Nevin Manimala

Medicine (Baltimore). 2025 Feb 28;104(9):e41614. doi: 10.1097/MD.0000000000041614.

ABSTRACT

The natural forces of the lunar cycle and seasonal solstice variation on the water surfaces have been studied extensively but not on patients with fluid problems such as heart failure (HF). This retrospective review investigates these temporal effects on admission rates of patients with heart failure and length of stay. In this study, we try to answer the following questions: Do moon cycles (full moon vs new moon) significantly affect the number of patients admitted? and Do moon cycles significantly affect the patient’s hospital length of stay (LOS?). All patients with HF exacerbation admission between January 1, 2016 to December 31, 2019, were filtered according to admission date based on the lunar calendar. Patients admitted on the day of, the day before, and the day after a new and full moon were included. Question 1, Poisson regression models were employed. The overdispersion obtained from the AER package was 1.63. All analyses were performed using R (R Core Team). A total of 758 patients were admitted during lunar cycles, 50.1% (N = 380) were admitted during the new moon and 49.4% (N = 378) during the full moon. The mean age is 78.4 (SD 7.2), the mean BMI is 28.8 (SD 6.7), and the mean LOS is 5.6 (SD 3.4) with no significant differences in patients admitted during both of the moon cycles. The seasons variable showed statistically significant coefficients, with the summer season (S2) having the highest impact (coefficient 0.85, P = .001). Some interaction between Moon-Cycle, summer season, and BMI influenced patient admissions during lunar cycles (coefficient = 0.49 P ≤ .001). This study showed that the moon cycle may impact patients with HF during the summer season only. Prospective studies are needed on a national level to investigate further the impact of the moon cycle on HF patients. This will help improve patient outcomes and pathogenesis, and there is excellent potential for reducing medical costs.

PMID:40020125 | DOI:10.1097/MD.0000000000041614

Medicine (Baltimore). 2025 Feb 28;104(9):e41660. doi: 10.1097/MD.0000000000041660.

ABSTRACT

There are studies evaluating the association of serum lactate dehydrogenase (LDH) and albumin levels with mortality in COVID-19 patients. The aim of our study was to evaluate the predictive effect of the LDH/albumin ratio (LAR) on mortality and poor clinical course in COVID-19 patients. A total of 2093 patients for whom LDH and albumin tests were available were included in the study. Demographic data, length of hospitalization, and signs of poor clinical course were recorded and compared with the LAR value at the time of hospitalization. The study included 1010 female (48.3%) and 1083 male (51.7%) patients. Notably, 1408 (67.3%) of the patients had at least 1 comorbidity. Oxygen was required in 860 patients (41.1%) and intensive care unit was required in 215 patients (10.3%). The mortality rate was 8.1% (n: 170). The median LAR value was 8.05. A positive correlation was observed between LAR and length of hospitalization. The LAR value was significantly higher in patients who died compared with those who survived, in patients who required intensive care compared with those who did not, and in patients who required oxygen compared to those who did not. The cutoff value for LAR in predicting mortality was calculated as 10.48. The sensitivity and specificity were determined as 73.5% and 73.7%. In conclusion, serum LAR at the time of admission is predictive of poor clinical course and mortality in COVID-19 patients. Patients with LAR values higher than the cutoff value should be closely monitored for poor clinical course.

PMID:40020123 | DOI:10.1097/MD.0000000000041660

Medicine (Baltimore). 2025 Feb 28;104(9):e41669. doi: 10.1097/MD.0000000000041669.

ABSTRACT

The study aims to comprehensively evaluate the demographic data, diagnostic spectrum, and temporal changes of 5.3 million patients in a state hospital emergency department in an urban area of Istanbul between 2019 and 2024. Data of 5,279,033 patients admitted to Sultanbeyli State Hospital Emergency Department between 2019 and 2024 were retrospectively analyzed. Sociodemographic characteristics, diagnoses, time of presentation, and seasonal variables of 879,839 average annual admissions (minimum: 653,746, maximum: 1068,504) were evaluated. Upper respiratory tract diseases accounted for 26.7% to 35.2% of the admissions during the period analyzed (P < .001). A remarkable increase in the prevalence of myalgia (2019: 5.01%, 2024: 10.29%; odds ratio: 2.17, 95% confidence interval: 1.98-2.37) was observed. In terms of age distribution, while the number of applicants aged 0 to 20 years was 493,382 (48.3%) in 2019, it decreased to 101,560 (15.5%) in 2024 (P < .001). Gender: female predominance was observed in all groups over 21 years of age (odds ratio: 1.43, 95% confidence interval: 1.35-1.52). During the pandemic period (2020-2021), the diagnosis of suspected disease increased to 24.42% and significant changes were observed in emergency department admission dynamics (annual coefficient of variation: 0.68, P < .001). This large-scale epidemiologic study reveals the presentation characteristics of an urban emergency department with an annual average of 880,000 visits. The data, especially the marked variation between age groups and changes in specific diagnostic categories, are of strategic importance for planning health services. Our findings provide an evidence-based basis for the organization of emergency health services in accordance with health needs.

PMID:40020118 | DOI:10.1097/MD.0000000000041669

Medicine (Baltimore). 2025 Feb 28;104(9):e41713. doi: 10.1097/MD.0000000000041713.

ABSTRACT

Previous studies have indicated that patients with uterine fibroids (UF) may have an elevated risk of cardiovascular disease (CVD), although the causal relationship between UF and CVD remains unclear. In this Mendelian randomization (MR) study, we aimed to investigate the causal association between genetic susceptibility to UF and the risk of developing CVD. We extracted summary statistics for single nucleotide polymorphisms associated with UF and 5 CVDs from multiple databases for further analysis. First, we used linkage disequilibrium score regression to assess the genetic correlation across the genome. Next, we performed univariate MR (UVMR), and to ensure the robustness of our results, we conducted sensitivity analyses using several methods. Additionally, we applied multivariable MR (MVMR) to adjust for potential confounders. The linkage disequilibrium score regression results showed that there was no genetic correlation between UF and coronary heart disease, myocardial infarction (MI), atrial fibrillation, heart failure, cardioembolic stroke (CES). The UVMR revealed a significant association between UF and CES (OR = 1.113, 95% confidence interval [CI]: 1.018-1.218, P = .019, PFDR = .047) and a suggestive causal relationship between UF and MI (OR = 0.943, 95% CI: 0.899-0.989, P = .015, PFDR = .075). In the MVMR analysis, after adjusting for a range of potential confounders, the causal relationships between UF and both CES (OR = 1.104, 95% CI = 1.012-1.205, P = .027) and MI (OR = 0.935, 95% CI = 0.882-0.992, P = .025) remained significant. Our study found that UF increase the risk of CES but decrease the risk of MI, providing a theoretical basis for further research into the underlying mechanisms.

PMID:40020116 | DOI:10.1097/MD.0000000000041713

JMIR Med Inform. 2025 Feb 28;13:e67984. doi: 10.2196/67984.

ABSTRACT

BACKGROUND: The digitalization of health care has increased the demand for efficient data exchange, emphasizing semantic interoperability. SNOMED Clinical Terms (SNOMED CT), a comprehensive terminology with over 360,000 medical concepts, supports this need. However, it cannot cover all medical scenarios, particularly in complex cases. To address this, SNOMED CT allows postcoordination, where users combine precoordinated concepts with new expressions. Despite SNOMED CT’s potential, the creation and validation of postcoordinated expressions (PCEs) remain challenging due to complex syntactic and semantic rules.

OBJECTIVE: This work aims to develop a tool that validates postcoordinated SNOMED CT expressions, focusing on providing users with detailed, automated correction instructions for syntactic and semantic errors. The goal is not just validation, but also offering user-friendly, actionable suggestions for improving PCEs.

METHODS: A tool was created using the Fast Healthcare Interoperability Resource (FHIR) service $validate-code and the terminology server Ontoserver to check the correctness of PCEs. When errors are detected, the tool processes the SNOMED CT Concept Model in JSON format and applies predefined error categories. For each error type, specific correction suggestions are generated and displayed to users. The key added value of the tool is in generating specific correction suggestions for each identified error, which are displayed to the users. The tool was integrated into a web application, where users can validate individual PCEs or bulk-upload files. The tool was tested with real existing PCEs, which were used as input and validated. In the event of errors, appropriate error messages were generated as output.

RESULTS: In the validation of 136 PCEs from 304 FHIR Questionnaires, 18 (13.2%) PCEs were invalid, with the most common errors being invalid attribute values. Additionally, 868 OncoTree codes were evaluated, resulting in 161 (20.9%) PCEs containing inactive concepts, which were successfully replaced with valid alternatives. A user survey reflects a favorable evaluation of the tool’s functionality. Participants found the error categorization and correction suggestions to be precise, offering clear guidance for addressing issues. However, there is potential for enhancement, particularly regarding the level of detail in the error messages.

CONCLUSIONS: The validation tool significantly improves the accuracy of postcoordinated SNOMED CT expressions by not only identifying errors but also offering detailed correction instructions. This approach supports health care professionals in ensuring that their PCEs are syntactically and semantically valid, enhancing data quality and interoperability across systems.

PMID:40019788 | DOI:10.2196/67984

JMIR Form Res. 2025 Feb 28;9:e67406. doi: 10.2196/67406.

ABSTRACT

BACKGROUND: Falls remain a major public health problem and a significant cause of preventable injury. Maintaining strength and balance by staying active can prevent falls in older adults, and public health advocates support referral to community exercise programs. Given the growth in use and acceptance of technological interfaces, there remains an interest in understanding the role of a synchronous exercise program designed to improve strength, postural alignment, and balance specifically designed to be delivered in a digital environment with respect to usability and feasibility.

OBJECTIVE: This study aims to design and implement a synchronously delivered digital fall prevention program to adults aged 60 years and older, to understand the usability, feasibility, and attendance.

METHODS: The “Strong Foundations” program, a 12-week, live, digitally delivered fall-prevention exercise program was informed from different existing in-person exercises and piloted to older adults who were considered a low fall risk by scores of 4 or less from the Centers for Disease Control and Prevention’s (CDC’s) Stopping Elderly Accidents and Deaths Initiative (STEADI) Staying Independent questionnaire. The System Usability Scale (SUS) measured usability and feasibility at the completion of this program, and digital measures of age-related function (timed up and go [TUG] and 30-second chair stand [30 CS]) were collected pre- and postintervention. Data were collected in 2021.

RESULTS: A total of 39 older adults were recruited and 38 completed the 12-week program with an average age of 72 years. The average SUS was 80.6, with an 85% attendance rate and an 8.5 (out of 10) self-reported satisfaction score. Digitally collected TUG and 30 CS statistically improved pre- and postintervention by 9% and 24%, respectively; by week 12, 64% (23/36) of participants improved in the timed up and go and 91% (32/35) improved the chair stands.

CONCLUSIONS: There was excellent usability and acceptability for Strong Foundations, a novel fall-prevention program designed to be delivered digitally and promising improvement of objective measures of fall risk.

PMID:40019778 | DOI:10.2196/67406

JAMA Netw Open. 2025 Feb 3;8(2):e2462130. doi: 10.1001/jamanetworkopen.2024.62130.

ABSTRACT

IMPORTANCE: Accurate and practical measures of nutrition security are needed to assess and monitor its prevalence and to identify its associated risk factors in the US.

OBJECTIVE: To propose a nutrition security measure derived from combining self-assessed food security and diet quality indicators available in the National Health and Nutrition Examination Survey (NHANES) and to assess the prevalence and associated sociodemographic and health factors of nutrition security.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from 6 cycles of NHANES, which collects data on general health status and behaviors, dietary intake, physiological measurements, and sociodemographic characteristics, conducted from 2007 to 2018. All participants were adults aged 20 years or older. Statistical analysis was performed between October 2023 and April 2024.

EXPOSURES: Sociodemographic and health characteristics, including age, sex, race and ethnicity, marital status, household size, presence of children in the household, educational level, poverty to income ratio (PIR), Supplemental Nutrition Assistance Program (SNAP) participation, weight status, chronic conditions, and health insurance coverage.

MAIN OUTCOMES AND MEASURES: A nutrition security measure was derived from combining self-assessed food security, measured using the US Department of Agriculture Household Food Security Survey Module, and self-rated diet quality indicators. Four nutrition security status categories were created from dichotomized food security and diet quality measures: food secure with high diet quality (FSHD), food secure with low diet quality (FSLD), food insecure with high diet quality (FIHD), and food insecure with low diet quality (FILD). Only respondents classified as FSHD were considered to be nutrition secure.

RESULTS: The unweighted analytic sample included 28 898 NHANES participants. The weighted mean [SD] age of participants was 47.3 [14.5] years; 51.9% (weighted) of the sample was female; 11.1% identified as Black, 13.6% as Hispanic, and 67.4% as White individuals; and 35.6% of those surveyed were classified by the proposed measure as nutrition insecure (ie, FSLD, FIHD, or FILD). Of these participants, 20.2% (95% CI, 19.4%-21.0%) were categorized as being nutrition insecure due to FSLD, 8.4% (95% CI, 7.8%-9.1%) due to FIHD, and 7.0% (95% CI, 6.4%-7.6%) due to FILD. The remaining 64.4% (95% CI, 63.2%-65.7%) were classified as FSHD (ie, nutrition secure). Younger age (20-44 years: average marginal effect [AME], -0.193; 95% CI, -0.217 to -0.168), low income (PIR <1.30: AME, -0.111; 95% CI, -0.136 to -0.085), lower educational level (≤high school diploma: AME, -0.135; 95% CI, -0.156 to -0.114), racial and ethnic minority status (Hispanic: AME, -0.054; 95% CI, -0.075 to -0.032), SNAP participation (AME, -0.073; 95% CI, -0.099 to -0.047), obesity (AME, -0.118; 95% CI, -0.138 to -0.097), and self-reported fair or poor general health (AME, -0.239; 95% CI, -0.260 to -0.217) were factors associated with nutrition insecurity.

CONCLUSIONS AND RELEVANCE: This cross-sectional study proposed a feasible and practical measure for assessing and monitoring nutrition security using validated measures in the NHANES. This study laid the groundwork for exploring other national datasets and performing regular data collection of key dimensions for nutrition security assessment and monitoring in the US.

PMID:40019763 | DOI:10.1001/jamanetworkopen.2024.62130

JAMA Netw Open. 2025 Feb 3;8(2):e2462139. doi: 10.1001/jamanetworkopen.2024.62139.

ABSTRACT

IMPORTANCE: Poisonings are a leading cause of preventable mortality and morbidity among children. Pediatric poisonings are commonly managed in pediatric intensive care units (PICUs) and may require complex treatment and specialized evaluation. Physicians specializing in medical toxicology are trained to treat poisoned patients of all ages; however, they are not universally part of the medical staff across hospital systems.

OBJECTIVE: To determine if there is a difference in mortality and length of stay for patients with toxicological exposures who receive a medical toxicology consultation.

DESIGN, SETTING, AND PARTICIPANTS: This is a secondary analysis of an ongoing, cross-sectional registry of patients admitted to PICUs from January 2019 to June 2023 as part of the Virtual Pediatric System (VPS), a database of PICU admissions across 135 medical sites in the US. Patients with toxicological exposure who were admitted to PICUs that participate in the VPS database were included. Data analysis occurred from May to August 2024.

EXPOSURES: Medical toxicology consultations.

MAIN OUTCOMES AND MEASURES: The primary outcome was mortality in the PICU and in the hospital overall. Secondary outcomes were length of stay in the PICU and in the hospital. Multilevel models were used to assess associations of toxicology consultations with the primary and secondary outcomes.

RESULTS: There were a total of 52 836 patients with toxicological exposures (29 867 aged 12 to <21 years [56.5%]; 29 401 female [55.6%]), including 2857 (5.4%) patients with medical toxicology consultations and 49 979 (94.6%) without a consultation. Patients who received medical toxicology consultations had similar risk of mortality at baseline, as measured by the Pediatric Risk of Mortality, compared with those without consultations. After adjusting for severity of illness, poisoning type, and other covariates, medical toxicology consultations were associated with 64% lower odds of death in the PICU (adjusted odds ratio, 0.36; 95% CI, 0.20 to 0.63) and 61% lower odds of mortality at any time during the hospitalization (aOR, 0.39; 95% CI, 0.24 to 0.64). Additionally, medical toxicology consultations were associated with a 15% reduced PICU length of stay (log estimate, -0.16; 95% CI, -0.21 to -0.11) and 10% reduced hospital length of stay (log estimate, -0.10; 95% CI, -0.14 to -0.06) after adjusting for all covariates and differences across hospital sites.

CONCLUSIONS AND RELEVANCE: In this study of patients with toxicological exposures requiring PICU care, having a medical toxicology consultation was associated with lower mortality and shorter LOS compared with not having a consultation, which suggests that medical toxicology consultations may provide life-saving treatment, particularly for the most severe poisonings in the PICU.

PMID:40019762 | DOI:10.1001/jamanetworkopen.2024.62139

JAMA Netw Open. 2025 Feb 3;8(2):e2462176. doi: 10.1001/jamanetworkopen.2024.62176.

ABSTRACT

IMPORTANCE: Use of the race-neutral Global Lung Initiative (GLI) equation has been shown to generate decreased lung function measures in Black children and adults. The effect on asthma detection and diagnosis in children is unknown.

OBJECTIVE: To compare the use of race-specific vs race-neutral equations on subsequent asthma diagnosis in children.

DESIGN, SETTING, AND PARTICIPANTS: The Childhood Asthma Management Program (CAMP, 1991-2012), the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS, 2001-2010), and the Mechanisms of Progression from Atopic Dermatitis to Asthma (MPAACH, 2016-2024) cohorts were included in this cohort study. Children in the CAMP cohort were aged 5 to 12 years with mild to moderate asthma. The CCAAPS and MPAACH cohorts included infants from atopic parents and children aged 0 to 2 years with atopic dermatitis, respectively. Data were analyzed from November 2023 to May 2024.

EXPOSURES: Race-specific vs race-neutral GLI equations to define lung function.

MAIN OUTCOMES AND MEASURES: Percent predicted values of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), asthma or asthma symptoms, and eligibility for reversibility testing were determined.

RESULTS: Among 1533 children, there were 849 CAMP (median [IQR] age, 8.7 [7.1-10.6] years; 138 [16%] Black, 711 [84%] White, and 498 [59%] male participants), 578 CCAAPS (median [IQR] age, 6.9 [6.7-7.0]; 115 [20%] Black, 463 [80%] White, and 315 [55%] male participants) and 106 MPAACH (median [IQR] age, 7.4 [7.1-7.8] years; 62 [58%] Black, 44 [42%] White, and 62 [58%] male participants). The median (IQR) percent predicted FEV1 in Black children decreased by 11.9 percentage points (pp) (10.4-13.1 pp) in CAMP, 13.5% pp (11.8-14.6 pp) in CCAAPS, and 13.2 pp (11.6-14.6 pp) in MPAACH compared with the race-specific equation. The race-specific equation failed to detect reduced percent predicted FEV1 in 12 of 22 Black children in CCAAPS with asthma symptoms (55%) and 5 of 15 Black children in MPAACH with asthma (41%). In CCAAPS, children with less than 90% predicted FEV1 based on race-specific equations were eligible for postreversibility testing to objectively diagnose asthma. When this asthma diagnostic algorithm was applied, 16 of 36 Black children in CCAAPS (44%) and 6 of 16 Black children in MPAACH (38%) who were not eligible for reversibility testing based on the race-specific equation became eligible with a less than 90% predicted FEV1 based on the race-neutral equation.

CONCLUSIONS AND RELEVANCE: In this cohort study of 1533 children, the use of the race-neutral equation improved the detection of asthma in children. These results support the universal use of the race-neutral equation to improve asthma detection in children and help guide medical practice toward alleviating asthma-related health disparities.

PMID:40019761 | DOI:10.1001/jamanetworkopen.2024.62176

JAMA Netw Open. 2025 Feb 3;8(2):e2462271. doi: 10.1001/jamanetworkopen.2024.62271.

ABSTRACT

IMPORTANCE: Stroke is a major cause of morbidity and mortality. Timely administration of intravenous thrombolysis (IVT) is essential for improving outcomes for patients with acute ischemic stroke. Significant disparities exist in IVT administration based on socioeconomic and racial and ethnic backgrounds. Understanding how hospital-level segregation is associated with stroke treatment outcomes is crucial for addressing these disparities.

OBJECTIVE: To investigate the association between hospital segregation, using the Index of Concentration at the Extremes (ICE), and IVT administration rates among patients with stroke.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used US hospital data from the 2016-2020 National Inpatient Sample database. Using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification codes, patients admitted to hospitals with acute ischemic stroke were included. Statistical analysis was performed from March through July 2024.

EXPOSURE: Hospital segregation measured by the ICE, quantifying socioeconomic and racial and ethnic extremes within hospitals. ICE values range from -1 (predominantly Black and socioeconomically disadvantaged) to 1 (predominantly White and socioeconomically advantaged). Hospitals were categorized into ICE quintiles, with the first quintile representing the most disadvantaged hospitals, the third quintile representing a balanced patient mix, and the fifth quintile representing the most privileged hospitals.

MAIN OUTCOMES AND MEASURES: The primary outcome was IVT administration rates. Secondary outcomes included racial and ethnic disparities in IVT administration across ICE quintiles.

RESULTS: Among 2 494 945 patients with stroke, the mean (SD) age was 70.1 (14.0) years, 50.2% were male, 0.5% were American Indian, 3.1% were Asian or Pacific Islander, 17.4% were Black, 8.2% were Hispanic, 68.2% were White, and 2.6% were other race or ethnicity. Of these patients, 65.4% were treated at hospitals in the third ICE quintile, while 1.2% of patients were treated at hospitals in the first ICE quintile. Patients at hospitals in the fourth and fifth ICE quintiles were significantly more likely to receive IVT (fourth quintile: adjusted odds ratio [AOR], 1.32 [95% CI, 1.26-1.38]; fifth quintile: AOR, 1.27 [95% CI, 1.21-1.34]) compared with those in the first quintile. Racial and ethnic disparities in IVT administration were most pronounced in the first ICE quintile, where Black patients were 32% less likely than White patients to receive IVT (AOR, 0.68 [95% CI, 0.58-0.79]). This disparity decreased but persisted in higher quintiles.

CONCLUSIONS AND RELEVANCE: In this study of hospital segregation and IVT administration rates, segregation was associated with lower likelihood of IVT administration for patients at hospitals serving predominantly Black and socioeconomically disadvantaged communities. Socioeconomic improvements were associated with reduced, but not eliminated, racial and ethnic disparities in stroke treatment. Addressing structural racism and segregation is crucial for equitable access to stroke care.

PMID:40019760 | DOI:10.1001/jamanetworkopen.2024.62271