Modified open anterior mesh repair Effective for Groin Hernias in Women in Low-Resource Settings: JAMA

Researchers have found in a new randomized clinical trial that modified open anterior mesh repair repair is a suitable option for groin hernia repair in women, especially in low-resource settings. Femoral hernias were highly prevalent, and exposing the femoral canal was crucial for their accurate detection. The study was published in JAMA Network by Alphonsus M. and colleagues.

The research was a two-arm, double-blind, randomized clinical trial between October 2019 and February 2023 in two public hospitals in Northern Uganda. The trial recruited 200 adult females aged 18 years or more, who all had a primary groin hernia and were of American Society of Anesthesiologists (ASA) class I or II. Informed consent was given by all the subjects. The women were randomized to receive either the routine OAM repair or the MOAM repair, the primary difference in the MOAM technique being opening of the transversalis fascia and closure of the femoral canal with a mesh flap.

There were 200 women who participated in the trial. The mean age was 52.7 years with a standard deviation of 14.0 years. Of the 200 women, 99 (49.5%) were randomly assigned to the OAM repair and 101 (50.5%) to the MOAM repair. It was interesting to observe that almost 45% of the participants (89 out of 200) had a femoral hernia. Surprisingly, 35 women (35.4%) assigned initially to the OAM group received the MOAM procedure instead because of intraoperative findings of femoral hernias necessitating femoral canal exposure.

Key Findings

  • At one-year follow-up, the total rate of recurrence for groin hernias among all participants was 5.6% (11 out of 195 patients).

  • In the control (OAM) group, 4 out of 97 participants (4.1%) had recurrence.

  • In the intervention (MOAM) group, 7 out of 98 participants (7.1%) had recurrence.

  • The absolute between-group difference in recurrence was −3.0 percentage points (95% confidence interval: −9.5 to 3.4), and this difference was not statistically significant (P = .36).

  • Notwithstanding this, the exposure of the femoral canal by MOAM permitted more sensitive detection and repair of femoral hernias, essential in female patients, in whom these hernias are more common.

This randomized clinical trial offers valuable evidence that modified open anterior mesh repair is a feasible and safe technique for the management of groin hernias among women in low-resource settings. The results justify the wider use of MOAM where laparoscopic surgery is unavailable, allowing women to be provided with complete and effective hernia repair.

Reference:

Matovu A, Nordin P, Wladis A, et al. Open Anterior Mesh Repair vs Modified Open Anterior Mesh Repair for Groin Hernia in Women: A Randomized Clinical Trial. JAMA Surg. Published online July 16, 2025. doi:10.1001/jamasurg.2025.2244

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Sildenafil Fails to Reduce Adverse Perinatal Outcomes Linked to Intrapartum Hypoxia: JAMA

Researchers have found in a new study that sildenafil citrate did not lower the incidence of adverse perinatal outcomes potentially associated with intrapartum hypoxia.

Sildenafil citrate may increase uteroplacental blood flow. Its ability to reduce perinatal complications related to fetal hypoxia during labor is uncertain. A study was doe to compare the effectiveness of intrapartum maternal oral sildenafil citrate vs placebo in improving perinatal outcomes potentially related to intrapartum hypoxia in term pregnancies. This pragmatic, multicenter, investigator-initiated, placebo-controlled randomized clinical trial including 3257 women was conducted in 13 Australian hospitals from September 6, 2021, to June 28, 2024. The last date of follow-up (28-day neonatal mortality) was July 26, 2024. Women aged 18 years or older with singleton or dichorionic twin pregnancies, planning vaginal birth at term by either spontaneous labor or induction of labor, were recruited. The primary composite outcome was intrapartum stillbirth, neonatal death, Apgar score less than 4 at 5 minutes (a score of <4 at 5 minutes is indicative of severe neonatal depression at birth, with scores ranging from 0 to 10), acidosis at birth (umbilical cord artery pH <7.0), hypoxic ischemic encephalopathy, neonatal seizures, neonatal respiratory support for greater than 4 hours, neonatal unit admission for greater than 48 hours, persistent pulmonary hypertension of the newborn, or meconium aspiration syndrome. Secondary outcomes were the individual components of the primary composite and emergency cesarean delivery or instrumental birth for intrapartum fetal distress. Results A total of 3257 women were randomized to sildenafil citrate (n = 1626 women and 1634 infants) or placebo (n = 1631 women and 1641 infants). Mean (SD) maternal age and gestation at randomization were similar in both groups (31.7 [5.1] vs 31.5 [5.0] years and 39.5 [1.2] vs 39.5 [1.1] weeks, respectively). A total of 868 participants (53.4%) vs 874 participants (53.6%) were of Australia/New Zealand ethnicity and 315 participants (19.4%) vs 311 participants (19.1%) were of European ethnicity. Most participants were nulliparous (944 of 1624 [58.1%; 2 missing values] vs 966 of 1630 [59.3%; 1 missing value]). Induction of labor occurred in 1353 of 1621 women (83.5%) in the sildenafil citrate group and 1348 of 1627 women (82.9%) in the placebo group. The primary outcome occurred in 83 of 1625 women (5.1%) in the sildenafil citrate group and 84 of 1625 (5.2%) in the placebo group (relative risk, 1.02; 95% CI, 0.75-1.37). Sildenafil citrate had no significant effect on emergency cesarean delivery or instrumental vaginal birth for fetal distress (relative risk, 1.12; 95% CI, 0.98-1.29) or on any of the individual components of the primary outcome. Subgroup analyses showed no evidence of heterogeneity of treatment effect. Sildenafil citrate did not result in a lower incidence of adverse perinatal outcomes potentially related to intrapartum hypoxia.

Reference:

Kumar S, Tarnow-Mordi W, Mol BW, et al. Intrapartum Sildenafil to Improve Perinatal Outcomes: A Randomized Clinical Trial. JAMA. 2025;334(2):149–159. doi:10.1001/jama.2025.7710

Keywords:

Sildenafil, Fails, Reduce, Adverse, Perinatal, Outcomes, Linked, Intrapartum, Hypoxia, JAMA, Kumar S, Tarnow-Mordi W, Mol BW

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Study finds olfactory impairment to increase the risk of cognitive decline

A new study published in the journal of International Forum of Allergy and Rhinology showed that the individuals with olfactory impairment (OI) had double the prevalence of cognitive decline (CD) when compared to people with normal olfactory perception.

Due to the fact that OI is a common symptom of COVID-19 and that many patients have ongoing symptoms, this previously disregarded sensory impairment has gained attention. Dementia and cognitive impairment are both crippling illnesses that can lower a patient’s and family’s quality of life and increase both individual and national healthcare costs. Thus, this study aimed to summarize the long-term relationship between OI and CD by synthesizing the existing evidence in a systematic review and meta-analysis.

Through August 9, 2024, Web of Science and Embase PubMed were searched for longitudinal studies that reported on self-reported and objectively evaluated OI in relation to CD using validated methodologies. Incident CD was the result of interest. Data extraction, bias assessment, and evidence strength grading were done by independent writers. Subgroup, sensitivity, and bias analyses were performed as part of a mixed-effects meta-analysis. OI-associated CD’s population-attributable fraction (PAF) was computed.

There were 37,783 participants and 48 papers in this research. When compared to people with normal olfaction, OI patients had a 2.06-fold higher risk of any CD (risk ratio [RR] = 2.06; 95% CI = 1.87‒2.26, I2 = 0%). In comparison to individuals with mild OI (RR = 1.51; 95% CI = 1.23‒1.85, I2 = 0%), those with severe OI had a greater risk of any CD (RR = 2.60; 95% CI = 2.12‒3.20, I2 = 0%).

Every 10% drop in olfactory score (RR = 1.18; 95% CI = 1.14‒1.22, I2 = 24%) and every point drop on the Sniffin’ Sticks Odor Identification Test (RR = 1.15; 95% CI = 1.11‒1.18, I2 = 0%) raised the probability of any CD by 18%. These findings held up well to additional examinations. The PAF of incident CDs linked to OI was 18%.

Overall, OI with higher category severity and deteriorating olfactory scores was linked to a higher risk of CD, according to a positive categorical and continuous dose-response association. Cognitive screening should be advised for individuals with chronic OI, and OI may be included as a component of early cognitive screening in high-risk patients.

Source:

Yeo, B. S. Y., Song, H. J. J. M. D., Tan, B. K. J., Suresh, A., Ho, O. T. W., Chan, J. H., Gao, E. Y., Tan, C. J.-W., Teo, C. B., Chen, C. L.-H., Tay, L., Lamoureux, E. L., Hummel, T., See, A., Xu, S., Toh, S. T., Charn, T. C., & Teo, N. W. Y. (2025). Olfactory impairment and incident cognitive decline: A systematic review and meta-analysis. International Forum of Allergy & Rhinology, e23635, e23635. https://doi.org/10.1002/alr.23635

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First Reported Case Links PreserFlo MicroShunt Surgery to RPE Tear and Serous Retinal Detachment

Japan: A recent case report published in BMC Ophthalmology by Ayako Sadahide and colleagues from the Department of Ophthalmology and Visual Science, Hiroshima University Hospital, Japan, documents the first known instance of serous retinal detachment (SRD) accompanied by a retinal pigment epithelium (RPE) tear following PreserFlo MicroShunt (PMS) surgery. The minimally invasive glaucoma device is designed to reduce intraocular pressure (IOP) with fewer complications than traditional filtration surgeries. However, this case highlights the need for careful postoperative monitoring, especially in patients with predisposing ocular and systemic factors.

The report describes a 53-year-old man with ocular hypertension and a history of cataract surgery with intraocular lens (IOL) fixation who underwent PMS due to uncontrolled IOP. The patient also had a history of atopic dermatitis and prolonged use of potent topical steroids, factors suspected to compromise choroidal microcirculation and RPE integrity.

Initially, the surgery appeared successful, lowering IOP from 42 mmHg to 10 mmHg on the first postoperative day. However, within days, the patient developed ciliochoroidal detachment (CD), a known complication of glaucoma surgery under hypotonic conditions. Despite conservative management with atropine and topical steroids, the condition progressed. By one month post-surgery, the patient’s vision dropped to 20/500, and bullous serous retinal detachment involving the macula was noted. Imaging revealed extensive RPE tears in the inferior regions of the retina.

To prevent further deterioration, surgeons performed scleral drainage and pars plana vitrectomy with sulfur hexafluoride (SF6) gas tamponade. The procedure successfully elevated IOP and led to the resolution of the detachment. Postoperatively, the patient’s IOP stabilized in the mid-teens with no recurrence of SRD, though postoperative angiography confirmed the presence of window defects consistent with RPE tears.

According to the authors, the case emphasizes that not only absolute postoperative hypotony but also a rapid and significant drop in IOP can disturb choroidal blood flow and compromise RPE function, especially in eyes with structural vulnerabilities. The findings suggest that eyes with exfoliation syndrome, long-term steroid exposure, or pre-existing choroidal circulatory compromise may be particularly susceptible to such complications.

Previous reports of SRD and RPE tears have been associated with conventional glaucoma filtration surgeries, but until now, none have been linked to PMS. The authors propose that the dramatic pressure change, combined with a fragile RPE due to chronic steroid use and atopic dermatitis, likely triggered the sequence of CD, RPE tear, and SRD in this case.

The report highlights the importance of individualized surgical planning and vigilant postoperative monitoring in glaucoma patients, especially when risk factors for RPE fragility exist. Early recognition of choroidal detachment and prompt IOP-elevating interventions may be critical in preventing vision-threatening outcomes.

“The study emphasizes that while PMS is generally safe and effective, clinicians should be aware of this rare but serious complication. Further research is needed to better understand the underlying mechanisms and to establish preventive strategies for high-risk patients undergoing minimally invasive glaucoma surgery,” the authors concluded.

Reference:

Sadahide, A., Harada, Y., Sakaguchi, H. et al. Serous retinal detachment with retinal pigment epithelium tear after PreserFlo MicroShunt surgery: a case report. BMC Ophthalmol 25, 424 (2025). https://doi.org/10.1186/s12886-025-04259-6

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Walking further and faster linked to reduced risk of cardiovascular events in people with high blood pressure

An analysis of over 36,000 people with high blood pressure has shown that taking more steps, even below the recommended daily target of 10,000 steps, and walking faster, is associated with a significant reduction in the risk of major problems of the heart and blood vessels.

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Potatoes may increase risk of type 2 diabetes—depending on their preparation

In a study that tracked the diets of more than 205,000 adults over decades, French fries were associated with an increased risk of developing type 2 diabetes (T2D), while other forms of potatoes—including baked, boiled, and mashed—were not. The study, led by Harvard T.H. Chan School of Public Health also found that swapping any form of potato for whole grains may lower the risk of T2D.

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Red blood cells drive blood clot shrinkage, overturning old assumptions

Red blood cells, long thought to be passive bystanders in the formation of blood clots, actually play an active role in helping clots contract, according to a new study by researchers at the University of Pennsylvania.

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COVID-19 mRNA vaccine targeting omicron JN.1 lineage safe

Vaccination with the updated COVID-19 mRNA vaccine containing the severe acute respiratory syndrome coronavirus-2 omicron JN.1 lineage was not associated with an increased risk for 29 adverse events, according to a study published online July 28 in JAMA Network Open.

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Study finds significant portion of adult pneumonia hospitalizations linked to preventable pneumococcal infections

In a recent multicenter prospective study conducted at three hospitals in Tennessee and Georgia, including Vanderbilt University Medical Center, researchers at VUMC found a substantial burden of hospitalizations for community-acquired pneumonia (CAP) among adults.

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Poststroke Depression Persists or Recurs in Majority of Affected Patients Over 5 Years: Study Finds

UK: A new study published in the Journal of the American Heart Association highlights the long-term burden of depression in stroke survivors and identifies key risk factors that contribute to its persistence and recurrence over five years. The research, led by Lu Liu, MMed, from the School of Life Course and Population Sciences at King’s College London, utilized data from the South London Stroke Register collected between 1997 and 2022.

The study examined 1,724 stroke survivors with a mean age of 65.5 years, of whom 55.9% were men and 65.2% identified as White. Depression was assessed at three months post-stroke and annually for up to five years using the Hospital Anxiety and Depression Scale. Participants with more than two depression assessments were included to evaluate long-term trajectories.

The findings revealed the following:

  • 61.9% of patients did not experience depression during the follow-up period.
  • 19% of patients had transient depressive symptoms.
  • 35.2% experienced recurrent episodes of depression.
  • 45.8% suffered from persistent depression.
  • Recurrent depression was associated with moderate to severe strokes (adjusted OR 1.81).
  • Significant physical disability increased the likelihood of recurrent depression (adjusted OR 1.59).
  • Persistent depression was linked to a history of depression before the stroke (adjusted OR 2.67).
  • Cognitive impairment after the stroke was associated with persistent depression (adjusted OR 2.09).
  • Early physical decline within the first three months post-stroke raised the risk of recurrent or persistent depression, independent of the initial severity of disability.

The study emphasizes the critical need for early screening and long-term monitoring of depression in stroke survivors. According to the authors, recognizing patterns of depression and their underlying risk factors can help tailor treatment strategies. For instance, patients with recurrent depression may benefit significantly from intensive physical rehabilitation, while those with persistent depression might respond better to targeted psychological therapies, particularly when cognitive impairment or a history of depression is present.

The researchers noted several strengths of the study, including its prospective design, large population-based sample, and repeated assessments over an extended follow-up period. However, they acknowledged certain limitations, such as the exclusion of patients with fewer than three assessments, which may have resulted in underrepresentation of individuals with more severe strokes, and the reliance on a screening tool rather than clinician-administered diagnostic interviews for depression.

Overall, the findings highlight the complex interplay between stroke severity, physical disability, cognitive function, and mental health in shaping long-term outcomes for stroke survivors. The study emphasizes the importance of integrated care approaches that address both physical and psychological needs to improve recovery and quality of life.

“Early identification and proactive management of depressive symptoms could play a key role in mitigating long-term disability and enhancing overall prognosis in this vulnerable population,” the authors concluded.

Reference:

Liu L, Marshall IJ, Bhalla A, Li X, Ayis S, Wolfe CDA, Wang Y, O’Connell MDL. Long-Term Course of Depression After Stroke and Risk Factors for Symptoms With Poor Progression: A Population-Based Study. J Am Heart Assoc. 2025 Jul 29:e041931. doi: 10.1161/JAHA.125.041931. Epub ahead of print. PMID: 40728181.

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