Nevin Manimala

Neurology. 2025 Mar 11;104(5):e213351. doi: 10.1212/WNL.0000000000213351. Epub 2025 Feb 5.

ABSTRACT

BACKGROUND AND OBJECTIVES: Headache evaluation and treatment are believed to be influenced by race and ethnicity. Specific headache diagnosis assigned in the pediatric emergency department (ED) may compound disparities. We sought to investigate racial and ethnic disparities in the diagnosis, testing, and treatment of pediatric patients with headache presenting to the ED.

METHODS: We performed a cross-sectional analysis of ED visits from 49 children’s hospitals between 2016 and 2022 from the Pediatric Health Information System, an administrative database of ED and hospitalized encounters within children’s hospitals in the United States. Index encounters in the ED from patients (aged 5-21 years, median age 13 [10-15]) with a primary diagnosis of migraine, headache, new daily persistent headache, or tension-type headache were included. Encounters with trauma, infection, and malignancy where secondary headache was possible were excluded. The primary outcomes were the rates of migraine diagnosis, testing, and treatment. We used generalized estimating equations to estimate associations between race and ethnicity and outcomes after adjusting for demographic factors, medical complexity, visit timing, and final headache diagnosis.

RESULTS: A total of 309,678 encounters were included while 61,677 repeat visits, 81,821 visits with diagnoses suggestive of secondary headache, and 5,714 visits from 3 hospitals with sparse data on patient race/ethnicity were excluded. Of 160,466 eligible visits (59.8% female), 41% were by non-Hispanic White (NHW) children, 24.8% non-Hispanic Black (NHB), and 26.0% Hispanic/Latino (HL). NHW children were more frequently diagnosed with migraine (45.5% vs NHB 28.2% and HL 28.3%, p < 0.001). NHB and HL children compared with NHW children received less testing including brain MRI scans (adjusted odds ratio [aOR]: NHB 0.56 [95% CI 0.46-0.69] and HL 0.54 [0.36-0.82]). There was no difference in the proportion of visits without administration of headache-related medications (NHW 23.3% vs NHB 24.6% and HL 23.4%, p = 0.64). NHB and HL children were more likely to receive only oral medications (aOR: NHB 1.37 [1.2-1.56] and HL 1.54 [1.34-1.76]) and less likely to be admitted inpatient (aOR: NHB 0.8 [0.66-0.97] and HL 0.65 [0.44-0.94]).

DISCUSSION: NHB and HL children in the pediatric ED with headache receive fewer migraine diagnoses, less testing, and less intensive treatment compared with NHW children. Beyond affecting headache management, this inequity in migraine diagnosis requires further consideration to include children from marginalized racial and ethnic groups in future migraine research.

PMID:39908468 | DOI:10.1212/WNL.0000000000213351

Dentomaxillofac Radiol. 2025 Feb 5:twaf011. doi: 10.1093/dmfr/twaf011. Online ahead of print.

ABSTRACT

OBJECTIVES: The current study aimed to automatically detect tooth presence, tooth numbering, and types of periodontal bone defects from CBCT images using a segmentation method with an advanced artificial intelligence (AI) algorithm.

METHODS: This study utilized a dataset of CBCT volumes collected from 502 individual subjects. Initially, 250 CBCT volumes were used for automatic tooth segmentation and numbering. Subsequently, CBCT volumes from 251 patients diagnosed with periodontal disease were employed to train an AI system to identify various periodontal bone defects using a segmentation method in web-based labeling software. In the third stage, CBCT images from 251 periodontally healthy subjects were combined with images from 251 periodontally diseased subjects to develop an AI model capable of automatically classifying patients as either periodontally healthy or periodontally diseased. Statistical evaluation included ROC curve analysis and confusion matrix model.

RESULTS: The AUC values for the models developed to segment teeth, total alveolar bone loss, supra-bony defects, infra-bony defects, perio-endo lesions, buccal defects, and furcation defects were 0.9594, 0.8499, 0.5052, 0.5613 (with cropping, AUC: 0.7488), 0.8893, 0.6780 (with cropping, AUC: 0.7592), and 0.6332 (with cropping, AUC: 0.8087), respectively. Additionally, the classification CNN model achieved an accuracy of 80% for healthy individuals and 76% for unhealthy individuals.

CONCLUSIONS: This study employed AI models on CBCT images to automatically detect tooth presence, numbering, and various periodontal bone defects, achieving high accuracy and demonstrating potential for enhancing dental diagnostics and patient care.

PMID:39908459 | DOI:10.1093/dmfr/twaf011

Rheumatology (Oxford). 2025 Feb 5:keaf067. doi: 10.1093/rheumatology/keaf067. Online ahead of print.

ABSTRACT

OBJECTIVE: Patient-reported outcomes (PROs) should be regarded as an important factor in the management of rheumatic diseases. The Patient-based disease activity score (PDAS) was developed as a clinically reliable composite measure for evaluating PROs in rheumatoid arthritis (RA) patients. To replicate and further characterize PDAS, we analyzed PDAS and its clinical relevancy in the National Database of Rheumatic Diseases in Japan (NinJa).

METHODS: Clinical data from the 2022 version of NinJa were analyzed. PDAS1 was calculated for each patient, and statistical analyses, including correlation analyses and multiple regression analysis, were conducted to evaluate the relationship between PDAS1 and other clinical measures. Propensity score (PS) matching was used to compare patients treated with different types of disease-modifying anti-rheumatic drugs (DMARDs).

RESULTS: The number of included patients was 11983. PDAS1 demonstrated strong correlations with DAS28(ESR) (R = 0.89, p< 2.2×1016) and CDAI, indicating its utility in assessing disease activity. The majority of patients (71.8%) achieved PDAS1-defined remission, aligning closely with DAS28 and CDAI remission. PDAS1 was significantly associated with serum rheumatoid factor (RF) titers (R = 0.25, p< 0.001), and RF-positive patients exhibited higher PDAS1 scores. Notably, PS matched comparison revealed that PDAS1 was lower in patients treated with IL-6 inhibitors, compared with those treated with TNF inhibitors, reflecting differences in lower patient global assessment.

CONCLUSION: PDAS1 is a reliable and useful tool for evaluating both disease activity and the functional state of RA patients, particularly from the perspective of PROs. Additionally, PDAS1 can be used for conducting clinical studies in RA patients.

PMID:39908454 | DOI:10.1093/rheumatology/keaf067

Plant Dis. 2025 Feb 5. doi: 10.1094/PDIS-09-24-1971-PDN. Online ahead of print.

ABSTRACT

Bayberry (Myrica rubra) is one of the most important fruit in China. In July 2023, circular leaf spots were noted on spring bayberry (cv. Dongkui Arbutus) tree planted in Guanshanhu, Guiyang, Guizhou, China (26°37’3″N，106°39’59″E). The disease incidence (diseased plants/total plants × 100) varied from 55 to 60% with 15 to 20% disease severity (diseased leaf area/total leaf area × 100). Disease incidence and severity were calculated from five infected fields of bayberry using by SPSS Statistics 22.0 (IBM Corp., NY, USA). The abundance of leaf spots on the trees was predominantly observed on the young leaves. Symptoms included round or irregular spots on leaves with grayish-red during early infection and later transferred to brown dark spots on the edge of the leaves, accompanied by a pale yellow aperture on the periphery. Sixty diseased leaves (three leaves from each diseased plant) from twenty plants (four plants from each infected field) in the same growth period were collected randomly and cut into small pieces (2 mm × 2 mm), disinfected with 75% alcohol for 30 s and with 1% NaClO for 60 s and rinsed 3 times with ddH2O. The diseased tissues were plated on PDA plate having Streptomycin and then incubated at 25 ˚C for 2 d under 16: 8 h light and dark regime. The single hypha was picked from plates and transferred to a new PDA plate having Streptomycin for purification. Sixty five pure cultures were obtained through single spore isolation and purification. After ITS-BLAST, the results indicated that among the cultures, sixty were Nigrospora sp. (92.31%), two were Flavodon sp. (3.07%) and three were Aureobasidium sp. (4.62%). Thus, the detection rate of Nigrospora sp. was the highest. From sixty obtained isolates with same morphological characters, six isolates (GUCC 23-0016, GUCC23-0017, GUCC23-0018, GUCC24-0244, GUCC24-0245 and GUCC 24-0246) were selected for pathogenicity and identification. Conidia (n = 40) were black, oval or round, smooth and size range was 11-16 × 12-14.5 µm in diameter. Based on disease symptoms and morphological characters, the pathogen was primarily recognized as a Nigrospora sp. (Wang et al. 2017). PCR was performed for each of the six isolates to amplify the internal transcribed spacer (ITS), the large subunit rDNA (LSU), β-tubulin 2 (tub2) and translation elongation factor 1-alpha (tef1) genes with primers sets of ITS4/ITS5 (Innis et al. 1990), LR0R/LR5 (Vilgalys & Hester 1990), Bt2a/Bt2b (Glass and Donaldson 1995), EF1-728F/EF-986R (Carbone and Kohn 1999), respectively and then PCR products were sequenced. GenBank accession numbers are OR647487, OR647489, OR647490, PQ803982, PQ803983 and PQ804003 for ITS, PQ351182, PQ351183, PQ351185, PQ805435, PQ804004 and PQ805436 for LSU, OR670516, OR670517 OR670518, PQ807000, PQ807001 and PQ807002 for tub2 and OR725093, OR725094 , OR725095, PQ807003, PQ807004 and PQ807005 for tef1. The BLAST results showed that DNA sequences of the present isolates were 100% identical to the type strain of N. aurantiaca (CGMCC 3.18130: KX986064.1, NG_069394, KY019295.1, KY019465.1) and the phylogenetic tree with four gene loci also indicated that our isolates belonged to N. aurantiaca. The pathogenicity test was conducted following Koch’s postulates. Ten bayberry trees of approximate ten years old were inoculated with six above isolates (GUCC 23-0016, GUCC23-0017, GUCC23-0018, GUCC24-0244, GUCC24-0245 and GUCC 24-0246) and two healthy trees were used as control. Twenty leaves from each tree were disinfected with 75% ethanol prior to pathogen inoculation. The leaves were inoculated by spraying a conidial suspension (1 × 105 spores/mL) of each isolate, while ddH2O was sprayed on forty control leaves from two trees. Pathogen inoculation was performed under natural field conditions. After 7 d, similar symptoms to those observed in the field were noted on inoculated leaves, while the control leaves were still healthy. We also inoculated bayberry detached leaves in vitro by spraying with conidia suspension (1 × 105 spores/mL) of each isolate, while ddH2O as control. Inoculated leaves were maintained in a greenhouse with temperature ranging from 23-25 ˚C at 75% relative humidity. After 7 d, similar symptoms were observed on the inoculated leaves, while the control remained healthy. Both experiments were repeated three times. The pathogen was re-isolated from both in vivo and in vitro inoculated leaves and were re-identified as N. aurantiaca through morphological identification and molecular identification by code amplification of ITS, LSU, tub2 and tef1. Thus, we proposed that N. aurantiaca caused the leaf spot of bayberry. Leaf spot diseases caused by N. aurantiaca on tobacco, Chinese chestnut and olive were reported in Guizhou (Huang et al. 2021), in Yanyuan (Luo et al. 2020) and Croatia (Petrović et al. 2023), respectively. However, to our knowledge, this is the first report of N. aurantiaca causing leaf spot diseases on bayberry in China. The identification of this disease offered a basis for further research on its proper management.

PMID:39908402 | DOI:10.1094/PDIS-09-24-1971-PDN

Sci Transl Med. 2025 Feb 5;17(784):eadi4000. doi: 10.1126/scitranslmed.adi4000. Epub 2025 Feb 5.

ABSTRACT

Accelerated tuberculosis drug discovery has increased the number of plausible multidrug regimens. Testing every drug combination in vivo is impractical, and varied experimental conditions make it challenging to compare results between experiments. Using published treatment efficacy data from a mouse tuberculosis model treated with candidate combination regimens, we trained and externally validated integrative mathematical models to predict relapse in mice and to rank both previously experimentally studied and unstudied regimens by their sterilization potential. We generated 18 datasets of 18 candidate regimens (comprising 11 drugs of six classes, including fluoroquinolone, nitroimidazole, diarylquinolines, and oxazolidinones), with 2965 relapse and 1544 colony-forming unit (CFU) observations for analysis. Statistical and machine learning techniques were applied to predict the probability of relapse in mice. The locked down mathematical model had an area under the receiver operating characteristic curve (AUROC) of 0.910 and showed that bacterial kill measured by longitudinal CFU cannot account for relapse alone and that sterilization is drug dependent. The diarylquinolines had the highest predicted sterilizing activity in the mouse model, and the addition of pyrazinamide to drug regimens provided the shortest estimated tuberculosis treatment duration to cure in mice. The mathematical model predicted the effect of treatment combinations, and these predictions were validated by conducting 11 experiments on previously unstudied regimens, achieving an AUROC of 0.829. We surmise that the next generation of tuberculosis drugs are highly effective at treatment shortening and suggest that there are several promising three- and four-drug regimens that should be advanced to clinical trials.

PMID:39908348 | DOI:10.1126/scitranslmed.adi4000

PLOS Digit Health. 2025 Feb 5;4(2):e0000729. doi: 10.1371/journal.pdig.0000729. eCollection 2025 Feb.

ABSTRACT

Adolescent obesity remains a public health concern, exacerbated by unhealthy food marketing, particularly on digital platforms. Social media influencers are increasingly utilized in digital marketing, yet their impact remains understudied. This research explores the frequency of posts containing food products/brands, the most promoted food categories, the healthfulness of featured products, and the types of marketing techniques used by social media influencers popular with male and female adolescents. By analyzing these factors, the study aims to provide a deeper understanding of how social media influencer marketing might contribute to dietary choices and health outcomes among adolescents, from a gender perspective, shedding light on an important yet underexplored aspect of food marketing. A content analysis was conducted on posts made between June 1, 2021, and May 31, 2022, that were posted by the top three social media influencers popular with males and female adolescents (13-17) on Instagram, TikTok, and YouTube (N = 1373). Descriptive statistics were used to calculate frequencies for posts containing food products/brands, promoted food categories, product healthfulness, and marketing techniques. Health Canada’s Nutrient Profile Model was used to classify products as either healthy or less healthy based on their content in sugar, sodium, and saturated fats. Influencers popular with males featured 1 food product/brand for every 2.5 posts, compared to 1 for every 6.1 posts for influencers popular with females. Water (27% of posts) was the primary food category for influencers popular with females, while restaurants (24% of posts) dominated for males. Influencers popular with males more commonly posted less healthy food products (89% vs 54%). Marketing techniques varied: influencers popular with females used songs or music (53% vs 26%), other influencers (26% vs 11%), appeals to fun or coolness (26% vs 13%), viral marketing (29% vs 19%), and appeals to beauty (11% vs 0%) more commonly. Influencers popular with males more commonly used calls-to-action (27% vs 6%) and price promotions (8% vs 1%). Social media influencers play a role in shaping adolescents’ dietary preferences and behaviors. Understanding gender-specific dynamics is essential for developing targeted interventions, policies, and educational initiatives aimed at promoting healthier food choices among adolescents. Policy efforts should focus on regulating unhealthy food marketing, addressing gender-specific targeting, and fostering a healthy social media environment for adolescents to support healthier dietary patterns.

PMID:39908339 | DOI:10.1371/journal.pdig.0000729

Clin Exp Dermatol. 2025 Feb 5:llaf067. doi: 10.1093/ced/llaf067. Online ahead of print.

ABSTRACT

BACKGROUND: Acanthosis nigricans (AN) is a prevalent dermatological issue with numerous treatment options that are not entirely sufficient. Topical vitamin D analogs were found to be effective and safe in treating AN; however, other preparations of vitamin D have not been studied yet.

OBJECTIVES: To evaluate the safety and efficacy of intralesional vitamin D3 injection in treating pseudo-acanthosis nigricans.

METHODS: We enrolled thirty subjects who had bilateral pseudo-acanthosis nigricans of the neck. Every patient received intralesional vitamin D3 therapy on the right side of the neck and intralesional saline as a control on the left side over the course of four sessions, each spaced one week apart. Cases were assessed clinically one month after the last treatment session by Acanthosis Nigricans Area and Severity Index (ANASI) score in addition to dermoscopic examination.

RESULTS: A statistically significant decrease in ANASI score was seen between the treated and control sides both before and after treatment, with the intralesional vitamin D treated side exhibiting a larger percentage of reduction than the control side. Intralesional vitamin D3 treatment significantly improved dermoscopic features such as cristae cutis, sulci cutis, and pigmented dots compared to the placebo treatment.

CONCLUSIONS: Intralesional vitamin D3 is a safe and effective modality for treating pseudo-acanthosis nigricans.

PMID:39908337 | DOI:10.1093/ced/llaf067

PLoS One. 2025 Feb 5;20(2):e0308765. doi: 10.1371/journal.pone.0308765. eCollection 2025.

ABSTRACT

Childhood stroke is a rare condition that significantly impacts affected children and their families due to children’s frequently persisting cognitive, physical, and behavioural problems. Existing research on adult stroke shows that the built environment plays a major role in their (partial or possible) recovery and everyday life, but its role has been overlooked in children population. This multidisciplinary research study aims to investigate (1) the role of informal (i.e., home, neighbourhood, school) and formal (i.e., hospital, rehabilitation clinic, outpatient clinic) care environments in the everyday life of children and families confronted with childhood stroke; (2) the families’ financial burden resulting from this rare disease and their economic situation likely affecting the access to care, informal care provision and ability to carry out home modifications.; as well as (3) children’s stroke-related cognitive impairments affecting their experiences of the built environment and their care. The research consists of the preparatory research phase, where existing materials are explored, and three main research phases, each related to one or multiple project objectives. A multi-method approach is adopted, including qualitative (in-depth interviews and participatory creative methods) and quantitative (online questionnaire and cognitive assessments) research methods. Participants are children affected by stroke and their families in Austria, Belgium and Germany. This is a 3-year project that will continue until the end of August 2025. Ethical approvals in all countries were obtained at the time of protocol submission, and data collection for all three research phases started in the second half of 2023 and is currently ongoing. This project will offer first insights into the role of built (care) environments in the experiences of families affected by childhood stroke. Findings are expected to deliver information on their design to improve the life of children affected by this rare disease and their families.

PMID:39908335 | DOI:10.1371/journal.pone.0308765

PLoS One. 2025 Feb 5;20(2):e0318332. doi: 10.1371/journal.pone.0318332. eCollection 2025.

ABSTRACT

OBJECTIVE: This study aimed to explore the prevalence and influencing factors of anemia in patients with ankylosing spondylitis (AS) using real-world data and to construct a predictive model for anemia in AS.

METHODS: In November 2023, we accessed the database from China Rheumatoid Arthritis Registry of Patients with Chinese Medicine (CERTAIN). Clinical data of AS collected from the CERTAIN between March 2022 and September 2023 were analyzed. Demographic information, clinical assessment scales, and laboratory test results of the patients were collected. According to the anemia diagnostic criteria established by the World Health Organization (WHO) in 2018, patients were divided into anemia group and non-anemia group. Statistical analyses were performed using SPSS 25.0 software, including χ2 tests, independent sample t-tests to compare differences between the two groups, and multivariate stepwise logistic regression analysis to explore the influencing factors of anemia in AS. The predictive efficacy of the model was evaluated by plotting receiver operating characteristic (ROC) curves. Calibration was assessed through the Hosmer-Lemeshow goodness-of-fit test, and a calibration curve was plotted to comprehensively evaluate the predictive capability of the model.

RESULTS: A total of 251 patients were included in this study, among which 58 cases had anemia (23.1%). There were significant differences in gender, ossification, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) indicators, and clinical assessment scale results between the two groups (P < 0.05). The results of multivariate stepwise logistic regression analysis showed that female gender, underweight, ossification, abnormal CRP and ESR were independent risk factors for anemia in AS (P < 0.05). Based on the results of multivariate stepwise logistic regression analysis, a predictive model for anemia in AS was established as Logit(P) = -5.02 + 2.041 × gender -1.11 × BMI(body mass index) category + 1.103 × ossification category + 0.942 × CRP category + 1.476 × ESR category. The ROC curve analysis showed that the area under the curve of the model for predicting anemia in AS was 0.857 (95% CI: 0.808 ~ 0.906). The Omnibus test of model coefficients yielded χ2 = 85.265, P < 0.001. The Hosmer-Lemeshow test showed χ2 = 7.005, P = 0.536 (P > 0.05).

CONCLUSION: Analysis of real-world AS diagnosis and treatment data showed that the prevalence of anemia in Chinese AS was 23.1%. The occurrence of anemia was closely related to female gender, underweight, ossification, and abnormal CRP and ESR. The logistic model constructed based on these indicators for predicting the risk of anemia in AS demonstrated good efficacy.

PMID:39908327 | DOI:10.1371/journal.pone.0318332

JMIR Form Res. 2025 Feb 5;9:e64444. doi: 10.2196/64444.

ABSTRACT

BACKGROUND: Technology that detects early when a patient at risk of falling leaves the bed can support nurses in acute care hospitals.

OBJECTIVE: To develop a better understanding of nurses’ perspectives and experiences with a bed-exit information system (BES) in an acute care hospital setting.

METHODS: BES was implemented on 3 wards of a university medical center. Nurses completed 2 online surveys at each time point (P0 and P1) and participated in focus groups before (P0) and after (P1) implementation. Additional patient data were collected. Descriptive statistics summarized the survey results, while content analysis was applied to focus group data. Patient rates and adverse events in both phases were compared using negative binomial models. Reporting of this study adhered to the GRAMMS checklist.

RESULTS: A total of 30 questionnaires were completed at P0 (30/72, 42%) and 24 at P1 (24/71, 33%). Of the participants, 15 completed both questionnaires (complete cases). At P1, 64% (9/14) of participants agreed that their perceived workload and strain in caring for patients with cognitive impairment was reduced by the use of the BES. The adverse event rate per patient per day was reduced by a factor of 0.61 (95% CI 0.393-0.955; P=.03). In addition, 11 nurses participated in 4 focus groups before and after the intervention. Participants found it challenging to operationalize the use of the BES due to the heterogeneity of care settings, but certain behaviors of patients with cognitive impairment were recognized as indicating a need for intervention. Negative experiences included information overload and alarm fatigue, leading to occasional removal of the system.

CONCLUSIONS: While BES provides some support in managing patients with cognitive impairment, its impact remains limited to specific scenarios and does not significantly reduce nurses’ workload or strain. Our findings highlight the need to manage expectations of BES performance to ensure alignment between expected and actual benefits. To improve BES effectiveness and long-term implementation, future research should consider both objective measures of patient care and subjective factors such as nurse experience, structural conditions, and technical specifications. Improving information mechanisms within call systems could help reduce alarm fatigue and increase perceived usefulness. Overall, successful integration of BES in acute care settings will require close collaboration with nursing staff to drive meaningful healthcare innovation and ensure that the technology meets the needs of both patients and nurses.

TRIAL REGISTRATION: German Register for Clinical Studies DRKS00021720; https://drks.de/search/de/trial/DRKS00021720.

PMID:39908092 | DOI:10.2196/64444