Category: Nevin Manimala

Clin Exp Dermatol. 2026 Mar 9:llag118. doi: 10.1093/ced/llag118. Online ahead of print.

ABSTRACT

BACKGROUND: Rosacea is a chronic skin disorder causing facial erythema, telangiectasias, papules, and pustules. Guidelines recommend sub-antimicrobial doses, such as doxycycline 40 mg. If symptoms persist, evaluating the efficacy and safety of sub-antimicrobial minocycline may expand therapeutic options.

AIM: The present systematic review and meta-analysis evaluates DFD-29 as a low-dose tetracycline alternative to treat rosacea.

METHODS: Our analysis included data from three RCTs sourced from PubMed, Embase, and Cochrane databases to compare the Investigator’s Global Assessment (IGA) success, reduction in inflammatory lesion counts, treatment-emergent adverse events (TEAEs), and serious adverse events (SAEs) in patients using DFD-29 versus modified-release doxycycline. Statistical analyses were conducted using RStudio.

RESULTS: In pooled analysis of 643 patients, DFD-29 significantly increased the likelihood of achieving a successful IGA score compared to doxycycline (OR 2.51; 95% CI 1.80 to 3.49; p < 0.001; I2 = 0%). The DFD-29 40 mg group had significantly greater reductions in IGA scores compared to the 20 mg group (p = 0.0210). The DFD-29 40 mg group also exhibited a higher reduction in inflammatory lesion counts than doxycycline (MD -4.56; 95% CI -6.18 to -2.93; p < 0.001), whereas the 20 mg group did not show significant results. There were no significant differences in TEAEs across groups (OR 0.96; 95% CI 0.55 to 1.66; p = 0.87; I2 = 0%), with only one SEA (atrial fibrillation) was reported with DFD-29.

CONCLUSION: Our meta-analysis showed that DFD-29 at 40 mg daily, is a superior and well-tolerated alternative to modified-release doxycycline for moderate-to-severe rosacea.

PMID:41802266 | DOI:10.1093/ced/llag118

Brain. 2026 Mar 9:awag084. doi: 10.1093/brain/awag084. Online ahead of print.

ABSTRACT

The skull bone marrow contributes to brain immune homeostasis via recently discovered skull-meningeal channels, enabling the bidirectional trafficking of immune cells between skull bone and underlying dura mater. In multiple sclerosis, autoreactive T cells migrate to the bone marrow and shift its hematopoietic output toward myeloid differentiation, contributing to disease progression. However, the role of the skull bone marrow in multiple sclerosis pathophysiology, and its relationship to brain damage and clinical disability remain largely unexplored. We utilized simultaneous MR-PET with the second-generation radioligand ¹¹C-PBR28 to characterize within the skull bone of multiple sclerosis patients the in vivo expression of the translocator protein (TSPO), an 18-kilodalton mitochondrial membrane protein largely expressed by microglia, astrocytes, and peripheral myeloid cells. Sixty-five multiple sclerosis subjects (46 relapsing-remitting, 19 secondary progressive) and 26 healthy controls underwent ¹¹C-PBR28 MR-PET to acquire 60-90-minute post-injection standardized uptake value maps and anatomical scans for brain volumetrics. Voxel-wise analyses of skull TSPO signal were conducted to assess group differences and associations with demographic, clinical, and brain volumetrics. Voxel-wise analyses revealed a divergent association between age and skull TSPO signal, with a negative correlation in healthy controls in bilateral frontal and right parietal regions (r=-0.67, p<0.001), and a positive correlation in multiple sclerosis patients in bilateral parietal and occipital skull bone regions (r=0.44, p<0.001). Compared to both healthy controls and relapsing-remitting multiple sclerosis, patients with secondary progressive multiple sclerosis showed widespread elevation in skull TSPO signal, in frontal, parietal, temporal, occipital, and skull base regions. No significant differences were detected between relapsing-remitting multiple sclerosis and healthy controls. Elevated skull TSPO signal was also observed in patients with more severe neurological disability irrespective of clinical phenotype. Widespread skull TSPO expression was observed to be positively correlated with EDSS scores (ρ=0.49, p<0.001) while a negative association was observed with white matter volume (r=-0.45, p<0.001) and SDMT z-scores (r=-0.48, p<0.001). In multivariable regression analysis, skull TSPO signal (β=6.63, SE=1.92, p=0.001) and T2-hyperintense white matter lesion volume (β=0.34, SE=0.14, p=0.020) were independently associated with disability, while white matter, cortical, and subcortical gray matter volumes did not retain statistical significance (all p>0.550). We provide in vivo evidence of skull TSPO overexpression in multiple sclerosis, observed in progressive disease and associated with clinical disability and structural brain damage. Overall, these findings suggest a role for the skull bone marrow in disease-related processes and highlight its potential as a novel radiological marker and therapeutic target.

PMID:41802262 | DOI:10.1093/brain/awag084

BJS Open. 2025 Mar 5;10(2):zraf178. doi: 10.1093/bjsopen/zraf178.

ABSTRACT

BACKGROUND: The incidence, aetiology, and outcome of unplanned intensive care unit admission after elective colon cancer surgery remain unclear. This study investigated the incidence of, and factors associated with, unplanned intensive care unit admission following elective colon cancer resection in Sweden.

METHODS: This nationwide retrospective registry study included adult patients undergoing elective colon cancer resection with curative intent in Sweden between 2010 and 2019. Patients with distant metastases, or rectal or appendiceal tumours were excluded. Data from the Swedish Colorectal Cancer Registry and the Swedish Intensive Care Registry were analysed. Patients not requiring intensive care unit admission served as controls.

RESULTS: Of 23 891 patients, 1343 (5.6%) required unplanned intensive care unit admission. These patients were older, had more co-morbidities, and were more likely to undergo open surgery and receive permanent stomas. Patients requiring surgical reintervention accounted for 43% of intensive care unit admissions and were identified later (day 5 versus day 1), had longer duration of stay in the intensive care unit (3 versus 1 day), and had worse outcomes than those with non-surgical complications, despite being younger, with less co-morbidity. Intensive care unit admission was linked to a higher unadjusted mortality rate at 30 days (13.9 versus 0.6%), 1 year (24.2 versus 4.6%), and 3 years (40.0 versus 15.3%). Laparoscopic surgery was associated with reduced intensive care unit admissions (odds ratio 0.59, 95% confidence interval 0.50 to 0.69) and lower 3-year mortality (odds ratio 0.79, 0.72 to 0.86), even after adjusting for patient- and surgery-related factors.

CONCLUSION: Unplanned intensive care unit admission was associated with increased short- and long-term mortality. Patients who had surgical reinterventions leading to intensive care unit admission were admitted later and had poorer outcomes than those with non-surgical complications, highlighting the need for earlier recognition and tailored postoperative monitoring strategies.

PMID:41802244 | DOI:10.1093/bjsopen/zraf178

J Med Internet Res. 2026 Mar 9;28:e78423. doi: 10.2196/78423.

ABSTRACT

BACKGROUND: Black veterans and veterans from lower socioeconomic backgrounds are more likely to have uncontrolled hypertension. One potential explanatory factor is reduced access to specific treatments that result in improved chronic disease management. In the Veterans Health Administration (VHA), veterans with hypertension may enroll in a remote patient monitoring (RPM) program, which consists of patient education, daily home blood pressure (BP) monitoring, health coaching, and case management. Barriers for socioeconomically disadvantaged patients may exist for similar programs in other health systems; however, the VHA is an integrated health care system, and these barriers may differ for veteran populations.

OBJECTIVE: The objective of this study was to assess the relationship between veteran race and neighborhood socioeconomic status and the likelihood of enrolling in the VHA RPM program.

METHODS: The study sample included VHA-enrolled veterans with a diagnosis of hypertension (average BP >130/80 mm Hg on ≥2 BP readings) between fiscal years 2020 and 2023. We ran random-effects logistic regression models to assess the relationship between veteran race and Area Deprivation Index and RPM enrollment each year, controlling for potential demographic and clinical confounders. For sensitivity analysis, we limited our sample to veterans with stage 2 hypertension (BP >140/90 mm Hg) and on antihypertensive medication.

RESULTS: Overall use of RPM was low, with only 4.1% (56,553/1,390,995; 95% CI 4%-4.1%) of veterans being enrolled in RPM. Black veterans, who represented 26.6% (n=35,096) of all veterans, were more likely (odds ratio [OR] 1.65, 95% CI 1.59-1.70) to enroll in RPM compared to White veterans. Asian American or Pacific Islander veterans were less likely to enroll (OR 0.83, 95% CI 0.74-0.94). We found no meaningful association between Area Deprivation Index and RPM enrollment (OR 1.00, 95% CI 0.99-1.00). When limiting our sample to those with stage or grade 2 hypertension, we found a similar association (OR 1.61, 95% CI 1.50-1.72) between Black race and RPM enrollment but no significant association with Asian or Pacific Islander race (OR 1.02, 95% CI 0.80-1.29).

CONCLUSIONS: Prior research on RPM in veterans has examined duration or outcomes of RPM enrollment but not the probability of initial enrollment. We found higher enrollment rates in the VHA RPM program among Black veterans but slightly lower enrollment among Asian American or Pacific Islander veterans. Higher enrollment among Black veterans and among those with higher comorbidity burden suggests that the VHA RPM program is successfully reaching those who could most benefit, despite low overall enrollment. Given the low enrollment in RPM, future research should focus on improving uptake among veterans who could additionally benefit from the program. Non-VHA systems, particularly those serving low-income or socioeconomically disadvantaged areas, should explore subsidized or free RPM programs for eligible patients similar to the VHA’s no-cost model for veterans.

PMID:41802237 | DOI:10.2196/78423

JMIR Form Res. 2026 Mar 9;10:e76838. doi: 10.2196/76838.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) is increasingly influencing medical student education, with AI-driven chatbots, such as ChatGPT, emerging as powerful study tools. While these technologies offer numerous benefits, they also pose challenges that warrant the adaptation of medical school curricula.

OBJECTIVE: This study examines medical students’ perceptions and use of ChatGPT. We hypothesize that ChatGPT is widely used for academic support, but concerns remain regarding reliability and academic integrity.

METHODS: We conducted a cross-sectional study from August 25 to December 10, 2024, in the United States. Students in all years of medical training who were enrolled in accredited allopathic or osteopathic medical schools were eligible to participate. Data were collected using an anonymous online questionnaire, which was distributed through institutional mailing lists. Overall, 188 schools were reached, of which 14 (7.4%) responded and agreed to distribute the survey. A total of 177 participants completed the survey. Survey items consisted primarily of Likert-scale and multiple-choice questions. Primary outcome measures included self-reported frequency of ChatGPT use, perceived usefulness of ChatGPT, and ChatGPT use habits.

RESULTS: Overall, 98.9% (175/177) of participants had heard of ChatGPT, with 88.7% (157/177) reporting having used it; 62.7% (111/177) identified as female, and 52% (92/177) had completed at least 1 block of clinical rotations. Medical students most often used ChatGPT to understand complex medical concepts, prepare for exams, and generate study materials. Moreover, 46.5% (73/157) used it to help complete medical school assignments. Medical students also reported using it clinically, with the most common use being to generate differential diagnoses. Notably, 21.0% (33/157) of participants responded having used ChatGPT to help write clinical notes. Moreover, 73.9% (116/157) reported that their experience with ChatGPT improved their overall perception of AI’s potential to assist in medical practice, and 86.6% (135/157) believed that having ChatGPT as a resource would make them more effective physicians. Statistical analyses were performed using the Pearson chi-square test with α=.05. Students who reported moderate or advanced baseline understanding of AI were more likely to practice conscientious use habits, such as cross-checking (odds ratio [OR] 2.31, 95% CI 1.08-4.97) and editing (OR 2.45, 95% CI 1.05-5.71) ChatGPT output before using it, than those who reported a basic or limited understanding.

CONCLUSIONS: Our study is among the few to examine medical student perceptions of ChatGPT at a national level. We examined responsible use habits to identify areas in which reliance on this technology may lead users astray. We found that ChatGPT is being used to complete academic assignments and write clinical notes, raising concerns about information verification, AI literacy, patient confidentiality, and ethical use. Together, these findings highlight the need for structured AI education to help students leverage these technologies effectively while mitigating risks associated with misinformation and overreliance on AI.

PMID:41802232 | DOI:10.2196/76838

J Med Internet Res. 2026 Mar 9;28:e73812. doi: 10.2196/73812.

ABSTRACT

BACKGROUND: Digital biomarkers are gaining interest as proxy markers for mental health, as they enable passive and continuous data collection. However, the association between digital biomarkers of health and anxiety, both generalized anxiety disorder and anxiety symptoms, remains unknown.

OBJECTIVE: This systematic review and meta-analysis examined the association between digital biomarkers of health obtained from wrist-worn wearables and anxiety in adults.

METHODS: Systematic literature searches were conducted across 6 databases, including unpublished gray literature. The final search was done on September 21, 2025. Cross-sectional or longitudinal studies investigating the association between digital biomarkers from wrist-worn wearables and anxiety were eligible. Studies using inferential statistics or machine learning methods were both eligible. Studies were excluded if participants received diagnoses of neurodegenerative disorders or physical health conditions. Two risk-of-bias tools were used: the National Heart, Lung, and Blood Institute assessment tool for inferential statistical studies, and the modified version of the Quality Assessment of Diagnostic Accuracy Studies-2 for machine learning studies. Whenever possible, effect sizes were combined across studies, for each digital biomarker of health separately, using random-effects meta-analyses. Sensitivity analyses were performed to assess whether results differed according to anxiety type (state or trait) and age group. Otherwise, studies were synthesized narratively.

RESULTS: A total of 44 studies from 42 articles were eligible. Among these, 36 studies used inferential statistical approaches for analysis (21 reporting sleep characteristics, 8 reporting physical activity, 2 reporting heart rate variability, and 5 reporting more than 1 type), and 8 studies used machine learning approaches. Sample size ranged from 17 to 170,320. Meta-analyses on 4 sleep metrics found no associations: sleep efficiency (Fisher z=-0.07, 95% CI -0.14 to 0.002; P=.06; PI -0.19 to 0.05), wake after sleep onset (Fisher z=0.13, 95% CI -0.04 to 0.30; P=.11; PI -0.15 to 0.41), total sleep time (Fisher z=0.009, 95% CI -0.01 to 0.03; P=.28; PI -0.02 to 0.03), and sleep onset latency (Fisher z=0.04, 95% CI -0.07 to 0.15; P=.08; PI -0.19 to 0.27). Qualitative syntheses revealed that lower physical activity levels and higher heart rate were associated with greater anxiety symptoms. Machine learning studies using wrist-worn wearable data alone showed varied performance, with predictive performance improving when wearable data were combined with other data sources.

CONCLUSIONS: This is the first review to synthesize evidence from inferential statistical (mostly fair quality) and machine learning studies examining association between wearable-derived digital biomarkers and anxiety. Meta-analyses found no associations between sleep metrics and anxiety. Although based on limited studies, lower physical activity levels and elevated heart rate were associated with greater anxiety symptoms. Digital biomarkers may be more useful when integrated with other data sources (eg, self-report and clinical data) rather than used as stand-alone screening tools.

TRIAL REGISTRATION: PROSPERO CRD42023409995; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023409995.

PMID:41802227 | DOI:10.2196/73812

JMIR Hum Factors. 2026 Mar 9;13:e86443. doi: 10.2196/86443.

ABSTRACT

BACKGROUND: Suboptimal design of infusion pumps may lead to usage errors, thereby compromising patient safety. Usability evaluation enables medical device design teams to identify and rectify design-related usability issues in a timely manner. Nevertheless, existing research on infusion pump usability continues to exhibit limitations in aspects such as task design.

OBJECTIVE: The study aimed to evaluate the usability of an infusion pump (SLGO SP-200 [SLGO Medical Technology Co, Ltd]) through simulation-based testing with nurses in a usability laboratory designed to simulate an intensive care unit.

METHODS: A total of 12 registered nurses with experience in using infusion pumps participated in this study. Nurses were asked to perform 12 operational tasks using the infusion pump. The participants were also asked to perform 7 knowledge tasks, where they were required to find relevant information in the user manual. Participants’ behavioral measures (task completion time, frequency of manual query, frequency of asking for assistance from researchers, frequencies of operation difficulties, near-misses, and failures), perceptions (perceived ease of use, perceived concentration level required, perceived likelihood of making programming errors, perceived mental workload, satisfaction, and use intention) were collected to evaluate the usability and identify interface design deficiencies of the pump.

RESULTS: The study found that the participants were generally able to complete the tasks. All operational tasks were completed within 3 minutes, and all knowledge tasks were completed within 2 minutes. Our study identified 79 difficult operations, 9 near-miss operations, and 36 operation failures. The causes of the above problems were analyzed. Participants generally found the infusion pump to be user-friendly, requiring a medium level of attention resources, and reported low levels of mental workload and likelihood of making programming errors.

CONCLUSIONS: The study results can provide a basis for the design of infusion pumps, help practitioners define the risks of use and the key content of training, and provide an important reference for the design of usability evaluation schemes for medical devices.

PMID:41802226 | DOI:10.2196/86443

Int J Epidemiol. 2026 Feb 18;55(2):dyag022. doi: 10.1093/ije/dyag022.

ABSTRACT

BACKGROUND: The burden of non-communicable diseases (NCDs) in adolescent and young adult females in sub-Saharan Africa (SSA) has not been comprehensively studied. To address this gap, we analysed data from the Global Burden of Diseases (GBD) 2021, focusing on death due to NCDs in females aged 10-24 years in SSA.

METHODS: We extracted data from GBD 2021 on NCD deaths in females aged 10-24 years in SSA from 2000 to 2021. We presented the numbers and death rates of NCDs, and the proportion of NCDs in all-cause deaths was calculated. Pearson’s correlation was applied to explore the NCD burden on the socioeconomic development and health system. Additionally, we projected the NCD burden until 2050 by applying mixed-effects models.

RESULTS: In 2021, 52 083.13 (42 018.18∼61 630.88) NCD deaths, at a mortality rate of 27.59 (22.26∼32.64) per 100 000 population, emerged, accounting for 21.13% (17.57%∼24.22%) of the total deaths. Neoplasms, cardiovascular diseases, digestive diseases, neurological disorders, and diabetes and kidney diseases were the top five leading causes of deaths. Inverse associations were observed between the NCD death rates and indicators of the socioeconomic and health system (P < .001). An increasing trend was observed of the NCD death numbers and the contributing proportions since 2000, and it was predicted to continue increasing through to 2050, with the highest increasing trend in neoplasms.

CONCLUSION: The rising disease burden of NCDs for adolescent and young adult females in SSA has attracted attention. Targeted interventions and strengthened health systems should be prioritized to address the concerning NCD burden in adolescent girls in SSA.

PMID:41802219 | DOI:10.1093/ije/dyag022

Int J Epidemiol. 2026 Feb 18;55(2):dyag030. doi: 10.1093/ije/dyag030.

ABSTRACT

BACKGROUND: During the perinatal period, the fetus can exert profound effects on processes that alter pre- and postnatal maternal physiology. It is possible to investigate the causal effect of offspring perinatal exposures on their mother’s health using Mendelian randomization (MR). However, analyses need to be adjusted for maternal genotype to avoid confounding. Such analyses are difficult to perform at scale because of the paucity of cohorts across the world with large numbers of genotyped maternal-offspring dyads and parent-offspring trios.

METHODS: We introduce the “offspring genotype-by-proxy” MR framework which can be employed in the absence of offspring genetic information to complement existing approaches in the triangulation of causal inference. The basic idea is to use paternal genotypes to proxy the direct effect of their offspring’s genotype on their offspring’s own exposures.

RESULTS: We compare our framework to other MR designs and investigate the consequences of model misspecification and spousal misclassification on statistical power, consistency, and bias. In addition, we discuss the key MR assumptions that prevent these approaches from being appropriate for investigating the effect of many offspring postnatal and later life exposures on maternal health.

CONCLUSION: Given the increasing availability of datasets such as the UK Biobank that (incidentally) include tens of thousands of genome-wide genotyped spousal pairs and large population biobanks with linked health record data for first-degree relatives, the offspring genotype-by-proxy MR approach could augment causal analyses of offspring perinatal exposures on their mother’s outcomes as implementation is not restricted to datasets with mother-offspring genotype information.

PMID:41802218 | DOI:10.1093/ije/dyag030

Int J Epidemiol. 2026 Feb 18;55(2):dyag015. doi: 10.1093/ije/dyag015.

ABSTRACT

BACKGROUND: Healthy worker survivor bias (HWSB) skews health outcome studies by favouring healthier employed individuals. While advanced statistical methods exist, their application in Korea has been limited due to insufficient occupational and mortality data. This study quantifies HWSB due to employment status changes (HWSB-ES) using Korea’s National Health Insurance Service (NHIS) database.

METHODS: This retrospective cohort study analysed NHIS data to assess HWSB-ES in individuals aged 30-59 years who maintained consistent insurance types from 2008 to 2010. The primary outcome, all-cause mortality, was tracked until December 2022. Insurance type determined employment status, with industry details collected for employees. Landmark analysis (origin: 2011; current: 2012-21) estimated HWSB-ES by assessing mortality risk attenuation in fixed and dynamic cohorts, stratified by age, sex, and landmark periods (1-10 years for short-term; 1-7 years for long-term).

RESULTS: After exclusions, 18 192 989 participants were included (median age: 44 years; 49.05% male). HWSB-ES was more pronounced in female, dynamic cohorts, and longer landmark periods. Importantly, the effect of HWSB-ES intensified with age but showed a smaller long-term attenuation compared to the short-term effect. Short-term HWSB-ES attenuated mortality risk by 25%-30% in male and 36%-39% in female. Long-term attenuation was lower, at 7%-15% in male and 12%-18% in female.

CONCLUSIONS: The quantified HWSB-ES results provide critical national-level estimates for adjustment, especially in female and older cohorts, to prevent the underestimation of adverse health effects in occupational research.

PMID:41802217 | DOI:10.1093/ije/dyag015