Tag: nevin manimala

JAMA Netw Open. 2025 Mar 3;8(3):e250024. doi: 10.1001/jamanetworkopen.2025.0024.

ABSTRACT

IMPORTANCE: Although mother’s own milk (MOM) is associated with reduced risk of neonatal complications of prematurity and improved neurodevelopmental outcomes, to our knowledge, there have been no large US studies reporting rates of MOM feeding initiation and sustained MOM feedings by gestational age (GA).

OBJECTIVE: To compare rates of MOM feeding initiation and continuation at 12 weeks for infants by GA.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study used state-level surveillance data for maternal characteristics and behaviors before and after pregnancy. Participants were women who gave birth from January 1 through December 31, 2021, in 36 US jurisdictions (33 states, the District of Columbia, New York City, and Puerto Rico) and completed the Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire. Data were analyzed from July 2023 to April 2024.

EXPOSURE: Infant GA, including early preterm (EPT; ≤27 weeks’ gestation), moderately preterm (MPT; 28-33 weeks’ gestation), late preterm (LPT; 34-36 weeks’ gestation), and early term to postterm (≥37 weeks’ gestation).

MAIN OUTCOMES AND MEASURES: MOM feeding initiation and continuation at 12 weeks after delivery. Weighted multivariable binary logistic regression models were used to test the association between MOM feeding initiation and continued provision at 12 weeks after delivery by infant GA.

RESULTS: Among 29 098 births, there were 0.4% EPT, 1.8% MPT, 6.7% LPT, and 91.1% early-term to postterm infants. Unadjusted MOM feeding initiation was highest for EPT infants (89.7% [95% CI, 85.0%-94.7%]) and lowest for LPT infants (81.8% [95% CI, 79.5%-84.1%]). For infants that initially received MOM, 71.6% (95% CI, 70.7%-72.6%) of early-term to postterm infants still received MOM at 12 weeks followed by 63.1% (95% CI, 52.9%-73.2%) of EPT infants, 61.2% (95% CI, 58.0%-64.3%) of LPT infants, and 58.6% (95% CI, 53.4%-63.8%) of MPT infants. After adjusting for maternal characteristics, LPT infants were 4.4 (95% CI, -6.7 to -2.1) percentage points less likely to initiate MOM feedings and those who received any MOM were 6.7 (95% CI, -9.9 to -3.5) percentage points less likely to receive MOM at 12 weeks compared with early-term to postterm infants. There were no differences in adjusted initiation or continuation rates among EPT (3.1 [95% CI, -1.4 to 7.5] percentage points for initiation and -0.0 [95% CI, -8.6 to 8.6] percentage points for continuation) or MPT (2.4 [95% CI, -0.5 to 5.3] percentage points for initiation and -3.3 [95% CI, -8.0 to 1.5] percentage points for continuation) infants compared with early-term to postterm infants.

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that MOM feeding initiation and continuation rates at 12 weeks after birth for LPT infants were substantially lower than rates for infants with other GAs. Research is needed to pinpoint barriers to MOM feeding initiation and continuation in this vulnerable population of infants.

PMID:40042846 | DOI:10.1001/jamanetworkopen.2025.0024

JAMA Netw Open. 2025 Mar 3;8(3):e250089. doi: 10.1001/jamanetworkopen.2025.0089.

ABSTRACT

IMPORTANCE: An important public health goal is to increase tobacco cessation, but there is limited research on associations of vaping with tobacco cessation.

OBJECTIVE: To estimate the association of vaping with long-term tobacco cessation among US cigarette smokers who used electronic nicotine delivery systems (ENDS; ie, e-cigarettes) in 2017.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a nationally representative sample of US cigarette smokers from the Population Assessment of Tobacco and Health cohort at wave 4 (2017) with follow-up at wave 6 (2021). Data were analyzed from June 2023 to June 2024.

EXPOSURE: Wave 4 ENDS use: daily, nondaily, or no use.

MAIN OUTCOMES AND MEASURES: The primary outcomes were 12 or more months’ abstinence from cigarette smoking and 12 or more months’ abstinence from both cigarette and ENDS use, ascertained at wave 6. Propensity score matching was used to control confounding on 14 potential confounders, including interest in quitting, income, age, education, nondaily smoking, and presence of a smoke-free home.

RESULTS: A total of 6013 smokers were included in the sample (3634 aged ≥35 years [weighted percentage, 65.2%]; 3182 female [weighted percentage, 46.5%]). Among smokers who vaped daily (228 individuals), an estimated 20.9% (95% CI, 15.0% to 26.8%) were abstinent from cigarette smoking at follow-up, compared with 14.3% abstinence (95% CI, 13.0% to 15.5%) among smokers who did not vape (5070 individuals) and 12.6% abstinence (95% CI, 9.8% to 15.4%) among smokers who vaped nondaily (715 individuals). Compared with similar propensity score-matched smokers who did not vape, smoking cessation was 4.1 percentage points lower among those who vaped daily (95% CI, -11.9 to 3.6 percentage points; P = .30), a nonsignificant difference. Smoking cessation was 5.3 percentage points lower among those who vaped nondaily (95% CI, -9.1 to -1.5 percentage points; P = .01) compared with similar propensity score-matched controls. Considering abstinence from both smoking and vaping, compared with matched controls, smokers who vaped daily had lower abstinence at follow-up by 14.7 percentage points (95% CI, -20.2 to -9.2 percentage points; P < .001), and those who vaped nondaily had lower abstinence by 7.2 percentage points (95% CI, -10.7 to -3.8 percentage points; P < .001).

CONCLUSIONS AND RELEVANCE: In this representative cohort study of US smokers who used ENDS, neither daily nor nondaily vaping was associated with increased smoking cessation, and each was associated with reduced tobacco abstinence, suggesting that careful adjustment of confounding is critical in studies of ENDS and smoking cessation.

PMID:40042845 | DOI:10.1001/jamanetworkopen.2025.0089

JAMA Netw Open. 2025 Mar 3;8(3):e250122. doi: 10.1001/jamanetworkopen.2025.0122.

ABSTRACT

IMPORTANCE: Improving mental health of young people is a major societal challenge, particularly among the high numbers of young people living in deprived urban areas.

OBJECTIVE: To identify factors associated with depression and anxiety among young people in deprived urban areas in South America.

DESIGN, SETTING, AND PARTICIPANTS: This case-control study recruited adolescents (age 15-16 years) and young adults (age 20-24 years) from education and community settings in deprived areas in Bogotá, Colombia; Buenos Aires, Argentina; and Lima, Peru, between April 2021 and November 2022. Participants who met threshold criteria for self-reported depression or anxiety. Community controls who did not meet the criteria were identified.

EXPOSURES: Sociodemographic characteristics, stressful life events before and during the past year, substance use, social capital, sports and arts activities, social media engagement.

MAIN OUTCOMES AND MEASURES: Depression, assessed using the 8-item Patient Health Questionnaire (range, 0-24, with higher scores indicating greater symptom severity), and anxiety, assessed using the 7-item Generalized Anxiety Disorder questionnaire (range, 0-21, with higher scores indicating greater symptom severity), were defined by threshold scores higher than 9. Various factors were compared between groups with and without anxiety and depression in multivariable logistic regression, testing for interactions by age group.

RESULTS: Of 2402 analyzed participants, 1560 (64.9%) were female, 1080 (45.0%) were adolescents, and 1322 (55.0%) were young adults; 1437 (59.8%) met the criteria for depression and/or anxiety, and 965 (40.2%) were controls. In a multivariable model, female gender (OR, 1.99 [95% CI, 1.65-2.40), more than 2 stressful life events in the previous year (OR, 1.67 [95% CI, 1.40-2.01]), more than 7 stressful life events before the previous year (OR, 1.52 [95% CI, 1.27-1.81), lifetime consumption of sedatives (OR, 2.26 [95% CI, 1.65-3.14]), participating in arts activities in the past 30 days (OR, 1.22 [95% CI, 1.01-1.48]), and stronger engagement with social media (OR, 1.59 [95% CI, 1.34-1.89]) were independently associated with increased odds of depression and anxiety, while sports activities were associated with reduced odds (OR, 0.80 [95% CI, 0.67-0.96]). The odds of having depression and/or anxiety symptoms associated with lifetime use of sedatives were higher among adolescents (OR, 6.54 [95% CI, 3.33-14.27]) than among young adults (OR, 2.54 [95% CI, 1.79-3.66]) (P = .01 for interaction).

CONCLUSIONS AND RELEVANCE: In this case-control study, female gender, stressful life events, substance use, arts activities, and social media engagement were associated with greater odds of depression and anxiety, while sport activities were associated with lesser odds. The findings suggest that policies for improving mental health in deprived urban neighborhoods in South America and related research should consider similar factors associated with mental distress in adolescents and young adults.

PMID:40042842 | DOI:10.1001/jamanetworkopen.2025.0122

Ann Surg. 2025 Mar 5. doi: 10.1097/SLA.0000000000006687. Online ahead of print.

ABSTRACT

SUMMARY OF BACKGROUND DATA: Intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic cancer is typically managed like pancreatic intraepithelial neoplasia (PanIN)-derived pancreatic cancer. However, in IPMN-derived pancreatic cancer, the role of chemotherapy remains controversial, particularly in the neoadjuvant setting (NAT).

OBJECTIVE: To evaluate the role of neoadjuvant chemotherapy in IPMN-derived pancreatic cancer.

METHODS: Patients with IPMN-derived pancreatic cancer treated with either upfront surgery (US) or NAT were identified from eight international centers (2000-2023). Clinicopathologic data were compared. Date of first treatment was used for Kaplan-Meier and log-rank tests to compare overall (OS) and recurrence free survival (RFS). Multivariable Cox-regression was performed in patients that underwent NAT.

RESULTS: In 1,019 patients, 76 (7%) underwent NAT. Patients who received NAT had higher baseline CA19-9 levels (P<0.001). Of these 76 patients, 27 (36%), 20 (26%), and 29 (38%) had resectable, borderline resectable, or locally advanced pancreatic cancer at diagnosis, respectively. Advanced resectability stage was significantly more common in the NAT patients as compared to those who underwent US (P<0.001). OS for US patients was 38.0 months (95%CI: 33.7.1-44.3), which was not statistically different than those that received NAT [27.5 mo (95%CI: 23.1-46.7), P=0.121]. This was also valid for patients with resectable disease [US: 38.1 mo vs. NAT: 35.6 mo, P=0.920)]. Complete or marked pathological treatment response (P=0.046) and serological CA19-9 normalization after NAT (P=0.017) were associated with improved survival. On Cox-regression for OS, N2 disease [HR: 4.15 (95%CI: 1.71-10.10)], elevated CA19-9 [HR: 2.02 (95%CI:1.06-3.85)] and R1 margin [HR: 2.36 (95%CI:1.20-4.61)] was independently associated with OS after NAT, while resectability status was not.

CONCLUSION: After NAT and resection, advanced resectability stage was not associated with worse OS indicating the value of this approach for borderline resectable and locally advanced IPMN-derived pancreatic cancer. The benefit of NAT in resectable disease is unclear and may require an individualized approach. Biological treatment effect can be assessed with CA19-9 and confirmed by pathologic response.

PMID:40042799 | DOI:10.1097/SLA.0000000000006687

Discov Oncol. 2025 Mar 5;16(1):266. doi: 10.1007/s12672-025-02023-2.

ABSTRACT

BACKGROUND: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths globally, and infection with the hepatitis B virus (HBV) is one of the major risk factors for the development of HCC. However, the definitive causal relationship between HBV infection and liver cancer has not been clearly established. In this study, we employed Mendelian randomization (MR) to estimate the causal effect of HBV infection on hepatocellular carcinoma by using genetic variations as instrumental variables.

METHODS: We obtained summary statistics from genome-wide association studies (GWAS) related to hepatocellular carcinoma and hepatitis B. We conducted Mendelian randomization analysis, using genetic variants associated with HBV infection as instrumental variables to estimate the risk of liver cancer. In our MR analysis, we employed the inverse variance weighted (IVW) method and performed sensitivity analyses and robustness assessments using MR Egger regression and the weighted median method.

RESULTS: Our MR analysis revealed a significant causal association, indicating that HBV infection leads to liver cancer (IVW odds ratio = 2.233, 95% confidence interval = 1.844-2.703, P < 0.001). Sensitivity analyses using MR Egger regression and the weighted median method confirmed the causal effect, with no evidence of horizontal pleiotropy. Similar results were observed across different MR methods, supporting a strong causal association between HBV and liver cancer risk. Specifically, we observed a causal effect of CD25 on the IgD-CD38- B cell subset (β = 1.15, 95% CI 1.07-1.24, P = 3.0 × 10^- 4). Additionally, five immune phenotypes were significantly associated with HCC risk: HLA DR + + monocytes.

CONCLUSION: This MR study demonstrates a causal relationship between HBV infection and liver cancer risk, highlighting HBV as a potential causal factor in the development of hepatocellular carcinoma.

PMID:40042791 | DOI:10.1007/s12672-025-02023-2

Oral Radiol. 2025 Mar 5. doi: 10.1007/s11282-025-00813-6. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the role of computed tomography (CT)/cone-beam computed beam CT (CBCT) in association with hypoesthesia of the mental region and lower lip during the surgical removal of DCs.

METHODS: A retrospective cohort study was performed involving 39 impacted mandibular DC cases between February 2011 and March 2022. We studied the association of hypoesthesia in relation to the age and sex of the patient and to growth direction and expansion of the DC on the CT/CBCT image findings. The preoperative CT/CBCT image findings were statistically analyzed in accordance with diagnoses of DCs confirmed based on pathology. Fisher’s exact test was used to test the relationship between hypoesthesia and CT/CBCT imaging findings. In addition, PubMed and PubMed Central were searched using keywords such as “hypoesthesia” to find relevant studies. Reports of hypoesthesia of the mental region and lower lip were derived from the selected literature.

RESULTS: The frequency of hypoesthesia recorded was 35.9%. No statistically significant association was observed for all hypoesthesia and CT/CBCT image findings.

CONCLUSIONS: Imaging evaluation was performed in 39 dentigerous cysts, and a literature review was performed. We found that CT/CBCT alone does not provide sufficiently reliable images required for predicting nerve lesions. Future prospective studies are required.

PMID:40042789 | DOI:10.1007/s11282-025-00813-6

J Nephrol. 2025 Mar 5. doi: 10.1007/s40620-024-02180-7. Online ahead of print.

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) is a frequent and severe complication in COVID-19 patients, associated with poor outcomes. This study evaluates the characteristics and outcomes of AKI in COVID-19-positive versus negative patients during the pandemic in an emerging country, emphasizing differences in incidence, recovery, and healthcare resource utilization.

METHODS: We conducted a retrospective cohort study including 9112 intensive care unit (ICU) patients from two major hospitals in Brazil, hospitalized between March 2020 and April 2022. Statistical analyses included logistic regression, Kaplan-Meier survival analysis, and time series analysis of AKI trends across COVID-19 waves.

RESULTS: 2333 patients (25.6%) tested positive for COVID-19. AKI incidence (79.7% vs. 52.6%, p < 0.001) and severity (Stage 3: 48.6% vs. 26.6%, p < 0.001) were significantly higher in the COVID-19-positive group. COVID-19 patients with AKI had longer ICU stays (median 11 vs. four days, p < 0.001) and higher mechanical ventilation needs (57.9% vs. 31.1%, p < 0.001). COVID-19 independently increased the risk of AKI (OR 2.03, CI 1.77-2.32); the coexistence of COVID-19 and AKI conferred significantly higher odds for mortality (OR 8.53, CI 6.67-11.02). Kidney recovery was less frequent in COVID-19 patients, with a higher incidence of acute kidney disease in survivors (OR 1.99, CI 1.74-2.28). Sensitivity analysis of septic patients confirmed higher AKI incidence and mortality in COVID-19 patients.

CONCLUSION: COVID-19 significantly affects AKI incidence, severity, and recovery, particularly in resource-limited settings. These findings emphasize the need for targeted strategies to manage kidney complications during pandemics and stress the importance of healthcare system preparedness in emerging countries.

PMID:40042786 | DOI:10.1007/s40620-024-02180-7

Indian J Pediatr. 2025 Mar 5. doi: 10.1007/s12098-025-05447-4. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare the proportion of children with withdrawal syndrome in sedoanalgesic drug rotation protocol vs. sedoanalgesia with no rotation using Withdrawal Assessment Tool Version-1 (WAT-1).

METHODS: Sixty children one mo to 18 y admitted to the Pediatric Intensive Care Unit (PICU) for mechanical ventilation were randomized into two groups in a 1:1 ratio. The intervention group received a protocolized rotation of sedative and analgesic drugs combination. In contrast, the control group received sedative and analgesic drugs without any rotation for the entire duration of ventilation. In both groups, adequate depth of sedation was achieved by titrating the sedatives using COMFORT-Behavioural (COMFORT-B) scores. The primary outcome assessed was the incidence of withdrawal syndrome as defined by a WAT-1 score ≥ 3. Secondary outcomes included cumulative doses of midazolam needed as rescue therapy, mechanical ventilation (MV) duration, need for inotropic support, and the length of stay (LOS) in the PICU.

RESULTS: In the present study, median (IQR) age of patients was 24 (7, 93) mo. There was a reduced incidence (20% vs. 53.3%; P = 0.004) and median duration of withdrawal syndrome (WAT-1 score ≥ 3) [1 (IQR 0, 2) vs. 0 (IQR 0, 0); P = 0.012] in the intervention group compared to the control group. The need for inotropic support was higher in the intervention group (62.5% vs. 37.5%; P = 0.038). No other statistically significant outcomes were seen.

CONCLUSIONS: The present study showed that protocolised rotation of sedoanalgesic drugs in mechanically ventilated children can result in lower incidence as well as the duration of withdrawal syndrome.

PMID:40042783 | DOI:10.1007/s12098-025-05447-4

Ann Nucl Med. 2025 Mar 5. doi: 10.1007/s12149-025-02034-7. Online ahead of print.

ABSTRACT

OBJECTIVE: Using fluorine-18-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT), a multiparametric analysis will be performed in the differential diagnosis of patients with single solitary pulmonary lesion and extrapulmonary malignant tumor to discriminate between a second primary lung cancer (SPLC) and pulmonary metastasis (PM).

METHODS: This study retrospectively studied 84 patients with preoperative exams utilizing ¹⁸F-FDG PET/CT. Using complementing PET/CT parameters, a composite model was developed. A receiver operating characteristic (ROC) analysis assessed the combined model and each independent parameter’s differential diagnostic efficacies. Furthermore, this study investigated the improvement in diagnostic efficacy using other metrics, such as integrated discriminatory improvement (IDI) and net reclassification improvement (NRI).

RESULTS: The highest discriminative diagnostic value was obtained by the independent parameters energy (1,039,358.1 [95126.2-1,965,032.2] vs. 92,011.0 [45916.3-365,322.9], P = 0.001). In comparison to peak standardized uptake value (SUVpeak), total lesion glycolysis (TLG), energy, lobulation, and spiculation alone, the combined model (addition of these factors) significantly improved the differential diagnostic efficacy of SPLCs and PMs (sensitivity = 76.2%, specificity = 83.8%, area under the curve [AUC] = 0.826) and permitted reclassification using IDI = 0.176 (P < 0.001), 0.169 (P < 0.001), 0.127 (P < 0.001), and categorical NRI = 0.678 (P < 0.001), 0.637 (P < 0.001), and 0.592 (P < 0.001) compared to SUVpeak, TLG and energy separately. DeLong’s test revealed a statistically significant enhancement in ROC when compared to SUVpeak (Z = 2.372, P = 0.018), TLG (Z = 2.095, P = 0.036), and energy (Z = 2.318, P = 0.020).

CONCLUSION: Combining multiple parameters using ¹⁸F-FDG PET/CT may further improve distinguishing between SPLCs and PMs in patients with single solitary pulmonary lesion and extrapulmonary malignant tumor.

PMID:40042775 | DOI:10.1007/s12149-025-02034-7

Vet Res Commun. 2025 Mar 5;49(3):129. doi: 10.1007/s11259-025-10695-y.

ABSTRACT

A cross-sectional study was conducted to estimate the prevalence of chorioptic mange affecting the distal legs of horses in Belgium, focusing on the association between mange and chronic progressive lymphedema (CPL) in Belgian draft horses. Clinical examinations and skin scrapings were performed on the distal legs of 156 Belgian draft horses and 142 Belgian warmblood horses. In the Belgian draft horse breed, 144 (92.31%) horses were infested with Chorioptes bovis mites, and 126 (80.77%) displayed clinical signs of CPL. CPL prevalence in draft horses aged < 1 year was 17.86%, while mites were detected in 85.71% of this age group, with infestations observed as early as 6 days of age. In a subset of horses aged ≥ 1 year, CPL and mange prevalence amounted to 94.53% and 93.75%, respectively. In contrast, no mites or CPL were detected in the Belgian warmblood horses examined. Statistical analysis revealed a strong association between C. bovis and CPL (prevalence odds ratio: 7.37; p = 0.002). The prevalence of CPL was approximately twice as high in horses with mites compared to non-infested horses (prevalence ratio: 2.02). Furthermore, the prevalence risk difference of 42.36%, indicates a substantial absolute increase in CPL prevalence among infested horses. This study demonstrates the high prevalence of C. bovis and its breed-specific predilection in Belgian draft horses. The strong association between mange and CPL highlights the potential role of C. bovis as a contributing factor in CPL pathogenesis.

PMID:40042772 | DOI:10.1007/s11259-025-10695-y