Category: Nevin Manimala

JAMA Surg. 2025 Aug 27. doi: 10.1001/jamasurg.2025.3089. Online ahead of print.

ABSTRACT

IMPORTANCE: Although randomized and well-controlled observational studies demonstrate the efficacy of glucagon-like peptide-1 receptor agonists (GLP-1s) for weight management after bariatric surgery, little is known regarding the frequency and predictors of such use.

OBJECTIVE: To characterize the use of and factors associated with GLP-1 initiation among US adults undergoing bariatric surgery.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted using a national multicenter database of electronic health records of approximately 113 million US adults. Adults undergoing bariatric surgery from January 2015 to May 2023 who did not use GLP-1s during the 12 months prior to surgery were eligible for inclusion. Data were analyzed from October 2024 to May 2025.

EXPOSURES: Sociodemographic factors (age, sex, race, region, etc) and clinical factors (bariatric surgery procedures, body mass index [BMI, calculated as weight in kilograms divided by height in meters squared], comorbidities, comedications).

MAIN OUTCOMES AND MEASURES: The primary outcome was GLP-1 initiation after bariatric surgery, first characterized using descriptive statistics. Cox proportional hazards models were then used to identify baseline patient characteristics associated with GLP-1 initiation. Time-dependent Cox models were also used to examine the association of postsurgery BMI with GLP-1 initiation.

RESULTS: Among 112 858 individuals undergoing bariatric surgery, mean (SD) age was 45.2 (12.9) years, and 88 994 individuals (78.9%) were female. By self-reported race, 1210 individuals (1.1%) were Asian, 24 941 (22.1%) were Black or African American, 72 423 (64.2%) were White, and 14 284 (12.6%) reported other race (American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, or unknown). A total of 15 749 individuals (14.0%) initiated GLP-1s after surgery, with 3391 (21.5%) beginning within 2 years of surgery and the remainder initiating during postsurgical years 3 to 4 (5082 [32.3%]), years 5 to 6 (3964 [25.2%]), or beyond (3312 [21.0%]). The overall median (IQR) BMI before GLP-1 initiation was 42.0 (38.3-45.6). In regression models, female patients (adjusted hazard ratio [aHR], 1.61; 95% CI, 1.54-1.69), those undergoing sleeve gastrectomy (aHR, 1.42; 95% CI, 1.37-1.47), and those with type 2 diabetes (aHR, 1.34; 95% CI, 1.28-1.39) were more likely to initiate GLP-1s than their counterparts. Each 1-unit increase in postsurgical BMI was associated with an 8% increase in likelihood of GLP-1 initiation (aHR, 1.08; 95% CI, 1.08-1.08).

CONCLUSIONS AND RELEVANCE: In this retrospective cohort study using a nationwide database, among a cohort of US adults undergoing bariatric surgery, approximately 1 in 10 initiated a GLP-1. Initiation was greater among women, those undergoing sleeve gastrectomy, and individuals with larger BMI regain than among their counterparts.

PMID:40864458 | DOI:10.1001/jamasurg.2025.3089

JAMA Cardiol. 2025 Aug 27. doi: 10.1001/jamacardio.2025.2827. Online ahead of print.

ABSTRACT

IMPORTANCE: Patients with heart failure with preserved ejection fraction (HFpEF) and physiologic pacemakers may benefit from pacing rates above the standard 60 beats per minute (bpm).

OBJECTIVE: To compare adverse event accrual between personalized accelerated pacing and usual care in HFpEF.

DESIGN, SETTING, AND PARTICIPANTS: This was an observational extension of the myPACE randomized clinical trial with up to 4 years of follow-up in 100 patients with stage B or C HFpEF and preexisting physiologic pacemakers treated at the University of Vermont Medical Center. The myPACE study was conducted from June 2019 to December 2021; follow-up for this report was concluded in June 2023.

INTERVENTION: Participants in the original myPACE trial were randomly assigned to either personalized accelerated pacing (myPACE) or 60 bpm (usual care).

MAIN OUTCOMES AND MEASURES: The primary outcome was the accrual of first and recurrent adverse clinical events during the open-label follow-up phase-including urgent visits or hospitalizations for heart failure or atrial fibrillation, myocardial infarction, stroke, or death-assessed using an intention-to-treat (ITT) analysis and a prespecified per-protocol (PP) analysis of patients who continued their assigned treatment. Secondary outcomes included event-free survival in both ITT and PP analyses.

RESULTS: Among the 100 original trial participants (48 in myPACE and 52 in usual care), the ITT analysis demonstrated a trend toward slower event accrual with the myPACE intervention (15 vs 33 events; Lin-Wei-Ying-Yang estimate [LWYY], 0.48; 95% CI, 0.22-1.06; P = .07) and longer event-free survival (hazard ratio [HR], 0.63; 95% CI, 0.31-1.29; P = .20) but did not reach statistical significance. In the prespecified PP analysis, 87 remained on their assigned heart rate setting over the 4-year follow-up (39 in myPACE and 48 in usual care). The mean (SD) age was 74 (10) years, and 48 participants (55%) were male. In this PP analysis, myPACE was associated with a slower accrual of clinical events (5 vs 31 events; LWYY, 0.16; 95% CI, 0.04-0.67; P = .01) and longer event-free survival (HR, 0.30; 95% CI, 0.11-0.80; P = .02) compared to usual care. These results were primarily driven by heart failure-related events.

CONCLUSIONS AND RELEVANCE: In this observational clinical events analysis of the myPACE trial, analysis by ITT did not achieve statistical significance between study arms. However, PP analysis showed that personalized accelerated physiologic pacing was associated with a slower accrual of adverse clinical events compared with the standard 60-bpm setting. These results are hypothesis generating and warrant confirmation in larger multicenter trials.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04721314.

PMID:40864451 | DOI:10.1001/jamacardio.2025.2827

JAMA Dermatol. 2025 Aug 27. doi: 10.1001/jamadermatol.2025.2889. Online ahead of print.

ABSTRACT

IMPORTANCE: Hidradenitis suppurativa (HS) is a chronic inflammatory condition characterized by painful nodules and abscesses that have a significant impact on quality of life. In addition to other psychological comorbidities, patients with HS often face body image issues and emotional distress that may increase the risk of maladaptive eating behaviors and disordered eating.

OBJECTIVE: To explore the role of disordered eating behaviors and diagnosed eating disorders among patients with HS and examine the underexplored relationship between HS and disordered eating.

EVIDENCE REVIEW: MEDLINE, Embase, Scopus, and Web of Science were searched from inception to May 2025 for this systematic review. Eligible articles reported on eating disorders or disordered eating behaviors in patients with HS, with the references of included articles searched for additional texts. Study quality was assessed with the Newcastle-Ottawa Scale.

FINDINGS: Seven studies were identified, including 2363 patients (1666 [73.7%] female; mean age, 44.7 years). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition eating disorders were found in 3.7% of patients (79 of 2123), comprising binge-eating disorder (53 of 79 [67.1%]), anorexia nervosa (6 of 79 [7.6%]), and bulimia nervosa (7/79 [8.9%]). Disordered eating behaviors were present in 27.8% of the cohort (84 of 302), including concerns surrounding dieting, body weight, or problematic eating behaviors (27 of 84 [32.1%]); improper laxative, diet pill, or diuretic use (30 of 84 [35.7%]); food addiction (18 of 84 [21.4%]); and emotional eating (9 of 84 [10.7%]).

CONCLUSIONS AND RELEVANCE: This study suggests that disordered eating may be part of the wider spectrum of psychological burden in patients with HS, highlighting the potential value of multidisciplinary care and clinical awareness to mitigate its adverse impact on treatment outcomes and quality of life. Future research is necessary to elucidate the nature and prevalence of disordered eating in people with HS compared with those with comparable demographic risk factors and in the general population.

PMID:40864442 | DOI:10.1001/jamadermatol.2025.2889

Probiotics Antimicrob Proteins. 2025 Aug 27. doi: 10.1007/s12602-025-10719-8. Online ahead of print.

ABSTRACT

This study aimed to evaluate the effect of the probiotic on the incidence of urinary tract infections (UTIs) during the postpartum period (primary outcome) and quality of life, breastfeeding performance, infant growth, and adverse effects (secondary outcomes). This double-blind, randomized, controlled trial was conducted in Tabriz-Iran. A total of 234 eligible women were randomly assigned to either the probiotic group or the placebo group using block randomization. The intervention group received a 500-mg capsule containing 2 × 10⁹ CFU of Lactobacillus acidophilus once daily for 8 weeks, while the control group received a 500-mg capsule containing regular corn starch with the same dosing schedule. A urine culture test was performed 8 weeks after the start of the intervention to assess the incidence of UTI. Quality of life was evaluated before and after the intervention. Other outcomes, including breastfeeding performance and infant growth, were assessed at the end of the intervention. The incidence of UTIs in the probiotic group was significantly lower than in the placebo group at the 2-month follow-up after the intervention (adjusted odds ratio, 0.41; 95%confidence interval, 0.17 to 0.93; p = 0.033). A statistically significant difference between groups was noted in the overall quality of life score (p = 0.003) and the mental health domain (p = 0.004). There was no statistically significant difference between groups regarding the mean breastfeeding performance score (p = 0.335) and infant growth (p = 0.493). Our results supported the hypothesis that probiotics can effectively reduce the incidence of UTIs. Further studies are recommended to reach definitive conclusions.Trial registration: Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N81. Date of registration: 1 March 2024; URL: https://irct.behdasht.gov.ir/user/trial/73821/view ; Date of first registration: 1 March 2024.

PMID:40864416 | DOI:10.1007/s12602-025-10719-8

Lifetime Data Anal. 2025 Aug 27. doi: 10.1007/s10985-025-09666-x. Online ahead of print.

ABSTRACT

Joint modeling of longitudinal responses and survival time has gained great attention in statistics literature over the last few decades. Most existing works focus on joint analysis of longitudinal data and right-censored data. In this article, we propose a new frailty model for joint analysis of a longitudinal response and interval-censored survival time. Such data commonly arise in real-life studies where participants are examined at periodical or irregular follow-up times. The proposed joint model contains a nonlinear mixed effects submodel for the longitudinal response and a semiparametric probit submodel for the survival time given a shared normal frailty. The proposed joint model allows the regression coefficients to be interpreted as the marginal effects up to a multiplicative constant on both the longitudinal and survival responses. Adopting splines allows us to approximate the unknown baseline functions in both submodels with only a finite number of unknown coefficients while providing great modeling flexibility. An efficient Gibbs sampler is developed for posterior computation, in which all parameters and latent variables can be sampled easily from their full conditional distributions. The proposed method shows a good estimation performance in simulation studies and is further illustrated by a real-life application to the patient data from the Aerobics Center Longitudinal Study. The R code for the proposed methodology is made available for public use.

PMID:40864412 | DOI:10.1007/s10985-025-09666-x

Eur J Epidemiol. 2025 Aug 27. doi: 10.1007/s10654-025-01291-0. Online ahead of print.

ABSTRACT

The nationwide Women in Healthy Transition (KISO) Survey Cohort is a population-based longitudinal prospective cohort study established to explore the significant data gap on women’s symptoms through different stages of menopause in a Northern European context. The KISO Survey Cohort was set up to represent women aged 45-59 years living in Denmark. In total 575,863 women were invited to participate in the study at baseline. Data were collected through digital questionnaires from June to December 2024 and included self-reported information on stages of menopause, menopausal symptoms, quality of life, physical activity, and work productivity loss using validated scales as well as information on various health, social and lifestyle factors. The follow-up of the KISO Survey Cohort will be conducted through digital questionnaires every three years over a 15-year period, inviting baseline respondents and eligible women aged 45-59 at follow-up. A total of 153,800 women completed the baseline questionnaire, yielding a 27% response rate. Among the participants, 8% were in premenopause, 24% in perimenopause, and 45% in postmenopause. Moreover, 13% had induced menopause and 10% were undergoing menopausal hormone therapy. The KISO Survey Cohort is the first large-scale longitudinal study on menopausal symptoms among women in Denmark. Data are coupled with the personal identification numbers (CPR) enabling opportunities to link data to national administrative registers. This ongoing study, thus, offers unique and extensive data, enabling future research to advance our understanding of menopause, how it affects women, and its long-term effects on women.

PMID:40864411 | DOI:10.1007/s10654-025-01291-0

J Am Geriatr Soc. 2025 Aug 27. doi: 10.1111/jgs.70063. Online ahead of print.

ABSTRACT

BACKGROUND: Perioperative neurocognitive disorders (PNDs) are among the most common complications in older adults after surgery. Awareness of PNDs is important as they often can be prevented, and early recognition can improve recovery. We sought to understand what older adults know about PNDs, the information provided, and the counseling provided to guide recovery when PND symptoms occur. We hypothesized that older adults rarely receive information regarding PND before surgery or counseling after experiencing symptoms.

METHODS: We conducted a mixed methods study by (1) employing a survey to better understand the information patients received before surgery and (2) conducting semi-structured interviews in patients who subjectively experienced PNDs to better understand what counseling they received after experiencing symptoms. Surveys were distributed preoperatively to older adults undergoing elective surgery. Semi-structured interviews were conducted with older adults who had undergone surgery and experienced symptoms of PND. The quantitative data were summarized using descriptive statistics, and qualitative data were analyzed using a hybrid inductive and deductive approach.

RESULTS: The response rate for survey participants was approximately 19%. Among survey participants (n = 312), 58% of participants were between 65 and 69 years of age, 24% were between 70 and 79 years of age, and 18% were ≥ 80 years of age. Before their scheduled elective surgery, 7% (n = 22) indicated a healthcare provider discussed the risk of PNDs during their preoperative visit. None of the patients received educational material regarding PNDs. Ten older adults participated in the semi-structured interviews, which revealed that 9 (90%) participants attempted to discuss symptoms after they occurred with a healthcare provider, but none received counseling or information on what to do next, and all were instructed to wait to see if symptoms persisted.

CONCLUSION: Our findings underscore that discussions about PND risk and symptom management do not occur as part of routine perioperative care, leaving patients without important information and guidance.

PMID:40864409 | DOI:10.1111/jgs.70063

Forensic Toxicol. 2025 Aug 27. doi: 10.1007/s11419-025-00737-0. Online ahead of print.

ABSTRACT

PURPOSE: Etomidate, which is a psychoactive drug with an anesthetic effect, is used as a substitute for expensive mainstream drugs. There has been a trend toward abuse of etomidate and its emerging structural analogues now. Faced with a large number of samples, a rapid and effective detection method is needed.

METHODS: In this study, ambient flame ionization (AFI) coupled with LTQ-Orbitrap mass spectrometry was used to analyze etomidate and its structural analogues in urine. It can realize detection in less than 0.2 min without sample preparation.

RESULTS: Ideal analysis conditions were obtained by optimizing various parameters and analytical performance was validated. The isomers (isopropoxate and propoxate) can be distinguished by ion abundance ratios. Positive samples (n = 75) were analyzed very efficiently and successfully from plenty of authentic specimens (n = 116). Statistical analysis was conducted on drug types, age, and gender of drug users. A new structural analogue was discovered in one of the samples, which was a very crucial discovery. That meant the market may face with the emergence of new structural analogues.

CONCLUSIONS: This study can satisfy both targeted and non-targeted screening, which provides support for timely monitoring and detection of novel drugs and offers a wider range of method choices for forensic laboratories. It can also better cope with the current situation of drug control and combat crimes related to new types of drugs.

PMID:40864408 | DOI:10.1007/s11419-025-00737-0

Forensic Sci Med Pathol. 2025 Aug 27. doi: 10.1007/s12024-025-01071-y. Online ahead of print.

ABSTRACT

This study presents an investigation of the potential of radiomic features extracted from postmortem computed tomography (PMCT) scans of the lungs to provide valuable insights into the postmortem interval (PMI), a crucial parameter in forensic medicine. Sequential PMCT scans were performed on 17 bodies with known times of death, ranging from 4 to 108 h postmortem. Radiomic features were extracted from the lungs, and a mixed-effects model, tailored for sequential data, was employed to assess the relationship between feature values and the PMI. Four model variants were tested to identify the most suitable functional form for describing this association. Several statistically significant trends between the PMI and radiomic features were observed, with twelve distinct features demonstrating selective relevance to postmortem changes in the lungs. Notably, cluster shade, a grey-level co-occurrence matrix (GLCM) feature, significantly decreased with the PMI, the median intensity increased over time, and the root mean squared feature values tended to decrease. The retained features included first-order statistical metrics, shape-based characteristics, and second-order texture attributes, which may reflect alterations such as gas formation and structural modifications within the lungs. This study highlights the potential of PMCT scan-based radiomics as a complementary tool to enhance existing postmortem interval estimation methods. These findings reinforce the role of quantitative imaging techniques in forensic investigations.

PMID:40864404 | DOI:10.1007/s12024-025-01071-y

J Racial Ethn Health Disparities. 2025 Aug 27. doi: 10.1007/s40615-025-02608-1. Online ahead of print.

ABSTRACT

INTRODUCTION: The rising Hispanic population in the U.S. is at significant end-stage kidney disease (ESKD) risk. However, Hispanic communities face notable challenges in kidney transplantation access. We aimed to identify U.S. regions that might lack kidney transplant centers (KTCs) actively engaging Hispanic individuals living with ESKD.

METHODS: We identified location of U.S. KTCs using the UNOS database from 2018 to 2022. We examined county-level prevalence and mortality of adult Hispanic individuals living with ESKD from the 2021 public USRDS dataset. We performed geospatial analysis to characterize the Hispanic population within a two-hour drive from each KTC, and identified statistically significant spatial hot and cold spot clustering for our variables of interest. Additionally, we identified KTCs with dedicated Hispanic kidney clinics (H-KTC) and analyzed pre- and post-implementation transplantation rates.

RESULTS: We included 196 KTCs and 11 H-KTCs. Geospatial analysis showed that there was a higher proportion of Hispanic individuals living with ESKD outside the two-hour driving zone than within the two-hour driving zone (0.23% vs. 0.21. Death count among Hispanic individuals living with ESKD was 11.4% outside vs. 10.2% within 2-h driving zone, with mortality rate > 10Std-Dev in some south-west regions of US out of the 2 h-driving zones. After H-KTC implementation, the median transplants per center among Hispanic recipients increased from 81 [IQR 58-146.5] to 109 [IQR 66-178.5] (p = 0.006).

CONCLUSION: Although the existing KTCs serving Hispanic populations are located within strategic geographic locations, there are still areas with a high prevalence of Hispanic individuals living with ESKD with limited access to KTCs. These populations might benefit from extensive outreach from new or existing KTCs.

PMID:40864380 | DOI:10.1007/s40615-025-02608-1