Category: Nevin Manimala

J Med Microbiol. 2025 Dec;74(12). doi: 10.1099/jmm.0.002104.

ABSTRACT

Introduction. Biofilms have been implicated as a potential cause of chronic rhinosinusitis (CRS), with patients showing an increased prevalence of biofilms, likely contributing to antibiotic ineffectiveness in these individuals. In many environments, biofilms are polymicrobial, with interspecies interactions promoting bacterial survival and encouraging robust growth. Improvements in visualization techniques for biofilms have enabled species-specific identification, leading to a growing body of literature using these techniques and examining severity in different phenotypes of CRS.Gap Statement. It is unclear whether sinus biofilms are typically poly- or monomicrobial, and if they are correlated with clinical severity in CRS.Aim. We conducted a scoping review to determine how prevalent biofilms were in sinus tissue of patients with CRS. Furthermore, we correlated disease severity with the presence of biofilms.Methodology. We searched PubMed, Scopus, Medline and Web of Science databases for all studies which directly visualized biofilms on tissue from patients with CRS. After screening 1,853 search results, 39 studies were included for analysis in this review.Results. Patients with CRS had a higher prevalence of biofilms compared with controls. We found no significant difference in the proportion of biofilms detected across visualization techniques or based on CRS phenotyping. Fifteen studies reported disease severity by biofilm status; most reported greater severity in patients with biofilms, although only some were statistically significant. Nine studies used techniques capable of detecting polymicrobial biofilms, all of which found a subset of polymicrobial biofilms.Conclusion. Our findings demonstrate an increased prevalence of biofilms in patients with CRS, which may correspond to increased disease severity. The evidence for biofilms being polymicrobial is compelling, although it is based on a small number of studies.

PMID:41405936 | DOI:10.1099/jmm.0.002104

JAMA. 2025 Dec 17. doi: 10.1001/jama.2025.20541. Online ahead of print.

NO ABSTRACT

PMID:41405908 | DOI:10.1001/jama.2025.20541

JAMA Psychiatry. 2025 Dec 17. doi: 10.1001/jamapsychiatry.2025.3828. Online ahead of print.

ABSTRACT

IMPORTANCE: Veterans with serious mental illness (SMI) experience a higher prevalence of obesity than the general veteran population; weight loss programs are needed that are tailored to this population.

OBJECTIVE: To evaluate a weight loss program, CoachToFit (CTF), which includes weekly calls from a Veteran Health Administration peer specialist, a Bluetooth-enabled scale and fitness tracker, and a smartphone application that provides health education and tracks steps, goals, and weight.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted within the Pittsburgh Veteran Affairs health care system and presents pre-post (6 months) analysis comparing CTF and usual care. Veterans with body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of 30 or higher and diagnosis of major depressive disorder, bipolar disorder, or schizophrenia were eligible for inclusion. Exclusion criteria included history of bariatric surgery or recent psychiatric hospitalization. The study was conducted from October 1, 2020, to September 30, 2025, and data analysis was conducted from January to October 2025.

EXPOSURE: Random assignment to CTF.

MAIN OUTCOMES AND MEASURES: The primary outcomes were weight (in kg), BMI, and cardiorespiratory fitness (meters walked in 6 minutes).

RESULTS: Among the sample (n = 256), mean (SD) age was 53.5 (13.1) years, 80 participants (31.3%) were female, and 199 (77.7%) were diagnosed with major depressive disorder. Mean (SD) weight loss at 6 months was -3.2 (6.2) kg in the CTF group (n = 128) compared to -1.6 (4.9) kg in the usual care group (P = .05). After adjustment, participants in CTF experienced greater, nonsignificant weight loss compared to usual care, with an adjusted mean difference (AMD) of -1.62 kg (95% CI, -3.38 to 0.14; P = .07). For BMI, the AMD in change between groups at 6 months was -0.56 (95% CI, -1.15 to 0.03; P = .06). Change in meters walked was not statistically significant between groups, with an AMD of 3.53 m (95% CI, -12.87 to 19.92; P = .67). At 6 months, 34 participants (36.6%) from the CTF group lost 5% or more of their body weight compared to 19 (22.4%) in usual care, representing a 1.93-fold greater likelihood in adjusted analyses (95% CI, 0.96-3.91; P = .07). More participants in CTF (n = 21 [22.6%]) lost 7% or more of their body weight compared to usual care (n = 7 [8.2%]), representing a 3.9-fold greater likelihood in adjusted analyses (95% CI, 1.45-10.36; P = .007).

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, a weight loss program tailored to veterans with SMI using remote technologies and paraprofessionals demonstrated the potential to help this population lose weight.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04560335.

PMID:41405896 | DOI:10.1001/jamapsychiatry.2025.3828

JAMA Netw Open. 2025 Dec 1;8(12):e2544153. doi: 10.1001/jamanetworkopen.2025.44153.

ABSTRACT

IMPORTANCE: The Planetary Health Diet (PHD), introduced by the EAT-Lancet Commission in 2019, emphasizes a plant-based diet. Several cohorts have assessed adherence using the PHD Index (PHDI), but evidence is limited on whether maternal periconceptional and early pregnancy adherence is associated with fetal growth.

OBJECTIVE: To examine the association of maternal PHDI adherence in early pregnancy with longitudinal 2-dimensional and 3-dimensional fetal biometric measures.

DESIGN, SETTING, AND PARTICIPANTS: Secondary analysis of a prospective cohort of pregnant women with singletons (July 2009 to January 2013) at 12 US clinical sites. Women with preexisting health conditions were excluded. Participants had data on fetal body composition and organ volumes (April 2016 to September 2019). Analyses were conducted June 2024 to August 2025.

EXPOSURE: PHDI adherence categorized as low, moderate, or high, assessed by the Food Frequency Questionnaire between 8 to 13 weeks’ gestation.

MAIN OUTCOMES AND MEASURES: Estimated fetal weight (EFW), head circumference (HC), humerus and femur lengths, abdominal circumference and area, abdominal subcutaneous tissue thickness, fractional thigh and arm volumes (total, lean, and fat), midthigh areas, ratio of fractional fat thigh volume to fractional thigh volume, and ratio of midthigh fat area to midthigh area, measured up to 5 times between 15 to 42 weeks’ gestation. Trajectories were modeled using linear mixed-effects models.

RESULTS: Analyses included 1464 women. Mean (SD) maternal age was 28.1 (5.6) years, and mean (SD) gestational age at delivery was 39.2 (1.7) weeks. High vs low PHDI adherence was associated with larger EFW at 32 to 40 weeks (32 weeks: difference, 35 g; 95% CI, 22 to 49 g; 40 weeks: difference, 165 g; 95% CI, 108 to 223 g), larger HC at 37 to 39 weeks (37 weeks: difference, 1.89 mm; 95% CI, 1.10 to 2.69 mm; 39 weeks: difference, 2.44 mm; 95% CI, 1.47 to 3.42 mm), smaller fractional lean arm volume at 34 to 37 weeks; (34 weeks: difference, -0.40 cm3; 95% CI, -0.56 to -0.25 cm3), larger fractional fat arm volume at 28 to 29 weeks; (28 weeks: difference, 0.23 cm3; 95% CI, 0.13 to 0.34 cm3), and larger abdominal area at 25 to 26 weeks (25 weeks: difference, 62.2 mm2; 95% CI, 34.4 to 90.0 cm3). Moderate adherence showed similar patterns.

CONCLUSIONS AND RELEVANCE: In this cohort study of pregnant women, higher maternal PHDI adherence in early pregnancy was associated with greater fetal adiposity and reduced lean tissue, suggesting potential implications for offspring metabolic health.

PMID:41405886 | DOI:10.1001/jamanetworkopen.2025.44153

JAMA Netw Open. 2025 Dec 1;8(12):e2550044. doi: 10.1001/jamanetworkopen.2025.50044.

ABSTRACT

IMPORTANCE: Little is known about food insecurity (FI) among graduate medical education (GME) trainees or how FI might relate to well-being outcomes in this population.

OBJECTIVES: To assess the prevalence of and factors associated with FI among GME trainees and to investigate the associations of FI with well-being outcomes such as burnout and social isolation in this population.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, a survey was distributed among 3408 resident and fellow physicians at 4 geographically distinct sites within 2 US academic institutions from May 2 to June 21, 2023. All resident and fellow physicians appointed at both institutions were eligible and were invited by email to participate.

MAIN OUTCOMES AND MEASURES: The primary outcome was prevalence of FI. Measurement instruments included a 2-item FI screening tool, a 2-item measure of burnout, items addressing intent to stay at one’s institution, social isolation, and demographic characteristics. Univariable analysis and multivariable Poisson and linear regression were used to characterize prevalence and factors associated with FI and associations with well-being outcomes and intent to stay at the institution.

RESULTS: Of those eligible, 1656 residents and fellows participated in the survey (a response rate of 48.6%). Of these respondents, 735 of 1458 (50.4%) who indicated their gender identified as men and 365 of 1402 (26.0%) who indicated their parental status reported having children. Of the 1551 respondents who reported their age, 519 (33.5%) were younger than 30 years, 770 (49.6%) were aged 31 to 35 years, 169 (10.9%) were aged 36 to 40 years, and 53 (3.4%) were older than 40 years. Among 1457 respondents indicating their race and ethnicity, the majority were Asian (310 [21.3%]) or White (654 [44.9%]). The overall prevalence of FI was 13.7%. FI proportions differed across training sites, with higher levels in large metropolitan locations (15.6%, 17.0%, and 21.3% for the 3 sites in large metropolitan areas vs 4.5% for the site in a small metropolitan area; P < .001). There were also differences by postgraduate year (16.9% for postgraduate year 1 vs 10.1% for postgraduate year ≥5; P = .003) and race and ethnicity (22.4% for Black or African American trainees compared with 8.4% for White trainees; P = .04). Those with FI were more likely to experience burnout (adjusted relative risk, 1.37 [95% CI, 1.18-1.60]; P < .001), were less likely to consider remaining at their institution after training (adjusted relative risk, 0.81 [95% CI, 0.68-0.98]; P = .02), and had higher social isolation scores (T-score parameter estimate 2.37 [95% CI, 0.89-3.86]; P = .002).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, nearly 1 in 7 GME trainees screened positive for FI. FI was associated with important well-being outcomes including burnout. These findings suggest that academic medical institutions should pursue systemic solutions to address FI among resident and fellow physicians as a means of supporting their well-being.

PMID:41405884 | DOI:10.1001/jamanetworkopen.2025.50044

JAMA Netw Open. 2025 Dec 1;8(12):e2550195. doi: 10.1001/jamanetworkopen.2025.50195.

ABSTRACT

IMPORTANCE: Standard preoperative radiotherapy (RT) for high-risk soft tissue sarcoma (STS) is delivered over 5 weeks, which can be a logistical challenge for patients.

OBJECTIVE: To evaluate the long-term toxic effects and clinical outcomes associated with a shorter 5-day, dose-equivalent preoperative RT regimen.

DESIGN, SETTING, AND PARTICIPANTS: Phase 2, single-group nonrandomized trial with an initial cohort (April 2016 to May 2018) and expansion cohort (October 2018 to May 2023) at a single academic center in the US. Participants were patients with histologically confirmed extremity or trunk STS recommended to undergo standard preoperative RT and surgery. Patients with planned neoadjuvant systemic therapy who were enrolled in the expansion group were excluded from this analysis. Analysis was conducted September 2024 to August 2025.

INTERVENTION: A total of 30 Gy in 5 fractions were delivered preoperatively.

MAIN OUTCOMES AND MEASURES: The primary end point was 2-year grade 2 or higher radiation toxic effects. Secondary end points included major wound complications (MWC), local failure, distant progression, and overall survival.

RESULTS: A total of 110 patients were treated with preoperative RT and surgery (42 patients [38%] were aged 65-79 years; 64 [58%] were male; 75 had tumors of the lower extremity [68%], and 64 patients [58%] had high-grade disease). The initial cohort accrued 50 patients who underwent surgery. The expansion cohort accrued 83 patients; 60 of 83 were treated without neoadjuvant chemotherapy and were included. Median (IQR) follow-up was 37.3 (20.1-60.6) months, including 64.2 (36.3-74.1) months for the initial cohort and 30.0 (13.5-40.2) months for the expansion cohort. At 2 years, 14 of 74 evaluable patients (18.9%) developed grade 2 or higher toxic effects (10 patients [25.0%] for the initial cohort and 4 patients [11.8%] for the expansion cohort). MWCs occurred in 33 of 110 patients (30.0%); (17 [34.0%] for the initial cohort and 16 [26.7%] for the expansion cohort). Time to wound closure exceeded 6 months for 15 patients (13.6%), including 12 of 29 patients (41.4%) who underwent local tissue advancement flaps. Two-year local control adjusting for competing risk of death was 92.4% (95% CI, 86.3%-96.5%). There were 3 (2.7%) bone fractures and 5 (4.5%) amputations.

CONCLUSIONS AND RELEVANCE: This nonrandomized clinical trial of ultrahypofractionated preoperative RT identified durable local control with MWC and favorable late grade 2 or higher toxic effects rates. Randomized data are necessary to differentiate the safety profiles of various fractionation regimens, especially duration of wound healing.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02701153.

PMID:41405883 | DOI:10.1001/jamanetworkopen.2025.50195

Health Rep. 2025 Dec 17;36(12):18-29. doi: 10.25318/82-003-x202501200002-eng.

ABSTRACT

BACKGROUND: An increasing number of Canadians are living with mental health problems, including mood disorders. However, few studies have examined the prevalence of, and factors associated with, mood disorders among older Canadians (65 years or older).

DATA AND METHODS: A pooled sample of 172,524 community-dwelling older Canadians from nine cycles of the annual Canadian Community Health Survey – 2015 to 2023 – was used to examine mood disorders and associated correlates. Multivariable logistic regression, stratified by sex, was implemented to identify factors associated with mood disorders.

RESULTS: From 2015 to 2023, on average, 7.0% of older Canadians reported a diagnosis of a mood disorder, with females (8.3%) more likely than males (5.5%) to do so. In a multivariable analysis that adjusted for demographic, socioeconomic, geographic, and health-related factors, Indigenous people (males and females) had higher odds of having a mood disorder than non-Indigenous, non-racialized populations. South Asian and Chinese males, as well as females belonging to Black and Other racialized groups, had significantly lower odds compared with their non-Indigenous, non-racialized counterparts. Living alone, being a male immigrant, and having lower household income were associated with a higher likelihood of experiencing mood disorders among older Canadians.

INTERPRETATION: The results of this study highlight the importance of considering racialized population groups, as well as socioeconomic, geographic, and health-related factors – separately for males and females – when examining mood disorders among older Canadians to inform screening and intervention programs.

PMID:41405853 | DOI:10.25318/82-003-x202501200002-eng

Health Rep. 2025 Dec 17;36(12):3-17. doi: 10.25318/82-003-x202501200001-eng.

ABSTRACT

BACKGROUND: The prevalence of household food insecurity in the 10 provinces rose from 16.8% in 2019 to 18.4% in 2022 and 22.9% in 2023. This study examines whether and how the sociodemographic and economic patterning of households’ vulnerability to food insecurity changed across these years.

DATA AND METHODS: Using data from the master files for households in the 10 provinces from the 2018, 2021, and 2022 cycles of the Canadian Income Survey, year-specific logistic regression models were conducted to estimate the predicted probability of household food insecurity by sociodemographic and economic characteristics. The predicted probability of food insecurity was also charted in relation to household income from the prior tax year, expressed in 2022 constant dollars and adjusted for household size, for each survey year.

RESULTS: The probability of food insecurity increased significantly for most households, irrespective of the sociodemographic or economic characteristics considered. In 2019 and 2022, households receiving 50% or more of their income from employment or self-employment had a lower probability of food insecurity than those with a smaller proportion of their income from employment, but there was no difference between these groups in 2023. The probability of food insecurity was significantly higher in 2022 than 2019 at all household income levels above $20,000 and higher along the entire household income continuum in 2023 than 2022.

INTERPRETATION: The probability of food insecurity is highest for low-income households, but food insecurity is becoming more prevalent among moderate- and higher-income households, and reliance on employment income is no longer protective against food insecurity.

PMID:41405852 | DOI:10.25318/82-003-x202501200001-eng

Adv Neonatal Care. 2025 Dec 15. doi: 10.1097/ANC.0000000000001331. Online ahead of print.

ABSTRACT

BACKGROUND: Palliative care is underutilized in the neonatal intensive care unit (NICU). Many patients who qualify for palliative care in the NICU are not being referred.

PURPOSE: The project’s purpose was to promote the integration of palliative care in the NICU by increasing the number of palliative care consultations through a diagnosis trigger list.

METHODS: The project director conducted a literature review and created and implemented a facility-specific diagnosis trigger list and educational module. Retrospective chart reviews were conducted from June 2023 through August 2023 to gather baseline data and from June 2024 through August 2024 to assess the project’s impact. The Neonatal Palliative Care Questionnaire for Nurses (NPCQN) and the Neonatal Palliative Care Attitude Scale (NiPCAS) were administered to neonatal nurse practitioners at the facility by pre- and post-tests before and after receiving the module.

RESULTS: The percentage of palliative care consultations placed improved from 4% to 13%. The NPCQN showed statistically significant improvement in knowledge with a P < .001. The NiPCAS showed statistically significant improvement in attitude concerning 2 of 26 questions, with values of P = .016 and P = .047.

IMPLICATIONS FOR PRACTICE AND RESEARCH: The implementation of a neonatal palliative care trigger list can increase the number of consultations placed. A palliative care trigger list can be generalized to other populations.

PMID:41405842 | DOI:10.1097/ANC.0000000000001331

Clin Exp Nephrol. 2025 Dec 17. doi: 10.1007/s10157-025-02800-x. Online ahead of print.

ABSTRACT

BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome, integrating cardiovascular disease (CVD), chronic kidney disease (CKD), and metabolic dysfunction, is a construct proposed by the American heart association. Although associations with CVD are well recognized, evidence linking CKM stage to renal outcomes remains limited.

METHODS: We analyzed health checkup data of 266,256 Japanese aged 40-74 years. Participants were classified into CKM stages 0-4a. Outcomes included all-cause mortality, cardiovascular death, and a composite renal outcome (end-stage kidney disease [eGFR < 15 mL/min/1.73 m²], ≥ 40% eGFR decline, or doubling of serum creatinine). Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs), with CKM stage 0 as the reference.

RESULTS: CKM stage 2 was the most prevalent stage (65.0%). Stage 4a showed the strongest association with all-cause and cardiovascular mortality (HRs 1.79, 3.16; 95% CIs 1.41-2.28, 1.92-5.20, respectively). In contrast, stage 3 conferred the highest risk of renal outcomes (HR 15.29, 95% CI 10.13-23.08). The number and type of metabolic risk factors correlated with outcomes, furthermore, severe CKD and prior CVD were stronger drivers of adverse outcomes than metabolic dysfunction.

CONCLUSION: CKM staging stratifies risk in the general population. No significant increase in risk was observed until CKM stage 2, and these findings underscore the progressive, cumulative nature of CKM syndrome. Metabolic dysfunction plays a crucial role in progression, stage 3 marks a pivotal inflection point for renal deterioration, and stage 4a identifies individuals at the greatest mortality risk. Early interventions targeting metabolic dysfunction may help prevent progression to advanced CKM stages and improve long-term outcomes.

PMID:41405790 | DOI:10.1007/s10157-025-02800-x