Category: Nevin Manimala

Clin Transplant. 2025 Oct;39(10):e70262. doi: 10.1111/ctr.70262.

ABSTRACT

BACKGROUND: In recent years, there has been a progressive increase in the number of Mycoplasma spp. infections (MIs) reported among kidney transplant (KT) recipients. Although in these patients MIs have been associated with life-threatening complications and graft failure, specific epidemiology, clinical characteristics, diagnostic work-up, and treatment strategies remain undefined.

METHODS: We performed a systematic review (PubMed, Embase, Scopus, and Cochrane) of MIs after kidney transplantation (PROSPERO ID: CRD42024520942).

RESULTS: Our work summarizes 13 case reports, 7 retrospective case series, and 1 retrospective uncontrolled cohort study, published between 1970 and 2023, collectively reporting 30 episodes of MIs. Due to the scarcity of information, incidence, prevalence, and predisposing factors could not be explored. Time interval between kidney transplantation and MIs ranged between 3 and 120 days. More often, the surgical site (n = 18) or the urinary tract (n = 6) was involved, with most infections sustained by Mycoplasma hominis (n = 28). Clinical features included fever (n = 18), abdominal pain (n = 8), leukocytosis (n = 8), and elevated CRP levels (n = 6). The definitive diagnosis was obtained using microbial cultures (n = 16) or PCR method (n = 12), and the time required for identification varied from 3 to 90 days. Preferred antibiotics were tetracyclines (n = 19) and quinolones (n = 9). Overall, MIs led to 20 surgical interventions, 6 graft losses, and 2 deaths.

CONCLUSION: Future research projects should consider the epidemiology of Mycoplasma spp. infection in solid organ transplant recipients.

PMID:40991313 | DOI:10.1111/ctr.70262

JAMA. 2025 Sep 24. doi: 10.1001/jama.2025.15488. Online ahead of print.

ABSTRACT

IMPORTANCE: US children’s health insurance is fragmented across public and private sources, with wide state variation. However, the extent of children’s interactions with Medicaid and Children’s Health Insurance Program (CHIP) and their experience of uninsurance over 18 years of childhood remains unclear. Such estimates can provide a baseline for gauging the potential impact of upcoming Medicaid policy changes.

OBJECTIVE: To estimate insurance dynamics in relation to Medicaid or CHIP and uninsurance over childhood under post-Affordable Care Act (ACA) prepandemic policy conditions.

DESIGN, SETTING, AND PARTICIPANTS: Using a microsimulation model, we projected individual-level monthly insurance coverage (Medicaid or CHIP, Marketplace, employment-based, other, or uninsured) from birth until the 18th birthday for a simulated nationally representative cohort of 100 000 US children. National data were synthesized (2015-2019), including natality records, Medical Expenditure Panel Survey pooled 2-year panels, and 1 Survey of Income and Program Participation (SIPP) 3-year panel. Monthly insurance status was simulated by matching dynamically updated predictors to SIPP samples every 12 months. Predictors included annual family income as a percentage of the federal poverty level, insurance history, state, and age. The analysis was bootstrapped 1000 times to generate 95% uncertainty intervals (95% UI).

EXPOSURES: Insurance status and state of residence at birth.

MAIN OUTCOMES AND MEASURES: Cumulative insurance experience, overall and by subgroup.

RESULTS: It was estimated that, by their 18th birthday, 61% (95% UI, 58%-63%) of US children were ever enrolled in Medicaid or CHIP and 42% (95% UI, 38%-46%) were ever uninsured. An estimated 26% (95% UI, 24%-29%) of children were continuously enrolled in employment-based or other insurance excluding Medicaid, CHIP, or Marketplace. Among children born with Medicaid or CHIP, the share ever uninsured was 59% (95% UI, 48%-66%) in ACA nonexpansion states vs 36% (95% UI, 30%-41%) in expansion states. Across alternative categorizations of policy restrictiveness, the highest share of ever uninsured among children born with Medicaid or CHIP was consistently estimated in states with the most restrictive Medicaid and CHIP eligibility criteria.

CONCLUSIONS AND RELEVANCE: An estimated 3 of 4 US children relied on publicly subsidized insurance (Medicaid, CHIP, or Marketplace) or experienced a period without any insurance by their 18th birthday in the post-ACA, prepandemic policy environment. Substantial state heterogeneity in childhood uninsurance underscores the critical role of Medicaid policies.

PMID:40991296 | DOI:10.1001/jama.2025.15488

JAMA Netw Open. 2025 Sep 2;8(9):e2533505. doi: 10.1001/jamanetworkopen.2025.33505.

ABSTRACT

IMPORTANCE: The Joint Commission requires hospitals and behavioral health care organizations to identify patients at risk of suicide (National Patient Safety Goal 15.01.01). Risk algorithms and in-person screening for suicide risk show utility in identifying patients at risk of suicidal behavior, yet there is little research examining their comparative performance in children and adolescents.

OBJECTIVE: To assess the performance of suicide risk screening and risk algorithms in identifying the risk of suicide attempts among pediatric patients in the emergency department (ED).

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included youths aged 10 to 18 years presenting to the ED of a northeastern US state between September 1, 2019, and August 31, 2021. Patients were screened for suicide risk using the Ask Suicide-Screening Questions survey and the Columbia-Brief Suicide Severity Rating Scale. Electronic health records from this same cohort containing data from May 31, 2017, to the date of their first encounter within this period were extracted to train a risk algorithm. To observe the presence or absence of a suicide attempt, patients were followed up from their first ED encounter for a minimum of 6 months and a maximum of 2.5 years, through March 2, 2022. Data were analyzed from May 2023 to December 2024.

EXPOSURE: Assessments from suicide risk screening and a risk algorithm.

MAIN OUTCOMES AND MEASURES: The occurrence of a suicide attempt following a patient’s first suicide risk screening or first visit in the screening period, if not screened.

RESULTS: Among 19 653 patients included in the analysis, the median age was 14.3 (IQR, 12.1-16.2) years, and 10 007 (50.9%) were female. Four hundred ninety-five patients (2.5%) were treated for a suicide attempt. Among patients screening positive for suicide risk in testing samples (mean, 8.1% [95% CI, 7.6%-8.6%]) and patients in the top 8.1% of the distribution on the algorithm, the algorithm correctly identified a mean of 50.7% (95% CI, 47.3%-54.1%) of those who attempted suicide in contrast to 36.5% (95% CI, 31.9%-41.2%) identified by screening. The algorithm uniquely identified 127% more youths who attempted suicide (125) than did screening (55).

CONCLUSIONS AND RELEVANCE: In this cohort study of pediatric patients, the risk algorithm was superior to screening across all performance metrics and could substantially assist health care organizations’ efforts to meet the Joint Commission’s National Patient Safety Goal to reduce the risk of suicide.

PMID:40991285 | DOI:10.1001/jamanetworkopen.2025.33505

J Craniofac Surg. 2025 Sep 24. doi: 10.1097/SCS.0000000000011778. Online ahead of print.

ABSTRACT

INTRODUCTION: Patients undergoing mandibular distraction osteogenesis (MDO) frequently have risk factors that may hinder bone healing during consolidation. Here, we examine how preoperative feeding modalities affect bone healing in MDO patients.

METHODS: Retrospective chart review was performed for patients undergoing MDO between 2015 and 2024. Data included patient demographics, preoperative feeding modality, and bone healing complications. SPSS was used for statistical analysis, employing Fisher exact test for categorical variables, and logistic regression to adjust for confounding variables.

RESULTS: Twenty-two patients were analyzed (average age=14.77 mo). Twenty-one patients had preoperative feeding difficulties, with 6 patients feeding by mouth (PO) and 16 patients requiring alternative (non-PO) methods. Ten patients experienced bone healing complications; 7 patients had delayed consolidation and 6 had nonunion. Proportions of complications between patients with PO versus non-PO feeding were comparable (Fisher exact P-Value= 1.000). Logistic regressions showed age at surgery, preoperative weight, non-PO feeding, and the presence of Pierre Robin Sequence or cleft palate did not predict the occurrence of bone healing complications, delayed consolidation, or nonunion (P>0.05). Non-PO feeding had the strongest association with the occurrence of bone healing complications and nonunion, with odds ratios of 2.016 (95% CI: 0.154-26.309, P-Value=0.593) and 7.155 (0.086-597.411, P-Value=0.383), respectively.

CONCLUSION: Our data indicates preoperative feeding modality does not correlate with bone healing complications, suggesting MDO can be considered for patients regardless of feeding modality, potentially expanding eligibility for the procedure without increased risk. Additional research is warranted to understand risk factor effects on MDO outcomes.

PMID:40991267 | DOI:10.1097/SCS.0000000000011778

Plast Reconstr Surg. 2025 Sep 23. doi: 10.1097/PRS.0000000000012472. Online ahead of print.

ABSTRACT

IMPORTANCE: Ulnar neuropathy at the elbow (UNE) is the second most common nerve compression in the upper extremity. Painful paresthesias in fingers progress to muscle weakness and atrophy impairing activities of daily living. Despite common occurrence and impacting lives, risk factors that predispose UNE and help understand disease severity are not investigated thoroughly.

METHODS: Patients enrolled in the Surgery for Ulnar Neuropathy (SUN) at the elbow study were included. Data on patient demographics, distance traveled, disease duration and comorbidities collected at the time of enrollment prior to surgery were used for this analysis. Ordinal logistic regression was used to determine risk factors associated with three-level UNE severity.

RESULTS: 225 study participants included in this analysis had an average age of 51 years. Age (OR= 1.05 (95% CI: 1.03, 1.08; p < 0.001) and disease duration (OR= 0.71; 95% CI: 0.54, 0.93; p = 0.01) were significantly associated with disease severity. Patients with longer disease duration prior to surgery were less likely to have severe disease.

CONCLUSION: In this NIH-funded clinical trial, distance traveled, and patient comorbidities were not associated with severity of UNE. Patients with longer disease duration were less inclined to seek treatment sooner likely owing to mild disease severity. Our results inform that distance traveled by patients is not a limitation for UNE treatment. Older individuals are at increased risk of severe disease and can benefit from early referral and treatment.

LEVEL OF EVIDENCE: Therapeutic, Level 1.

TRIAL REGISTRATION: ClinicalTrials.gov (https://clinicaltrials.gov/): NCT04254185, Date 1/31/2020.

PMID:40991254 | DOI:10.1097/PRS.0000000000012472

J Clin Hypertens (Greenwich). 2025 Sep;27(9):e70155. doi: 10.1111/jch.70155.

ABSTRACT

This systematic review and meta-analysis evaluated the efficacy and safety of lorundrostat in adults with uncontrolled hypertension. Following PRISMA guidelines and PROSPERO registration (CRD420251088503), five databases were systematically searched through July 2025 for randomized controlled trials comparing lorundrostat with placebo in this population. The primary outcome was change in systolic blood pressure (SBP), while secondary outcomes included diastolic blood pressure, severe BP events, and adverse effects. Three RCTs comprising 1568 participants across 10 study arms were included. Lorundrostat significantly reduced 24-h ambulatory SBP (mean difference [MD]: -7.45 mmHg; 95% CI: -12.54 to -2.36; p = 0.0041; p² = 0%) and diastolic BP (MD: -3.49 mmHg; 95% CI: -5.56 to -1.41; p = 0.0010; I² = 0%). While office SBP showed a non-significant reduction in the primary analysis (MD: -13.55 mmHg; p = 0.077; I² = 94%), it became statistically significant in a sensitivity analysis (MD: -9.08 mmHg; p < 0.0001). Lorundrostat also significantly lowered the risk of severely elevated BP events (odds ratio [OR]: 0.37; 95% CI: 0.17-0.81; p = 0.028). Adverse effects included an increased risk of hyperkalemia (OR: 3.22; p < 0.001) and hyponatremia (OR: 2.16; p = 0.037), with no significant difference in serious adverse events between groups. In conclusion, lorundrostat demonstrates significant reductions in both ambulatory and diastolic BP in patients with uncontrolled hypertension, with a generally tolerable safety profile. Hyperkalemia and hyponatremia remain notable risks. Further long-term trials are warranted to validate its sustained efficacy and safety.

PMID:40991241 | DOI:10.1111/jch.70155

J Clin Hypertens (Greenwich). 2025 Sep;27(9):e70153. doi: 10.1111/jch.70153.

ABSTRACT

Hypertension (HTN) is the leading cause of death worldwide, yet only 8% of individuals have controlled blood pressure (BP) in low- and middle-income countries, with particular challenges in humanitarian crisis settings including Haiti. The Haiti Cardiovascular Disease Cohort, an observational population-based cohort in Port-au-Prince, offers a unique opportunity to evaluate the HTN Care Continuum in a setting of extreme poverty and civil unrest. From 2019 to 2021, 3005 adults were enrolled, with BP measured every 6 months and free clinical care provided. HTN was defined as SBP ≥ 140, DBP ≥ 90, or antihypertensive medication use. We assessed screening, awareness, treatment, and BP control (BP < 140/90 on antihypertensives) at enrollment and 24 months. Multivariable Poisson regression identified sociodemographic factors associated with BP control. Of 3005 adults, 878 had HTN at enrollment (median age 57; 62% female; 71% earned < $1/day). Among 568 hypertensive participants with 24-month follow-up, awareness increased from 67% to 95%, treatment from 40% to 71%, and BP control from 11% to 32%. Median BP decreased from 150/91 to 138/82 mmHg. Across visits, 67% had ≥ 1 controlled BP and 35% had control at more than half of visits. Younger age (18-39 vs. ≥60 years) was associated with lower BP control (PR: 0.40, 95% CI: 0.18-0.77). Substantial improvements in HTN care, including a threefold rise in BP control and a mean SBP decrease of 12 mmHg, are achievable even in settings of extreme adversity and humanitarian crises. Trial Registration: ClinicalTrials.gov identifier: NCT03892265.

PMID:40991240 | DOI:10.1111/jch.70153

Br Poult Sci. 2025 Sep 24:1-8. doi: 10.1080/00071668.2025.2527227. Online ahead of print.

ABSTRACT

1. Liver-enriched antimicrobial peptide 2 (LEAP2), ghrelin and growth hormone secretagogue receptor (GHSR) are critical components of the appetite regulation system. This study analysed changes in LEAP2-ghrelin-GHSR expression across diverse feeding conditions and body weights in adult broilers and investigated the effects of intraperitoneally injected LEAP2 and ghrelin peptides on the feed intake of chicks.2. In adult broilers, the expression of LEAP2 in the liver and intestine exhibited significant variations under different feeding conditions (fed, fasting and refeeding), with a notable reduction observed during fasting. Compared to the fed group, proventriculus ghrelin and hypothalamus GHSR gene expression doubled, but was not statistically significant. Serum analyses revealed that fasting significantly decreased LEAP2 levels relative to the fed state and a significant negative correlation was identified between LEAP2 levels and body weight in fasting chickens. Conversely, ghrelin levels remained stable irrespective of feeding states and showed no correlation with body weight.3. Intraperitoneal injection of LEAP2 mature peptide, comprising the N-terminal 14 amino acids significantly reduced feed intake of chicks within the initial 4 h. In contrast, ghrelin injection resulted in a decrease in feed intake during the first 30 min. However, prior administration of ghrelin followed by LEAP2 mitigated the suppressive effect of ghrelin on feed intake within this timeframe.4. This study demonstrated that chicken LEAP2 gives a more sensitive feedback factor than ghrelin under different feeding conditions in adult broilers. It revealed that LEAP2 in a chick model modulated feed intake. These findings provide a theoretical basis for exploring the underlying mechanisms of LEAP2-mediated feed intake regulation in poultry.

PMID:40991231 | DOI:10.1080/00071668.2025.2527227

Indian J Med Res. 2025 Jul;162(1):111-116. doi: 10.25259/IJMR_355_2025.

ABSTRACT

Background & objectives Non-neoplastic diseases make a considerable part of daily workload of gastroenterologist and an endoscopist. As there are only a few endoscopic findings in literature to suggest a large era of colonic diseases, endoscopic biopsy is a must, to reach a definitive diagnosis. This needs a checklist or a similar format that contains all the important histological features to be seen in a colonic biopsy which is currently lacking in published literature. Hence, this study aimed to develop a format for reporting endoscopic colonic biopsies a first of a kind as per our knowledge particularly for non-neoplastic colonic diseases using modified kappa statistics. Methods Seventy one questions were included in this format after searching in various search engines using various phrases. These questions were reviewed by experts and changes were done accordingly. The finalized questionnaire was further shared with 20 subject matter experts. Their feedback was utilized to determine the Content Validity Index (CVI), calculated at both the item level (I-CVI) and the overall scale level (S-CVI), along with the modified kappa coefficient. For studies involving more than six experts, an I-CVI of 0.78 and an S-CVI/average of 0.9 were considered acceptable benchmarks. Results Fourteen out of 20 experts responded. Mean I-CVI for relevance across all items was 0.933, S-CVI/Average (based on proportion data) across all experts was 0.94 and Mean I-CVI was well above 0.78 (0.928). Interpretation & conclusions The scores indicated a strong agreement among experts on various histological features to be seen in an endoscopic colonic biopsy. These findings clearly indicates that the format met the content validity criteria and hence histological sections of endoscopic colonic biopsies can be read using this format.

PMID:40991214 | DOI:10.25259/IJMR_355_2025

Indian J Med Res. 2025 Jul;162(1):117-123. doi: 10.25259/IJMR_827_2024.

ABSTRACT

Background & objectives This study compared the effectiveness of Progressive Muscle relaxation technique (PMRT) and Spinal Muscle Training (SMT) against Standard Neurosurgical Care (SNC) for the management of post-acute-COVID-19 syndrome (PACS)-associated paraspinal myalgia (PM), via changes in serum interleukin (IL)-17 and functional independence measured by Katz index of activities of daily living (ADL). Methods Male manual labourers aged 40-50 yr with PACS-associated PM were enrolled and allocated to the experimental group receiving PMRT and SMT and the control group receiving SNC delivered via telerehabilitation over 12 wk. IL-17 and ADL were measured pre- and post-intervention. Data analysis involved paired and unpaired t-tests, with a P value < 0.05 being statistically significant. Results There was a notable decrease in IL-17 in the experimental and control groups, from (31.13±3.68 pg/mL) to (18.96±2.56 pg/mL) and (31.05±4.24 pg/mL) to (28.89±4.58 pg/mL), respectively. The experimental group’s ADL scores increased from 2.93±0.94 to 5.03±0.85, while the control improved from 2.5±1.13 to 3.53±1.04. The experimental intervention was supported by large effect sizes and statistically significant differences in IL-17 reduction and ADL improvement on inter-group comparisons. Interpretation & conclusions The combination of PMRT and SMT was significantly efficacious than SNC at lowering systemic inflammation and improving functional independence in PACS patients with PM. This study also highlighted the role of telerehabilitation in intervention delivery to socio-demographically limited populations. Future studies should investigate long-term effects and generalizability to larger populations.

PMID:40991213 | DOI:10.25259/IJMR_827_2024