Amulya Marellapudi

Background: Excess prescribing of antibiotics and opioids is a major public health concern. A greater understanding of prescribing patterns at the prescriber and beneficiary level could inform enhanced and integrated interventions. Methods: Using 2023 Medicare Part D Public Use data, we conducted a cross-sectional study to assess opioid and antibiotic prescribing patterns among primary care clinicians (internal medicine, family medicine, geriatrics, nurse practitioners, and physician assistants) in New York State (NYS) treating ≥20 Medicare beneficiaries aged ≥65. For each provider, the total days’ supply of antibiotics and opioids per beneficiary was calculated. Multivariate logistic regression models identified provider and practice characteristics associated with high-prescribing. Results: Of the 19,823 eligible prescribers, 647 (3.3%) were high antibiotic prescribers and 554 (2.8%) were high opioid prescribers. Antibiotic high-prescribing was associated with nurse practitioners (NP) (adjusted odds ratio (aOR 2.47, 95% CI 1.83–3.34)), physician assistants (PA) (aOR 1.90, 95% CI 1.43–2.54), more years in practice (aOR 1.62 per SD, 95% CI 1.47–1.78), and panels with higher average beneficiary risk scores (aOR 1.36 per SD, 95% CI 1.29–1.43). Opioid high-prescribing was associated with geriatrics (aOR 4.30, 95% CI 1.79–10.32), NP (aOR 1.80, 95% CI 1.36–2.37), male gender (aOR 1.55, 95% CI 1.17–2.04).), greater years in practice (aOR 1.68, 95% CI 1.51–1.86), and higher proportions of dual-eligible beneficiaries (aOR 1.38, 95% CI 1.23–1.56). Conclusions: A small number of NYS clinicians account for a disproportionate share of antibiotic and opioid prescribing. Identifying provider- and panel-level characteristics associated with higher prescribing may inform targeted stewardship strategies.

Translation: The University of Toledo Journal of Medical Sciences is the online journal launched by the University of Toledo. Manuscripts will be considered on the understanding that they report original work and are not under consideration for publication by any other journal. The journal publishes original articles reporting experimental results of basic or clinical research, case reports, and reviews. The journal uses a single blind peer review system and each manuscript, based on the results presented in its original submission, will be evaluated by two student reviewers and one faculty reviewer. This process will provide an opportunity for medical students, graduate students, residents, fellows and faculty to publish research observation in a timely manner.

Diet-induced models of chronic kidney disease (CKD) offer several advantages, including clinical relevance and animal welfare, compared with surgical models. Oxalate is a plant-based, terminal toxic metabolite that is eliminated by the kidneys through glomerular filtration and tubular secretion. An increased load of dietary oxalate leads to supersaturation, calcium oxalate crystal formation, renal tubular obstruction, and eventually CKD. Dahl-Salt-Sensitive (SS) rats are a common strain used to study hypertensive renal disease; however, the characterization of other diet-induced models on this background would allow for comparative studies of CKD within the same strain. In the present study, we hypothesized that SS rats on a low-salt, oxalate rich diet would have increased renal injury and serve as novel, clinically relevant and reproducible CKD rat models. Ten-week-old male SS rats were fed either 0.2% salt normal chow (SS-NC) or a 0.2% salt diet containing 0.67% sodium oxalate (SS-OX) for five weeks.Real-time PCR demonstrated an increased expression of inflammatory marker interleukin-6 (IL-6) (p < 0.0001) and fibrotic marker Timp-1 metalloproteinase (p < 0.0001) in the renal cortex of SS-OX rat kidneys compared with SS-NC. The immunohistochemistry of kidney tissue demonstrated an increase in CD-68 levels, a marker of macrophage infiltration in SS-OX rats (p < 0.001). In addition, SS-OX rats displayed increased 24 h urinary protein excretion (UPE) (p < 0.01) as well as significant elevations in plasma Cystatin C (p < 0.01). Furthermore, the oxalate diet induced hypertension (p < 0.05). A renin–angiotensin–aldosterone system (RAAS) profiling (via liquid chromatography–mass spectrometry; LC–MS) in the SS-OX plasma showed significant (p < 0.05) increases in multiple RAAS metabolites including angiotensin (1–5), angiotensin (1–7), and aldosterone. The oxalate diet induces significant renal inflammation, fibrosis, and renal dysfunction as well as RAAS activation and hypertension in SS rats compared with a normal chow diet. This study introduces a novel diet-induced model to study hypertension and CKD that is more clinically translatable and reproducible than the currently available models.

Objective: Paraoxanases (Pon) are hydrolytic enzymes with three distinct isoforms. Decreased circulating Pon activity is associated with increased oxidant stress and adverse clinical outcomes in the setting of chronic kidney disease (CKD), yet the mechanism of action is unknown. We tested the hypothesis that Pon-3 is cardioprotective in a Dahl salt-sensitive model of hypertensive renal disease. Methods: Ten week old, age-matched, Dahl salt-sensitive wildtype and Pon3 mutant male and female rats were maintained on eight percent high salt diets for eight weeks to initiate the salt-sensitive hypertensive renal disease characteristic of this model. After eight weeks, animals were euthanized and hearts were processed for histology. Echocardiography was performed to measure left ventricular function. Results: By 8 weeks, mortality was observed in 18.2% of male SS-Pon3 KO rats on high salt; no mortality was observed in male SS male rats on high salt. In female rats, by 8 weeks 100% mortality was observed in SS-Pon3 KO rats on high salt diet while no mortality was observed in SS rats on high salt. High salt fed SS-Pon3 KO male rats that survived the echocardiography study demonstrated significantly decreased left ventricular end-systolic diameter and end-diastolic diameter, as well as significant increases in left ventricular relative wall thickness compared to age matched SS rats. Furthermore, SS-Pon3 KO rats demonstrated significantly increased heart-weight-to-body-weight ratio compared to age matched SS rats. Conclusion: These findings suggest a cardioprotective role for PON-3 in the setting of salt-sensitive hypertensive renal disease.

Peer-reviewed publications using tobacco surveillance data represent a critical step toward evidence-based tobacco control, but research and publication capacity in countries with fewer resources may be limited. This paper describes patterns in use of the Global Adult Tobacco Survey (GATS) and/or Global Youth Tobacco Survey (GYTS) data for publications, investigates the origin of the data versus the origin of lead authorship, and describes geographic patterns of publications by country, region, and country income. A bibliometric inventory using six search engines was conducted for relevant studies using data from either of these surveys between January 1999 and January 2021. Descriptive statistics, including frequencies and percentages,were used to analyze publication characteristics. Our search strategy retrieved 1,834 initial records; 493 publications were ultimately included: 249 (50.5%) used adult surveillance data (GATS) and 248 (50.3%) used youth surveillance data (GYTS). Most publications were in English (97.2%, n=479). Data published 50 or more times represented 12 low- and middle-income countries (LMIC): India, Bangladesh, Vietnam, Mexico, Egypt, Thailand, Poland, Philippines, China, Russian Federation, Turkey and Ukraine. While many of the papers analyzed data from low- and middle-income countries, the number of publications by origin of lead author was the highest for the United States ( n =135) and India ( n =84). Over 80% of the world’s 1.3 billion tobacco users live in low- and middle-income countries (LMIC) and we found underrepresentation of these countries as lead authors. These findings can be used to identify opportunities to enhance capacity for analysis, research and dissemination of global tobacco control data in LMIC.