Category: Nevin Manimala

Epilepsia. 2025 Nov 18. doi: 10.1111/epi.70022. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine whether initiation of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) is associated with seizure recurrence and related outcomes in adults with epilepsy and type 2 diabetes.

METHODS: We conducted a retrospective cohort study using de-identified electronic health records from the TriNetX Research Network (January 2003-August 2025), including adults ≥18 years with ≥3 epilepsy or recurrent seizure diagnoses. Patients initiating a GLP-1 RA (exenatide, liraglutide, dulaglutide, lixisenatide, semaglutide, or tirzepatide) without prior comparator therapy were compared with those initiating other glucose-lowering agents (sodium-glucose cotransporter 2 inhibitors, dipeptidyl peptidase 4 inhibitors, sulfonylureas, or insulin) without GLP-1 RA exposure. Propensity score matching (1:1) was performed on 82 covariates, yielding 8688 matched pairs. Outcomes were assessed using Cox proportional hazards models.

RESULTS: After matching, the mean age was 52.6 years, and 67.6% were female. Median follow-up was 514 days (interquartile range [IQR] 671) for GLP-1 RA initiators and 415 days (IQR 769) for comparators. GLP-1 RA initiation was associated with lower risk of seizure recurrence (HR .82, 95% confidence interval [CI] .78-.86; RD -2.1%), hospitalization (HR .35, 95% CI .29-.43; RD -2.6%), and all-cause mortality (HR .40, 95% CI .34-.47; RD -4.8%). Associations with status epilepticus (HR .75, 95% CI .66-.85; RD -.7%) and ICU admission (HR .82, 95% CI .69-.96; RD -.3%) were smaller; the latter was not statistically significant.

SIGNIFICANCE: In this large multinational cohort, GLP-1 RA initiation was associated with reduced risks of seizure recurrence, hospitalization, and mortality compared with other glucose-lowering therapies. These hypothesis-generating findings warrant confirmation in prospective studies before translation into clinical practice.

PMID:41251033 | DOI:10.1111/epi.70022

Clin J Pain. 2025 Nov 18. doi: 10.1097/AJP.0000000000001342. Online ahead of print.

ABSTRACT

OBJECTIVES: Sickle cell disease (SCD) is associated with vaso-occlusive episodes (VOEs) that often require inpatient care. Parenteral opioids are recommended as first-line VOE treatment in hospitalized patients. The Current Opioid Misuse Measure (COMM) survey was used to screen for aberrant opioid use in SCD patients hospitalized for VOE. Goals were to estimate the proportion of positive screens and evaluate associations with length of stay (LOS), electronic health record (EHR) data, and Prescription Drug Monitoring Program (PDMP) assessments.

METHODS: SCD patients hospitalized for VOE were approached to complete COMM surveys. Descriptive statistics and multivariate modeling were used to evaluate whether COMM results were associated with LOS or secondary variables.

RESULTS: 111 patients were approached and 89 completed surveys. Approximately 6 in 10 (57.3%) respondents screened positive for aberrant opioid use using a sensitive COMM threshold (≥9). A more specific threshold (≥13) identified about 3 in 10 (31.7%) of respondents. Positive COMM screens were more common among younger patients and those with a higher EHR risk index (Epic general risk score). COMM score was positively correlated with LOS (Spearman r=0.25, P=0.025), although this association was non-significant in survival models adjusted for sex and age (P≥0.081).

DISCUSSION: A high proportion of adults admitted for VOE screened positively using the COMM survey, which is a sensitive indicator of opioid misuse among outpatients. Our findings demonstrate feasibility of inpatient screening using the COMM survey and support further investigation of this tool for SCD patients hospitalized with VOE.

PMID:41251024 | DOI:10.1097/AJP.0000000000001342

Basic Clin Pharmacol Toxicol. 2025 Dec;137(6):e70139. doi: 10.1111/bcpt.70139.

ABSTRACT

Queries from healthcare professionals to drug information centres may represent drug-related aspects of importance in healthcare. In this study, queries and replies from all drug information centres in Sweden, published on svelic.se (January 2023 to May 2024) and specifically related to the discipline of pharmacy, were explored. Pharmaceutical queries were defined in an iterative process starting with seven definitions of ‘pharmacy’ and independent assessments by two assessors. Three categories emerged: galenic queries, lookup queries and pharmacy practice queries. Out of 767 studied queries, 60 (8%) were categorised as pharmaceutical (kappa: 0.84), distributed across galenic (n = 46), lookup (n = 12) and pharmacy practice queries (n = 2). Galenic queries primarily concerned crushing or splitting of medications (n = 13), alternative routes of administration (n = 12) or compatibility (n = 10). Out of 21 drugs asked about in crushing/splitting-related queries, six lacked information in the national Medication Crushing Database. Out of nine specific drug pairs asked about in compatibility queries, two were incompatible, and information regarding seven was not obtainable from the national Pharmaceutical Compatibility Database. In conclusion, almost one tenth of queries to drug information centres in Sweden, recorded on svelic.se, were specifically pharmaceutical. The requested information was often for crushing/splitting-related queries, and seldom for compatibility queries, accessible from the knowledge resources.

PMID:41251016 | DOI:10.1111/bcpt.70139

Clin J Pain. 2025 Nov 19. doi: 10.1097/AJP.0000000000001343. Online ahead of print.

ABSTRACT

OBJECTIVE: Mindfulness-based interventions (MBIs) show promise in managing chronic pain but often require substantial time commitments, leading to high attrition and concerns about acceptability. This meta-analysis evaluated attrition rates in MBIs for chronic pain and examined moderators contributing to participant withdrawal.

METHODS: Following PRISMA guidelines, we searched relevant databases for studies of MBIs for pain. Eligible studies included randomised controlled trials, controlled trials, and quasi-experimental designs that reported attrition data for adults (≥18 y) with chronic pain lasting over 3 months. Data extraction covered attrition metrics, program characteristics, and participant demographics. Statistical analyses included random-effects meta-analyses of proportions, sensitivity analyses, meta-regression, and publication bias assessments.

RESULTS: Forty-four studies (45 intervention conditions) were included. The pooled attrition rate was 30.1% (95% CI: 24.5% to 37.3%) with substantial heterogeneity (I²=89.0%). Attrition increased with stricter completion thresholds (minimum sessions required for programme completion status) (P<0.001, R²=28.1%): 18.0% (≥3-4 sessions), 31.6% (≥5-6 sessions), and 49.7% (>6 sessions). Online delivery showed higher attrition (51.0%) than in-person delivery (25.6%, P=0.002, R²=17.1%). Individually delivered MBIs were also associated with higher attrition than group formats (β=0.216, P=0.039, R²=5.5%). Publication bias analyses suggested minor influence on the pooled effect, which remained robust after adjustment.

DISCUSSION: Attrition rates for MBIs in chronic pain vary widely. Higher attrition is associated with stricter completion criteria, online delivery, and individual formats. These findings highlight the need to optimise MBI programme structure for management of pain.

PMID:41250993 | DOI:10.1097/AJP.0000000000001343

Epilepsia. 2025 Nov 18. doi: 10.1111/epi.70017. Online ahead of print.

ABSTRACT

OBJECTIVE: Acute symptomatic seizures (ASyS) occur in up to 30% of patients with intracerebral hemorrhage (ICH) when continuous electroencephalography (cEEG) is used, potentially worsening outcomes. Identification of early EEG biomarkers of ASyS may help guide personalized antiseizure medication (ASM) prophylaxis. Here, we aimed to describe early interictal EEG patterns, their dynamics, and their association with seizure risk, considering the effect of prophylactic levetiracetam.

METHODS: This prospective analysis used data from the PEACH phase 3 trial (2017-2020), which enrolled adults with acute spontaneous supratentorial ICH, randomized to receive levetiracetam or placebo. Patients underwent systematic 48-h cEEG within 48 h of symptom onset. Electrographic seizures and interictal EEG patterns were analyzed using standardized terminology of the American Clinical Neurophysiology Society. Associations between rhythmic and periodic patterns (RPPs) and seizures with clinical and radiological variables were assessed using univariate analyses. We also conducted exploratory testing of the CAV (cortical involvement, age < 65 years, volume > 10 mL) score for predicting ASyS, incorporating RPPs and ASM exposure.

RESULTS: Forty-two patients were included (median [Q1-Q3] age = 72 [60-79] years, 29% women), 19 in the levetiracetam group. Interictal EEG abnormalities were common and not influenced by ASM, including background asymmetry (73%), sporadic epileptiform discharges (62%), and RPPs (52%). RPPs were associated with ICH volume (p = .039) and cortical involvement (p = .003). Among patients with RPPs, 50% developed ASyS (20% in those treated with ASM vs. 75% in untreated patients, p = .030). Most patients (91.7%) with seizures had RPPs that preceded seizures, in >90% cases by 12 (Q1-Q3 = 4-25) h. Integrating RPPs into the CAV model led to an improvement of ASyS prediction (area under the curve = .949 vs. .918, p = .53) that was statistically nonsignificant.

SIGNIFICANCE: RPPs are strong markers of ictogenesis in acute ICH and precede ASyS, thus offering a potential therapeutic window. These findings support the use of early cEEG for risk stratification and personalized ASM prophylaxis.

PMID:41250972 | DOI:10.1111/epi.70017

Int J Eat Disord. 2025 Nov 18. doi: 10.1111/eat.70004. Online ahead of print.

ABSTRACT

OBJECTIVE: Program-led and focused models may overcome structural barriers to accessing ED care, such as limited availability, for youth with EDs by prioritizing strategic, evidence-based care delivered through a structured approach. The Rapid Intervention to Support Eating Issues (RISE) pilot aimed to promote weight restoration and prevent hospitalization among malnourished adolescents at risk for hospitalization. We used a “home hospital” approach, integrating medical oversight, family-based treatment principles, and nutritional support via structured outpatient care.

METHODS: Participants completed 4-5 visits with adolescent medicine and nutrition over 8 weeks. They received psychoeducation and support in implementing home hospital. Vital signs, anthropometrics, dietary intake, ED behaviors, and cognitions were assessed.

RESULTS: A total of 27 patients participated. Patients experienced low hospitalization rates (n = 1 throughout; 3.7%) and significant weight gain (M_{end of treatment} = +2.7 kg from baseline, 95% CI: 2.6-4.7). There were statistically significant increases in calorie intake (M_baseline = 43.3% of recommendation; M_{end of treatment} = 76.0% of recommendation; dz = 0.98, 95% CI: 0.45-1.50) and decreases in the report of disordered weight control behaviors (n reporting at baseline = 10 [37%], n reporting at end of treatment = 3 [11.1%]; paired RD = -1.00, 95% CI: -1.00–0.33).

DISCUSSION: This program-led and focused intervention produced meaningful outcomes and circumvented hospitalization for youth at high risk in a short time frame. This approach offers promise for scalable, early ED care that leverages programmatic expertise, consistent with evolving models of mental health service delivery.

PMID:41250963 | DOI:10.1111/eat.70004

Int J Eat Disord. 2025 Nov 18. doi: 10.1002/eat.24594. Online ahead of print.

ABSTRACT

OBJECTIVE: To estimate the prevalence of probable eating disorders and self-reported eating disorder diagnoses among East Asian young adults aged 18-25 years across US colleges.

METHOD: Using data from the 2020 to 2023 Healthy Minds Study, a repeated cross-sectional survey of US college students, we analyzed data from East Asian and White participants aged 18-25 years (N = 160,740). Eating disorder risk was assessed using the SCOFF questionnaire and eating disorder diagnoses were self-reported. Using multivariable logistic models, we generated odds ratios (OR) and confidence intervals (CI) to estimate inequities in the prevalence of a probable eating disorder and eating disorder diagnoses between East Asian and White young adults, adjusting for gender identity, age, international student status, sexual orientation, financial stress, and study year.

RESULTS: We found no statistically significant differences in the prevalence of a probable eating disorder among East Asian young adults compared to White young adults (OR: 1.04; 95% CI: 0.97-1.11) after adjustment. Among those with a probable eating disorder (n = 68,651), East Asian young adults had nearly half the odds (OR: 0.55; 95% CI: 0.47-0.65) of having a self-reported diagnosed eating disorder compared to White young adults.

DISCUSSION: While the prevalence of having a probable eating disorder was similar among East Asian and White young adults, East Asians had almost half the odds of self-reporting an eating disorder diagnosis compared to White young adults. Future research is warranted to better understand barriers to eating disorder diagnosis among East Asian young adults in the US.

PMID:41250962 | DOI:10.1002/eat.24594

Matern Child Nutr. 2026 Mar;22(1):e70126. doi: 10.1111/mcn.70126.

ABSTRACT

Poor diet quality may contribute to the multiple forms of malnutrition among children in Ghana. This cross-sectional study (1) described the prevalence and frequency of consumption of fruits, vegetables, sugar-sweetened beverages (SSB), salty snacks and sweet snacks among children 2-5 years in northern Ghana; (2) identified factors associated with consumption; and (3) examined relationships between consumption and nutritional status. Households were recruited from urban and rural clusters in Tolon and Kumbungu districts. Children’s (2-5 years; n = 243) dietary data were collected using a questionnaire modelled after the WHO STEPS tool. We assessed children’s height, weight, haemoglobin and micronutrient biomarker (n = 125) concentrations. We used multi-variable logistic and linear regression to identify individual, maternal and household factors predicting consumption of the food groups and relationships between consumption and nutritional status. In a typical week, most children consumed vegetables (98%), sweet snacks (81%) and fruits (76%); 50% consumed salty snacks and 46% consumed SSB. Average number of servings consumed weekly, mean (SD), was: 7.9 (7.3) vegetables, 2.9 (2.5) sweet snacks, 2.6 (3.9) SSB, 1.8 (1.7) fruits and 1.2 (1.7) salty snacks. Children in households with higher food insecurity were more likely to report consumption of all food groups (> 0 servings fruits, SSB, salty snacks and sweet snacks; ≥ 7 servings vegetables weekly), but other characteristics did not consistently predict consumption. Few associations were found between consumption and nutritional status. Interventions to increase fruit and vegetable intake to align with guidelines, while avoiding SSB and snack foods, are needed.

PMID:41250954 | DOI:10.1111/mcn.70126

Mol Ecol Resour. 2026 Jan;26(1):e70072. doi: 10.1111/1755-0998.70072.

ABSTRACT

More than 25 years ago, Aitchison showed that the logratio principal component analysis of multiple samples of a biallelic polymorphism can evidentiate the Hardy-Weinberg law. However, hitherto compositional data analysis, that is, the logratio approach, has had little impact in population genetics. This article extends Aitchison’s work to multiallelic polymorphisms showing how the Hardy-Weinberg law manifests itself in a logratio based statistical analysis with larger genotypic compositions. Excellent visualisations of equilibrium and disequilibrium are achieved by using compositional biplots based on allele and genotype frequencies taken across multiple populations. Some fundamental relationships between allelic and genotypic compositions are derived, and the close relationships between the logratio principal component analysis of allelic and genotypic compositions and the corresponding compositional biplots are established. Simulations and practical genetic data analysis are used to explore the implications of Hardy-Weinberg equilibrium for the logratio principal component analysis of genotypic compositions. A general multiallelic compositional measure for disequilibrium is presented, and shown to relate to the classical inbreeding coefficient. The proposed compositional analysis is illustrated with biallelic glyoxalase genotypes and with two multiallelic loci from the 1000 Genomes project, the forensic microsatellite D2S441 and the ABO locus. For the latter, a haplotype based approach is used and generates predictions of the three-allele ABO genotypes for the individuals of the expanded 1000 Genomes project.

PMID:41250929 | DOI:10.1111/1755-0998.70072

Influenza Other Respir Viruses. 2025 Nov;19(11):e70190. doi: 10.1111/irv.70190.

ABSTRACT

We estimated the burden of influenza, SARS-CoV-2 and RSV from patients hospitalized with acute respiratory infection systematically tested between weeks 40/2024 and 20/2025 in Spain. The hospitalization rate per 100,000 was highest for influenza [67.5 (95% Confidence Interval: 52.5-87.3)] followed by RSV [46.6 (35.4-62.2)] and SARS-CoV-2 [15.8 (10.2-24.6)]. Hospitalization rates peaked in ≥ 60-year-olds and < 5-year-olds, ICU admissions in < 1-year-olds and deaths in ≥ 80-year-olds. Hospitalization for SARS-CoV-2 at 80-85 years was comparable to influenza at 60-65 years, potentially signaling the appropriateness of increasing the COVID-19 vaccination age cut-off. RSV prevention appeared a priority in < 5-year-olds but substantial preventive potential was identified in the elderly.

PMID:41250923 | DOI:10.1111/irv.70190