Category: Nevin Manimala

JAMA Dermatol. 2025 Aug 20. doi: 10.1001/jamadermatol.2025.2881. Online ahead of print.

ABSTRACT

IMPORTANCE: Previous research suggests that patients with hidradenitis suppurativa (HS) may face a higher risk of serious infections compared with those with psoriasis. However, these studies are subject to limitations that could constrain their reliability.

OBJECTIVE: To compare the risk of hospitalization from noncutaneous infections, infection profiles, and the length of stay (LOS) of adult patients with HS and psoriasis treated with adalimumab.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted using deidentified claims data from the MarketScan database. All adult patients with HS or psoriasis who initiated adalimumab therapy between January 2017 and December 2020 were included. Data were analyzed from October 2023 to March 2024.

EXPOSURES: New users of adalimumab diagnosed with psoriasis or HS, identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes and adalimumab prescriptions.

MAIN OUTCOMES AND MEASURES: The primary outcome was hospitalization from noncutaneous infections in a time-to-event analysis using inverse probability weighting to account for confounders in the Cox regression models. Secondary outcomes included the infection types compared using incidence rate ratios and LOS analyzed with multivariable Poisson regression.

RESULTS: Of 10 349 included patients, 5641 (54.5%) were female, and the mean (SD) age was 44.8 (12.8) years. The cohort included 1650 patients with HS and 8699 with psoriasis. The HS cohort was younger (mean [SD] age, 36.2 [11.5] years vs 46.5 [12.4] years) and predominantly female (1271 [77.0%] vs 4370 [50.2%]), with higher rates of obesity, Crohn disease, anxiety, and depression. The weighted Cox analysis indicated an increased risk of serious infection in patients with HS (hazard ratio, 1.53; 95% CI, 1.34-1.86). This group also had a higher likelihood of sepsis and genitourinary infections (sepsis: incidence rate ratio, 2.07; 95% CI, 1.35-3.12; genitourinary infections: incidence rate ratio, 2.22; 95% CI, 1.22-3.86) and greater odds of prolonged LOS (odds ratio, 1.28; 95% CI, 1.13-1.45) compared with the psoriasis cohort.

CONCLUSIONS AND RELEVANCE: In this cohort study, among adults treated with adalimumab, those with moderate to severe HS had an elevated risk of infection and different infection profiles compared with those with psoriasis. Future research should focus on the impacts of disease severity and treatment regimens on infection risk and develop targeted prevention strategies.

PMID:40833768 | DOI:10.1001/jamadermatol.2025.2881

J Antimicrob Chemother. 2025 Aug 20:dkaf305. doi: 10.1093/jac/dkaf305. Online ahead of print.

ABSTRACT

BACKGROUND: The global rise in antimicrobial resistance (AMR) is a significant health concern. Nitrofurantoin is used as a first-line antibiotic against many uropathogenic bacterial pathogens, including uropathogenic Escherichia coli (UPEC), and an analysis is required to assess the current global prevalence of nitrofurantoin-resistant UPEC.

METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search using PubMed and Google Scholar was performed to find studies reporting nitrofurantoin-resistant UPEC in humans. Studies were included/excluded based on predefined criteria and focused only on isolates collected from the urinary tract. The quality of the studies was assessed using the Joanna Briggs Institute’s (JBI’s) Checklist for Prevalence Studies. Statistical analysis was performed using Metafor and Meta (R packages) to estimate the pooled prevalence, assess publication bias and perform heterogeneity analysis.

RESULTS: Sixty-three studies comprising 774 499 UPEC isolates collected between 1996 and 2024 were analysed and demonstrated a global pooled prevalence of nitrofurantoin-resistant UPEC isolates to be 6.9% (95% CI: 4.8%-9.7%). Continent-wise subgroup analysis showed Europe to have the lowest prevalence, while Asia has the highest prevalence. Decade-wise subgroup analysis showed the global prevalence increased from 2.8% (1996-04) to 8.2% (2005-14) and then decreased to 7.6% in the last decade (2015-24). Substantial heterogeneity was seen among the studies examined, as well as statistically significant publication bias.

CONCLUSIONS: The findings show considerable global prevalence of nitrofurantoin-resistant UPEC isolates, with the prevalence being higher in low- and middle-income countries (LMICs). Sufficient education should be provided where possible, and antimicrobial stewardship should be intensified to slow the rate of AMR increase worldwide.

PMID:40833762 | DOI:10.1093/jac/dkaf305

JAMA Dermatol. 2025 Aug 20. doi: 10.1001/jamadermatol.2025.2980. Online ahead of print.

ABSTRACT

IMPORTANCE: Achieving good disease control in psoriatic arthritis (PsA) remains a major challenge. Combining multiple systemic immunomodulatory therapies has been shown to be beneficial in other immune-mediated diseases with reasonable safety profiles, but data on the current use and safety of combination targeted therapy among individuals with PsA are limited.

OBJECTIVE: To evaluate the use and safety of combination targeted therapies among adults with PsA.

DESIGN, SETTING, AND PARTICIPANTS: Data from the IBM MarketScan Commercial Claims Database from January 2015 to December 2024 were used to describe use patterns and perform safety analyses. Data were analyzed from April 2024 to June 2025. A validated claims algorithm was used to identify adults with PsA, who were separated into a standard therapy control cohort that was matched 2:1 with the combination targeted therapy cohort.

MAIN OUTCOMES AND MEASURES: Descriptive analysis of the use of combination targeted therapies. The safety analysis included a comparison of frequencies of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes for serious or opportunistic infections requiring an inpatient level of care. Relative risks (RRs) were calculated before and after propensity score matching.

RESULTS: Among 82 399 individuals identified with PsA, 542 individuals (median [IQR] age, 52.5 [44.0-59.0] years; 341 female individuals [62.9%]) were receiving combination targeted therapy for 3 consecutive months and 200 (median [IQR] age, 55.0 [45.0-61.0] years; 114 female individuals [57.0%]) were receiving combination therapy for 6 consecutive months. The 2 most common combinations used were a tumor necrosis factor inhibitor with apremilast (34%-37%) and an interleukin 17 inhibitor with apremilast (27%-29%). The serious infection incidence rate among patients receiving combination targeted therapy ranged from 7.38 to 15.00 events per 1000 patients; the opportunistic infection incidence rate ranged from 0 to 1.85 events per 1000 patients. Patients receiving combination targeted therapy did not have a significantly increased risk of serious infection (propensity score-matched 3-month and 6-month RRs, 0.53 [95% CI, 0.17-1.63] and 1.50 [95% CI, 0.34-6.65], respectively) or opportunistic infection (adjusted 3-month and 6-month RRs, 1.00 [95% CI, 0.09-11.02] and not applicable, respectively) across all analyses.

CONCLUSIONS AND RELEVANCE: The results of this cohort study suggest that among commercially insured adults with PsA, around 1% of individuals were receiving combination targeted therapy. The most common combinations used different biologics with apremilast. This study found no significant difference between the incidence of serious bacterial and opportunistic infections requiring hospitalization compared with standard therapy, suggesting that combination targeted therapy may not be associated with significantly increased infection risk, but further larger studies are needed.

PMID:40833728 | DOI:10.1001/jamadermatol.2025.2980

Maxillofac Plast Reconstr Surg. 2025 Aug 20;47(1):22. doi: 10.1186/s40902-025-00477-6.

ABSTRACT

BACKGROUND: This study aims to evaluate the outcomes of secondary alveolar bone grafting in patients with cleft lip and palate by comparing the clinical effectiveness of autologous bone grafts and xenogeneic graft materials. The objective is to provide evidence-based insight into the comparative efficacy of these grafting approaches.

MAIN BODY: A systematic search of the literature published between January 2004 and January 2023 identified 606 studies. Following a series of screening processes, five studies met the inclusion criteria, including only two randomized controlled trials (RCTs). The selected studies specifically evaluated xenogeneic bone graft materials derived from bovine sources, with allograft materials excluded. The results demonstrated no statistically significant difference between autologous and xenograft grafts in terms of postoperative bone graft volume and height in patients with cleft lip and palate. These findings provide important insight into the comparative effectiveness of grafting materials used in secondary alveolar bone grafting.

CONCLUSIONS: In summary, the findings indicate that autologous and xenogeneic graft materials yield comparable outcomes in secondary alveolar bone grafting for patients with cleft lip and palate. These results may inform clinical decision-making and guide future research in optimizing grafting strategies.

PMID:40833719 | DOI:10.1186/s40902-025-00477-6

Endocrine. 2025 Aug 20. doi: 10.1007/s12020-025-04378-6. Online ahead of print.

ABSTRACT

PURPOSE: In recent years, endocrinology research has increasingly focused on machine learning (ML) applications. ML offers the possibility of utilizing large data sets and extracting imperceptible patterns. It might contribute in optimizing healthcare outcomes and unveiling new understandings of the intricate mechanisms of endocrine disorders. This review covers the basic aspects of ML and highlights specific areas of endocrinology with potential of ML application.

METHODS: This narrative review with a systematic literature search comprises studies on endocrine conditions with ML methods used in statistical analysis, published between January 2000 and December 2024.

RESULTS: A total of 1130 studies were analyzed. Thyroid-related research was the most prevalent, followed by studies concerning the pituitary, adrenal and parathyroid glands. ML applications included medical imaging analysis, tumor classification, treatment response prediction, complication risk estimation and identification of molecular markers.

CONCLUSION: ML has the potential to enhance the diagnosis, treatment and understanding of endocrine diseases. However, the use of ML is still limited by issues such as lack of model transparency, data imbalance and difficulties with clinical implementation. To enable safe and effective application of ML in endocrinology, further validation, interdisciplinary collaboration and standardized approaches are essential.

PMID:40833706 | DOI:10.1007/s12020-025-04378-6

JAMA Netw Open. 2025 Aug 1;8(8):e2527805. doi: 10.1001/jamanetworkopen.2025.27805.

ABSTRACT

IMPORTANCE: Cancer is a significant global health concern, with India ranking second in Asia and third in the world in terms of cancer incidence. Regular monitoring and updates on cancer statistics are vital for assessing the impact and burden of the disease and the effectiveness of cancer control measures.

OBJECTIVE: To measure the recent patterns and trends in cancer incidence and mortality across 43 geographic regions in India from 2015 to 2019 and to provide estimates for 2024.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from 43 population-based cancer registries across India, covering varying periods between January 1, 2015, and December 31, 2019. Population at-risk data were obtained from the Census of India, and findings were assessed by registry area. Data were analyzed from May 1 to December 20, 2024.

MAIN OUTCOMES AND MEASURES: Number of cases, crude rates, and age-adjusted rates (per 100 000 population) for cancer incidence and mortality, estimated average annual percent change (AAPC) from time trends, and estimated cancer cases in India for 2024.

RESULTS: Incidence of 708 223 cases with 206 457 deaths from 43 population-based cancer registries were included. The lifetime risk of developing cancer in India was 11.0%, while Mizoram in the Northeastern region reported lifetime risks of 21.1% in males and 18.9% in females. The district of Aizawl reported the highest age-adjusted incidence rate (AAIR) in both males (256.1; 95% CI, 245.2-267.0) and females (217.2; 95% CI, 207.6-226.7). The most common cancers were oral, lung, and prostate in males and breast, cervical, and ovarian in females. Among metropolitan cities (defined as an urban agglomeration with a population of over 1 million), Delhi had the highest overall cancer AAIR for males (146.7; 95% CI, 145.1-148.3), while Srinagar recorded the highest AAIR for lung cancer (39.5; 95% CI, 35.8-43.2). Oral cancer showed significant increases in 14 population-based cancer registries (PBCRs) among males and 4 PBCRs among females; Ahmedabad Urban had an increase of 4.7% (95% CI, 2.9% to 6.6%) in males and 6.9% (95% CI, 4.1% to 9.7%) in females. The estimated AAPC in AAIR (all sites) showed a significant increase over time in Kamrup Urban in males (3.3%; 95% CI, 2.3%-4.3%) and Thiruvananthapuram Taluk in females (3.4%; 95% CI, 3.1%-3.8%). The estimated cancer incidence for 2024 was 1 562 099 cases; estimated cancer mortality, 874 404 cases.

CONCLUSIONS AND RELEVANCE: This cross-sectional study highlighted significant regional disparities in cancer incidence across India and the increasing cancer burden. The findings provide key insights for policymakers to enhance resource allocation and strengthen cancer control strategies nationwide.

PMID:40833697 | DOI:10.1001/jamanetworkopen.2025.27805

JAMA Netw Open. 2025 Aug 1;8(8):e2527934. doi: 10.1001/jamanetworkopen.2025.27934.

ABSTRACT

IMPORTANCE: Adolescents who experienced childhood socioeconomic deprivation report more eating disorder symptoms compared with their counterparts with higher socioeconomic status but may have more barriers in receiving diagnoses and accessing eating disorder services.

OBJECTIVE: To investigate the associations of childhood socioeconomic indicators with eating disorder symptoms across adolescence.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study used a population-based sample from the Avon Longitudinal Study of Parents and Children (ALSPAC). ALSPAC recruited pregnant women in the former region of Avon, United Kingdom, with expected delivery dates from April 1, 1991, to December 31, 1992. This study used follow-up data of the mother-offspring collected until 2010. The final analytical sample included children who were alive at 1 year of age and who had complete exposures, retaining 1 twin at random. Data were analyzed from October 1, 2022, to November 25, 2024.

EXPOSURES: The main exposures were parental income, education, occupation, financial hardship (range, 0-15; higher score indicates more hardship), reported by mothers between 32 weeks’ gestation and 47 months postpartum, and area-level deprivation, derived from the Office for National Statistics indicators linked to the participant’s residential post code at 32 weeks’ gestation.

MAIN OUTCOMES AND MEASURE: Primary outcomes were disordered eating, weight and shape concerns, and body dissatisfaction at ages 14, 16, and 18 years. Individual disordered eating behavior was a secondary outcome.

RESULTS: The sample included 7824 participants (4003 [51.1%] male). A 1-point increase in financial hardship was associated with increased odds of disordered eating (odds ratio [OR], 1.06; 95% CI, 1.04-1.10), an increase in weight and shape concerns (coefficient, 0.02 (95% CI, 0.01-0.04), and an increase in body dissatisfaction (coefficient, 0.22 (95% CI, 0.06-0.37). Lower parental education was associated with higher odds of disordered eating (OR, 1.80; 95% CI, 1.46 to 2.23).

CONCLUSIONS AND RELEVANCE: This cohort study using ALSPAC data found that eating disorder symptoms were more common in individuals experiencing socioeconomic deprivation. Potential socioeconomic inequalities in eating disorder presentation and diagnosis in clinical settings require further investigation. Reducing population-level socioeconomic inequalities could also aid eating disorder prevention.

PMID:40833695 | DOI:10.1001/jamanetworkopen.2025.27934

JAMA Netw Open. 2025 Aug 1;8(8):e2528529. doi: 10.1001/jamanetworkopen.2025.28529.

ABSTRACT

IMPORTANCE: Several large, randomized clinical trials have tested the efficacy of adding behavioral therapy to medical management (high-quality, low-intensity medical counseling) and buprenorphine treatment of opioid use disorder. These studies have consistently reported strong rates of treatment response overall, without a significant additive benefit of additional behavioral therapy.

OBJECTIVE: To address gaps in knowledge about additional behavioral therapy for patients receiving buprenorphine, including the association of additional behavioral therapy with retention and functional outcomes, and whether certain subgroups respond better to additional behavioral therapy.

DESIGN, SETTING, AND PARTICIPANTS: This study is a secondary analysis of 4 randomized clinical trials conducted in Connecticut, Southern California, and 10 other US sites between 2000 and 2011. Participants included adults with Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) opioid dependence. Analyses were conducted between January 2024 and July 2025.

EXPOSURE: Buprenorphine and varying levels of behavioral therapy, including standard medical management, physician management, physician management plus cognitive behavioral therapy, contingency management, contingency management plus cognitive behavioral therapy, standard medical management plus opioid dependence counseling, or no additional behavioral treatment.

MAIN OUTCOMES AND MEASURES: The main outcomes included weeks of buprenorphine retention and functioning across 7 domains (medical, employment and financial support, social and family, alcohol, drug, legal, and psychiatric), assessed using the Addiction Severity Index. Data on additional behavioral therapy (structured cognitive-behavioral and counseling approaches) combined with buprenorphine and medical management were harmonized to provide needed statistical power for considering moderation effects.

RESULTS: The combined sample consisted of 869 adults (mean [SD] age, 34.2 [10.4] years; 287 female [33%]). Results demonstrated that additional behavioral therapy was not associated with opioid-free weeks (mean [SD] number of opioid-free weeks, 7.16 [4.35]) compared with medical management and buprenorphine (mean [SD] number of opioid-free weeks, 7.00 [4.33]) (B = 0.28; 95% CI, -0.33 to 0.89; P = .37). Additional behavioral therapy was also not associated with greater buprenorphine retention (mean [SD] number of weeks of buprenorphine, 10.29 [3.21] out of 12) compared with medical management and buprenorphine (mean [SD] number of weeks of buprenorphine, 10.21 [3.15]) (B = 0.00; 95% CI, -0.43 to 0.43; P = .98). Measures of functioning indicated minimal change over the course of treatment, and there were no differences between randomized groups. No moderational effects of subgroups (eg, history of heroin use) were significant when correcting for multiple comparisons.

CONCLUSIONS AND RELEVANCE: In this secondary analysis of 4 randomized clinical trials, results highlighted the strong efficacy of buprenorphine treatment when combined with medical management for opioid use disorder. Although there was certainly room for improvement in outcomes-particularly functioning-trials of novel adjuncts for buprenorphine treatment may encounter statistical power challenges outperforming such a robust control condition.

TRIAL REGISTRATION: NCT00316277, NCT00591617, NCT00632151, NCT00023283.

PMID:40833692 | DOI:10.1001/jamanetworkopen.2025.28529

JAMA Cardiol. 2025 Aug 20. doi: 10.1001/jamacardio.2025.2698. Online ahead of print.

ABSTRACT

IMPORTANCE: Plasma levels of the gut microbiota-dependent metabolite trimethylamine N-oxide (TMAO) are associated with prevalent abdominal aortic aneurysms (AAA) in humans and fostering of AAA progression in animal models; therapeutic targeting of TMAO production blocks AAA progression and rupture in multiple mouse models. A blood biomarker that identifies individuals at risk for incident AAA development, accelerated AAA expansion, or recommendation for surgical AAA repair could be an asset for risk stratification.

OBJECTIVE: To determine whether TMAO is associated with risk for AAA development, rapid AAA expansion, and risk for recommended surgical intervention.

DESIGN, SETTING, AND PARTICIPANTS: This was a prospective cohort study using 2 independent clinical cohorts undergoing aorta imaging surveillance: a European cohort and a US cohort. Included in this study were patients undergoing serial imaging surveillance of the aorta and long-term outcome monitoring. Patients were recruited from single-center studies in Uppsala, Sweden, and Cleveland, Ohio. Study data were analyzed from October 2023 to May 2025.

EXPOSURES: Plasma TMAO concentrations measured by stable isotope dilution liquid chromatography with tandem mass spectrometry.

MAIN OUTCOMES AND MEASURES: The association of TMAO levels with AAA risk, fast-growing AAA (≥4.0 mm per year), and recommended surgical intervention (≥4.0 mm per year or ≥5.5 cm diameter).

RESULTS: The European cohort included 237 individuals (median [IQR] age, 65 [65-73] years; 211 male [89.0%]), and the US cohort included 658 individuals (median [IQR] age, 63 [57-70] years; 523 male [79.5%]). In the European cohort, elevated circulating TMAO was significantly associated with AAA risk independent of traditional risk factors and kidney function. Moreover, elevated TMAO predicted both greater risk for fast-growing AAA (adjusted odds ratio [aOR], 2.75; 95% CI, 1.20-6.79) and recommended surgical intervention (aOR, 2.67; 95% CI, 1.24-6.09). Similar patterns were observed in the US cohort and the combined European and US cohort, with heightened circulating TMAO corresponding with significantly increased adjusted risk for fast-growing AAA (US cohort: aOR, 2.71; 95% CI, 1.53-4.80; combined cohort: aOR, 2.30; 95% CI, 1.47-3.62) and recommended surgical intervention (US cohort: aOR, 2.73; 95% CI, 1.56-4.80; combined cohort: aOR, 2.41; 95% CI, 1.55-3.74). Addition of TMAO to base models containing traditional cardiovascular risk factors resulted in significant improvement in both risk estimation for fast-growing AAA and predicting recommended surgical intervention.

CONCLUSION AND RELEVANCE: Results of this cohort study suggest that elevated circulating TMAO levels were associated with increased risk of AAA and identified patients at heightened risk for fast-growing AAA and recommended surgical intervention. TMAO may help identify individuals who may benefit from more frequent surveillance imaging and early surgical intervention to prevent aortic dissection or rupture.

PMID:40833686 | DOI:10.1001/jamacardio.2025.2698

JAMA Psychiatry. 2025 Aug 20. doi: 10.1001/jamapsychiatry.2025.2110. Online ahead of print.

NO ABSTRACT

PMID:40833677 | DOI:10.1001/jamapsychiatry.2025.2110