Category: Nevin Manimala

Obes Surg. 2025 Aug 1. doi: 10.1007/s11695-025-08115-w. Online ahead of print.

ABSTRACT

BACKGROUND: Large language models (LLMs) can generate human-like, empathetic responses within seconds. Their potential in terms of comprehensibility, empathy, and completeness to support physician-patient communication in bariatric surgery care needs to be evaluated.

METHODS: We collected 200 real-world questions from patient support groups, initial consultations, and follow-up visits, which were answered by GPT-4o and two human bariatric experts. An independent bariatric expert then blindly evaluated the responses for their overall quality, accuracy, and comprehensiveness. If needed, the responses were corrected, and the correction time was documented. Afterwards, bariatric patients (n = 189) across Germany rated the responses, assessing each one on its clarity, empathy, and completeness.

RESULTS: The LLM required significantly less time (2.7 vs. 87.2 s, p < 0.0001) and generated longer responses (607 vs. 262 characters, p = 0.001) than human experts. LLM-generated responses were rated significantly higher by patients in terms of clarity (4.8 vs. 4.6), completeness (4.5 vs. 3.4), and empathy (4.1 vs. 3.2, all p < 0.0001). In total, 64.9% of patients preferred LLM-generated responses, while 18.5% preferred physician responses. Notably, patients with a lower degree of education showed a stronger preference for LLM responses over physician responses.

CONCLUSION: LLMs could possibly act as an assistant for physicians and help improve their response efficiency while maintaining accuracy under physicians’ oversight. This approach could optimize physician time management and enhance patient satisfaction in bariatric care communication.

PMID:40748576 | DOI:10.1007/s11695-025-08115-w

Clin Drug Investig. 2025 Aug 1. doi: 10.1007/s40261-025-01465-4. Online ahead of print.

ABSTRACT

BACKGROUND: Memantine is an N-methyl-D-aspartate (NMDA) receptor antagonist with favorable safety and side effect profiles. There is a growing body of evidence for memantine as an adjunctive therapy for the positive, negative, and cognitive symptoms of schizophrenia.

OBJECTIVE: This meta-analysis examined the efficacy of memantine as an add-on to treatment with antipsychotic(s) for the primary negative symptoms (PNS) of schizophrenia.

METHODS: We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched for relevant publications in PubMed, Cochrane Library, PsycINFO, Embase, and China Journal Net databases from inception using the following search terms: memantine, schizophrenia, randomized controlled trials (RCTs), RCT, and clinical trial. Searches were limited to English- and Chinese-language articles to date. Standardized mean differences (SMDs) with 95% confidence intervals were calculated using RevMan 5.4 to assess the effect size. Risk of bias was assessed using RoB 2.0.

RESULTS: In total, 13 RCTs were identified (N = 681). Memantine was superior to placebo in treating negative symptoms, with an SMD of 0.79 (p = 0.0001, N = 631, 12 RCTs). Analysis of three studies whose corresponding authors provided original datasets showed an SMD of 2.16 (p = 0.25, N = 97) after adjusting for change in psychosis, depression, and extrapyramidal symptoms, suggesting that memantine is efficacious in treating PNS. Additionally, cognitive testing significantly improved, with an SMD of 0.66 (p = 0.0001, N = 395, eight RCTs). Positive symptoms were not significantly improved (SMD = 0.24, p = 0.1, N = 631, 12 RCTs).

CONCLUSIONS: To our knowledge, this is the first study showing a large effect size for treating PNS with memantine. Although statistical significance was not reached because of the small sample size (N = 97), the results were as expected because drugs such as memantine that act at NMDA receptors are unlikely to be effective as stand-alone treatments. Future RCTs should evaluate NMDAergic drugs in combination with complementary medications to optimize therapeutic effects for all three domains of schizophrenia psychopathology.

PMID:40748569 | DOI:10.1007/s40261-025-01465-4

J Assist Reprod Genet. 2025 Aug 1. doi: 10.1007/s10815-025-03604-4. Online ahead of print.

ABSTRACT

PURPOSE: To identify provider-level differences in the role of body mass index (BMI) in in vitro fertilization (IVF).

METHODS: A cross-sectional survey was distributed electronically to Society of Reproductive Endocrinology and Infertility members (n = 827). Analysis implemented descriptive statistics and Fisher’s exact tests.

RESULTS: One hundred eighty-seven responses were received from practices across the USA (22% response rate). Eighty-four percent of responders turned away at least one patient, in the past year, due to either BMI (82%) or a medical comorbidity other than obesity (68%). Eighty-six percent of respondents implement a cutoff. Implementation of cutoffs did not differ significantly by practice setting or geographic region. The most common reported BMI cutoff was ≥ 40. 95% cited anesthesia requirements as the primary reason for cutoffs. Only 11% of respondents perform hospital retrievals, where all 20 providers were academically affiliated. Those not performing retrievals cited lack of access to a mobile embryology lab (60%), patient cost (39%), and scheduling difficulties (55%) as common barriers.

CONCLUSIONS: Most surveyed REIs said they had excluded a patient due to BMI or a medical comorbidity in the past year, likely due to surgical and anesthetic concerns. Very few providers have access to hospital retrievals, but even outpatient retrievals for women with BMI ≥ 40 are considered safe. We agree with avoidance of a universal BMI cutoff; rather, we advocate for streamlined referral systems for otherwise excluded women, and further work in weight loss management interventions and cost effectiveness of IVF.

PMID:40748566 | DOI:10.1007/s10815-025-03604-4

Mol Biol Rep. 2025 Aug 1;52(1):777. doi: 10.1007/s11033-025-10864-x.

ABSTRACT

BACKGROUND: Gabapentin is the pharmacologic treatment of choice for symptom relief in diabetic neuropathy. However, its effect on high glucose (HG)-induced neurotoxicity and genotoxicity under diabetic neuropathy conditions remains unclear. The aim of this study was to investigate the effects of gabapentin on cytogenotoxicity in HG-induced neuropathy in dorsal root ganglion (DRG) neurons.

METHODS: DRG neurons were isolated from neonatal Sprague-Dawley rats (n = 10). After treatment of these neurons with HG (45 mmol/L) and gabapentin (1,10, 100, and 1000 µM), cell viability was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2 H-tetrazolium bromide (MTT) assay. Furthermore, the effects on DNA damage in DRG neurons exposed to HG (45 mmol/L) and gabapentin (10 and 100 µM) were investigated by comet assay.

RESULTS: When HG + Gabapentin (1 µM), HG + Gabapentin (10 µM), HG + Gabapentin (100 µM), and HG + Gabapentin (1000 µM) groups were compared with the HG group, no statistically significant change in cell viability was determined (p > 0.05). HG + Gabapentin (10 µM) and HG + Gabapentin (100 µM) groups were not statistically significant in genotoxicity compared to HG group (p > 0.05).

CONCLUSIONS: Our results suggest that gabapentin does not modulate HG-induced cytogenotoxicity in HG-exposed DRG neurons. Our findings, which emphasize the safety of gabapentin in diabetic neuropathy, need more detailed studies.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40748554 | DOI:10.1007/s11033-025-10864-x

Jpn J Ophthalmol. 2025 Aug 1. doi: 10.1007/s10384-025-01253-9. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to investigate the vascular characteristics of pediatric patients with familial Mediterranean fever (FMF) with homozygous c.~(p.M694V) mutations in the MEFV gene by comparing their retinal vascular densities with those of healthy controls by use of optical coherence tomography angiography (OCTA).

STUDY DESIGN: Prospective observational study.

METHODS: A total of 80 participants, 35 FMF pediatric patients and 45 healthy controls, were included in the study. The baseline demographic and clinical characteristics were examined, and OCTA was used to assess vascular densities in various regions of the superficial and deep capillary plexus (DCP) and optic disc. Statistical analyses were performed to identify significant differences between the groups.

RESULTS: The study demonstrated that patients with FMF exhibited a significant reduction in vascular density within the parafoveal deep capillary plexus (DCP) (P = 0.047). Additionally, vascular density in the inferior and temporal subregions of the perifoveal DCP was significantly lower in the FMF group than in the controls (P = 0.038 and P = 0.027, respectively), with a similar trend observed for the overall perifoveal DCP vascular density (P = 0.025). In addition, optic disc vascular density was significantly lower in the FMF patients than in the healthy controls (P = 0.026). Approximately 60% of the FMF patients had severe disease symptoms, whilst 40% of them had mild symptons.

CONCLUSIONS: The findings suggest significant reductions in deep capillary plexus and optic disc vascular density in children with FMF, further suggesting an underlying vascular pathology related to this autoinflammatory disease. Regular ophthalmic evaluations are necessary to monitor potential effects on retinal health in pediatric FMF patients, even when anterior segment examination findings are normal.

PMID:40748552 | DOI:10.1007/s10384-025-01253-9

JAMA Health Forum. 2025 Aug 1;6(8):e251988. doi: 10.1001/jamahealthforum.2025.1988.

ABSTRACT

IMPORTANCE: While community pharmacies provide many valuable prescription and professional services, they are also retail businesses. Evaluating pharmacy closures through the lens of a retail business framework may provide more context on what is happening in this industry and identify potential solutions to address closures and/or shortages.

OBJECTIVE: To evaluate community pharmacy turnover (openings and closings) in the US over time and by ownership type.

DESIGN AND SETTING: This cross-sectional analysis of all community pharmacy openings and closings in the US from 2010 to 2023 used pharmacy-level data from the US National Council for Prescription Drug Programs database. National-, state-, and county-level turnover was assessed using economic indicators of business dynamics, such as total population, population growth, household income, total firm changes for all industries, and net job creation.

EXPOSURES: Pharmacy class type defined as either a chain pharmacy (4 or more pharmacies under common ownership) or an independent or franchise pharmacy using the US National Council for Prescription Drug Programs classifications.

MAIN OUTCOMES AND MEASURES: Pharmacy turnover rate from 2010 to 2023, calculated as the sum of pharmacy openings and closings over the full study period divided by the total pharmacies in the market at the beginning of the period (2010).

RESULTS: The analyses found that US pharmacy market turnover rate for this 14-year period was 86.8% (52 974 total openings and closures of 61 054 total pharmacies in 2010) or 6.2% annually. When comparing across pharmacy types, independent pharmacy turnover was substantially higher (152.7%) than chain pharmacy turnover (49.9%) across the entire US. Counties with high turnover were associated with net increases in pharmacies from more independent pharmacy openings over the period. Turnover rates for all businesses were higher in counties with both low and high pharmacy turnover, even when adjusting for population size.

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that the community pharmacy market in the US has an annual turnover rate of approximately 6.2%, with independent pharmacies opening and closing more frequently than chain pharmacies.

PMID:40748545 | DOI:10.1001/jamahealthforum.2025.1988

JAMA Health Forum. 2025 Aug 1;6(8):e252258. doi: 10.1001/jamahealthforum.2025.2258.

ABSTRACT

IMPORTANCE: The utilization of elective surgical procedures is lower for patients enrolled in Medicare Advantage (MA) than in traditional Medicare (TM), but it remains unclear whether surgical episode costs differ between MA and TM for comparable patients.

OBJECTIVE: To compare the estimated costs, markers of resource use (eg, length of stay and location of surgery), and outcomes of surgical episodes for similar patients enrolled in MA and TM.

DESIGN, SETTING, AND PARTICIPANTS: In this retrospective cohort study, 2019 Medicare claims and encounters data were analyzed to compare differences in surgical episode costs for beneficiaries with MA vs TM who underwent common elective surgical procedures across 11 categories. Procedures performed in either inpatient or outpatient settings were included in the analysis. Data were analyzed from January 2023 to March 2025.

EXPOSURES: Enrollment in MA or TM.

MAIN OUTCOMES AND MEASURES: The primary outcomes were estimated 30-day costs of surgical episodes and factors affecting costs and/or outcomes, including share of inpatient procedures, length of stay, share of patients discharged home, and 30-day readmission rates. A secondary outcome explored potential facility selection and patient steering by estimating the distance traveled to surgery. Multivariable linear regression models adjusted for the type of surgical procedure, patient characteristics, and their Elixhauser Comorbidity Index were used to compare outcomes of surgical episodes in patients with MA vs TM within hospital referral regions.

RESULTS: The analysis included 1 177 700 surgical procedures among 1 110 263 Medicare beneficiaries (mean [SD] age, 73.42 [5.8] years; 686 708 females [58.3%]). The overall rate of surgery utilization was lower among MA patients vs TM patients (difference in rate, -4.4%; 95% CI, -4.8% to -4.1%), with variation found across surgical categories. Across procedures, 30-day surgical episode costs for MA patients vs TM patients were, on average, $671 (95% CI, $639-$702) lower. The share of procedures billed at the higher inpatient rate was 5.41 (95% CI, 5.23-5.58) percentage points (pp) lower for MA patients than for TM patients, and the mean length of inpatient stay was 0.27 (95% CI, 0.26-0.29) days shorter. The share of patients discharged home was higher for those with MA vs TM (3.82 [95% CI, 3.65-3.99] pp). MA patients traveled a mean of 2.32 (95% CI, 1.62-3.01) miles farther for surgery. Readmission rates were lower for patients with MA (-0.70 [95% CI, -0.83 to -0.58] pp).

CONCLUSIONS AND RELEVANCE: This study found that in addition to lower utilization of common elective surgical procedures, the costs of surgical episodes were lower for patients enrolled in MA than those enrolled in TM. MA plans had lower costs because more procedures were performed in outpatient settings, required shorter lengths of stay, and less expensive postacute care, with no apparent harm to overall quality. Physician and surgical facility selection and patient steering likely contributed to these cost differences. These findings highlight potential mechanisms by which MA plans may achieve cost savings compared with TM plans.

PMID:40748544 | DOI:10.1001/jamahealthforum.2025.2258

J Math Biol. 2025 Aug 1;91(2):23. doi: 10.1007/s00285-025-02237-6.

ABSTRACT

We study a reaction-diffusion system involving two species competing in temporally periodic and spatially heterogeneous environments. In this system, the species move horizontally and vertically with different probabilities, which can be regarded as dispersal strategies. The selection mechanisms in this case are more intricate than those observed in random diffusion scenarios. We investigate the stability of the semi-trivial periodic solutions in terms of the sign of the principal eigenvalue associated with a linear periodic eigenvalue problem. Furthermore, we provide sufficient conditions for the coexistence of two species. Additionally, numerical simulations are performed to facilitate further research and exploration.

PMID:40748525 | DOI:10.1007/s00285-025-02237-6

Res Health Serv Reg. 2025 Aug 1;4(1):11. doi: 10.1007/s43999-025-00071-3.

ABSTRACT

BACKGROUND: Maternal and infant mortality is a major public health concern especially in South Asian nations. A significant proportion of mothers and infant died as a result of complications during birth. The delivery of healthcare facilities plays key role to lowering these mortality rates. The present study aimed to explore the prevalence of institutional delivery and its determinants in five South Asian countries.

METHODS: Data were extracted from five South Asian countries latest demographic and health survey data, including Afghanistan (2015), Bangladesh (2017-18), Nepal (2016), Myanmar (2015-16), and Pakistan (2017-18), all of which were pooled for the present study. A total of 38,975 women were included in this study after data handling. A multivariate binary logistic regression model was performed to identify the factors influencing institutional delivery.

RESULTS: More than half of all deliveries among the women were reported as occurring in a medical facility. The proportion of institutional deliveries was highest in Pakistan (68.80%), and lowest in Myanmar (40.60%). This study found that women who give birth at after 20 years’ age had 1.25 times higher chance of getting healthy facility during delivery (OR 1.25, [1.19, 1.32]). The odds of institutional delivery were 2.18 times higher for highly educated women (OR 2.18, [1.89, 2.52]) and 2.88 times higher for rich women (OR 2.88, [2.70, 3.07]). The likelihood of getting his wife delivered in a hospital increased with the husband’s education level. Women who accessed by any media showed 33% higher chance of getting healthy facility during child birth. Women who did not obtain ANC from a skilled provider had a reduced likelihood of selecting healthcare facility delivery by 71% (OR 0.29, [0.28, 0.31]) compared to women who did. Women who didn’t take any health care decision by-self had 16% lower chance of getting institutional delivery facility than others. Most importantly, rural area in south Asian countries presented lower odds of receiving healthy facility during delivery (OR 0.63, [0.59, 0.68]).

CONCLUSIONS: In conclusion, improving maternal health among South Asian countries requires addressing both individual and community-level factors. Women with higher education, better socioeconomic status, media exposure, and access to prenatal care are more likely to utilize medical services. Strengthening evidence-based health policies and ensuring strong leadership can enhance women’s quality of life through better access to health care.

PMID:40748514 | DOI:10.1007/s43999-025-00071-3

Rheumatol Int. 2025 Aug 1;45(8):177. doi: 10.1007/s00296-025-05931-2.

ABSTRACT

Previous studies have shown the role of uric acid in triggering inflammatory reactions through its influence on a large group of cytokines. Therefore, searching for possible relationships between treating hyperuricemia and the course of inflammatory processes may provide valuable knowledge for clinical practice. The study was designed to determine the relationship between uric acid levels and interleukin-6 (IL-6) and interleukin-1-beta (IL-1 beta) levels determined in older adults during hospitalization. Patients were assigned to different study groups based on the uric acid levels and effectiveness, lack of treatment, or recognition of hyperuricemia. Classical variance analysis methods or nonparametric Kruskal-Wallis tests were used for statistical analysis. The analysis showed different correlations between the concentration of uric acid and the mentioned interleukins and designated study groups. In the case of properly treated hyperuricemia, a weak negative correlation is observed between the level of uric acid and interleukin IL-1β. There is a statistically significant positive correlation between the value of uric acid and interleukins IL-6 and IL-1β in people with untreated hyperuricemia and, to a lesser extent, in people with normal uric acid levels. The study’s results suggest that effective treatment may be associated with appropriate control of uric acid concentration and modulation of the inflammatory response. However, due to several measurement limitations, further research is warranted to better elucidate these associations.

PMID:40748502 | DOI:10.1007/s00296-025-05931-2