Nevin Manimala

Clin Transl Sci. 2025 Feb;18(2):e70080. doi: 10.1111/cts.70080.

ABSTRACT

Selection of rational antagonists of P2Y₁₂ receptor for CAD patients who inherit CYP2C19 LoF alleles remains still conflicting. This study compared the clinical outcomes in CAD patients inheriting CYP2C19 LoF alleles undergoing PCI and treated with clopidogrel against alternative antagonists of P2Y₁₂ receptor. A thorough literature search was performed across multiple scientific databases following the PRISMA guidelines and PICO model. Setting the statistical significance at p < 0.05 and RevMan software was used to calculate the risk ratios (RRs). Estimation of the pooled analysis revealed a significant 62% increased risk of major adverse cardiovascular events (MACE) in CAD patients inheriting CYP2C19 LoF alleles and treated with clopidogrel against those treated with alternative P2Y₁₂ receptor antagonists such as prasugrel or ticagrelor (RR 1.62; 95% CI 1.42-1.86; p < 0.00001). In addition, Asian CAD patients were found at a significantly higher risk of MACE (RR 1.93; 95% CI: 1.49-2.49; p < 0.00001) juxtaposed to CAD patients of other ethnicities (RR 1.51; 95% CI: 1.29-1.78; p < 0.00001). Conversely, between these two treatment groups, taking clopidogrel against prasugrel/ticagrelor, who possess CYP2C19 LoF alleles, no significant differences in bleeding events were observed (RR 0.94; 95% CI 0.79-1.11; p = 0.47). CAD patients undergoing PCI who inherited CYP2C19 LoF alleles and treated with clopidogrel were associated with significantly higher risk of MACE against those treated with alternative antagonists of P2Y₁₂ receptor, that is, prasugrel or ticagrelor.

PMID:39953666 | DOI:10.1111/cts.70080

Immun Inflamm Dis. 2025 Feb;13(2):e70152. doi: 10.1002/iid3.70152.

ABSTRACT

PURPOSE: Multiple organ dysfunction syndrome (MODS), defined as two or more organ dysfunction during infection or following shock or trauma, correlates with poor outcomes. Clinical data, including MODS in the renal intensive care unit (ICU), are scarce. Therefore, we investigate the clinical characteristics and prognosis of patients with MODS in the renal ICU.

METHODS: A single-center, retrospective cohort study of 99 adult patients with MODS admitted to the renal ICU of the National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing, China, from October 1, 2011 to October 1, 2021.

RESULTS: 99 patients had a mean age of 49.7 ± 16.5 years old, and 51 (51.5%) patients died within 28 days after being admitted to the renal ICU. Infection (80 patients, 80.8%) was the most common reason for admission, with 47 cases being pulmonary infections. Of all of the 99 patients, 73 (73.7%) presented with persistent lymphocytopenia (lymphocyte count < 1.1 × 10⁹/L from the day of ICU admission through to day 7), with 33 and 40 presenting moderate (lymphocyte count 0.6-1.1 × 10⁹/L) and severe persistent lymphopenia (lymphocyte count ≤ 0.6 × 10⁹/L), respectively. These patients had higher illness severity and chronic kidney disease (CKD) prevalence. Patients with severe persistent lymphopenia were associated with higher 28-day ICU mortality (87.5% vs. 42.4% vs. 7.7%, p < 0.001) versus those with moderate and without persistent lymphopenia. Multivariable logistic regression analysis revealed that the number of organs involved, APACHE-II score, and persistent lymphopenia were independent risk factors for 28-day mortality in patients with MODS. The value of lymphocyte count on day 7 of admission in predicting poor prognosis of patients was higher than on other days (Area Under Curve, AUC = 0.831).

CONCLUSIONS: Patients with MODS are critically ill with high mortality. Persistent lymphopenia is frequent in patients with MODS and is independently associated with 28-day mortality. Lymphocyte counts on day 7 of admission were shown to be highly predictive of prognosis.

PMID:39953665 | DOI:10.1002/iid3.70152

J Forensic Leg Med. 2025 Feb 10;110:102826. doi: 10.1016/j.jflm.2025.102826. Online ahead of print.

ABSTRACT

BACKGROUND: Non-fatal strangulation (NFS) is a major risk factor for female homicide. Victims may present in a variety of clinical settings. In this study, we analysed reported signs, symptoms and injuries following NFS.

METHODS: This is a clinical audit of 170 NFS victims who underwent a documented clinical examination, including forensic photography.

RESULTS: Patients reported neck pain (77.6 %), an inability to breathe (60 %), headache (55.9 %), sore throat (52.9 %) and voice changes (47.1 %). In 76.5 % neck injuries were detected comprising non-petechial bruising (59.2 %), linear abrasions (scratch marks) (25.4 %), neck swelling (12.3 %), petechial haemorrhage (7.7 %) and ligature marks (1.5 %) with no detectable neck injury in 23.5 % of cases. There was no typical patient profile of NFS signs, symptoms or injuries or correlation of any signs, despite extensive interrogation by statistical analyses.

CONCLUSIONS: To assist with therapeutic care and forensic evidence collection following NFS, signs, symptoms and injuries should be documented. A lack of detectable injury to the neck following NFS does not exclude NFS. In addition, detectable injury may indicate a defensive response by the patient and/or multiple applications of force.

PMID:39951846 | DOI:10.1016/j.jflm.2025.102826

Pregnancy Hypertens. 2025 Feb 13;39:101200. doi: 10.1016/j.preghy.2025.101200. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore the relationship between blood pressure (BP) variability and perinatal outcomes.

STUDY DESIGN: This was a retrospective study of 996 pregnant women with hypertension/risk factors for hypertension in pregnancy. BP variability was calculated by visit-to-visit standard deviation (SD) and mean difference (MD). Logistic regression explored the relationship between BP variability and perinatal outcome, adjusting for confounders.

MAIN OUTCOME MEASURES: Correlation between BP variability and i) fetal growth restriction (FGR) and ii) preterm birth (PTB).

RESULTS: FGR and PTB complicated 128/996 (13 %) and 233/996 (23 %) pregnancies. At visit 1, 61 (6 %) women were taking labetalol, 125 (13 %) were taking calcium channel blockers and 780 (78 %) were not taking antihypertensives. Increased BP variability was associated with FGR and PTB. These relationships persisted after adjustment for number of antihypertensives, pre-pregnancy BP, BMI, ethnicity and previous FGR for systolic but not diastolic BP variability (adjusted OR for FGR: 1.16 [95 % C.I. 1.03-1.30]; PTB: 1.16 [1.05-1.29]). However, statistical significance was lost after adjustment for maximum BP. Nifedipine was associated with increased BP variability, compared with labetalol, despite adjustment for ethnicity and pre-existing hypertension (adjusted difference: 1.93 mmHg [0.13-3.73], p = 0.04).

CONCLUSIONS: Increased visit-to-visit systolic but not diastolic BP variability is associated with adverse perinatal outcomes. Nevertheless, it is unclear whether BP lability directly influences perinatal outcome, or merely reflects peak BP. The difference in BP variability between antihypertensives may reflect varying effectiveness or factors influencing antihypertensive choice. Prospective research is needed to investigate any potential link between antihypertensive medications, BP variability and perinatal outcome.

PMID:39951841 | DOI:10.1016/j.preghy.2025.101200

Opt Lett. 2025 Feb 15;50(4):1393-1396. doi: 10.1364/OL.541372.

ABSTRACT

In this paper, we propose a novel, to the best of our knowledge, and efficient parameter estimator based on the k-nearest neighbor (kNN) and data generation method for the lognormal-Rician turbulence channel, which is of vital importance to the free-space optical/quantum communications. The Kolmogorov-Smirnov (KS) goodness-of-fit statistical tools are employed to investigate the validity of the kNN approximation under different channel conditions, and it is shown that the choice of k plays a significant role in the approximation accuracy. We present several numerical results to illustrate that solving the constructed objective function can provide a reasonable estimate of the actual values. The mean square error simulation results show that increasing the number of generated samples by two orders of magnitude does not lead to a significant improvement in estimation performance when solving the optimization problem by the gradient descent algorithm. However, the estimation performance under the genetic algorithm (GA) approximates to that of the saddlepoint approximation and expectation-maximization (EM) estimators. Therefore, combined with the GA, we demonstrate that the proposed estimator achieves the best trade-off between the computation complexity and the accuracy.

PMID:39951812 | DOI:10.1364/OL.541372

J Med Internet Res. 2025 Feb 14;27:e59015. doi: 10.2196/59015.

ABSTRACT

BACKGROUND: The emergence of disease-modifying treatment options for Alzheimer disease is creating a paradigm shift in strategies to identify patients with mild symptoms in primary care settings. Systematic reviews on digital cognitive tests reported that most showed diagnostic performance comparable with that of paper-and-pencil tests for mild cognitive impairment and dementia. However, most studies have small sample sizes, with fewer than 100 individuals, and are based on case-control or cross-sectional designs.

OBJECTIVE: This study aimed to examine the predictive validity of the Japanese Cognitive Function Test (J-Cog), a new computerized cognitive battery test, for dementia development.

METHODS: We randomly assigned 2520 older adults (average age 72.7, SD 6.7 years) to derivation and validation groups to determine and validate cutoff points for the onset of dementia. The Mini-Mental State Examination (MMSE) was used for comparison purposes. The J-Cog consists of 12 tasks that assess orientation, designation, attention and calculation, mental rotation, verbal fluency, sentence completion, working memory, logical reasoning, attention, common knowledge, word memory recall, and episodic memory recall. The onset of dementia was monitored for 60 months. In the derivation group, receiver operating characteristic curves were plotted to determine the MMSE and J-Cog cutoff points that best discriminated between the groups with and without dementia. In the validation group, Cox proportional regression models were developed to predict the associations of the group classified using the cutoff points of the J-Cog or MMSE with dementia incidence. Harrell C-statistic was estimated to summarize how well a predicted risk score described an observed sequence of events. The Akaike information criterion was calculated for relative goodness of fit, where lower absolute values indicate a better model fit.

RESULTS: Significant hazard ratios (HRs) for dementia incidence were found using the MMSE cutoff between 23 and 24 point (HR 1.93, 95% CI 1.13-3.27) and the J-Cog cutoff between 43 and 44 points (HR 2.42, 95% CI 1.50-3.93). In the total validation group, the C-statistic was above 0.8 for all cutoff points. Akaike information criterion with MMSE cutoff between 23 and 24 points as a reference showed a poor fit for MMSE cutoff between 28 and 29 points, and a good fit for the J-Cog cutoff between 43 and 44 points.

CONCLUSIONS: The J-Cog has higher accuracy in predicting the development of dementia than the MMSE and has advantages for use in the community as a test of cognitive function, which can be administered by nonprofessionals.

PMID:39951718 | DOI:10.2196/59015

J Med Internet Res. 2025 Feb 14;27:e55007. doi: 10.2196/55007.

ABSTRACT

BACKGROUND: The COVID-19 pandemic catalyzed an uptake in virtual care. However, the rapid shift left unanswered questions about the impact of virtual care on the quality of primary care and its appropriateness and effectiveness. Moving forward, health care providers require guidance on how best to use virtual care to support high-quality primary care.

OBJECTIVE: This study aims to identify and summarize clinical studies and systematic reviews comparing virtual care and in-person care in primary care, with a focus on how virtual care can support key clinical functions such as triage, medical assessment and treatment, counseling, and rehabilitation in addition to the management of particular conditions.

METHODS: We conducted a scoping review following an established framework. Comprehensive searches were performed across the following databases: Embase, MEDLINE, PsycInfo, Emcare, and Cochrane Database of Systematic Reviews. Other well-known websites were also searched. PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines were followed. Articles were selected by considering article type, language, care provided, intervention, mode of care delivery, and sample size.

RESULTS: A total of 13,667 articles were screened, and 219 (1.6%) articles representing 170 studies were included in the review. Of the 170 studies included, 142 (83.5%) were primary studies, and 28 (16.5%) were systematic reviews. The studies were grouped by functions of primary care, including triage (16/170, 9.4%), medical assessment and treatment of particular conditions (63/170, 37.1%), rehabilitation (17/170, 10%), and counseling (74/170, 43.5%). The studies suggested that many primary care functions could appropriately be conducted virtually. Virtual rehabilitation was comparable to in-person care and virtual counseling was found to be equally effective as in-person counseling in several contexts. Some of the studies indicated that many general primary care issues could be resolved virtually without the need for any additional follow-up, but data on diagnostic accuracy were limited. Virtual triage is clinically appropriate and led to fewer in-person visits, but overall impact on efficiency was unclear. Many studies found that virtual care was more convenient for many patients and provided care equivalent to in-person care for a range of conditions. Studies comparing appropriate antibiotic prescription between virtual and in-person care found variable impact by clinical condition. Studies on virtual chronic disease management observed variability in impact on overall disease control and clinical outcomes.

CONCLUSIONS: Virtual care can be safe and appropriate for triage and seems equivalent to in-person care for counseling and some rehabilitation services; however, further studies are needed to determine specific contexts or medical conditions where virtual care is appropriate for diagnosis, management outcomes, and other functions of primary care. Virtual care needs to be adapted to fit a new set of patient and provider workflows to demonstrate positive impacts on experience, outcomes, and costs of care.

PMID:39951717 | DOI:10.2196/55007

J Med Internet Res. 2025 Feb 14;27:e62851. doi: 10.2196/62851.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) shows considerable promise in the areas of lymphoma diagnosis, prognosis, and gene prediction. However, a comprehensive assessment of potential biases and the clinical utility of AI models is still needed.

OBJECTIVE: Our goal was to evaluate the biases of published studies using AI models for lymphoma histopathology and assess the clinical utility of comprehensive AI models for diagnosis or prognosis.

METHODS: This study adhered to the Systematic Review Reporting Standards. A comprehensive literature search was conducted across PubMed, Cochrane Library, and Web of Science from their inception until August 30, 2024. The search criteria included the use of AI for prognosis involving human lymphoma tissue pathology images, diagnosis, gene mutation prediction, etc. The risk of bias was evaluated using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Information for each AI model was systematically tabulated, and summary statistics were reported. The study is registered with PROSPERO (CRD42024537394) and follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 reporting guidelines.

RESULTS: The search identified 3565 records, with 41 articles ultimately meeting the inclusion criteria. A total of 41 AI models were included in the analysis, comprising 17 diagnostic models, 10 prognostic models, 2 models for detecting ectopic gene expression, and 12 additional models related to diagnosis. All studies exhibited a high or unclear risk of bias, primarily due to limited analysis and incomplete reporting of participant recruitment. Most high-risk models (10/41) predominantly assigned high-risk classifications to participants. Almost all the articles presented an unclear risk of bias in at least one domain, with the most frequent being participant selection (16/41) and statistical analysis (37/41). The primary reasons for this were insufficient analysis of participant recruitment and a lack of interpretability in outcome analyses. In the diagnostic models, the most frequently studied lymphoma subtypes were diffuse large B-cell lymphoma, follicular lymphoma, chronic lymphocytic leukemia, and mantle cell lymphoma, while in the prognostic models, the most common subtypes were diffuse large B-cell lymphoma, follicular lymphoma, chronic lymphocytic leukemia, and Hodgkin lymphoma. In the internal validation results of all models, the area under the receiver operating characteristic curve (AUC) ranged from 0.75 to 0.99 and accuracy ranged from 68.3% to 100%. In models with external validation results, the AUC ranged from 0.93 to 0.99.

CONCLUSIONS: From a methodological perspective, all models exhibited biases. The enhancement of the accuracy of AI models and the acceleration of their clinical translation hinge on several critical aspects. These include the comprehensive reporting of data sources, the diversity of datasets, the study design, the transparency and interpretability of AI models, the use of cross-validation and external validation, and adherence to regulatory guidance and standardized processes in the field of medical AI.

PMID:39951716 | DOI:10.2196/62851

J Neurosurg. 2025 Feb 14:1-12. doi: 10.3171/2024.9.JNS241175. Online ahead of print.

ABSTRACT

OBJECTIVE: Patients with autosomal dominant polycystic kidney disease (ADPKD) have been identified to have a significantly increased risk of developing intracranial aneurysms (IAs). These patients are diagnosed at younger ages and are also at increased risk for IA rupture. The objective of this systematic review and meta-analysis was to identify risk factors associated with IA detection during screening of asymptomatic ADPKD patients.

METHODS: The authors searched for studies reporting the prevalence of IA among patients with ADPKD screened using MRA, CTA, or DSA on PubMed, Embase, Google Scholar, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov prior to August 2023 by using individualized standardized search strategies. Eligibility of all retrieved studies was assessed according to the PRISMA guidelines. Risk of bias of the included observational studies was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed using a random-effects model.

RESULTS: Twenty-four observational studies involving 5907 patients with ADPKD were identified for quantitative analysis. The authors observed an overall prevalence of IA of 12.6%. They identified several risk factors for IA with statistically significantly increased odds for unruptured IA (UIA) detection, including female sex (18 studies, OR 1.63, 95% CI 1.37-1.94, I2 = 0%), family history of either IA or subarachnoid hemorrhage (SAH) (12 studies, OR 2.17, 95% CI 1.68-2.81, I2 = 0%), family history of SAH (3 studies, OR 2.67, 95% CI 1.25-5.71, I2 = 66.0%), stage 3 or greater chronic kidney disease (CKD) (4 studies, OR 2.55, 95% CI 1.84-3.54, I2 = 0%), and hypertension (13 studies, OR 1.41, 95% CI 1.04-1.91, I2 = 34%). Age > 45 years, family history of ADPKD, smoking status, and presence of liver cysts did not reach statistical significance as risk factors during this meta-analysis.

CONCLUSIONS: The results of the authors’ meta-analysis suggest increased risk of UIA detection in screening of ADPKD patients who are female, have a family history of IA or SAH, have hypertension, or have moderate or more severe CKD. Given the increased prevalence of IA in ADPKD patients with these risk factors, these patients may stand to benefit from screening for IA early in treatment or at time of diagnosis, even if neurologically asymptomatic.

PMID:39951701 | DOI:10.3171/2024.9.JNS241175

J Med Internet Res. 2025 Feb 14;27:e64017. doi: 10.2196/64017.

ABSTRACT

BACKGROUND: Gender-affirming hormone therapy (GAHT) has shown potential for improving mental health outcomes among transgender and gender-diverse adults. How clinical outcomes change among adults receiving GAHT via telehealth across the United States is not well known.

OBJECTIVE: This study evaluated the relationship between initiating GAHT via a telehealth clinic and changes in depression, anxiety, and suicide ideation over a 3-month period.

METHODS: This cohort study evaluated the relationship between initiating GAHT via a telehealth clinic and changes in mental health over a 3-month period. Data were collected at baseline and 3 months later among adults who had their first GAHT visit between August and November 2023. The study included adults aged 18 years and older initiating GAHT for the first time, with a final sample of 342 adults across 43 states (192 initiated estrogen and 150 initiated testosterone therapy). The primary outcomes were depression symptoms using the Patient Health Questionnaire-9 (PHQ-9), anxiety symptoms using the General Anxiety Disorder-7 (GAD-7), and suicide ideation in the past 2 weeks.

RESULTS: Before GAHT initiation, 40% (136/342) of participants reported depression (PHQ-9 ≥10), 36% (120/342) reported anxiety (GAD-7 ≥8), and 25% (91/342) reported suicidal ideation. By follow-up, significant reductions were observed in PHQ-9 (-2.4, 95% CI -3.0 to -1.8) and GAD-7 scores (-1.5, 95% CI -2.0 to -1.0). Among those with elevated symptoms, 40% (48/120) to 42% (56/133) achieved a clinically meaningful response (≥50% reduction in baseline scores), and 27% (36/133) to 28% (33/120) achieved remission (PHQ-9 or GAD-7 score <5). Of those with suicide ideation at baseline, 60% (50/83) had none at follow-up.

CONCLUSIONS: This study highlights the important relationship between telehealth-delivered GAHT and mental health, emphasizing the importance of accessible and timely care.

PMID:39951700 | DOI:10.2196/64017