Nevin Manimala

Sci Prog. 2025 Apr-Jun;108(2):368504251330037. doi: 10.1177/00368504251330037. Epub 2025 Apr 3.

ABSTRACT

ObjectiveTo assess medication appropriateness using the medication appropriateness index (MAI) criteria, the prevalence of potentially inappropriate medication (PIM) prescribing, and factors associated with increased PIM use in elderly ambulatory patients with cirrhosis.MethodsA cross-sectional study of 70 elderly ambulatory patients with cirrhosis (≥65 years old), from January to December 2021. Two clinical pharmacists evaluated medication appropriateness using the MAI tool. Data were analyzed using SPSS version 27.0. Descriptive statistics were used to present patient demographics, clinical characteristics, and MAI responses. Regression analysis was used to identify predictive factors for PIM prescribing. The kappa statistic was used to assess interrater agreement.ResultsAll participants had at least one medication with ≥ 1 inappropriate MAI criterion, with the most common issue being incorrect treatment duration (18%). Of 610 evaluated medications, 44.1% were classified as PIMs. The mean MAI scores per patient and per medication were 15.97 (±10.48) and 1.83 (±3.18), respectively, consistent with other studies. However, the prevalence of PIMs was higher, likely due to the specific disease population studied, as this is the first study to evaluate medication appropriateness in cirrhotic patients. Good interrater agreement was observed (kappa = 0.74), indicating good interrater reliability. Increased inappropriate prescribing was associated with the number of medications, age and severe renal impairment.ConclusionsPIMs are common in elderly patients with cirrhosis, highlighting the need for better prescribing practices to ensure medication safety. Involving clinical pharmacists with geriatrics expertise and using medication appropriateness tools can reduce PIMs and drug-related problems. Further, healthcare team training is essential to improve prescribing practices. Assessing PIMs in this population could enhance clinical outcomes, reduce adverse drug reactions, and lower healthcare costs. Incorporating comprehensive medication management into routine care for elderly cirrhotic patients is a key strategy to improve patient safety and quality of life.

PMID:40179219 | DOI:10.1177/00368504251330037

Science. 2025 Apr 4;388(6742):eadx8687. doi: 10.1126/science.adx8687. Epub 2025 Apr 3.

NO ABSTRACT

PMID:40179204 | DOI:10.1126/science.adx8687

Science. 2025 Apr 4;388(6742):eadt0548. doi: 10.1126/science.adt0548. Epub 2025 Apr 4.

ABSTRACT

Whether a gut-joint axis exists to regulate osteoarthritis is unknown. In two independent cohorts, we identified altered microbial bile acid metabolism with reduced glycoursodeoxycholic acid (GUDCA) in osteoarthritis. Suppressing farnesoid X receptor (FXR)-the receptor of GUDCA-alleviated osteoarthritis through intestine-secreted glucagon-like peptide 1 (GLP-1) in mice. GLP-1 receptor blockade attenuated these effects, whereas GLP-1 receptor activation mitigated osteoarthritis. Osteoarthritis patients exhibited a lower relative abundance of Clostridium bolteae, which promoted the formation of ursodeoxycholic acid (UDCA), a precursor of GUDCA. Treatment with C. bolteae and Food and Drug Administration-approved UDCA alleviated osteoarthritis through the gut FXR-joint GLP-1 axis in mice. UDCA use was associated with lower risk of osteoarthritis-related joint replacement in humans. These findings suggest that orchestrating the gut microbiota-GUDCA-intestinal FXR-GLP-1-joint pathway offers a potential strategy for osteoarthritis treatment.

PMID:40179178 | DOI:10.1126/science.adt0548

Neurologist. 2025 Apr 3. doi: 10.1097/NRL.0000000000000613. Online ahead of print.

ABSTRACT

OBJECTIVE: Our study explores the relationship between fasting triglyceride levels and initial infarct volume in acute ischemic stroke (AIS) patients.

METHODS: We performed a retrospective chart review and cross-sectional analysis of AIS patients admitted to a tertiary care center in Kansas from 2010 to 2023. Inclusion criteria were AIS patients who (1) underwent CTA and CTP within 24 hours of stroke onset, and (2) had fasting triglyceride levels measured within 24 hours of admission. Infarct volume was calculated using RAPID software (iSchemaView Inc.). Statistical analyses were conducted using STATA (Release 16), with T tests, ANOVA, χ2 tests, and multivariable linear regression applied as appropriate.

RESULTS: We included 178 patients, 52% (n=92) of whom were male, and 31% were aged 61 to 70 years. Mean TG levels were 116.91±70.23 mg/dL, and mean infarct volume was 41.64±53.35 mL. Linear regression showed a significant positive association between TG levels and infarct volume (P<0.01, β=0.17, 95% CI: 0.06-0.28), with a 0.17 mL increase in infarct volume per unit increase in TG levels. Patients with Embolic stroke of undetermined source (ESUS) had larger infarct volumes compared with those with large artery atherosclerosis (P<0.05) and the highest mean TG levels (135.61 mg/dL).

CONCLUSION: Hypertriglyceridemia was positively associated with larger infarct volumes, particularly in ESUS patients, who had the highest TG levels and larger infarct sizes. These findings suggest that elevated TG may predict worse stroke outcomes and could be a potential therapeutic target for stroke prevention.

PMID:40178873 | DOI:10.1097/NRL.0000000000000613

JAMA Netw Open. 2025 Apr 1;8(4):e253063. doi: 10.1001/jamanetworkopen.2025.3063.

ABSTRACT

IMPORTANCE: Aspirin (acetylsalicylic acid) and intravenous immunoglobulin (IVIG) are standard treatments for Kawasaki disease (KD) to reduce coronary artery lesions (CALs). However, the optimal duration and dosage of aspirin remain inconsistent across hospitals. The absence of large-scale, multicenter randomized clinical trials hinders a clear understanding of the effectiveness of high-dose aspirin.

OBJECTIVE: To evaluate the effectiveness of IVIG alone compared with IVIG combined with high-dose aspirin as the active interventional therapy for KD and to compare treatment effectiveness across various KD subgroups.

DESIGN, SETTING, AND PARTICIPANTS: In this prospective, evaluator-blinded, multicenter noninferiority randomized clinical trial, children (aged <6 years) who had been diagnosed with KD according to American Heart Association criteria were recruited from 5 medical centers in Taiwan and were enrolled between September 1, 2016, and August 31, 2018, with follow-up assessments at 6 weeks and 6 months after treatment. Data were analyzed between January 23, 2023, and January 29, 2024.

INTERVENTION: The standard group received IVIG (2 g/kg) plus high-dose aspirin (80-100 mg/kg per day) until fever subsided for 48 hours. The intervention group received IVIG (2 g/kg) alone.

MAIN OUTCOMES AND MEASURES: The primary outcome was the occurrence of CALs at 6 weeks. The noninferiority margin was set at 10%. Data analysis was performed using χ2 tests for categorical variables; independent t tests for continuous, normally distributed variables; generalized estimating equations for variables without specific distributions at multiple time points; and repeated-measures analysis of variance for continuous variables at multiple time points.

RESULTS: The final cohort consisted of 134 patients with KD (mean [SD] age, 1.8 [1.3] years; 82 males [61.2%]), with matched age, weight, height, and sex distributions in 2 groups. Overall, in the IVIG plus aspirin group, among 69 patients, CAL occurrence decreased from 9 (13.0%) at baseline to 2 (2.9%) at 6 weeks and to 1 (1.4%) at 6 months. In the IVIG-only group, among 65 patients, CAL occurrence decreased from 7 (10.8%) at diagnosis to 1 (1.5%) at 6 weeks and to 2 (3.1%) at 6 months. No statistically significant differences in CAL frequency were observed between the 2 groups (0.7 percentage points [95% CI, -4.5 to 5.8 percentage points]; P = .65). There were also no significant differences in the treatment or prophylactic effect.

CONCLUSIONS AND RELEVANCE: This randomized clinical trial demonstrated the noninferiority of IVIG alone compared with IVIG plus aspirin, with a noninferiority margin set at 10%. The findings suggest that addition of high-dose aspirin during initial IVIG treatment is not clinically meaningful for CAL reduction in children with KD. Future studies on IVIG treatment alone for CAL reduction in KD across diverse racial and ethnic groups, beyond the Asian population, may be necessary to confirm minimal racial and ethnic variability and the broad applicability of these findings.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02951234.

PMID:40178858 | DOI:10.1001/jamanetworkopen.2025.3063

Plast Reconstr Surg. 2025 Apr 1. doi: 10.1097/PRS.0000000000012135. Online ahead of print.

ABSTRACT

BACKGROUND: Hyaluronic acid (HA) facial fillers are a non-surgical treatment for age-related changes. Literature on long-term volumetric results and patient-reported outcomes (PROs) is limited. This prospective study aims to precisely define and measure objective tissue metrics and PROs of HA fillers in different facial regions over 12 weeks.

METHODS: Females aged 40 to 65 received injections in facial regions using HA fillers: Restylane-L® in nasolabial folds and marionette lines, Restylane-L Lyft® in the malars, and Restylane Silk® in the lip border. Patients completed FACE-Q® questionnaires, were photographed with 3D Vectra® M3 Imaging Software pre-injection, immediately post-injection, and at 2-, 4-, and 12-weeks post-injection. Volumes were analyzed from eight regions: left, right malars and extended midface (MEM), upper perioral (UP), lower perioral and jawline (LPJ), and lips. Tissue displacement factor (TDF) and effective volume (EV) were calculated. Statistical analyses included Mann Whitney U tests and risk-adjusted linear regression.

RESULTS: 101 women participated. Restylane-L Lyft® had the highest TDF, 1.25, followed by Restylane-L®, 1.14, and Restylane Silk®, 0.56. EV for Restylane-L Lyft® was highest, 89.8%, followed by Restylane-L®, 89.7%, and Restylane Silk®, 70%. Volume maintenance was 65.5% (whole face), 79.2% (MEM), 62.7% (UP), and 37.2% (lips) over 12 weeks. PROs demonstrated improvements in facial appearance, treated regions, psychological and social function.

CONCLUSIONS: We define the novel tissue metrics, TDF and EV, relative to HA treatments, with greatest volume maintenance in the midface and greatest loss around the mimetic areas throughout 12 weeks. Significantly improved PROs were observed for patients undergoing large volume HA filler injections.

PMID:40178806 | DOI:10.1097/PRS.0000000000012135

Environ Sci Pollut Res Int. 2025 Apr 3. doi: 10.1007/s11356-025-36328-0. Online ahead of print.

ABSTRACT

Landfilling is a common method for disposing of municipal solid waste, but it generates landfill leachate, a significant environmental concern due to its potential ecotoxicity. Effective treatment of landfill leachate is essential to minimize environmental pollution. This study analysed 421 leachate samples from 257 disposal sites across 27 countries in Asia, examining the concentration and pollution potential of leachate pollutants in relation to site characteristics such as age, type, operational status, climatic conditions, mean annual temperature, and precipitation. The revised leachate pollution index (r-LPI) was used to quantify pollution potential, and statistical analyses were conducted to determine the influence of these factors on pollutant concentrations. The results indicated that the age of disposal sites is a significant factor, with older sites showing reduced concentrations of organic pollutants and heavy metals, while inorganic pollutant levels remained stable. Climatic conditions also significantly impacted leachate characteristics; arid regions produced more concentrated leachate with higher r-LPI values, while regions with higher rainfall produced more diluted leachate with lower r-LPI values. This study also gives the recommendation of treating leachate aiming to inform policy and regulatory frameworks for sustainable landfill management, contributing to the protection of environmental and public health.

PMID:40178789 | DOI:10.1007/s11356-025-36328-0

Environ Geochem Health. 2025 Apr 3;47(5):150. doi: 10.1007/s10653-025-02457-1.

ABSTRACT

Groundwater quality is progressively declining due to over-exploitation and long-term use for irrigation needs. This study aims to assess the suitability of groundwater for irrigation use in an intense agricultural region in Visakhapatnam, southern India. Groundwater samples were collected during the pre-monsoon (PRM) (n = 75) and post-monsoon (POM) (n = 72) seasons. In-situ measurements of pH, electrical conductivity (EC), and total dissolved solids (TDS) were taken using a portable multimeter, while the major ions (Na⁺, K⁺, Ca²⁺, Mg²⁺, F^–, Cl^–, NO₃^–, SO₄^2-) were determined through ion chromatography. The Irrigation Water Quality Index (IWQI), integrated with Geographic Information Systems (GIS), revealed declining groundwater quality from south to north, with higher EC, sodium adsorption ratio (SAR), and chloride concentrations near coastal regions and thermal power plants. IWQI values ranged from 31 to 96 in the PRM and from 30 to 97 in the POM seasons. Approximately 27% of groundwater samples from the PRM and 22% from the POM were unsuitable for irrigation, particularly near industrial areas. Hydrochemical plots, including Wilcox, USSL, and Doneen classifications, highlighted salinity and permeability issues linked to local industrial pollution, affecting groundwater. Multivariate statistical analysis, including PCA, Pearson Correlation, and HCA, revealed that natural and human activities, such as seawater intrusion and agricultural runoff, significantly affect groundwater quality. Salinity, driven by sodium and chloride, persists in both seasons, while nitrate contamination from fertilizers is more prominent during the monsoon. This study highlights the necessity for continuous monitoring and targeted treatment measures for sustainable groundwater use for irrigational practices.

PMID:40178773 | DOI:10.1007/s10653-025-02457-1

J Med Syst. 2025 Apr 3;49(1):43. doi: 10.1007/s10916-025-02178-z.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) chatbots are increasingly used for medical inquiries, including sensitive topics like sexually transmitted diseases (STDs). However, concerns remain regarding the reliability and readability of the information they provide. This study aimed to assess the reliability and readability of AI chatbots in providing information on STDs. The key objectives were to determine (1) the reliability of STD-related information provided by AI chatbots, and (2) whether the readability of this information meets the recommended standarts for patient education materials.

METHODS: Eleven relevant STD-related search queries were identified using Google Trends and entered into four AI chatbots: ChatGPT, Gemini, Perplexity, and Copilot. The reliability of the responses was evaluated using established tools, including DISCERN, EQIP, JAMA, and GQS. Readability was assessed using six widely recognized metrics, such as the Flesch-Kincaid Grade Level and the Gunning Fog Index. The performance of chatbots was statistically compared in terms of reliability and readability.

RESULTS: The analysis revealed significant differences in reliability across the AI chatbots. Perplexity and Copilot consistently outperformed ChatGPT and Gemini in DISCERN and EQIP scores, suggesting that these two chatbots provided more reliable information. However, results showed that none of the chatbots achieved the 6th-grade readability standard. All the chatbots generated information that was too complex for the general public, especially for individuals with lower health literacy levels.

CONCLUSION: While Perplexity and Copilot showed better reliability in providing STD-related information, none of the chatbots met the recommended readability benchmarks. These findings highlight the need for future improvements in both the accuracy and accessibility of AI-generated health information, ensuring it can be easily understood by a broader audience.

PMID:40178771 | DOI:10.1007/s10916-025-02178-z

Indian Pediatr. 2025 Apr 3. doi: 10.1007/s13312-025-00029-1. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the prevalence of minimum dietary diversity (MDD) and explore its associated determinants among children aged 6-60 months in rural Puducherry.

METHODS: 143 children aged 6-60 months were selected from rural areas of Puducherry using systematic random sampling in a cross-sectional study conducted between January and February 2024. Data were collected through a semi-structured questionnaire based on World Health Organization (WHO) guidelines for Infant and Young Child Feeding (IYCF) practices. MDD was defined as the consumption of at least five of eight food groups for children aged 6-24 months and seven food groups for children aged 25-60 months. Sociodemographic factors, food group consumption, and anthropometric measurements were also recorded. Statistical analysis involved Chi-square tests and binary logistic regression to identify associations between MDD and various factors.

RESULTS: 55.24% of the children achieved MDD. Children aged 25-60 months (P < 0.001) and those with mothers over 30 years old (P = 0.001) were significantly more likely to meet MDD. Underweight (P = 0.001) and severely underweight children (P = 0.001) had a lower likelihood of achieving MDD. Factors such as gender, birth order, and socioeconomic status were not significantly associated with MDD.

CONCLUSION: Despite a higher MDD rate than the national average, a substantial proportion of children in rural Puducherry do not meet dietary diversity standards, particularly younger (< 24 months) and underweight children.

PMID:40178757 | DOI:10.1007/s13312-025-00029-1