Tag: nevin manimala

JAMA Netw Open. 2025 Sep 2;8(9):e2531341. doi: 10.1001/jamanetworkopen.2025.31341.

ABSTRACT

IMPORTANCE: Pre-exposure prophylaxis (PrEP) is a proven effective intervention to reduce the risk for HIV infection. Critically, changes in policies that lead to increased out-of-pocket PrEP costs or that decrease access to proximate PrEP locations could reduce PrEP coverage, resulting in excess HIV infections and costs.

OBJECTIVE: To estimate how decreases in PrEP coverage that would be likely results of federal policy changes may be associated with new HIV infections and their costs.

DESIGN, SETTING, AND PARTICIPANTS: In this economic evaluation, US population-based data sources were used to describe population-level PrEP use and new diagnoses under different hypothetical changes in PrEP coverage. Estimations of excess HIV infections under different policy changes were conducted using parameters from a previously published ecological model of the association between PrEP coverage and new HIV infections. Data on PrEP prescriptions from January 1, 2012, to December 31, 2022, and estimates from a previously reported original clinical model, which described decreases in HIV diagnoses associated with increases in population PrEP use, were analyzed. Data were analyzed from February 25 to May 23, 2025.

EXPOSURE: Change in PrEP coverage.

MAIN OUTCOMES AND MEASURES: Estimated change in new HIV infections under different assumed reductions in PrEP coverage, costs of treatment for avoidable HIV infections, and net costs of avoidable infections after accounting for costs of PrEP medications. We also estimated increases in new HIV diagnoses associated with hypothesized levels of decreasing PrEP coverage, and the costs of treating infections not averted.

RESULTS: In 2012, there were 9565 PrEP users in the US; they were predominately male (5857 [61.2%]), and 7109 (74.3%) were aged 25 to 54 years. By race and ethnicity, 1235 PrEP users (12.9%) were Hispanic, 1857 (19.4%) were non-Hispanic Black, and 5404 (56.5%) were non-Hispanic White. Based on analyses of data from a census of US PrEP users including 17 333 732 person-years of time using PrEP, an absolute 3.3% annual reduction in PrEP coverage during the next 10 years (eg, 2023 to 2033) would result in 8618 avoidable HIV infections, with lifetime medical costs of $3.6 billion (discounted) for treatment.

CONCLUSIONS AND RELEVANCE: In this economic evaluation estimating effects of the possible health care policy changes on HIV transmission, findings suggest that even modest reductions in PrEP coverage would result in thousands of avoidable HIV infections and billions of dollars of increases in net health care costs.

PMID:40932715 | DOI:10.1001/jamanetworkopen.2025.31341

JAMA Netw Open. 2025 Sep 2;8(9):e2531366. doi: 10.1001/jamanetworkopen.2025.31366.

ABSTRACT

IMPORTANCE: Although the use of anticoagulants or antiplatelets is known to increase bleeding risk, there is limited evidence on whether they contribute to a higher incidence of intraocular hemorrhage in patients with age-related macular degeneration (AMD).

OBJECTIVE: To examine the association between anticoagulant or antiplatelet use and clinically important intraocular hemorrhage requiring vitrectomy in patients with exudative AMD.

DESIGN, SETTING, AND PARTICIPANTS: In this nationwide, population-based, retrospective cohort study using the Korean Health Insurance Review and Assessment Service database, 149 620 patients with exudative AMD older than 40 years were identified from May 1, 2014, to April 30, 2023.

EXPOSURES: Use of anticoagulants or antiplatelets.

MAIN OUTCOMES AND MEASURES: The main study outcome was clinically important intraocular hemorrhage requiring vitrectomy. The analysis used a retrospective, longitudinal cohort study design using Cox proportional hazards regression analysis and Kaplan-Meier survival analyses (exposure vs nonexposure group) and a cross-sectional case-control study design using logistic regression analysis (hemorrhage vs no hemorrhage group). All analyses were adjusted for demographics and comorbidities.

RESULTS: A total of 94 449 patients (mean [SD] age, 71.8 [9.8] years; 55 677 [59.0%] male) were included in the cohort study, and 8110 patients (mean [SD] age, 70.2 [9.6] years; 5090 [62.8%] male) were included in the case-control study. In the Cox proportional hazards regression analysis, anticoagulant or antiplatelet exposure was associated with a higher risk of intraocular hemorrhage requiring vitrectomy (adjusted hazard ratio, 1.15; 95% CI, 1.02-1.29). The incidence probability of intraocular hemorrhage requiring vitrectomy was higher in the exposure group than the nonexposure group. In the logistic analysis, the use of anticoagulants (adjusted odds ratio [aOR], 1.88; 95% CI, 1.45-2.44) or antiplatelets (aOR, 1.37; 95% CI, 1.19-1.57) was associated with intraocular hemorrhage requiring vitrectomy. The combined use of anticoagulants and antiplatelets showed the highest aOR (aOR, 2.28; 95% CI, 1.65-3.15). Higher medication adherence was also associated with a higher aOR of intraocular hemorrhage (aOR, 1.69; 95% CI, 1.45-1.97).

CONCLUSIONS AND RELEVANCE: In this nationwide cohort study of patients with exudative AMD, antithrombotic medications were associated with a higher risk of intraocular hemorrhage requiring vitrectomy. These results suggest the need for proactive communication and tailored monitoring strategies to help minimize such sight-threatening complications.

PMID:40932714 | DOI:10.1001/jamanetworkopen.2025.31366

Crit Care Explor. 2025 Sep 11;7(9):e1307. doi: 10.1097/CCE.0000000000001307. eCollection 2025 Sep 1.

ABSTRACT

IMPORTANCE: Physical therapy (PT) interventions for patients supported with extracorporeal membrane oxygenation (ECMO) is thought to help preserve independence, but the impact of PT frequency on ECMO recovery is not well understood.

OBJECTIVES: To explore the relationship between PT frequency and functional outcomes in patients supported with ECMO.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective, single-center study of patients supported with ECMO at a large volume ECMO referral center. Patients were grouped by PT frequency (high < 3 d, moderate 3-7 d, and low > 7 d between sessions).

MAIN OUTCOMES AND MEASURES: The primary outcome was the final Activity Measure for Post-Acute Care (AM-PAC) “6-Clicks” Basic Mobility Score. For the subgroup of patients discharged alive, a multivariable logistic model was used to understand what affected a patient’s odds of a final AM-PAC score greater than or equal to 18, indicating functional independence.

RESULTS: One hundred forty-two subjects were included with a median age of 48 years (interquartile range, 35-58 yr). Patients received venovenous (55%, n = 78/142) or venoarterial (45%, n = 64/142) ECMO. Of the cohort, 61% (n = 86/142) were discharged alive. A final AM-PAC score of greater than or equal to 18 was seen in 30% of patients (n = 43/142) before discharge. High- and moderate-frequency groups were more likely to survive to hospital discharge (76%, n = 22/29 and 75%, n = 38/51 vs. 44%, n = 27/62; p = 0.001). Controlling for age, sex, PT frequency, and the number of PT sessions after ECMO, logistic regression showed the number of PT sessions on ECMO (odds ratio, 1.13; 95% CI, 1.02-1.28) significantly impacted the odds of a final AM-PAC score greater than or equal to 18.

CONCLUSIONS AND RELEVANCE: In patients supported with ECMO, high- and moderate-frequency of PT and PT on ECMO were associated with improved functional outcomes at hospital discharge.

PMID:40932702 | DOI:10.1097/CCE.0000000000001307

J Interpers Violence. 2025 Sep 11:8862605251360030. doi: 10.1177/08862605251360030. Online ahead of print.

ABSTRACT

Families living in heavily policed and incarcerated communities bear a disproportionate burden of intimate partner violence (IPV), with serious consequences for children. Incidents of IPV may bring parents into contact with the criminal legal system, but parents’ criminal legal system contact (whether for IPV or other charges) may also precipitate IPV. This study examines the bidirectional relationship between inter-parental IPV and fathers’ contact with the criminal legal system, using data collected from young parents in the Future of Families and Child Well-being Study (N = 4,898) when their children were ages 1, 3, 5, and 9. Autoregressive cross-lagged model results indicate that paternal incarceration (for any charge) predicts later maternal IPV victimization and that maternal IPV victimization predicts later paternal incarceration. Observed effects diminish over the child’s early years and are statistically insignificant by age 9. Beta values indicate that incarceration is a stronger predictor of later IPV than IPV is of later jailing or imprisonment. Extending prior empirical work on IPV and the legal system-traditionally focused more on outcomes of domestic violence calls for service, protective orders, and domestic violence criminal adjudication than on IPV-impacted families’ broader encounters with the legal system-this study suggests that in a time of mass incarceration, fathers’ broader criminal legal system contact may exacerbate early childhood IPV exposure.

PMID:40932691 | DOI:10.1177/08862605251360030

Radiol Med. 2025 Sep 11. doi: 10.1007/s11547-025-02089-6. Online ahead of print.

ABSTRACT

PURPOSE: We aimed to systematically review the studies that utilized deep learning (DL)-based networks to predict hematoma expansion (HE) in patients with intracerebral hemorrhage (ICH) using computed tomography (CT) images.

METHODS: We carried out a comprehensive literature search across four major databases to identify relevant studies. To evaluate the quality of the included studies, we used both the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and the METhodological RadiomICs Score (METRICS) checklists. We then calculated pooled diagnostic estimates and assessed heterogeneity using the I² statistic. To assess the sources of heterogeneity, effects of individual studies, and publication bias, we performed subgroup analysis, sensitivity analysis, and Deek’s asymmetry test.

RESULTS: Twenty-two studies were included in the qualitative synthesis, of which 11 and 6 were utilized for exclusive DL and combined DL meta-analyses, respectively. We found pooled sensitivity of 0.81 and 0.84, specificity of 0.79 and 0.91, positive diagnostic likelihood ratio (DLR) of 3.96 and 9.40, negative DLR of 0.23 and 0.18, diagnostic odds ratio of 16.97 and 53.51, and area under the curve of 0.87 and 0.89 for exclusive DL-based and combined DL-based models, respectively. Subgroup analysis revealed significant inter-group differences according to the segmentation technique and study quality.

CONCLUSION: DL-based networks showed strong potential in accurately identifying HE in ICH patients. These models may guide earlier targeted interventions such as intensive blood pressure control or administration of hemostatic drugs, potentially leading to improved patient outcomes.

PMID:40932678 | DOI:10.1007/s11547-025-02089-6

Spine Deform. 2025 Sep 11. doi: 10.1007/s43390-025-01175-z. Online ahead of print.

ABSTRACT

PURPOSE: Anterior vertebral body tethering (VBT) is a viable option for children with idiopathic scoliosis. Treating double major curves with bilateral VBT may allow patients to avoid spinal fusion while improving the coronal Cobb angle.

METHODS: A single center retrospective study was conducted to identify all patients who underwent bilateral VBT (lowest instrumented vertebra L3 or 4) with minimum 2-year follow-up. Clinical and radiographic parameters were collected, including complications and reoperations. Statistical analysis was performed utilizing Students’ t-test.

RESULTS: Seventy-three patients (67 female, 91.8%) underwent bilateral VBT with mean follow-up of 4.2 ± 1.5 years. Preoperatively, all patients were skeletally immature (age 12.7 ± 1.2 years with a Sanders score of 3.3 ± 0.8 and Risser grade of 0.6 ± 0.8). The preoperative lumbar Cobb angle was 51.1° ± 7.9° which corrected to 20.7° ± 11.3° at most recent follow-up (p < 0.01) and the thoracic Cobb angle measured 52.3° ± 9.0° which corrected to 27.0° ± 11.3° (p < 0.01) at most recent follow-up. At latest follow-up, 51/73 (69.9%) had a thoracic Cobb angle <30°, 59/73 patients (80.8%) had a lumbar Cobb angle <30°, and 47/73 (64.4%) had both thoracic and lumbar Cobb angles <30°. 15 patients (20.5%) underwent 17 reoperations with overcorrection being the most common indication (8/17, 47.1%). Broken tethers led to reoperation in 3/17 instances (17.6%). Five patients (6.8%) eventually required posterior spinal fusion.

CONCLUSIONS: Bilateral VBT is a safe procedure and may be a viable option for patients with double curves, with the majority of curves measuring <30° at most recent follow-up. Surgeons can use these data to help patients and parents make informed decisions regarding treatment options.

PMID:40932668 | DOI:10.1007/s43390-025-01175-z

Nervenarzt. 2025 Sep 11. doi: 10.1007/s00115-025-01877-9. Online ahead of print.

ABSTRACT

With the introduction of the 11th revision of the World Health Organization (WHO) “International Statistical Classification of Diseases and Related Health Problems” (ICD-11), structural and content-related adjustments were made to the diagnostic guidelines for affective disorders, which are presented in this review article. The update has resulted in some changes to the diagnostic classification of affective disorders, based on the American Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). The ICD-11 assigns depressive symptoms to so-called clusters, the main symptoms of depressed mood and joylessness can be accompanied by cognitive, behavioral or neurovegetative symptoms. In the case of remission of depressive episodes, the ICD-11 distinguishes between partial and complete remission. A persistent depressive disorder is present if the depressive episode lasts continuously for more than 2 years. In future, bipolar disorder will be divided into type I and type II. Manic episodes can still only be coded in the context of bipolar disorders and cannot be diagnosed as an independent, separate disorder. The concept of persistent affective disorders in the ICD-10 is abandoned, dysthymia is categorized as a depressive disorder and cyclothymia as a bipolar disorder.

PMID:40932648 | DOI:10.1007/s00115-025-01877-9

J Neurooncol. 2025 Sep 11. doi: 10.1007/s11060-025-05218-3. Online ahead of print.

ABSTRACT

PURPOSE: Surveillance of patient outcomes with real-world data is essential to uncover regional disparities in clinical practice or quality of care. This study explored survival differences among glioblastoma patients in Norway and investigated the role of demographic and treatment factors.

METHODS: We analyzed real-world data from the Norwegian Cancer Registry on 1158 adults with histologically confirmed glioblastoma during 2019-2023. Surgical treatment rates per 100,000 inhabitants per region (South-East, West, Mid, North) were compared using adjusted Poisson models. Full treatment included surgical resection, radiotherapy (≥ 55 Gy for ≤ 70 years; ≥30 Gy for > 70 years), and temozolomide. Standardized survival was estimated with flexible parametric models, standardized for age, sex, year, and distances to treatment facilities.

RESULTS: Patients from the North were older and lived further from treatment centers. For patients aged 18-70, treatment and survival did not significantly differ across regions; national median standardized survival was 14.4 months (95%CI:13.6-15.2). For elderly patients (71-89 years), the North demonstrated a higher surgical treatment rate (rate ratio = 1.32; 95%CI = 0.99-1.77), but lesser use of postoperative radiotherapy and temozolomide. Median standardized survival for elderly patients in the North was 4.5 months (95%CI: 3.5-5.7) versus 7.7 (6.9-8.6) months nationally. Early mortality was particularly high for elderly patients in the North, yet those surviving beyond six months matched other regions’ survival probability.

CONCLUSION: Lower glioblastoma survival in the North was associated with higher early mortality among elderly patients, likely due to selecting frailer patients for surgery, who less often subsequently received anti-neoplastic treatment.

PMID:40932639 | DOI:10.1007/s11060-025-05218-3

Psychol Res. 2025 Sep 11;89(5):141. doi: 10.1007/s00426-025-02153-w.

ABSTRACT

Congenital amusia is a neurodevelopmental disorder resulting in impaired pitch perception and memory. Here we investigated whether participants with congenital amusia have deficits in temporal processing of auditory information, in addition to pitch processing deficits. Individuals with amusia (n = 19) and matched controls (n = 21) were presented with sequences of five tones in which one tone was sometimes shifted in pitch or in time, and we adaptively assessed psychophysical thresholds for detecting these shifts. Pitch thresholds of the amusia group were higher (i.e., worse) than those of the control group as expected, and, crucially, time thresholds were too, although the group difference for time thresholds was smaller. Across participants, time thresholds correlated with pitch thresholds. Principal component analysis revealed that all pitch- and time-related variables (thresholds and amusia battery scores) were correlated to one component that also distinguished between amusics and controls; whereas a second component captured additional variability on the time task. Simulations suggest that prior studies had not found these time processing deficits because they had less statistical power, likely due to smaller sample sizes. The observed time processing deficit is in agreement with amusic individuals’ subjective reports about their difficulties following the rhythm of the music. These data suggest that amusia deficits are not restricted to pitch, but extend to the time domain, yet with a smaller effect size, and at least when the stimuli have a clear pitch content, such as for tone sequences or music.

PMID:40932635 | DOI:10.1007/s00426-025-02153-w

Breast Cancer Res Treat. 2025 Sep 11. doi: 10.1007/s10549-025-07794-4. Online ahead of print.

ABSTRACT

INTRODUCTION: This study examines the intermittent discontinuation of palbociclib based on its availability and its clinical outcomes during the Lebanese economic crisis in patients with metastatic Breast Cancer (BC) HR+ between the years 2019 and 2023.

METHODS: This study carries out a retrospective analysis on 46 patients treated with palbociclib – Letrozole during the years 2019 and 2023 in Lebanon. It used descriptive tables and figures to summarize demographic, clinical, and outcome characteristics. It analyzed the data using Student T test for parametric variables, Wilcoxon and Kruskal-Wallis tests for non-parametric variables, and Chi-squared and Fisher tests for qualitative variables. Pearson’s correlation and regression models were used to associate between the intermittent administration of palbociclib and its clinical outcomes.

RESULTS: Our sample had a mean age of 59.33 +/-13.27 years. 87% had ductal carcinomas and 13% had lobular carcinomas. 52.2% of patients had treatment for their metastases prior to palbociclib, and a discontinuation was observed in 63.1 %. Intermittent discontinuation is associated with advanced age (p=0.048) and statistically reduces PFS (p=0.026). The intermittent drug intake also affects PFS (p=0.03) but has no effect on the disease progression.

CONCLUSION: This study is the only research in the world focused on intermittent intake of palbociclib. The intermittent discontinuation of palbociclib is influenced by age and affects the PFS. These results highlight the significance of adherence and protocol compliance.

PMID:40932628 | DOI:10.1007/s10549-025-07794-4