Category: Nevin Manimala

Echo Res Pract. 2025 Aug 4;12(1):19. doi: 10.1186/s44156-025-00086-z.

ABSTRACT

BACKGROUND: Transthoracic echocardiography (TTE) is used to assess aortic stenosis (AS) severity and track disease progression. As the field moves to study medical therapies to halt disease progression, reliable non-invasive imaging markers that are sensitive to small changes in disease progression are needed to enable efficient trial designs. The signal-to-noise ratio of commonly obtained TTE-based measures of progressive (non-severe) AS severity is unknown.

METHODS: This is a retrospective study of TTEs done at a tertiary referral centre (Tufts Medical Center, Boston MA). A cohort of patients with progressive AS who had two TTEs done within 30 days (in the absence of valve intervention) and a cohort of progressive AS patients with TTEs ≥ 1 year apart, also without valvular intervention, were assembled. Limits of agreement (LOA) and intraclass correlation (ICC) were calculated for aortic valve area (AVA) by continuity equation, peak velocity, and mean gradient. Cohen’s d-statistic (d) was calculated for each hemodynamic assessment and a composite marker to assess sensitivity for detecting disease progression normalised to measurement variability.

RESULTS: The reproducibility cohort included 24 patients. The progression cohort included 35 patients. The median age was 70 years (interquartile range [IQR] 13). 22 patients (37.3%) were female. In the progression cohort, the median time between TTEs was 2.2 years (IQR 3.1 years). In the reproducibility cohort, AVA LOA were -0.7 to 0.8, ICC = 0.61; peak velocity LOA were -149.0 to + 126.7, ICC = 0.29; and mean gradient LOA were -16.2 to 12.2, ICC = 0.06. The d-statistic for annualised change in AVA was -0.29, the d-statistic for annualised change in maximum velocity was 0.46, the d-statistic for mean gradient was 0.55. The d-statistic for a composite, including all three hemodynamic markers, was 0.45.

CONCLUSIONS: Standard TTE markers of AS severity have variable sensitivity for detecting AS progression. For patients with progressive (non-severe) AS, mean gradient has the highest signal-to-noise ratio and may be the most reliable TTE-based assessment of disease progression.

PMID:40754590 | DOI:10.1186/s44156-025-00086-z

J Health Popul Nutr. 2025 Aug 3;44(1):275. doi: 10.1186/s41043-025-01032-9.

ABSTRACT

BACKGROUND: Magnesium, an essential dietary trace element, plays a crucial role in numerous physiological processes, and its deficiency has been associated with the development of hyperlipidemia. However, its potential to predict long-term outcomes and inform risk stratification in hyperlipidemic patients remains underexplored.

METHODS: This retrospective cohort study introduces the magnesium depletion score (MgDS), a novel index for quantifying magnesium deficiency, and investigates its association with mortality outcomes in individuals with hyperlipidemia. Data from 12,592 participants in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 were analyzed. Advanced statistical methods, including weighted Cox proportional hazards models, restricted cubic spline (RCS) analysis, Kaplan-Meier survival curves, and receiver operating characteristic (ROC) analysis, were employed to assess the association between MgDS and mortality risks.

RESULTS: The results indicate that higher MgDS is significantly associated with increased risks of both all-cause and cardiovascular mortality in individuals with hyperlipidemia, even after adjusting for confounders. Subgroup analyses identified prediabetes, smoking, and alcohol consumption as significant modifiers of this association. RCS analysis confirmed a linear relationship between MgDS and mortality, further supporting its value as a reliable predictor of long-term outcomes. ROC analysis demonstrated the potential of MgDS as an independent tool for predicting mortality at 1, 3, and 5 years. Notably, high MgDS levels in hyperlipidemic individuals with binge drinking habits were associated with significantly higher mortality risks.

CONCLUSIONS: These results establish MgDS as a promising biomarker for mortality risk stratification in patients with hyperlipidemia. This novel index offers important insights for clinical practice and could facilitate the development of tailored management strategies, particularly for high-risk hyperlipidemia populations, to mitigate long-term health risks.

PMID:40754582 | DOI:10.1186/s41043-025-01032-9

Light Sci Appl. 2025 Aug 4;14(1):259. doi: 10.1038/s41377-025-01914-x.

ABSTRACT

The photo-kinetics of fluorescent molecules have enabled the circumvention of the far-field optical diffraction limit. Despite its enormous potential, the necessity to label the sample may adversely influence the delicate biology under investigation. Thus, continued development efforts are needed to surpass the far-field label-free diffraction barrier. The statistical similarity or finite coherence of the scattered light off the sample in label-free mode hinders the application of existing super-resolution methods based on incoherent fluorescence imaging. In this article, we present physics and propose a methodology to circumvent this challenge by exploiting the photoluminescence (PL) of silicon nitride waveguides for near-field illumination of unlabeled samples. The technique is abbreviated EPSLON, Evanescently decaying Photoluminescence Scattering enables Label-free Optical Nanoscopy. We demonstrate that such an illumination has properties that mimic the photo-kinetics of nano-sized fluorescent molecules, i.e., such an illumination permits incoherence between the scattered fields from various locations on the sample plane. Thus, the illumination scheme enables the development of a far-field label-free incoherent imaging system that is linear in intensity and stable over time, thereby permitting the application of techniques like structured illumination microscopy (SIM) and intensity-fluctuation-based optical nanoscopy (IFON) in label-free mode to circumvent the diffraction limit. In this proof-of-concept work, we observed a two-point resolution of ~ 180 nm on super-resolved nanobeads and resolution improvements between 1.9× to 2.8× over the diffraction limit, as quantified using Fourier Ring Correlation (FRC), on various biological samples. We believe EPSLON is a step forward within the field of incoherent far-field label-free super-resolution microscopy that holds a key to investigating biological systems in their natural state without the need for exogenous labels.

PMID:40754581 | DOI:10.1038/s41377-025-01914-x

Trop Dis Travel Med Vaccines. 2025 Aug 4;11(1):24. doi: 10.1186/s40794-025-00260-5.

ABSTRACT

INTRODUCTION: Enteric diseases are a leading cause of mortality in developing countries, yet are highly preventable. Typhoid vaccines remain underutilized, and diagnostic capacity constraints impede treatment and prevention. Wastewater monitoring could provide a more accurate picture of disease burden if detection and quantification of Salmonella Typhi in wastewater are advanced. To motivate why countries should invest to improve wastewater testing methods, we conducted a cost-benefit analysis, quantifying the value this approach could yield.

METHODS: We estimated benefits that could accrue if wastewater data informed the early launch of a theoretical typhoid vaccine campaign in Cox’s Bazar, Bangladesh. After empirically estimating the lead-time advantage of wastewater data over clinical data to flag case upticks, we simulated changes in case counts from a 1- to 14-day early campaign launch, using ordinary differential equation modeling. We quantified benefits resulting from averted cases (from preserved caregiver time, school days, and wages), hospitalizations (from savings to public funds), and deaths (using the value of statistical life). We then calculated how cumulative benefits, costs, and the ratio of the two varied by campaign launch timing scenario over a five-year period.

RESULTS: Wastewater concentrations of Salmonella Typhi upticked up to 13 days before case counts. Cumulative benefits varied by year and launch timing. With a 13-day early launch, every $100 spent on wastewater monitoring could yield $295 in societal benefits by year 5. Cumulative benefits roughly equaled cumulative costs with a 5-day early launch and outweighed costs when the campaign was launched even earlier.

CONCLUSION: If wastewater data can be advanced to reliably provide early warnings of new typhoid outbreaks, governments could reap large benefits that more than justify spending on program implementation. Our findings could generalize to other high-aid countries that, like Bangladesh, experience routine enteric disease outbreaks and have strong operational networks.

PMID:40754580 | DOI:10.1186/s40794-025-00260-5

BMC Med. 2025 Aug 4;23(1):453. doi: 10.1186/s12916-025-04249-x.

ABSTRACT

BACKGROUND: With respiratory syncytial virus vaccines recently approved for use among older adults, country-level respiratory syncytial virus (RSV) disease burden estimates are needed to inform local RSV immunisation strategy. We aimed to estimate country-level RSV hospitalisation burden in older adults in Europe.

METHODS: We compiled data on RSV hospitalisation burden in adults aged ≥ 60 years in Europe from published studies (systematic review: PROSPERO CRD42024516945), surveillance data, and unpublished data from international collaborators. We adjusted for diagnostic testing, clinical specimens, and case definitions through statistical modelling techniques and generated country-level hospitalisation rate estimates; for countries with no available data, we developed an ensemble model to predict RSV hospitalisation rates. We also estimated RSV in-hospital case fatality ratio (hCFR) for countries with available data.

RESULTS: We included 14 studies (3 unpublished studies). The adjusted RSV-associated hospitalisation rates were overall 2.2 to 6.4 times higher than unadjusted estimates. Among 5 countries with available data, adjusted annual RSV hospitalisation rates ranged from 193/100,000 person-years in the Netherlands (95% confidence interval [CI]: 125-304) and Finland (141-274) to 414/100,000 in Denmark (322-514). The RSV hospitalisation rates predicted by the ensemble model in 23 additional countries ranged from 223/100,000 to 317/100,000 person-years. RSV hCFR ranged from 6.73% (4.63-9.69) in Spain to 10.14% (4.91-19.79) in Switzerland.

CONCLUSIONS: This study addresses knowledge gaps in RSV hospitalisation burden among older adults in Europe while highlighting the importance of adjusting for RSV case under-ascertainment. These findings might be relevant for country’s considerations of RSV immunisation strategies for older adults.

PMID:40754579 | DOI:10.1186/s12916-025-04249-x

BMC Med. 2025 Aug 4;23(1):454. doi: 10.1186/s12916-025-04257-x.

ABSTRACT

BACKGROUND: Ensuring adherence to clinical practice guidelines (CPGs) is critical for improving patient outcomes. However, how the impact of guideline adherence on clinical outcomes is studied remains unclear. Our objectives are (1) to identify studies that assess the impact of adherence to CPGs; (2) to describe the research questions of these studies; and (3) to describe their study designs, methods, and reporting. We focused on CPGs addressing the pharmacologic management of major chronic diseases, specifically musculoskeletal diseases (rheumatoid arthritis, osteoarthritis, axial spondyloarthritis, and psoriatic arthritis), diabetes, and hypertension.

METHODS: We conducted a scoping review. We searched PubMed on March 3, 2023, for studies published since 2013. We included studies assessing the impact of adherence to CPGs for the pharmacologic management of adult patients. One reviewer screened the titles and abstracts and full texts and a second reviewer independently screened 20%. Two reviewers independently extracted data using a standardized pilot-tested data extraction form. Data were analyzed descriptively.

RESULTS: Of 7952 records retrieved, 16 studies were eligible for inclusion. The studies addressed CPGs for the management of diabetes (n = 8), hypertension (n = 6), and axial spondyloarthritis (n = 2). All studies were cohort studies, but none emulated a target trial. The median number of participants analyzed was 511 (IQR 350; 10,536) and the median follow-up time was 9 months (IQR 4; 18). Four studies explicitly reported the recommendations for which the impact of adherence was assessed, nine precisely defined adherence, and eight studies evaluated only surrogate outcomes. Thirteen studies accounted for confounding factors. There was serious or critical risk of bias in selection of participants in 13 studies.

CONCLUSIONS: The impact of adherence to clinical practice guidelines is rarely and inadequately evaluated. Future research should employ rigorous study designs and reporting standards to generate more reliable insights into the impact of CPG adherence.

PMID:40754575 | DOI:10.1186/s12916-025-04257-x

Neurosurg Rev. 2025 Aug 4;48(1):587. doi: 10.1007/s10143-025-03713-9.

ABSTRACT

BACKGROUND AND OBJECTIVES: Elderly patients with subarachnoid hemorrhage (SAH) face a disproportionately high burden of morbidity and mortality. While endovascular coiling is often favored in this population, direct comparisons with surgical clipping are limited. We conducted a meta-analysis to compare outcomes of clipping versus coiling in SAH patients aged ≥ 60 years.

METHODS: A systematic search of PubMed, Embase, and Cochrane databases identified studies comparing the two treatments in this age group. The primary outcome was a composite of unfavorable outcomes (modified Rankin Scale [mRS] > 2 and mortality). Secondary outcomes included mortality, favorable outcome (mRS 0-2), rebleeding, and hospital length of stay. Heterogeneity was assessed using I² statistics, with subgroup analysis by age decade.

RESULTS: Twenty-seven studies (2 randomized controlled trials [RCTs]) involving 51,415 patients (59.6% treated with clipping) were included. There were no significant differences between clipping and coiling for unfavorable outcome (RR 1.03; 95% CI 0.96-1.11), favorable outcome (RR 1.02; 95% CI 0.93-1.11), mortality (RR 1.08; 95% CI 0.97-1.19), or rebleeding (RR 1.21; 95% CI 0.57-2.57). However, coiling was associated with shorter hospital stays (MD -2.53 days; 95% CI -4.58 to -0.49; p = 0.0152). RCTs showed a non-significant trend favoring coiling, while observational studies leaned toward clipping. Heterogeneity for main outcomes was moderate (I² = 57.7%). Using the GRADE framework, overall certainty of evidence was rated very low, mainly due to the predominance of non-randomized studies, moderate risk of bias, and inconsistency across studies.

CONCLUSIONS: In SAH patients aged ≥ 60 years, clipping and coiling show comparable outcomes, with coiling associated with shorter hospital stays. Given the very low certainty of evidence, these findings should be interpreted with caution. Prospective multicenter cohorts are needed to establish more definitive evidence.

PMID:40754563 | DOI:10.1007/s10143-025-03713-9

Sci Rep. 2025 Aug 3;15(1):28320. doi: 10.1038/s41598-025-14219-1.

ABSTRACT

This research seeks to explore the application value of carbon nanoparticle (CN) in transoral endoscopic thyroidectomy vestibular approach (TOETVA) with the goal of providing more reliable clinical evidence for minimally invasive treatment of thyroid cancer.A total of 110 patients with differentiated thyroid cancer (DTC) met the inclusion and exclusion criteria from September 2019 to January 2020. They were divided into an experimental group (TOETVA group) of 80 patients and a control group (OT group) of 30 patients based on their cosmetic preferences. All patients were treated with CN during surgery, and the surgeon actively selected lymph nodes and sent them separately for examination according to < 5 mm (small) and ≥ 5 mm (large), recording the number of row retrieved lymph nodes (RRLN). Routine medical examination was conducted to report the number of retrieved lymph nodes (RLN) and positive central lymph nodes (PLNs) detected one week after surgery. The positive rate (PR) of lymph nodes and the proportion of lymph node positive individuals were calculated. Compared with the control group, there was no significant difference between the experimental group and the control group in the proportion of RRLN, RLN, PLN, PR, and lymph node positivity. The differences in the number of lymph nodes of the same group: small lymph nodes have more RRLN and RLN than large lymph nodes, and the difference is statistically significant. In the experimental group, RRLN is larger than RLN, the difference is statistically significant. There is a slight difference between the control group and the experimental group, RRLN is generally higher than RLN. The lymph node clearance effect of TOETVA and OT is basically consistent. The use of CN can improve the detection rate of small lymph nodes in TOETVA, and it is recommended to use CN during the procedure.

PMID:40754562 | DOI:10.1038/s41598-025-14219-1

EJNMMI Rep. 2025 Aug 4;9(1):27. doi: 10.1186/s41824-025-00258-4.

ABSTRACT

BACKGROUND: In the last decade, immunotherapy, particularly immune checkpoint inhibitors, has revolutionized cancer treatment and improved prognosis. However, severe checkpoint inhibitor-induced liver injury (CHILI), which can lead to treatment discontinuation or death, occurs in up to 18% of the patients. The aim of this study is to evaluate the value of PET/CT radiomics analysis for the detection of CHILI.

MATERIALS AND METHODS: Patients with CHILI grade 2 or higher who underwent liver function tests and liver biopsy were retrospectively included. Minors, patients with cognitive impairments, and patients with viral infections were excluded from the study. The patients’ liver and spleen were contoured on the anonymized PET/CT imaging data, followed by radiomics feature extraction. Principal component analysis (PCA) and Bonferroni corrections were used for statistical analysis and exploration of radiomics features related to CHILI.

RESULTS: Sixteen patients were included and 110 radiomics features were extracted from PET images. Liver PCA-5 showed significance as well as one associated feature but did not remain significant after Bonferroni correction. Spleen PCA-5 differed significantly between CHILI and non-CHILI patients even after Bonferroni correction, possibly linked to the higher metabolic function of the spleen in autoimmune diseases due to the recruitment of immune cells.

CONCLUSION: This pilot study identified statistically significant differences in PET-derived radiomics features of the spleen and observable changes in the liver on PET/CT scans before and after the onset of CHILI. Identifying these features could aid in diagnosing or predicting CHILI, potentially enabling personalized treatment. Larger multicenter prospective studies are needed to confirm these findings and develop automated detection methods.

PMID:40754557 | DOI:10.1186/s41824-025-00258-4

Sci Rep. 2025 Aug 3;15(1):28330. doi: 10.1038/s41598-025-12851-5.

ABSTRACT

Cervical cancer, a leading cancer among women, is strongly associated with Human Papillomavirus infection, but host genetic factors also contribute to the progression from high-grade squamous intraepithelial lesions (HSIL) to invasive cancer. Interleukin-10 (IL-10), an immunosuppressive cytokine, may influence susceptibility to HSIL and cervical cancer through genetic variations. This study aimed to compare IL-10 gene promoter polymorphisms, -1082 A > G and – 819T > C, in women diagnosed with HSIL or cervical cancer and those with negative for intraepithelial lesion or malignancy (NILM). In this case-control study, 309 women were analyzed, including 142 with HSIL or cervical cancer and 167 controls with NILM. Blood samples were collected for DNA extraction and genotyping of polymorphisms through PCR amplification. Statistical analyses included comparisons of genotype and allele frequencies, haplotype frequency, and assessments of Hardy-Weinberg equilibrium and linkage disequilibrium. The mean age was 33.4 years for cases and 41.7 years for controls (p < 0.05). For the – 1082 A > G polymorphism, the GG genotype was significantly associated with a decreased risk of HSIL and cervical cancer (p = 0.0266, OR = 0.35). Recessive model (GG vs. AA + AG) confirmed this association (p = 0.0045, OR = 0.29). AC/GC diplotype was associated with a 2-fold increased risk of cervical lesions. Further studies are needed to confirm our results.

PMID:40754553 | DOI:10.1038/s41598-025-12851-5