Nevin Manimala

JAMA Netw Open. 2025 Jan 2;8(1):e2456793. doi: 10.1001/jamanetworkopen.2024.56793.

ABSTRACT

IMPORTANCE: This study addresses the characteristics, kidney replacement therapy (KRT) modalities, and outcomes in children diagnosed with crush syndrome following an earthquake in Turkey.

OBJECTIVE: To analyze the associations of different KRT modalities with long-term dialysis dependency and length of stay (LOS) in the pediatric intensive care unit (PICU).

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, prospective, and retrospective cohort study was conducted across 20 PICUs in Turkey. Participants included children diagnosed with crush syndrome after the 2023 Kahramanmaraş earthquake, and eligibility criteria included age, diagnosis, and need for KRT. Data were analyzed from August to October 2024.

EXPOSURE: Children diagnosed with crush syndrome who underwent KRT.

MAIN OUTCOMES AND MEASURES: The primary outcome was dialysis dependency at discharge. Secondary outcomes included LOS in the PICU.

RESULTS: The study included 183 pediatric patients (median [IQR] age, 158 (108-192) months; 49 [54.4%] males) with earthquake-related injury, of whom 90 required KRT. The median (IQR) time under the rubble was 25.7 (1-137) hours. At admission, 51 patients (56.6%) had stage 3 acute kidney injury, and the median (IQR) serum creatinine phosphokinase level was 15 555 (9386-59 274) IU/L. There was a significant association between the Kidney Disease-Improving Global Outcomes (KDIGO) stage at admission and serum creatinine phosphokinase level (area under the curve, 0.750; 95% CI, 0.621-0.879; P < .001). Among patients undergoing KRT, 33 (36.7%) received continuous venovenous hemodiafiltration, and 23 (25.6%) underwent intermittent hemodialysis (IHD). IHD treatment was the only independent factor associated with shorter PICU LOS (odds ratio [OR], 6.87; 95% CI, 1.54-30.67; P = .01). The dialysis dependency at discharge was higher in children who were transferred late to the PICU (β = 0.003; 95% CI, 0.001-0.005; P < .001) and those with a high Pediatric Trauma Score (β = 0.022; 95% CI, 0.003-0.041; P = 02). IHD was not statistically significantly associated with remaining dialysis-dependent at discharge (OR, 2.18; 95% CI, 0.53-8.98; P = .28). The overall mortality rate in the cohort was 6 patients (6.6%).

CONCLUSIONS AND RELEVANCE: This cohort study found that children who were transferred late to intensive care and those with a high trauma score after earthquake-related crush injury were more likely to remain dialysis-dependent at discharge. Furthermore, KDIGO stage at admission was associated with elevated serum creatinine phosphokinase levels. These findings highlight the critical importance of early intervention and appropriate treatment in children with AKI following prolonged entrapment.

PMID:39869334 | DOI:10.1001/jamanetworkopen.2024.56793

JAMA Netw Open. 2025 Jan 2;8(1):e2456825. doi: 10.1001/jamanetworkopen.2024.56825.

ABSTRACT

IMPORTANCE: Incidence of distant stage prostate cancer is increasing in the United States. Research is needed to understand trends by social and geographic factors.

OBJECTIVE: To examine trends in prostate cancer incidence and mortality rates in California by stage, age, race and ethnicity, and region.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used mortality data from the California Cancer Registry and California Department of Public Health’s Center for Health Statistics, and incidence data from the National Cancer Institute Surveillance, Epidemiology, and End Results program and the US Census. The dataset for these analyses was released in April 2024. Participants included males residing in California between 2004 and 2021. Analyses were conducted from April to October 2024.

EXPOSURES: Stage at diagnosis, age, race and ethnicity, and region of California.

MAIN OUTCOMES AND MEASURES: The delay-adjusted incidence rates and mortality rates were calculated and age-adjusted to the 2000 US standard population. Annual percentage changes (APC) were calculated using NCI’s Joinpoint Regression Program.

RESULTS: Between 2004 and 2021, there were 387 636 prostate cancer cases (27 938 distant stage) and 58 754 prostate cancer deaths in California. In this study, 203 038 cases (52.4%) occurred among males aged 55 to 69 years, and 153 884 (39.7%) occurred among males 70 years or older. The distribution of race and ethnicity among cases was: 1031 American Indian or Alaska Native (0.3%); 31 366 Asian American, Native Hawaiian, and Pacific Islander (8.1%); 66 695 Hispanic or Latino (17.2%); 36 808 non-Hispanic Black (9.5%); 238 229 non-Hispanic White (61.5%); and 13 507 unknown or other races (3.5%). On average, the incidence of distant prostate cancer increased 6.7% (95% CI, 6.2% to 7.3%) per year between 2011 and 2021. By race and ethnicity, the APC ranged from 6.5% (95% CI, 4.2% to 13.4%) among Asian American, Native Hawaiian, and Pacific Islander males between 2011 and 2021 to 8.0% (95% CI, 6.9% to 9.5%) among Hispanic males between 2014 and 2021. In 9 of the 10 California regions, the incidence of distant prostate cancer increased by approximately 6% or more per year. Prostate cancer mortality rates declined 2.6% per year between 2004 and 2012 but plateaued between 2012 to 2021 (APC, 0.1%; 95% CI, -0.6% to 1.6%). The plateau in mortality occurred across ages, races and ethnicities, and regions.

CONCLUSIONS AND RELEVANCE: In this cohort study among California residents, the incidence of distant stage prostate cancer increased throughout the state between 2011 and 2021. Mortality rates plateaued between 2012 and 2021, ending previous decades of decline. Implementation of more effective prostate cancer screening strategies are critically needed.

PMID:39869333 | DOI:10.1001/jamanetworkopen.2024.56825

JAMA Pediatr. 2025 Jan 27. doi: 10.1001/jamapediatrics.2024.5286. Online ahead of print.

ABSTRACT

IMPORTANCE: Cyclophosphamide and calcineurin inhibitors are the most used nonsteroid immunosuppressive medications globally for children with various chronic inflammatory conditions. Their comparative effectiveness remains uncertain, leading to worldwide practice variation. Nephrotic syndrome is the most common kidney disease managed by pediatricians globally and suboptimal treatment is associated with high morbidity.

OBJECTIVE: To evaluate the comparative effectiveness of cyclophosphamide vs calcineurin inhibitors (tacrolimus or cyclosporine) for childhood nephrotic syndrome relapse prevention.

DESIGN, SETTING, AND PARTICIPANTS: Using target trial emulation methods, the study team emulated a pragmatic, open-label clinical trial using available data from the Insight Into Nephrotic Syndrome: Investigating Genes, Health, and Therapeutics (INSIGHT) study. INSIGHT is a multicenter, prospective cohort study in the Greater Toronto Area, Canada. Participants included children (1 to 18 years) with steroid-sensitive nephrotic syndrome diagnosed between 1996 and 2019 from the Greater Toronto Area, who initiated cyclophosphamide or a calcineurin inhibitor treatment. Data analysis was performed in 2024.

EXPOSURES: Incident cyclophosphamide or calcineurin inhibitor treatment. Randomization was emulated by overlap weighting of propensity scores for treatment assignment.

MAIN OUTCOMES: The primary outcome was time to relapse, analyzed by weighted Kaplan-Meier and Cox proportional hazards models. Secondary outcomes included relapse rates, subsequent immunosuppression, kidney function, hypertension, adverse events, and quality of life.

RESULTS: Of 578 children (median age at diagnosis, 3.7 [IQR, 2.8-6.0] years; 371 male [64%] and 207 female [36%]), 252 initiated cyclophosphamide, 131 initiated calcineurin inhibitors, and 87 sequentially initiated both medications. Baseline characteristics were well balanced after propensity score weighting. During median 5.5-year (quarter 1 to quarter 3, 2.5-9.2) follow-up, there was no significant difference in time to relapse between calcineurin inhibitor vs cyclophosphamide treatment (hazard ratio [HR], 1.25; 95% CI, 0.84-1.87). Relapses were more common after calcineurin inhibitor treatment than cyclophosphamide (85% vs 73%) in the weighted cohorts, but not statistically significant. There were also no significant differences in subsequent relapse rates, nonsteroid immunosuppression use, or kidney function between medications. Calcineurin inhibitor treatment was associated with more hospitalizations (HR, 1.83; 95% CI, 1.14-2.92) and intravenous albumin use (HR, 2.81; 95% CI, 1.65-4.81).

CONCLUSIONS AND RELEVANCE: In this study, there was no evidence of difference in time to relapse after cyclophosphamide and calcineurin inhibitor treatment in children with nephrotic syndrome. Cyclophosphamide treatment is shorter in duration and more accessible globally than calcineurin inhibitors.

PMID:39869322 | DOI:10.1001/jamapediatrics.2024.5286

JAMA Pediatr. 2025 Jan 27. doi: 10.1001/jamapediatrics.2024.5594. Online ahead of print.

ABSTRACT

IMPORTANCE: Condoms are effective at preventing sexually transmitted infections and pregnancy; however, only 52% of sexually active US adolescents used a condom at last intercourse.

OBJECTIVE: To examine (1) the association between 36 psychosocial variables and adolescent condom use to determine the strongest correlates of condom use behavior across the literature, (2) heterogeneity of these effects, and (3) the moderating roles of age, gender/sex, race/ethnicity, sexual orientation, and year of study.

DATA SOURCES: A systematic search was conducted of studies published between January 2000 and February 2024 using Medline, CINAHL, PsycINFO, and Communication Source databases, plus relevant review articles and unpublished data.

STUDY SELECTION: Studies were included if they (1) were observational studies of US adolescents (mean sample age <19 years), (2) included adolescent reports of condom use behavior and a correlate of interest, and (3) were available in English after January 2000.

DATA EXTRACTION AND SYNTHESIS: Investigators extracted data on participant characteristics, study methods, settings, correlates, condom use outcomes, and study quality. Correlation coefficients and 95% CIs were computed from studies and meta-analyzed using random-effects models.

MAIN OUTCOMES AND MEASURES: The primary outcome was adolescent-reported condom use behavior.

RESULTS: A total of 249 studies with 283 independent samples (251 713 adolescents; weighted mean age, 16.2 years) were synthesized. Twenty-three correlates were significantly associated with adolescent condom use. The correlates of condom use with the largest weighted mean effects were condom use at first sex (Pearson r = 0.47; 95% CI, 0.36-0.56), condom use intentions (Pearson r = 0.42; 95% CI, 0.35-0.48), and condom communication with a partner (Pearson r = 0.41; 95% CI, 0.29-0.52). Safer sex knowledge-a primary focus of many sex education efforts-was not significantly associated with condom use (Pearson r = -0.03; 95% CI, -0.10 to 0.05). Most effects (24 of 31 [77%]) were statistically significantly heterogeneous; age, gender/sex, sexual orientation, and year of study explained heterogeneity in only a few effects.

CONCLUSIONS AND RELEVANCE: This systematic review and meta-analysis identified the strongest and weakest correlates of adolescent condom use across nearly 25 years of research. These results can be used to refine sexual behavior theory and guide more targeted evidence-based intervention efforts for adolescents.

PMID:39869320 | DOI:10.1001/jamapediatrics.2024.5594

Drug Saf. 2025 Jan 27. doi: 10.1007/s40264-024-01512-7. Online ahead of print.

ABSTRACT

INTRODUCTION: Large administrative healthcare databases can be used for near real-time sequential safety surveillance of drugs as an alternative approach to traditional reporting-based pharmacovigilance. The study aims to build and empirically test a prospective drug safety monitoring setup and perform a sequential safety monitoring of rofecoxib use and risk of cardiovascular outcomes.

METHODS: We used Danish population-based health registers and performed sequential analysis of rofecoxib use and cardiovascular outcomes using case-time-control and cohort study designs from January 2000 to September 2004. Each monitoring period added 6 months of data until the end of the study period. In the case-time-control study, incident cases of myocardial infarction (MI) and ischemic stroke were identified and matched with up to five time controls on age, sex, and calendar time. Exposure status on the date of diagnosis was assessed using a 60-day focal window, with reference windows 120, 180, and 240 days prior to the diagnoses. In the cohort study, incident users of rofecoxib were matched up to 1:4 with ibuprofen users (active comparators) using high-dimensional disease risk scores and were followed for 60 days.

RESULTS: The earliest association between rofecoxib use and the risk of MI was seen in study period 2 for case-time-control design (OR 1.42, 95% CI 1.04-1.93) and in study period 7 for the cohort study design (RR 1.22; 95% CI 1.02-1.47).

CONCLUSIONS: Our prospective drug safety monitoring setup showed that the risk of MI could have been detected 3.5 years before the ultimate market withdrawal of rofecoxib. However, further research is needed to validate this approach.

PMID:39869300 | DOI:10.1007/s40264-024-01512-7

J Autism Dev Disord. 2025 Jan 27. doi: 10.1007/s10803-025-06735-w. Online ahead of print.

ABSTRACT

We aimed to compare sleep problems in autistic and non-autistic adults with co-occurring depression and anxiety. The primary research question was whether autism status influences sleep quality, after accounting for the effects of depression and anxiety. We hypothesized that autistic adults would report higher levels of depression, anxiety, and sleep problems compared to non-autistic adults, after controlling for these covariates. We recruited 208 adults (109 non-autistic, 99 autistic) through a crowdsourcing platform, Prolific. Participants completed the Pittsburgh Sleep Quality Index, the Center for Epidemiologic Studies Depression Scale, and the Generalized Anxiety Disorder 7-item scale. Statistical analyses included Mann-Whitney U tests to compare group scores and a generalized linear model to assess the effect of autism status on sleep problems while controlling for depressive and anxiety symptoms. Autistic adults reported significantly higher levels of depressive and anxiety symptoms compared to non-autistic adults. However, after controlling for depression and anxiety, autism status alone did not have a statistically significant effect on overall sleep quality. The findings suggest that while autistic adults experience more severe sleep problems, these issues are closely related to higher levels of depression and anxiety rather than autism status itself. This study contributes to the understanding of sleep difficulties in autistic individuals, highlighting the importance of addressing co-occurring mental health conditions. Further research should explore the specific factors that exacerbate sleep problems in this population.

PMID:39869275 | DOI:10.1007/s10803-025-06735-w

J Epidemiol Glob Health. 2025 Jan 27;15(1):9. doi: 10.1007/s44197-025-00354-5.

ABSTRACT

The incidence of thyroid cancer has shown marked increases globally over recent decades. This study investigated how the incidence of papillary thyroid carcinoma (PTC) subtypes and World Health Organisation (WHO) endocrine tumour classification changes have affected overall thyroid cancer incidence recorded in Australia. Using incidence data from the Australian Institute of Health and Welfare cancer registry (spanning 1982 to 2019), this descriptive epidemiological study employed joinpoint regression analysis to assess temporal trends in thyroid carcinoma incidence, focusing on PTC. Results were then compared with WHO endocrine tumour classification changes over the same period. The results showed increasing trends for the classic PTC subtype over the entire 38-year period and for thyroid microcarcinomas post-2003, while a declining trend for the follicular variant of PTC was observed commencing in 2015. Examination of PTC incidence also revealed distinct changes in trends that align with the WHO classification of papillary microcarcinoma as a subtype in 2004 and the reclassification of some encapsulated follicular variant of PTCs to non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) in 2016/17. Even when taking these WHO classification changes into account, significant increases in PTC over the last three decades are observed. These findings underscore the shifts in classification driven by improving diagnostic clarity influencing thyroid carcinoma incidence patterns. However, thyroid carcinoma cases in Australia have dramatically increased over the last three decades independent of WHO classification changes, suggesting a genuine increase rather than simply being a direct consequence of improved reporting and diagnostics.

PMID:39869269 | DOI:10.1007/s44197-025-00354-5

Lasers Med Sci. 2025 Jan 27;40(1):48. doi: 10.1007/s10103-024-04272-z.

ABSTRACT

The aim of this study was to compare the effectiveness of different types of low level laser treatment (LLLT) in reducing pain levels, changing oxygen saturation and bite force in patients with myofacial pain syndrome (MPS). 45 patients were randomly assigned to three groups: Group 1 (GRR laser, n = 15) received LLLT with Gallium-Aluminium-Arsenide (GaAlAs) diode laser with a wavelength of 904 nm and red laser with a wavelength of 650 nm over masseter muscle region. Group 2 (Nd: YAG laser, n = 15) were treated with Neodymium-doped Yttrium Aluminium Garnet laser with a wavelength of 1064 nm and the same protocol with Nd: YAG laser was performed in the Group 3 (placebo, n = 15) using sham device. Pain was evaluated by visual analogue scale (VAS), change in oxygen concentration in the masseter muscle was measured by functional near-infrared spectroscopy- fNIRS and bite force was measured with Flexiforce sensors before and after treatment. There was a significant decrease in VAS scores after treatment in all three groups. When pain scores were compared, a greater reduction was seen in the Group 1 and Group 2. The change in oxygen saturation level was not statistically significant in all three groups (p > 0.05). Bite force values showed a significant decrease in treatment groups (p < 0.05), while there was no significant change in the placebo group (p > 0.05). Nd: YAG and GRR laser treatments were effective in reducing the pain caused by MPS and in reducing bite force values. Clinically, GRR laser system provides more effective results with its regional and practical application. ClinicalTrials.gov ID: NCT06442553.

PMID:39869221 | DOI:10.1007/s10103-024-04272-z

Arch Gynecol Obstet. 2025 Jan 27. doi: 10.1007/s00404-024-07906-3. Online ahead of print.

ABSTRACT

PURPOSE: The objective of this study is to evaluate the impact of pelvic floor physical therapy (PFPT) on symptoms and quality of life in women who experienced third- and fourth-degree perineal tears (Obstetric Anal Sphincter Injuries, OASIS) during childbirth. OASIS can lead to anal incontinence and dyspareunia, having important implications regarding the quality of life and health of women but, unfortunately, there is no standard practice for postpartum care following OASIS.

METHODS: In this retrospective observational study, patients diagnosed with OASIS between January 2016 and June 2023 were enrolled. Since 2016, all women with OASIS have been routinely referred for physiatric evaluation and pelvic floor rehabilitation. Validated questionnaires (Wexner score and Marinoff scale) were administered to enrolled women to assess anal incontinence and dyspareunia.

RESULTS: The study included 148 women, of whom 88 responded to the questionnaires. Participants were divided into two groups: those who underwent PFPT (N = 68) and those who declined it (N = 20). The mean follow-up period was 1447.35 days. The Wexner score was lower in the PFPT group compared to the no-PFPT group (p = 0.050). The Marinoff score did not show a statistically significant difference between the two groups (p = 0.381).

CONCLUSION: PFPT was shown to be effective in reducing AI symptoms in women with OASIS, improving quality of life and maintaining its effects in the long term, but without providing benefits for dyspareunia. Strengths of this study include the use of validated questionnaires, the long follow-up period, and the involvement of a specialized team of physiatrists and physiotherapists.

PMID:39869199 | DOI:10.1007/s00404-024-07906-3

Eur J Trauma Emerg Surg. 2025 Jan 27;51(1):84. doi: 10.1007/s00068-024-02692-8.

ABSTRACT

OBJECTIVE: To evaluate the NEXUS Chest CT ALL decision instrument (DI) in reducing unnecessary chest CT imaging in minor blunt trauma patients while preserving high sensitivity for detecting clinically meaningful injuries. Additionally, we examined the impact of delayed presentation, chronic disease, and anticoagulation/anti-aggregation medications on trauma outcomes.

METHODS: This retrospective study included 853 adult minor blunt trauma patients who underwent chest CT in the emergency department (ED) of Tel-Aviv Sourasky Medical Center between 2018 and 2022. Clinically meaningful outcomes were defined as trauma-related interventions or hospital admissions. The NEXUS Chest CT DI criteria, along with three additional criteria, were analyzed using logistic regression to identify independent predictors for the primary outcome. These predictors formed a modified DI, and its performance was compared to the original NEXUS DI.

RESULTS: Among 853 patients (median age 44.5 years, 64.2% male), 230 (27.0%) had trauma-related chest CT findings, and 64 (7.5%) experienced clinically meaningful outcomes. Independent predictors included abnormal chest X-ray (aOR 6.5, p < 0.001), chronic disease (aOR 5.2, p < 0.001), sternal tenderness (aOR 4.7, p = 0.007), rapid deceleration (aOR 3.7, p < 0.001), and chest wall tenderness (aOR 3.1, p < 0.001). The NEXUS DI achieved 92.1% sensitivity, reducing imaging by 41.3%, while the modified DI increased sensitivity to 98.4% with a 34.3% imaging reduction.

CONCLUSIONS: The NEXUS Chest CT ALL DI significantly reduces unnecessary imaging while maintaining high diagnostic precision. A modified version enhances sensitivity, refining decision-making in emergency care. Integrating such decision tools, particularly in cases of minor trauma, is highly recommended to optimize resource use and improve patient outcomes.

PMID:39869184 | DOI:10.1007/s00068-024-02692-8