Tag: nevin manimala

Cureus. 2025 May 10;17(5):e83868. doi: 10.7759/cureus.83868. eCollection 2025 May.

ABSTRACT

Objective The objective of this study is to compare titanium elastic nailing (TEN) to hip spica casting (HSC) in the treatment of paediatric femoral shaft fractures, focusing on hospital stay duration and time to initiation of weight bearing. Study design This was a quasi-experimental study conducted at the Department of Orthopaedic Surgery, Benazir Bhutto Hospital, Rawalpindi, over a six-month period. Duration and place of study The data for this study were collected at the Department of Orthopaedic Surgery, Benazir Bhutto Hospital, a major tertiary care and trauma referral centre, over a six-month period from 8 August 2018 to 8 February 2019. Patients and methods A total of 60 children aged 6-12 years with femoral shaft fractures were enrolled using consecutive sampling and divided into two groups based on the treatment provided by the consultant orthopaedic surgeon. Group A (n=30) received titanium elastic nailing, while Group B (n=30) underwent early hip spica casting after initial skin traction. Follow-ups were conducted at two, four, six, eight and 12 weeks to evaluate hospital stay, time to weight bearing and bone healing. Clinical assessment included the range of motion and pain evaluation to guide weight bearing. Data were analysed using SPSS version 22 (IBM Corp., Armonk, NY); means and standard deviations were calculated for quantitative variables, and independent t-tests were used for group comparisons. Stratification was done for age, gender and fracture side, with a p-value of <0.05 considered statistically significant. Results In Group A (TEN group), the mean duration of hospital stay was 3.93±0.78 days, compared to 3.03±1.03 days in Group B (HSC group) (p<0.05). The time to start weight bearing was 30.57±6.81 days in Group A and 59.5±14.03 days in Group B (p<0.05). In the TEN group, surgery was typically performed within 48-72 hours of injury, depending on patient stabilisation and operating room availability. In the HSC group, hip spica casting was applied within 72 hours of injury following initial skin traction. Weight-bearing decisions in both groups were based on a combination of clinical evaluation, including the absence of pain on movement and the restoration of joint mobility, and the radiological evidence of bone healing, defined as callus formation on at least three out of four cortices on anteroposterior (AP) and lateral radiographs. Conclusion This study observed that titanium elastic nailing was associated with the earlier initiation of weight bearing compared to hip spica casting in children aged 6-12 years with femoral shaft fractures. As hip spica casting is more commonly recommended for younger children under five years of age, our findings suggest that titanium elastic nailing may be a more suitable option in older paediatric patients, particularly in settings where surgical infrastructure is available. While TEN demonstrated potential advantages in terms of earlier functional recovery, it is important to interpret these findings within the context of the study’s focus on time to weight bearing and hospital stay.

PMID:40497210 | PMC:PMC12149466 | DOI:10.7759/cureus.83868

Cureus. 2025 May 11;17(5):e83898. doi: 10.7759/cureus.83898. eCollection 2025 May.

ABSTRACT

OBJECTIVE: The HEART pathway is a widely used clinical decision-making tool to risk-stratify patients presenting with chest pain in the emergency department (ED). A HEART score of 0-3 is generally accepted as “low risk,” often serving as a threshold for safe discharge. This study aimed to evaluate the performance of the HEART pathway in an urban academic ED and determine the associated rate of major adverse cardiac events (MACE) at a HEART score of 3. MACE were defined as all-cause mortality, cardiovascular death, myocardial infarction, heart failure hospitalization, or stroke within 90 days.

METHODS: We conducted a retrospective chart review of 1,284 ED visits for chest pain from September 1, 2017, to August 31, 2018, at Louisiana State University Health Shreveport (LSUHS), Shreveport, Louisiana. HEART scores, demographics, and 90-day MACE outcomes were collected and analyzed using non-parametric statistical methods.

RESULTS: Of 1,284 patients, 79 (6.2%) experienced MACE. Among patients with a HEART score of 3 or less, the MACE rate was 4.4% using Wilcoxon’s rank-sum test (p < 0.001). The HEART score showed a positive correlation with MACE using Spearman’s rank correlation coefficient (ρ = 0.223, p < 0.001). Age correlated moderately with the HEART score (ρ = 0.568), but not with MACE. Gender showed no significant correlation with either HEART score or MACE outcomes.

CONCLUSION: A HEART score of 3 was associated with a MACE rate higher than the traditionally accepted 2% threshold for low risk. Clinicians should approach disposition decisions for these patients with caution and consider shared decision-making and observation. Further research is needed to refine HEART score interpretation at this critical threshold.

PMID:40497209 | PMC:PMC12151265 | DOI:10.7759/cureus.83898

Cureus. 2025 May 11;17(5):e83901. doi: 10.7759/cureus.83901. eCollection 2025 May.

ABSTRACT

Introduction Virtual fracture clinics (VFCs) were established to improve the efficiency of orthopedic care by reducing unnecessary face-to-face consultations, decreasing waiting times, and providing timely specialist advice. This study aims to evaluate the utilization of the VFC at Addenbrooke’s Hospital, Cambridge University Hospital NHS Foundation Trust (Cambridge, GBR), over 12 months and assess its effectiveness in managing patients referred from emergency departments and minor injury units. Methods This retrospective study included all patients referred to the VFC between January 2023 and January 2024. Data were collected from hospital electronic records and analyzed using SPSS Statistics version 20.0 (IBM Corp., Armonk, NY, USA). Patients were assessed by a consultant orthopaedic surgeon based on referral details and imaging findings. Clinical outcomes were documented as face-to-face consultation, discharge with patient-initiated follow-up (PIFU), or referral to subspecialty clinics. Results A total of 5,034 patients were reviewed by the VFC. The most common injuries involved the wrist, hand, foot, ankle, shoulder, and knee. Of the total patients, 62% were discharged with PIFU, while 30.4% required face-to-face consultation. Among patients initially discharged with PIFU, 16.9% were subsequently rebooked into subspecialty clinics for further evaluation. Statistical analysis demonstrated a significant association between injury type and VFC outcome, indicating a moderate effect size. Conclusions The VFC model effectively managed a substantial proportion of patients referred from emergency departments and minor injury units, providing safe and efficient care while reducing the burden on traditional fracture clinics.

PMID:40497207 | PMC:PMC12151311 | DOI:10.7759/cureus.83901

World J Surg. 2025 Jun 10. doi: 10.1002/wjs.12657. Online ahead of print.

ABSTRACT

BACKGROUND: Surgical site infections (SSI) are common complications in emergency general surgery (EGS), contributing to morbidity, prolonged hospitalization, and excessive healthcare costs. Bundled care interventions have been shown to reduce SSI rates in elective procedures, but evidence for their effectiveness in EGS remains limited. This study aimed to evaluate the impact of a multifaceted SSI prevention bundle on SSI rates in patients undergoing open EGS.

METHODS: After IRB a prospective before-and-after study at a tertiary referral center between November 2020 and February 2023 was conducted. Consecutive adult patients undergoing open abdominal EGS operations were included. The pre-bundle group received standard care, whereas the intervention group was managed with an 11-point SSI prevention bundle. Centers for Disease Control and Prevention definitions of SSI were used. A doubly robust approach with inverse probability weighting and multivariable regression was deployed to adjust for confounders.

RESULTS: A total of 343 cases were included: 226 in the pre-bundle group and 117 in the bundle group. Adjusted analysis showed statistically significant risk reductions at 48%, 68%, and 55% for superficial, deep, and intra-abdominal infections, respectively. The bundle group had a significantly shorter median length of stay (8 vs. 13 days, p = 0.010), despite a longer operative time. No differences were observed in the Clavien-Dindo grade of the SSI or the proportion of SSIs presenting post-discharge.

CONCLUSIONS: Implementation of the SSI prevention bundle significantly reduced infection rates and length of hospital stay in patients undergoing EGS. These findings support the adoption of bundled strategies in emergency surgical care.

PMID:40495267 | DOI:10.1002/wjs.12657

Syst Rev. 2025 Jun 10;14(1):127. doi: 10.1186/s13643-025-02870-8.

ABSTRACT

OBJECTIVES: The aim of this study was to assess the reporting quality of rapid reviews (RRs) against the Cochrane Rapid Reviews Methodological Guidance to identify areas for improvement.

METHODS: A literature quality assessment was conducted through systematic searches in PubMed, the Cochrane Library, and Web of Science until February 28, 2023. An expert guided the search strategy, and the reporting quality of RRs was evaluated. Descriptive statistics were used to summarize reporting quality, and subgroup analyses were performed to examine differences between groups. Categorical variables were compared using the chi-square (χ²) test to identify statistically significant differences in reporting adherence across different subgroups.

RESULTS: Among the 112 rapid reviews analyzed, fewer than 50% fully reported four key methodological components: topic refinement with stakeholders, eligibility criteria co-definition, risk of bias assessment tools, and protocol/software reporting. Reports published after 2021 demonstrated slightly higher overall quality compared to those published before 2020, with significant improvements in protocol development (Item 2: χ² = 10.434, P < 0.0001), PICOS specification (Item 3: χ² = 5.378, P = 0.02), and protocol registration (Item 23: χ² = 6.638, P = 0.01). Cochrane Rapid Reviews (CRRs) achieved 100% compliance in several key areas, including setting restrictions with justification (Item 4: χ² = 52.923, P < 0.001) and study selection (Item 14: χ² = 14.897, P < 0.001). The impact of journal prestige was also evident: publications in high-impact factor (IF > 5) journals showed significantly better compliance in stakeholder involvement (Item 1: χ² = 8.856, P = 0.003) but comparable adherence to protocol registration (Item 23: ≤ 20.3%).

CONCLUSIONS: While RR quality is improving post-2021, critical gaps persist in stakeholder engagement and protocol transparency. Mandatory adoption of Cochrane guidelines-particularly protocol registration (Item23) and dual data extraction (Item17)-should be prioritized in journal submission policies.

PMID:40495249 | DOI:10.1186/s13643-025-02870-8

BMC Psychol. 2025 Jun 10;13(1):625. doi: 10.1186/s40359-025-02802-0.

ABSTRACT

BACKGROUND: Facial attractiveness is a relevant feature in many societies, and self-perceived attraction has been shown to affect a wide range of aspects in human lives, including quality of life. The present study assessed the mediating effects of behavioral determinants on self-reported dental and facial esthetics in an academic population.

METHODS: A cross-sectional observational study on 1,232 students from Universidad Cooperativa de Colombia, Pasto, Colombia was conducted. Socio-demographic variables such as age, sex, residency, place of birth, living zone, socioeconomic status, and type of faculty (Dentistry, Medicine, Nursing, Engineering and Law) were included. Moreover, clinical characteristics related to oral rehabilitations of anterior teeth (composites and crowns) were recorded. Behavioral determinants such as self-esteem, self-compassion, social achievements, and social anxiety were evaluated through Rosenberg’s Self-Esteem Scale (RSE), Self-compassion Scale (SCS), Social Achievement Goal Scale (SAG) and Social Anxiety Questionnaire for Adults (SAQ-A30). The Orofacial Esthetic Scale (OES) was employed to determine self-rated dental and facial esthetics. A paper-and-pencil self-administered survey was utilized. Descriptive statistics (frequencies, means and standard deviations) were calculated to determine the levels of personal factors. Structural Equation Modeling (SEM) was performed with robust unweighted least squares estimation method to assess the mediating effects of the behavioral variables on dental and facial esthetics. Analyses were conducted using SPSS 28.0 and EQS 6.2 statistical package. Statistical significance was set at P < 0.05.

RESULTS: The sample comprised 496 (40.3%) males and 736 (59.7%) females. 1,068 (86.7%) participants were 18-25 years old, and 164 (13.3%) > 25 years old. The mean and standard deviations (SD) of scales were: RSE = 24.24, SD ± 1.91; SCS = 3.16, SD ± 0.54; SAG = 32.55, SD ± 7.97; SAQ-A30 = 74.61, SD ± 21.33; and OES = 58.12, SD ± 13.12. SEM found self-compassion (β = 0.38, P = 0.03), social goals achievement (β = 0.34, P = 0.02) and self-esteem (β = 0.25, P = 0.02) had moderate and direct effects on dental and facial esthetics, while social anxiety (β = -0.19, P = 0.02) displayed a moderate indirect effect.

CONCLUSIONS: Behavioral factors predicted dental and facial esthetics self-perception in college students. Clinicians and educators should be aware of the identified effects which may, in turn, affect overall quality of life of patients and students.

PMID:40495247 | DOI:10.1186/s40359-025-02802-0

Arch Public Health. 2025 Jun 10;83(1):147. doi: 10.1186/s13690-025-01621-4.

ABSTRACT

BACKGROUND: The numerous benefits of adult participation in sports are widely acknowledged. However, the sports participation (SP) rate among Chinese adults remains low. Moreover, the correlates of SP across countries may differ significantly compared to the existing literature. In addition, as a form of health behavior, SP is shaped by multiple factors at both individual and environmental levels, as outlined by the ecological model. This study systematically incorporates variables across these levels to explore the multidimensional correlates of SP among Chinese adults.

METHODS: This study utilized data from the 2021 China General Social Survey (CGSS), screening 1,613 valid samples. The dataset included the dependent variable-sport participation and 41 independent variables across seven dimensions ranging from the individual level to the environmental level. Data analysis was conducted using descriptive statistics, the univariate analysis, and hierarchical regression analysis.

RESULTS: In the final model, eight variables were significantly associated with sport participation. At the individual physiological level, age (p < 0.001) and health issues influence (p < 0.001) were strongly and independently associated with SP. At the individual psychological level, health perception for society (p < 0.001) was significantly associated with SP. At the individual socioeconomic level, education (p < 0.001) was a significant factor. At the individual lifestyle level, watching competitions (p < 0.001) and friend socializing (p < 0.001) were strongly associated with SP. At the family environment level, no variables were significantly associated with SP; however, the variable children (p = 0.078) warrants caution. At the community environment level, the variable suitable for sports (p = 0.001) was significantly associated with SP. At the social environment level, the type of settlement (p < 0.001) also showed a significant association. The remaining variables demonstrated no significant relationship with sport participation.

CONCLUSION: This study highlights the multilayered factors influencing SP among Chinese adults, confirming that this behavior is shaped by influences spanning individual to environmental levels. The findings align with, yet differ from, those of many existing studies on sport participation. Notably, the most novel findings relate to age, which differs significantly from the results reported in much of the existing literature.

PMID:40495242 | DOI:10.1186/s13690-025-01621-4

Syst Rev. 2025 Jun 10;14(1):126. doi: 10.1186/s13643-025-02837-9.

ABSTRACT

BACKGROUND: Post-abortion family planning (PAFP) refers to the use of modern contraceptive methods, preferably immediately following an abortion and within 48 h of the abortion, or before fertility returns. It is highly recommended to delay pregnancy for at least 6 months following an induced or spontaneous abortion to reduce the occurrence of adverse maternal and neonatal outcomes. In sub-Saharan Africa (SSA), there is a high burden of unsafe abortions and an unintended pregnancy rate. Additionally, there are inconsistent study findings that have been done to investigate the prevalence and determinant factors of post-abortion family planning use in the region.

METHODS: This systematic review followed standard methods and reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol for this study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with reference number CRD42024518297. The eligible publications were searched by PubMed, Research4Life, Scopus, EMBASE, and Google Scholar. The data were extracted using Microsoft Excel 2019 and analyzed using Stata software version 17. The methodological quality of the included studies was assessed using the Joanna Briggs Institute’s (JBI) Critical Appraisal Checklist. Publication bias was assessed by using the funnel plot and Egger’s test. A random-effects model was used to estimate the pooled prevalence of post-abortion family planning. The I² test was performed to assess the statistical heterogeneity among the included studies.

RESULTS: This systematic review and meta-analysis included 80 eligible articles from 16 sub-Saharan African countries, with a total of 248,299 study participants. The pooled prevalence of post-abortion family planning use in sub-Saharan Africa was 60.67% (95% CI 55.61-65.73). In addition, the commonly adopted contraception methods after abortion were injectables, 34.98% (95% CI 27.59, 42.37), followed by 20.71% (95% CI 17.20, 24.22) of oral contraception pills, and 20.38% (95% CI 16.82, 23.94) utilized implants. Women aged 15-24 years (AOR = 3.40, 95% CI 2.12, 5.44), being married (AOR = 2.70, 95% CI 1.68, 4.34), attaining secondary school (AOR = 2.75, 95% CI 1.62, 4.66) and college or above (AOR = 2.92, 95% CI 1.85, 4.62), unplanned pregnancy (AOR = 5.03, 95% CI 2.93, 8.61), having prior history of abortion (AOR = 1.88, 95% CI 1.35, 2.62), having good knowledge about family planning (AOR = 2.86, 95% CI 2.37, 3.46), prior family planning use (AOR = 3.82, 95% CI 2.62, 5.58), positive attitude towards family planning methods (AOR = 2.78, 95% CI 1.81, 4.28), partner support (AOR = 2.32, 95% CI 1.64, 3.30), and received post-abortion family planning counseling (AOR = 2.86, 95% CI 2.37, 3.46) were predictors that significantly associated with contraceptive utilization following abortion.

CONCLUSIONS: This meta-analysis indicates that the pooled prevalence of post-abortion contraception use in sub-Saharan Africa remains low. Therefore, appropriate planning and implementation of effective strategies are crucial to scaling up post-abortion family planning use, including improving educational attainment, advocating for post-abortion contraceptive methods, and providing effective post-abortion family planning counseling.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024518297.

PMID:40495240 | DOI:10.1186/s13643-025-02837-9

Int J Retina Vitreous. 2025 Jun 10;11(1):63. doi: 10.1186/s40942-025-00689-y.

ABSTRACT

PURPOSE: Congenital syphilis (CS) is associated with interstitial keratitis, chorioretinitis, uveitis, and optic atrophy mainly in inadequately treated patients. We conducted a retrospective cohort analysis evaluating ocular findings in children born in 2015 with CS treated with ceftriaxone at the time of delivery during the period of penicillin shortage in a city located at Northeast of Brazil and compared them with those adequately treated.

METHODS: 469 children were reported with CS at birth during the penicillin shortage period and 171 were actively searched and invited to an ophthalmological assessment and retrospective analysis of their information recorded in the medical records of the municipality’s health services.

RESULTS: A total of 68 children came to the assessment, median age 8 years of age (range 7-8 years), 48 were treated with penicillin (70.5%) and 20 with ceftriaxone (29.5%). There were no significant differences in demographic or perinatal characteristics between the groups. The majority of children had a completely normal ophthalmological examination (67.6%). Regarding findings that are more associated with CS, one child in ceftriaxone group (5.0%) had optic atrophy in one eye and one in the penicillin group (2.9%) had glaucomatous optic disc changes. No interstitial keratitis was found. There was no significant association between the child’s treatment and the prevalence of ophthalmologic findings (p = 0.663). There was also no association between the medication and a current reactive VDRL (p = 1.000).

CONCLUSION: After an 8-year follow-up, no statistically significant difference was observed in the incidence of ophthalmologic manifestations among individuals treated for CS with either penicillin or ceftriaxone. These findings suggest that ceftriaxone may serve as an effective alternative for the prevention of CS and its associated ocular complications.

PMID:40495236 | DOI:10.1186/s40942-025-00689-y

Acta Neuropathol Commun. 2025 Jun 10;13(1):128. doi: 10.1186/s40478-025-02042-8.

ABSTRACT

Alzheimer’s disease (AD) is classically defined by central hallmarks such as amyloid-beta plaques, tau hyperphosphorylation, and synaptic failure. However, mounting evidence suggests that dysfunction outside the brain, particularly in the peripheral nervous system, may also play a significant role in disease progression. The adrenal medulla-a key regulator of systemic neurotransmission and stress response-has received little attention in this context. In this study, we investigated whether chromaffin cells (CCs) from the triple transgenic AD mouse model (3xTg) exhibit functional alterations that could contribute to peripheral neurochemical imbalance. Using electrophysiology, high-resolution amperometry, and neurotransmitter quantification, we identified early and progressive defects in CC function. Remarkably, even at two months of age-prior to cognitive decline-3xTg CCs showed impaired exocytosis, reduced vesicle release, and slower fusion pore kinetics. These changes were accompanied by diminished sodium (I_Na), calcium (I_Ca), and nicotinic (I_ACh) currents, compromising CC excitability. With age, a shift toward increased potassium (I_K) currents and enhanced catecholamine secretion may reflect compensatory adaptations aimed at preserving output. These functional deficits were paralleled by structural remodeling of the actin cytoskeleton and systemic neurotransmitter disturbances. Noradrenaline levels increased in both plasma and brain, while dopamine decreased peripherally but paradoxically increased in the prefrontal cortex and hippocampus. Serotonin levels consistently declined across compartments. These imbalances correlated with altered behavior: 3xTg mice displayed increased exploration of exposed areas and heightened behavioral despair, pointing to anxiety- and depression-like phenotypes. Together, our findings identify the adrenal medulla as a previously underrecognized site of early catecholaminergic dysregulation in AD. The observed associations between peripheral CC dysfunction, systemic neurotransmitter imbalance, and behavioral changes point to a potential link between peripheral neuroendocrine alterations and central disease features. These results broaden the current understanding of AD pathophysiology and support the adrenal medulla as a promising candidate for further investigation as a therapeutic target and source of peripheral biomarkers.

PMID:40495232 | DOI:10.1186/s40478-025-02042-8