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  1. Balaraman AK, Moglad E, Afzal M, Babu MA, Goyal K, Roopashree R, et al.
    Clin Chim Acta, 2025 Feb 01;567:120105.
    PMID: 39706249 DOI: 10.1016/j.cca.2024.120105
    Pancreatic cancer is a highly fatal malignancy due to poor early detection rate and resistance to conventional therapies. This review examines the potential for liquid biopsy as a transformative technology to identify diagnostic and therapeutic targets in pancreatic cancer. Specifically, we explore emerging biomarkers such as exosomal non-coding RNAs (ncRNAs), circulating tumor DNA (ctDNA), and circulating tumor cells (CTCs). Tumor-derived exosomes contain nucleic acid and protein that reflect the unique molecular landscape of the malignancy and can serve as an alternative diagnostic approach vs traditional biomarkers like CA19-9. Herein we highlight exosomal miRNAs, lncRNAs, and other ncRNAs alongside ctDNA and CTC-based strategies, evaluating their combined ability to improve early detection, disease monitoring and treatment response. Furthermore, the therapeutic implications of ncRNAs such as lncRNA UCA1 and miR-3960 in chemoresistance and progression are also discussed via suppression of EZH2 and PTEN/AKT pathways. Emerging therapeutic strategies that target the immune response, epithelial-mesenchymal transition (EMT) and drug resistance are explored. This review demonstrates a paradigm shift in pancreatic cancer management toward personalized, less invasive and more effective approaches.
  2. Alfawaz Altamimi AS, Arockia Babu M, Afzal M, Bishoyi AK, Roopashree R, Saini S, et al.
    Med Oncol, 2025 Mar 18;42(4):114.
    PMID: 40100465 DOI: 10.1007/s12032-025-02647-y
    Natural killer cell-derived exosomes (NK-Exos) hold great promise as immune modulators and immunotherapeutics against cancer due to their intrinsically latent anti-tumor effects. They use these nanosized vesicles to deliver cytotoxic molecules, such as perforin, granzymes, and miRNAs, directly to cancer cells to kill them, avoiding immune suppression. NK-Exos has particular efficacy for treating aggressive breast cancer by modulating the TME to activate the immune response and suppress immunosuppressive factors. Bioengineering advances have extended the therapeutic potential of NK-Exos, which permits precise tumor cell targeting and efficient delivery of therapeutic payloads, including small RNAs and chemotherapeutic agents. In engineered NK-Exos, sensitization of cancer cells to apoptosis, reduction of tumor growth, and resistance to drugs have been demonstrated to be highly effective. When combined, NK-Exos synergizes with radiotherapy, chemotherapy, or checkpoint inhibitors, enhancing therapeutic efficacy, and minimizing systemic toxicity. This review emphasizes the critical role of NK-Exos in breast cancer treatment, their integration into combination therapies, and the need for further research to overcome existing limitations and fully realize their clinical potential.
  3. Shabil M, Gaidhane S, Roopashree R, Kaur M, Srivastava M, Barwal A, et al.
    BMC Infect Dis, 2025 Jan 22;25(1):102.
    PMID: 39844097 DOI: 10.1186/s12879-025-10512-6
    BACKGROUND: Mpox is a viral zoonotic disease that has seen a resurgence in recent years, with outbreaks reaching beyond its traditional endemic zones in Central and West Africa to parts of Europe and North America. The relationship between human immunodeficiency virus (HIV) infection and mpox outcomes, particularly hospitalization rates, remains underexplored despite the known immunosuppressive effects of HIV. This systematic review and meta-analysis aimed to clarify the association between HIV infection and the likelihood of hospitalization in mpox cases.

    METHODS: A literature search was conducted through PubMed, Embase, Web of Science, Scopus, and the Cochrane Library up until August 10, 2024. The eligibility criteria focused on observational studies that evaluated hospitalization rates among mpox cases, distinguishing between HIV-positive and HIV-negative individuals. Newcastle-Ottawa Scale was used for evaluating study quality. The meta-analysis used a random-effects model to accommodate expected study heterogeneity using R software (V. 4.4).

    RESULTS: The search yielded 686 records, with 14 studies meeting the inclusion and exclusion criteria after screenings and full-text assessments. The pooled analysis revealed a 56.6% increased risk of hospitalization among HIV-positive mpox cases compared to HIV-negative individuals (95% CI: 18.0-107.7%). Notable heterogeneity (I² = 76%) was observed, likely reflecting variations in study settings and methodologies. Sensitivity analysis confirmed the robustness of these findings, and no significant publication bias was detected (Egger's test p-value = 0.733).

    CONCLUSION: HIV infection is associated with a statistically significant increased risk of hospitalization in mpox cases. There is a critical need for integrated care and enhanced surveillance, especially in populations with high HIV prevalence. Our findings emphasize the importance of ongoing research to better understand HIV and mpox co-infection and to refine management strategies for this vulnerable group. Future studies should focus on long-term outcomes and the effectiveness of various management strategies across different healthcare settings.

  4. Akashanand, Khatib MN, Balaraman AK, Roopashree R, Kaur M, Srivastava M, et al.
    J Asthma, 2025 Feb 01.
    PMID: 39817407 DOI: 10.1080/02770903.2025.2453810
    OBJECTIVE: Asthma poses a significant health burden in South Asia, with increasing incidence and mortality despite a global decline in age-standardized prevalence rates. This study aims to analyze asthma trends from 1990 to 2021, focusing on prevalence, incidence, mortality, and disability-adjusted life years (DALYs) across South Asia. The study also assesses the impact of risk factors like high body mass index (BMI), smoking, and occupational exposures on asthma outcomes.

    METHOD: We extracted asthma data from the Global Burden of Disease database for South Asia (1990-2021). Joinpoint regression analysis was used to assess temporal trends in asthma burden. Total Percentage change (TPC) in age-standardized rates of incidence, mortality, and DALYs were calculated. Data were stratified by gender, and the contribution of risk factors was evaluated.

    RESULTS: Asthma-related mortality in South Asia decreased by 37%, from 27.78 per 100,000 (1990) to 17.54 per 100,000 (2021). The Maldives showed the most significant reduction in mortality (78.31%), while Bangladesh recorded a 47.44% reduction in prevalence and a 62.64% decrease in DALYs. High BMI, smoking, and environmental risks contributed significantly to DALYs, with environmental factors playing a major role in countries like Afghanistan (20.73%) and Bhutan (18.58%). Females, particularly those over 20, experienced higher asthma-related DALYs than males.

    CONCLUSION: Asthma burden in South Asia has reduced over the past three decades, yet the absolute number of cases continues to rise, driven by population growth and environmental risk factors. Targeted interventions addressing risk factors and healthcare disparities are essential for further reducing asthma burden.

  5. Malvi A, Khatib MN, Balaraman AK, Roopashree R, Kaur M, Srivastava M, et al.
    BMC Pulm Med, 2025 Jan 29;25(1):48.
    PMID: 39881272 DOI: 10.1186/s12890-025-03516-0
    BACKGROUND: Cannabis is the third most widely used psychoactive substance globally, and its consumption has been increasing, particularly with the growing trend of legalization for medicinal and recreational use. Recent studies have raised concerns about the potential impact of cannabis on respiratory health, specifically the risk of asthma, a significant public health concern. This systematic review aimed to consolidate research on the association between cannabis use and the risk of asthma.

    METHODS: A comprehensive search was conducted across PubMed, Embase, and Web of Science, covering studies published up to September 30, 2024. We included peer-reviewed observational studies evaluating the link between cannabis consumption and the risk of asthma diagnosis. Data synthesis employed a random-effects meta-analysis to account for heterogeneity. R statistical software (version 4.4) was used for statistical analyses.

    RESULTS: The search yielded 8 relevant studies after screening 1,887 records. The pooled odds ratio (OR) for the association between cannabis consumption and the risk of asthma diagnosis was 1.31, 95% confidence interval (CI): 1.19-1.44, indicating greater odds of having asthma compared to non-users. Moderate heterogeneity was observed (I² = 46%), and sensitivity analysis confirmed the robustness of the findings.

    CONCLUSION: This systematic review and meta-analysis identifies a significant association between cannabis use and greater odds of having asthma. These findings emphasize the importance of raising awareness about the potential respiratory risks associated with cannabis use. Future research should prioritize identifying moderating factors, such as the frequency and mode of cannabis consumption, to enhance understanding of this association and provide a stronger evidence base for potential public health interventions.

    CLINICAL TRIAL NUMBER: Not applicable.

  6. Kumar V, Singh M, Khatib MN, Balaraman AK, Roopashree R, Kaur M, et al.
    Expert Rev Respir Med, 2025 Feb 12.
    PMID: 39917855 DOI: 10.1080/17476348.2025.2464882
    BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality globally, particularly in low- and middle-income countries like India. This study aims to analyze regional trends and project future burden of COPD in India using data from the Global Burden of Disease (GBD) 1990-2021.

    METHODS: This analysis utilized data from the GBD study to assess age-standardized prevalence (ASPR), incidence (ASIR), disability-adjusted life years (DALYs) (ASDR), and mortality rates (ASMR) for COPD across Indian states. Joinpoint regression was used to analyze temporal trends, while ARIMA models predicted future incidence rates.

    RESULTS: In 2021, the highest ASIR was observed in Rajasthan at 306.28, and the highest ASMR was observed in Uttarakhand at 227.19. Projections suggest that the ASIR for COPD in India will decrease from 265.16 in 2022 to 258.19 by 2031. The heatmap analysis identified states like Uttarakhand and Rajasthan as having the highest DALYs attributable to COPD risk factors, including air pollution and tobacco use.

    CONCLUSION: COPD remains a public health challenge in India, with regional variability. Targeted interventions addressing air pollution, smoking cessation, and improved healthcare access are essential to mitigate the disease's future burden, particularly in high-risk regions.

  7. Sharma N, Khatib MN, Roopashree R, Kaur M, Srivastava M, Barwal A, et al.
    BMC Cardiovasc Disord, 2025 Jan 06;25(1):5.
    PMID: 39757193 DOI: 10.1186/s12872-024-04460-3
    BACKGROUND: Atrial fibrillation (AF) is the most prevalent form of sustained cardiac arrhythmia, with vascular endothelial growth factor (VEGF) increasingly recognized for its potential role in the pathogenesis of AF through mechanisms involving atrial remodeling, inflammation, and fibrosis. This systematic review aims to synthesize available evidence on the association between VEGF and AF, exploring the implications of VEGF as a biomarker and therapeutic target.

    METHODS: We conducted a comprehensive search across PubMed, Embase, and Web of Science until November 10 2024, selecting studies based on pre-defined criteria that involve adults with AF and measurements of VEGF levels. The selected studies included observational and experimental designs, excluding non-English and methodologically insufficient publications. Narrative synthesis was used for summarising the results.

    RESULTS: Eight studies met the inclusion criteria. The studies show a general trend of elevated VEGF levels in AF patients compared to controls, with significant heterogeneity in findings across studies. VEGF subtypes such as VEGF-A and VEGF-D demonstrated stronger associations with AF risk compared to VEGF-C. These variations point to the complex role of VEGF in AF, influencing factors like angiogenesis, endothelial function, and inflammatory responses.

    CONCLUSION: VEGF is potentially a significant contributor to AF pathophysiology, with its levels reflecting disease activity. The variability observed across studies suggests a need for standardized measurement approaches and further investigation into VEGF subtypes. Future research should focus on longitudinal studies to better understand the causal relationships and the potential of VEGF as a therapeutic target and biomarker in AF management.

    CLINICAL TRIAL NUMBER: Not applicable.

  8. Sharma N, Khatib MN, Balaraman AK, Roopashree R, Kaur M, Srivastava M, et al.
    Int Urol Nephrol, 2025 Apr;57(4):1039-1049.
    PMID: 39495435 DOI: 10.1007/s11255-024-04266-4
    BACKGROUND: Prostate cancer is one of the most prevalent malignancies among men globally. Glucagon-like peptide 1 receptor agonists (GLP-1 RAs), primarily used for type 2 diabetes mellitus (T2DM) management, have been investigated for their potential effects on cancer risks. This systematic review and meta-analysis aimed to assess the association between GLP-1 RA use and risk reduction of prostate cancer.

    METHODS: A comprehensive literature search was conducted across PubMed, Embase, and Web of Science up to July 30, 2024. Studies that met the inclusion criteria randomized controlled trials, cohort studies, case-control studies, and observational studies assessing the incidence of prostate cancer in GLP-1 RA-treated patients were included. The quality of studies was evaluated using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool. Meta-analysis was performed using a random effects model.

    RESULTS: A total of five studies were included, analyzing data from diverse international contexts. The included studies showed a reduced risk of prostate cancer with both adjusted and unadjusted effect estimates with GLP-1 RAs. The meta-analysis revealed an RR of 0.72 (95% CI: 0.610 to 0.832), indicating a statistically significant 28% reduction in prostate cancer risk associated with GLP-1 RA use compared to placebo or other antidiabetic drugs. Moderate heterogeneity was observed (I2 = 51%). Sensitivity analysis confirmed the results.

    CONCLUSION: The findings suggest a significant protective association between GLP-1 RA use and reduced prostate cancer risk in men, particularly those with T2DM. This supports the potential of GLP-1 RAs not only in diabetes management but also as a strategy to mitigate cancer risk. Further research is required to confirm these findings and explore the underlying mechanisms, considering different dosages, durations of therapy, and patient subgroups based on demographic and metabolic characteristics.

  9. Soni M, Khatib MN, Balaraman AK, Roopashree R, Kaur M, Srivastava M, et al.
    J Epidemiol Glob Health, 2025 Mar 13;15(1):43.
    PMID: 40080234 DOI: 10.1007/s44197-025-00359-0
    BACKGROUND: Neonatal disorders represent a significant public health challenge, particularly in low- and middle-income countries, where they account for 79% of global neonatal mortality. South Asia, comprising countries such as India, Pakistan, Bangladesh, Nepal, and Bhutan, bears a disproportionately high burden, contributing to 38% of the world's neonatal deaths. Despite notable progress, South Asia remains off track in meeting the Sustainable development goals (SDG). This study aims to assess the current burden, trends in neonatal disorders, and forecast mortality rates across South Asian countries, providing insights to guide investment priorities and improve neonatal outcomes.

    METHODS: Data for this study were sourced from the Global burden of disease (GBD) 2021 study, which utilizes a Bayesian meta-regression model to estimate mortality, prevalence, and disability-adjusted life years (DALYs). Spatial maps depicting the age-standardized prevalence rate and age-standardized mortality rate for neonatal disorders in South Asia were generated using QGIS software. Mortality forecasts for the period 2022-2031, attributed to various neonatal disorders, were produced employing the Auto-Regressive Integrated Moving Average model in R software. Additionally, an analysis of overall neonatal mortality trends from 1980 to 2021 was conducted, supplemented by a heat map that compares DALYs attributable to various neonatal disorders across South Asian countries in 2021.

    RESULTS: Between 1980 and 2021, South Asia experienced a substantial decline in neonatal mortality rates, with India and Bangladesh leading the progress. Mortality decreased by 40%, while DALYs fell by 35%, despite a 15% increase in the prevalence. The prevalence of neonatal encephalopathy due to birth asphyxia and trauma surged by 355%, yet its mortality dropped by 31%. Pakistan recorded the highest neonatal mortality and disease burden, particularly for hemolytic disease and other neonatal jaundice and neonatal encephalopathy due to birth asphyxia and trauma. In India and Bangladesh, neonatal preterm birth and neonatal sepsis and other neonatal infections contributed most to mortality. Neonatal encephalopathy due to birth asphyxia and trauma accounted for the highest DALYs. Forecasts predict continued reductions in neonatal mortality across South Asia, except in Pakistan, where persistently high rates are expected till 2031.

    CONCLUSION: For South Asian countries to meet the SDG target for neonatal mortality by 2030, intensified and continuous efforts are required. These efforts should focus on identifying high-risk pregnancies and improving the quality of care during childbirth to address the root causes and reduce preventable neonatal deaths.

  10. Kumar V, Jena D, Zahiruddin QS, Roopashree R, Kaur M, Srivastava M, et al.
    Int J Urol, 2025 Mar;32(3):277-284.
    PMID: 39670291 DOI: 10.1111/iju.15641
    OBJECTIVES: The objectives of this study were to analyze trends in prostate cancer incidence, incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021 via data from the Global Burden of Disease (GBD) study in South Asia. Additionally, the study projects future prostate cancer incidence rates up to 2031 to inform public health interventions in South Asia.

    METHODS: Data covering South Asian countries such as Bangladesh, Bhutan, India, Nepal, and Pakistan were obtained from the GBD 2021 portal. Age-standardized rates (ASRs) for prostate cancer metrics, including incidence (ASIR), prevalence (ASPR), mortality (ASMR), and DALYs (ASDR), were analyzed via joinpoint and ARIMA modeling techniques. Geographic variations in ASRs were mapped via QGIS software.

    RESULTS: The prostate cancer ASIR, ASPR, and ASDR significantly increased from 1990 to 2021, particularly among individuals aged 60-65 years. The highest incidence and mortality rates were observed in Pakistan. The total percentage change in incidence in India was the highest at 61%. Projections indicate a continued rise in prostate cancer incidence, with South Asia's ASIR expected to reach 9.34 per 100 000 by 2031.

    CONCLUSIONS: The growing burden of prostate cancer in South Asia highlights the need for enhanced screening programs, public awareness, and healthcare infrastructure improvements. Without intervention, the increasing incidence and mortality rates could strain healthcare resources, emphasizing the urgency of region-specific public health strategies.

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