Nevin Manimala

J Glaucoma. 2025 May 9. doi: 10.1097/IJG.0000000000002586. Online ahead of print.

ABSTRACT

PRECIS: The present study highlights the high correlation of outcomes of bilateral trabeculectomy in subjects with different types of glaucoma after mid-term follow-up.

PURPOSE: To evaluate the mid-term outcomes of bilateral trabeculectomy and assess the differences and associations in outcome between the first-operated and the second-operated eye.

METHODS: Patients with different types of glaucoma who underwent bilateral trabeculectomy from 2006 to 2022 were included in this retrospective study. All patients were followed for at least 24 months after surgery in each eye. The main outcome measure was surgical success. Complete success was defined according to intraocular pressure (IOP)≤16 mmHg and at least 20% reduction from preoperative baseline IOP without any IOP lowering medications. Cumulative success was defined according to IOP≤16 mmHg and at least 20% reduction from preoperative baseline IOP, with or without IOP-lowering medications. Secondary outcome measures were IOP and the number of IOP-lowering medications.

RESULTS: In total, 186 eyes of 93 patients were included. There was no statistically significant difference in terms of the baseline IOP and number of IOP-lowering medications between the first and second operated eyes before and after surgery (P-value>0.05). The mean follow-up time was 64.35±41.13 months and 57.13±38.41 months for the first operated and the second operated eyes, respectively. At the 24-month follow-up point, among patients whose first operated eyes were considered a complete success, 78.2% of surgeries in second eyes were successful (P-value=0.002). On the other hand, among patients whose first operated eyes were considered a cumulative success, 80.3% of surgeries in second eyes were successful (P value=0.012). In a multivariate analysis of factors affecting cumulative success, the outcome of the surgery in the first operated eye was the only factor that significantly impacted the outcome of surgery in the second operated eye. If the first operated eye achieved cumulative success, the odds of the second operated eye experiencing cumulative success were 6.5 (P-value=0.02). The rates of postoperative complications in the two eyes were similar and did not show statistically significant differences.

CONCLUSION: The present study demonstrates a significant correlation in surgical outcomes of trabeculectomy between the two eyes of the same patient in mid-term follow-up. Surgical success in the first-operated eye increases the odds of success in the second eye 6.5 fold.

PMID:40341455 | DOI:10.1097/IJG.0000000000002586

Sleep Breath. 2025 May 8;29(2):179. doi: 10.1007/s11325-025-03346-8.

ABSTRACT

BACKGROUND: High-quality sleep is essential for both physical well-being and mental health, particularly in promoting the health and longevity of older adults. However, limited evidence exists regarding the relationship between chronic diseases and sleep quality in this population.

METHODS: The study investigated 35 common chronic diseases among 1186 older individuals aged 60 and above from six rural communities in northwest China. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Multiple logistic regression and interaction analyses were employed to explore the relationship between multiple chronic diseases and sleep quality.

RESULTS: Compared with the first quartile (≤ 1) of the number of chronic diseases, the second (2), third (3-4), and fourth (≥ 5) quartile ORs were 1.771 (95% CI: 1.191-2.631, p = 0.005), 2.434 (95% CI: 1.660-3.567, p < 0.001), and 3.180 (95% CI: 2.039-4.959, p < 0.001), respectively. For the duration of chronic diseases, compared with the first quartile (≤ 4.32 years) of duration of chronic diseases, the second (4.33-7.49 years), third (7.50-11.32 years) and fourth (≥ 11.33 years) quartile ORs were 1.350 (95% CI: 0.931-1.957, p = 0.113), 1.381 (95% CI: 0.953-2.000, p = 0.088), and 1.629 (95% CI: 1.122-2.365, p = 0.010), respectively. Older adults with multimorbidity and a longer duration of chronic diseases (≥ 7.5 years) had poorer sleep quality than those without multimorbidity and shorter duration of chronic diseases.

CONCLUSION: The higher number and longer duration of chronic diseases are associated with poorer sleep quality among older adults, with a stronger correlation observed in females compared to males.

PMID:40341452 | DOI:10.1007/s11325-025-03346-8

Rev Esc Enferm USP. 2025 May 2;59:e20240281. doi: 10.1590/1980-220X-REEUSP-2024-0281en. eCollection 2025.

ABSTRACT

OBJECTIVE: To identify the factors affecting breastfeeding self-efficacy and LATCH scores and to assess the impact of postnatal breastfeeding education on mothers’ self-efficacy.

METHOD: This study employed a quasi-experimental pretest-posttest design with a single group. It was completed with 217 mothers who gave birth in a hospital in Turquía between May 2023 and December 2023. Data were collected using Breastfeeding Self-efficacy Scale, and LATCH assessment tool. Breastfeeding education was given to mothers before discharge. Breastfeeding self-efficacy was re-evaluated on the phone four weeks after discharge.

RESULTS: The mean LATCH score among mothers was 9,2 ± 1.3 (min = 3, max = 10). Higher LATCH scores were observed in mothers with primary or secondary education, those who were unemployed, had four or more pregnancies and children, breastfed within the first hour, and had prior breastfeeding experience before discharge. Mothers with breastfeeding experience and those with four pregnancies and three children had higher breastfeeding self-efficacy scores before discharge. Four weeks after discharge was given to mothers, the mean breastfeeding self-efficacy score increased significantly from 58,9 ± 6,7 to 68,4 ± 1,9. A statistically significant improvement in breastfeeding self-efficacy was observed only among mothers with prior breastfeeding experience four weeks after discharge.

CONCLUSION: Regular breastfeeding education in the early postpartum period is crucial, particularly for young, primiparous mothers with higher education levels, those who are employed, with a history of cesarean deliveries, or lack of prior breastfeeding experience. The findings indi-cate that breastfeeding education positively impacts mothers’ breastfeeding self-efficacy.

PMID:40341446 | DOI:10.1590/1980-220X-REEUSP-2024-0281en

AAPS J. 2025 May 9;27(4):91. doi: 10.1208/s12248-025-01076-z.

ABSTRACT

The pharmacokinetics of antibodies with varied binding kinetics were simulated to assess the role of affinity and binding microconstants (kon, koff) on tumor exposure and intra-tumoral distribution. Anti-HER2 constructs (trastuzumab, pertuzumab, VK3VH6, and conjugates with DM1 and gelonin) were produced, purified, and tested for binding and cytotoxicity in vitro, and for intra-tumoral distribution and anti-tumor efficacy in mice. Simulations demonstrated that homogeneity in intra-tumoral distribution increases with increases in koff and with decreases in kon. Interestingly, simulations also predicted that homogeneity in tumor distribution may be improved by decreasing kon and koff in parallel (without changing affinity). Relative to trastuzumab, pertuzumab exhibits similar affinity but a ~ fivefold smaller kon and koff, while VK3VH6 exhibits a similar koff but a ~ 30-fold lower kon and affinity. Conjugate concentrations associated with 50% inhibition of cell proliferation (IC50s) were found to vary with affinity, where IC50 values were similar for pertuzumab and trastuzumab, and higher for VK3VH6. Consistent with model simulations, VK3VH6 and pertuzumab demonstrated more homogeneous tumor distribution than trastuzumab. Although treatment differences were not statistically significant, pertuzumab and VK3VH6 conjugates showed trends for increased survival time relative to mice treated with trastuzumab conjugates. Our simulation and experimental results demonstrate complex relationships between antibody-antigen binding kinetics, intratumoral distribution, and efficacy. The rate constant of association, kon, is an underappreciated determinant of intra-tumoral distribution; among high-affinity antibodies, those with lower values of kon may be expected to exhibit improved intra-tumoral distribution and, potentially, efficacy.

PMID:40341444 | DOI:10.1208/s12248-025-01076-z

JAMA Oncol. 2025 May 8. doi: 10.1001/jamaoncol.2025.0985. Online ahead of print.

ABSTRACT

IMPORTANCE: The benefits and harms of immune checkpoint inhibitor (ICI) therapy for lung cancer vary across groups, including those typically underrepresented in randomized clinical trials.

OBJECTIVE: To quantify the harms and benefits of ICI-containing regimens in individuals with non-small cell lung cancer and assess heterogeneity across priority subgroups.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study conducted in 2024 used 2013 to 2019 Surveillance, Epidemiology, and End Results (SEER) Medicare data of individuals 66 years or older with non-small cell lung cancer who were exposed to any ICI.

EXPOSURES: ICI + chemotherapy, single ICI (reference group).

MAIN OUTCOMES: Severe immune-related adverse events (irAE; harm) and mortality (when delayed mortality was the benefit). Severe irAEs were defined using validated diagnosis and medication codes. Mortality was ascertained from Medicare data. Hazard ratios (HRs) were estimated and 95% CIs were stratified by whether an ICI was used as the first or second or later systemic anticancer treatment (SACT) and in subgroups defined by preexisting autoimmune disease, sex, and age. The harm-benefit tradeoff was described as excess severe irAEs per year of life gained in which the gain in survival time was assessed using restricted mean survival time.

RESULTS: Of 17 681 Medicare beneficiaries, 8797 (49.5%) were female, and the mean (SD) age was 74 (6.0) years. Compared with a single ICI (14 249 [80.6%]), individuals treated with ICI + chemotherapy (3432 [19.4%]) had an elevated risk of severe irAE in the first SACT setting (hazard ratio [HR], 1.18; 95% CI, 1.06-1.30) but not in the second or later SACT setting (HR, 1.04; 95% CI, 0.92-1.19); there was a decreased risk of mortality in the first SACT setting (HR, 0.66; 95% CI, 0.62-0.72) but not in the second or later SACT setting (HR, 0.94; 95% CI, 0.68-1.03). In the first SACT setting, ICI + chemotherapy delayed mortality more among patients with (vs without) autoimmune disease at baseline. For each 1 year of life gained, the risk of severe irAEs was 0.31 (95% CI, 0.09-0.53) and the tradeoff was also statistically significant in men and patients without autoimmune disease.

CONCLUSIONS: The results of this cohort study suggest that given both treatment-related harms and benefits, ICI + chemotherapy use in the first SACT setting requires informed decision-making; the potential benefits of ICI + chemotherapy vs single ICI in high-risk subgroups is encouraging.

PMID:40338588 | DOI:10.1001/jamaoncol.2025.0985

Psychol Assess. 2025 May 8. doi: 10.1037/pas0001379. Online ahead of print.

ABSTRACT

When using the experience sampling method (ESM), researchers must navigate a delicate balance between obtaining fine-grained snapshots of phenomena of interest and avoiding undue respondent burden, which can lead to disengagement and compromise data quality. To guide that process, we investigated how questionnaire length and sampling frequency impact careless and insufficient effort responding (C/IER) as an important yet understudied aspect of ESM data quality. To this end, we made use of existing experimental ESM data (Eisele et al., 2022) from 163 students randomly assigned to one of two questionnaire lengths (30/60 items) and one of three sampling frequencies (3/6/9 assessments per day). We employed a novel mixture modeling approach (Ulitzsch, Nestler, et al., 2024) that leverages screen time data to disentangle attentive responding from C/IER and allows investigating how the occurrence of C/IER evolved within and across ESM study days. We found sampling frequency, but not questionnaire length, impacted C/IER, with higher frequencies resulting in higher overall C/IER proportions and sharper increases of C/IER across, but not within days. These effects proved robust across various model specifications. Further, we found no substantial relationships between model-implied C/IER and other engagement measures, such as self-reported attentiveness, attention checks, response-pattern-based attentiveness indicators, and compliance. Our findings contrast previous studies on noncompliance, suggesting that respondents may employ different strategies to lower the different types of burden imposed by questionnaire length and sampling frequency. Implications for designing ESM studies are discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40338562 | DOI:10.1037/pas0001379

JAMA Netw Open. 2025 May 1;8(5):e259246. doi: 10.1001/jamanetworkopen.2025.9246.

ABSTRACT

IMPORTANCE: Depression and heart failure (HF) affect millions of US adults. Incident HF risk following depression diagnosis is understudied.

OBJECTIVE: To examine the association between incident HF and prevalent depression among veterans.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed sociodemographic and clinical data of US veterans participating in the Veterans Affairs (VA) Birth Cohort. Data were obtained from the VA Corporate Data Warehouse between January 1, 2000, and October 1, 2015. Participants were born between 1945 and 1965, were free of HF at baseline, and met a medical home definition (had 3 outpatient visits within 5 years). Statistical analysis was performed from May 2022 to February 2025.

EXPOSURES: Prevalent depression, defined as 1 inpatient or 2 outpatient visits with International Classification of Diseases, Ninth Revision (ICD-9) or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes for depression.

MAIN OUTCOMES AND MEASURES: The primary outcome was time to incident HF, defined as time from baseline to documented date of the first inpatient or second outpatient visit with ICD-9 or ICD-10 codes for HF. A Cox proportional hazards regression model adjusted for relevant covariates was used to assess the association of depression and incident HF.

RESULTS: A total of 2 843 159 veterans (median [SD] age, 54 [49-59] years; 2 677 919 males [94.2%]; 556 914 [19.6%] self-identified as Black, 144 485 [5.1%] as Hispanic, 1 975 068 [69.5%] as White, and 99 011 [3.5%] as other race and ethnicity) were included. Participants were followed up for incident HF over a median (IQR) duration of 6.9 (3.4-11.0) years. Generally, 8.0% of participants (226 247 of 2 843 159) had prevalent depression at baseline. Females made up a larger percentage of those with vs without depression (11.4% vs 5.3%). Participants with depression demonstrated higher unadjusted incident HF rates compared with those without depression (136.9 [95% CI, 132.2-141.7] cases per 10 000 person-years vs 114.6 [95% CI, 113.4-115.9] cases per 10 000 person-years, respectively). After adjusting for sociodemographic and cardiovascular risk factors, depression was associated with an increase in incident HF hazard of 14.0% (hazard ratio [HR], 1.14; 95% CI, 1.13-1.16), with an estimated adjusted median (IQR) incidence rate difference of 16.0 (14.9-18.3) cases per 10 000 person-years. Among patients without comorbidities, depression was associated with a higher increase in incident HF hazard (HR, 1.58; 95% CI, 1.39-1.80), with an estimated adjusted median (IQR) rate difference of 14.2 (9.5-19.5) cases per 10 000 person-years.

CONCLUSIONS AND RELEVANCE: In this cohort study, depression among veterans was associated with an increased hazard of incident HF after controlling for demographic and cardiovascular risk factors. Higher incident HF rates in patients with depression remained consistent in an otherwise low-risk cohort.

PMID:40338547 | DOI:10.1001/jamanetworkopen.2025.9246

JAMA Netw Open. 2025 May 1;8(5):e259486. doi: 10.1001/jamanetworkopen.2025.9486.

ABSTRACT

IMPORTANCE: Medical gaslighting, in which a patient’s concerns are dismissed without proper evaluation, has been described anecdotally in vulvovaginal patient care, but has not been quantified.

OBJECTIVE: To use a patient-centered instrument to measure adverse experiences in vulvovaginal care.

DESIGN, SETTING, AND PARTICIPANTS: Common themes from National Vulvodynia Association patient testimonials were used to design a mixed-methods measure of patient experience that included both quantitative and qualitative questions. An instrument was created and submitted to officers from the National Vulvodynia Association and Tight-Lipped, another patient advocacy organization, for feedback. The measure was then completed by patients before their first appointment at a vulvovaginal disorder referral clinic from August 2023 to February 2024.

EXPOSURE: Participation in the survey.

MAIN OUTCOMES AND MEASURES: The primary outcome was the incidence of reported clinician behavior and consequent distress as reported on the survey instrument. Quantitative data were analyzed using simple descriptive statistics (mean [SD], median [IQR], and percentage). Narrative responses provided by patients were analyzed using the clinical-qualitative method for content analysis.

RESULTS: A total of 520 patients completed surveys; 5 were eliminated because the patient was younger than 18 years, 6 were eliminated for duplication, 6 were eliminated because they had no past clinician, and 56 were eliminated for completely blank responses. Thus, surveys of 447 patients (mean [SD] age, 41.7 [15.2] years) were analyzed (86% response rate). Patients had a mean (SD) of 5.50 (4.53) past clinicians. Patients reported that a mean (SD) of 43.5% (33.9%) of past practitioners were supportive, 26.6% (31.7%) were belittling, and 20.5% (30.9%) did not believe the patient. In total, 186 patients (41.6%) were told they just needed to relax more, 92 (20.6%) were recommended to drink alcohol, 236 (52.8%) considered ceasing care because their concerns were not addressed, 92 (20.6%) were referred to psychiatry without medical treatment, 72 (16.8%) felt unsafe during a medical encounter, and 176 (39.4%) said they were made to feel crazy, the most distressing surveyed behavior (rated at a mean [SD] of 7.39 [3.06] of 10 on a numerical rating scale of distress). A total of 1150 quotations were analyzed qualitatively; common themes included lack of clinician knowledge (247 quotations) and dismissive behaviors (211 quotations).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, a patient-centered measure of adverse experiences in vulvovaginal care was developed. Participants reported common past experiences with gaslighting and substantial distress; they frequently considered ceasing care. There is an urgent need for education supporting a biopsychosocial, trauma-informed approach to vulvovaginal pain and continued development of validated instruments to quantify patient experiences.

PMID:40338544 | DOI:10.1001/jamanetworkopen.2025.9486

Psychol Trauma. 2025 May 8. doi: 10.1037/tra0001948. Online ahead of print.

ABSTRACT

OBJECTIVE: The Roboski massacre, which took place on December 28, 2011, is remembered as a major tragedy resulting from a cross-border operation by the Turkish Air Force that led to the loss of 34 civilians, including 19 children. This event not only caused significant physical losses but also left a profound psychological, social, and political impact on those affected. An enhanced comprehension of prolonged grief disorder’s development can assist professionals in identifying bereaved individuals requiring assistance and augment the efficacy of treatments. The aim of this study is to examine the relationship between the grief process and symptoms of posttraumatic stress, perceived discrimination, and political trust within the framework of the theory of prolonged grief in a sample of the bereaved family members who lost their relatives in the Roboski massacre almost 12 years postloss.

METHOD: In total, 88 Kurdish individuals (M_age = 37.13, SD = 16.4; 53.4% males) who had lost their close relatives in the Roboski incident in 2011 participated in this study. The Prolonged Grief Scale, the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the Perceived Discrimination Scale, and the Political Trust Scale were used to collect data.

RESULTS: The findings of the study revealed that, even approximately 12 years after the Roboski massacre, a significant portion of the participants continue to experience symptoms of prolonged grief and posttraumatic stress reactions. There was a positive correlation between prolonged grief symptoms and posttraumatic stress reactions (r = .71) as well as perceived discrimination (r = .53). It was also found that the subdimensions of posttraumatic stress, namely “reexperiencing” (β = .19, p < .05), “negative cognitive alterations” (β = .39, p < .05), and “perceived collective discrimination” (β = .11, p < .05), were significant predictors of prolonged grief.

CONCLUSIONS: Our findings revealed that professionals should focus on identifying bereaved people who experience prolonged grief after a traumatic loss. Targeting these symptoms may alleviate the exacerbation of persistent grief reactions several years after a traumatic loss. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40338538 | DOI:10.1037/tra0001948

Psychol Trauma. 2025 May 8. doi: 10.1037/tra0001937. Online ahead of print.

ABSTRACT

OBJECTIVE: Natural disasters are a salient source of traumatic exposures for many youth, although not all youth exposed to these traumatic experiences go on to develop posttraumatic stress symptoms or other maladaptive reactions. Given the low resource context and high need for psychological support engendered by natural disasters globally, efficient, evidentiary, culturally appropriate tools for assessing risk are needed to effectively identify youth most in need of services.

METHOD: The present study used a sample of 96,108 Puerto Rican youth collected in 2018, 5-9 months after Hurricane Maria in 2017, to examine the psychometric properties of a Spanish translation of the University of California Los Angeles Posttraumatic Stress Disorder Reaction Index-Brief Form (RI-5-BF). Participants completed measures of hurricane exposure, posttraumatic stress symptoms, and depressive symptoms.

RESULTS: Results indicated a strong fit between the data and the four-factor Diagnostic and Statistical Manual of Mental Disorders, fifth edition, model of posttraumatic stress disorder (root-mean-square error of approximation = .030, 90% confidence interval [.029, .031], Tucker-Lewis index = .976, comparative fit index = .983) and multigroup factor analysis indicated measurement invariance by gender at the scalar level. Normative values for this population by grade and gender were also estimated by examining the descriptive statistics of participants’ responses and convergent validity analysis indicated a strong relationship between the University of California Los Angeles Posttraumatic Stress Disorder Reaction Index-Brief Form total score and a measure of depressive symptoms (r = .64).

CONCLUSIONS: The implications of psychometric research for improving global efforts to triage and respond to psychological distress in the aftermath of natural disasters are discussed, with an emphasis on the critical need for psychometric research to diversify through development and adaptation of instruments in global populations. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40338537 | DOI:10.1037/tra0001937