Nevin Manimala

BMC Neurol. 2025 Aug 2;25(1):318. doi: 10.1186/s12883-025-04342-x.

ABSTRACT

BACKGROUND: Blood pressure management strategies in patients with hemorrhagic stroke remain ineffective in reducing mortality. The circadian blood pressure pattern has been shown to be associated with mortality in patients with non-hemorrhagic stroke, but few studies have explored this association in patients with hemorrhagic stroke. We aimed to investigate the relationship between circadian blood pressure pattern and mortality in patients with hemorrhagic stroke.

METHODS AND RESULTS: Adult hemorrhagic stroke patients hospitalized in intensive care unit for more than 24 h in the Medical Information Mart for Intensive Care (MIMIC-IV) database were recruited for this retrospective cohort study. All patients were divided into the dipping group, the nondipping group, the reverse dipping group and the extreme dipping group. We used binary logistic regression analysis to explore the relationship between circadian blood pressure patterns and mortality of patients with hemorrhagic stroke. The overall cohort comprised 1040 patients. The patients in the extreme dipping group had higher mortality than other groups (57.1% versus 15.6%,17.0%, and 22.3%, respectively). After adjusting for covariates, the statistical analysis showed that the extreme dipping pattern was significantly associated with the mortality of hemorrhagic stroke patients in intensive care unit (odds ratio: 4.961[95%CI: 1.289-19.086]). Interaction analysis had no statistical significance in all results.

CONCLUSIONS: The extreme dipping pattern may be an important risk factor for increased mortality in patients with hemorrhagic stroke.

PMID:40753399 | DOI:10.1186/s12883-025-04342-x

J Exp Clin Cancer Res. 2025 Aug 2;44(1):224. doi: 10.1186/s13046-025-03481-w.

ABSTRACT

BACKGROUND: Bone marrow dissemination of tumor cells, common in various cancers, including neuroblastoma, is associated with poor outcome, necessitating sensitive detection methods for bone marrow minimal residual disease (MRD) and offer detection of biomarkers for therapy stratification. Current standard-of-care diagnostics, involving cytomorphological and histological assessment of bone marrow aspirates and trephine biopsies, lack sensitivity, leading to undetected MRD in many patients, and do not allow molecular biomarker assessment.

METHODS: This study evaluates advanced multi-modal high-sensitivity MRD detection techniques in 509 bone marrow specimens from 108 high-risk neuroblastoma patients across two centers. We employed automatic immunofluorescence plus interphase fluorescence in situ hybridization (AIPF) and reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) panels to quantify disseminated tumor cells (DTCs), disialoganglioside 2 (GD2) and CD56/Neural cell adhesion molecule (NCAM) levels, and adrenergic (ADRN) and mesenchymal (MES)-phenotype mRNA markers.

RESULTS: This multi-modal analysis significantly improved MRD detection compared to standard-of-care methods; 395 samples yielded results for RT-qPCR-ADRN, AIPF and CM/histology and 223 showed concordant results (64 positive, 159 negative). 114 samples did not produce results as either no cytospins were prepared (n = 96) or results were inconclusive (all techniques n = 18). AIPF and RT-qPCR complemented each other in detecting MRD and characterizing ADRN- and MES-phenotypes and GD2 immunotherapy target. RT-qPCR-ADRN alone frequently detected low tumor cell burden. High DTC infiltration at diagnosis showed bilateral bone marrow disease, whereas MRD settings often involved only one side. RT-qPCR-MES, despite lower sensitivity, identified 37 additional cases and showed delayed clearance of MES markers post-chemotherapy, with increases prior to relapse.

CONCLUSIONS: Our findings demonstrate the feasibility of integrating high-sensitivity techniques with standard-of-care assessments in an international multicenter setting. Advanced multi-modal MRD detection, monitoring phenotype switches and assessing immunotherapy targets are crucial for improving patient outcomes in neuroblastoma and other cancers.

PMID:40753395 | DOI:10.1186/s13046-025-03481-w

BMC Public Health. 2025 Aug 2;25(1):2627. doi: 10.1186/s12889-025-23963-y.

ABSTRACT

PURPOSE: For decades, incidence of human papillomavirus (HPV)-associated cancers has been increasing in rural communities across the United States. Although emerging evidence shows a widening rural-urban disparity, rural intersectionality has been understudied. Our study examined the incidence of HPV-associated cancers within rural communities to identify differences by race/ethnicity for males and females, and explore how these differences varied by cancer type, socioeconomic, and geographic factors.

METHODS: We accessed age-adjusted cancer incidence rates (2010-2019) from the North American Association of Central Cancer Registries (NAACCR) for HPV-associated cancers (cervical, vaginal, vulvar, penile, anal, oropharyngeal) in rural counties. Stratifying by sex, we calculated incidence rate ratios by race/ethnicity. Subgroup analyses included age, site, census-tract poverty, census tract socioeconomics, and region.

RESULTS: Between 2010 and 2019, rural HPV-associated cancer was 11.8 cases per 100,000 population. We found significant heterogeneity within male (10.5) and female (13.2) rates. For males, the lowest rate was found in non-Hispanic Asian-American/Pacific-Islander populations (3.7) and Hispanic populations (4.8), and the highest rate was found in non-Hispanic White populations (11.2). For females, the lowest rate was also found in Hispanic Asian-American/Pacific-Islander populations (8.8) and the highest rates were found in non-Hispanic Black (13.8) and non-Hispanic American Indian/Alaska Native populations (14.5). However, these racial/ethnic differences varied across rural subpopulations, geography, and poverty.

CONCLUSIONS: Appreciating the diversity of the rural cancer burden can be used to effectively develop and implement public health interventions to address HPV-related cancer disparities in rural communities. Actions are needed to prioritize reducing the burden of HPV-associated cancer in AIAN populations in high-poverty rural communities.

PMID:40753394 | DOI:10.1186/s12889-025-23963-y

BMC Prim Care. 2025 Aug 2;26(1):238. doi: 10.1186/s12875-025-02920-z.

ABSTRACT

INTRODUCTION: Vertigo is a common symptom that strongly impacts patients’ quality of life. More than 80% of patients experiencing vertigo are primarily treated by their general practitioner (GP). The GP’s’diagnostic toolkit’ for vertigo has serious limitations, though, because diagnostic accuracy studies on conditions that may cause vertigo have never been performed in a general practice setting. Our aim was to determine which tests should be investigated in a diagnostic accuracy study for patients with vertigo in general practice.

METHOD: We conducted an online Delphi procedure involving national and international experts. The experts were asked to judge a selection of 40 diagnostic tests based on the Dutch GP guideline on vestibular symptoms, supplemented by tests identified during a systematic review. Panellists were allowed to suggest additional tests after the first round. In case of consensus of at least 70%, a test was included or excluded. We also conducted a secondary sub-analysis of our Delphi procedure to demonstrate non-dominance of Dutch experts within our expert panel. Data were analysed using descriptive statistics and content analysis. Data were analysed using descriptive statistics and content analysis.

RESULTS: A panel of 20 experts from five countries, including 7 specialists in otolaryngology, 6 neurologists and 7 GPs, participated in the Delphi procedure. The panel judged 46 diagnostic tests in total, with 6 additional tests added to the original selection based on suggestions by experts. After the first two rounds (100% response rate), 16 tests were included, 22 tests were excluded and no consensus was reached on 8 tests. During the consensus round, one of the 8 tests was added to the included 16 tests. Of these 17 tests, 15 are recommended by the Dutch GP guideline, supplemented by the non-recommended Tandem walking test and the Romberg test.

CONCLUSIONS: An international expert panel reached consensus on 17 tests for vertigo in general practice that should be investigated in a diagnostic accuracy study.

PMID:40753388 | DOI:10.1186/s12875-025-02920-z

J Foot Ankle Res. 2025 Sep;18(3):e70053. doi: 10.1002/jfa2.70053.

ABSTRACT

INTRODUCTION: Understanding podiatrists’ perceptions of their undergraduate education is important to ensure that educational content and delivery meets the needs of the current workforce to inform future planning. This study aims to explore podiatrists’ perceptions of their undergraduate podiatry training at the University of Newcastle, Australia, and their preferences regarding educational content and delivery.

METHODS: We conducted an online survey of podiatry graduates from the University of Newcastle, Australia. Data were analysed using descriptive statistics and Fisher’s exact test to compare responses between groups. Qualitative responses were analysed using inductive content analysis.

RESULTS: A total of 114 podiatrists responded. Nail avulsions, business management and modifying orthoses were perceived as being given insufficient time and focus in undergraduate training, with a higher proportion of private (71%) compared to public (33%) podiatrists reporting business management as lacking (p = 0.02). There was strong support for embedding endorsed scheduled medicines training within the programme (80%) and for delivering theoretical content face-to-face rather than online. Inductive content analysis revealed four areas to be emphasised in future curricula: modern technologies, biomechanics, wound care and routine podiatric care. Potential strategies to reduce examination stress included mock assessments, changed assessment weighting, reduced exam structure rigidity and reducing assessor bias.

CONCLUSIONS: This study provides insights into Australian podiatrists’ preferences for pre-registration curricula. Topics to emphasise in future curricula at the University of Newcastle, Australia, include greater manual skills and business training, modern technologies, biomechanics and routine podiatric care. Our results suggest exercising caution when substituting face-to-face with online learning. These findings provide valuable guidance for future curricula in a context of declining student numbers and increasing healthcare demands.

PMID:40751492 | DOI:10.1002/jfa2.70053

Clin Exp Allergy. 2025 Aug 2. doi: 10.1111/cea.70125. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study is to evaluate the effectiveness and safety of JAK inhibitors in patients with moderate to severe atopic dermatitis by performing a systematic review and meta-analysis using data from studies in real-world settings.

DESIGN: Systematic review and meta-analysis. Pooled estimates for effectiveness and safety were assessed using the Freeman-Tukey Double ArcSine method. Statistical heterogeneity was assessed using I² statistics. A random-effects model (DerSimonian-Laird method) was applied to consider the heterogeneity within and between studies and to give a more conservative estimate. The study quality assessment tools developed by the National Heart, Lung, and Blood Institute were used.

DATA SOURCE: Relevant studies were searched in March 2025 using four databases: PubMed, Embase, Scopus, and Web of Science.

ELIGIBILITY CRITERIA: Studies evaluating the effectiveness or safety of systemic JAK inhibitors among patients with moderate to severe atopic dermatitis in a real-world setting were included.

RESULTS: A total of 50 studies were included in this review. Regarding their effectiveness, the pooled estimates with a 95% CI of Eczema Area and Severity Index (EASI)-75 were 44% (34%-55%), 45% (28%-62%), 59% (51%-66%), 73% (64%-81%), 70% (57%-81%), and 86% (72%-96%) at 4, 8, 12, 16, 24, and 52 weeks. For safety, the most common adverse events were acne (16%), followed by increased creatine phosphokinase levels (13%) and increased lipids (12%).

CONCLUSION: Our meta-analysis of JAK inhibitors in patients with atopic dermatitis demonstrated that the overall outcomes from real-world settings are comparable to those from clinical trials.

SYSTEMATIC REVIEW REGISTRATION: Protocol Registration: PROSPERO CRD42024569258.

PMID:40751489 | DOI:10.1111/cea.70125

BJS Open. 2025 Jul 1;9(4):zraf076. doi: 10.1093/bjsopen/zraf076.

ABSTRACT

BACKGROUND: Cholecystectomy is a common procedure with a notable risk of iatrogenic bile duct injury. Understanding the factors contributing to bile duct injury and the effectiveness of preventative measures is crucial for improving surgical outcomes. This meta-analysis aimed to identify and synthesize high-quality evidence on risk factors and mitigating measures associated with bile duct injury after cholecystectomy.

METHODS: Following the PRISMA guidelines, a comprehensive literature search was conducted across multiple databases. Included studies reported on adult patients undergoing cholecystectomy with relevant risk factors for bile duct injury. Meta-analyses of unadjusted and adjusted risk estimates were conducted with a random-effects model to account for heterogeneity. The study period across all included studies spanned from 1989 to 2016.

RESULTS: The review included 31 studies comprising 6 513 599 cholecystectomies and 18 259 bile duct injuries. The primary risk factors identified were male sex (adjusted odds ratio 1.27, 95% confidence interval 1.13 to 1.39) and acute cholecystitis (adjusted odds ratio 1.74, 1.27 to 2.39). The critical view of safety was inconsistently documented and not statistically linked to reduced bile duct injury. Intraoperative cholangiogram’s routine use did not show a statistically significant association with reduced incidence of bile duct injury (adjusted odds ratio 0.92, 0.70 to 1.23).

CONCLUSION: Male sex and acute cholecystitis significantly increase the risk of bile duct injury after cholecystectomy. Risk stratification for these patients before surgery would ultimately aid the shared decision-making consent process.

PMID:40751483 | DOI:10.1093/bjsopen/zraf076

Liver Int. 2025 Sep;45(9):e70259. doi: 10.1111/liv.70259.

ABSTRACT

BACKGROUND AND AIMS: A recanalisation-specific model for Budd-Chiari syndrome (BCS) is lacking. We aimed to develop a novel score for individual long-term outcome prediction and risk stratification.

METHODS: Overall, 834 BCS patients undergoing recanalisation (566 received percutaneous transluminal angioplasty alone, and 268 with routine stenting) from January 2010 to May 2019 were included from six Chinese centres. The model was developed using Cox multivariable regression, internally validated through a 1000-times bootstrapped method, and compared its performance with existing BCS prognostic models, like the Clichy score.

RESULTS: During the median follow-up period of 58.0 months, 44 patients were converted to transjugular intrahepatic portosystemic shunt (TIPS), none underwent orthotopic liver transplantation (OLT) and 75 died. The final BCS-Recanalisation score incorporated: variceal bleeding history, degree of ascites, albumin, creatinine, urea, white blood cell count and Ln (alkaline phosphatase). The score outperformed other available models with good discrimination (C-index: 0.74) and calibration in predicting TIPS-free survival in the whole cohort, internal validation and most subgroups. Moreover, patients were categorised as low-risk (BCS-Recanalisation score ≤ 2.0), intermediate-risk (2.0-2.6) and high-risk (> 2.6) groups using X-tile software, with a 5-year TIPS-free survival rate of 92.2% (95% CI: 89.5%-95.0%), 84.7% (95% CI: 80.0%-90.0%) and 67.8% (95% CI: 59.4%-77.5%), respectively (p < 0.001). Significant differences were observed in overall survival, stenting-TIPS-free survival and competing-risk adjusted outcomes (restenosis, symptom recurrence, TIPS conversion) across risk strata.

CONCLUSIONS: The BCS-Recanalisation score enables individualised outcome prediction and risk stratification in recanalisation-treated patients with BCS, showing promise for clinical application. Future external validation is required.

PMID:40751473 | DOI:10.1111/liv.70259

J Clin Hypertens (Greenwich). 2025 Aug;27(8):e70044. doi: 10.1111/jch.70044.

ABSTRACT

The protective effect of influenza vaccination on stroke risk has been inconclusive. In this study, we aimed to investigate the impact of influenza vaccination on the 1-year risk of stroke in individuals aged 60 years and older with COPD and hypertension or diabetes mellitus. We conducted a retrospective cohort study in four districts of Shanghai, China, from August 2017 to July 2019. Data were collected from various information systems related to chronic disease management, cardiovascular reporting, and immunizations. The incidence of stroke within 1 year was compared between vaccinated and unvaccinated chronic disease patients. Cox proportional hazards regression was used to calculate hazard ratios (HRs). Sensitivity analysis was performed using the Poisson regression model to examine the association between influenza vaccination and stroke incidence, and propensity score matching was employed to address confounding. We found that influenza vaccination was associated with a lower risk of stroke during the two influenza seasons, 2017-2018 (adjusted HR, 0.27; 95% CI, 0.10-0.73) and 2018-2019 (adjusted HR, 0.46; 95% CI, 0.21-1.02). The results from the Poisson regression model (RR, 0.26; 95% CI, 0.10-0.70) were consistent with those obtained from the Cox model analysis. The reduction in stroke risk associated with influenza vaccination ranged from 54% to 73%. Our findings suggest that influenza vaccination is associated with a lower 1-year risk of stroke in individuals with chronic illnesses, compared to those who are not vaccinated.

PMID:40751465 | DOI:10.1111/jch.70044

J Clin Hypertens (Greenwich). 2025 Aug;27(8):e70108. doi: 10.1111/jch.70108.

ABSTRACT

Understanding class-specific antihypertensive adherence is crucial for optimizing hypertension management. This retrospective cohort study analyzed adherence to antihypertensive medication among commercially insured adults (18-64 years) from 2018 to 2023 using Merative MarketScan data. Adherence was defined as the proportion of days covered (PDC) ≥ 80%. Among 2 770 855 hypertensive patients with single-pill therapy, the majority were older (43% aged 55-64 years) and predominantly male (53%). The South had the highest prevalence of hypertension (53%). Overall adherence improved significantly from 56.61% in 2018-2019 to 75.55% in 2022-2023 across all medication classes. Patients receiving angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARB) combination therapies had the highest adherence rate (79.18%), while diuretics (67.58%) and “Other Drugs” (57.38%) had the lowest in 2022-2023. Logistic regression showed that younger patients (18-34 years) were significantly less adherent than older adults (OR = 0.434, 95% CI: 0.420-0.448). Males were more likely to adhere than females (OR = 1.142, 95% CI: 1.129-1.156). Regional variations were notable, with patients in the Northeast exhibiting 15% higher adherence than those in the West. Insurance types also influenced adherence, with managed care plan enrollees showing better adherence than those in fee-for-service plans (OR = 1.165, 95% CI: 1.151-1.179). Surprisingly, prescription refill monitoring reduced adherence, decreasing odds by 52% (OR = 0.482, 95% CI: 0.470-0.490). Monotherapy and combination therapy users differed significantly across all demographics (p < 0.0001). Higher comorbidity burden correlated with lower adherence, with diabetes being most prevalent among users of diuretics (12.88%), beta-blockers (12.8%), and other antihypertensives (26.01%). These findings highlight the multifaceted barriers to antihypertensive adherence and emphasize the need for targeted interventions that address medication-specific and patient-specific factors.

PMID:40751459 | DOI:10.1111/jch.70108