Tag: nevin manimala

Am J Clin Dermatol. 2025 Aug 26. doi: 10.1007/s40257-025-00977-1. Online ahead of print.

ABSTRACT

BACKGROUND: Erythrodermic psoriasis (EP) is a severe and rare variant of psoriasis. Clinical features include scaling and erythema affecting more than 75% of body surface area, associated with systemic symptoms such as lymphadenopathy, arthralgia, fever, fatigue, dehydration, serum electrolyte disturbances, and tachycardia, making this condition a potentially life-threatening disease. Differential diagnosis can be challenging, encompasses atopic dermatitis, cutaneous adverse drug reaction, and advanced cutaneous lymphoma. Following a correct diagnostic framing, appropriate systemic treatment must be initiated. Unfortunately, there are no recent up-to-date guidelines and standardized treatment options for EP are still lacking.

OBJECTIVE: To review the current reported systemic treatment options for EP.

METHODS: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and based on a search in MEDLINE, PubMed, Scopus, and Cochrane Library for articles in English from first available publication to 9 November 2024.

RESULTS: In all, 145 studies were included in the review. Case reports and case series are the main available work, reporting heterogeneous outcomes and effectiveness with nonbiologic and biologic systemic agents. Among non-biologic systemic treatments, methotrexate and cyclosporin are the most widely reported as treatment for EP, showing clinical response in over 60% of cases, with cyclosporine offering a faster onset of action and being suitable for acute management. Available randomized controlled trials include patients with EP treated with etretinate, infliximab, certolizumab-pegol (CZP), Ixekizumab, guselkumab, risankizumab, and deucravacitinib. However, these trials were not specifically designed for erythrodermic psoriasis, and the sample size of EP patients included is limited, resulting in reduced statistical power and limiting the reliability of the findings. Among TNF-α inhibitors, infliximab is the most reported agent, with data on 103 patients. Certolizumab pegol (CZP) also showed promising results, with PASI 75 achieved in over 80% of patients at 52 weeks. A retrospective analysis comparing infliximab, adalimumab, etanercept, ustekinumab, and efalizumab found TNF-α inhibitors to be superior to other biologic classes. Regarding IL-17 inhibitors, secukinumab is the second most frequently studied biologic, with 93 patients reported. It demonstrated rapid efficacy, achieving PASI 75 in more than 80% of patients by week 8. A head-to-head comparison with ixekizumab showed comparable outcomes. Among IL-23 inhibitors, risankizumab led to PASI 90 in over 75% of patients at week 16, suggesting high efficacy despite more limited data.

CONCLUSIONS: Non-biologic systemic drugs appear to be a rational first-line therapy, with cyclosporine showing good results in managing the acute phase and methotrexate being effective in maintaining remission. In the case of contraindications or treatment failure of traditional systemic therapies, among biologic drugs, the rapidity of action, safety, and limited evidence of efficacy are in favor of IL-17 inhibitors and risankizumab. However, the findings we report are limited by the evidence available in current literature, which is characterized by low statistical power.

PMID:40856907 | DOI:10.1007/s40257-025-00977-1

Clin Implant Dent Relat Res. 2025 Aug;27(4):e70085. doi: 10.1111/cid.70085.

ABSTRACT

OBJECTIVES: The primary aim of this study was to compare the histomorphometric characteristics of two different cortico-cancellous collagenic porcine bone (CCPB) formulations combined with a stabilizing agent used for alveolar ridge preservation (ARP), and the secondary aim was to evaluate and compare clinical and aesthetic outcomes of dental implants placed in augmented sites.

MATERIALS AND METHODS: This was a prospective, cohort-comparative study conducted on patients requiring a tooth extraction followed by ARP and subsequent implant placement. Tooth extractions were performed trying to reduce the surgical trauma as much as possible, and then ARP was performed using two different formulations of CCPB combined with a thermogel in different ratios (50:50 hand-mixed and 80:20 pre-mixed). After 4 months of healing, implant placement was performed, and a bone biopsy was retrieved from the surgical site for histomorphometric analyses. Implants were rehabilitated 3 months following placement with screw-retained crowns, then patients were re-evaluated 1 year following prosthetic loading.

RESULTS: We report the clinical and histomorphometric outcomes of 20 patients divided into the two study groups (10 patients per group). ARP performed with a hand-mixed biomaterial in a 50:50 ratio had higher percentages of newly formed bone (36.15% vs. 27.18%) when compared to a pre-mixed biomaterial in an 80:20 ratio, even though the difference was not statistically significant (p = 0.064). Implants placed in ARP-treated sites showed a very low mean marginal bone loss at the 1-year follow-up in both experimental groups (0.06 ± 0.15 mm in the 50:50 group and 0.25 ± 0.35 mm in the 80:20 group) with no statistically significant differences (p = 0.42), as well as the aesthetic outcomes assessed through the pink aesthetic score.

CONCLUSIONS: Both biomaterials showed effective and favorable outcomes, and the histomorphometric differences observed in our sample did not have any impact on the final clinical and aesthetic outcomes.

PMID:40853738 | DOI:10.1111/cid.70085

Ophthalmic Plast Reconstr Surg. 2025 Aug 23. doi: 10.1097/IOP.0000000000003018. Online ahead of print.

ABSTRACT

PURPOSE: The vasculature within the lower eyelid fat pads in bilateral lower eyelid blepharoplasty (BLLB) surgery is not well described. Characterization of vasculature may help prevent excessive bleeding by describing the locations where pre-emptive cautery may be indicated. We hypothesize that during BLLB, vasculature is most often encountered within the nasal fat pads compared with the central and lateral fat pads.

METHODS: Retrospective chart review of patients who underwent BLLB by a single surgeon was performed. Patients were included if they underwent transconjunctival BLLB with documentation of the encountered intrafat vasculature (I-FV). I-FV was defined as the vessels coursing through the nasal, central, and lateral fat pads and excludes the fine vasculature in the surrounding fat pad shea th. If I-FV was present, it was recorded as “mild,” “moderate,” or “large.” If no vasculature was observed, “minimal” vasculature was documented.

RESULTS: A total of 222 lower eyelids of 111 patients were included. About 78% (173/222) of lower nasal fat pads contained I-FV, which was statistically higher than the 15% (33/222) of lateral (p < 0.001) and 5% (10/222) of central fat pads (p < 0.001). Symmetry in the presence or absence of I-FV between the left and right sides was found in 65% (72/111) of patients.

CONCLUSIONS: During BLLB, I-FV is most prevalent in the nasal fat pads than in the central or lateral fat pads. We recommend extra caution and potential pre-emptive cautery when manipulating the nasal fat pad to prevent bleeding. The pattern of vasculature encountered on the first operative site may provide insight into the contralateral side.

PMID:40853729 | DOI:10.1097/IOP.0000000000003018

Pacing Clin Electrophysiol. 2025 Aug 25. doi: 10.1111/pace.70033. Online ahead of print.

ABSTRACT

INTRODUCTION: Premature ventricular complexes (PVC) are a common phenomenon observed in both normal and pathological heart conditions. However, they do not always behave in the same way. Different PVCs present with varying QRS morphologies, mechanisms, and origin sites. These differences may imply distinct prognoses. To date, the impact of the three-dimensional distribution of PVCs across the heart on the prognosis of ICD recipients has not been adequately investigated.

MATERIAL AND METHODS: We conducted an ambidirectional cohort study. Patients underwent two twelve-lead ambulatory ECG recordings during follow-up. The spatial distribution of PVCs was analyzed using the algorithm proposed by Kuchar et al. The impact of this spatial distribution on clinical variables was assessed using mixed generalized models.

RESULTS: Fifty-five patients were enrolled, with a mean follow-up time of 41.12 ± 13.48 months. All patients underwent two 12-lead ambulatory ECG recordings. The median PVC count was 91.5. PVCs were classified according to the algorithm proposed by Kuchar et al. PVCs arising from exit sites located in the intermediate left ventricle were associated with a higher number of therapies (odds ratio [OR]: 4.78; 95% confidence interval [CI], 1.19-19.26; p = 0.028) and prolonged QRS duration. PVCs with exit sites located in the septal region were associated with higher NYHA functional classes (OR: 2.22 [95% CI: 1.08-4.44]; p = 0.030). No statistically significant interaction was found between PVC topography and gender, number of ATP episodes, ATP success rate, or number of shock episodes.

CONCLUSION: The spatial distribution of PVCs influenced the prognosis of ICD recipients.

PMID:40853721 | DOI:10.1111/pace.70033

J Law Med. 2025 Jul;32(2):294-297.

ABSTRACT

Risk assessment is an important component of many areas of the law, including criminal law. Forensic psychologists and psychiatrists are sometimes called upon to provide evidence of the risk of future criminal activity through identifying and measuring risk factors with the aid of tools that use scales based on statistical or actuarial risk prediction. At present, there is an emphasis on “structured professional judgment” which combines the use of risk assessment tools with clinical judgment. However, the development of risk assessment tools by private companies using algorithms that are not released to the public raises both ethical and legal issues that are highlighted in this column.

PMID:40853693

JAMA Netw Open. 2025 Aug 1;8(8):e2526148. doi: 10.1001/jamanetworkopen.2025.26148.

ABSTRACT

IMPORTANCE: Transcranial direct current stimulation (tDCS) is emerging as a home-based intervention for neuropsychiatric conditions and cognitive enhancement. However, its effectiveness is limited by interindividual variability, as fixed-dose protocols have failed to account for anatomic differences influencing current delivery to targeted regions and treatment outcome. While computational modeling supports individualized dosing to improve consistency, experimental validation remains limited.

OBJECTIVE: To compare the behavioral and neurophysiologic outcomes of fixed-dose vs individualized-dose tDCS.

DESIGN, SETTING, AND PARTICIPANTS: This comparative effectiveness study using a within-participant, double-masked, crossover design was conducted from January 1, to March 31, 2024, at the National Institute of Mental Health and Neurosciences in India. Adult participants (aged 21-35 years) received 3 sessions of tDCS (fixed-dose, individualized-dose, and sham stimulation) in counterbalanced order. Individualized doses were calculated using a custom-built simulation toolbox.

MAIN OUTCOMES AND MEASURES: Behavioral performance was measured using reaction time during a rapid naming task. Neurophysiologic effects were assessed using motor-evoked potentials (MEPs) recorded before and after stimulation. Linear mixed-effects models were used for the statistical analysis.

RESULTS: Sixteen right-hand-dominant, bilingual English-Dravidian speakers (mean [SD] age, 23.1 [3.9] years; 8 female [50%]) were included. Individualized-dose tDCS associated with significantly greater reaction time improvement over sham (estimated marginal mean [SD]: before, 753.0 [41.1] ms; after, 619.0 [41.1] ms; change [Δ] = 133.6 ms; SE, 10.2 ms; z score ratio, 13.09) compared with fixed-dose tDCS (before, 694.0 [41.1] ms; after, 680.0 [41.1] ms; Δ = 14.6 ms; SE, 10.1 ms; z score ratio, 1.45). Variability was lower with individualized-dose stimulation (coefficient of variation, -1.14 vs 0.39 fixed vs individualized dose, respectively). Sex-stratified analyses showed that women had improvements with both fixed (Δ = 58.0 ms; P = .003) and individualized (Δ = 113.8 ms; P < .001) stimulation, while men had improvement only with individualized tDCS (Δ = 153.4 ms; P < .001). Seven participants (5 men and 2 women) converted from nonresponders to responders with individualized dosing. For MEPs, individualized-dose tDCS showed greater poststimulation amplitude increases over sham (β [SE], 0.91 [0.23]), although fixed-dose tDCS poststimulation amplitude was smaller, but significant (β [SE], 0.56 [0.23]; P = .02) and showed a higher percentage change (β [SE], 144.26% [55.74%]; P = .01) and reduced variability (coefficient of variation, -0.79 vs 1.12 [fixed]).

CONCLUSIONS AND RELEVANCE: In this comparative effectiveness study, dose-controlled tDCS was associated with consistent behavioral and neurophysiologic improvement, highlighting its translational importance in the treatment of neuropsychiatric disorders.

PMID:40853662 | DOI:10.1001/jamanetworkopen.2025.26148

JAMA Netw Open. 2025 Aug 1;8(8):e2526990. doi: 10.1001/jamanetworkopen.2025.26990.

ABSTRACT

IMPORTANCE: Cancer screening is a critical tool in cancer control, reducing cancer-specific mortality. However, it also has potential harms, including overdiagnosis and overtreatment. Measuring the effect of screening based on all-cause mortality is insensitive to both benefits and harms and requires substantially large sample sizes. Understanding the impact of screening on noncancer-related (off-target) mortality is essential for evaluating its overall benefit.

OBJECTIVE: To assess the association between cancer screening and off-target mortality by comparing mortality rates between screened and unscreened populations based on randomized clinical trials (RCTs).

DATA SOURCES: The analysis examined all RCTs included in a previously published (August 28, 2023) meta-analysis of cancer screening trials that included the end point of all-cause mortality in addition to targeted cancer mortality.

STUDY SELECTION: All RCTs included in the previous meta-analysis were included. The latest search in that meta analysis was conducted on October 12, 2022, with no language or publication date restrictions.

DATA EXTRACTION AND SYNTHESIS: The study followed relevant portions of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Two authors independently extracted data, and a third author verified those data. Off-target mortality was analyzed using rate ratios (RRs) and 95% CIs via a fixed-effects model. Heterogeneity was assessed using the I2 statistic.

MAIN OUTCOME AND MEASURES: The primary outcome was off-target mortality, defined as deaths with a cause that was not the targeted cancer.

RESULTS: A total of 17 RCTs (8 of colorectal, 3 prostate, 3 lung, 2 breast, and 1 multiple cancers) including 1 305 924 participants with 18 508 192 person-years of follow-up were included. Screening did not significantly increase off-target mortality (RR, 1.00; 95% CI, 1.00-1.01); the overall increase in off-target mortality was 0.2% (95% CI, -0.5% to 0.9%). There was no evidence of heterogeneity between trials (I2 = 0.00%; Cochran Q = 14.96, df = 18; P = .66). The trial-specific RRs ranged from 0.89 (95% CI, 0.69-1.15) to 1.09 (95% CI, 0.98-1.22), with all 95% CIs including 1. Targeted cancer deaths accounted for 2.6% to 33.1% of all deaths, depending on the cancer type.

CONCLUSIONS AND RELEVANCE: These findings show that randomization to cancer screening was not associated with more than a very small increase in noncancer-related mortality, with the 95% CI excluding an increase of greater than 1%. The findings emphasize the importance of evaluating targeted and off-target mortality separately rather than relying solely on all-cause mortality.

PMID:40853661 | DOI:10.1001/jamanetworkopen.2025.26990

JAMA Netw Open. 2025 Aug 1;8(8):e2528844. doi: 10.1001/jamanetworkopen.2025.28844.

ABSTRACT

IMPORTANCE: Diagnosis of breast and gynecologic cancers may hamper employment; little is known about who is at greater risk of resignation.

OBJECTIVE: To examine whether a breast or gynecologic cancer diagnosis is associated with resignation in working women and to identify high-risk subpopulations.

DESIGN, SETTING, AND PARTICIPANTS: This matched cohort study included women aged 15 to 58 years insured by the Japan Health Insurance Association. From April 2017 to March 2023, women newly diagnosed with breast, cervical, uterine, or ovarian cancer were identified and matched in a 1:10 ratio to working women without these cancers.

EXPOSURE: Cancer diagnosis was based on International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10).

MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause resignation, and the secondary outcome was a composite of resignation and death, both assessed during a 2-year follow-up. Stratified Cox proportional-hazards models were applied, with multiple imputation and covariate adjustments. Subgroup analyses by prespecified covariates assessed effect size moderation and interactions between exposure and these covariates.

RESULTS: The study included 99 964 women with cancer, including 59 452 women with breast cancer (median [IQR] age, 48 [44-53] years), 14 713 women with cervical cancer (median [IQR] age, 46 [39-51] years), 16 933 women with uterine cancer (median [IQR] age, 49 [44-53 years]), and 8866 women with ovarian cancer (median age [IQR] age, 47 [40-52] years), as well as 999 640 matched controls (594 520 for the breast cancer cohort, 147 130 for the cervical cancer cohort, 169 330 for the uterine cancer cohort, and 88 660 for the ovarian cancer cohort). Most women with cancer were working in the medical, health care, or welfare sector (32 123 women [32.1%]). During follow-up, resignation rates were significantly higher for women with cancer vs controls (breast cancer: 10 820 women [18.2%] vs 97 892 women [16.5%]; hazard ratio [HR], 1.18; 95% CI, 1.16-1.20; cervical cancer: 3296 women [22.4%] vs 27 476 women [18.7%]; HR, 1.31; 95% CI, 1.26-1.36; uterine cancer: 3161 women [18.7%] vs 27 786 women [16.4%]; HR, 1.24; 95% CI, 1.19-1.29; ovarian cancer: 2004 women [22.6%] vs 15 847 women [17.9%]; HR, 1.44; 95% CI, 1.37-1.51). Regarding the composite outcome of resignation and death, there was an increased risk for all cohorts, ranging from an HR of 1.25 (95% CI, 1.22-1.27) for breast cancer to 1.81 (95% CI, 1.73-1.89) for ovarian cancer. Among all 4 cancer cohorts, resignation risk was higher among women with older age, lower income, and a history of depression.

CONCLUSIONS AND RELEVANCE: In this cohort study using a nationwide health claims database in Japan, breast and gynecologic cancers were associated with a higher resignation risk, especially among those with older age, lower income, and depression history. These findings suggest that developing targeted support interventions may benefit women at high resignation risk after a cancer diagnosis.

PMID:40853656 | DOI:10.1001/jamanetworkopen.2025.28844

Work. 2025 Aug 25:10519815251370711. doi: 10.1177/10519815251370711. Online ahead of print.

ABSTRACT

BackgroundThe burnout syndrome has been described mainly among the working population. However, it is observed that students experience burnout syndrome as well, and that physician burnout may already start during the studies od medicine. Findings also show increased problem of alcohol consumption among medical students.ObjectiveDetermine the risk of burnout in the sample of medical students, and to evaluate their alcohol consumption, as well as to determine whether there is any association between these two entities.MethodsParticipants were 290 students of Faculty of Medicine, from all six study years. Maslach Burnout Inventory – Student Survey (MBI-SS) was used to evaluate the degree of burnout. Alcohol Use Disorder Identification Test (AUDIT) was used to evaluate alcohol consumption.ResultsIn the MBI-SS subcategory of Emotional Exhaustion, 81% reported high burnout risk. Results of low burnout risk in the subcategory of Cynicism, gradually decreased during the course of studies. The highest medium burnout risk was reported in the subcategory of Academic Efficacy, at 45.20%. The number of students belonging to the minimum risk level, Zone 1, on the AUDIT test, gradually decreased as the years of study increased. There is a slightly statistically significant, positive correlation between Emotional Exhaustion and alcohol use (p ≤ 0.05), as well as between Cynicism and alcohol use (p ≤ 0.05).ConclusionHigh burnout levels and their association with alcohol use in medical students imply a further investigation of these complex and harmful issues, and raise concern for the mental well-being of the future medical practitioners.

PMID:40853638 | DOI:10.1177/10519815251370711

World J Pediatr Congenit Heart Surg. 2025 Aug 25:21501351251360692. doi: 10.1177/21501351251360692. Online ahead of print.

ABSTRACT

Background: The World Database for Pediatric and Congenital Heart Surgery (WDPCHS) was utilized to define the incidence of one-year mortality and identify associated risk factors following surgery for congenital heart disease. Methods: The WDPCHS was queried from January 2017 to September 2022 for all tier 1 surgeries submitted to the database. Out-of-hospital death was defined as a death between 30 days postoperatively and up to one year. Preoperative risk factors and other demographics were evaluated. Chi-square test was used to evaluate associations, a multivariable logistic regression model was performed and the P value for statistical significance was set at <.05. Results: Among 9764 patients alive at hospital discharge (or 30 days), overall, one-year mortality was 1.47% (n = 144). Mortality was highest in STAT 5, 22.88% (27/118) (P < .0001). Risk factors with a higher incidence of one-year mortality included: non-Trisomy 21 genetic syndromes 6.38% (18/282), more than three preoperative risk factors 12.12% (16/132), more than three postoperative complications 9.81% (37/377) all P < .0001. Highest mortality by procedure was seen with the Norwood procedure 22.88% (27/118) and truncus arteriosus repair 8.97% (7/78), both P < .0001. By multivariable analysis, the risk of one-year mortality remained significantly higher with more than three preoperative risk factors (OR 5.85, 95% CI 3.12-10.96), non-Trisomy 21 chromosomal abnormalities (OR 3.04, 95% CI 1.75-5.29), and STAT 5 cases (OR 28.4, 95% CI 15.02-53.71). Conclusions: Based on these findings, there are certain risk factors (multiple preoperative risk factors, chromosomal abnormalities, STAT 5 category) that warrant targeted increased surveillance to improve one-year outcomes.

PMID:40853632 | DOI:10.1177/21501351251360692