Tag: nevin manimala

J Diabetes. 2025 Jun;17(6):e70108. doi: 10.1111/1753-0407.70108.

ABSTRACT

AIMS: In patients with new onset type 2 diabetes, this study aimed to analyze glucose-lowering medication use patterns between 2014 and 2022.

MATERIALS AND METHODS: This retrospective study included adults with incident type 2 diabetes in the University of California Health System between 2014 and 2022. We determined medications used within 1 year of diagnosis and evaluated statistical evidence of use pattern changes via Mann-Kendall trend tests. Four categories of high-risk patients requiring cardio-kidney-metabolic protection were also evaluated in stratified analyses based on 2024 ADA guidelines.

RESULTS: Of 40 150 patients with incident type 2 diabetes, 38.5% initiated glucose-lowering medication within 1 year. Metformin remained the most used medication from 2014 to 2022. From 2014 to 2022, usage of GLP-1 receptor agonists and SGLT-2 inhibitors increased exponentially. GLP-1 receptor agonist use increased from below 2.5%-21%. While SGLT-2 inhibitor use increased from less than 2.5%-14%. This growth coincided with a decline in sulfonylurea usage. Among high-risk, insulin was most prevalent in those with heart failure or chronic kidney disease. However, usage of insulin declined overall in all groups. Utilization of SGLT-2 inhibitors was particularly high in patients with prior heart failure.

CONCLUSIONS: In adults with new onset type 2 diabetes, GLP-1 receptor agonist and SGLT-2 inhibitor utilization has markedly increased, coordinating with evolving guidelines that emphasize cardiovascular and chronic kidney disease management. However, overall adoption rates of these medications remain low based on indicated populations. Sulfonylurea use declined while metformin remains the most frequently initiated treatment.

PMID:40464139 | DOI:10.1111/1753-0407.70108

Emerg Med Australas. 2025 Jun;37(3):e70081. doi: 10.1111/1742-6723.70081.

ABSTRACT

INTRODUCTION: Emergency departments (ED) in Australia have experienced an increase in patient presentations. To address this demand, we introduced phlebotomists at ED triage seeking to reduce ED waiting and disposition times. We report the impact of this intervention.

METHOD: Using a quantitative retrospective comparative study design guided by the STROBE checklist, we investigated the impact on ED performance before and after the introduction of phlebotomists (the intervention). Data from two periods-T1 (January-June 2021) and T2 (January-June 2023) were obtained and analysed for all ED presentations.

RESULTS: A total of 90,020 patients were included (T1: 46,639; T2: 43,381). Post-intervention improvements included an increase in short stay unit-admissions from triage (3.1% vs. 5.9%, p < 0.001) and a decrease in the proportion of patients transferred to a cubicle from the waiting room (T1: 78.8%; T2: 76.4%). However, patients who left the ED before treatment was completed (known as ‘Did not Wait’) rose significantly (9.8% vs. 11.5%) as did waiting room times (80.02 vs. 112.91 min). Overall, ED length of stay (EDLOS) increased significantly (mean T1: 305.1 to T2: 319.4 min; p < 0.001). There were significant increases in blood tests (T1: 52.0% vs. T2: 59.9%) and ECGs (16.5% vs. 19.1%) performed.

CONCLUSION: The introduction of phlebotomists at triage failed to reduce waiting, treatment and disposition times and increased the number of investigations performed with an overall increase in EDLOS. We observed an increase in the number of patients directed from the waiting room to the short stay unit and fewer patients transferred from the waiting room to an ED cubicle.

PMID:40464127 | DOI:10.1111/1742-6723.70081

Am J Med Genet A. 2025 Jun 4:e64143. doi: 10.1002/ajmg.a.64143. Online ahead of print.

ABSTRACT

The main objective of this study is to establish normative craniocervical junction parameters in pediatric patients with achondroplasia and evaluate differences between patients with and without symptoms of foramen magnum stenosis (FMS) using static and dynamic MRI. A retrospective chart review identified 80 pediatric patients with achondroplasia evaluated at a single institution between 2007 and 2023. Patients were categorized into two groups based on clinical presentation: those with symptoms suggestive of FMS (FMSS group) and those who underwent imaging for unrelated indications (Non-FMSS group). Craniocervical MRI parameters, including minimal canal and cord diameters, atlanto-dental interval (ADI), clival-axial angle (CXA), and space available for the cord (SAC), were measured in neutral, flexion, and extension positions. Statistical comparisons were performed using t-tests, with p-values < 0.05 considered significant. A total of 80 neutral and 69 flexion-extension MRIs were analyzed. Patients in the FMSS group displayed significantly smaller minimal cord and canal diameters across all positions compared to the Non-FMSS group (p < 0.001). SAC measurements were also significantly smaller in the FMSS group. Changes in ADI between flexion and extension were modest and not clinically significant. Interobserver reliability was high across all measured parameters. This study provides preliminary normative data for craniocervical junction parameters in pediatric patients with achondroplasia, highlighting key differences between those with and without symptoms of foramen magnum stenosis. The findings suggest that SAC, minimal cord, and canal diameters may serve as valuable measurements for evaluating cervical stenosis in this population. Further research with larger cohorts and standardized protocols is necessary to validate these parameters.

PMID:40464123 | DOI:10.1002/ajmg.a.64143

J Cosmet Dermatol. 2025 Jun;24(6):e70231. doi: 10.1111/jocd.70231.

ABSTRACT

BACKGROUND: Single-wavelength lasers (755 or 810 nm) are widely used to remove unwanted hair. Recently, combined-wavelength diode lasers have been introduced to improve the safety of darker skin types, owing to their varying absorption spectra and penetration depths. However, their application beyond hair removal remains unclear.

AIMS: This study aimed to evaluate the efficacy of a high-power triple-wavelength diode laser (810, 940, and 1060 nm) in treating hirsutism, inflammatory follicular disorders, and aesthetic concerns such as hairline enhancement in darker skin types.

PATIENTS/METHODS: This retrospective study was conducted at the Escallent Institute of Lasers & Aesthetic Medicine (EILAM), Gurugam, India, using a Primelase device with a triple-wavelength diode laser. The study involved adults with skin type IV who presented with facial hirsutism and follicular disorders, including trichostasis spinulosa, pilonidal sinus disease, and hidradenitis suppurativa. Efficacy was assessed using hair counting and the Global Aesthetic Improvement Scale (GAIS), whereas safety was evaluated based on reported adverse effects, such as pain, erythema, and edema.

RESULTS: The GAIS scores indicated a mean improvement of 3.4 ± 0.4 out of 4, representing a 50%-75% improvement. Hair counting revealed a statistically significant hair reduction of 82.9% ± 15.4%, with reductions ranging from 56% to 100%. No adverse events were observed.

CONCLUSION: The high-power triple-wavelength diode laser demonstrated both efficacy and safety in treating facial hirsutism and other follicular disorders as well as aesthetic concerns such as hairline enhancement, particularly in darker skin tones.

PMID:40464115 | DOI:10.1111/jocd.70231

Clin Endocrinol (Oxf). 2025 Jun 4. doi: 10.1111/cen.15289. Online ahead of print.

ABSTRACT

BACKGROUND: Calcium homeostasis is critical for numerous physiological functions, and while total calcium is commonly measured in clinical practice, albumin-adjusted calcium is widely used to account for protein binding, despite concerns about its accuracy and lack of standardized reference intervals. This study aims to establish a reliable reference range for albumin-adjusted calcium using real-world data from a high-volume tertiary care laboratory.

METHODS: This study analyzed data from 33,159 individuals aged 18-80 years, selected from an initial population of 106,920 patients based on specific biochemical and clinical exclusion criteria. Statistical analysis involved outlier detection, partitioning, and calculation of age-specific reference intervals using the 2.5th and 97.5th percentiles.

RESULTS: The study established age-stratified reference intervals for albumin-adjusted calcium (18-49 years: 2.17-2.55 mmol/L; 50-79 years: 2.20-2.61 mmol/L) and total calcium (18-49 years: 2.17-2.56 mmol/L; 50-79 years: 2.17-2.62 mmol/L).

CONCLUSIONS: Our study reveals that albumin-adjusted calcium reference intervals are age-dependent, with slightly higher upper limits (≈0.05 mmol/L) than traditionally used total calcium ranges, potentially reducing overdiagnosis of hypercalcemia. Further studies are needed to validate these reference intervals across different automated analyzers and diverse patient populations to ensure broader clinical applicability.

PMID:40464109 | DOI:10.1111/cen.15289

Pharmacoepidemiol Drug Saf. 2025 Jun;34(6):e70167. doi: 10.1002/pds.70167.

NO ABSTRACT

PMID:40464089 | DOI:10.1002/pds.70167

Stroke. 2025 Jun 4. doi: 10.1161/STROKEAHA.125.051088. Online ahead of print.

ABSTRACT

BACKGROUND: Oral anticoagulants are superior to antiplatelet agents for preventing cardioembolic stroke but concerns about increased risk of intracranial hemorrhage limit their use. Although rivaroxaban demonstrably increases intracranial bleeding risk compared with aspirin, the comparative risk of intracranial hemorrhage with apixaban versus aspirin remains uncertain. We aimed to clarify this risk through a meta-analysis of randomized controlled trials.

METHODS: We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov for randomized controlled trials comparing apixaban with aspirin for ischemic stroke prevention. Studies were excluded if no intracranial hemorrhage events were reported in either arm. In the primary analysis, we used the Mantel-Haenszel method to meta-analyze the relative risk of intracranial hemorrhage with apixaban versus aspirin therapy. We conducted sensitivity analyses to examine the strength of these findings and to examine the secondary outcome of hemorrhagic stroke (which excludes epidural and subdural hematomas).

RESULTS: Three randomized controlled trials met our inclusion criteria, comprising a total of 10 626 patients and 74 incident intracranial hemorrhage events. In the pooled analysis, the relative risk of intracranial hemorrhage with apixaban versus aspirin therapy was 0.67 ([95% CI, 0.43-1.08]; P=0.10). These findings were consistent in sensitivity analyses utilizing alternative statistical estimators, in analyses limited to primary prevention trials, and in analyses utilizing the outcome of hemorrhagic stroke (relative risk, 0.72 [95% CI, 0.39-1.31]; P=0.28).

CONCLUSIONS: In randomized controlled trials evaluating ischemic stroke prevention, apixaban demonstrated a safety profile comparable-and potentially superior-to aspirin with respect to intracranial hemorrhage risk. These findings warrant a reconsideration of clinical practices that favor aspirin over apixaban, because of the concerns about intracranial hemorrhage risk.

PMID:40464082 | DOI:10.1161/STROKEAHA.125.051088

Int J Gynaecol Obstet. 2025 Jun 4. doi: 10.1002/ijgo.70232. Online ahead of print.

ABSTRACT

BACKGROUND: A recent publication regarding intrapartum care in low- and middle-income countries (LMICs) found that India has the one of the highest proportions of women receiving pharmacological augmentation of labor (51%-78%). National guidelines on the use of uterotonics during labor are available in India, requiring appropriate indication and monitoring for optimal maternal and fetal outcomes.

OBJECTIVES: The aim of this research was to quantify induction and augmentation of labor in India and describe the characteristics of these practices and related outcomes for women and newborns.

SEARCH STRATEGY: The following electronic databases of published studies and gray literature were searched: PubMed, MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Global Health, African Journals Online, Global Health Library, Global Index Medicus, ProQuest Dissertations & Theses, Cochrane Central Register of Controlled Trials, EMCare, Google Scholar, JSTOR, and Snowglobe (snowball search). We also consulted gray literature in Clinicaltrials.gov, WHO Trials, Cochrane Trials, OpenGrey, and the International Clinical Trials Registry Platform. All searches were completed on October 6, 2022. Search terms relevant to the research aims were applied, with initial searches for research conducted in any LMIC.

SELECTION CRITERIA: The review included primary research articles in English on induction and augmentation of labor in any setting in India, between January 1, 2011 and October 6, 2022. Two reviewers worked independently screening titles and abstracts for relevance to the research aims using Covidence® software. Non-concordant selection was resolved by a third team member. The full texts of included references were then retrieved for review and data extraction. Studies with low quality of evidence were excluded.

DATA COLLECTION AND ANALYSIS: The data extraction grid was piloted on five full-text reports. One reviewer manually extracted data from each full text. Three categories of variables were included in that grid: study characteristics, exposure variables, and outcome variables. The quality of the evidence was assessed by one reviewer using the National Institute for Health and Care Excellence preferred tools for the corresponding study design. To synthesize and present results, we used percentages for prevalence studies, survey studies, and for descriptive sections of comparative studies. For comparative studies, associations between variables were presented using odds ratios, risk ratios, and risk differences with their 95% confidence interval (CIs) and P-values (where the latter was the only measure used to assess difference). For each quantitative outcome of the review, we compiled and interpreted results extracted from individual studies. Qualitative findings were grouped by domains of interest (settings, category of providers, induction and augmentation procedures). Meta-analysis was not possible due to the marked heterogeneity between studies.

MAIN RESULTS: This review included 59 studies and provided evidence of moderate quality that high proportions of laboring women receive induction and augmentation of labor for facility-based childbirth across Indian geographies. Included studies reported that from 2.6% to 84.3% of laboring women received induction of labor; and from 9.6% to 86.9% received augmentation of labor. The review indicated that induction and augmentation are used in home-based childbirths as well, although these account for less than 10% of deliveries in India. The review identified several practices related to induction and augmentation of labor that are non-compliant with WHO guidelines, driven by synergistic promoting factors pertaining to both health systems and communities. Studies documented relatively high rates of complications, and reported descriptions suggest that these were related to type and regimens of induction and augmentation drugs, settings, and qualifications of providers. However, statistical associations between induction and augmentation and complications were not assessed. Included studies also revealed varied and inappropriate oxytocin storage conditions across settings. Finally, this review indicated that women were generally satisfied with the care provided to them during induction and augmentation of labor.

CONCLUSIONS: This review documented high use of pharmaceuticals for the induction and augmentation of labor, including practices that are not compliant with global and Indian recommendations for safety and quality. The review also identified both provider- and community-side drivers of these practices. These findings suggest multiple interventions that can be taken at the policy, facility, and community levels to monitor and improve induction and augmentation practices at health facilities in India. This review was funded by USAID and its protocol was registered in PROSPERO (2022 CRD42022298949).

PMID:40464073 | DOI:10.1002/ijgo.70232

Curr Protoc. 2025 Jun;5(6):e70156. doi: 10.1002/cpz1.70156.

ABSTRACT

Mitochondria in plants typically appear as discrete spherical or slightly tubular organelles, with their morphology and volume serving as indicators of metabolic state and dysfunction. Measuring changes in mitochondrial volume is relatively straightforward in organisms lacking plastids. However, in chlorophyll-rich tissues, such assessments often require purification protocols that may compromise accuracy. Here, we present protocols for the quantitative assessment of mitochondrial volume transitions in leaf mesophyll cells of Arabidopsis thaliana. The methods are simple and highly sensitive and offer a reliable approach for studying mitochondrial morphology transitions under both physiological and stress conditions. © 2025 The Author(s). Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: Leaf mesophyll treatment and mitochondrial imaging Basic Protocol 2: Leaf mesophyll mitochondrial volume assessment Basic Protocol 3: Mitochondrial volume statistics.

PMID:40464066 | DOI:10.1002/cpz1.70156

Health Data Sci. 2025 Jun 3;5:0209. doi: 10.34133/hds.0209. eCollection 2025.

ABSTRACT

Background: The use of antidepressants in the treatment of bipolar depression remains controversial due to concerns about their potential to induce mood polarity switches. This multinational observational study aims to examine the association between the use of antidepressants and the risk of hypomanic/manic switch among bipolar depressive patients. Methods: Four electronic health record databases (IQVIA Disease Analyzer Germany, IQVIA Disease Analyzer France, IQVIA US Hospital Charge Data Master, and Beijing Anding Hospital) and one administrative claims database (IQVIA US Open Claims) were analyzed, and the study period covered from January 2013 until December 2017. Treatment patterns of patients with bipolar depression were collected. The hazard ratio (HR) was calculated by comparing the incidence of hypomanic/manic switch in patients who received antidepressants (AD group) with that in those who did not receive any antidepressant (non-AD group) in 730 days after the date of the first diagnosis of bipolar depression. Results: The analysis included a total of 122,843 patients from the 5 databases; 60.6% of them received antidepressants for bipolar depression. Across the 5 data sources, the mean age at index date ranged from 37.50 (15.72) to 52.10 (16.22) years. After controlling potential confounders by propensity score matching, the AD group’s manic switch risk was not significantly higher than the non-AD group’s (HR 1.04 [95% CI, 0.96 to 1.13]; P = 0.989). Additionally, no statistically significant difference was observed between patients prescribed antimanic drugs and those who were not (HR 0.69 [95% CI, 0.38 to 1.25]; P = 0.535). Conclusions: This study indicated that antidepressants were widely used in clinical settings for managing bipolar depression. The use of antidepressants was not associated with the risk of mania/hypomania switch when compared to non-antidepressants treatment. Therefore, antidepressants could be considered a treatment option for bipolar depression.

PMID:40464055 | PMC:PMC12130621 | DOI:10.34133/hds.0209