Nevin Manimala

Biomark Med. 2025 May 29:1-15. doi: 10.1080/17520363.2025.2511466. Online ahead of print.

ABSTRACT

INTRODUCTION: MicroRNA (miRNA) single nucleotide polymorphisms (miRNA-SNPs) have been associated with pediatric acute lymphoblastic leukemia (ALL). However, since the results of these individual studies have been inconsistent, we performed a meta-analysis to help establish a statistical significance for the association between miRNA-SNPs and pediatric ALL risk. We also analyzed whether they confer susceptibility across country-specific studies by using different genetic models.

METHODS: Articles published from 2001 to 2023 were collected from PubMed and Google Scholar databases. Through MetaGenyo, the association between miRNA- SNPs and pediatric ALL risk was calculated by pooled odds ratio [ORs] and 95% CI. A subgroup analysis of pooled ORs in country-specific studies was also performed.

RESULTS: Based on the inclusion and exclusion criteria, 14 studies were analyzed to extract data on miR146 rs2910164, miR-196a2 rs11614913, miR-612 rs12803915 and mir-499 rs3746444. While the pooled data analysis did not reveal any association, a subgroup analysis demonstrated country-specific differences in allele frequencies of all the four miRNAs in various genetic models, implying ethnicity-based risk.

CONCLUSION: Our results suggested that miRNA-SNPS can still be considered as a potential risk factor to be explored in more populations.

PMID:40438964 | DOI:10.1080/17520363.2025.2511466

Mol Omics. 2025 May 29. doi: 10.1039/d5mo00018a. Online ahead of print.

ABSTRACT

The progressive illness known as chronic kidney disease (CKD) can often be challenging to diagnose in its early stages with conventional diagnostic approaches such as serum creatinine and albumin assessment. Early-stage CKD (stages G1-G3) is defined by a GFR of ≥30 mL min^-1/1.73 m², which indicates normal to moderately reduced kidney function with or without symptoms of impaired kidney function. Identifying possible biomarkers for early detection and personalised treatment, as well as physiological changes linked to early CKD-an area that has not been fully investigated before-is the goal of the study to address this gap. We performed a metabolomic analysis using ¹H NMR on 115 human serum samples (24 healthy controls and 91 patients with early-stage CKD). MetaboAnalyst 6.0 was used for data pre-processing and statistical analyses (PCA, PLS-DA, OPLS-DA, ANOVA, and Wilcoxon Mann-Whitney test). Strong differentiation between CKD stages was achieved by random forest modelling. The KEGG database was used to perform pathway enrichment, and ROC analysis was used to evaluate the diagnostic value of important metabolites. Across CKD stages, significant changes were observed in ten different metabolites: myo-Inositol, glycerol, pyruvate, carnitine, phenylalanine, tyrosine, histidine, TMAO, 2-hydroxyisobutyrate, and 3-hydroxyisobutyrate (p < 0.05, VIP > 1). AUC values > 0.7 from ROC curves demonstrated its potential for diagnosis. Pathway analysis revealed significant dysregulation in the metabolism of inositol phosphate, tyrosine, histidine, and pyruvate, and biosynthesis of phenylalanine, tryptophan and tyrosine. This comprehensive metabolomics investigation identified potential early-stage CKD biomarkers in addition to significant metabolic abnormalities. These findings could help provide individualized care for early CKD management.

PMID:40438956 | DOI:10.1039/d5mo00018a

Arthritis Care Res (Hoboken). 2025 May 29. doi: 10.1002/acr.25576. Online ahead of print.

ABSTRACT

OBJECTIVE: This systematic review and meta-analysis aims to evaluate the participation of historically marginalized populations in systemic lupus erythematosus (SLE) clinical trials conducted in the US.

BACKGROUND: SLE, a complex autoimmune disease characterized by a dysregulated immune response leading to inflammation and tissue damage in multiple organ systems, exhibits a mortality rate four times higher in historically marginalized populations compared to the general population. It is essential for clinical trials to accurately represent the disease population to effectively evaluate treatment modalities. However, the current trial design lacks appropriate representation of historically marginalized populations, limiting the generalizability of results. Our study addresses this research gap by evaluating the participant demographics in SLE clinical trials.

METHODS: Relevant clinical trials were obtained in a comprehensive search of MEDLINE (PubMed) and Embase (Elsevier) in May of 2024. Included trials were published in the United States between January 1, 2018, and December 31, 2023. Two reviewers independently performed screening and data extraction via a standardized Google Form.

RESULTS: Having met our inclusion criteria, 18 U.S. SLE clinical trials were evaluated for participant sex, age, racial, and ethnic data. Analysis of sex/gender revealed that the included population accurately represented the disease population. Regarding race/ethnicity participation, 11/18 (61.1%) received an overall Poor rating, and none received a Good rating. Analysis revealed that 14/18 (77.8%) of studies demonstrated statistically insignificant underrepresentation of Black, Asian, and Hispanic populations. No studies reported the inclusion of older adults in their sample, suggesting a significant need for better age representation.

CONCLUSION: The results of this study reveal disparities in the representation of the SLE disease population in clinical trials, emphasizing insufficient inclusion of Black, Asian, and Hispanic/Latinx participants and the disproportionate overrepresentation of white participants. Our study highlights the need for the initiation of effective strategies to engage historically marginalized populations in SLE clinical trials. Addressing these gaps is necessary to prioritize the participation of inequitable populations, increase standardization of SLE treatments, and improve the relevance of SLE research.

PMID:40438917 | DOI:10.1002/acr.25576

J Appalach Health. 2025 May 1;7(1):63-80. doi: 10.13023/jah.0701.04. eCollection 2025.

ABSTRACT

BACKGROUND: Wearable health devices capture metrics (e.g., physical activity, ECG, sleep) that can enhance care when shared with providers. Yet, willingness to share wearable data may differ in Appalachia, where chronic disease burdens, mistrust, and limited infrastructure pose unique challenges.

OBJECTIVE: This study explored (1) which sociodemographic, health, and digital behaviors correlate with willingness to share wearable data and (2) how these insights can guide region-specific interventions in Appalachia.

METHODS: We analyzed 320 Appalachian respondents from the Health Information National Trends Survey (HINTS 6). Descriptive statistics and logistic regression models examined willingness to share wearable data. Because of small cell counts, we supplemented with a Firth (penalized) logistic regression for robustness.

RESULTS: Approximately 25.0% unweighted (27.9% weighted) were willing to share wearable data, but two-thirds did not respond or were inapplicable. The final adjusted model (n=47) revealed:Income: Higher income correlated with increased willingness (e.g., aOR=8.52e+04 for $35-49k vs.Self-Rated Health: “Good” or “very good” health was associated with higher odds of sharing than “poor” health (aOR=4406.52; p<.05).Messaging: Surprisingly, participants who never messaged providers showed greater willingness (aOR=1.93e+07; p.

CONCLUSIONS: These preliminary findings suggest that household income, perceived health, and digital behaviors influence wearable data-sharing in Appalachia, whereas national demographic trends may not apply. Future work should use larger samples, mixed methods, and region-specific approaches to address mistrust, privacy concerns, and infrastructural barriers, aiming to enhance remote patient monitoring and reduce health disparities.

PMID:40438881 | PMC:PMC12112009 | DOI:10.13023/jah.0701.04

Cureus. 2025 Apr 28;17(4):e83108. doi: 10.7759/cureus.83108. eCollection 2025 Apr.

ABSTRACT

BACKGROUND: Adolescence is a stage characterized by behaviors that pose significant risks to long-term health, and smoking is one of the most prominent risks among young people. This period is also considered a stage with an increased need for interaction and acceptance from peer groups, which can lead adolescents to take on new risks. In this context, smoking, in various forms (cigarettes, cigarillos, vape/e-cigarettes, chewing tobacco, etc.), is a major public health issue among young people. Tobacco use, perceived as a socializing factor, provides adolescents with the opportunity to integrate more easily into groups.

OBJECTIVE: The objective of this research was to identify potential changes in adolescents’ smoking behaviour during the COVID-19 pandemic, based on sociodemographic data. Additionally, we aimed to identify the existence of vulnerabilities that could lead to the later development of the smoking habit.

MATERIAL AND METHODS: The research sample comprised 521 subjects aged 15-19 years, both girls and boys, from rural and urban areas in the southern (Olt) and northern (Suceava) regions of Romania. The study was cross-sectional and included data collected online through an anthropological questionnaire between April and May 2021. The study participants were enrolled in high school education conducted exclusively online during this period due to the context generated by the pandemic. The questionnaire included a series of questions related to smoking-related behaviours among adolescents, such as the age of onset of smoking temptation and the subsequent development of this habit, analyzed in relation to sociodemographic variables. Data were processed using IBM SPSS Statistics, version 26 (IBM Corp., Armonk, USA). Results: The results were obtained from the analysis of data provided by the 521 subjects in the research sample. Approximately 45% of our study subjects were tempted and tried to smoke, but only 17.3% became regular smokers and smoked daily, while 4.2% continued to be occasional smokers (3-5 cigarettes/month). It was found that there were no statistically significant differences by gender, place of origin, or geographical area in the age at which adolescents were tempted and even tried smoking. About 52.5% of the adolescents who tried to smoke did not become regular smokers, while those who became regular or occasional smokers represented 47.5%. In our sample, the vulnerable age for the subsequent establishment of regular smoking behaviour was between 13 and 14 years. Adolescents who perceived their family income as high or average reported higher tobacco consumption compared to those who perceived their family income as low.

CONCLUSIONS: Tobacco consumption habits did not seem to be influenced by the new situation created by the COVID-19 pandemic. Regardless of gender, place of origin (rural or urban), or geographical region, the age at which the temptation to smoke was most likely to develop into a habit was 14 or younger. It is noteworthy that more than half of the adolescents were not tempted to experiment with smoking. Among those who tried tobacco and continued smoking, boys showed a higher percentage than girls. Furthermore, a correlation was observed between family income and the quantity of tobacco consumed.

PMID:40438863 | PMC:PMC12119062 | DOI:10.7759/cureus.83108

Cureus. 2025 Apr 27;17(4):e83076. doi: 10.7759/cureus.83076. eCollection 2025 Apr.

ABSTRACT

BACKGROUND: Angina pectoris remains a significant public health concern, highlighting disparities in cardiovascular health influenced by demographic, socioeconomic, and geographic factors. Analyzing the prevalence of trends is crucial to addressing health inequities and informing targeted interventions. The study of National Health Interview Survey (NHIS) data from 2019 to 2023 allowed us to observe how the pandemic affected cardiovascular care utilization when it decreased in 2020 and later rebounded into 2023 while investigating shifts in reported angina prevalence rates among main groups. Angina pectoris condition-related research requires assessment of current trends for effective health inequities intervention and targeted intervention planning.

OBJECTIVE: This study aims to examine the prevalence of angina pectoris among United States (US) adults from 2019 to 2023 and across demographic, socioeconomic, and geographic factors.

METHOD: Data from the NHIS were analyzed to determine the prevalence of angina pectoris, which was identified through self-reported diagnosis or symptoms. The identification of angina pectoris in the NHIS dataset was based on self-reported physician diagnosis alongside responses to definite survey questions regarding chest pain and discomfort consistent with the symptoms of angina. Angina pectoris was identified in the NHIS dataset based on self-reported physician diagnoses and responses to specific survey questions on chest pain or discomfort consistent with angina. Stratified analyses assessed variations in prevalence across key demographic, socioeconomic, and geographic factors over a five-year period. The statistical analyses included both inferential analyses and descriptive statistics, including hypothesis testing and confidence interval estimation, to evaluate associations and divergences within the data. The prevalence of angina was evaluated across socioeconomic, demographic, and geographic groups using stratified analyses.

RESULTS: The overall prevalence of angina pectoris remained stable (1.5-1.7%) from 2019 to 2023. Higher rates were observed among males (1.8%), older adults (4.5% in those aged 75 years and older), and US-born individuals (1.6%). Disparities observed across race/ethnicity further revealed disparities, with American Indian/Alaska Native individuals (2.1%) and Black individuals (1.2%) showing distinct patterns. Geographic trends highlighted a higher prevalence in areas with high social vulnerability (1.7%). Socioeconomic disparities were notable, with lower-income individuals (<100% federal poverty level (FPL)) experiencing higher prevalence (2.8-3.1%) and elevated rates among those with lower educational attainment. Employment status influenced prevalence, with unemployed individuals showing higher rates (3.4%).

CONCLUSION: The prevalence of angina pectoris reflects persistent disparities across demographic, socioeconomic, and geographic factors. The findings highlight the need for policies that enhance access to preventive cardiovascular care, early screening, and intervention, as well as address the social determinants of health, to minimize disparities in underserved populations.

PMID:40438860 | PMC:PMC12116826 | DOI:10.7759/cureus.83076

Cureus. 2025 Apr 28;17(4):e83134. doi: 10.7759/cureus.83134. eCollection 2025 Apr.

ABSTRACT

Background Catheter-associated urinary tract infections (CAUTIs) are a significant concern in ICU patients, often leading to complications such as bloodstream infections, urosepsis, prolonged hospitalization, and increased mortality, particularly due to delayed diagnosis and rising antibiotic resistance. For therapy to be effective, the causing pathogens must be identified quickly and accurately. This study compares conventional microbiological methods with Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) for identifying urinary isolates in CAUTI cases and examines their antibiotic susceptibility patterns. Methods Over one year, we analyzed 780 catheterized urine samples from ICU patients at a tertiary care hospital. All samples were processed using standard culture techniques and MALDI-TOF MS for pathogen identification. Antibiotic susceptibility testing was performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Descriptive statistics were used for data summarization, and Chi-square test assessed associations between risk factors and CAUTI occurrence, with agreement between MALDI-TOF MS and conventional identification methods evaluated by Cohen’s Kappa analysis. The Chi-square test’s statistical significance was set at p < 0.05. Results Out of 780 samples, 156 (20%) showed significant bacterial or fungal growth. The most common pathogens were Candida species (56.4%), Enterococcus (17.9%), and Escherichia coli (12.2%). MALDI-TOF MS demonstrated good accuracy, with misclassifications in 12 isolates (7.7%) mainly involving misidentification in Enterococcus and Candida. Despite these discrepancies, a strong agreement was observed between the two methods, with a Cohen’s Kappa value of 0.787. High resistance was observed against fluoroquinolones and cephalosporins, while fosfomycin and linezolid remained effective against Enterococcus spp. Conclusion MALDI-TOF MS enhances the speed and accuracy of pathogen identification, making it a valuable tool for managing CAUTI cases. The increasing antibiotic resistance observed in this study highlights the urgent need for targeted treatment strategies and stricter infection control measures in ICU settings.

PMID:40438855 | PMC:PMC12118601 | DOI:10.7759/cureus.83134

Cureus. 2025 Apr 28;17(4):e83124. doi: 10.7759/cureus.83124. eCollection 2025 Apr.

ABSTRACT

Introduction Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the U.S., with disparities in incidence, survival, and age at diagnosis across racial, ethnic, and socioeconomic groups. The rising incidence of early-onset CRC (<50 years) has amplified concerns regarding access to care, screening disparities, and outcomes, particularly among minorities. This study examines the impact of race, ethnicity, socioeconomic status (SES), and sex on CRC survival and age at diagnosis in Texas from 1995 to 2016. Methods This retrospective cohort study utilized Texas Cancer Registry (TCR) data, including 235,076 CRC cases diagnosed between 1995 and 2016. Kaplan-Meier analysis and log-rank tests assessed 10-year survival by race and ethnicity and time period (1995-2005 vs. 2006-2016). Kruskal-Wallis tests with Bonferroni correction were used to compare survival years between racial/ethnic groups within each period. Age at diagnosis was analyzed by race and ethnicity, and SES using Welch ANOVA and Games-Howell post hoc testing. Welch’s t-tests compared intra-race changes across decades. Sex-based differences in diagnosis age were assessed using Mann-Whitney U tests. Results Significant racial, ethnic, and socioeconomic disparities were observed in CRC outcomes. Black: Non-Hispanic and Black: Hispanic patients exhibited some of the lowest median survival times, with minimal overall improvement between the two time periods. Although Black: Hispanic patients exhibited the lowest median survival, the difference was not statistically significant in the 2006-2016 cohort (p = 0.12). Hispanic and Black patients were diagnosed at younger ages compared to White: Non-Hispanic patients. Lower SES was associated with younger age at diagnosis and worse survival. Male patients were consistently diagnosed earlier than female patients across both decades. Despite some improvement in survival for certain groups, disparities persisted, particularly for Black: Non-Hispanic and Black: Hispanic patients. Conclusion Disparities in CRC survival and diagnosis age persist across racial, ethnic, SES, and sex lines in Texas. These findings underscore the need for tailored screening efforts, improved healthcare access, and targeted interventions for high-risk populations. Persistent sex-based differences highlight a need for further research into biological and systemic factors. Addressing social determinants of health may help reduce these disparities.

PMID:40438851 | PMC:PMC12119150 | DOI:10.7759/cureus.83124

Cureus. 2025 Apr 26;17(4):e83042. doi: 10.7759/cureus.83042. eCollection 2025 Apr.

ABSTRACT

Objectives The prevalence of pediatric pain, either related to the child’s hospital visit or because of diagnostic and/or therapeutical interventions, is of primordial importance in pediatric emergency departments (PEDs). In this study, we evaluate the evolution of pain assessment and management in Portuguese PEDs over 11 years. Methods We prepared a questionnaire addressed to head physicians of 45 Portuguese PEDs in 2007 and statistically compared the responses to those provided in 2018, where we also posed these questions to nurse managers. Results Pain assessment in our cohort of Portuguese PEDs has significantly improved, namely, with the establishment of local protocols and widespread use of pain scales (from 52% to 93%, p = 0.03). However, effective adoption of pain management remains insufficient, as mild to moderate pain is still far from being universally treated (only 22% always use analgesia). Nonetheless, there seems to be adequate treatment of severe pain and respective common use of opioids, but correct practices were not generally adopted when specific types of pain were analyzed. Procedural sedation and analgesia have significantly increased but are not yet universally practiced. In the year 2018, about 88% of these inadequacies are reflected by the staff’s perception that pain management remains suboptimal, and more training is needed. Conclusion The development of collective awareness and the institution of national guidelines for pediatric pain have helped to improve the conjuncture in Portuguese PEDs. However, a coordinated nationwide plan to promote local training and optimize knowledge translation is still lacking.

PMID:40438844 | PMC:PMC12116828 | DOI:10.7759/cureus.83042

Cureus. 2025 Apr 27;17(4):e83093. doi: 10.7759/cureus.83093. eCollection 2025 Apr.

ABSTRACT

OBJECTIVE: Concerning endovascular treatment for acute ischemic stroke with intracranial vessel occlusion, shortening the door-to-puncture time (DTP) improves the patient’s outcome. To determine endovascular treatment, magnetic resonance angiography or computed tomography angiography is performed for occluded vessel detection. Another detection method of internal carotid artery (ICA) occlusion or middle cerebral artery first segment (M1) occlusion is ultrasound (US). Bilateral flow pattern analysis of common carotid arteries by US leads to the diagnosis of ICA or M1 occlusion within a few minutes. Moreover, it can be conducted in the emergency department. The addition of the US for the initial evaluation of vessel occlusion can shorten the DTP. In this study, we evaluated the effectiveness of carotid artery US imaging in detecting large vessel occlusion (LVO) and shortening the DTP.

MATERIALS AND METHODS: This is a retrospective case-control study. Our analysis was based on the data from 150 patients with LVO or medium vessel occlusion who underwent endovascular revascularization treatment at our hospital between January 2015 and December 2022. Among them, 104 patients who had an anterior circulation vessel occlusion were included. They were divided into the US evaluation group and the non-US evaluation group, and their characteristics, treatment time course, and outcomes were compared.

RESULTS: This study included 104 patients with a median age of 81 years (interquartile range: 73-89 years), 57.7% were females, and the pre-stroke modified Rankin Scale (mRS) median was 0.5 (interquartile range: 0-3). Our cohort included advanced aged patients; therefore, this study included 56.7% of patients over 80 years old and 35.6% of pre-stroke mRS over 3. The US (US group) and non-US (non-US group) evaluation groups included 54 and 50 patients, respectively. As magnetic resonance imaging evaluation in the non-US group was performed over the 4.5 hours delayed arrival of patients from the last known well (LKW) to consider the evaluation of tPA administration, selection bias occurred. The US group included high National Institutes of Health Stroke Scale (NIHSS) patients (P = 0.0152) and more ICA occlusions (P = 0.0146). Onset (LKW) to door time was shorter in the US group (median, 75 min (35-146.5 minutes)) than the non-US group (median, 179 minutes (47.3-432.8 minutes); P = 0.0426), and the DTP was shorter for the US group (median, 75.5 minutes (63.8-87.3 minutes)) than for the non-US group (median, 85 minutes (67-129 minutes); P = 0.0102). Statistical difference was not seen in puncture to reperfusion time among the US group (median, 71.5 minutes (51-114 minutes)) and non-US group (median, 67 minutes (42.3-98.5 minutes); P = 0.5581). The onset (LKW) to reperfusion was shorter for the US group (median, 251 minutes (201-327.3 minutes)) than for the non-US group (median, 319 minutes (200-633.5 minutes); P = 0.0348). No statistical differences were seen for thrombolysis in cerebral infarction grade 2b-3 after treatment, improvement of NIHSS, and mRS at 90 days.

CONCLUSION: US is a useful imaging method to identify an anterior circulation LVO. It can distinguish patients with severe internal carotid or middle cerebral artery occlusion from medium vessel occlusion or other peripheral vessel occlusions. US helps to shorten the DTP time of LVO.

PMID:40438838 | PMC:PMC12116222 | DOI:10.7759/cureus.83093