Category: Nevin Manimala

CNS Drugs. 2025 Sep 11. doi: 10.1007/s40263-025-01225-0. Online ahead of print.

ABSTRACT

BACKGROUND: Individuals with schizophrenia and comorbid substance use disorder (SUD) often experience poor treatment adherence, leading to worse clinical outcomes. However, high-quality evidence from randomized trials on the preferred mode of antipsychotic treatment in this population remains limited.

AIMS: The aim was to examine whether long-acting injectable (LAI) antipsychotic treatment reduces the risk of all-cause discontinuation (ACD) compared with oral antipsychotics in individuals with early phase schizophrenia and comorbid SUD.

METHODS: This study was a secondary analysis of the European Long-Acting Antipsychotics in Schizophrenia Trial (EULAST), a multisite, randomized, open-label trial conducted across multiple European healthcare settings. A total of 471 individuals with early phase schizophrenia were included in this secondary analysis, stratified by presence (n = 143) or absence (n = 328) of comorbid SUD. The observation period lasted 18 months. Participants were randomly assigned to second-generation LAI or oral second-generation antipsychotic treatment. The primary outcome was ACD, an indirect measure of treatment efficacy, defined as discontinuation of the initially assigned treatment for any reason. Hazard ratios (HRs) were estimated using Cox proportional hazards regression models, adjusted for relevant covariates.

RESULTS: Among 143 individuals with schizophrenia and SUD, LAI treatment was associated with a 36% lower risk of ACD compared with oral antipsychotics (adjusted HR = 0.641; 95% CI, 0.438-0.938; P = 0.022). Kaplan-Meier curves showed longer median time to ACD for LAI treatment (158 days) versus oral antipsychotics (97 days). By contrast, among the 328 individuals without SUD, LAI treatment did not significantly reduce ACD risk (P = 0.282). Crude HRs were also assessed, replicating the adjusted hazard findings.

CONCLUSIONS: LAI antipsychotics significantly delayed treatment discontinuation compared with oral antipsychotics in participants with early phase schizophrenia and comorbid SUD but not in those without SUD. While these findings provide robust evidence supporting the use of LAIs in people with schizophrenia and comorbid SUD, future studies are needed to more precisely quantify the potential clinical benefits and tolerability of LAIs in this high-risk population. EULAST was registered at ClinicalTrials.gov (NCT02146547).

PMID:40932600 | DOI:10.1007/s40263-025-01225-0

Mol Biol Rep. 2025 Sep 11;52(1):896. doi: 10.1007/s11033-025-11002-3.

ABSTRACT

INTRODUCTION: Human papillomavirus (HPV) is the most common sexually transmitted infection and a major cause of genital warts and anogenital cancers in both sexes. This study assessed HPV genotype distribution in a large outpatient population in southwestern Iran to inform preventive strategies.

MATERIALS AND METHODS: In this cross-sectional study, 10,739 outpatient samples were collected from 2018 to 2023. Specimens included urine from men and vaginal swabs from women with normal cytology. HPV genotypes were assessed using DNA extraction, PCR and Direct Flow Chip method.

RESULTS: HPV prevalence was 41.6% (94.8% in females, 5.2% in males). Women had a higher positivity rate (42.0%) than men (34.2%). The highest prevalence (44.3%) occurred in the 31-40 age group. High-risk types were present in 65.8% of positive cases. Women were more affected by high-risk genotypes, while low-risk types predominated in men. The most frequent high-risk genotypes were HPV-16, -53, -52, -66, and – 39; the most common low-risk types were HPV-6, -54, -42, -62, and – 44. Most individuals had a single infection. Mixed infections, more common in women, often involved both high- and low-risk types and showed greater diversity with age.

CONCLUSION: HPV prevalence, particularly of high-risk types, is notably high among women in southwestern Iran. The peak age of infection is higher than in developed countries. Differences in genotype distribution compared to American and other Iranian studies highlight the need for region-specific vaccination strategies targeting locally prevalent genotypes.

PMID:40932599 | DOI:10.1007/s11033-025-11002-3

Clin Drug Investig. 2025 Sep 11. doi: 10.1007/s40261-025-01481-4. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Direct head-to-head evidence of propranolol and amitriptyline for migraine prophylaxis is limited. This clinical trial compared the efficacy, safety, and cost-effectiveness of low-dose propranolol versus amitriptyline for episodic migraine prophylaxis over a 3-month period.

METHODS: This randomized, controlled, open-label, prospective, parallel, single-center trial was conducted at a tertiary care hospital in India. A total of 60 prophylaxis-naïve patients with episodic migraine were randomized 1:1 to receive either low-dose propranolol (80 mg/day) or amitriptyline (10 mg/day). The primary outcome was the improvement in the monthly headache frequency at 3 months from baseline, while the secondary outcomes included improvements from baseline in the proportions of patients achieving a ≥ 50% reduction in monthly headache days, headache severity, headache-induced disability, monthly rescue medication intake, quality of life, and cost-effectiveness (measured by the average cost-effectiveness ratio [ACER] and incremental cost-effectiveness ratio [ICER]).

RESULTS: At 3 months, propranolol showed a significantly greater reduction in monthly headache frequency compared with amitriptyline (- 3.67 ± 1.47 versus – 2.87 ± 1.36 days, P = 0.03). More patients in the propranolol group (60%) achieved a ≥ 50% reduction in monthly headache days compared with the amitriptyline group (43.33%) (P = 0.02). Propranolol also showed a greater reduction in monthly rescue medication intake (P = 0.01), but differences in headache severity, headache-induced disability, and quality of life were not significant. Both groups experienced mild adverse drug reactions. Cost-effectiveness analysis revealed propranolol had a higher ACER (US $5.44) and ICER (US $0.40/1% reduction) than amitriptyline.

CONCLUSIONS: In our trial, low-dose propranolol demonstrated superior efficacy to amitriptyline in episodic migraine prophylaxis. Both drugs were well tolerated. Our study suggests that amitriptyline was more cost-effective than propranolol.

TRIAL REGISTRATION NUMBER: Clinical Trial Registry-India (Date: 27 October 2020; registration no.: CTRI/2020/01/022972).

PMID:40932597 | DOI:10.1007/s40261-025-01481-4

J Adv Nurs. 2025 Sep 11. doi: 10.1111/jan.70216. Online ahead of print.

ABSTRACT

AIMS: To assess self-reported practices and knowledge of nurses and prescribers (i.e., physicians and nurse practitioners) on intravenous fluid therapy, and to evaluate how this is documented through a clinical documentation review.

DESIGN: Multicentre cross-sectional study, between April 2022 and July 2022, across 13 wards from four Dutch hospitals.

METHODS: A survey study was conducted to assess self-reported practices related to intravenous fluid therapy. A 12-item questionnaire evaluated knowledge. To gain insights into documentation practices, a retrospective chart review was performed. Data analysis involved descriptive statistics, with group differences analysed using the chi-squared test or Fisher’s exact test, as appropriate.

RESULTS: Three hundred and four healthcare professionals completed the questionnaire (92% nurses). The majority of prescribers (n = 20/25; 80%) expected that nurses would start, stop or change intravenous fluid therapy. Overall, the median number of correct answers to knowledge questions was eight (IQR 7-9, range 0-12); four participants (1%) answered all knowledge questions correctly. Knowledge about the composition of sodium chloride 0.9% solution was limited. Analysis of patient charts revealed that 54% (196/362) received intravenous fluids, most commonly 0.9% sodium chloride infusion (168/195; 86%), although the indication was described in 3% (6/196). Thirty-one percent (61/196) of patients received intravenous fluids to keep the vein open (< 30 mL/h).

CONCLUSION: The study identified shared responsibility, a knowledge gap, and limited documentation concerning intravenous fluids. Prescribers expect nurses to adjust intravenous fluids without consulting a prescriber, which aligns with what nurses do, although they are not legally authorised. Given the limited documentation of the indication for intravenous fluids, it is plausible that several patients received intravenous fluids unnecessarily.

IMPLICATIONS: The perceived shared responsibility presents an opportunity to develop a protocol engaging both prescribers and nurses, aiming to guide more targeted infusion therapy.

IMPACT: Reducing unnecessary infusions to keep-the-vein-open can help eliminate low-value care.

REPORTING METHOD: CROSS guideline.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

PMID:40931896 | DOI:10.1111/jan.70216

Arthritis Care Res (Hoboken). 2025 Sep 11. doi: 10.1002/acr.25633. Online ahead of print.

NO ABSTRACT

PMID:40931879 | DOI:10.1002/acr.25633

Haematologica. 2025 Sep 11. doi: 10.3324/haematol.2025.287910. Online ahead of print.

ABSTRACT

Not available.

PMID:40931858 | DOI:10.3324/haematol.2025.287910

Arthritis Care Res (Hoboken). 2025 Sep 11. doi: 10.1002/acr.25647. Online ahead of print.

ABSTRACT

BACKGROUND: Interstitial lung disease (ILD) is a significant cause of morbidity and mortality in systemic sclerosis (SSc), particularly among Black patients. Pulmonary function tests (PFTs) are critical to screen for and monitor SSc-ILD. We examined whether race-specific and race-neutral PFT reference equations impact classification of restrictive lung disease (RLD) severity in Black and White patients with SSc.

METHODS: Baseline percent predicted forced vital capacity (ppFVC) was calculated for self-identified Black (N=641) and White (N=2909) patients in the Johns Hopkins Scleroderma Center Research Registry using race-specific (Global Lung Initiative 2012 [GLI 2012], National Health and Nutrition Examination Survey III [NHANES]) and race-neutral (GLI Global) equations. The percentage of Black and White individuals who switched RLD severity categories (normal (ppFVC≥80%); mild (70≤ppFVC<80%), moderate (60%≤ppFVC<70%), severe (50%≤ppFVC<60%) or very severe (ppFVC<50%)) when using race-neutral versus race-specific equations was calculated. The percentage who would meet typical ppFVC thresholds for immunosuppression, clinical trial eligibility, and lung transplant referral was compared.

RESULTS: Black individuals had lower absolute FVC values than White individuals. 47% (n=303) of Black individuals were reclassified as having more severe RLD and 17% (n=487) of White individuals were reclassified as having less severe RLD when using the GLI Global versus GLI 2012 equations. Statistically greater proportions of Black individuals met ppFVC thresholds for immunosuppression, clinical trial eligibility and lung transplant referral with race-neutral versus race-specific equations.

CONCLUSIONS: The use of race-specific PFT reference equations may result in systematic misclassification of ILD severity with potential impact on healthcare delivery and clinical trial eligibility.

PMID:40931854 | DOI:10.1002/acr.25647

Ann Otol Rhinol Laryngol. 2025 Sep 11:34894251363745. doi: 10.1177/00034894251363745. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop, implement, and evaluate a novel process used for residency application review that deemphasizes metrics known to create bias with the goal of interviewing and matching a more diverse resident cohort.

METHODS: Between 2020 and 2023, a novel standardized rubric and application review process were developed and implemented at the authors’ academic training program. The rubric deemphasized USMLE scores, honor society membership, and number of publications while utilizing an AI-driven pre-sort of applications, facilitating holistic review. This weighted applicant attributes identified in personal statements, life experiences, achievements in community, leadership roles, otolaryngology-specific impressions highlighted in letters of recommendation, and otolaryngology-specific research and publications similarly to academic metrics (clerkship grades and standardized test scores). Demographics of applicants interviewed and matched into our program were compared pre- and post-implementation using descriptive statistics.

RESULTS: Using a standardized rubric to review residency applications that deemphasizes traditional metrics, the authors’ otolaryngology residency program has interviewed, ranked, and matched more diverse candidates. As a result, from 2019 to 2022, the overall resident cohort has diversified from 4% historically marginalized residents to 24%, from 28% female residents to 44%, and from 33% of residents outside our geographic region to 66%.

CONCLUSION: There is significant underrepresentation among otolaryngology residents. Selection based upon USMLE Step 1 scores, honor society membership, and number of publications have been shown to restrict diversity. Purposeful holistic review increases diversity in interviewed and matched resident cohort.

PMID:40931850 | DOI:10.1177/00034894251363745

Hypertension. 2025 Sep 11. doi: 10.1161/HYPERTENSIONAHA.125.25157. Online ahead of print.

ABSTRACT

BACKGROUND: The association between season of screening blood pressure (BP) measurement and adverse outcomes has not been examined among populations without prior physician-diagnosed hypertension. We aimed to investigate the association between the season of screening clinic BP measurement and the risk of all-cause mortality.

METHODS: This was a prospective cohort study, and data were analyzed from an ongoing community hypertension screening program in Shanghai between 2018 and 2024. In this study, 166 670 participants aged 35 to 89 years who were free of prior physician-diagnosed hypertension were included and had their BP measured with an automated office BP platform in Shanghai community health centers. Participants were categorized into 4 groups by season of screening BP measurement: spring, summer, autumn, and winter. Deaths were ascertained from linkage to the Shanghai Vital Statistics Registry with follow-up until September 30, 2024. Cox regression models were used to examine the association between seasons of BP measurement and risk of all-cause mortality.

RESULTS: During a median follow-up of 1.6 years, 1850 (1.1% of participants) all-cause deaths occurred. The incidence rate of all-cause mortality was 5.0 per 1000 person-years and was higher in participants with screening BP measured in summer (5.4 per 1000 person-years) than in other seasons (4.4, 5.3, and 4.9 per 1000 person-years in spring, autumn, and winter, respectively). After adjustment for age, sex, residential region, and systolic and diastolic BP, the hazard ratio for the risk of all-cause mortality in participants with screening BP measured in summer relative to the overall population was 1.14 (95% CI, 1.05-1.24). There was no any significant interaction between the season of screening BP measurement and sex, age, and hypertension status in relation to the risk of all-cause mortality (all P≥0.05).

CONCLUSIONS: Screening for raised BP in summer was associated with significantly higher risks of all-cause mortality, though the mean systolic/diastolic BP was lowest in summer. The findings imply that if only clinic BP is measured for hypertension screening in 4-season countries and regions, repeated BP measurements, preferably in different seasons, might be needed.

PMID:40931832 | DOI:10.1161/HYPERTENSIONAHA.125.25157

Emerg Med Australas. 2025 Oct;37(5):e70130. doi: 10.1111/1742-6723.70130.

ABSTRACT

OBJECTIVES: Acute pyelonephritis (APN) is a common diagnosis among patients presenting to the Emergency Department (ED). It is treated by empiric antibiotics within the ED. With a rise in antimicrobial resistance globally, it is unknown whether patients are being managed with empiric antibiotics that are appropriate for the causative organisms of APN. The aim of this study was to describe the pathogens causing APN and to assess whether the current choice of empirical antibiotics is appropriate.

METHODS: A single-centre retrospective review of patients with a discharge diagnosis of APN at an adult tertiary referral hospital in metropolitan Melbourne over a 5-year period (2018-2022) was conducted. Eligible cases were identified from ICD-10 discharge diagnoses. Demographics, cultured organisms and antibiotic regimens were extracted using explicit chart review.

RESULTS: There were 557 patients included with APN with 569 urine samples cultured after initial assessment. The most common pathogen cultured was E. coli, identified in 232 (40.8%) culture results. There were 26 (4.7%; 95% CI: 3.1-6.6) patients managed in the ED with inappropriate antibiotics. This occurred most frequently when ampicillin or amoxicillin monotherapy was prescribed. Patients were discharged with inappropriate antibiotics in 76 (13.6%) cases. This occurred most commonly when no antibiotic was prescribed on discharge.

CONCLUSION: Most empiric antibiotic prescribing for APN was appropriate and sensitive against the cultured organism. E. Coli in urine samples was commonly resistant to amoxicillin, ampicillin or trimethoprim. Strict adherence to national clinical guidelines can further reduce the rates of inappropriate antibiotic prescriptions.

PMID:40931827 | DOI:10.1111/1742-6723.70130