Nevin Manimala

Cardiovasc Drugs Ther. 2025 Jun 25. doi: 10.1007/s10557-025-07741-x. Online ahead of print.

ABSTRACT

INTRODUCTION: Direct oral anticoagulants (DOACs) are the standard treatment for reducing thromboembolic risk in patients with atrial fibrillation (AF); however, bleeding remains a major concern. Factor XIa inhibitors have emerged as a potential alternative, but evidence about their therapeutic potential remains unclear. We performed a systematic review and meta-analysis to evaluate the comparative efficacy and safety of Factor XIa inhibitors versus DOACs for AF.

METHODS: PubMed, Embase, and Cochrane Library were systematically searched until February 15, 2025, to identify RCTs comparing Factor XIa inhibitors with DOACs in AF patients. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using a random-effects model. Statistical analysis was performed in RevMan 5.4 with p-value < 0.05 considered significant, and meta-analyses were conducted using a bivariate random-effects model. Study heterogeneity was measured using I² statistics, and study quality was assessed using the revised Cochrane risk-of-bias (RoB 2) tool.

RESULTS: Three RCTs comprising 16,845 patients (41% females) were included. The mean age of the participants was 74 years. Factor XIa inhibitors were associated with a significantly higher risk of ischemic stroke (RR: 3.32; 95% CI: 2.24-4.90, I²: 0%, p < 0.00001) but a lower risk of major or clinically relevant non-major (CRNM) bleeding (RR: 0.41; 95% CI: 0.33-0.49, I²: 0%, p < 0.00001) and minor bleeding (RR: 0.68; 95% CI: 0.49-0.93, I²: 64%, p = 0.02) compared to DOACs. However, there was no significant difference in the risk of all-cause mortality, cardiovascular mortality, or hemorrhagic stroke between the two groups.

CONCLUSION: Factor XIa inhibitors are associated with a reduced risk of major, minor, and clinically relevant non-major bleeding than DOACs but simultaneously increase the risk of ischemic stroke. No significant differences were found in the risk of hemorrhagic stroke or overall mortality rates compared to DOACs.

PMID:40560486 | DOI:10.1007/s10557-025-07741-x

Environ Monit Assess. 2025 Jun 25;197(7):803. doi: 10.1007/s10661-025-14238-5.

ABSTRACT

Environmental pollution, of which cassava mill effluent is a component, is a global concern that appears particularly devastating to the environment and its habitats. As such, the geospatial assessment of the effects of cassava mill effluent on the environment in Ika North East Local Government Area, Delta State, was conducted. The considered parameters include potential of hydrogen (pH), electrical conductivity (EC), nitrogen (N), chloride (Cl), copper (Cu), iron (Fe), zinc (Zn), lead (Pb), calcium (Ca), magnesium (Mg), and potassium (K). Data were analyzed with a student t-test using a statistical package for the social sciences (SPSS) version 21. The parameters of the sampled soils changed due to cassava mill effluent exceeding WHO standards for land discharge. The affected soil by cassava effluent was acidic (pH = 4.92), while the unaffected soil was neutral (pH = 7.00). The significant difference between the impacted and unaffected soils by cassava mill effluent (P = .036) indicates an alteration of soil quality that can potentially induce toxicological effects on the environment and biodiversity, including humans. The values of pH, EC, N, and Fe, among others, in cassava mill effluent include 5.57, 2210, 0.40, and 50.0411, respectively. The simple linear regression analysis of cassava mill factories showed no pattern, implying the distribution is random (P = .000***). The study offers a spatial understanding of cassava effluent, its environmental impact, and pollution hotspots, enabling targeted interventions and management strategies to prevent soil, water, and air contamination in Ika and other developing regions. By leveraging tools like Geographic Information Systems (GIS) and other geospatial technologies, environmental processes can be monitored, analyzed, and modeled, leading to more informed decisions and effective strategies for sustainable cassava processing and effluent management. The study suggests effluent should be channeled into a designated pond and treated before discharge for effective control and management.

PMID:40560482 | DOI:10.1007/s10661-025-14238-5

Eur J Nutr. 2025 Jun 25;64(5):228. doi: 10.1007/s00394-025-03626-9.

ABSTRACT

PURPOSE: Front-of-package labelling (FOPL) schemes have been developed to provide more useful information to consumers and facilitate more critical and healthier food choices. This single-blinded multi-arm parallel-group randomised controlled trial aimed at assessing the effect of different FOPL schemes on the objective understanding of the nutritional content and intention to purchase products, in El Salvador.

METHODS: Participants (n = 1204) were exposed to two-dimensional images of 15 mock-up products presented at random and balanced orders. Participants were exposed to mock-ups featuring no FOPL scheme (control group, n = 305) or one of the following schemes: black octagonal warning labels (OWL) (n = 302), traffic-light labelling (TFL) (n = 297), or guideline daily amounts (GDA) (n = 300).

RESULTS: The odds for choosing to purchase the least harmful of the options more often was the highest in the OWL group compared to the control group: two times higher in the OWL group (OR 2·21, 95% confidence interval 1·58 – 3·11), and 49% higher in the TFL (1·49, 95%CI 1·06 – 2·11), with no changes in the GDA (1·06, 95%CI 0·75 – 1·50). OWL also resulted in the highest odds for correctly identifying the least harmful option (OR 3·77, 95%CI 2·79 to 5·09), and for correctly identifying a product with higher amounts of sugars, sodium, total fat, and/or saturated fats (3·26, 95%CI 2·40 to 4·43).

CONCLUSION: OWL outperformed GDA and TFL in its ability to improve objective understanding of nutritional information and purchase intention. Results support the adoption of OWL in El Salvador.

TRIAL REGISTRATION NUMBER: ISRCTN 12,389,597.

DATE OF REGISTRATION: 17 July 2023 (retrospectively registered).

PMID:40560477 | DOI:10.1007/s00394-025-03626-9

Eur J Pediatr. 2025 Jun 25;184(7):446. doi: 10.1007/s00431-025-06266-7.

ABSTRACT

Type 1 diabetes (T1D) is a common childhood disease with a complex management that could adversely impact the quality of life of young sufferers. Executive functioning problems and psychopathology are factors that appear to have a detrimental effect on T1D-related quality of life (T1D-QoL). However, research on these factors is limited, and the pathways through which they do so remain unclear. This study aims to replicate the relationship between EF and T1D-QoL and to explore the possible mediating role of the clinical dysregulation profile (CBCL-DP) in this relationship. A total of 68 children and adolescents aged 10-18 living with T1D were recruited for this cross-sectional study. Parents reported on youth executive functioning, T1D-QoL, CBCL-DP, and socio-demographic data. In addition, clinical records of the youth were consulted to collect endocrinological information. Statistical analyses encompassed bivariate correlations, linear regressions, and bootstrap analyses to test the mediation model. Results demonstrate that executive function, CBCL-DP, and T1D-QoL are significantly correlated. The mediation model of the CBCL-DP variable in the relationship between executive function and T1D-QoL is significant. In linear regressions, executive function ceases to be significant on T1D-QoL when CBCL-DP is taken into account. The CBCL-DP significantly accounts for 55% of the variance in T1D-QoL.

CONCLUSION: This study identifies the CBCL-DP as a full mediator between executive function and T1D-QoL, highlighting the importance of emotional and behavioral regulation for quality of life in youth with T1D. The CBCL-DP scale may be useful in identifying regulatory issues and guiding early interventions to improve outcomes in children and adolescents with T1D.

WHAT IS KNOWN: • Previous studies have suggested that EF problems may negatively affect T1D-QoL; however, no studies have investigated the underlying mechanisms by which these variables are associated and the mediating role of CBCL-DP.

WHAT IS NEW: •This study suggests that there is an absence of a direct association between EF problems and T1D-QoL and identifies the CBCL-DP as a complete mediator between these variables. Furthermore, the study indicates that clinical dysregulation acts as a risk factor for diminished T1D-QoL in children and adolescents with T1D.

PMID:40560466 | DOI:10.1007/s00431-025-06266-7

Bull Math Biol. 2025 Jun 25;87(8):102. doi: 10.1007/s11538-025-01482-6.

ABSTRACT

This study investigates the nutrient-driven adaptability of foraging efforts in producer-grazer dynamics. We develop two stoichiometric producer-grazer models: a base model incorporating a fixed energetic cost of feeding and an adaptive model where feeding costs vary over time in response to environmental conditions. By comparing these models, we examine the effects of adaptive foraging strategies on population dynamics. Our adaptive model suggests a potential mechanism for evolutionary rescue, where the population dynamically adjusts to environmental changes, such as fluctuations in food quality, by modifying its feeding strategies. However, when population densities oscillate in predator-prey limit cycles, fast adaptation can lead to very wide amplitude cycles, where populations are in danger of stochastic extinction. Overall, this increases our understanding of the conditions under which nutrient-driven adaptive foraging strategies can yield benefits to grazers.

PMID:40560462 | DOI:10.1007/s11538-025-01482-6

Lasers Med Sci. 2025 Jun 25;40(1):299. doi: 10.1007/s10103-025-04552-2.

ABSTRACT

Zerumbone (ZER), a sesquiterpene extracted from Zingiber zerumbet (L.) Smith, enhances the antibiofilm effects of antimicrobial photodynamic therapy (aPDT) by reducing the extracellular matrix of biofilms and increasing the generation of reactive oxygen species (ROS) when applied prior to aPDT. To reduce treatment application time, ZER was combined with Photodithazine® (PDZ) in a single solution. Then, this study investigated the potential of aPDT mediated by a mixture of ZER with PDZ in the inactivation of Staphylococcus aureus, Escherichia coli, fluconazole-susceptible (CaS) and resistant (CaR) Candida albicans biofilms. The solutions of ZER, PDZ and their mixture (ZER + PDZ) were analyzed using absorbance spectroscopy (AS), high-performance liquid chromatography (HPLC), and mass spectrometry (MS) to confirm the absence of molecular alterations in the mixture of ZER + PDZ. 48 h-biofilms were growth and treatments were performed: 1-ZER (256 µg/mL); 2-PDZ (200 µg/mL); 3-PDZ + LED; 4-ZER + PDZ + LED; 5- MIX (ZER + PDZ) + LED; Control (without treatment). Irradiation was performed using a red LED (660 nm, 50 J/cm², 30 mW/cm²). Sterile PBS was employed as the control group. For cytotoxicity assessments ffi broblast (HGF) and keratinocyte (NOK-si) oral cells were cultured for 24 h and submitted to treatments. Both ZER + PDZ + LED and MIX (ZER + PDZ) + LED groups showed the greatest statistically significant reduction in CFU/mL when compared to the control group (p ≤ 0.011) in all evaluated strain, with no significant difference between them (p ≥ 0.218). The reduction observed was 2.74, 2.89, 2.45 and 2.07 log₁₀ for S. aureus, E. coli, CaS, CaR, respectively. Cell viability reduction in NOK-si and FGH did not exceed 17%. AS, HPLC, and MS analyses demonstrated that PDZ retained its original characteristics following combination with ZER. Zerumbone combined with PDZ enhances the effect of antimicrobial photodynamic treatment regardless of strain characteristics and showed no cytotoxic effects.

PMID:40560448 | DOI:10.1007/s10103-025-04552-2

World J Urol. 2025 Jun 25;43(1):389. doi: 10.1007/s00345-025-05774-3.

ABSTRACT

BACKGROUND: Chemotherapy can lead to severe and prolonged immunosuppression, which puts oncologic patients at a higher risk of UTIs. This review determined the global prevalence and etiologic agents of UTIs among oncologic patients.

METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for reporting. The article search was performed via PubMed, Medline, EMBASE, Google Scholar, Hinari, Web of Science, Science Direct, and African Journals Online. Data were extracted via a Microsoft Excel spreadsheet and analyzed via STATA version 11.0. A random effects model was used to estimate the pooled effect size across the studies. The heterogeneity was checked via the I² statistic. The publication bias was determined via a funnel plot and Egger’s test, with a p-value < 0.05 indicating statistically significant bias. Subgroup and sensitivity analyses were subsequently performed.

RESULTS: Eighteen articles were eligible for this review. The pooled estimate of UTI incidence was 34.39% (95% CI: 22.29-46.49), with high heterogeneity (I² = 96.2%) and statistical significance (p < 0.001). In the subgroup analysis, a high prevalence of UTIs was observed in Asia (49.71%), with studies not reporting the type of malignancy (68.87%; 95% CI: 59.95-77.79%), symptomatic bacteriuria (34.86%), and adults (39.87%). Among the etiologic agents of UTI, the most common was E. coli (19.99%, 95% CI: 10.27-29.71%), followed by Klebsiella spp. (5.12%, 95% CI: 2.47-7.76%). The pooled prevalence of UTIs among patients with bladder cancer was 22.09% (95% CI: – 13.75-57.94, I² = 95.5%).

CONCLUSION: There is a significant global burden of UTIs (34.39%) in oncologic patients. This requires regular screening of UTIs in oncologic patients to minimize further complications, better monitoring, and early treatment.

PMID:40560443 | DOI:10.1007/s00345-025-05774-3

Eur Radiol. 2025 Jun 25. doi: 10.1007/s00330-025-11774-z. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the performance of the ultrasound hepatorenal index (US-HRI) for the diagnosis of hepatic steatosis in patients with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease (MASLD), using MRI proton density fat fraction (MRI-PDFF) as reference.

MATERIALS AND METHODS: This two-center prospective study included 129 and 263 patients in the training and validation cohorts, respectively, between 2019 and 2022. Hepatic steatosis was classified according to MRI-PDFF as S0 (≤ 6.5%), S1 (6.5-16.5%), S2 (16.5-22%), and S3 (> 22%). Obuchowski measurement (OB) was performed to assess the diagnostic performance of US-HRI in the whole cohort. Optimal cut-offs of US-HRI for diagnosing ≥ S1 and ≥ S2 were identified in the training cohort by maximizing the Youden index and were applied in the validation cohort.

RESULTS: Overall, 392 patients were included (mean age, 59 years ± 9.5; 235 men). The OB (four class problem S0 to S3) was 0.79 ± 0.01. Pairwise accuracy was good for S0 vs S1, S2 or S3 (0.78 to 0.89) but decreased for distinguishing among higher grades (0.54 to 0.62). Optimal US-HRI threshold for diagnosing ≥ S1 was 1.16, with a sensitivity of 82.7% (95% CI: 77.4-87.3), specificity of 80.0% (95% CI: 56.3-94.3), and AUC of 0.81 (95% CI: 0.76-0.86). The threshold for diagnosing ≥ S2 was 1.47, with a sensitivity of 49.0% (95% CI: 39.1-59.0), specificity of 73.0% (95% CI: 65.3-79.7), and AUC of 0.61 (95% CI: 0.55-0.67).

CONCLUSION: US-HRI was a reliable tool for diagnosing steatosis in type 2 diabetic patients with MASLD. However, its performance in assessing more severe grades of steatosis was inadequate.

KEY POINTS: Question Ultrasound hepatorenal index (US-HRI) performance for the diagnosis of steatosis in type 2 diabetic patients with metabolic dysfunction-associated steatotic liver disease (MASLD) is not well defined. Findings US-HRI demonstrated good diagnostic performance for steatosis (S0 vs S1-S3), but this decreased for diagnosing S2-S3. Clinical relevance US-HRI provides a quantitative approach for detecting hepatic steatosis in patients with MASLD and type 2 diabetes, but has shown limited effectiveness in grading higher grades.

PMID:40560415 | DOI:10.1007/s00330-025-11774-z

Eur Radiol. 2025 Jun 25. doi: 10.1007/s00330-025-11772-1. Online ahead of print.

ABSTRACT

OBJECTIVES: Rejection is the leading cause of graft failure, and its diagnosis remains a challenge. Elastography and dynamic contrast-enhanced ultrasound (DCE-US) are novel non-invasive techniques for quantifying tissue elasticity and perfusion. Their role in pancreas graft rejection has not yet been defined.

MATERIALS AND METHODS: From October 16 to January 20, all pancreas transplantations performed at our institution were prospectively studied with elastography and DCE-US at 1 week, 3 weeks, and 12 months post-transplantation. Surveillance biopsies were performed at 3 weeks and 12 months. Elastography and DCE-US were also conducted in all requested biopsies during this period (regardless of the date of transplantation). Patients were categorized according to the biopsy result: normal/rejection. Grafts with other complications were excluded. Cut-off values were established.

RESULTS: One hundred twenty-one elastography and 127 DCE-US in 56 patients were included. All parameters showed a high dispersion during the first 90 days post-transplantation. After this period, the rejection group presented higher stiffness (0.97 vs 1.46 m/s, p < 0.001) and lower perfusion. The optimal cut-off value for elastography was 1.27 m/s (AUC 0.80), and for DCE-US were: peak enhancement 601 a.u. (AUC 0.67), wash-in AUC 2748 a.u. (AUC 0.70), wash-in rate 118 a.u. (AUC 0.65), wash-in perfusion index 369 a.u. (AUC 0.67), wash-out AUC 5181 a.u. (AUC 0.69) and total AUC 6388 a.u. (AUC 0.68). A combined predictive score showed that alteration of elastography and DCE-US was associated with a 23.2-fold probability of rejection.

CONCLUSION: After the first 90 days post-transplantation, pancreas graft rejection is associated with higher stiffness and lower graft perfusion.

KEY POINTS: Question Pancreas graft rejection remains a clinical challenge, as there are currently no reliable non-invasive tests for its diagnosis. Findings After the first 90 days post-transplantation, elastography and DCE-US show higher stiffness and lower pancreas graft perfusion in the presence of rejection. Clinical relevance These non-invasive tools, which can be easily integrated into daily routine practice, may be useful in identifying grafts at higher risk of rejection, allowing closer follow-up or early biopsy to establish early rejection treatment, improving graft and patient survival.

PMID:40560414 | DOI:10.1007/s00330-025-11772-1

Eur Radiol. 2025 Jun 25. doi: 10.1007/s00330-025-11775-y. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate LI-RADS major and ancillary features for MRI-based diagnosis of pediatric malignant liver tumors.

MATERIALS AND METHODS: This single-center retrospective study enrolled pediatric patients who underwent contrast-enhanced liver MRI for focal liver lesions from January 2010-February 2023. Three readers independently performed imaging analysis based on LI-RADS v2018. The reference standard was a pathological diagnosis or stability/regression for over one year on follow-up. Estimation of diagnostic accuracy and multivariable logistic regression were conducted to identify LI-RADS features associated with malignant hepatocellular tumors and hepatic malignancy in general.

RESULTS: Of the 102 patients (median age [interquartile range], 4.5 [0.6-14.0] years; boys:girls, 54:48), 58.8% (60/102) had malignant liver tumors and 49.0% (50/102) had malignant hepatocellular tumors. The sensitivity and specificity of major features for diagnosis of malignant hepatocellular tumors were as follows: nonrim arterial enhancement, 73.4% and 39.6%; enhancing capsule, 56.7% and 92.0%; nonperipheral washout, 70.1% and 94.2%. Nonperipheral washout (sensitivity, 70.1%; specificity, 94.2%; adjusted OR, 34.5; p < 0.001), restricted diffusion (sensitivity, 97.9%; specificity, 53.8%; adjusted OR, 72.3; p = 0.001), and fat-in-mass (sensitivity, 29.0%; specificity, 93.0%; adjusted OR, 4.3; p = 0.01) were associated with malignant hepatocellular tumors, while nonperipheral washout (sensitivity, 58.7%; specificity, 94.5%; adjusted OR, 12.5; p < 0.001), restricted diffusion (sensitivity, 97.1%; specificity, 65.8%; adjusted OR, 31.1; p < 0.001), and mosaic architecture (sensitivity, 79.5%; specificity, 90.0%; adjusted OR, 20.4; p < 0.001) were associated with hepatic malignancy in general.

CONCLUSION: Restricted diffusion was a sensitive MRI LI-RADS feature, while nonperipheral washout and mosaic architecture were specific features for diagnosing pediatric malignant liver tumors.

KEY POINTS: Questions MRI is the recommended modality for pediatric focal liver lesions, but only a few studies have examined the diagnostic accuracy of MRI LI-RADS features in children. Findings Restricted diffusion was sensitive for malignant liver tumors, while mosaic architectures were specific for malignant liver tumors. Nonperipheral washout was specific for diagnosing malignant hepatocellular tumors. Clinical relevance Nonperipheral washout, restricted diffusion, and mosaic architecture were reliable MRI LI-RADS features for diagnosing pediatric malignant liver tumors.

PMID:40560413 | DOI:10.1007/s00330-025-11775-y