Nevin Manimala

Am Surg. 2025 Sep 4:31348251371182. doi: 10.1177/00031348251371182. Online ahead of print.

ABSTRACT

BackgroundHealthcare disparities often cause rural BIG 1 TBI patients to be transferred to a higher level of care due to a fear of clinical decline.MethodsWe conducted a retrospective cohort study from 2020 to 2022 that compared patients with the principal diagnosis of BIG1 TBI who were transferred from rural critical access facilities in the upper Midwest to a tertiary care center vs those who were admitted directly to the same tertiary care center. The primary outcomes were cost and mortality. Statistical significance in mortality rates and length of stay was determined using Pearson’s Chi Squared and Kruskal-Wallis tests, with significance thresholds set at α = 0.05.Results62 BIG1 patients were examined in the study and 18 were excluded. Of the 44 patients studied, there were no deaths in either group, and length of stay was not significant (P = .36). Transferred patients also underwent more head CT scans when compared to directly admitted patients (mean 2.5 vs 2.1, P = .003). For in-network costs, the average cost of transferred patients was $13,956 and the average cost for direct admissions was $9216 (P = .0003). For out-of-network costs, the average cost of transferred patients was $20,041 and the average cost for direct admission was $13,789 (P = .02).ConclusionCompared to patients who are directly admitted, transfer patients have an increased cost of care while having no difference in clinical outcomes. Technological advances in telemedicine and protocolized care may assist with decreasing the cost while increasing efficiency of care for these patients.

PMID:40906907 | DOI:10.1177/00031348251371182

Hepatol Commun. 2025 Sep 5;9(9):e0803. doi: 10.1097/HC9.0000000000000803. eCollection 2025 Sep 1.

ABSTRACT

BACKGROUND: In Michigan, Asian Americans are disproportionately infected with HBV and HCV. As many infections are first diagnosed when patients present with advanced liver disease or liver cancer, HBV and HCV screening, awareness, and early treatment are critical to improving outcomes.

METHODS: Using a theory-informed approach, we administered a bi-level qualitative study to identify determinants of viral hepatitis and liver cancer care and treatment in Michigan Asian American communities. We conducted a focus group involving representatives from public health agencies, cancer coalitions, and Asian diaspora organizations across the state. We then completed 1:1 interviews with leaders from the communities. Groups and interviews were taped, transcribed, and used to identify common and distinct themes according to the National Institute of Minority Health and Health Disparities framework.

RESULTS: According to community leaders, language barriers, costs, and a lack of viral hepatitis education appeared among the top shared screening barriers between the 3 communities. Conversely, common facilitators included pre-existing health programs, interpretation services, and community partnerships. Such sentiments were also echoed by the stakeholder focus group. However, the communities also raised distinct concerns about medical mistrust and positive health messaging.

CONCLUSIONS: This qualitative report marks the first phase of a bi-level mixed methods study in Asian American Michigan communities to understand determinants of viral hepatitis and liver cancer care and treatment. This work lays the foundation for a quantitative survey that will gather data from community members to inform the development of a future intervention.

PMID:40906889 | DOI:10.1097/HC9.0000000000000803

Hepatol Commun. 2025 Sep 5;9(9):e0794. doi: 10.1097/HC9.0000000000000794. eCollection 2025 Sep 1.

ABSTRACT

BACKGROUND: The approach to appropriate risk stratification for metabolic dysfunction-associated steatotic liver disease (MASLD) is variable, and the adoption of non-invasive liver disease assessments in clinical practice is suboptimal. In this study, we implemented an electronic decision support tool for primary care patients with MASLD to assess its influence on linkage to care.

METHODS: We performed a prospective, before-and-after pilot study in which post-implementation providers were presented with an electronic decision aid automating non-invasive liver disease assessments with the Fibrosis-4 score and providing individualized, guideline-directed recommendations. Patients were included if attending an outpatient primary care visit with a study provider, had a pre-existing diagnostic code for MASLD, and had not established care with a hepatologist in the 3 years before the office visit. The primary outcome was linkage to care, defined as adherence to guideline-directed recommendations for the next step of care. A total of 503 encounters were included, accounting for 301 unique patients.

RESULTS: Provider adherence to guideline-directed clinical recommendations increased from 29.7% to 45.8% post-implementation (p<0.001). The effect of this intervention remained significant when controlling for patient age, race, sex, resident physician involvement in the clinic visit, and concomitant comorbidities of diabetes, hypertension, and hyperlipidemia (OR 2.11 [95% CI 1.42-3.14]; p<0.001). There was a modest increase in the number of referrals to hepatology post-implementation (2.3%-7.1%; OR 3.27 [95% CI 1.33-9.18]; p=0.014).

CONCLUSIONS: In conclusion, we present a novel, electronically integrated, innovative methodology for direct delivery of individualized guidance for the management of patients with MASLD that significantly enhanced the direction of care toward necessary guideline-directed liver assessments.

PMID:40906885 | DOI:10.1097/HC9.0000000000000794

Science. 2025 Sep 4;389(6764):1016-1023. doi: 10.1126/science.adp4629. Epub 2025 Sep 4.

ABSTRACT

The global burden of kidney disease displays marked sexual dimorphism. Lineage tracing and single-cell RNA-sequencing revealed that starting from puberty, estrogen signaling in female mice supports self-renewal and differentiation of renal progenitors to increase filtration capacity, reducing sensitivity to glomerular injury compared with that of males. This phenomenon accelerated as female kidneys adapted to the workload of pregnancy. Deletion of estrogen receptor α in renal progenitors disrupted this adaptation, leading to preeclampsia, fetal growth restriction, and increased maternal risk of hypertension and chronic kidney disease. Offspring from affected mothers had fewer nephrons, resulting in early-life hypertension and greater susceptibility to kidney disease. These results highlight the fundamental role of kidney fitness and renal progenitors for pregnancy and preeclampsia and as a determinant of sexual dimorphism in kidney disease.

PMID:40906846 | DOI:10.1126/science.adp4629

PLoS One. 2025 Sep 4;20(9):e0330998. doi: 10.1371/journal.pone.0330998. eCollection 2025.

ABSTRACT

BACKGROUND: The consumption of sorghum-based foods has been associated with reduced postprandial blood glucose levels and increased satiety in previous studies. Sorghum’s low glycemic index, high fiber content, and rich profile of bioactive compounds may contribute to improved health outcomes. Nutritional strategies incorporating sorghum could serve as a valuable tool for the prevention of diabetes, obesity, as well as other non-communicable diseases.

PURPOSE: To identify and evaluate the evidence on the effectiveness of the sorghum-based foods in modulating blood glucose levels and promoting satiety in adults.

METHODS AND EXPECTED OUTPUTS: This systematic review protocol was developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. We will include randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) published through February 2025 that assess the effects of sorghum-based food consumption. Qualitative studies, guidelines, and reviews will be excluded. Six electronic databases-MEDLINE/PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and ScienceDirect-will be systematically searched. Additional sources will include ClinicalTrials.gov, The British Library, Google Scholar, International Diabetes Federation, and American Diabetes Association (ADA). No restrictions on language or publication date will be applied. Two independent reviewers will perform study selection, data extraction, and risk of bias assessment according to the study design. A qualitative synthesis will be presented. Statistical heterogeneity will be assessed using the I² statistic. If appropriate, a meta-analysis will be conducted using a random-effects model.

EXPECTED OUTCOMES: To the best of our knowledge, this will be the first systematic review to specifically address the impact of sorghum-based food consumption on glycemic response and satiety. The findings are expected to provide robust evidence to inform future research and support nutritional strategies involving sorghum-based products for health promotion.

PROSPERO REGISTRATION ID: CRD42023431520.

PMID:40906791 | DOI:10.1371/journal.pone.0330998

PLoS One. 2025 Sep 4;20(9):e0329451. doi: 10.1371/journal.pone.0329451. eCollection 2025.

ABSTRACT

BACKGROUND: The SARS-CoV-2 pandemic has highlighted the critical deficiency of infectious disease (ID) specialists, a subspecialty that remains underrepresented among Japanese medical students.

METHODS: This nationwide cross-sectional survey was administered between April and August 2024 via an online questionnaire distributed to medical students throughout Japan. The survey assessed awareness of and interest in ID specialization, categorizing students by academic year: lower (first- and second-year students), middle (third- and fourth-year students), and upper grades (fifth- and sixth-year students).

RESULTS: Of 502 respondents, data for 492 medical students were eligible, of whom 69.7% demonstrated awareness of ID specialists, with recognition rates increasing proportionally with academic progression. Regarding career aspirations, 9.8% of respondents expressed interest in pursuing ID specialization, with the highest proportion observed among upper-grade students (19.4%). Male students (14.8%) expressed greater interest in ID specialization than female students (5.2%). The pandemic positively influenced 5.5% of students to consider ID specialization as a future career, whereas only 0.6% reported a negative impact.

CONCLUSIONS: These findings underscore the necessity of enhanced educational initiatives to promote ID specialization among medical students, addressing current shortages and future infectious disease preparedness.

PMID:40906766 | DOI:10.1371/journal.pone.0329451

Biology (Basel). 2025 Aug 13;14(8):1043. doi: 10.3390/biology14081043.

ABSTRACT

Novel infection control practices are necessary to reduce the incidence of healthcare-associated infections (HAIs). Since 2007, probiotic-based cleaning solutions have been proposed as an alternative to traditional methods using disinfectants and detergents in healthcare settings, including hospitals. We conducted a comprehensive search across Google Scholar, PubMed, Scopus, and Web of Science resources. Studies that assessed the reduction in pathogens on surfaces and the emergence of HAIs after the use of probiotic-based cleaning solutions were eligible for evaluation. A total of 16 studies (13 in clinical settings and 3 on experimental surfaces) were included. The Staphylococcus species were most commonly identified before and after the use of probiotic-based cleaning solutions. All studies showed numerically lower pathogen counts and fewer HAIs after using probiotic-based cleaning solutions compared to disinfectants and detergents. Three studies indicated a reduction in antimicrobial resistance genes after use of probiotic-based cleaning solutions. One of these showed statistically significant differences compared to traditional disinfectants (alcohol, amines, and quaternary ammonium compounds) and detergents (non-ionic and anionic surfactants). The results of the included studies suggest the consideration of probiotic-based cleaning solutions for infection control in healthcare systems. However, given the novelty of this approach, further studies are needed to verify the evaluated findings and investigate the short- and long-term effectiveness, and safety of probiotic-based cleaning solutions on infection control practices in healthcare settings.

PMID:40906379 | DOI:10.3390/biology14081043

Dermatol Ther (Heidelb). 2025 Sep 4. doi: 10.1007/s13555-025-01503-1. Online ahead of print.

ABSTRACT

INTRODUCTION: Atopic dermatitis (AD) is a chronic, highly pruritic, relapsing inflammatory disease associated with high quality-of-life burden. Topical 1.5% ruxolitinib cream is a selective Janus kinase (JAK)1/JAK2 inhibitor that is well tolerated and effective in improving itch and lesion clearance in patients ≥ 12 years old. This analysis estimates comparative efficacy for 1.5% ruxolitinib cream relative to systemic therapies for treatment of patients ≥ 12 years with AD.

METHODS: A systematic literature review (SLR) identified randomized controlled trials evaluating 1.5% ruxolitinib cream, oral JAK inhibitors, monoclonal antibodies, phosphodiesterase 4 inhibitors, and systemic immunosuppressants. A feasibility assessment evaluated whether indirect treatment comparison (ITC) was appropriate and determined appropriate ITC methods. This network meta-analysis (NMA) assessed the comparative efficacy of 1.5% ruxolitinib cream against systemic therapies in a “systemic-eligible moderate AD” subgroup defined as ≥ 12 years old and eligible for topical and systemic therapies (Investigator’s Global Assessment [IGA] = 3, Eczema Area and Severity Index [EASI] ≥ 16, and body surface area ≥ 10%); an ITC with the full study populations was not feasible. A frequentist framework using a penalized likelihood NMA included outcomes of IGA 0/1 with at least a 2-point improvement from baseline, EASI-75, and Itch Numerical Rating Scale 4 (NRS4).

RESULTS: The SLR identified 25 studies, of which 12 reported outcomes for the relevant subgroup for four interventions: 1.5% ruxolitinib cream, dupilumab 300 mg, upadacitinib (15 mg, 30 mg), and abrocitinib (100 mg, 200 mg), which were compared against placebo or placebo + topical corticosteroids. There were no statistically significant differences between active comparators for IGA 0/1, EASI-75, and Itch NRS4, although point estimates numerically favored 1.5% ruxolitinib cream for IGA 0/1 and EASI‑75.

CONCLUSION: For patients with moderate AD who are eligible for systemic therapies, 1.5% ruxolitinib cream might provide disease control comparable to systemic treatments, such as dupilumab, regarding IGA 0/1, EASI-75, and Itch NRS4.

PMID:40906354 | DOI:10.1007/s13555-025-01503-1

Dermatol Ther (Heidelb). 2025 Sep 4. doi: 10.1007/s13555-025-01505-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Interleukin-1 receptor-associated kinase 4 (IRAK4) is expressed in various immune cells and regulates proinflammatory cytokine production. Its inhibition represents a novel, promising therapeutic option in the treatment of atopic dermatitis (AD). Zabedosertib (BAY1834845) is a potent, selective IRAK4 inhibitor that suppresses markers of local and systemic immune responses. This study aimed to evaluate the efficacy and safety of zabedosertib in adults with moderate-to-severe AD.

METHODS: DAMASK was a randomized, double-blind, 12-week, placebo-controlled, phase 2a, proof-of-concept study. Patients were randomized 2:1 to receive oral zabedosertib 120 mg twice daily or placebo. The primary efficacy endpoint was a composite of 75% reduction from baseline on the Eczema Area and Severity Index (EASI-75), no discontinuation of study medication for lack of efficacy, no rescue medication during the 4 weeks before Day 84, and no initiation of systemic AD treatment. Other efficacy assessments included validated Investigator’s Global Assessment for Atopic Dermatitis (vIGA-AD), Peak Pruritus numerical rating scale score, and affected body surface area (BSA); for safety, it included frequency and severity of treatment-emergent adverse events (TEAEs).

RESULTS: Of 77 randomized patients, 69 were included in the primary efficacy analysis (zabedosertib, n = 47; placebo, n = 22); 55 patients completed treatment. At Week 12, there was no significant difference between zabedosertib and placebo in the primary efficacy endpoint (32.3% vs. 37.4%) or percentage change in EASI from baseline (- 44.6% vs. – 55.9%). There were also no significant differences between zabedosertib and placebo at Week 12 in vIGA-AD response (15.9% vs. 28.5%), Peak Pruritus response (16.4% vs. 25.0%), percentage change in Peak Pruritus (- 20.7% vs. – 27.3%), or percentage change in BSA affected by AD (- 13.3% vs. – 20.3%). No severe or serious TEAEs were reported throughout the study.

CONCLUSIONS: Zabedosertib was safe and well tolerated in adults with moderate-to-severe AD but showed no evidence of efficacy in reducing disease severity or pruritus in this placebo-controlled study.

TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT05656911.

PMID:40906353 | DOI:10.1007/s13555-025-01505-z

J Nephrol. 2025 Sep 4. doi: 10.1007/s40620-025-02380-9. Online ahead of print.

ABSTRACT

BACKGROUND: Kidney function decline is associated with cardiovascular disease and various other morbidities. Previous studies regarding polygenic risk scores of estimated glomerular filtration rate (eGFR) change were generally based on individuals of European ancestry and not validated on populations of East Asian ancestry.

METHODS: We conducted a genome-wide association study for eGFR slope among 26,755 non-diabetic individuals from the Taiwan Biobank. We developed an eGFR slope polygenic risk score and validated its prediction power on chronic kidney disease (CKD) in another sample with 58,777 non-diabetic individuals.

RESULTS: Eight candidate loci associated with eGFR slope (P-value ranging from 1.56 × 10^-6 to 8.73 × 10^-6) located in the SLC9A9, SLC26A8, DEPTOR, OBP2B, PRMT8, C19orf44 genes and an intergenic locus between MTMR12-ZFR genes were identified and a polygenic risk score for eGFR slope was constructed. The polygenic risk score was validated externally to be significantly associated with CKD in another set of individuals (P-value = 0.0182; odds ratio = 0.753; 95% confidence interval: 0.5936-0.9504).

CONCLUSIONS: We constructed a genome-wide polygenic risk score for eGFR decline and externally validated its use in predicting CKD in another Taiwan population. Our eGFR slope polygenic risk score might be useful for clinical CKD risk assessment in future, especially for East Asians.

PMID:40906351 | DOI:10.1007/s40620-025-02380-9