Category: Nevin Manimala

JAMA Netw Open. 2025 Jul 1;8(7):e2522154. doi: 10.1001/jamanetworkopen.2025.22154.

ABSTRACT

IMPORTANCE: Historically Black Colleges and Universities (HBCUs) play a pivotal role in higher education and the physician career path in the US. Studies have highlighted the importance of HBCU medical schools in the training of Black physicians. However, little is known about the contributions of HBCU undergraduate institutions to the medical school pathway over the past 30 years.

OBJECTIVE: To describe trends in Black HBCU undergraduate students’ medical school application and acceptance rates from 1980 to 2022.

DESIGN, SETTING, AND PARTICIPANTS: This descriptive cross-sectional study analyzed data from the Association of American Medical Colleges from 1980 to 2022 on medical school applicantions and acceptances, as well as National Center for Education Statistics data on Black bachelor’s degree recipients (1990-2020). Data were analyzed from August to December 2023.

MAIN OUTCOMES AND MEASURES: The number and proportion of medical school applicants and accepted students were compared over time for Black students who completed their undergraduate training at HBCUs vs non-HBCUs.

RESULTS: The study population included 1 666 145 total applicants (754 580 female [45.3%]; 146 852 Black [8.8%]). Between 1990 and 2020, Black bachelor’s degree recipients from HBCUs increased by 50% (from 17 930 to 26 944 recipients), while those from non-HBCUs rose 271% (from 48 445 to 179 583 recipients). Black representation among medical school applicants grew from 7.2% in 1980 (2490 of 34 369 applicants) to 11.5% (5895 of 51 385 applicants) in 2022. From 1990 to 2017, Black HBCU graduates made up a higher proportion of Black medical school applicants, but from 2018 to 2020, non-HBCU graduates contributed more to the applicant pool. Throughout the study period, Black HBCU applicants had consistently lower medical school acceptance rates than their non-HBCU counterparts.

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that while HBCUs consistently produced a significant portion of Black medical school applicants, Black HBCU graduates faced lower medical school acceptance rates compared with their non-HBCU peers. Underinvestment in HBCUs and potential biases within medical school admissions may contribute to these challenges, limiting the full potential of HBCU students in diversifying the physician workforce; addressing these disparities through HBCU support, partnerships, and funding could enhance pathways to medical careers for Black students and contribute to achieving greater health equity.

PMID:40690215 | DOI:10.1001/jamanetworkopen.2025.22154

JAMA Netw Open. 2025 Jul 1;8(7):e2522203. doi: 10.1001/jamanetworkopen.2025.22203.

ABSTRACT

IMPORTANCE: The Title X Family Planning Program is a US federal grant program designed to offer comprehensive and confidential family planning and preventive health services to individuals in the US, regardless of their ability to pay. In 2019, a major change to the program-called the Final Rule-led to about 25% of participating clinics, including all Planned Parenthood affiliates, leaving the Title X program. Because Planned Parenthood of Michigan (PPMI) had served about 70% of Michigan’s Title X clients, its withdrawal from Michigan’s Title X program was anticipated to significantly alter the service coverage provided by the Title X program in the state.

OBJECTIVE: To examine the changes in geographic distribution, organizational profiles, and service delivery volumes of Title X health centers in Michigan-including those that left the program and then rejoined-before and after the implementation of the Final Rule.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included Title X-funded health centers in Michigan’s 83 counties from January 1, 2017, to December 31, 2023.

EXPOSURE: The enactment and reversal of the Title X Final Rule.

MAIN OUTCOMES AND MEASURES: Changes in service delivery volume, seen in (1) Title X penetration rate (number of unique females served at Title X-funded health centers), (2) PPMI penetration rate (number of unique females served by PPMI), and (3) reproductive health safety net penetration rate (sum of the females served by the Title X program and PPMI during the years it was excluded from Title X).

RESULTS: Title X service delivery counts decreased from 92 clinics before the implementation of the Final Rule in 2019 to 76 clinics during the Final Rule and increased to 92 after reversal of the Final Rule. Penetration rates were significantly higher before implementation of the Final Rule (incidence rate ratio [IRR], 3.98; 95% CI, 3.93-4.02) and after the Final Rule period (IRR, 2.96; 95% CI, 2.93-3.00). However, when PPMI service counts were included during the Final Rule period when PPMI was not formally part of Title X, there was considerably more stability in service delivery rates across the 3 periods (preperiod vs Final Rule period: IRR, 1.33; 95% CI 1.32-1.34; and postperiod vs Final Rule period: IRR, 0.99; 95% CI, 0.98-1.00). The mean PPMI penetration rate was only 1.41 times higher in the preperiod than in the Final Rule period (IRR, 1.41; 95% CI, 1.40-1.43).

CONCLUSIONS AND RELEVANCE: This cohort study highlights PPMI’s role in the state’s Title X program and overall reproductive health safety net. During the relatively short time the Final Rule was in place, PPMI was able to maintain service delivery, protecting the public’s health against these regulations. It is not clear if PPMI, or similar organizations, could maintain service delivery over a longer period.

PMID:40690214 | DOI:10.1001/jamanetworkopen.2025.22203

Acta Oncol. 2025 Jul 21;64:894-901. doi: 10.2340/1651-226X.2025.43700.

ABSTRACT

INTRODUCTION: The purpose of this study is to present the nationwide disease burden and survival of nasopharyngeal carcinoma (NPC) in Sweden. The subcohort from the Stockholm-Gotland region was included to investigate the prevalence of Epstein-Barr virus (EBV) in NPC and to describe pattern of relapse.

METHODS: This population-based nationwide study included patients diagnosed with NPC in Sweden during 2008-2021. The series was retrieved from the Swedish Head and Neck Cancer Register. Age at diagnosis, sex, tumor histopathology, stage, treatment intent, treatment, radiation dose, follow-up time, time to relapse, and site of relapse were recorded. The Stockholm-Gotland region series was used to obtain an updated histopathological analysis including EBV status and to analyze site of relapse.

RESULTS: The nationwide study cohort comprised 399 patients, 33% were female. Mean age at diagnosis did not differ between the sexes: 56.3 years for females, 57.5 years for males. Seventy-one percent presented with Stage III or IV. The 5-year overall survival (OS) was 73.2%. In the regional cohort, 73.9% were EBV positive. In the competing risk analysis, the cumulative incidence of distant metastatic relapse was higher than that of local and/or regional relapse at 5 years (18.7% vs. 12.4%). However, the confidence intervals were wide, and the difference should be interpreted with caution.

INTERPRETATION: The survival outcome in our study seems comparable to previous studies in nonendemic countries. There was a high percentage of EBV-positive tumors compared with the previous studies in nonendemic countries.

PMID:40690205 | DOI:10.2340/1651-226X.2025.43700

Otol Neurotol. 2025 Jun 25. doi: 10.1097/MAO.0000000000004584. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine if cochlear implant recipients who have low-frequency hearing preservation after surgery can benefit from electric-acoustic stimulation (EAS) even after a period of electric-only stimulation.

STUDY DESIGN: Prospective, crossover controlled, clinical study.

SETTING: Private practice single-specialty clinic.

PATIENTS: Patients who are native English speakers, implanted with a 28-mm lateral wall electrode, had residual low-frequency hearing post-cochlear implantation and had at least 3 months of electric-only stimulation before enrollment.

INTERVENTION: Participants were reprogrammed from electric-only stimulation to EAS-A (with electric and acoustic overlap in the preserved frequencies) for 3 months. Outcomes were measured, and then the participants were changed to EAS-B, a non-overlap program. Outcomes and the patients’ map preferences were recorded.

MAIN OUTCOME MEASURES: Speech perception for each programming strategy was measured with CNC and AzBio testing. Participants subjective performance was measured with CCIQ and APHAB testing for each modality.

RESULTS: Out of a total of 117 consecutive CI patients with preoperative low-frequency hearing thresholds of at least 65 db HL, 43 (36.8%) had at least one low-frequency threshold less than 65 dB allowing the use of EAS. Twelve participants with 16 implanted ears were enrolled and completed the study. Statistical analysis showed that participants performed significantly better (p < 0.05) on CNC words with EAS-A (overlap, 71.6%) versus electric (65.5%) or EAS-B (non-overlap, 68%). There was not a difference between the strategies on AzBio testing. The overall scores on CCIQ and APHAB were also not statistically significant. A chi-squared test was performed for subjects’ preferred programming strategy, revealing that there was a preference of the EAS strategies over electric only (p = 0.04).

CONCLUSIONS: There may be an advantage to EAS over electric-only stimulation in patients with low-frequency hearing preservation after cochlear implant even after a period of electric-only stimulation.

PMID:40690201 | DOI:10.1097/MAO.0000000000004584

Otol Neurotol. 2025 Jul 10. doi: 10.1097/MAO.0000000000004597. Online ahead of print.

ABSTRACT

BACKGROUND: Bell’s palsy (BP), a sudden onset of facial paralysis, has been reported in patients with COVID-19. The relationship between COVID-19 infection and BP remains unclear, as does the impact of COVID-19 vaccination on its incidence. This study aims to assess the occurrence of BP before and after the COVID-19 pandemic and to explore any potential effects of COVID-19 vaccination on BP cases.

METHODS: This study utilized data from the TriNetX global health research network, specifically the US Collaborative Network of 68 healthcare organizations, encompassing 99,852,106 patients with ICD codes from 2016 to 2024. BP cases were identified using ICD-10 code G51.0, while COVID-19 vaccinations and infections were identified using CPT codes and TNX Curated 9088, respectively. We conducted an incidence and prevalence analysis of BP cases annually over the 8-year period to detect trends and compared BP rates between prepandemic (2016-2020) and postpandemic (2020-2024) periods using odds ratios. Additionally, we assessed BP incidence among COVID-19 patients and performed a subgroup analysis on vaccinated individuals to evaluate the impact of vaccination on BP incidence. To reduce potential confounding, we employed propensity score matching using the greedy nearest neighbor method available in the TriNetX platform, matching patients on age, sex, race, type 2 diabetes mellitus, and vascular commodities. Statistical analyses were executed within the TriNetX platform and supplemented by online AI tools using Python.

RESULTS: The analysis of BP cases from 2016 to 2024 revealed an upward trend in both incidence and prevalence. The incidence proportion rose from 48 cases per 100,000 people in 2016-2017 to 69 cases per 100,000 by 2023-2024, with a significant increase noted from 2021 onwards. Similarly, the incidence rate increased from 0.00000155 to 0.00000333 over the same period. Prevalence also showed a steady rise, from 228 to 434 cases per 100,000 people. Trend analyses confirmed these increases as statistically significant, with p-values indicating upward trends in incidence and prevalence. Comparing prepandemic (2016-2020) to postpandemic (2020-2024) periods, there was a significant rise in incidence proportions (p-value ≈ 0.0074) and prevalence rates (p-value = 0.0180). Among COVID-positive patients, the incidence proportion remained stable, while prevalence increased, indicating a higher burden compared to the general population. After propensity score matching, vaccinated individuals exhibited a significantly lower risk of BP compared to unvaccinated individuals (hazard ratio: 0.723, 95% CI: 0.618-0.84, p < 0.001).

CONCLUSION: This highlights a significant increase in the incidence and prevalence of BP during the COVID-19 pandemic years compared to prepandemic levels. While the incidence of BP among vaccinated individuals showed a gradual increase, when mitigating for confounding influences using propensity score-matched analyses, it is revealed that these rates remained significantly lower than in unvaccinated populations, indicating a potentially protective association with vaccination. Changes in lifestyle, stress, and distribution of environmental viral loads and potentials during the pandemic may have contributed to a higher susceptibility to BP in the general population.

PMID:40690195 | DOI:10.1097/MAO.0000000000004597

Stat Med. 2025 Jul;44(15-17):e70177. doi: 10.1002/sim.70177.

ABSTRACT

For many diseases and disorders, such as Alzheimer’s disease, patients demonstrate considerable heterogeneity in their responses to treatment interventions. One treatment may be most effective for some patients, while another may be most effective for others, and neither may be effective for another subset of patients. This potentially renders the conventional parallel group design highly inefficient. An attractive alternative is the N-of-1 design, also called the multi-crossover randomized controlled trial. In this design, each participant serves as their own control in a series of randomized blocks of treatment assignments. We propose novel designs for both the single-person and multi-person N-of-1 trials that employ sequential monitoring. In particular, we allow for early stopping for a single participant as soon as there is sufficient evidence of a preferred treatment for them, and early stopping for the group of participants as soon as there is sufficient evidence of a preferred treatment for the population of patients. We provide sample size calculations and decision rules for terminating the trial early and illustrate their properties in simulation studies. We apply our proposed methods to N-of-1 studies of brain tumor excisions and of methylphenidate in mild cognitive impairment.

PMID:40690192 | DOI:10.1002/sim.70177

J Neurooncol. 2025 Jul 21. doi: 10.1007/s11060-025-05107-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Colorectal cancer (CRC) is the third most common cancer globally with rising incidence in the young population. While rare, brain metastasis (BM) in CRC patients leads to significant morbidity and mortality. The incidence of BM is expected to rise due to improved screening and treatments extending patient survival. However, limited screening guidelines exist to detect BM in patients with CRC.

METHODS: Adult patients with colon and rectum tumors, with and without brain metastases, diagnosed between January 1, 2013, and December 31, 2023, were identified using ICD-10 codes from the TrinetX Oncology database. Statistical analyses were performed on TrinetX. The “incidence and prevalence” function assessed BM prevalence, while the “explore cohorts” function evaluated BM diagnoses over time. The “compare cohorts” function compared patient demographics and oncological characteristics, and the “compare outcomes” function generated Kaplan-Meier survival curves.

RESULTS: There were 8,621 patients with CRC diagnosed at Stage IV and 279 (3.4%) developed BM. Patients who develop BM were younger (58.5 ± 12.6 years vs. 62.3 ± 14 years, p < 0.001) and a greater proportion had a KRAS mutation (37.0% vs. 16.0%, p < 0.001) and HER2 amplification (23.0% vs. 12.0%). BM were more common in primary CRC located on the left, specifically in the rectum (41.0%, vs. 36.0%, p < 0.001) or rectosigmoid junction (48.0% vs. 24.0%, p < 0.001). Patients with lung metastasis (OR [95%CI]: 1.67 [1.11-2.57]) or bone (OR [95%CI]: 4.30 [3.05-5.85]) had increased odds of developing BM. Patients with bone metastases developed BM at a median time of less than six months. Stage IV CRC patients who developed BM had decreased overall survival compared to those without BM (liver HR [95%CI]: 1.35 [1.11-1.64]; lung: 1.98 [1.62-2.43]; bone: 1.69 [1.42-2.07]).

CONCLUSION: Brain metastasis significantly reduces overall survival in Stage IV CRC patients. Stage IV CRC with pulmonary or osseous metastases have increased risk of BM development. These patients merit increased surveillance to identify BM early and improve survival. Other risk factors include a younger age at diagnosis, left sided primary tumor, KRAS mutation, or HER2 amplification.

PMID:40690187 | DOI:10.1007/s11060-025-05107-9

Int Urol Nephrol. 2025 Jul 21. doi: 10.1007/s11255-025-04671-3. Online ahead of print.

ABSTRACT

BACKGROUND: Overactive bladder (OAB) is a common condition in children, affecting 5-12% of children between the ages of 5 and 10 years. It is characterized by urinary urgency, frequency, and nocturia, often leading to incontinence. OAB significantly impacts a child’s emotional and social development, causing anxiety, low self-esteem, and social withdrawal. Oxybutynin is the standard treatment for overactive bladder in children, but side effects like dry mouth, constipation, and cognitive issues can make it difficult for patients to stick with the therapy.

METHODS: This study systematically reviewed and analyzed existing research to evaluate and compare the effectiveness and safety of transcutaneous electrical nerve stimulation (TENS) versus oxybutynin for treating overactive bladder in children. We performed an electronic search of PubMed, Cochrane, and other databases up to April 2023 to identify randomized controlled trials (RCTs) that reported outcomes related to symptom improvement and adverse effects in children with OAB. We included studies based on the PICO criteria: pediatric patients (under 18 years), OAB treatment (TENS or Oxybutynin), and outcomes such as urinary urgency and incontinence. The risk ratios were calculated to compare the two treatments, and heterogeneity was assessed using the I² statistics.

RESULTS: The search found six relevant studies and three of these were suitable for the meta-analysis. The results showed that TENS was much more effective than oxybutynin in improving symptoms, with a risk ratio of 1.93 (95% CI 1.35-2.74). TENS also caused fewer side effects compared to oxybutynin, with a risk ratio of 0.09 (95% CI 0.03-0.30). There was no variation between the studies (I² = 0), indicating that the results were consistent across all trials.

CONCLUSION: TENS has been shown to be both more effective and safer than oxybutynin for treating overactive bladder in children. It leads to greater improvement in symptoms and is linked to fewer side effects. These results indicate that TENS may be a better option, especially for children who have difficulty tolerating medication due to adverse reactions.

PMID:40690105 | DOI:10.1007/s11255-025-04671-3

Forensic Sci Med Pathol. 2025 Jul 21. doi: 10.1007/s12024-025-01045-0. Online ahead of print.

ABSTRACT

A diagnosis of atherosclerotic cardiovascular disease is critical importance in forensic medicine, particularly because severe atherosclerosis is known to be associated with a high risk of sudden death. In South Korea, the assessment of coronary atherosclerosis during autopsy largely depends on the forensic pathologist’s visual measurements, which may limit diagnostic accuracy. The objective of this study was to develop a deep learning algorithm for rapid and precise assessment of coronary atherosclerosis and to identify factors influencing the model’s prediction of atherosclerosis severity. A total of 3,717 digital photographs were retrospectively extracted from a database of 1,920 forensic autopsies, with one image each selected for the left anterior descending coronary artery and the right coronary artery. The deep learning algorithm developed in this study demonstrated a high level of agreement (0.988, 95% CI: 0.985-0.990) and absolute agreement (0.986, 95% CI: 0.978-0.991) between predicted and ground truth atherosclerosis values on the test set. The model demonstrated strong overall performance on the test set, achieving a weighted F1-score of 0.904. However, the class-wise F1-scores were 0.957 for mild, 0.785 for moderate, and 0.876 for severe grades, indicating that performance was lowest for the moderate grade. Additionally, decomposition, stent implantation, and thrombi did not have a statistically significant impact on coronary atherosclerosis assessment except for calcification. Although enhancing model performance for moderate grades remains a challenge, this study’s findings demonstrate the potential of artificial intelligence as a practical tool for assessing coronary atherosclerosis in autopsy photographs.

PMID:40690102 | DOI:10.1007/s12024-025-01045-0

Invest New Drugs. 2025 Jul 21. doi: 10.1007/s10637-025-01565-0. Online ahead of print.

ABSTRACT

INTRODUCTION: No correlation between the dose, adverse events, and efficacy was detected in clinical trials of anti-PD-1 antibodies across a range of solid and hematological malignancies. Given that dose reduction with potentially comparable clinical efficacy may improve access to treatment, particularly in low-income regions, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of low-dose PD-1 inhibitor monotherapy in relapsed/refractory (r/r) classic Hodgkin lymphoma (cHL).

MATERIALS AND METHODS: Relevant reports were identified through PUBMED, MEDLINE, Cochrane, ScienceDirect databases, and major international conference proceedings, from inception till December 1, 2024. The risk of bias was assessed independently by two authors using the Joanna Briggs’s critical appraisal checklist for studies reporting prevalence data. Heterogeneity was assessed using Cochran’s Q test, with statistical significance defined as p < 0.05; I² statistic was used to quantify heterogeneity. Random effects models (Der-Simonian method) was used to pool results from primary studies in the presence of significant heterogeneity.

RESULTS: After screening, 13 reports including 148 patients were included in the systematic review. After exclusion of duplicated reports, studies with less than 5 patients, and studies with unextractable data, five studies with a total of 84 patients were included in the meta-analysis. The pooled objective response rate (ORR) with low-dose PD-1 inhibition in r/r cHL, as determined by meta-analysis, was 87% (95% CI, 71.9%-100%), with a corresponding complete response (CR) rate of 53.9% (95% CI, 34.7%-73.1%). The ORR with low-dose nivolumab was 83.8% (95% CI, 64.2%-100%), with a CR rate of 43.3% (95% CI, 29.7%-56.9%). The pooled rate of any-grade adverse events after low-dose PD-1 inhibition was 55.7% (95% CI, 36.1%-75.3%), with a grade 3-4 adverse event rate of 7.5% (95% CI, 1.7%-13.3%).

CONCLUSIONS: This systematic review and meta-analysis demonstrated the high efficacy and acceptable toxicity of low-dose PD-1 inhibition in r/r cHL.

PMID:40690099 | DOI:10.1007/s10637-025-01565-0