Nevin Manimala

Am J Clin Dermatol. 2025 Jul 8. doi: 10.1007/s40257-025-00958-4. Online ahead of print.

ABSTRACT

BACKGROUND: Multimodal noninvasive imaging is a novel technique in dermatology. Its purpose is to overcome the limitations of unimodal techniques. This is done by combining higher resolution images with deeper imaging depth and/or tissue specificity within a single device for improvement of diagnosis and management of skin lesions.

OBJECTIVE: Our aim was to systematically review multimodal imaging devices currently used in dermatology clinics and their diagnostic accuracy of skin lesions.

METHODS: A comprehensive search was conducted in October 2022 for studies on multimodal imaging technologies in vivo, in human subjects, used in dermatology. An additional search was made in March 2024. Four databases were selected: MEDLINE, Embase, CENTRAL, and Web of Science. This review was registered with the international Prospective Register of Systematic Reviews (PROSPERO record number CRD42022364864). The search strategy used Medical Subject Headings (MeSH) and keywords from two concepts: Multimodal Imaging and Dermatological Conditions. Reference lists were also searched for relevant studies. Selected studies included multimodal techniques in neoplastic, inflammatory, and pigmentary skin disorders. Ex vivo imaging, non-human studies, and non-clinical settings were excluded. Data extraction and quality assessment were performed using QUADAS and STARD criteria. Data extraction was conducted by one researcher and then reviewed by an additional researcher. A third researcher resolved any disagreements. The statistical analysis involved diagnostic accuracy meta-analysis, subgroup comparisons (multimodal vs single modal, multimodal vs multimodal), and SROC curves. The primary outcomes were the diagnostic accuracy, sensitivity, and specificity of multimodal imaging devices in diagnosing dermatological conditions.

RESULTS: The analysis included 92 studies, predominantly case reports or series (83.7%), with basal cell carcinoma (BCC) being the most frequently imaged lesion (11.8%). The studies had a moderate risk of bias (QUADAS score: 0.6) with histology as the reference test in most cases. Meta-analysis showed multimodal devices have high sensitivity and specificity for BCC diagnosis. These results indicate reliable diagnostic accuracy.

CONCLUSIONS: In a clinical setting, multimodal imaging can be useful to perform bedside diagnosis and management of skin lesions.

PMID:40627274 | DOI:10.1007/s40257-025-00958-4

J Epidemiol Glob Health. 2025 Jul 8;15(1):95. doi: 10.1007/s44197-025-00392-z.

ABSTRACT

BACKGROUND: In Madagascar, a sentinel surveillance system was set up in 18 hospitals since 2014 and was managed by the Ministry of Public Health and the Institut Pasteur de Madagascar. In order to improve the access to appropriate health care in Madagascar, the main clinical diagnoses in hospitalized patients were analyzed.

METHODS: At hospitalization of a patient, each unit involved in the sentinel surveillance recorded the clinical diagnosis through an e-health platform. Data from September 2014 to July 2018 were analyzed. Morbidity and annual incidence of diseases according to ICD-10 were reported.

RESULTS: A total of 140,789 inpatients information was recorded. The median age was 28.2 years (IQR: 18.3; 45.3). 21.6% of the children < 15 years suffered from communicable diseases. The hospital morbidity was 4.01% for malaria, 0.84% for tuberculosis, 0.09% for HIV/AIDS and 0.05% for plague. The hospital morbidity of non-communicable diseases was higher compared to communicable diseases with 7.8%, 7.1% and 3.1% for “Diseases of the circulatory system”, “Injury, poisoning and certain other consequences of external causes” and “Mental and behavioural disorders”, respectively. “Pregnancy, childbirth and puerperium” represented 20.5% of the hospitalized patients.

CONCLUSIONS: The e-health platform enabled continuous and standardized data collection. Communicable diseases affect mainly children < 15 years. Non-communicable diseases are on the rise and need more attention by national health authorities. A number of hospitalizations could be prevented by a better health care management at the community-based health care level and by implementation of a Universal Health Coverage (UHC) in Madagascar.

PMID:40627272 | DOI:10.1007/s44197-025-00392-z

Sleep Breath. 2025 Jul 8;29(4):236. doi: 10.1007/s11325-025-03400-5.

ABSTRACT

PURPOSE: Obstructive sleep apnea (OSA) is associated with systemic inflammation and cardiovascular disease, including atherosclerosis. S100A8 and S100A9 are pro-inflammatory proteins involved in atherogenesis, but their expression in the aortic walls of OSA patients remains unknown. This study aimed to determine the relationship between OSA severity and S100A8/S100A9 expression in aortic tissue from patients undergoing coronary artery bypass grafting (CABG).

METHODS: This study included 46 patients who underwent CABG. OSA severity was assessed using the WatchPAT™ home sleep apnea test, classifying patients into control and mild (0 < AHI < 15), and moderate to severe (AHI ≥ 15) OSA groups. Aortic wall samples were collected intraoperatively, and S100A8 and S100A9 expression was evaluated using immunohistochemistry. Statistical analysis compared protein expression across OSA severity groups.

RESULTS: Patients with moderate-to-severe OSA exhibited higher S100A8 and S100A9 expression in aortic tissue compared to control and mild OSA groups. The difference was statistically significant for S100A9 (p < 0.01), while S100A8 showed a non-significant increasing trend (p = 0.073).

CONCLUSION: This study provides novel evidence that S100A8 and S100A9 are overexpressed in the aortic walls of patients with moderate-to-severe OSA. These findings suggest a potential role for these proteins in OSA-related vascular inflammation and atherosclerosis. Further research is needed to explore their potential as biomarkers or therapeutic targets in OSA-related cardiovascular disease.

PMID:40627268 | DOI:10.1007/s11325-025-03400-5

Eur J Health Econ. 2025 Jul 8. doi: 10.1007/s10198-025-01809-z. Online ahead of print.

ABSTRACT

INTRODUCTION: To ensure fair competition and prevent risk selection by sickness funds, Germany employs a morbidity-based risk-adjustment scheme, primarily using diagnostic data to record insured persons’ morbidity. However, concerns about the manipulability and quality of diagnostic coding have sparked discussions. This study proposes and evaluates an alternative risk-adjustment model based on pharmaceutical data, assessing its potential as an extension or an alternative to the diagnosis-based status quo.

METHODS: We adapted an existing pharmacy-based model to German conditions and simulated various models. In order to create comparability to the status quo, we constructed a representative sample for the German statutory health insurance (SHI), using claims data of about 4.5 million insured persons. We evaluated the sample by assessing the standardized differences of the weighted means of the relevant covariates. For a quantitative assessment of the models we used the coefficients of determination (R²), Cumming’s Predictive Measure (CPM), and the mean absolute prediction error (MAPE). Under- and overcompensation within different risk groups were also analysed.

RESULTS: The sample closely matched SHI data (overall effect size after matching < 0.0001). Substituting diagnostic data with pharmacy cost groups (PCGs) showed comparable model quality, but worsened under- and overcompensation for groups vulnerable to risk selection. Conversely, integrating PCGs into the status quo improved nearly all performance measures.

CONCLUSION: Introducing pharmacy-based models into the German risk compensation scheme demonstrates significant potential. Extending the current model with PCGs enhances statistical performance, improves morbidity measurement, and offers a viable approach to mitigate coding manipulation incentives.

PMID:40627257 | DOI:10.1007/s10198-025-01809-z

Eur J Neurol. 2025 Jul;32(7):e70283. doi: 10.1111/ene.70283.

ABSTRACT

AIMS: The present systematic review and meta-analysis study aimed to investigate the putative relationship between pre-diabetes and neuropathy.

METHODS: Original studies that assessed the association of pre-diabetes patients with neuropathy disorders in humans without setting and country were selected. The methodological quality of the included articles was evaluated using NHLBI quality assessment tools for observational studies. The meta-analysis was conducted using the relevant effect sizes to compare outcomes and the random-effects restricted model. An I² value > 50% and a p < 0.05 indicated substantial heterogeneity. Galbraith plot is demonstrated for heterogeneity. Egger’s and Begg’s test was used to evaluate publication bias. A non-parametric trim-and-fill analysis of publication bias was used to assess the number of missing studies.

RESULTS: According to the standardized mean difference (SMD) of included articles, there was a statistically significant association between pre-diabetes and the occurrence of peripheral neuropathy in the increasing neuropathy assessment metrics (e.g., Impaired unilateral vibration perception, Neuropathic pain, Sensory nerve dysfunction) 0.23[0.14; 0.33] and in decreasing neuropathy assessment metrics (e.g., corneal nerve fiber density, corneal nerve fiber length, warm threshold, cold threshold) -1.04[-1.05; -0.57].

CONCLUSION: Policymakers should give special attention to preventive strategies and effective lifestyle interventions for these patients to reduce the risk of neuropathy and its consequences.

PMID:40626353 | DOI:10.1111/ene.70283

J Chin Med Assoc. 2025 Jul 8. doi: 10.1097/JCMA.0000000000001265. Online ahead of print.

ABSTRACT

BACKGROUND: The Montreal Cognitive Assessment (MoCA) may not be appropriately interpreted in Taiwan because of the lack of large-scale normative data. Moreover, examinees’ demographic characteristics may influence their MoCA scores. However, previous studies have not adequately adjusted for these effects. This study aimed to use regression-based methods to establish demographically adjusted MoCA norms.

METHODS: Participants were recruited from six hospitals and neighboring communities from all geographic areas of Taiwan. Multiple regression analyses were conducted to quantify the effects of age, education, and sex on MoCA total and domain scores, resulting in correction equations and adjusted cutoff scores.

RESULTS: A total of 2,310 cognitively healthy participants were included in the analysis. Age and education significantly affected the total and all domain scores. Sex affected naming, language, and abstract thinking domain scores. Correction equations and corresponding cutoffs were proposed for MoCA total and domain scores to support more precise clinical interpretations.

CONCLUSION: This study provides regression-adjusted norms for the MoCA, improving its accuracy and clinical utility in Taiwan. An adjusted total MoCA score of 23 points is recommended as the cutoff for identifying potential cognitive impairment, with domain-specific cutoffs further supporting individualized interpretation.

PMID:40626349 | DOI:10.1097/JCMA.0000000000001265

Glob Chang Biol. 2025 Jul;31(7):e70341. doi: 10.1111/gcb.70341.

ABSTRACT

The physical environment of nearshore Southern Ocean (coastal Antarctica) is altering rapidly in response to climate change, but also has other long cyclicity due to El Nino Southern Oscillation and Southern Annular Mode. Detecting biological responses to such physical change, which is complex in time and space, is very challenging not least because of remoteness, difficulty of access, frequency of iceberg destruction and short funding cycles but also the paucity of research stations with SCUBA (or ROV) facilities. At one of those few, Rothera, Adelaide Island on the West Antarctic Peninsula, we immersed arrays of artificial substrata (settlement panels) for 1 year repeatedly for over two decades. Whilst many ‘mature assemblages’ are monitored at nearshore sites around the world, there are few of similar duration for recruitment and colonisation. We report the variability in annual biodiversity descriptive statistics with the crucial context of also recording adjacent long (here defined as > 1 decade) term seabed disturbance and biophysical oceanography at Rothera. We ask how variable is annual colonisation, recruitment and early community development in Antarctica’s shallows, what aspect of recruitment changes over two decades and in what way? Of 40 recorded, most species recruiting to our panels at 12 m depth at Adelaide Island (67.568° S, 68.127° W) were rare, comprising cheilostome and cyclostome bryozoans, polychaetes, calcarea and demosponge sponges, hydroid cnidarians and ascidians. The most striking finding was a sustained decrease in total richness of recruits over time, mainly due to loss of rare species. Unlike losses of seasonal sea ice, iceberg disturbance and benthos mortality, such findings are unlikely to be climate-forced responses. This raises important questions of whether this is a chance finding, (the data only spans 20 years), driven by a recent complex of stressors and most of all is losing rare species a wider polar problem?

PMID:40626345 | DOI:10.1111/gcb.70341

J Cosmet Dermatol. 2025 Jul;24(7):e70326. doi: 10.1111/jocd.70326.

ABSTRACT

BACKGROUND: Hyperpigmentation and periorbital dark circles remain challenging dermatological concerns due to their multifactorial etiology, including vascular, pigmentary, and structural components. This study evaluates the efficacy of a novel multi-action topical formulation designed to target hyperpigmentation and skin aging through a synergistic blend of active ingredients.

OBJECTIVE: To assess the objective and clinical effects of a dermatological composition containing niacinamide, arbutin, tranexamic acid, ubiquinone, a DHEA-like component, curcuma oily extract, and marine exopolysaccharides on periorbital hyperpigmentation and skin quality.

METHODS: Subjects with visible under-eye dark circles applied the formulation twice daily over a treatment period of 6 weeks. The evaluation included instrumental quantitative assessments of skin pigmentation along with standardized imaging. A separate safety study and cosmetic efficacy questionnaire of patient experience were completed.

RESULTS: The formulation demonstrated statistically significant improvements in pigmentation intensity. The twice daily use of the under-eye serum resulted in an average overall reduction in under-eye hyperpigmentation of 47.94%, with no adverse effects observed.

CONCLUSION: This novel topical composition offers a safe and effective multi-targeted approach for improving periorbital hyperpigmentation and promoting overall skin rejuvenation. The synergistic action of its active components supports its use in clinical and aesthetic dermatology for the treatment of dark circles and age-related changes.

PMID:40626342 | DOI:10.1111/jocd.70326

Clin Trials. 2025 Jul 8:17407745251350289. doi: 10.1177/17407745251350289. Online ahead of print.

ABSTRACT

Dose selection is a key component of drug development, yet inadequate dose-response characterization remains a major challenge, contributing to late-stage attrition and post-marketing regulatory commitments. Effective dose-response characterization for both efficacy and safety supports benefit-risk assessments of therapeutic interventions and relies on two main elements: Trial design and trial analysis. In trial design, selecting an appropriate dose range, determining the number of dose levels, and ensuring proper dose spacing are essential to capture both the steep and plateau regions of a dose-response curve. Adaptive trial designs provide additional flexibility to address uncertainties during trial planning and execution, increasing the chances of identifying optimal doses and improving trial efficiency. In trial analysis, modeling approaches support dose-response characterization by utilizing data across dose levels to fit a continuous curve rather than analyzing each dose level separately. Model-based methods, such as Emax modeling or MCP-Mod (which combines multiple comparison procedures and modeling), incorporate assumptions about the dose-response relationship to improve the precision of dose-response and target dose estimation. Additional precision can often be achieved by modeling dose-exposure-response relationships, recognizing that exposure (e.g. drug concentration in the plasma) often mediates the relationship between dose and clinical response. Dose-exposure response models may also enable the prediction of dose-response relationships of alternative regimens (e.g. when applying a different frequency of administration than the tested ones). This article reviews key considerations for the design and analysis of dose-response trials, focusing on strategies to improve decision-making and regulatory alignment.

PMID:40626332 | DOI:10.1177/17407745251350289

JAMIA Open. 2025 Jul 4;8(4):ooaf059. doi: 10.1093/jamiaopen/ooaf059. eCollection 2025 Aug.

ABSTRACT

OBJECTIVES: To determine whether a novel digital tool, the Community Vulnerability Compass (CVC), built using large datasets, can accurately measure neighborhood- and individual-level social determinants of health (SDOH) at scale. Existing SDOH indexes fall short of this dual requirement.

MATERIALS AND METHODS: Setting: A cross-sectional study by Parkland Health (Parkland) and Parkland Center for Clinical Innovation (PCCI) to design, build, deploy, and validate CVC in Dallas County/across Texas (2018-2024). Data Sources: Parkland Electronic Health Records; population-level data from diverse national datasets. Statistical Analysis: CVC’s Community Vulnerability Index (CVI), and 4 subindexes were used to classify all 18 638 Texas census-block groups as Very-High, High, Moderate, Low, and Very-Low social vulnerability. Individuals were assigned the vulnerability of their home address census-block group. CVC’s classifications were compared against 3 existing SDOH neighborhood tools (Area Deprivation Index [ADI], Social Vulnerability Index [SVI], or Environmental Justice Index [EJI]) and validated against individual-level SDOH screening tools or Z-code documentation. Spearman rank correlation was used for neighborhood-level comparisons and precision/recall, for individual-level comparisons.

RESULTS: Neighborhood-level CVI measurement of social vulnerability strongly correlated with EJI (r = 0.83), SVI (r = 0.82), and ADI (r = 0.79). Individual-level CVI measurement had higher recall than ADI (68% vs 39%, respectively; P < .001) and high recall across self-reported SDOH (77%-79.6%). Precision was highest for food needs (75.1%); lowest for safety needs (1.2%).

DISCUSSION: CVC measured a cross-cutting range of neighborhood social vulnerabilities and accurately approximated individual-level SDOH, outperforming existing indexes.

CONCLUSION: CVC can be leveraged as an accurate and scalable SDOH digital measurement tool.

PMID:40626323 | PMC:PMC12231598 | DOI:10.1093/jamiaopen/ooaf059