Nevin Manimala

P R Health Sci J. 2025 Jun;44(2):84-88.

ABSTRACT

OBJECTIVE: The objective of this study was to analyze and compare the distribution patterns of fentanyl, morphine, meperidine, and codeine in the continental US compared to Puerto Rico from 2018-2023. Attention was given to meperidine due to its extensive adverse effect profile and irreversible central nervous system toxicity.

METHODS: Data was collected from Automation of Reports and Consolidated Orders Systems (ARCOS). The dataset included annual distribution data for meperidine, fentanyl, morphine, and codeine in the US and Puerto Rico. Population data was collected from US Census data and the American Community Survey. Data analyses were conducted using Microsoft Excel Version 2410. For each opioid, the mean distribution and standard deviation (SD) were calculated for the continental US. The mean distribution in Puerto Rico was compared to the US mean distribution with a 95% confidence interval. ANOVA tests were performed to assess differences in distribution of each opioid across years (2018, 2020, and 2022) within the continental US. All descriptive statistics and ANOVA calculations were conducted with statistical significance determined at p < 0.05.

RESULTS: From 2018 to 2023, meperidine distribution declined in both regions but decreased more sharply in the continental US (82.6%) compared to Puerto Rico (43.5%). Distribution levels exceeded six standard deviations above the US mean in 2023. Fentanyl and morphine distributions were consistently lower in Puerto Rico than in the continental US.

CONCLUSION: There was a disproportionately high distribution of meperidine in Puerto Rico compared to the continental US across the years studied.

PMID:40532054

Biostatistics. 2024 Dec 31;26(1):kxaf016. doi: 10.1093/biostatistics/kxaf016.

ABSTRACT

In basket trials a single therapeutic treatment is tested on several patient populations simultaneously, each of which forming a basket, where patients across all baskets on the trial share a common genetic aberration. These trials allow testing of treatments on small groups of patients, however, limited basket sample sizes can result in inadequate precision and power of estimates. It is well known that Bayesian information borrowing models such as the exchangeability-nonexchangeability (EXNEX) model can be implemented to tackle such a problem, drawing on information from one basket when making inference in another. An alternative approach to improve power of estimates, is to incorporate any historical or external information available. This paper considers models that amalgamate both forms of information borrowing, allowing borrowing between baskets in the ongoing trial whilst also drawing on response data from historical sources, with the aim to further improve treatment effect estimates. We propose several Bayesian information borrowing approaches that incorporate historical information into the model. These methods are data-driven, updating the degree of borrowing based on the level of homogeneity between information sources. A thorough simulation study is presented to draw comparisons between the proposed approaches, whilst also comparing to the standard EXNEX model in which no historical information is utilized. The models are also applied to a real-life trial example to demonstrate their performance in practice. We show that the incorporation of historic data under the novel approaches can lead to a substantial improvement in precision and power of treatment effect estimates when such data is homogeneous to the responses in the ongoing trial. Under some approaches, this came alongside an inflation in type I error rate in cases of heterogeneity. However, the use of a power prior in the EXNEX model is shown to increase power and precision, whilst maintaining similar error rates to the standard EXNEX model.

PMID:40532037 | DOI:10.1093/biostatistics/kxaf016

J Am Heart Assoc. 2025 Jun 18:e039290. doi: 10.1161/JAHA.124.039290. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with acute coronary syndrome (ACS) are at high risk for recurrent cardiovascular events and bleeding complications, particularly in Asian populations. The long-term impact of multiple cardiovascular events and bleeding on outcomes remains unclear.

METHODS: Using Taiwan’s National Health Insurance Research Database, this retrospective cohort study included 28 086 patients with ACS categorized into single-event and multiple-event groups based on cardiovascular events occurring within 2 years of the index ACS event. After matching for age, sex, and event interval, 8756 patients were assigned to the multiple-event group and 17 446 to the single-event group.

RESULTS: The multiple-event group had higher comorbidity rates, including hypertension, prior coronary disease, heart failure, stroke, and chronic kidney disease. Over 5 years, the multiple-event group had significantly higher all-cause mortality (34.0% versus 24.0%) and cardiovascular mortality (11.2% versus 5.5%) compared with the single-event group (both P <0.0001). Major (8.4% versus 1.6%) and minor (35.5% versus 7.4%) bleeding rates were also higher (both P <0.0001). Notably, major bleeding persisted beyond 3 months in the multiple-event group, whereas the single-event group showed reduced bleeding after 1 month. In the multiple-event group, each additional major bleeding event was associated with earlier subsequent cardiovascular events (coefficient=-0.2875, P=0.0325).

CONCLUSIONS: Patients with ACS with multiple cardiovascular events have higher rates of all-cause mortality, cardiovascular mortality, and major bleeding than patients with ACS with a single cardiovascular event. Major bleeding may also be associated with the risk of subsequent cardiovascular events, highlighting the importance of implementing a tailored antiplatelet strategy in Asian populations.

PMID:40530479 | DOI:10.1161/JAHA.124.039290

J Phys Chem B. 2025 Jun 18. doi: 10.1021/acs.jpcb.5c02405. Online ahead of print.

ABSTRACT

Free energies of solvation in liquid benzene and hexafluorobenzene have been computed for 42 uncharged solutes. Monte Carlo statistical mechanics was used with the free-energy perturbation theory and the OPLS-AA force field. The results address the transferability of the potential functions developed for pure liquids to mixed systems and the potential importance of explicit polarization for neutral organic molecules in aromatic solvents. Although the free-energy results cover an 11 kcal/mol range, the average error in comparison with experimental data points is only 0.4 kcal/mol. There is no systematic pattern to the discrepancies, so the need to add explicit treatment of solute-solvent polarization effects is not supported. This contrasts the situation with cationic solutes as reflected in cation-π interactions. Results for free energies of hydration are also provided for the 42 solutes in TIP4P water and give an average error of 0.49 kcal/mol. Implications for modeling biomolecular systems with standard force fields are considered. It is also interesting to note the overall similar values for free energies of solvation in benzene and hexafluorobenzene despite the reversal of polarity for the aromatic rings; the most significant exception is the more favorable solvation of perfluoroalkanes in the perfluoro solvent. Alternative accommodations of solutes in the two solvents are illustrated.

PMID:40530466 | DOI:10.1021/acs.jpcb.5c02405

J Oral Pathol Med. 2025 Jun 18. doi: 10.1111/jop.70001. Online ahead of print.

ABSTRACT

BACKGROUND: To evaluate the impact of case descriptions, alongside clinical photographs, on telediagnosis accuracy in Oral Medicine.

METHODS: An analytical cross-sectional observational study used 100 cases from Oral Medicine services at three universities. Three specialists in Oral Diagnosis remotely analyzed these cases. Simulated teleconsultations were presented via Google Forms, requesting: (a) diagnostic hypotheses based solely on clinical photographs; (b) identification of essential information for diagnosis; and (c) revised hypotheses after reviewing case descriptions. The specialists’ opinions, with and without case descriptions, were compared to in-person diagnoses and categorized as: negative impact, maintenance of incorrect opinion, maintenance of correct opinion, and refinement of the response.

RESULTS: Diagnostic accuracy based on images alone were 84%, 83%, and 75%. There was no statistically significant difference in accuracy before and after accessing case descriptions. Although these descriptions were not essential for a correct diagnosis, they contributed to refining diagnostic hypotheses in some cases. The most frequently requested information was the “duration of the condition” (84% of cases).

CONCLUSION: Experienced Oral Diagnosis specialists demonstrate satisfactory diagnostic accuracy when analyzing cases of oral lesions from a distance using photos, even when no clinical information is provided about the cases.

PMID:40530448 | DOI:10.1111/jop.70001

Int J Low Extrem Wounds. 2025 Jun 18:15347346251348797. doi: 10.1177/15347346251348797. Online ahead of print.

ABSTRACT

BackgroundDiabetic foot ulcers (DFUs), a severe chronic complication of diabetes, are characterized by refractory wounds and high risks of amputation/mortality, posing substantial public health challenges. Mesenchymal stem cells (MSCs) demonstrate therapeutic potential through synergistic mechanisms including paracrine signaling, immunomodulation, neovascularization, and tissue regeneration. This study conducts a systematic review and meta-analysis of randomized controlled trials (RCTs) to comprehensively evaluate the clinical efficacy of MSC-based therapy for DFUs, aiming to optimize treatment strategies with evidence-based insights.MethodWe systematically searched PubMed, Embase, Cochrane Library, and Web of Science for RCTs investigating MSC therapy in DFUs. Following PRISMA guidelines, studies were selected with pre-defined criteria. Meta-analyses employed random-/fixed-effects models based on I² statistics. Primary endpoints encompassed complete healing rate (100% epithelialization), amputation incidence, serious adverse events (SAEs) risk, and recurrence rate. Furthermore, sensitivity analyses were conducted to evaluate the robustness of the findings. A comprehensive assessment of potential publication bias in the current meta-analysis was performed using Egger’s linear regression test, Begg’s rank correlation test, and funnel plot visualization.ResultsSix RCTs were included. MSC therapy significantly improved overall complete healing rates (RR = 1.63, 95% CI: 1.23-2.16; P = .0007), particularly in small ulcers (<5 cm²; RR = 1.71, 1.11-2.63, P = .02), but showed no efficacy for large ulcers (≥5 cm²; RR = 1.18, 0.75-1.86, P = .46). No significant differences emerged in amputation risk (P = .16), serious adverse events (P = .38), and recurrence (P = .33). Low heterogeneity and no publication bias were observed.ConclusionThis meta-analysis demonstrates MSCs therapy significantly enhances wound closure in diabetic foot ulcers, particularly achieving in small ulcers. However, no stable therapeutic benefits were observed for large ulcers, amputation prevention, recurrence reduction, and SAEs. Future multicenter phase III trials with standardized protocols are warranted to establish ulcer stage/size-specific treatments.

PMID:40530428 | DOI:10.1177/15347346251348797

Psychedelic Med (New Rochelle). 2025 May 26;3(2):71-80. doi: 10.1089/psymed.2024.0021. eCollection 2025 Jun.

ABSTRACT

OBJECTIVE: Prior research has found an association between psychedelic use and reduced stigma attached to mental illness. However, whether psychedelics alleviate stigma-related distress remains unclear. Since stigma impacts different groups uniquely, any moderating effect of psychedelics on stigma-related distress is likely to vary across subpopulations. This study addresses two main questions: (1) Do psychedelics moderate the relationship between stigma and distress? and (2) does this relationship vary by gender and race/ethnicity? By exploring these questions, this research seeks to contribute to our understanding of psychedelic use and its impact on mental health across diverse populations.

METHODS: Data from the National Survey of Drug Use (2008-2019) were analyzed, with a weighted sample of 458,372. The main analysis used regression models in Stata 18 to examine the associations between lifetime psychedelic use (LPU) (psilocybin, lysergic acid diethylamide [LSD], N,N-dimethyltryptamine, peyote/mescaline, ayahuasca, and 3,4-Methylenedioxymethamphetamine), stigma attached to seeking mental health care, and psychological distress. This analysis examines whether the association between stigma and distress differs by gender, race/ethnicity, and psychedelic use (i.e., White men, White women, Black men, Black women, Asian men, Asian women, Hispanic men, and Hispanic women).

RESULTS: Results indicate that men report lower perceived stigma than women, while women report higher distress. White, Black, and Hispanic women report the highest stigma levels. Regression analysis suggests that among the total population, stigma is statistically associated with higher distress, and interaction terms indicate that MDMA, psilocybin, LSD, and LPU are linked to variations in this relationship. Regression models stratified by gender and race/ethnicity suggest that while LPU, LSD, and DMT were statistically associated with differences in the relationship between stigma and distress for White men, these associations appeared weaker for other groups.

CONCLUSION: Psychedelic use is associated with lower reported distress from internalized stigma, though the directionality and mechanisms underlying this association remain unclear. Further research should be conducted to investigate how psychedelics can be integrated into comprehensive health treatment programs outside of psychedelics-assisted therapy. However, it is worth noting that individuals from gender and racial/ethnic minority groups may not experience the same level of benefits, suggesting other strategies may be necessary to address the stigma experienced by different groups.

PMID:40530404 | PMC:PMC12169202 | DOI:10.1089/psymed.2024.0021

Cureus. 2025 Jun 17;17(6):e86239. doi: 10.7759/cureus.86239. eCollection 2025 Jun.

ABSTRACT

Background Gastroparesis (GP) is a chronic condition in which the stomach takes too long to empty its contents into the small intestine, despite the absence of any physical blockage. Females are generally more susceptible to developing GP than males. The objective of this study was to compare clinical outcomes between male and female patients hospitalized with GP using the Nationwide Inpatient Sample (NIS) database. Methods Using the NIS databases from 2020 to 2022 and the International Classification of Diseases, Tenth Edition Revision (ICD-10) codes, we performed a retrospective study of adult patients admitted with GP. We compared inpatient outcomes of GP between males and females. All-cause in-hospital mortality was the primary outcome. Secondary outcomes were total hospitalization cost adjusted to the year 2022, length of stay (LOS), incidence of sepsis, acute renal failure (ARF), shock, and need for intensive care unit (ICU) admission. We used STATA, version 16.1 (StataCorp LLC, College Station, TX), to perform the statistical analyses. Multivariate logistic regression analysis was conducted to assess whether gender was an independent predictor for these outcomes and to adjust for any confounders. Results It was noted that 31,114 adult patients were admitted for GP from 2020 to 2022; 23,886 (76.77%) were females, and 7,228 (23.23%) were males. The mean age of both males and females was 47.2 years. Males had a higher prevalence of diabetes mellitus type 1 (DM1), diabetes mellitus type 2 (DM2), congestive heart failure (CHF), chronic kidney disease (CKD), and smoking/tobacco use. Females had a higher prevalence of prior cerebrovascular accident (CVA) and obesity. We found that female patients with GP had significantly longer LOS (+0.88 days, 95% CI: 0.53 – 1.29, P <0.01), higher total hospitalization costs (+$9,129.4, 95% CI: 4,946.0-13,312.7, P <0.01), and higher likelihood of venous thromboembolism (VTE) (adjusted odds ratio (aOR) 1.69, 95% CI: 0.83-3.44, P=0.147) as compared to males. Female patients had lower odds of developing sepsis (aOR: 0.60, 95% CI: 0.43-0.85, P <0.01), ARF (aOR 0.48, 95% CI: 0.41-0.56, P <0.01), shock (aOR: 0.54, 95% CI: 0.24-1.22, P=0.143), ICU admission (aOR 0.73, 95% CI: 0.57-0.92, P <0.01), and in-hospital mortality (aOR: 0.15, 95% CI: 0.05-0.45, P <0.01) as compared to males. Conclusions We found that female patients had longer hospital LOS, total hospitalization charges, and a higher risk of VTE, while males had a higher risk of ARF, sepsis, shock, ICU admission, and all-cause in-hospital mortality. Although females are more frequently hospitalized for GP, males had significantly poorer clinical outcomes as compared to females. Our findings indicate that male patients with GP experience worse inpatient outcomes and require more aggressive treatment to reduce the risk of mortality and morbidity.

PMID:40530392 | PMC:PMC12173479 | DOI:10.7759/cureus.86239

IJTLD Open. 2025 Jun 13;2(6):333-338. doi: 10.5588/ijtldopen.25.0031. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Adolescents and young adults (AYA) with TB have distinct physical and social characteristics compared to other age groups. This study describes a cohort of AYA with TB in a low TB-prevalence, high-income setting and investigates whether demographic or social factors affect management outcomes.

METHODS: A retrospective cohort study was conducted at a TB referral centre in North West London, including patients aged 10-24 years from 2015 to 2022. Median days from symptom onset to healthcare presentation were determined and risk factors for late presentation (>60 days) were assessed.

RESULTS: Among 158 patients (median age 20 years, IQR 17-23), 53.6% had pulmonary TB, 39.9% extrapulmonary disease, and 5.7% disseminated disease; 25.3% had cavities. Social risk factors were present in 32.3% of patients. Median delay to presentation was 45 days (IQR 14-96), with 38.7% presenting after two months. Delays were longer in patients with incarceration, drug misuse, or mental health issues, though not statistically significant. Patients with social risk factors were more likely to receive observed therapy (OR 2.65, IQR 1.27-5.64).

CONCLUSIONS: AYA with TB in this setting experienced delays in healthcare presentation and a quarter had cavitary disease. Social risk factors were common but not significantly related to outcomes.

PMID:40530382 | PMC:PMC12168727 | DOI:10.5588/ijtldopen.25.0031

Fed Pract. 2024 Dec;41(12):1-7. doi: 10.12788/fp.0540. Epub 2024 Dec 23.

ABSTRACT

BACKGROUND: Posthoc analyses have found an increased bleeding risk in oral anticoagulation with concomitant nonsteroidal anti-inflammatory drug (NSAID) use. However, this research was primarily conducted in mixed populations prescribed both direct oral anticoagulants (DOACs) and warfarin. Research evaluating bleeding risk with NSAID use among DOACs alone is limited. This study evaluates bleeding rates in patients taking rivaroxaban and apixaban with and without NSAID use and investigates the potential impact of NSAID selectivity or proton pump inhibitor (PPI) coprescribing.

METHODS: This single-center retrospective cohort study compared bleeding rates between rivaroxaban or apixaban among NSAID and non-NSAID users. The primary endpoint was a composite of any bleeding event per International Society on Thrombosis and Haemostatis criteria. The secondary endpoint was bleeding rates for NSAID users based on NSAID choice and PPI coprescribing.

RESULTS: The study included 681 patients on rivaroxaban and 3225 patients on apixaban. Seventy-two patients on rivaroxaban (10.6%) and 300 patients on apixaban (9.3%) were NSAID users. There was no statistically significant difference between rivaroxaban and apixaban among NSAID users (hazard ratio 1.04; 95% CI, 0.98-1.12) or non-NSAID users (hazard ratio 1.15; 95% CI, 0.80-1.66). There was no clinically significant difference observed for NSAID selectivity or PPI coprescribing for NSAID users.

CONCLUSIONS: Bleeding rates were not significantly different between patients taking rivaroxaban and patients taking apixaban, regardless of NSAID use. A population health management tool may provide a safe approach for coprescribing NSAIDs with DOACs. Additional prospective studies are needed to quantify the comparative bleeding risk with concomitant NSAID use among DOACs alone.

PMID:40530373 | PMC:PMC12169640 | DOI:10.12788/fp.0540