials to intervene to promote access to much healthier foods across the settlements.

PMID:40921999 | DOI:10.1007/s11524-025-00999-4

Pharmacoeconomics. 2025 Sep 8. doi: 10.1007/s40273-025-01537-5. Online ahead of print.

ABSTRACT

Cardiovascular disease (CVD) is a major contributor to the health and economic burden of disease globally. In this paper we discuss the literature on the health economics of the prevention and early intervention in CVD. We reveal the large economic impact of CVD and provide the economic argument supporting the calls for early detection and diagnosis of CVD outlined in the Global Heart Hub’s patient-led Manifesto for Change. Many challenges in conducting cost-effectiveness analyses of interventions for CVD prevention are identified, as well as the emerging statistical and economic methods to help overcome these issues. Lastly, we acknowledge the profound disparities in cardiovascular health faced by minority or underserved populations, and the important role that prevention and early intervention can play in improving health equity.

PMID:40921978 | DOI:10.1007/s40273-025-01537-5

J Mol Histol. 2025 Sep 8;56(5):303. doi: 10.1007/s10735-025-10513-4.

ABSTRACT

Survivin, an inhibitor of apoptosis protein, is minimally expressed in normal adult tissues but overexpressed in multiple cancers. This study investigates survivin expression alongside autophagy markers ATG7 and LC3B in seven solid tumor types in Indian patient samples. Immunohistochemical analysis was performed on 48 cancer tissue samples (breast n = 7, buccal n = 6, cervical n = 5, colon n = 8, renal n = 6, liver n = 10, thyroid n = 6) and adjacent normal tissues (n = 9) using anti-human antibodies against survivin, ATG7, and LC3B. Expression levels were semi-quantitatively scored (0-3 +) and statistically analyzed. Survivin demonstrated significant overexpression in cancer tissues compared to normal tissues across all tumor types (p ≤ 0.05-0.0001). Moreover, a statistically significant inverse correlation was observed between survivin and autophagy marker (ATG7/LC3B) expression in 85% of examined samples. Breast, buccal, liver, and kidney cancers showed strong-to-moderate survivin expression in > 50% of cases, while thyroid cancers exhibited predominantly weak survivin expression with strong autophagy marker expression. These findings demonstrate consistent survivin overexpression with concomitant autophagy suppression in Indian cancer patients. The inverse relationship between survivin and autophagy marker expression suggests survivin inhibition as a potential therapeutic strategy to activate autophagic cell death, particularly in breast, buccal, liver, and kidney cancers with high survivin expression. Future large-scale validation studies and mechanistic investigations are warranted to translate these findings into personalized survivin-targeted therapeutic strategies. This study contributes to a better understanding of survivin and its relation to autophagy in various solid tumors, paving the way for novel therapeutics for cancer.

PMID:40921963 | DOI:10.1007/s10735-025-10513-4

Obes Surg. 2025 Sep 8. doi: 10.1007/s11695-025-08222-8. Online ahead of print.

ABSTRACT

BACKGROUND: Bariatric surgery pre-operative workup mandates many multidisciplinary visits demanding patient’s commitment in time and travel. Due to the COVID pandemic, our bariatric clinic transitioned to a telemedicine model. The objective of this work is to determine the impact of this shift.

METHODS: Our population is adults who underwent gastric bypass or sleeve gastrectomy at a single hospital between 2018 and 2022. We analyzed the impact of telemedicine on demographics, days from consultation to surgery, length of hospital stay, type of procedures, BMI, and complications. Statistical analyses were conducted using χ² tests for categorical variables and t-test for continuous variables as well as logistic regression.

RESULTS: Of 794 patients, 71.3% received in-person care while 28.7% received telemedicine. There were no differences in race, ethnicity, or gender. The average duration from consultation to surgery was longer (p < 0.001) for in-person (551.1 days) compared to telemedicine (375.8 days). The pre-operative BMI was higher for the in-person cohort versus telemedicine (45.5; SD 8.0 vs. 43.9; SD 6.7; p < 0.001), but there was no difference in percent weight loss at 12 months. The average length of stay was longer in the in-person group compared to telemedicine (1.9 vs 1.2 days). There was no difference in readmission or emergency department visit rates.

CONCLUSION: Despite being the best treatment for severe obesity, bariatric surgery remains underutilized. When comparing telemedicine to an in-person model, we found shorter time to surgery, shorter length of stay, and similar outcomes with no difference in weight loss or complications. Telemedicine may be a safe and useful way to improve access.

PMID:40921958 | DOI:10.1007/s11695-025-08222-8

Obes Surg. 2025 Sep 8. doi: 10.1007/s11695-025-08228-2. Online ahead of print.

ABSTRACT

BACKGROUND: Metabolic bariatric surgery (MBS) is the most effective obesity treatment. The increasing number of MBS among young patients has led to more post-bariatric pregnancies. Our study investigates how breastfeeding duration impacts postpartum weight retention and health outcomes for mothers and babies after MBS.

METHODS: MOMBARIS (Maternal Outcomes of Bariatric Surgery and Pregnancy Study) is a multicentre study. The population is derived from MOMBARIS 2, which focused on obstetric outcomes. It included patients who became pregnant following MBS, analysing pre-operative metrics, type of surgery, pregnancy details, and breastfeeding duration. Data analysis was conducted using Julius.ai.

RESULTS: We analysed 156 patients post-MBS, with 148 pregnancies leading to childbirth. Among them, 131 had laparoscopic sleeve gastrectomy (LSG), 12 underwent Roux-en-Y gastric bypass (RYGB), and 5 had one anastomosis gastric bypass (OAGB). The mean age was 31.7 ± 5.45 years (range 19-48) with a pre-operative BMI of 43.9 kg/m² ± 5.8 kg/m² (range 31.9-68.8). The mean %EWL was 72% (± 28.6). Seventeen patients had multiple children. Breastfeeding results indicated that 116 patients (78.4%) initiated breastfeeding, with 40.5% continuing beyond 6 months. No significant differences were found in BMI metrics across breastfeeding groups.

CONCLUSIONS: Bariatric outcomes (%EWL, %TWL) show no statistical difference based on breastfeeding patterns, nor does breastfeeding significantly affect weight loss maintenance post-surgery. Additionally, delaying pregnancy after surgery does not guarantee more significant weight loss.

PMID:40921955 | DOI:10.1007/s11695-025-08228-2