Tag: pubmed

Ulus Travma Acil Cerrahi Derg. 2025 Nov;31(11):1130-1136. doi: 10.14744/tjtes.2025.64744.

ABSTRACT

BACKGRUND: Acute appendicitis is an important clinical condition that usually occurs as a result of obstruction of the appendix lumen due to fecaloma or reactive lymphoid hyperplasia. However, rarely, various nonspecific and unusual pathologies can cause acute appendicitis or mimic this clinical condition. The aim of this study was to present patients who underwent surgery with a preliminary diagnosis of acute appendicitis and to determine the incidence of incidentally diagnosed nonspecific and unusual pathologies found during histopathological examination of the specimens.

METHODS: Data from 2633 patients who underwent appendectomy with a preliminary diagnosis of acute appendicitis in our clinic between January 2014 and June 2023 were retrospectively analyzed. Patients who underwent elective appendectomy in addition to other intra-abdominal operations were excluded. Specimens with unusual diagnoses were re-evaluated histopathologically. The data were analyzed statistically.

RESULTS: A total of 2633 patients were included in the study, 1617 (61.4%) male and 1016 (38.6%) female. The mean age was 11.32+-3.66 (range: 1-18) years. All patients underwent the standard appendectomy procedure. After histopathological examination, the specimens were detected to show inflamed appendicitis in 2150 cases (81.65%), perforated appendicitis in 162 cases (6.15%), fibrous obliteration in 104 cases (3.94%) and unusual histopathological findings in 57 cases (2.16%). Of the patients with unusual histopathological findings, 40 were female and 17 were male. Enterobius vermicularis was detected in 41 patients (1.55%), appendicular carcinoid tumor in 10 patients (0.4%) and serous appendicitis in 6 patients (0.2%). Microscopic findings of acute appendicitis were not observed in 35 of these patients.

CONCLUSION: Nonspecific and unusual histopathological findings are more common in childhood appendectomy specimens than in those from adults. Careful histopathological evaluation of appendix specimens will allow early diagnosis and treatment of these rarely seen pathologies.

PMID:41392845 | DOI:10.14744/tjtes.2025.64744

Ulus Travma Acil Cerrahi Derg. 2025 Nov;31(11):1102-1108. doi: 10.14744/tjtes.2025.60464.

ABSTRACT

BACKGROUND: This study aimed to investigate the effects of the minimally invasive direct lateral approach, performed using standard hip surgery instruments, on operation duration, early postoperative pain, postoperative blood loss, and hospital stay in the treatment of femoral neck fractures with hemiarthroplasty (HA), compared with the standard Hardinge direct lateral approach (referred to in this study as the conventional group, CG).

METHODS: We retrospectively collected clinical data from the medical records of our hospital. Inclusion criteria were a diagnosis of femoral neck fracture resulting from low-energy trauma and treatment with HA surgery. Patients were divided into two groups based on the surgical approach: the conventional group (CG) and the mini-incision group (MG). Twenty-four patients comprised the MG (case group), while 18 patients were in the CG (control group). The average wait time for surgery was 3.8 days for the MG and 3.6 days for the CG. Statistical analyses were conducted to evaluate differences in postoperative pain scores, hospital stay, postoperative blood transfusion, operation duration, hemoglobin, and hematocrit levels between the groups.

RESULTS: There was no significant difference in age or gender distribution between the case and control groups (p>0.05). The average age of the mini-incision group was 83.8 years, while the average age of the CG was 86.9 years. In both groups, the fracture types were equally distributed between Garden type III and IV. However, the visual analog scale (VAS) scores on the first and third postoperative days were significantly lower in the case group than in the CG (p<0.05). Patients in the MG required significantly fewer postoperative blood transfusions compared to the control group. Hospitalization duration, as well as hemoglobin and hematocrit levels both preoperatively and at discharge, were comparable between the groups.

CONCLUSION: The data from this study indicate that the mini-incision technique is an effective and reliable method for treating femoral neck fractures. Compared with the conventional group, the minimally invasive direct lateral approach for femoral neck fractures significantly reduces early postoperative pain, results in less blood loss, offers better cosmetic outcomes, and maintains a similar length of hospital stay. Clinical studies with larger sample sizes and assessments of long-term postoperative outcomes are necessary.

PMID:41392844 | DOI:10.14744/tjtes.2025.60464

Ulus Travma Acil Cerrahi Derg. 2025 Nov;31(11):1095-1101. doi: 10.14744/tjtes.2025.58436.

ABSTRACT

BACKGROUND: This study aimed to compare the long-term continence outcomes of patients who underwent surgical repair for obstetric anal sphincter injuries (OASIS) and non-OASIS, based on the Jorge Wexner score. Additionally, predictive factors associated with complete continence restoration versus persistent fecal incontinence were analyzed.

METHODS: A retrospective analysis was conducted on 13 patients treated surgically for anal sphincter injuries at Erciyes University Faculty of Medicine between 2016 and 2019, with a minimum follow-up duration of five years. Patients were categorized into obstetric (n=8) and non-obstetric (n=5) groups. Functional outcomes were assessed using the Jorge Wexner score at 6 months, 1 year, and 5 years postoperatively. Continuous variables were analyzed using the Mann-Whitney U test, categorical variables with Fisher’s exact test, longitudinal changes with the Friedman test, and potential predictors of full continence were assessed via binary logistic regression.

RESULTS: The non-OASIS group exhibited significantly higher mean age (p=0.045) and longer hospital stays (p=0.006) compared to the obstetric group. Perineal examination revealed more extensive tissue loss and contamination in non-OASIS cases, often requiring fecal diversion, whereas obstetric injuries were typically cleaner and linear in nature. Although higher Wexner scores were observed in the non-OASIS group at all time points, between-group differences were not statistically significant. Wexner scores varied significantly over time within the non-OASIS group (p=0.014) but not within the obstetric group (p=0.257). No individual factor showed a significant association with complete continence restoration. The logistic regression model was statistically significant overall (p=0.027), though none of the independent predictors reached significance.

CONCLUSION: Compared with obstetric injuries, non-OASIS cases tend to involve a more prolonged recovery course and longer hospitalization. These findings suggest a more complex clinical trajectory in non-OASIS patients.

PMID:41392843 | DOI:10.14744/tjtes.2025.58436

Ulus Travma Acil Cerrahi Derg. 2025 Nov;31(11):1109-1118. doi: 10.14744/tjtes.2025.52643.

ABSTRACT

BACKGROUND: Hemorrhagic shock is a leading cause of preventable trauma deaths, particularly within the first hours following injury. Early identification of patients requiring massive transfusion or with high mortality risk is critical to optimizing trauma management. Early identification of massive transfusion needs supports timely blood product preparation. Likewise, predicting mortality risk early can influence therapeutic planning and clinical decisions. Numerous trauma and transfusion scoring systems have been developed to guide such early decisions; however, their comparative predictive performance remains unclear. This study aimed to evaluate the effectiveness of trauma and transfusion scoring systems in predicting massive transfusion requirements and in-hospital mortality within the first four hours of trauma.

METHODS: This retrospective study included 117 trauma patients who received at least one unit of red blood cell transfusion within the first four hours of admission to a tertiary care center between 2018 and 2022. Data on demographics, trauma mechanism, clinical and laboratory findings were collected. Each patient was evaluated using 16 trauma and transfusion scoring systems. Patients were categorized based on the need for massive transfusion, defined as receiving ≥5 units of blood products within four hours. Receiver Operating Characteristic (ROC) analysis was used to assess the performance of each scoring system, and optimal cut-off values were determined using the Youden Index.

RESULTS: Massive transfusion was required in 23 patients (19.7%), with firearm injuries being the most common mechanism among these cases. All 16 scoring systems significantly differentiated patients with and without massive transfusion. The Shock Index demonstrated the highest predictive accuracy for massive transfusion (area under the curve [AUC]=0.911). For in-hospital mortality, all scoring systems except the Schreiber Score showed significant predictive ability. The Trauma Related Injury Severity Score (TRISS) achieved the highest predictive value for mortality (AUC=0.975). Several scoring systems required revised threshold values for optimal performance in this cohort, highlighting the need for population-specific calibration.

CONCLUSION: Early-phase application of trauma and transfusion scoring systems provides valuable insights for predicting clinical outcomes in trauma patients. Among the systems analyzed, the Shock Index was the most reliable predictor of massive transfusion. Separately, TRISS demonstrated superior accuracy in forecasting in-hospital mortality. These findings emphasize the importance of rapid, score-based assessment in early trauma care and support further validation of scoring systems across diverse patient populations.

PMID:41392841 | DOI:10.14744/tjtes.2025.52643

Ulus Travma Acil Cerrahi Derg. 2025 Nov;31(11):1075-1081. doi: 10.14744/tjtes.2025.03388.

ABSTRACT

BACKGROUND: Pediatric femoral neck fractures (PFNFs) are rare but are associated with high complication rates due to the precarious vascularity of the femoral head. Cannulated screw fixation (CSF) is the most common surgical technique, though optimal strategies remain debated. The objective of this study was to evaluate the radiological and functional outcomes of proximal femoral neck fractures (PFNFs) treated with CSF and to identify predictors of postoperative complications.

METHODS: The retrospective study was performed of 28 patients (mean age 12.4 years; range 5-18) treated with CSF between June 2020 and December 2024. Fractures were classified using the Delbet-Colonna and Garden systems. Reduction quality was assessed radiographically, and functional outcomes were measured by the Harris Hip Score (HHS). Statistical analyses included univariate and multivariate logistic regression.

RESULTS: Radiographic union was achieved in 92.9% of patients. The overall complication rate was 42.9%, including coxa vara (17.8%), avascular necrosis (AVN, 14.3%), premature physeal closure (PPC, 10.7%), and non-union (7.1%). Patients with AVN (mean HHS 72.5) and non-union (mean HHS 70.0) had the lowest functional scores, while those with coxa vara (82.0) and PPC (85.0) maintained relatively better function. Patients without complications achieved the best outcomes (mean HHS 88.5). Multivariate analysis identified higher Garden grade (OR 4.1, p=0.038) and non-anatomical reduction (OR 3.75, p=0.046) as independent predictors. PPC was significantly associated with implant removal (p=0.003). Despite the small sample, a post-hoc power analysis based on HHS indicated approximately 85% power to detect large effects.

CONCLUSION: PFNFs remain a challenging pediatric injury with high complication rates despite surgical fixation. Precise anatomic alignment is essential to minimize complications, particularly AVN and coxa vara. Close monitoring is recommended for patients with PPC, as it may necessitate implant removal and carries a risk of hip deformity or leg length discrepancy. Larger prospective studies are needed to refine surgical strategies for this rare but clinically significant injury.

PMID:41392836 | DOI:10.14744/tjtes.2025.03388

Riv Psichiatr. 2025 Oct-Dec;60(6):270-278. doi: 10.1708/4617.46260.

ABSTRACT

BACKGROUND: Mental pain (psychache) is a key risk factor for suicide, surpassing traditional constructs like depression and anxiety. While its correlation with suicidal ideation is well-established, few studies have evaluated its predictive value for actual suicide attempts in clinical populations. This study aimed to evaluate whether mental pain predicts short-term suicide attempts in a clinical sample, and to assess its potential role as a screening tool in suicide prevention.

METHODS: A longitudinal study on 179 psychiatric outpatients recruited at the University Hospital of Varese between 2020 and 2022. At baseline, participants completed the Psychache Scale (PAS), Beck Hopelessness Scale (BHS), Beck Depression Inventory-II (BDI-II), and Columbia Suicide Severity Scale (C-SSRS), among others. Sociodemographic, clinical, and laboratory data were also collected. Suicide attempts were tracked over a 12-month follow-up. Binary logistic regression was used to identify predictors of suicide attempts.

RESULTS: Twenty-six patients attempted suicide during follow-up, with 24 cases occurring within the first 6 months. Higher scores on the PAS, BHS, BDI-II, and Columbia Severity Rating Scale (C-SSRS) were significantly associated with increased suicide risk. In logistic regression, the PAS emerged as an independent predictor: each point increase corresponded to a 3.8% rise in suicide attempt probability (p=0.015). The BDI-II showed the strongest model fit (R2=0.169). Unemployment and history of substance abuse were also significantly associated with increased risk. No significant associations were found with routine laboratory parameters.

CONCLUSIONS: The PAS, alongside the BDI-II, BHS, and C-SSRS scales may serve as an effective tool for early suicide risk detection, especially in psychiatric and primary care settings. Mental pain appears to be a relevant short-term risk indicator, highlighting the need for targeted screening and prevention strategies. Further research should explore its application in general healthcare to enhance suicide prevention efforts.

PMID:41392811 | DOI:10.1708/4617.46260

Riv Psichiatr. 2025 Oct-Dec;60(6):232-252. doi: 10.1708/4617.46258.

ABSTRACT

The objective of this review is to examine the recent literature on intimate partner violence (IPV) and witnessing domestic violence (WDV) with a view to providing definitions, prevalence data for Italy and other countries, and for special populations (such as patients with severe mental illness), investigations into risk factors (alcohol, substances, child abuse) and the consequences for general and mental health. In addition to a free search with Google, Medline was interrogated, using PubMed and PsycInfo for both topics. A total of 757 publications were extracted from PubMed and 338 from PsycInfo for IPV and mental disorders, while 334 publications were found in PubMed and 205 in PsycInfo for WDV; updated epidemiological data was obtained from Italian websites (e.g. ISTAT, Office for National Statistics). We concluded that given the increasing incidence of domestic violence, health and academic institutions should frame the phenomenon in epidemiological and clinical terms, providing updated research data to the stakeholders in order to improve treatment and prevention practices.

PMID:41392809 | DOI:10.1708/4617.46258

Am J Hum Biol. 2025 Dec;37(12):e70177. doi: 10.1002/ajhb.70177.

ABSTRACT

BACKGROUND: Across generations, girls’ early marriage recurs in high-risk groups; however there is poor understanding of how behavior and biology interact in this context. We hypothesized an intergenerational cycle of risk, linking early marriage, preterm birth, and school dropout, and evaluated evidence for specific components of this cycle in low-/middle-income countries.

METHODS: We conducted a systematized review, searching articles published from 2000 to 2025. We tested four hypotheses. H1: early marriage is associated with preterm birth; H2: preterm birth is associated with low educational attainment; H3: school dropout is associated with early marriage. Hypothesis-specific search terms and eligibility criteria were applied. We also tested hypothesis H4: preterm birth is associated with reduced cognitive function, by evaluating systematic reviews of research from any setting.

RESULTS: We identified 184 empirical articles for H1-H3, with 26 satisfying the criteria for full review, and 5 systematic reviews for H4. The available evidence supported H1 and H3, but was weak for H2. For H3, studies indicated contrasting directions of association. The systematic reviews demonstrated evidence supporting H4. The majority of empirical studies reviewed had a low risk of bias.

CONCLUSIONS: An intergenerational cycle of risk linking early marriage, preterm delivery and low educational attainment is plausible, involving both behavioral pathways (e.g., school dropout and early marriage) and biological mechanisms (e.g., preterm birth and cognitive function). Few studies have investigated the prospective associations of preterm birth with school outcomes, or school dropout with early marriage, in low- and middle-income countries.

PMID:41392805 | DOI:10.1002/ajhb.70177

BJPsych Open. 2025 Dec 15;12(1):e17. doi: 10.1192/bjo.2025.10931.

ABSTRACT

BACKGROUND: There is ample evidence that women do not progress in mental health publishing as quickly as men. The movement from first to last (senior) author is one indicator of progression.

AIMS: To understand whether there are changes in women’s authorship position following our academic institution’s introduction of support mechanisms to reduce the gender gap in career development.

METHOD: Data from publicly held databases in three cohorts (2016, 2018 and 2020) were assessed for gender and authorship position at the Institute of Psychiatry, Psychology and Neuroscience. Regression analyses included authorship gender and change over time in authorship roles, by school and topic.

RESULTS: We found substantial, statistically significant differences in gender between author roles (χ²(2) = 29.18, P < 0.0001), with women being mainly first authors (marginal mean 62.2:40.1%, respectively, odds ratio 2.463, 95% CI 1.807 to 3.357). The three schools differed (χ²(2) = 14.06, P < 0.001) and, although men were predominant as last authors in all topics in both 2016 and 2020, women did show a modest increase. The trend for an interaction between gender and first-author publications on the likelihood of last-author publications in 2018 (incidence rate ratio 1.839, 95% CI 0.914 to 3.698) had disappeared by 2020.

CONCLUSIONS: Although women were represented as first and corresponding authors, there was still a gender gap for last-author positions. Over time, women have increased their representation in many of the topic areas. The disappearance of any gender-moderating effect suggests that institutional policies may have had an effect, in addition to sector-wide changes.

PMID:41392762 | DOI:10.1192/bjo.2025.10931

BJPsych Open. 2025 Dec 15;12(1):e13. doi: 10.1192/bjo.2025.10925.

ABSTRACT

BACKGROUND: AVATAR therapy, a digitally supported intervention, utilises avatars to promote recovery in people who experience distressing auditory hallucinations. This approach was recently evaluated in a multicentre randomised controlled trial comparing brief (AV-BRF) and extended (AV-EXT) forms of therapy with treatment as usual (TAU). There was evidence for the effectiveness of therapy, particularly for AV-EXT. However, value for money needs to be assessed.

AIMS: To compare separately the cost utility of the brief and extended forms of AVATAR therapy with TAU.

METHOD: In a three-arm randomised controlled trial the use of health services was measured, and costs (2021/2022; pounds sterling) calculated from a health and social care perspective over a 28-week follow-up period. Quality-adjusted life years (QALYs; derived from the 5-level version of the EuroQol 5-Dimension questionnaire) were combined with costs.

RESULTS: AV-BRF resulted in extra costs of £319 (95% CI, -£1558 to £2496), and AV-EXT in lower costs of £1965 (95% CI, -£1912 to £1519), compared with TAU. Over the follow-up, AV-BRF resulted in 0.0159 (95% CI, -0.0103 to 0.0422) and AV-EXT in 0.0173 (95% CI, -0.0049 to 0.0395) more QALYs than TAU. The cost per QALY for AV-BRF compared with TAU was £20 016, while AV-EXT dominated TAU (lower costs and more QALYs).

CONCLUSIONS: Neither version of AVATAR had a substantial impact on QALYs. However, AV-EXT did result in reduced care costs – albeit not statistically significant – and was potentially cost-effective compared with TAU. AV-BRF had an incremental cost-effectiveness ratio that indicated lower potential cost-effectiveness. These findings are uncertain, but could still inform decision-making regarding interventions in this field.

PMID:41392761 | DOI:10.1192/bjo.2025.10925