Category: Nevin Manimala

Diagn Cytopathol. 2025 Sep 21. doi: 10.1002/dc.70025. Online ahead of print.

ABSTRACT

BACKGROUND: Although core needle biopsy is widely preferred for evaluating renal lesions, fine needle aspiration (FNA) combined with rapid on-site evaluation (ROSE) remains a valuable diagnostic method in selected cases. This study aims to assess the diagnostic efficacy of renal FNA and highlight the impact of ROSE on achieving definitive diagnoses.

METHODS: This retrospective study included 273 patients who underwent ultrasound- or CT-guided FNA for renal lesions between 2010 and 2018 at Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine. Lesions were evaluated based on size, radiologic features, localization, ROSE status, and number of smears. Cytopathological results were categorized as nondiagnostic, limited, non-neoplastic, or neoplastic. Histopathological correlation was assessed in available cases. Statistical analyses were performed using SPSS v25.0, with p < 0.05 considered significant.

RESULTS: Of the 273 cases, 218 (79.8%) yielded diagnostic results. Definitive diagnosis rates increased with lesion size and were significantly higher in solid (86.3%) and mixed (91.4%) lesions compared to cystic lesions (60%) (p = 0.001). ROSE was performed in 177 cases, significantly improving diagnostic yield compared to cases without ROSE (85.8% vs. 68.7%, p = 0.001). Histopathological follow-up was available in 119 cases, with an overall cytological-histological concordance of 84%, reaching 98% in cases with adequate material.

CONCLUSION: Renal FNA remains a reliable and accurate diagnostic method when combined with ROSE, especially in well-sampled cases. It aids in identifying both primary and metastatic tumors and can guide clinical decision-making, particularly when surgery is not feasible.

PMID:40975883 | DOI:10.1002/dc.70025

J Eval Clin Pract. 2025 Sep;31(6):e70279. doi: 10.1111/jep.70279.

ABSTRACT

BACKGROUND: Older populations are prone to various chronic diseases and takes polypharmacy, which can lead to potentially inappropriate medications (PIMs), causing several complications. This research aimed to estimate PIMs and potential prescribing omissions (PPOs) in older adults via the STOPP/START criteria, version 3.

METHODS: This multicentric retrospective observational study was executed among subjects aged ≥ 65 years, who were hospitalized at two Ministry hospitals from July 2023 to June 2024. The medicines of the geriatric population were assessed for PIMs/PPOs via the STOPP/START criteria, version 3. The data were scrutinized via SPPSS 27. Descriptive statistics were performed for qualitative and quantitative data. Multinomial logistic regression was applied to evaluate the effects of sex, age, comorbidities and medicines on PIMs and PPOs. Multiple linear regression analysis was conducted to evaluate potential multicollinearity among the predictors associated with PIMs and PPOs.

RESULTS: In total, 385 subjects were included in this study. The participants’ mean age was 75.7 ± 8.76 years and 50.13% were male. Among the study population, 48.83% had potentially inappropriate prescriptions, 37.66% with PIMs and 20.52% with PPOs. In total, 190 PIMs and 108 PPOs were identified, and the most frequently prescribed PIM was calcium channel blockers (20%). Comorbidities were significantly associated with PIMs and PPOs.

CONCLUSION: Overall, 48.83% of the prescriptions were potentially inappropriate. The percentage of PIMs/PPOs is lower in our population than in previous versions of the STOPP/START criteria. However, scheduled audits should be performed to keep the PIMs/PPOs at the lowest range. A comprehensive list of medications that are appropriate or inappropriate for use in older adults should be established, and prescribers should consult this list before prescribing to help prevent potentially inappropriate prescriptions.

PMID:40975859 | DOI:10.1111/jep.70279

Matern Child Nutr. 2025 Sep 21:e70108. doi: 10.1111/mcn.70108. Online ahead of print.

ABSTRACT

We evaluated the association between the inflammatory potential of the maternal diet during pregnancy and levels of inflammatory biomarkers measured in cord blood and maternal serum at birth. Dietary inflammatory potential was calculated using the energy-adjusted dietary inflammatory index (E-DII) in the French EDEN and ELFE birth cohorts. Biomarkers of inflammation (interleukin [IL]-1β, IL-6, IL-10, tumor necrosis factor α [TNF-α]) were measured from cord blood (EDEN [n = 758]; ELFE [n = 899]) and maternal serum (in ELFE only; [n = 911]) collected at birth. Additionally, leptin was also measured from cord blood in EDEN (n = 1202) and C-reactive protein was measured from cord blood in ELFE (n = 895). Linear regression models, adjusted for confounders, were used to investigate the association between tertiles of the E-DII score and each log-transformed biomarker. There were no significant associations between the E-DII score and maternal or cord blood biomarkers in either cohort. The energy-adjusted dietary inflammatory index score during pregnancy was not associated with concentrations of inflammatory biomarkers in either maternal serum or cord blood at birth.

PMID:40975853 | DOI:10.1111/mcn.70108

J Eval Clin Pract. 2025 Sep;31(6):e70278. doi: 10.1111/jep.70278.

ABSTRACT

BACKGROUND: Nonattendance at new patient appointments leads to missed opportunities for engagement in care, lost revenue, and suboptimal resource utilization.

OBJECTIVE: To assess the effectiveness of outreach calls to new patients, prioritized by a no-show predictive algorithm and conducted by volunteers, on visit attendance.

DESIGN: Rapid randomized quality improvement project.

PARTICIPANTS: Patients with new patient appointments at an urban safety-net adult primary care clinic scheduled to occur between August 1, 2024 and September 30, 2024.

INTERVENTION: Estimated probability of visit no-show for patients was calculated using a predictive algorithm embedded in the electronic health record and used to sort lists of patients with upcoming appointments. Every other patient received an outreach call from a trained volunteer within 3 business days of their appointment plus usual automated reminder messages versus usual automated reminder messages alone.

MAIN MEASURES: New patient visit attendance compared between intervention and control groups. We conducted subgroup analyses of attendance by visit modality (in-person vs. telehealth), preferred language, and quartile of predicted no-show probability.

KEY RESULTS: Patients in the intervention group (n = 281) had higher visit attendance than those in the control group (n = 280): 68.0% versus 54.1% (p < 0.01). There was a significant difference in attendance for in-person (70.7% vs. 51.7%; p < 0.01) but not telehealth (60.6% vs. 61.2%; p = 0.94) visits. Patients who preferred English had the biggest increase in attendance (17.2%; p < 0.01). Patients in the second and third quartiles of predicted no-show probability (31%-38% and 39%-45% predicted probability) had the biggest increases in attendance (22.2% [p = 0.01] and 15.4% [p = 0.05]).

CONCLUSIONS: Outreach calls for new patients, prioritized by a no-show predictive algorithm and conducted by volunteers, can be a feasible and effective approach to improving visit attendance in a targeted fashion. Further investigation is needed to understand how to better support non-English preferring patients and patients with telehealth appointments.

PMID:40975847 | DOI:10.1111/jep.70278

Int Urol Nephrol. 2025 Sep 21. doi: 10.1007/s11255-025-04795-6. Online ahead of print.

ABSTRACT

BACKGROUND: Peritoneal dialysis-associated peritonitis (PDAP) remains a major complication in patients undergoing peritoneal dialysis (PD), often leading to technique failure, hospitalization, and increased mortality. This study aims to systematically evaluate and compare existing risk prediction models for PDAP and quantify their overall performance and key predictors.

METHODS: Following PRISMA guidelines, eight databases were systematically searched including PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Journal Database (VIP), Wanfang, and SinoMed, covering literature from their inception to March 19, 2025. Data extraction focused on study design, participant characteristics, sample size, outcome definitions, predictors, and model performance. The bias risk assessment tool for prediction model studies (PROBAST) was employed to assess bias risk and applicability, while Stata 17.0 facilitated meta-analysis.

RESULTS: Eleven studies involving 11 logistic regression models were included. The reported area under the curve (AUC) values ranged from 0.659 to 0.997, with a combined AUC of 0.88 (95% CI 0.83-0.93), indicating robust predictive performance. Four predictors associated with peritonitis were albumin (Alb) (OR = 0.672; 95% CI 0.475-0.868; P < 0.001), C-reactive protein (CRP) (OR = 2.568; 95% CI 1.081-4.055; P < 0.001), neutrophil-to-lymphocyte ratio (NLR) (OR = 1.377; 95% CI 1.065-1.689; P < 0.001), and diabetes mellitus (DM) (OR = 3.549; 95% CI 1.272-5.825; P < 0.002).

CONCLUSIONS: Despite demonstrating strong predictive capabilities, the models exhibited high bias risks, primarily due to data sources and statistical methods. Future research should prioritize large-scale, multicenter studies with rigorous designs and external validation to enhance reliability and clinical applicability.

PMID:40975843 | DOI:10.1007/s11255-025-04795-6

J Eval Clin Pract. 2025 Sep;31(6):e70276. doi: 10.1111/jep.70276.

ABSTRACT

BACKGROUND: Although testimonies of devastating impacts of care delivered in nondesignated hospital areas (corridor care) are mounting, there is a paucity of quantitative data. This study aimed to assess the associations between: (1) care in nondesignated areas and key performance indicators (KPIs), including ward moves and length of stay (LOS); and (2) between KPIs and mortality.

METHODS: Data from this cross-sectional study were derived from the National Hip Fracture Database audit programme (a quality-improvement initiative commissioned by the Healthcare Quality Improvement Partnership, NHS England). In total, 508 patients (65% women) consecutively admitted with hip fractures (January 2024-January 2025) were included. The duration (h:min) of care in nondesignated areas was categorised by tertiles (< 1:20; 1:20-4:20; > 4:20). Associations between variables were determined by logistic regression, presented as odds ratios (OR) and 95% confidence intervals.

RESULTS: Patients cared for in nondesignated areas (11%) and bed care patients (89%) had similar clinical characteristics (median age = 85.5 years). Care in nondesignated areas varied inversely with seasonal average local temperatures: 10.7% in summer (22.5°C), 19.6% autumn (15.9°C), 44.6% winter (8.6°C), and 25.0% spring (14.9°C), which was more discernible than the corresponding distribution of bed care: 21.2%, 23.7%, 25.9% and 29.2%. Compared with bed care patients, those cared for in nondesignated areas for ≥ 1 h:20 min were associated with ≥ 3 ward moves: OR = 4.02 (1.61-10.06). LOS on orthogeriatric wards for bed care patients was 13.4 days, and care in nondesignated areas > 4 h:20 min was 17.2 days, which increased to 19.7 days for all patients cared for in nondesignated areas with ≥ 3 ward moves. In turn, higher in-hospital mortality was associated with multiple ward moves: OR = 2.63 (1.23-5.66) and prolonged LOS: OR = 3.23 (1.53-6.81).

CONCLUSIONS: The impact of care delivered in nondesignated areas exposed by KPIs is consistent with testimonies from patients and NHS staff. This evidence serves as a stimulus to take urgent action to abolish care in nondesignated areas.

PMID:40975842 | DOI:10.1111/jep.70276

Community Dent Health. 2025 Sep 21:265539X251381496. doi: 10.1177/0265539X251381496. Online ahead of print.

ABSTRACT

Genome-Wide Association Studies (GWAS) are the primary method used to investigate the effects of common genetic variants on health and disease and are increasingly used as an arena for applied epidemiological methods. There are now a growing number of applications of GWAS in oral health research, yielding exciting findings and holding great potential for future discoveries. While exciting, the GWAS approach has inherent limitations, and the success of these experiments depends on achieving adequate statistical power. In the context of dental diseases, where multiple genetic variants have small effects, very large samples are needed to unlock the full potential of GWAS. This article discusses the motivation for undertaking these studies, introduces the GWAS method, and highlights the potential of GWAS to help unravel the complex factors influencing oral health and diseases. Alongside the promises of GWAS, this article also summarizes the key challenges that need to be addressed for this method to be deployed usefully and suggests criteria to consider during the appraisal of a GWAS paper.

PMID:40975827 | DOI:10.1177/0265539X251381496

Hand (N Y). 2025 Sep 21:15589447251369034. doi: 10.1177/15589447251369034. Online ahead of print.

ABSTRACT

BACKGROUND: Brief electrical stimulation (ES) of injured peripheral nerves for 1 hour has been shown to accelerate nerve regeneration with proximal action potential conduction to the neuron cell body, a requirement to elicit therapeutic benefit. Local anesthetic is often used to manage pain in patients. However, using lidocaine after ES therapy has been controversial. We assessed the effects of extraneural usage of lidocaine after ES therapy on nerve regeneration in a rodent nerve injury model.

METHODS: Lewis rats underwent tibial nerve transection and immediate repair and randomized to 4 groups: control (REP), extraneural lidocaine alone (REP + LIDO), 60-minute ES (60 ES), and 60-minute ES with extraneural lidocaine (60 ES + LIDO). The tibial nerve was retrograde labeled distally from the neurorrhaphy 28 days post repair. Spinal cords and dorsal root ganglia were harvested to assess motor and sensory neuron counts. Data were analyzed using 1-way analysis of variance (ANOVA) with a post-hoc Tukey correction.

RESULTS: Using lidocaine after nerve repair did not affect nerve regeneration in the control group (REP vs REP + LIDO) or ES group (60 ES vs 60 ES + LIDO), with motor and sensory neuron counts not statistically different between groups. Electrical stimulation therapy showed at least a 60% increase in motor and sensory neuron counts than controls, a statistically significant effect (P < .001).

CONCLUSIONS: Extraneural usage of lidocaine after ES does not abolish the improved effect of ES on nerve regeneration. Future clinical studies should evaluate the usage of subcutaneous injection of lidocaine post ES for analgesia control.

PMID:40975801 | DOI:10.1177/15589447251369034

Ann Pharmacother. 2025 Sep 21:10600280251368386. doi: 10.1177/10600280251368386. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of the study was to review acoramidis, a new transthyretin stabilizer, for treatment of transthyretin amyloid cardiomyopathy by means of pharmacology, efficacy, and safety.

DATA SOURCES: An Embase, PubMed, and ClinicalTrials.gov search was conducted using the keywords acoramidis, Attruby, and AG10.

STUDY SELECTION AND DATA EXTRACTION: We included full-text, English-language studies that evaluated the pharmacology, efficacy, and safety of acoramidis in transthyretin amyloid cardiomyopathy.

DATA SYNTHESIS: Acoramidis slows or halts the accumulation of amyloid deposits in the heart by binding to the thyroxine-binding sites on the tetrameric transthyretin (TTR) protein preventing the TTR tetramer from dissociating into monomers. Acoramidis did not achieve statistical significance in terms of mortality reduction, but it outperformed placebo with respect to death from any cause, cardiovascular-related hospitalization, change in N-terminal pro-B-type natriuretic peptide, and change in 6-minute walk distance. In addition, by the end of the phase II clinical trial all acoramidis-treated patients achieved normal serum TTR concentrations. The overall incidence of subjects who experienced any treatment-emergent adverse events was similar between the acoramidis and placebo groups.Relevance to patient care and clinical practice in comparison to existing drugs:Acoramidis is the second TTR stabilizer approved for the treatment of transthyretin amyloid cardiomyopathy (ATTR-CM). Each medication to manage ATTR-CM similarly decreases the combined endpoints of all-cause mortality and progression of heart failure symptoms, when adjusted for risk factors. However, its place in therapy remains unclear among the treatment options for the management of ATTR-CM due to the lack of head-to-head trials.

CONCLUSIONS: Acoramidis is an effective and safe medication for the treatment of transthyretin amyloidosis cardiomyopathy.

PMID:40975800 | DOI:10.1177/10600280251368386

Ann Pharmacother. 2025 Sep 21:10600280251367432. doi: 10.1177/10600280251367432. Online ahead of print.

ABSTRACT

INTRODUCTION: While consensus guidelines exist for phenotype-guided proton pump inhibitor (PPI) dosing in Helicobacter pylori infection, the impact in gastroesophageal reflux disease (GERD) treatment in a real-world setting is unknown. The study aims were to determine whether CYP2C19 rapid metabolizers (RMs) and ultrarapid metabolizers (UMs) have higher PPI doses and more treatment failures than normal metabolizers (NMs) in the treatment of GERD.

METHODS: In this retrospective chart review, adults with pharmacogenetic (PGx) testing results at the study center and treated with PPI therapy for GERD were included for enrollment into 1 of 3 cohorts: CYP2C19 UM, RM, and NM. Pertinent baseline characteristics collected were age, body mass index, tobacco, and alcohol history. The primary outcome was the comparison of total daily omeprazole equivalents (OEs) of the highest prescribed PPI dose. Secondary outcomes included incidence of upper gastrointestinal bleed (UGIB) and historical trials of PPIs, histamine-2 blockers, antacids, sucralfate, and prokinetics. Continuous outcomes were compared with one-way analysis of variance, and nominal outcomes were compared with a χ² in RStudio.

RESULTS: There were 48 UM, 298 RM, and 432 NM that met study inclusion. Baseline characteristics were similar across cohorts. Mean total OE did not differ between groups: UM 41.6 mg, RM 40.1 mg, NM 38.5 mg (P = 0.52). There were no differences seen among individual gastric agents or mean total number of historical gastric medications trialed: UM 2.5, RM 2.4, NM 2.3 (P = 0.17) medications. The incidence of UGIB was not statistically different between cohorts: UM 12.5%, RM 12.8%, NM 9.3% (P = 0.13).

CONCLUSION AND RELEVANCE: There was no association between CYP2C19 phenotype and historical medication prescribing for GERD.

PMID:40975799 | DOI:10.1177/10600280251367432