Nevin Manimala

Medwave. 2025 Aug 6;25(7):e3088. doi: 10.5867/medwave.2025.07.3088.

ABSTRACT

INTRODUCTION: In Chile, the number of migrants affected by tuberculosis has experienced a significant increase from 7.1% in 2014 to 29.7% in 2023, ranking as the first group at risk. The objective was to estimate the time to diagnosis of tuberculosis from arrival in Chile in a series of migrants undergoing treatment between January 2021 and March 2022.

METHODS: We analyzed a cohort of migrants over 18 years of age with a diagnosis of tuberculosis treated in the communes of Recoleta and Independencia. Those who agreed to participate and signed the informed consent form were included. Cases with non-tuberculous mycobacteria and residents outside the Metropolitan Region were excluded. Sociodemographic, clinical, and arrival dates, as well as symptoms and diagnoses, were recorded. Proportional hazards models in STATA v.18 were used to analyze times according to independent variables. A p value < 0.05 was considered significant.

RESULTS: The median time to diagnosis was 93.5 months, varying by subgroup. The recent migration subgroup without Chilean documentation had a hazard ratio of 13.1, which indicates that, at any time after arrival, these individuals have a 13-fold increased risk of tuberculosis diagnosis compared to the reference subgroup (traditional migration with Chilean identity documents). This hazard ratio is reduced by 2.4 times when these types of migrants have documentation from Chile (95% confidence interval: 1.2 to 4.5).

CONCLUSIONS: There is a wide range of time from arrival in Chile to the diagnosis of tuberculosis. Factors such as the type of migration and the type of identity document have an impact on the development of this disease. It is necessary to expedite the legal administrative process for migrants and implement timely screening policies, along with follow-up and improved access to healthcare, to reduce exposure and risk of tuberculosis.

PMID:40768753 | DOI:10.5867/medwave.2025.07.3088

Chaos. 2025 Aug 1;35(8):083114. doi: 10.1063/5.0244302.

ABSTRACT

The Dansgaard-Oeschger events are sudden and irregular warmings of the North Atlantic region that occurred during the last glacial period. A key characteristic of these events is a rapid shift to warmer conditions (interstadial), followed by a slower cooling toward a colder climate (stadial), resulting in a saw-tooth pattern in regional proxy temperature records. These events occurred many times during the last 100 000 years and have been hypothesized to result from various mechanisms, including millennial variability of the ocean circulation and/or nonlinear interactions between ocean circulation and other processes. Our starting point is a non-autonomous, conceptual, but process-based, model of Boers et al. [Proc. Natl. Acad. Sci. 115, E11005-E11014 (2018)] that includes a slowly varying non-autonomous forcing represented by reconstructed global mean temperatures. This model can reproduce Dansgaard-Oeschger events in terms of shape, amplitude, and frequency to a reasonable degree. However, the model of Boers et al. has instantaneous switches between different sea-ice evolution mechanisms on crossing thresholds and, therefore, cannot show early warning signals of the onset or offset of these warming events. In this paper, we regularize this model by adding a fast dynamic variable so that the switching occurs smoothly and in finite time. This means the model has the potential to show early warning signals for sudden changes. However, the additional fast timescale means these early warning signals may have short time horizons. Nonetheless, we find some evidence of early warning for the transition between slow and rapid cooling for the model.

PMID:40768746 | DOI:10.1063/5.0244302

N Engl J Med. 2025 Aug 7;393(6):544-555. doi: 10.1056/NEJMoa2413772.

ABSTRACT

BACKGROUND: Plague is a high-consequence infectious disease with epidemic potential. Current treatment guidelines are based on weak evidence.

METHODS: We enrolled persons (excluding pregnant persons) in Madagascar who had clinically suspected bubonic plague during 2020-2024. Using an open-label noninferiority design, we compared two treatments included in the national plague guidelines: oral ciprofloxacin for 10 days (ciprofloxacin monotherapy) or injectable aminoglycoside for 3 days followed by oral ciprofloxacin for 7 days (aminoglycoside-ciprofloxacin). The primary end point was treatment failure on day 11, with treatment failure defined as death, fever, secondary pneumonic plague, or alternative or prolonged plague treatment. To show noninferiority of ciprofloxacin monotherapy among patients with laboratory-confirmed or probable infections, the upper boundary of the 95% confidence interval around the risk difference had to be less than 15 percentage points.

RESULTS: A total of 933 patients underwent screening; 450 patients with suspected bubonic plague were enrolled and underwent randomization. A total of 220 patients (110 per group) had confirmed infection, and 2 (1 per group) had probable infection. Of the patients who underwent randomization, 53.2% were male, and the median age was 14 years (range, 2 to 72). Ciprofloxacin monotherapy was noninferior to aminoglycoside-ciprofloxacin therapy: among the patients with confirmed or probable infection, treatment failure occurred in 9.0% (10 of 111 patients) in the ciprofloxacin monotherapy group and 8.1% (9 of 111 patients) in the aminoglycoside-ciprofloxacin group (difference, 0.9 percentage points; 95% confidence interval, -6.0 to 7.8). Noninferiority was consistent in other prespecified analysis populations. A total of 5 patients in the ciprofloxacin monotherapy group and 4 patients in the aminoglycoside-ciprofloxacin group died, and secondary pneumonic plague developed in 3 patients in each group. The incidence of adverse events among patients with confirmed or probable infections was similar in the two groups – 18.0% in the ciprofloxacin monotherapy group and 18.9% in the aminoglycoside-ciprofloxacin group had adverse events, and 7.2% and 5.4%, respectively, had serious adverse events.

CONCLUSIONS: Oral ciprofloxacin monotherapy for 10 days was noninferior to an aminoglycoside-ciprofloxacin sequential combination for the treatment of patients with bubonic plague. (Funded by the U.K. Foreign, Commonwealth, and Development Office and Wellcome; IMASOY ClinicalTrials.gov number, NCT04110340.).

PMID:40768716 | DOI:10.1056/NEJMoa2413772

Eur J Dent Educ. 2025 Aug 6. doi: 10.1111/eje.70030. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study was to evaluate access cavity preparation quality, procedure time, and working posture of general dentistry residents using different types of magnification (naked eye, traditional loupe and deflection loupe).

METHODS: This in vitro study used a randomised cross-over design. Thirty general dentistry residents performed access cavity preparations using naked eye, traditional loupe, and deflection loupe on plastic right maxillary first molars in manikins. The working posture was evaluated using the Posture Assessment Instrument (PAI). The access cavity preparation quality scores, procedure time, and PAI scores were compared between groups. Questionnaire results on residents’ perceptions were also analysed.

RESULTS: The access cavity preparation scores were higher for both loupe groups than the naked eye group. Procedure time was not different between groups. Both PAI_total and PAI_neck scores were statistically lower in the deflection loupe group and traditional loupe group than in the naked eye group. The deflection loupe group had lower PAI_neck scores than the traditional loupe group. Both traditional loupe and deflection loupe were rated positively in terms of precision, ergonomics, treatment quality, and adaptability. The deflection loupe was considered superior in ergonomics but less comfortable. Eye fatigue is a common problem for both types of loupes.

CONCLUSION: Both deflection loupe and traditional loupe can improve working posture and access cavity preparation quality. Deflection loupe had an ergonomic advantage over traditional loupe. The comfort of deflection loupe needed improvement because of its heavy weight. Another perceived problem of deflection loupe and traditional loupe was eye fatigue.

PMID:40768709 | DOI:10.1111/eje.70030

Am J Public Health. 2025 Sep;115(9):1518-1528. doi: 10.2105/AJPH.2025.308136.

ABSTRACT

Objectives. To expand COVID-19 containment indicators to evaluate the relationship between excess mortality and government response. Methods. We developed a longitudinal study analyzing excess mortality, COVID-19 containment, and structural conditions in 34 countries between 2020 and 2022. Results. The average excess mortality ratios of the 34 countries were 1.09, 1.14, and 1.11 in 2020, 2021, and 2022, respectively. Thirteen countries experienced continuous annual rises, while only 2 had consistent annual declines. Top-performing countries significantly reduced excess deaths by 5.7% (b = -0.06; 95% CI [confidence interval] = -0.10, -0.01; P = .02) in 2020 and 12.9% (b = -0.13; 95% CI = -0.17, -0.08; P < .001) in 2021, compared to bottom performers. Middle-performing countries saw reductions of 6.7% (b = -0.07; 95% CI = -0.11, -0.02; P = .01) and 10.6% (b = -0.11; 95% CI = -0.15, -0.06; P < .001). These findings suggest that better containment is associated with fewer excess deaths, even after accounting for preexisting structural differences. Conclusions. The COVID-19 containment indicators’ precision emphasizes the association between better containment and lower excess mortality during early and postvaccine development periods. Public Health Implications. Our findings urge governments to utilize new metrics that balance flexibility and strictness for pandemic strategies, informing future policy interventions. (Am J Public Health. 2025;115(9):1518-1528. https://doi.org/10.2105/AJPH.2025.308136).

PMID:40768708 | DOI:10.2105/AJPH.2025.308136

Am J Public Health. 2025 Sep;115(9):1417-1425. doi: 10.2105/AJPH.2025.308148.

ABSTRACT

Objectives. To examine how perceived authenticity may buffer the impact of racial discrimination on depressive symptoms and suicidal ideation among young Black/African American men. Methods. In 2024, we collected data online in the United States using Qualtrics. Participants were 350 Black men aged 18 to 24 years (mean = 21.49; SD = 1.96), most of whom identified as heterosexual or straight and had completed a high school diploma or general equivalency diploma. We measured suicidal ideation, depressive symptoms, racial discrimination, and perceived authenticity through self-report questionnaires. Results. Authenticity reduced suicidal ideation (b = -0.24; P < .001) and depressive symptoms (b = -0.22; P < .001). An interaction effect emerged for suicidal ideation (b = -0.09; P = .045) but not depressive symptoms (b = 0.02; P = .58). Conclusions. Perceived authenticity served as a protective factor for young Black men. Public Health Implications. Practitioners may consider incorporating strategies to enhance perceived authenticity as part of interventions aimed at improving men’s mental health. (Am J Public Health. 2025;115(9):1417-1425. https://doi.org/10.2105/AJPH.2025.308148).

PMID:40768697 | DOI:10.2105/AJPH.2025.308148

Am J Public Health. 2025 Sep;115(9):1508-1517. doi: 10.2105/AJPH.2025.308205.

ABSTRACT

Objectives. To determine the Connect intervention’s effectiveness in reducing substance use among rural and tribal adolescents in northeastern Oklahoma. Methods. We conducted a 2-arm cluster randomized trial from 2021 to 2024, with 10 high schools per condition. Results. At baseline, 919 students were enrolled (mean age = 15 years), and the majority were American Indian or White. Alcohol-use days during the past 30 days was reduced by 18% per survey wave in the intervention compared with the control condition (rate ratio [RR] = 0.82; 95% confidence interval [CI] = 0.72, 0.93; t = -3.02; P = .003), binge drinking was reduced by 26% (RR = 0.74; 95% CI = 0.64, 0.86; t = -3.90; P < .001), cannabis use was reduced by 11% (RR = 0.89; 95% CI = 0.80, 1.00; t = -2.03; P = .04), and prescription opioid misuse was reduced by 40% (RR = 0.60; 95% CI = 0.43, 0.85; t = -2.86; P = .004). Model-predicted means revealed the control condition followed the expected developmental trajectory of increased substance use and the intervention condition showed a flat or decreasing use pattern. Conclusions. The Connect intervention prevented the typical escalation of substance use during adolescence. Trial Registration. ClinicalTrials.gov NCT04839978. Registered on April 9, 2021. Version 10, April 30, 2025. (Am J Public Health. 2025;115(9):1508-1517. https://doi.org/10.2105/AJPH.2025.308205).

PMID:40768695 | DOI:10.2105/AJPH.2025.308205

JCO Glob Oncol. 2025 Aug;11:e2500062. doi: 10.1200/GO-25-00062. Epub 2025 Aug 6.

ABSTRACT

PURPOSE: To test the feasibility of a point-of-care (POC) real-time urine metabolomics test, evaluate its validity in diagnosing colorectal cancer (CRC) among at-risk patients, and assess the willingness of patients in Southwestern Nigeria to use and pay for the test.

METHODS: This was a pilot-controlled trial carried out among 72 patients (34 cases and 38 controls) in southwestern Nigeria. The cases were those with histopathological diagnosis of CRC while controls were at-risk adults. The POC biosensor used a disposable chip and can be connected to a smart device using Bluetooth, and reported if the patient’s urine contained metabolites consistent with CRC. We assessed validity of the test using sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV), and prespecified a specificity of 50% with a goal of ≥80% sensitivity to estimate the potential of the test to half the referrals to colonoscopy. Additionally, we assessed perception toward the test and willingness to uptake the urine test using structured questionnaires.

RESULTS: The overall sensitivity, specificity, PPV, and NPV for all respondents were 91.18%, 81.58%, 81.58%, and 91.18% respectively, with an area under the receiver operating characteristic curve of 0.86. With specificity fixed at 50%, the overall sensitivity for all respondents was 94.5%, and all stratifications had sensitivity >90%. Overall, 70 (98.6%) were satisfied with the urine-based CRC screening, and respondents were willing to pay a mean amount of 8,008.20 Naira (about $5.2 US dollars) for the test.

CONCLUSION: Our urine metabolite early diagnosis POC test met our predetermined criteria for success and had high acceptance rates among Nigerian patients, supporting a future multi-institutional implementation trial assessing our ability to scale up utilization.

PMID:40768684 | DOI:10.1200/GO-25-00062

JMIR Cardio. 2025 Aug 6;9:e66557. doi: 10.2196/66557.

ABSTRACT

BACKGROUND: Virtual reality (VR) has emerged as a promising, low-risk strategy to manage many forms of psychological stress and may be a modality to improve cardiovascular health. Recent scientific statements on the mind-heart-body connection call for better adherence to psychological screening and adoption of more holistic “behavioral cardiology” interventions that improve the overall health of patients with or at risk for cardiovascular disease (CVD).

OBJECTIVE: The aim of this study is to assess safety and preliminarily explore how a VR experience can aid in stress reduction among patients with or at risk for CVD.

METHODS: A convergent mixed methods approach was used for this single-arm prospective pilot study. In total, 20 patients were recruited from the University of California Los Angeles adult cardiology clinics and cardiac rehabilitation. Surveys and physiologic parameters were collected before, during, and after a 30-minute VR experience aimed at relaxation. The primary outcome was the State-Trait Anxiety Inventory-State (STAI-S) scale. They participated in a 90-minute visit, during which they completed surveys, including the STAI-S scale, before and after a 30-minute VR experience. Physiological parameters were also collected before, during, and after the experience. Visits concluded with semistructured interviews analyzed with inductive thematic analysis to add depth and nuance to our analysis.

RESULTS: STAI-S scale scores after the VR experience were significantly decreased from baseline (median 31, IQR 28-38 vs median 24, IQR-29.25; P<.001). Verbal feedback revealed that participants experienced a relaxing sense of “distance from stress” moderated by unexpected, intense audiovisual components. Heart rate significantly decreased (mean 73, SD 8 vs mean 67, SD 6 beats per minute; P<.001), while blood pressure (mean systolic 128, SD 14 vs mean systolic 129, SD 18 mm Hg; P=.75 and mean diastolic 79, SD 9 vs mean diastolic 80, SD 10 mm Hg; P=.60) and galvanic skin response (mean 0.74, SD 0.89 vs mean 0.70, SD 0.57 microsiemens; P=.45) remained the same. Changes in heart rate variability parameters were consistent with increased vagal tone over time but were only statistically significant at certain time points. Survey results and interviews generally indicated safety, tolerability, and openness to using VR again.

CONCLUSIONS: This sample of patients with CVD or risk of CVD had above-average stress, consistent with epidemiological data; the statistically and clinically significant decrease in subjective perception of stress partially converged with physiologic data. Overall, the VR intervention was a safe and feasible stress reduction method. Future research is needed to evaluate the effectiveness of this immersive therapy in reducing cardiovascular risk profiles.

PMID:40768664 | DOI:10.2196/66557

J Trauma Acute Care Surg. 2025 Aug 1;99(3S Suppl 1):S20-S26. doi: 10.1097/TA.0000000000004699. Epub 2025 Aug 6.

ABSTRACT

BACKGROUND: Hemorrhage resulting from trauma is a leading cause of potentially survivable death. Current monitoring devices that offer measures of traditional vital signs can delay patient management during the early compensatory phases of treatment, creating a capability gap for advanced decision support in the austere prehospital setting. In this investigation, we tested the hypothesis that arterial waveform feature analysis outperforms standard vital signs (SVSs) for early detection of progressive reductions in central blood volume and prediction of hemodynamic decompensation.

METHODS: Tolerance to progressive reductions in central blood volume was determined for 187 human subjects (aged 18 to 55 years) who underwent exposure to lower-body negative pressure as a model to simulate human hemorrhage. Tolerance was defined by the onset of clinical decompensated shock as defined by a systolic blood pressure of <80 mm Hg with concurrent expression of presyncopal symptoms (e.g., nausea, cold sweat, tunnel vision). Continuous noninvasive beat-to-beat measurements of systolic, diastolic, and mean arterial blood pressures; heart rate; shock index; blood oxygen saturation; and respiration rate were measured. Arterial waveforms were recorded for arterial waveform feature analysis using a machine learning algorithm called the compensatory reserve measurement. Receiver operating characteristic area under the curve was calculated for predicting the onset of hemodynamic decompensation, and statistical assessment was performed on measurements of sensitivity, specificity, and accuracy for detection of reduced central blood volume.

RESULTS: Compensatory reserve measurement receiver operating characteristic area under the curve (0.94) for predicting onset of decompensated shock was greater (p < 0.001) compared with eight SVSs (0.57 to 0.83). Sensitivity, specificity, and accuracy for detecting reduced central blood volume were significantly higher (0.88, 0.87, 0.85) compared with the respective SVSs (0.57 to 0.83).

CONCLUSION: Arterial waveform feature analysis provides a breakthrough monitoring capability with earlier detection of ongoing hemorrhage and superior discriminative ability to predict the onset of decompensated shock compared with standard vital signs.

LEVEL OF EVIDENCE: Diagnostic Test or Criteria; Level III.

PMID:40768656 | DOI:10.1097/TA.0000000000004699