Nevin Manimala

J Antimicrob Chemother. 2025 Oct 28:dkaf398. doi: 10.1093/jac/dkaf398. Online ahead of print.

ABSTRACT

OBJECTIVES: This study investigated CYP3A4-mediated pharmacokinetic interactions between ruxolitinib (JAK1/2 inhibitor for steroid-refractory acute and chronic graft-versus-host disease) and posaconazole (antifungal prophylaxis in haematological malignancies) to inform clinical dosing strategies.

METHODS: In this open-label, fixed-sequence trial, eight Chinese patients with haematological malignancies received ruxolitinib 5 mg once daily (Day 1: monotherapy) followed by ruxolitinib 5 mg plus posaconazole 200 mg three times daily (Days 2-6: combination). Plasma concentrations of ruxolitinib and posaconazole were analysed using validated LC-MS/MS. Geometric mean ratios (GMRs) with 90% CIs for PK parameters were calculated to assess PK interactions.

RESULTS: All patients completed the study. Co-administration with posaconazole increased ruxolitinib AUC0-24h by 58% (GMR: 1.58; 90% CI: 1.32-1.88). Geometric mean AUC0-24h values were 179.80 μg·h/L [monotherapy, coefficient of variation (CV) 39.26%] versus 283.60 μg·h/L (combination, CV 41.42%). No significant change in Cmax was observed (GMR: 1.10; 90% CI: 0.90-1.36). Geometric mean of the maximum plasma concentration at steady state (Cmax,ss) and AUC0-24h of posaconazole were 1543.52 μg/L (CV 41.81%) and 31 404.37 μg·h/L (CV 32.14%). There was no significant correlation between the systemic exposure of posaconazole (AUC or Cmax,ss) and the ratio of ruxolitinib AUC0-24h when co-administered versus administered alone.

CONCLUSIONS: Although co-administration of posaconazole with ruxolitinib resulted in a statistically significant increase in ruxolitinib systemic exposure, the magnitude of this interaction was clinically moderate. Although ruxolitinib dose adjustment may not be routinely required when used concomitantly with posaconazole, close monitoring for ruxolitinib-related adverse effects is recommended under this combination therapy setting.

PMID:41148123 | DOI:10.1093/jac/dkaf398

J Back Musculoskelet Rehabil. 2025 Oct 28:10538127251391101. doi: 10.1177/10538127251391101. Online ahead of print.

ABSTRACT

BackgroundNon-specific low back pain (NSLBP) has been associated with proprioceptive deficits that may also affect the knee joint.ObjectiveThis study aimed to examine knee proprioception in young adults with NSLBP and to assess dynamic postural stability using the Biodex Balance System (BBS). It further explored whether gender influences these outcomes.MethodsEighty-eight participants, aged 18 to 26 years with a body mass index under 30 kg/m² and diagnosed with NSLBP, were recruited. They were assigned to male (n = 44) and female (n = 44) groups. Assessments included the Oswestry Disability Index (ODI), knee joint repositioning error (JPE) measured with a digital inclinometer, and dynamic balance evaluated with the BBS. The BBS provided overall stability index (OSI), anterior-posterior index (API), and medial-lateral index (MLI) scores. Statistical analyses were performed using SPSS with significance set at p < 0.05.ResultsThere were no significant gender differences in JPE (males: 30.97 ± 3.62; females: 30.28 ± 5.42, p > 0.05) or ODI. BBS outcomes, however, showed elevated OSI (4.2 ± 1.1 compared with 2.5 ± 0.5 in healthy controls, p < 0.01), API (3.8 ± 0.9 compared with 2.0 ± 0.4, p < 0.01), and MLI (3.5 ± 0.8 compared with 1.8 ± 0.3, p < 0.01), indicating impaired dynamic balance. No significant gender differences were observed in BBS indices.ConclusionNSLBP significantly impairs dynamic knee proprioception, as demonstrated by BBS findings. Gender did not influence proprioceptive performance in this cohort.

PMID:41148105 | DOI:10.1177/10538127251391101

J Nutr Educ Behav. 2025 Oct 28:S1499-4046(25)00441-5. doi: 10.1016/j.jneb.2025.09.006. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to expand knowledge and develop a list of technical assistance needs related to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) online shopping for small, tribal, and rural vendors; farmers; and farmers’ markets.

DESIGN: A modified Delphi method was used, collecting information via a web-based survey, facilitated workshops, a listening session, and individual interviews from October 2023 to February 2024.

SETTING: Surveys were distributed through Qualtrics. Zoom was used to conduct virtual workshops, a listening session, and individual interviews.

PARTICIPANTS: Purposive sampling techniques were used to recruit the study sample. Of the 435 invited, 239 completed 50% of the survey; 22 survey respondents attended the workshop; 3 tribal vendors and/or farmers attended interview sessions; and 5 non-WIC-authorized vendors, farmers, and farmers’ markets attended the listening session.

MAIN OUTCOME MEASURE(S): The overall phenomenon of interest included themes related to facilitators and barriers to WIC online shopping.

ANALYSIS: Statistical software was used to report descriptive statistics. A rapid qualitative analysis inductive approach was used to construct themes for the study.

RESULTS: Facilitators included support and guidance, a robust platform, and feedback mechanisms, whereas barriers included time, resources, and technology.

CONCLUSIONS AND IMPLICATIONS: To ensure WIC online shopping success, it is essential to address both the barriers and facilitators experienced by vendors, farmers, and farmers’ markets. While this study collected various perspectives and experiences from merchants, future research may also focus attention on WIC participant perceptions of shopping online with these food retailers.

PMID:41148074 | DOI:10.1016/j.jneb.2025.09.006

Dentomaxillofac Radiol. 2025 Oct 28:twaf078. doi: 10.1093/dmfr/twaf078. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the diagnostic ability of relative values of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion kurtosis imaging (DKI) quantitative parameters for salivary gland tumors (SGTs).

METHODS: A total of 107 patients with histopathologically confirmed SGTs (18 malignant [MTs], 38 pleomorphic adenomas [PAs], 31 Warthin tumors [WTs], 20 basal cell adenomas [BCAs]) underwent MRI with DKI and DCE-MRI sequences. Quantitative parameters included DCE-MRI-derived volume transfer constant (Ktrans), rate constant (Kep), fractional volume of the extravascular-extracellular space (Ve), plasma fraction (Vp), and DKI-derived mean kurtosis (MK) and mean diffusion (MD).The receiver operating characteristic (ROC) curve were used for statistical analysis. Statistical significance was set at P < 0.05.

RESULTS: PAs exhibited the lowest MK (0.49 ± 0.15) among all groups (P < 0.05). Compared to WTs, PAs showed lower Kep (366.89[260.06, 568.32]×10-³ min-1), higher MD (2.02 ± 0.42 × 10-³ mm2/s), and higher Ve (551.83[388.10, 883.19]×10-³). PAs also displayed higher Ve, lower Kep, and lower Vp (85.42[20.53, 332.72])×10-³) than BCAs, and lower Vp with higher Ve than MTs (all P < 0.05). WTs had significantly lower Ve (218.86[142.07, 341.76]×10-³) than MTs (P = 0.001). BCAs demonstrated lower MK (0.61 ± 0.23) and higher MD (1.97 ± 0.44 × 10-³ mm2/s) compared to WTs and MTs (P < 0.05), alongside lower Ktrans (355.25[211.88, 506.92]×10-³ min-1) and Ve (380.89[271.28, 589.53]×10-³) than WTs (P < 0.05). Logistic regression analysis revealed enhanced discrimination: MK+Ve (AUC = 0.895) and MK+MD+Ve+Kep (AUC = 0.936) differentiated PAs from WTs; Kep+Vp+Ve distinguished PAs from BCAs (AUC = 0.843); MD+MK+Vp separated PAs from MTs (AUC = 0.854); Ktrans+MK differentiated WTs from BCAs (AUC = 0.856).

CONCLUSION: DKI and DCE-MRI parameters complement each other, enabling accurate SGT subtype differentiation. Combined use of these parameters achieves high diagnostic accuracy, and a stepwise diagnostic flowchart was designed to facilitate systematic discrimination among the four tumor types.

PMID:41148036 | DOI:10.1093/dmfr/twaf078

Indian J Ophthalmol. 2025 Nov 1;73(11):1640-1646. doi: 10.4103/IJO.IJO_912_25. Epub 2025 Oct 29.

ABSTRACT

PURPOSE: To look at the outcomes of various interventions in treatment-naive pediatric rhegmatogenous retinal detachment (RRD).

METHODS: This study was conducted at a tertiary care hospital in North India. Children below 16 years with treatment-naive RRD with a minimum 6-month follow-up were enrolled retrospectively from July 2012 to June 2021 and prospectively from July 2021 to June 2022. Patient demographics at presentation, risk factors, preoperative ophthalmic findings including best-corrected visual acuity (BCVA), the choice of surgery and tamponade, and postoperative assessment parameters were recorded. The primary outcome measure was anatomical success after surgery. Secondary outcome measures included functional success, that is, postoperative BCVA at last follow-up, improvement in vision, number of surgeries required to achieve final anatomical success, and correlation of factors such as age and etiology with outcomes. Functional success was taken as postoperative BCVA ≥ logMAR 1.3.

RESULTS: Among the 333 pediatric patients (348 eyes), the most common etiology was trauma (44.8%), followed by high myopia (17%) and idiopathic causes (15.5%). Primary anatomical success was achieved in 66.9% of cases, improving to 88.5% with additional surgeries. Functional success was recorded in 46.3% of cases. Combined scleral buckling (SB) and pars plana vitrectomy (PPV) provided the best anatomical (66.01%) and functional (48.32%) outcomes.

CONCLUSION: Pediatric RRD presents significant management challenges. Combined SB + PPV yielded superior outcomes. Functional recovery remains limited, emphasizing the need for early detection, improved surgical strategies, and long-term follow-up for optimal visual rehabilitation.

PMID:41148019 | DOI:10.4103/IJO.IJO_912_25

Indian J Ophthalmol. 2025 Nov 1;73(11):1633-1639. doi: 10.4103/IJO.IJO_1692_24. Epub 2025 Oct 29.

ABSTRACT

PURPOSE: To assess optical coherence tomography angiography (OCTA) changes in acute nonarteritic anterior ischemic optic neuropathy (NAION) eyes compared to fellow unaffected eyes and describe the longitudinal OCTA changes within the first 12 weeks of onset while the disc is still edematous.

DESIGN: A prospective observational study.

METHODS: A total of 30 patients, diagnosed with unilateral acute NAION, were included. Bilateral OCT and OCTA of the macula and optic nerve head (ONH) were done. Scans were performed at presentation and then at 6 weeks and 12 weeks thereafter.

RESULTS: Nerve fibre layer thickness (NFLT) and ganglion cell complex thickness (GCC) were significantly lower in diseased eyes after resolution of edema. Similarly, ONH and peripapillary vessel densities were significantly reduced in NAION eyes throughout the three visits, while macular superficial vessel density demonstrated a statistically significant decrease only from the second visit onward. Conversely, deep macular and foveal avascular zone (FAZ) vessel density (VD) showed no significant change in NAION eyes except at the third visit with lower VD in NAION eyes. However, all VD biomarkers of NAION eyes, including deep macular and FAZ VD, demonstrated a significant decrease in the 6-week and 12-week visits compared to baseline.

CONCLUSIONS: OCTA VD changes in NAION demonstrated a temporal sequence where radial peripapillary capillary vascular density was the first to decrease, followed by macular superficial vascular density and last the macular deep vascular density. Moreover, there was a progressive decrease in all OCTA VD measurements in NAION eyes during follow-up.

PMID:41148018 | DOI:10.4103/IJO.IJO_1692_24

Indian J Ophthalmol. 2025 Nov 1;73(11):1620-1626. doi: 10.4103/IJO.IJO_992_25. Epub 2025 Oct 29.

ABSTRACT

PURPOSE: To compare the clinical and imaging characteristics of isolated retinal astrocytic hamartoma (RAH) versus tuberous sclerosis complex (TSC)-associated RAH.

METHODS: This retrospective multicenter study included 38 patients diagnosed with RAH between 2000 and 2023. Clinical data and imaging findings were evaluated, including color fundus photography, optical coherence tomography (OCT), B-scan ultrasonography, and fundus autofluorescence. Statistical comparisons were performed between isolated and TSC-associated RAH.

RESULTS: The mean patient age was 26 years, with a slight male predominance (55%). Bilateral involvement was more common in TSC-associated RAH (55%). Overall, optical coherence tomography (OCT) of 18 eyes revealed optically empty cavities (44%), inner retinal disorganization (13%), outer retinal disorganization (8%), complete retinal disorganization (8%), and associated subretinal (SRF) and intraretinal fluid in 28% and 17% of eyes, respectively. Autofluorescence showed hyperautofluorescence in 86% and hypoautofluorescence in 14%, corresponding to calcified and noncalcified regions. Compared with isolated RAH, TSC-associated RAH demonstrated a higher prevalence of multifocal lesions (47% vs. 29%), superior quadrant involvement (86% vs. 40%), complete retinal disorganization (71% vs. 20%), and presence of SRF (100% vs. 0%).

CONCLUSION: TSC-associated RAH exhibits distinct morphological and imaging features, including greater multifocality and superior quadrant involvement. TSC-associated RAH exhibits more extensive retinal disorganization, frequent loss of deeper retinal layer visibility, and association with SRF, which may serve as an important diagnostic marker for systemic screening. Recognizing these differences aids ophthalmologists when evaluating RAH and associated TSC.

PMID:41148016 | DOI:10.4103/IJO.IJO_992_25

Indian J Ophthalmol. 2025 Nov 1;73(11):1596-1601. doi: 10.4103/IJO.IJO_930_25. Epub 2025 Oct 29.

ABSTRACT

PURPOSE: To evaluate real-world outcomes of faricimab in treating diabetic macular edema (DMO) in treatment-naive and treatment-switch patients.

DESIGN: Retrospective audit.

METHODS: All patients with DMO initiating 6 mg faricimab at a London hospital between 01/01/2022-02/02/2024 were included. The protocol comprised four four-weekly loading doses followed by a treat-and-extend regimen tailored to response. Data collected included demographics, best-corrected visual acuity (BCVA), and central macular thickness (CMT).

RESULTS: Overall, 65 patients (87 eyes) received faricimab; 34 eyes (39.1%) were treatment-naive, and 53 eyes (60.9%) had switched from other treatments. In the treatment-naive group (24 patients; mean follow-up 8 months, SD = 3.8; 3-8 injections), mean age was 66 years (SD = 10), baseline VA: 59.5 EDTRS (SD = 13), and CMT: 485.1 μm (SD = 80), reducing to 327.2 μm (SD = 70; P < 0.0001). Final VA was 62.7 EDTRS (SD = 14; P = 0.259). The treatment-switched group (41 patients, 53 eyes) had a mean age of 65 (SD = 11) years. A total of 32 eyes (60.4%) had a single prior treatment; 25 had received aflibercept, four eyes had received ranibizumab, and three eyes had received dexamethasone implants. The other 21 (39.6%) eyes had combinations of these medications. Patients received 2-11 faricimab injections. Mean follow-up was 8.4 months (SD = 3.9), initial VA: 59.7 EDTRS (SD = 12.9), and CMT: 439.5 μm (SD = 102), decreasing to 366.9 μm (SD = 80.7) (P < 0.0001); final VA was 61.4 (SD = 15.4) (P = 0.55).

CONCLUSION: Faricimab significantly reduced CMT in both groups, with a greater reduction in treatment-naive eyes. VA improvement was, however, not statistically significant. Further studies are warranted to explore factors influencing visual outcomes.

PMID:41148014 | DOI:10.4103/IJO.IJO_930_25

Indian J Ophthalmol. 2025 Nov 1;73(11):1581-1589. doi: 10.4103/IJO.IJO_927_25. Epub 2025 Oct 29.

ABSTRACT

PURPOSE: To present results from the Vitreo Retina Society-India (VRSI) 2024 Preference and Trends Survey, focusing on polypoidal choroidal vasculopathy (PCV) and diabetic retinopathy (DR) management practices among Indian vitreoretinal surgeons.

METHODS: Responses to a 62-item questionnaire, distributed to all VRSI members over email via Google Forms, were collected over 6 weeks in July–August 2024. Data were analyzed using descriptive statistics.

RESULTS: A total of 289 members participated in the survey. The majority of respondents preferred multimodal imaging for the diagnosis of PCV (44.68%) and aflibercept for initiation of therapy (63.12%). Respondents preferred a loading dose with a pro-re-nata regimen (46.45%) and a switch after three injections in cases of suboptimal response (57.45%), with a strong preference for switching to brolucizumab (63.93%). Pan-retinal photocoagulation was the predominantly preferred treatment modality for all cases of proliferative DR, with an increased preference for combining it with antivascular endothelial growth factor (anti-VEGF) in cases with high-risk characteristics. For centre-involving diabetic macular edema, ranibizumab biosimilars (40.79%) in a by pro re nata regimen (53.21%) were preferred. Respondents would switch to steroids (54.48%) for suboptimal response after three anti-VEGF injections (91.04%).

CONCLUSIONS: The current preferences in the management of PCV and DR among Indian vitreoretinal surgeons are reported here. The results of this survey will assist fellow practitioners in understanding contemporary real-world practices in relation to established literature and in developing appropriate guidelines.

PMID:41148013 | DOI:10.4103/IJO.IJO_927_25

Geospat Health. 2025 Jul 7;20(2). doi: 10.4081/gh.2025.1393. Epub 2025 Oct 27.

ABSTRACT

This study is a quantitative, ecological, descriptive, retrospective, cross-sectional study on dengue in the state of Paraíba in north-eastern Brazil aimed to compare the performance of spatial clustering methods based on epidemiological data. The population consisted of all people residing in the state, and the sample was all dengue fever cases reported annually between 2018 and 2022. The residence localization of people suffering from dengue fever was used to identify the spatial distribution of this infection in the Paraíba State. Scan Statistics, Besag-Newell, Getis-Ord, MStatistics and Tango were used and it was observed that the methods Getis-Ord, M-Statistic and Tango showed large spatial clusters, which included municipalities with high and low values. Scan Statistics and Besag-Newell’s method also showed most of these clusters, with Scan Statistic providing better agreement with the high Standardized Incidence Ratio (SIR) than Besag-Newell’s method. In conclusion, Scan statistic outperformed the other methods by identifying significant clusters in greater proportion in all study periods when mapping using Rigorous Impact Evaluation (RIE) was applied. However, it is necessary to consider each method’s assumptions to select the most appropriate method for each application. Thus, this study provides relevant elements to help decision makers manage and prevent diseases, such as dengue fever and other vector-borne diseases.

PMID:41147980 | DOI:10.4081/gh.2025.1393