Tag: nevin manimala

J Glob Health. 2025 Jan 31;15:04023. doi: 10.7189/jogh.15.04023.

ABSTRACT

BACKGROUND: The prevalence of antibiotic prescribing among total prescriptions, the percentage of combined antibiotic prescribing among prescriptions containing at least one antibiotic, and factors influencing hospital antibiotic prescribing are currently unknown. In this systematic review, we aimed to summarise antibiotic prescribing in hospitals worldwide and identify the associated factors.

METHODS: We searched PubMed/MEDLINE, Ovid/Embase, and the Web of Science for articles published between 1 January 2000 and 28 February 2023 that reported antibiotic prescribing in hospitals or the associated factors. Four reviewers independently screened studies, extracted data, and assessed the risk of bias. We used meta-analysis with random-effects models to estimate the pooled effect sizes.

RESULTS: We included 403 studies covering 93 economies. The pooled prevalence of antibiotic prescribing among total prescriptions was 34.3% (95% CI = 29.6-39.3) in outpatient settings and 47.7% (95% CI = 45.8-49.5) in inpatient settings. The pooled percentages of antibiotics in the ‘access’ group were 48.5% (95% CI = 34.5-62.7) in outpatient settings and 43.8% (95% CI = 39.2-48.5) in inpatient settings. Subgroup analysis showed the prevalence of antibiotic prescribing was significantly higher in low-income compared to high-income economies. Additionally, there was a rising trend of the prevalence in inpatient settings over time. The studies showed that patients’ gender, education level, health status, and physicians’ work experience were associated with hospital antibiotic prescribing.

CONCLUSIONS: The global prevalence of antibiotic prescribing in hospitals is high, with significant disparities across regions. Multifaceted measures with multi-sectoral cooperation are required, such as regulatory interventions, professional training for physicians, and public health education.

REGISTRATION: PROSPERO: CRD42022354076.

PMID:39883879 | DOI:10.7189/jogh.15.04023

J Int Med Res. 2025 Jan;53(1):3000605241311405. doi: 10.1177/03000605241311405.

ABSTRACT

OBJECTIVES: Central nervous system complications of acute pancreatitis (AP) can result in cerebral edema (CE). We assessed the risk of serious outcomes and health care features associated with CE in patients hospitalized with AP.

METHODS: We conducted a retrospective cohort study using the National Inpatient Sample database. Patients were divided into the AP-CE group that developed CE and the AP-only group that did not. Outcome data were analyzed using Stata software.

RESULTS: Among 543,464 patients hospitalized with AP, 220 (0.04%) developed CE. In multivariate analysis, primary outcomes included increased length of hospital stay (adjusted odds ratio [aOR] 10.1; 95% confidence interval [CI] 0.50-19.70), hospital charges (aOR USD 208,713; 95% CI 27,095-390,330), and risk of death (aOR 17.17; 95% CI 5.88-50.07) in the AP-CE group. Secondary outcomes showed patients with AP-CE had a significantly increased risk of serious complications, particularly cardiac arrest (aOR 64.24; 95% CI 24.27-170.02), and higher hospital resource utilization.

CONCLUSION: Patients with AP who develop CE face worse outcomes, including increased mortality risk, prolonged hospital stay, and greater resource utilization. Timely identification and effective management of CE in AP may reduce mortality and ease the health care burden associated with this neurological complication.

PMID:39883809 | DOI:10.1177/03000605241311405

Science. 2025 Jan 31;387(6733):464-467. doi: 10.1126/science.adw3275. Epub 2025 Jan 30.

ABSTRACT

A small statistical agency within the U.S. Department of Agriculture was torn apart under Trump-and then rebuilt. What did it lose, and what can other U.S. research agencies learn from it?

PMID:39883767 | DOI:10.1126/science.adw3275

Science. 2025 Jan 31;387(6733):522-527. doi: 10.1126/science.adr8891. Epub 2025 Jan 30.

ABSTRACT

Phase diagrams and crystallography are standard tools for studying structural phase transitions, whereas acquiring kinetic information at the atomistic level has been considered essential but challenging. The η-to-θ phase transition of alumina is unidirectional in bulk and retains the crystal lattice orientation. We report a rare example of a statistical kinetics study showing that for nanoparticles on a bulk Al(OH)₃ surface, this phase transition occurs nondeterministically through an ergodic equilibrium through the molten state, and the memory of the lattice orientation is lost in this process. The rate of the interconversion was found to be insensitive to the electron dose rate, and this process had a small Gibbs free energy of activation. These nondeterministic kinetics should be a key feature of crystal nucleation occurring in high-surface-energy regions of bulk crystals.

PMID:39883752 | DOI:10.1126/science.adr8891

PLoS One. 2025 Jan 30;20(1):e0305787. doi: 10.1371/journal.pone.0305787. eCollection 2025.

ABSTRACT

OBJECTIVES: Hearing impairment can have major impacts on behavior, educational attainment, social status, and quality of life. In congenital hypothyroidism, the incidence of hearing impairment reaches 35-50%, while in acquired hypothyroidism there is a reported incidence of 25%. Despite this, knowledge of the pathogenesis, incidence and severity of hearing impairment remains greatly lacking. The aim of our study was to evaluate hearing in patients with acquired hypothyroidism.

METHODS: 30 patients with untreated and newly diagnosed peripheral hypothyroidism (H) and a control group of 30 healthy probands (C) were enrolled in the study. Biochemical markers were measured, including median iodine urine concentrations (IUC) µg/L. The hearing examination included a subjective complaint assessment, otomicroscopy, tympanometry, transitory otoacoustic emission (TOAE), tone audiometry, and brainstem auditory evoked potential (BERA) examinations. The Mann-Whitney U test, Fisher’s Exact test and multivariate regression were used for statistical analysis.

RESULTS: The H and C groups had significantly different thyroid hormone levels (medians with 95% CI) TSH mU/L 13.3 (8.1, 19.3) vs. 1.97 (1.21, 2.25) p = 0 and fT4 pmol/L 10.4 (9.51, 11.1) vs. 15 (13.8, 16.7) p = 0. The groups did not significantly differ in age 39 (34, 43) vs. 41 (36,44) p = 0.767 and IUC 142 (113, 159) vs. 123 (101, 157) p = 0.814. None of the hearing examinations showed differences between the H and C groups: otomicroscopy (p = 1), tympanometry (p = 1), TOAE (p = 1), audiometry (p = 0.179), and BERA (p = 0.505).

CONCLUSIONS: We did not observe any hearing impairment in adults with acquired hypothyroidism, and there were no associations found between hearing impairment and the severity of hypothyroidism or iodine status. However, some forms of hearing impairment, mostly mild, were very common in both studied groups.

PMID:39883737 | DOI:10.1371/journal.pone.0305787

Biomacromolecules. 2025 Jan 30. doi: 10.1021/acs.biomac.4c01598. Online ahead of print.

ABSTRACT

2,2,6,6-Tetramethylpiperidine-N-oxyl (TEMPO) structures possess potent antioxidant activities for biomedical applications. TEMPO immobilization on hydrophilic polymers is a powerful strategy to improve its properties; however, it is mostly limited to reversible-deactivation radical polymerizations or postpolymerization approaches. Here, we immobilized TEMPO units on a hydrophilic poly(2-ethyl-2-oxazoline) (PEtOx) backbone through cationic ring-opening polymerization (CROP) of a new 2-oxazoline monomer bearing a methoxy-protected TEMPO 2-substituent with 2-ethyl-2-oxazoline (EtOx). The ratios of EtOx/TempOx were adjusted to optimize the nitroxide content while maintaining suitable water solubility of the resulting P(EtOx_x-stat-TempOx-O_y^•) copolymers upon deprotection. P(EtOx₄₀-stat-TempOx-O₁₀^•) and P(EtOx₃₃-stat-TempOx-O₁₇^•) showed a dual stimuli-responsive behavior and demonstrated significant radical-trapping activities in aqueous media. Particularly, a meaningful augmentation in the activity of TempOx-O^• was observed when it was immobilized as P(EtOx_x-stat-TempOx-O_y^•). The P(EtOx₄₀-stat-TempOx-O₁₀^•) system exhibited a longer-lasting activity in water, statistically comparable to that of the antioxidant ferrostatin-1 (Fer-1). Overall, this study introduces a biocompatible polymeric platform for TEMPO immobilization that augments its radical-trapping activity and offers controllable stimuli-responsive properties.

PMID:39883722 | DOI:10.1021/acs.biomac.4c01598

G3 (Bethesda). 2025 Jan 30:jkaf018. doi: 10.1093/g3journal/jkaf018. Online ahead of print.

ABSTRACT

Genetic studies of Plasmodium parasites increasingly feature relatedness estimates. However, various aspects of malaria parasite relatedness estimation are not fully understood. For example, relatedness estimates based on whole-genome-sequence (WGS) data often exceed those based on sparser data types. Systematic bias in relatedness estimation is well documented in the literature geared towards diploid organisms, but largely unknown within the malaria community. We characterise systematic bias in malaria parasite relatedness estimation using three complementary approaches: theoretically, under a non-ancestral statistical model of pairwise relatedness; numerically, under a simulation model of ancestry; and empirically, using data on parasites sampled from Guyana and Colombia. We show that allele frequency estimates encode, locus-by-locus, relatedness averaged over the set of sampled parasites used to compute them. Plugging sample allele frequencies into models of pairwise relatedness can lead to systematic underestimation. However, systematic underestimation can be viewed as population-relatedness calibration, i.e., a way of generating measures of relative relatedness. Systematic underestimation is unavoidable when relatedness is estimated assuming independence between genetic markers. It is mitigated when relatedness is estimated using WGS data under a hidden Markov model (HMM) that exploits linkage between proximal markers. The extent of mitigation is unknowable when a HMM is fit to sparser data, but downstream analyses that use high relatedness thresholds are relatively robust regardless. In summary, practitioners can either resolve to use relative relatedness estimated under independence, or try to estimate absolute relatedness under a HMM. We propose various tools to help practitioners evaluate their situation on a case-by-case basis.

PMID:39883524 | DOI:10.1093/g3journal/jkaf018

Pulmonology. 2025 Dec 31;31(1):2411806. doi: 10.1080/25310429.2024.2411806. Epub 2024 Oct 30.

ABSTRACT

New ultrathin bronchoscopes (UTBs) enable the inspection and biopsy of small airways, potentially offering diagnostic advantages in sarcoidosis. In this prospective study, patients with suspected sarcoidosis underwent airway inspection with a UTB. Observed airway abnormalities were categorised into six predefined patterns. UTB-directed small airway biopsies (SABs) were collected from the upper lobes following a standardised procedure. We evaluated the prevalence and patterns of SAAs, as well as the diagnostic yield of UTB-directed SAB. Among 79 participants, 65 (82.3%) were diagnosed with sarcoidosis. Small airway abnormalities were identified in 26/65 (40%) patients, predominantly in those with parenchymal involvement on CT compared to those with lymphadenopathy only (58.1% VS. 23.5%, P = 0.005). The diagnostic yield of SABs for detecting granulomas was significantly higher in patients with SAAs than in those without (65.4% VS. 23.1%, P = 0.001) and in patients with parenchymal disease on CT compared to those without (54.8% VS. 26.5%, P = 0.02). Notably, random biopsies taken under direct visualisation from small airway carinas revealed peribronchiolar parenchyma in 23% of the patients. Small airway abnormalities are prevalent in sarcoidosis patients with parenchymal involvement, and biopsying these abnormalities yields a high rate of granuloma detection.

PMID:39883493 | DOI:10.1080/25310429.2024.2411806

Pulmonology. 2025 Dec 31;31(1):2423541. doi: 10.1080/25310429.2024.2423541. Epub 2024 Nov 8.

ABSTRACT

Guidelines for the follow-up of pulmonary subsolid nodule (SSN) vary in terms of frequency and criteria for discontinuation. We aimed to evaluate the growth risk of SSNs and define appropriate follow-up intervals and endpoints. The immediate risk (IR) and cumulative risk (CR) of SSN growth were assessed using the Kaplan-Meier method according to nodule consistency and size. Follow-up plans were proposed based on optimal growth risk threshold of 5%. 892 SSNs, comprising 833 pure ground-glass nodules (pGGNs) and 59 part-solid nodules (PSNs) were included. For pGGNs ≤ 6.6 mm, the CR exceeded 5% at every 3-year interval in the first 9 years. For pGGNs measuring 6.6-8.8 mm and >8.8 mm, the IR remained above 5% for the first 2-7 years, and the 2-year CR for pGGNs measuring 6.6-8.8 mm in the 8th and 9th years achieved 6.66%. For PSNs, the IR peaked in the 4th year (44%) and then declined. Therefore, triennial follow-up for 9 years is recommended for pGGNs ≤ 6.6 mm, annual follow-up for 7 years followed by biennial follow-up for 2 years for pGGNs measuring 6.6-8.8 mm, annual follow-up for 7 years for pGGNs > 8.8 mm, and continuous annual follow-up until nodule growth for PSNs.

PMID:39883492 | DOI:10.1080/25310429.2024.2423541

JAMA Netw Open. 2025 Jan 2;8(1):e2457300. doi: 10.1001/jamanetworkopen.2024.57300.

ABSTRACT

IMPORTANCE: Rising prescription medication costs under Medicaid have led to increased procedural prescription denials by health plans. The effect of unresolved denials on chronic condition exacerbation and subsequent acute care utilization remains unclear.

OBJECTIVE: To examine whether procedural prescription denials are associated with increased net spending through downstream acute care utilization among Medicaid patients not obtaining prescribed medication following a denial.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used Medicaid claims data from 2022 to 2023 for patients at inpatient, outpatient, and pharmacy sites of care across 2 states (Virginia and Washington) and 2 independent health plans. Patients with at least 1 prescription denial in the study period (January 1 through July 31, 2023) were matched to those without denials in a given medication class, based on demographics, health plan data, chronic condition history, and health care utilization. Rates of and spending for physiologically related acute care visits in the 60 days following a medication fill or denial were compared for the study period.

MAIN OUTCOMES AND MEASURES: The main outcomes were all-cause acute care utilization and total medical spending (in 2023 US dollars per member per year [PMPY]) for principal diagnoses physiologically related to each medication class, in the 60 days following a medication fill or denial. Sensitivity analyses were performed to check for spurious associations or unmeasured confounders.

RESULTS: The 19 725 patients in this study had a median age of 41 (IQR, 29-55) years, and most (60.7%) were female. Patients had a mean (SD) of 3.3 (16.1) comorbidities, 1.0 (2.6) all-cause acute care visits, and 5.6 (7.8) primary care visits during the baseline period. Patients experiencing specific procedural prescription denials had a higher risk of physiologically related emergency department visits and hospitalizations compared with those without a denial in the subsequent 60 days (adjusted odds ratio, 1.40 [95% CI, 1.03-1.88] minimum vs 1.75 [95% CI, 1.39-2.20] maximum for exposure and control groups across the 7 medication classes with significant differences). Denials in 6 medication classes were associated with net total medical spending increases, ranging from $624 (95% CI, $435-$813) to $3016 (95% CI, $1483-$4550) in additional expense PMPY after accounting for both prescription and medical costs attributed to denials.

CONCLUSIONS AND RELEVANCE: The findings of this cross-sectional study suggest that although procedural prescription denials aimed to curb immediate drug costs, some denials prompted heightened acute care utilization and costs that outweighed the short-term prescription budget savings. Health plans should incorporate this potential unintended consequence when shaping prescription coverage policies. Future research should systematically review all medication classes across plans nationally.

PMID:39883462 | DOI:10.1001/jamanetworkopen.2024.57300