Nevin Manimala

JAMA Health Forum. 2025 Aug 1;6(8):e252465. doi: 10.1001/jamahealthforum.2025.2465.

ABSTRACT

IMPORTANCE: The number of physicians and advanced practitioners (APs) whose care is concentrated in nursing homes (often referred to as nursing home or skilled nursing facility specialists [SNFists]) has increased rapidly. Therefore, whether these clinicians provide better care is important.

OBJECTIVE: To examine the association between SNFist care and outcomes of long-stay nursing home (NH) residents with Alzheimer disease and related dementias (ADRD).

DESIGN, SETTING, AND PARTICIPANTS: In this retrospective cohort study of 417 378 residents with ADRD in US NHs, claims for a 20% national sample of Medicare fee-for-service beneficiaries between 2013 and 2019 were analyzed. Adjusted estimates were based on a machine learning approach that incorporated a doubly robust procedure using a generalized estimating equation with inverse probability treatment weighting. Three secondary analyses were conducted: (1) stratified analyses for physicians and APs, (2) inclusion of physicians of any specialty and APs, and (3) use of proxy outcomes for in-place deaths. Data were analyzed from June 1, 2024, to May 3, 2025.

INTERVENTION: Receipt of care from a SNFist; SNFists included generalist physicians and APs.

MAIN OUTCOMES AND MEASURES: Hospitalizations and emergency department (ED) visits for ambulatory care-sensitive (ACS) conditions. Death without an ACS hospitalization and death without any hospitalization were used in secondary analyses.

RESULTS: Of the total 417 378 residents, 242 540 received care from SNFists (mean [SD] age, 83.5 [8.7] years), and 174 838 never received care from SNFists (mean [SD] age, 84.8 [8.5] years). Compared with the residents who never received care from SNFists, the residents who received care from SNFists were more likely to be Black (12.6% vs 9.4%; P < .001), dually eligible (77.5% vs 73.1%; P < .001), and have more chronic conditions (eg, anemia, 60.9% vs 57.6%). Compared with non-SNFist clinicians, the SNFist clinicians were more likely to be female (physicians, 37.1% vs 23.3%; APs, 88.1% vs 85.1%), practice at more facilities (mean [SD] number of facilities, 9.4 [8.7] for SNFist physicians vs 6.4 [6.1] for non-SNFist physicians; 8.6 [8.1] for SNFist APs vs 7.1 [6.8] for non-SNFist APs), and less likely to practice in rural areas (physicians, 9.3% vs 25.4%; APs, 8.1% vs 20.2%). In adjusted analyses, receiving care from a SNFist vs non-SNFist was associated with 7% lower odds of an ACS hospitalization (odds ratio [OR], 0.93; 95% CI, 0.90-0.96) and 7% lower odds of an ACS ED visit (OR, 0.93; 95% CI, 0.90-0.96). In stratified analyses, receiving care from a SNFist physician vs a non-SNFist physician was associated with 13% lower odds (OR, 0.87; 95% CI, 0.83-0.90) of an ACS hospitalization and 7% lowers odds of an ACS ED visit (OR, 0.93, 95% CI, 0.88-0.97); comparisons of SNFist APs vs non-SNFist APs were not statistically significant. Estimates from the analysis including physicians of any specialty and APs were consistent with the primary results. SNFist care was associated with increased odds of in-place death.

CONCLUSIONS AND RELEVANCE: Findings of this cohort study suggest that the use of SNFists by NHs may enhance the quality of care for residents with ADRD.

PMID:40815522 | DOI:10.1001/jamahealthforum.2025.2465

Protein Sci. 2025 Sep;34(9):e70250. doi: 10.1002/pro.70250.

ABSTRACT

Intrinsically disordered proteins (IDPs) play key roles in various biological processes; they are associated with liquid-liquid phase separation and are targets in disorder-based drug design. Efforts to identify their structural propensities-that can be linked to molecular recognition, malfunction, targeting-still lead to ambiguous results. Secondary structure is routinely assessed by NMR spectroscopy by calculating the secondary chemical shifts (SCSs). Focusing on a given environment in the polypeptide backbone, SCSs highlight the deviation from the “random coil” state. However, the analysis is dependent on which of the numerous random coil chemical shift (RCCS) predictors is applied in the calculations, resulting in an especially pronounced ambiguity for IDPs. To overcome this, we introduce two novel statistical tools that enable the sound identification of structural propensities. We propose the chemical shift discordance ratio (DR) for prefiltering RCCS predictors based on self-consistency. Further on, we introduce the Structural Propensity Identification by t-statistics (SPIT) approach for extracting maximum information from SCS data by using multiple RCCS predictors simultaneously. This way SCS patterns indicating structural propensities can be clearly distinguished from the “noise”. The applicability of these methods is demonstrated for four proteins of varying degrees of disorder. Ubiquitin and α-synuclein are used as respective benchmarks for a globular and a disordered protein, while two proline-rich IDPs are included as especially challenging molecules in secondary structure analysis.

PMID:40815493 | DOI:10.1002/pro.70250

Mol Biol Rep. 2025 Aug 15;52(1):829. doi: 10.1007/s11033-025-10931-3.

ABSTRACT

BACKGROUND: Crimean-Congo Hemorrhagic Fever (CCHF) is a tick-borne disease caused by a virus belonging to the Orthonairovirus genus. Mononuclear phagocytic cells, hepatocytes and endothelial cells are known to be the primary targets of the CCHF virus during the infection. Epitranscriptomes refers to all chemical modifications of RNA within a cell. The most common among these-and the focus of this study- is N6-methyladenosine (m6A) methylation.

METHODS AND RESULTS: In this study, for the first time, we investigated the expression profiles of ALKBH5, FTO and YTHDF2 genes using quantitative real-time polymerase chain reaction (qPCR) in CCHF patients. The case group consisted of individuals diognosed with CCHF, while the control group comprised healthy individuals with no active infections. The patient group was further classified into mild and severe cases based on clinical presentation. The expression of the ALKBH5 and YTHDF2 genes was statistically significantly upregulated in fatals (p < 0.001). In addition, ALKBH5 genes were differentially expressed in fatals compared to nonfatal case (p = 0.005). Furthermore, we found that FTO gene was significantly upregulated in severe CCHF patients (p = 0.03). We also compared gene expression levels in patients grouped by clinical parameters that above or within normal limits. FTO expression was found to be significantly decreased in patient with elevated ALT and AST levels (p = 0.043 and p = 0.048, respectively).

CONCLUSION: We suggest that upregulated expression of these genes may be associated with CCHF prognosis. These genes may also serve as potential molecular biomarker for diseaase progression.

PMID:40815491 | DOI:10.1007/s11033-025-10931-3

Int Orthop. 2025 Aug 15. doi: 10.1007/s00264-025-06640-y. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the clinical and radiological outcomes between posterior laminectomy and laminoplasty hybrid decompression and laminectomy with lateral mass screw fixation in multilevel degenerative cervical myelopathy.

METHODS: A total of 158 patients for multilevel degenerative cervical myelopathy (DCM) undergoing surgical treatment were enrolled in this study from May 2018 to December 2023, including 97 patients who underwent posterior laminectomy and laminoplasty hybrid decompression (PLLDH) and 61 patients treated with posterior lateral mass screw fixation (PLMSF). To minimize potential confounding factors, propensity score matching was employed for inter-group comparison. Neurological function scores and radiographic parameters were systematically compared between the two surgical groups.

RESULTS: Following propensity score matching (PSM), baseline characteristics showed no statistically significant differences between the two surgical groups. The matched cohorts demonstrated that operative duration, intraoperative blood loss, VAS scores, Cobb angle, dural sac cross-sectional area at the narrowest level, and posterior dural displacement had no statistically significant differences(P > 0.05). However, significant inter-group differences were observed in JOA scores (P<0.05), NDI scores (P<0.05), and cervical range of motion (P<0.05) postoperatively.

CONCLUSION: Both PLLDH and PLMSF are effective surgical approaches for treating multilevel DCM, demonstrating satisfactory clinical outcomes. However, PLMSF resulted in greater postoperative loss of cervical mobility compared to PLLDH.

PMID:40815488 | DOI:10.1007/s00264-025-06640-y

Eur Arch Paediatr Dent. 2025 Aug 15. doi: 10.1007/s40368-025-01092-9. Online ahead of print.

ABSTRACT

PURPOSE: The aim of the present study was to investigate oral health-related quality of life (OHRQoL) and factors associated with sleep bruxism (SB) in preschool children through a comparative cross-sectional study.

METHODS: One hundred thirty-five preschool children (27 with SB and 108 without SB) were randomly selected from primary care units in the city of Diamantina, Minas Gerais, Brazil. The groups were matched for age, sex, and family income at a proportion of 1:4. Parents/guardians answered a questionnaire addressing sociodemographic and gestational characteristics as well as information on the child’s health, and breastfeeding. The Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) was used to investigate the impact of oral problems on the OHRQoL of the preschool children, for which higher scores denote a greater negative impact. Oral clinical examinations were performed for the diagnosis of dental caries (dmft index), traumatic dental injuries, and malocclusion. Statistical analysis involved descriptive statistics as well as unadjusted and adjusted conditional logistic regression models (95%CI, p < 0.05).

RESULTS: The final adjusted logistic regression model revealed that children who resided in rural areas (OR = 3.75; 95%CI: 1.41-9.95; p = 0.008), those with cohabitating parents (OR = 3.99; 95%CI: 1.21-13.20; p = 0.023), and those with a Baume type II lower arch (OR = 3.35; 95%CI: 1.25-8.98; p = 0.016) were more likely to have SB.

CONCLUSION: The occurrence of SB was greater in children who resided in rural areas, those with cohabitating parents, and those with a Baume type II lower arch. OHRQoL was not associated with the outcome.

PMID:40815450 | DOI:10.1007/s40368-025-01092-9

Eur Arch Paediatr Dent. 2025 Aug 15. doi: 10.1007/s40368-025-01094-7. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess whether defects related to Molar Incisor Hypomineralisation (MIH) and Hypomineralised Second Primary Molar (HSPM), located on working cusps, exhibit greater extent and severity than those on balancing cusps.

MATERIALS AND METHODS: A total of 605 children aged 6 to 12 years were evaluated, of whom 110 presented with MIH/HSPM, comprising 268 molars (65 primary and 203 permanent). The molars were divided into two groups based on defect location: G1 (n = 170) with defects on working cusps, and G2 (n = 98) with defects on balancing cusps. Comparative assessments of defect location, extent, and severity were performed using Chi-square and Mann-Whitney tests, with a significance level of 5%.

RESULTS: In the overall sample, including both primary and permanent molars, no statistically significant differences were observed between G1 and G2 regarding extent (p = 0.15) or severity (p = 0.46). However, in primary molars only, significant differences were found for extent (p = 0.008), with greater lesion extension on working cusps, while severity showed no significant difference (p = 0.568).

CONCLUSION: Hypomineralisation-related defects located on working cusps of primary molars exhibited greater extent than those on balancing cusps.

PMID:40815449 | DOI:10.1007/s40368-025-01094-7

Eur J Pediatr. 2025 Aug 15;184(9):555. doi: 10.1007/s00431-025-06368-2.

ABSTRACT

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes and a leading cause of Pediatric Intensive Care Unit (PICU) admissions. The use of continuous glucose monitoring (CGM) during the acute and critical phase of DKA has been rarely explored and remains uncertain due to concerns about accuracy and utility in a setting where frequent capillary glucose measurements are standard practice. Data was collected from medical records of patients admitted to the PICU with new-onset DKA as the initial presentation of type 1 diabetes (T1D). Mean absolute relative difference (MARD) and Clarke Error Grid (CEG) analysis were used to assess CGM accuracy. Data from 19 patients (mean age 9.9 ± 3.4 years) were included. Within the first 48 h, 16 hypoglycemic episodes were recorded, with CGM detecting 14 episodes and capillary glucose detecting two. A total of 238 matched pairs of capillary and CGM interstitial glucose values were analyzed. Statistical analysis found capillary glucose values significantly higher than interstitial values (p < 0.001). The overall MARD was 14.5% and CEG analysis indicated 89.1% of matched pairs within zones A and B.

CONCLUSIONS: CGM might be a useful point-of-care tool that provides valuable information that may help clinicians to make timely management decisions. The ability of CGM to indicate trends in glucose fluctuations could be its main clinical advantage, particularly in anticipating and preventing potentially dangerous hypoglycemic events, thereby optimizing patient management and safety.

WHAT IS KNOWN: • DKA emergencies require close glucose monitoring. Standard methods, such as capillary glucose monitoring or venous blood glucose measurements, have some limitations in terms of comfort, frequency, and trend detection. • CGM is currently rarely used in PICU or DKA due to a lack of clinical trials, resulting in uncertainty about its accuracy in pediatric DKA. Additionally, CGM has not been FDA-approved for use in inpatients and to manage diabetes emergencies.

WHAT IS NEW: • CGM may benefit children with DKA from the onset. • DKA management in PICUs by showing glucose trends and enabling hypoglycemia to be detected early, supporting timely interventions, reducing workload, and minimizing patient discomfort through fewer capillary punctures.

PMID:40815433 | DOI:10.1007/s00431-025-06368-2

Biotechnol Lett. 2025 Aug 15;47(5):91. doi: 10.1007/s10529-025-03618-z.

ABSTRACT

BACKGROUND: Biofilm formation in Pseudomonas aeruginosa provides protection against multiple stressors and contributes to its pathogenicity. Pyocyanin, a virulence factor regulated by quorum sensing, is crucial for infections. This study aimed to evaluate how various physicochemical conditions impact biofilm formation and pyocyanin production in P. aeruginosa PA14.

METHODS: Biofilm formation and pyocyanin production were assessed under varying conditions, including nutrient availability, NaCl concentrations, pH, temperature, heavy metal salts, light exposure, and microbial competition. Biofilm levels were quantified using a crystal violet assay, while pyocyanin levels were measured spectrophotometrically. Statistical analyses were performed to identify significant trends and correlations.

RESULTS: Key findings revealed that biofilm formation and pyocyanin production were reduced under most stress conditions examined in this study, compared to controls, with few exceptions. FeCl₃ enhanced biofilm formation, while NaCl concentrations above 3% and extreme pH values inhibited it. NiCl₂ was the most effective at reducing biofilm amount among the salts which we examined. Pyocyanin production followed similar trends, peaking under neutral pH and nutrient-enriched conditions. Positive correlations between biofilm and pyocyanin production were observed, particularly in nutrient-limited media. Additionally, light exposure and inter-microbial competition significantly reduced biofilm levels.

CONCLUSION: This study highlights the differential responses of P. aeruginosa to various stress conditions, underscoring the importance of environmental factors in modulating biofilm formation and virulence. These findings provide insights into bacterial adaptive strategies and offer potential avenues for developing targeted interventions against biofilm-associated infections.

PMID:40815394 | DOI:10.1007/s10529-025-03618-z

Eur J Nucl Med Mol Imaging. 2025 Aug 15. doi: 10.1007/s00259-025-07516-4. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the efficacy and safety of robotic-arm-assisted [¹⁸F]NaF-PET/CT-guided intra-articular block for lumbar facet joint (LFJ) or sacroiliac joint (SIJ) arthropathy.

MATERIALS AND METHODS: In this single-centre, non-randomized, prospective phase 2 clinical-trial, participants with chronic low back pain (CLBP) were recruited from August 2022 to June 2024. Participants having NaF-avid LFJ or SIJ on [¹⁸F]NaF-PET/CT underwent robotic-arm-assisted intra-articular block with steroids and local anaesthesia. Baseline, immediate post-procedural, and 3-month follow-up visual analog score (VAS), Low-Back Outcome Scale (LBOS), Oswestry Disability Index (ODI), and change in SUV values of target joints were documented. The primary end-point of the trial was ≥ 50% improvement in VAS at 3 months, and secondary end-points were improvements in ODI, LBOS by at least one grade and change in SUV. Descriptive statistics were applied. Qualitative variables were reported in percentages.

RESULTS: Out of 85 enrolled participants, 79 (92.9%) underwent [¹⁸F]NaF-PET/CT. Among them, 61 (77.2%) had NaF-avid joints, and 55(69.6%) underwent PET/CT-guided robotic-arm-assisted intra-articular blocks. The primary end-point was met in 84% (46/55) participants, and secondary end-points in 96% (53/55) and 89% (49/55), respectively. The procedure was technically successful in all the target joints. A significant change in pre- and post-procedural median SUVmax and SUVpeak of the treated joints was noticed. No major adverse effects were noticed in the participants.

CONCLUSION: Robotic-arm-assisted [¹⁸F]NaF-PET/CT guided intra-articular blocks of LFJ and SIJ in CLBP appear to be safe and feasible in NaF-avid arthropathy. However, lack of comparison with the standard of care, small sample size, selection bias and radiation exposure limit its generalizability.

PMID:40815392 | DOI:10.1007/s00259-025-07516-4

Probiotics Antimicrob Proteins. 2025 Aug 15. doi: 10.1007/s12602-025-10716-x. Online ahead of print.

ABSTRACT

Prediabetes and type 2 diabetes mellitus (T2DM) are closely linked with increased risk of hypertension, contributing significantly to cardiovascular complications. While probiotics and synbiotics have shown potential benefits in metabolic health, their specific effects on blood pressure (BP) regulation in this population remain unclear. This study aims to evaluate the impact of probiotics and synbiotics supplementation on BP control in adults with prediabetes and T2DM, addressing this critical knowledge gap. A comprehensive search was conducted on online databases from their inception to January 2025 to identify relevant randomized controlled trials (RCTs). Data were extracted from selected studies. The overall effect size was determined using weighted mean differences (WMD) with 95% confidence intervals (CIs) through a random-effects model. All statistical analyses were carried out using STATA software. The pooled analysis of 17 RCTs (19 effect sizes) with 1,281 participants (646 cases and 635 controls) showed that probiotics and synbiotics supplementation led to a significantly reduction in both systolic BP (WMD: -3.27 mmHg, 95% CI: -5.38 to -1.16, p = 0.002), and diastolic BP (WMD: -1.78 mmHg, 95% CI: -2.61 to -0.95, p < 0.001). The GRADE assessment rated the quality of evidence for SBP as moderate due to significant heterogeneity, which resulted in serious inconsistency; however, no other major limitations were identified. In comparison, the quality of evidence for DBP was rated as very high. This meta-analysis suggests that supplementation with probiotics and synbiotics can effectively reduce BP in adults with prediabetes and T2DM, highlighting their potential as an adjunctive strategy for BP management. Clinically, incorporating these supplements may offer a safe, accessible option to support traditional therapies and help reduce cardiovascular risk in this high-risk population.

PMID:40815364 | DOI:10.1007/s12602-025-10716-x