Category: 8. Health

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“Forever chemicals” or per- and polyfluoroalkyl substances (PFAS) have been widely used in consumer and industrial products for the better part of a century, but do not break down in the natural environment. One PFAS, perfluorohexanoic acid or PFHxA, is made up of a shorter chain of molecules and is thought to have less of an impact on human health. New research from the Del Monte Institute for Neuroscience at the University of Rochester suggests otherwise, finding that early life exposure to PFHxA may increase anxiety-related behaviors and memory deficits in male mice.

“Although these effects were mild, finding behavioral effects only in males was reminiscent of the many neurodevelopmental disorders that are male-biased,” said Ania Majewska, PhD, professor of Neuroscience and senior author of the study out today in the European Journal of Neuroscience. Research has shown, males are more often diagnosed with neurodevelopmental disorders such as autism and ADHD. “This finding suggests that the male brain might be more vulnerable to environmental insults during neurodevelopment.”

Researchers exposed mice to PFHxA through a mealworm treat given to the mother during gestation and lactation. They found that the male mice exposed to higher doses of PFHxA in utero and through the mother’s breastmilk showed mild developmental changes, including a decrease in activity levels, increased anxiety-like behaviors, and memory deficits. They did not find any behavioral effects in females that were exposed to PFHxA in the same way.

“Finding that developmental exposure to PFHxA has long-term behavioral consequences in a mammalian model is concerning when considering short-chain PFAS are thought to be safer alternatives to the legacy PFAS that have been phased-out of production,” said Elizabeth Plunk, PhD (’25), an alumna of the Toxicology graduate program at the University of Rochester School of Medicine and Dentistry and first author of the study. “Understanding the impacts of PFHxA on the developing brain is critical when proposing regulations around this chemical. Hopefully, this is the first of many studies evaluating the neurotoxicity of PFHxA.”

Researchers followed these mice into adulthood and found that in the male mice PFHxA exposure affects behavior long after exposure stops, suggesting that PFHxA exposure could have effects on the developing brain that have long-term consequences.

“This work points to the need for more research in short-chain PFAS. To our knowledge, PFHxA has not been evaluated for developmental neurobehavioral toxicity in a rodent model,” said Majewska. “Future studies should evaluate the cellular and molecular effects of PFHxA, including cell-type specific effects, in regions associated with motor, emotional/fear, and memory domains to elucidate mechanistic underpinnings.”

Despite its shorter chain, PFHxA has been found to be persistent in water and was restricted by the European Union in 2024. This follows years of restrictions on longer chain PFAS. Last year, the Environmental Protection Agency set its first-ever national drinking water standard for PFAS, which will reduce PFAS exposure for millions of people. PFAS are man-made chemicals that have the unique ability to repel stains, oil, and water have been found in food, water, animals, and people. They are linked to a range of health issues, including developmental issues in babies and kidney cancer.

Reference: Plunk EC, Manz KE, Gomes A, Pennell KD, Sobolewski ME, Majewska AK. Gestational and lactational exposure to perfluorohexanoic acid affects behavior in adult male mice: a preliminary study. Eur J of Neuroscience. 2025;62(1):e70174. doi: 10.1111/ejn.70174

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Dakar – On July 1, 2025, Senegal officially launched the introduction of the hexavalent vaccine into its Expanded Program on Immunization (EPI). Following in Mauritania’s footsteps, Senegal is part of this regional dynamic of vaccine innovation. This vaccine is a combination that protects against six diseases: diphtheria, tetanus, whooping cough, hepatitis B, Haemophilus influenzae type B (Hib), and poliomyelitis. It replaces the pentavalent and inactivated polio vaccines (IPV), previously administered separately.

The introduction of hexavalent meets three major scientific objectives. Firstly, to reduce the number of injections infants undergo at each visit: a single injection now replaces the two previously required for Penta and IPV. Secondly, to reinforce protection against polio by increasing the number of doses of inactivated vaccine from two to three before the age of 6 months. Thirdly, to introduce an essential booster dose at 15 months, in line with the latest recommendations from the World Health Organization (WHO), to consolidate herd immunity and optimize the vaccination schedule.

This change is also a response to regional issues, as some derived poliovirus variants are still circulating in Africa, and the WHO recommends two-dose IPV coverage to deal with this.

Funding for this introduction is provided mainly by Gavi, the Vaccine Alliance, which covers most of the costs associated with the supply of doses. The Senegalese government is contributing a further 20%, demonstrating its commitment to the sustainability of this program.

This is a game-changer for children’s health in Senegal, as the teams not only protect children more effectively but also strengthen the fight against polio, which remains a global public health emergency of international concern.

In his speech, Dr Ibrahima Sy, Minister of Health and Social Action, underlined the significance of this reform: “For the past 18 months, our teams have been working tirelessly to prepare this transition. Hexavalent embodies our commitment to offering Senegalese children simplified and reinforced protection. Thanks to this vaccine, we expect to avoid 2,300 hospitalizations a year from targeted diseases by 2030.” The Minister also paid tribute to the technical partners and health workers whose dedication has made this breakthrough possible.

The WHO has played a central role in the success of this transition. Nearly 6,000 health workers, including district management teams (ECD) and regional management teams (ECR), have been trained in the specifics of the new vaccine. This intensive training covered the rigorous management of the cold chain, as hexavalent must be kept between +2°C and +8°C and never frozen. Agents were also certified on precise intramuscular administration techniques in the right thigh of infants, and on the protocol for monitoring benign side effects such as local redness or transient fever. To ensure a smooth transition, the WHO provided real-time monitoring tools enabling each vial to be traced throughout the country.

WHO also supported the development of interpersonal communication materials, enabling health workers to better explain the change to parents, reassure them of the vaccine’s safety, and stress the importance of adhering to the vaccination schedule.

Dr Jean-Marie Vianny Yameogo, WHO Representative in Senegal, hailed this historic milestone: “This launch marks 46 years of evolution for the Senegalese EPI. Hexavalent is not simply a scientific advance, it is an act of equity that protects every child, whatever their origin. By reducing the burden of preventable diseases, we are unleashing the potential of an entire generation.”

As a long-standing EPI partner, UNICEF has also contributed to the supply, logistics, and awareness-raising around this essential vaccine. Dr Jacques Boyer, UNICEF Representative in Senegal, underlined: “This introduction marks a decisive turning point for the survival and well-being of children. By strengthening access to a more complete and convenient vaccine, we are bringing Senegal closer to a future where every child has an equal chance to grow up healthy.”

This initiative positions Senegal as a key player in vaccine innovation in sub-Saharan Africa. By merging several antigens into a single product, the country is demonstrating how to optimize healthcare systems with limited resources. Reducing the number of injections not only improves the experience of children and parents, but also simplifies logistics, cuts storage costs, and boosts immunization coverage rates. According to projections, this strategy will make a significant contribution to achieving the goals of the WHO’s IA2030 Agenda, which aims to save 50 million lives through immunization by the end of the decade. Several neighboring countries, such as Côte d’Ivoire and Burkina Faso, are already studying this model for their own programs.

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Melanoma remains the most aggressive form of skin cancer. Despite major advances in immunotherapy, effective treatments for patients with advanced melanomas are still limited. Now, an international team, led by researchers from Lund University, has identified that certain aggressive melanoma tumours rely heavily on two critical mitochondrial processes. Their findings, published in the scientific journal CANCER, provide new hope for treating melanoma by repurposing drugs already approved for other medical uses.

Mitochondria have long been recognised as the ‘powerhouse’ of the cell due to their crucial role in energy production. However, their involvement in melanoma progression has previously received limited attention. This new study shows that rapidly growing melanoma tumours frequently exhibit overactive mitochondrial protein synthesis and energy production pathways, driving their aggressive growth.

The researchers mapped the mitochondrial signature of melanoma tumours, uncovering a unique biological fingerprint indicating heightened mitochondrial activity.

The research group behind the study focuses extensively on understanding mitochondrial roles in melanoma and other cancers.

The study involved detailed analyses of 151 tissue samples from healthy skin and melanoma tumours, sourced from both living patients and deceased donors. Researchers discovered notably increased mitochondrial activity – particularly energy production (oxidative phosphorylation) and mitochondrial protein synthesis – in the most treatment-resistant melanoma cases, notably in patients with metastatic disease and genetic mutation in the BRAF gene. 

Using existing approved drugs, the team successfully inhibited these tumour-driving mitochondrial processes in laboratory experiments. Treatment of melanoma cells with specific mitochondrial inhibitors and commonly used antibiotics (doxycycline, tigecycline, azithromycin), typically prescribed to disrupt bacterial protein synthesis, resulted in the effective elimination of melanoma cells while sparing healthy skin cells.

The researchers believe that these results strengthen the case for targeting mitochondrial activity as part of future treatments for advanced melanoma. Since the drugs used are already approved for use in humans, the findings open up the possibility of repurposing them for a new use, which could accelerate the process of reaching clinical trials.

“The results apply to laboratory studies in cells and analyses of patient tumours. The findings point to a promising avenue for combination therapy with drugs already approved and available for other indications. But we have not conducted any clinical trials; those will be needed to see if this will also work in humans. So, this is a first step, but it shows that mitochondria are not only part of the cancer process – they may also be the tumour’s Achilles’ heel,” says Jeovanis Gil.

Furthermore, the researchers suggest that mitochondrial activity could serve as an early biomarker, helping clinicians predict the risk of melanoma relapse and identify patients who could benefit from such treatment even at an early stage.

“These signatures can be measured in standard biopsy samples, providing a valuable tool for early identification and targeted intervention. We see that the signature is present from the beginning.” 

Reference: Kim Y, Doma V, Çakır U, et al. Mitochondrial proteome landscape unveils key insights into melanoma severity and treatment strategies. Cancer. 2025;131(13):e35897. doi: 10.1002/cncr.35897

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Introduction

Persistent left superior vena cava (PLSVC) is the most common congenital anomaly of the thoracic venous system, occurring in approximately 0.3–0.5% of the general population and up to 12% in individuals with congenital heart disease. A much rarer variant, isolated PLSVC with absent right superior vena cava (RSVC), has a reported prevalence of 0.07% to 0.13% in the general population.^1–3 While often asymptomatic and incidentally discovered during imaging or procedures, PLSVC can present with various clinical manifestations, including arrhythmias.^1,4 The association between PLSVC and atrial fibrillation is rare but clinically significant, as the anomalous venous return may influence the heart’s conduction system and serve as a source of ectopic electrical activity, potentially leading to rhythm disturbances.^5,6 Understanding this relationship is crucial for accurate diagnosis and effective management of patients presenting with unexplained arrhythmias, especially when standard workups fail to identify a structural or ischemic cause. In such cases, recognizing PLSVC as a potential contributor allows for targeted imaging, better risk stratification, and tailored therapeutic strategies.⁷

Case Presentation

A 45-year-old male patient presented to the hospital with complaints of progressive symptoms of palpitation, dyspnea, fatigue, and reduced exercise tolerance. There was no history of chest pain, syncope, or cyanosis. No clear triggers were identified, but symptoms were exacerbated by exertion. The patient had no significant past medical history of hypertension, diabetes mellitus, or thyroid disorders. There was no family history of arrhythmias, sudden cardiac death, or congenital heart defects. He was a non-smoker, did not consume alcohol, and had no history of illicit drug use. On physical examination, the patient appeared mildly distressed due to dyspnea. His vital signs were as follows: blood pressure of 110/75 mmHg, heart rate of 110 beats per minute with an irregular rhythm, respiratory rate of 22 breaths per minute, and oxygen saturation of 96% on room air. Cardiovascular examination revealed no visible jugular venous distention, no parasternal heave, and an apex beat was laterally displaced. Auscultation revealed normal S1 and S2 heart sounds, with no obvious murmurs, but an irregular cardiac rhythm was noted. Respiratory examination was unremarkable with clear breath sounds and no signs of pulmonary congestion. There were no signs of peripheral edema, hepatomegaly, or neurological deficits.

An initial electrocardiogram (ECG) revealed an irregular rhythm suggestive of atrial fibrillation (Figure 1). Echocardiography showed a reduced left ventricular ejection fraction (35–40%), enlargement of the heart chambers, moderate mitral regurgitation, and a notably dilated coronary sinus—findings that raised suspicion for a persistent left superior vena cava (PLSVC). To confirm this, a bubble contrast study was conducted, which demonstrated contrast filling the coronary sinus from the left side, consistent with PLSVC drainage (Figure 2A and B). Further imaging with cardiac CT angiography revealed the presence of a persistent left superior vena cava (PLSVC) draining into a markedly dilated coronary sinus, accompanied by complete absence of the right superior vena cava. Instead, the left and right innominate veins were observed converging to form a prominent left SVC, which drained into the right atrium via the coronary sinus. These anatomical findings confirmed the venous anomaly and excluded other structural cardiac abnormalities. The axial CT view (Figure 3) demonstrates coronary sinus dilatation (red arrow) and the course of the left superior vena cava (green arrow). Coronal and sagittal reconstructions (Figure 4) illustrate the left and right innominate veins (blue arrow) merging to form the left SVC (red arrow), which ultimately drains into the right atrium via the coronary sinus (yellow arrow).

Figure 1 Electrocardiography showing atrial fibrillation with normal ventricular response.

Figure 2 Echocardiography: (A) Parasternal short axis view showing a dilated Coronary sinus (28x28mm) with dilated left atrium (green arrow). (B) A bubble study showing direct filling of Coronary sinus form left system (yellow arrow). (C) Angulated apical 4 chamber view showing dilated coronary sinus (red arrow). (D) A bubble appearance in CS before right atrium (red arrow).

Figure 3 Axial CT image showing dilated coronary sinus (A; red arrow) and the course of the left SVC (B, C; green arrow).

Figure 4 Coronal and sagittal CT views showing innominate veins (A; blue arrow) merging into the left SVC (B-D; red arrow) draining into the coronary sinus (D; yellow arrow).

Full laboratory tests including thyroid function tests and serum electrolytes were within normal limits. The patient was managed with rate control using beta-blockers, and anticoagulation therapy was initiated due to the presence of atrial fibrillation. After stabilization, he was referred for an electrophysiological study (EPS) to assess the conduction abnormalities associated with PLSVC.

This case highlights a rare presentation of persistent left superior vena cava with absent of right superior vena cava manifesting with arrhythmia. Although isolated persistent left superior vena cava (PLSVC) with absent right superior vena cava (RSVC) is often asymptomatic and discovered incidentally, its association with conduction abnormalities—particularly atrial arrhythmias—highlights the importance of comprehensive cardiovascular evaluation in patients presenting with unexplained rhythm disturbances. Early recognition of this rare vascular anomaly is essential for guiding appropriate management and minimizing the risk of procedural complications, thereby optimizing patient outcomes.

Discussion

PLSVC results from aberrant anterior cardinal venous system development during embryonic development. The right anterior cardinal vein forms the right SVC while the left anterior cardinal vein typically regresses by the tenth week of pregnancy. In approximately 90% of cases, a persistent left superior vena cava (PLSVC) drains into the right atrium through the coronary sinus, whereas in 10–20% of cases, it drains directly into the left atrium or pulmonary veins, causing left-to-rights hunting, cyanosis, or paradoxical embolism.^8–10 This abnormality is often linked to other congenital conditions that worsen haemodynamic effects, like unroofed coronary sinus or atrial septal defects (ASD),¹¹ ventricular septal defects, bicuspid aortic valves, coarctation of the aorta, coronary sinus atresia, abnormal pulmonary venous return, and tetralogy of Fallot.¹² The association between PLSVC and AF is well-documented. The presence of myocardial sleeves extending into the PLSVC can serve as arrhythmogenic foci, potentially initiating and sustaining AF. In the case presented, a 41-year-old patient experienced progressive shortness of breath and palpitations, leading to the diagnosis of PLSVC with associated AF.

Advanced imaging modalities play a crucial role in diagnosing PLSVC. Transthoracic echocardiography may reveal a dilated coronary sinus, prompting further investigation. Definitive diagnosis is often achieved through computed tomography (CT) or magnetic resonance imaging (MRI), which can delineate the anomalous venous anatomy. In this case, CT angiography confirmed the presence of PLSVC draining into the right atrium, facilitating appropriate management strategies.¹³

Although central venous catheterization is generally straightforward in patients with a normal right superior vena cava (RSVC), the procedure becomes technically challenging in the absence of the RSVC. In such cases, left-sided venous access is required, which increases the risk of catheter malposition. Similarly, pacemaker or implantable cardioverter-defibrillator (ICD) lead placement, typically uncomplicated via the right SVC, becomes more complex and technically demanding when advancement must occur solely through the left-sided persistent superior vena cava (PLSVC).^14,15

Management of AF in the context of PLSVC often involves catheter ablation, targeting the arrhythmogenic sites within the PLSVC. Recent advancements have introduced pulsed-field ablation (PFA) as a novel technique with promising outcomes. PFA utilizes non-thermal energy to achieve myocardial tissue ablation, potentially reducing collateral damage to surrounding structures. Studies have reported successful isolation of the PLSVC using PFA, resulting in effective arrhythmia control.¹⁶

Conclusion

Although PLSVC is often an incidental finding, early recognition is crucial—particularly in patients presenting with unexplained arrhythmias or a dilated coronary sinus. A thorough diagnostic workup, including multimodal imaging, is essential for accurate identification. Given its potential role in arrhythmogenesis, especially atrial fibrillation, timely detection of PLSVC enables appropriate therapeutic planning. Advances in ablation techniques, such as pulsed-field ablation (PFA), offer promising treatment options, underscoring the importance of targeted intervention in reducing the burden of recurrent AF.

Ethics Approval

Based on the regulations of the review board of Mogadishu Somali Türkiye Training and Research Hospital, institutional review board approval is not required for case reports.

Consent for Publication

Written informed consent was obtained from the patient’s daughter for publication of this case report and accompanying images.

Author Contributions

All authors made a significant contribution to the work reported, whether in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Funding

The authors confirm that they did not receive any financial support for this study.

Disclosure

The authors report no conflicts of interest in this work.

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14. Kaur S, Firdaus S, Solano J, et al. Incidental finding of a persistent left superior vena cava during permanent dual-chamber pacemaker implantation: a case report. Cureus. 2024;16(11). doi:10.7759/cureus.72865

15. Kasarla R, Jordan D, Elias M, et al. Persistent left superior vena cava: clinical and procedural challenges. Cureus. 2025;17(4).

16. Menè R, Sousonis V, Combes S, et al. Pulsed field ablation of a persistent left superior vena cava in recurrent paroxysmal atrial fibrillation and its effect on the mitral isthmus: a case report. HeartRhythm Case Rep. 2024;10(1):6–10. doi:10.1016/j.hrcr.2023.10.009

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