Category: 8. Health

  • Metformin vs Lifestyle: 20-Year Diabetes Study Results

    Metformin vs Lifestyle: 20-Year Diabetes Study Results


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    In the early 2000s the U.S. Diabetes Prevention Program (DPP), a large randomized clinical trial, showed that intensive lifestyle modification was better than a medication called metformin at preventing at-risk patients from developing Type 2 diabetes.

    In a newly completed follow-up study, a team of researchers including Vallabh “Raj” Shah, professor emeritus in The University of New Mexico Departments of Internal Medicine and Biochemistry & Molecular Biology at the School of Medicine, found that the health benefits from the lifestyle intervention persisted more than 20 years later.

    In a paper published in The Lancet Diabetes & Endocrinology, they reported that the greatest results from both interventions were seen in the first few years of the study, and they were durable, Shah said. “The data suggests that those people who didn’t get diabetes also didn’t get diabetes after 22 years,” he said.

    The DPP was launched in 1996 to compare the benefits of metformin – then newly approved by the FDA to treat Type 2 diabetes – and a lifestyle modification regimen that included exercise and a healthy diet. The study enrolled 3,234 patients with prediabetes at 30 institutions in 22 states.

    The intensive lifestyle intervention reduced the development of diabetes by 24%, and metformin reduced diabetes development by 17%, according to the new study. The DPP had previously found that after the first three years of study, the lifestyle intervention of moderate weight loss and increased physical activity reduced the onset of Type 2 diabetes by 58% compared with a placebo medicine, while metformin reduced development of diabetes by 31%.

    Compared with the original placebo group, the median time without diabetes was extended by three-and-a-half years in the lifestyle group and two-and-a-half years in the metformin group.

    “Within three years, they had to stop the study because lifestyle was better than metformin,” Shah said. “That means lifestyle, which everybody is banking on, is more effective – that is the news.”

    But because a wealth of health and biological data had already been collected for patients participating in the project, the DPP was repurposed into the DPP Outcomes Study (DPPOS), enabling researchers to follow their health outcomes in multiple domains over a period of decades, he said.

    Shah has contributed to kidney disease research for more than three decades, conducting multiple studies at Zuni Pueblo and other American Indian communities in western New Mexico. He has also overseen the participation of the American Indian cohort enrolled in the DPPOS. Meanwhile, David Schade, MD, chief of the Division of Endocrinology in the UNM School of Medicine, recruited New Mexico participants in the study.

    More recently, he said, DPPOS researchers have taken advantage of their large, well-documented cohort to repurpose the study to focus on diseases associated with aging, such as cancer and dementia, Shah said.

    Reference: Knowler WC, Doherty L, Edelstein SL, et al. Long-term effects and effect heterogeneity of lifestyle and metformin interventions on type 2 diabetes incidence over 21 years in the US Diabetes Prevention Program randomised clinical trial. Lancet Diabetes Endocrinol. 2025;13(6):469-481. doi: 10.1016/S2213-8587(25)00022-1

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  • Forever Chemicals Linked to Anxiety and Memory Issues

    Forever Chemicals Linked to Anxiety and Memory Issues


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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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  • Senegal Introduces Hexavalent Vaccine into its National Immunization Programme – GPEI

    Senegal Introduces Hexavalent Vaccine into its National Immunization Programme – GPEI

    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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  • Targeting Mitochondrial Processes To Treat Melanoma

    Targeting Mitochondrial Processes To Treat Melanoma

    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

    This article has been republished from the following materials. Note: material may have been edited for length and content. For further information, please contact the cited source. Our press release publishing policy can be accessed here.

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  • Late Diagnosis of Persistent Left Superior Vena Cava (PLSVC) as an Und

    Late Diagnosis of Persistent Left Superior Vena Cava (PLSVC) as an Und

    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.

    References

    1. Corîci OM, Gașpar M, Mornoș A, et al. Cardiac arrhythmias in patient with isolated persistent left superior vena cava. Curr Health Sci J. 2017;43(2):163.

    2. Goyal SK, Punnam SR, Verma G, et al. Persistent left superior vena cava: a case report and review of literature. Cardiovascu Ultrasound. 2008;6(1):1–4. doi:10.1186/1476-7120-6-50

    3. Sanku K, Nemalikanti S, Colna M, et al. A rare case of an isolated persistent left superior vena cava. J Ame College Cardiol. 2024;83(13_Supplement):3128. doi:10.1016/S0735-1097(24)05118-0

    4. Bisoyi S, Jagannathan U, Dash A, et al. Isolated persistent left superior vena cava: a case report and its clinical implications. Ann Cardiac Anaesth. 2017;20(1):104–107. doi:10.4103/0971-9784.197847

    5. Paval J, Nayak S. A persistent left superior vena cava. Singapore Med J. 2007;48(3):e90–3.

    6. Morgan LG, Gardner J, Calkins J. The incidental finding of a persistent left superior vena cava: implications for primary care providers—case and review. Case Rep Medicine. 2015;2015:198754. doi:10.1155/2015/198754

    7. Mingyang GAO, Bian Y, Huang L, et al. Catheter ablation for atrial fibrillation in patients with persistent left superior vena cava: case series and systematic review. Front Cardiovascu Med. 2022;9:1015540. doi:10.3389/fcvm.2022.1015540

    8. Kesieme EB, BUCHAN KG. Clinical anatomy of the coronary venous system and relevance to retrograde cardioplegia and cardiac electrophysiological interventions. Clin Anat. 2025;38(1):43–53. doi:10.1002/ca.24195

    9. Azizova A, Onder O, Arslan S, et al. Persistent left superior vena cava: clinical importance and differential diagnoses. Insights Imaging. 2020;11(1):1–19. doi:10.1186/s13244-020-00906-2

    10. Nguyen Duy T, Nguyen Van L, Pham Phuong Thao A, et al. Transvenous dual-chamber pacemaker implantation in a patient with persistent left superior vena cava undergoing maintenance hemodialysis. Inter Med Case Rep J. 2025;273–279.

    11. Batouty NM, Sobh DM, Gadelhak B, et al. Left superior vena cava: cross-sectional imaging overview. La radiologia medica. 2020;125(3):237–246. doi:10.1007/s11547-019-01114-9

    12. Stiver C, Ball MK, Cua CL. Pulmonary venous anomalies. In: Anderson RH, Bacha E, Webb G, editors. Pediatric Cardiology: Fetal, Pediatric, and Adult Congenital Heart Diseases. Cham: Springer International Publishing; 2024:1377–1419.

    13. Turagam MK, Atoui M, Atkins D, et al. Persistent left superior vena cava as an arrhythmogenic source in atrial fibrillation: results from a multicenter experience. J Interv Card Electrophysiol. 2019;54(2):93–100. doi:10.1007/s10840-018-0444-x

    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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  • Mobile testing for ‘hidden virus’ hepatitis C across the region

    Mobile testing for ‘hidden virus’ hepatitis C across the region

    Getty Images A test tube of blood has a sticker on it saying Hepatitis C held by a hand wearing a blue glove. Test tubes with colourful lids can be seen in the background, blurred.
Getty Images

    Hull is believed to have one of the highest rates of hepatitis C in the country

    Mobile units are being used to test for hepatitis C in one of the areas where the virus is thought to be particularly prevalent.

    It is curable if caught early but can cause liver damage and cancer if left untreated.

    The mobile service will offer blood tests and liver scans across northern Lincolnshire, East Yorkshire and Hull.

    The city is believed to have one of the highest rates of the blood-borne virus in the country, according to the NHS Humber Health Partnership.

    The partnership added that more than 4,900 people had been tested locally over the past three years, with about 15% found to be antibody positive.

    The health partnership, which is made up of Hull University Teaching Hospitals NHS Trust and Northern Lincolnshire and Goole NHS Foundation Trust, said it was a “hidden virus” with many people unaware they have it.

    It said hepatitis C used to be associated more with intravenous drug users, but there had been a growing number of people contracting it when having a piercing or a tattoo with unsterilised equipment, for example.

    NHS Humber Health Partnership NHS staff – some wearing medical uniforms – lined up between the white vans, which have NHS logos on the front.NHS Humber Health Partnership

    The two vans are staffed by specialist hepatitis C nurses

    The vans will visit areas where people are believed to be at higher risk of contracting the virus, such as health centres, food banks and hostels.

    They will also attend community events to given health advice.

    “For us, it’s really about reaching out to people who may find it hard to access routine health services or who might not be able to afford to travel to appointments,” said the health partnership’s Kasey P.

    “[It’s also about reaching] those who simply don’t know they’re at risk, to offer proactive advice, screening and treatment.”

    Listen to highlights from Hull and East Yorkshire on BBC Sounds, watch the latest episode of Look North or tell us about a story you think we should be covering here.

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  • This Model Beats Docs at Predicting Sudden Cardiac Arrest

    This Model Beats Docs at Predicting Sudden Cardiac Arrest

    An artificial intelligence (AI) model has performed dramatically better than doctors using the latest clinical guidelines to predict the risk for sudden cardiac arrest in people with hypertrophic cardiomyopathy.

    The model, called Multimodal AI for ventricular Arrhythmia Risk Stratification (MAARS), is described in a paper published online on July 2 in Nature Cardiovascular Research. It predicts patients’ risk by analyzing a variety of medical data and records such as echocardiogram and radiology reports, as well as all the information contained in contrast-enhanced MRI (CMR) images of the patient’s heart.

    Natalia Trayanova, PhD, director of the Alliance for Cardiovascular Diagnostic and Treatment Innovation at Johns Hopkins University in Baltimore, led the development of the model. She said that while hypertrophic cardiomyopathy is one of the most common inherited heart diseases, affecting 1 in every 200-500 individuals worldwide, and is a leading cause of sudden cardiac death in young people and athletes, an individual’s risk for cardiac arrest remains difficult to predict.

    Current clinical guidelines from the American Heart Association and American College of Cardiology, and those from the European Society of Cardiology, identify the patients who go on to experience cardiac arrest in about half of cases.

    “The clinical guidelines are extremely inaccurate, little better than throwing dice,” Trayanova, who is also the Murray B. Sachs Professor in the Department of Biomedical Engineering at Johns Hopkins, told Medscape Medical News.

    Compared to the guidelines, MAARS was nearly twice as sensitive, achieving 89% accuracy across all patients and 93% accuracy for those 40-60 years old, the group of people with hypertrophic cardiomyopathy most at risk for sudden cardiac death.

    Building a Model

    MAARS was trained on data from 553 patients in The Johns Hopkins Hospital, Baltimore, hypertrophic cardiomyopathy registry. The researchers then tested the algorithm on an independent external cohort of 286 patients from the Sanger Heart & Vascular Institute hypertrophic cardiomyopathy registry in Charlotte, North Carolina.

    The model uses all of the data available from these patients, drawing on electronic health records, ECG readings, reports from radiologists and imaging technicians, and raw data from CMR.

    “All these different channels are fed into this multimodal AI predictor, which fuses it together and comes up with the risk for these particular patients,” Trayanova said.

    The inclusion of CMR data is particularly important, she said, because the imaging test can identify areas of scarring on the heart that characterize hypertrophic cardiomyopathy. But clinicians have yet to be able to make much use of those images because linking the fairly random patterns of scar tissue to clinical outcomes has been a challenge.

    But that is just the sort of task that deep neural networks  are particularly well-suited to tackle. “They can recognize patterns in the data that humans miss, then analyze and combine them with the other inputs into a single prediction,” Trayanova said.

    Clinical Benefits

    Better predictions of the risk for serious adverse outcomes will help improve care, by ensuring people get the right treatments to reduce their risk, and avoid the ones that are unnecessary, Trayanova said  The best way to protect against sudden cardiac arrest is with an implantable defibrillator — but the procedure carries potential risks that are best avoided unless truly needed.

    “More accurate risk prediction means fewer patients might undergo unnecessary ICD implantation, which carries risks such as infections, device malfunction, and inappropriate shocks,” said Antonis Armoundas, PhD, from the Cardiovascular Research Center at Massachusetts General Hospital in Boston.

    The model could also help personalize treatment for patients with hypertrophic cardiomyopathy, Trayanova said. “It’s able to drill down into each patient and predict which parameters are the most important to help influence the management of the condition,” she said.

    Robert Avram, MD, MSc, a cardiologist at the Montreal Heart Institute, Montreal, Quebec, Canada, said the results are encouraging. “I’m especially interested in how a tool like this could streamline risk stratification and ultimately improve patient outcomes,” he said.

    But it is not yet ready for widespread use in the clinic. “Before it can be adopted in routine care, however, we’ll need rigorous external validation across diverse institutions, harmonized variable definitions, and unified extraction pipelines for each modality, along with clear regulatory and workflow-integration strategies,” Avram said.

    Armoundas said he would like to see the model tested on larger sample sizes, with greater diversity in healthcare settings, geographical regions, and demographics, as well as prospective, randomized studies and comparisons against other AI predictive models.

    “Further validation in larger cohorts and assessment over longer follow-up periods are necessary for its full clinical integration,” he said.

    Armoundas, Avram, and Trayanova reported having no relevant financial conflicts of interest.

    Brian Owens is a freelance journalist based in New Brunswick, Canada.

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  • Australian man dies from ‘extremely rare’ bat bite virus

    Australian man dies from ‘extremely rare’ bat bite virus

    SYDNEY – An Australian man has died from an “extremely rare” rabies-like infection transmitted by a bat bite, health officials said on July 3.

    The man in his 50s was bitten by a bat carrying Australian bat lyssavirus several months ago, the health service in New South Wales said.

    “We express our sincere condolences to the man’s family and friends for their tragic loss,” NSW Health said in a statement.

    “While it is extremely rare to see a case of Australian bat lyssavirus, there is no effective treatment for it.”

    The man from northern New South Wales, who has not been identified, was this week listed as being in a “critical condition” in hospital.

    Officials said he was treated following the bite and they were investigating to see whether other exposures or factors played a role in his illness.

    The virus – a close relative to rabies, which does not exist in Australia – is transmitted when bat saliva enters the human body through a bite or scratch.

    First symptoms can take days or years to appear.

    Early signs of the disease are flu-like – a headache, fever and fatigue, the health service said.

    The victim’s condition rapidly deteriorates, leading to paralysis, delirium, convulsions and death.

    There were only three previous cases of human infection by Australian bat lyssavirus since it was first identified in 1996 – all of them fatal.

    People should avoid touching or handling bats, as any bat in Australia could carry lyssavirus, the New South Wales health service said.

    Only wildlife handlers who are trained, protected, and vaccinated should interact with the flying mammals, it warned.

    “If you or someone you know is bitten or scratched by a bat, you need to wash the wound thoroughly for 15 minutes right away with soap and water and apply an antiseptic with anti-virus action,” it said.

    “Patients then require treatment with rabies immunoglobulin and rabies vaccine.”

    The virus has been found in species of flying foxes and insect-eating microbats, NSW Health said.

    The species of bat involved in the latest fatality has not been identified.

    “Australian bat lyssavirus is very closely related to rabies and will cause death in susceptible people if they become infected and are not treated quickly,” said Professor James Gilkerson, infectious diseases expert at the University of Melbourne.

    Australian bat lyssavirus was first identified in May 1996 by scientists at the national science agency Csiro, who examined brain tissue from a flying fox that had been showing “nervous signs” in New South Wales.

    Later that year, a bat handler in Queensland became ill.

    “The initial numbness and weakness suffered in her arm progressed to coma and death,” the science agency said in an online document on the virus.

    “Two further cases in Queensland – a woman in 1998 and an eight year old boy in 2013 – resulted in death after being bitten or scratched by a bat,” it said.

    There are subtle differences between the lysssavirus in flying foxes and insectivorous bats, the science agency has found.

    Infected bats can transmit the virus to people, other bats and other mammals. AFP

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  • Prenatal exposure to air pollution and climatic factors associated with adverse birth outcomes in India

    Prenatal exposure to air pollution and climatic factors associated with adverse birth outcomes in India

    Prenatal exposure to ambient fine particulate matter and climatic factors, such as temperature and rainfall, are associated with adverse birth outcomes in India, according to a study published July 2nd, 2025, in the open-access journal PLOS Global Public Health by Mary Abed Al Ahad from the University of St Andrews, U.K.

    Ambient air pollution poses a global threat to human health, with a disproportionate burden of its detrimental effects falling on those residing in low and middle-income countries. Referred to as the silent killer, ambient air pollution is among the top five risk factors for mortality in both males and females. With a diameter of less than 2.5 microns, ambient fine particulate matter 2.5 (PM2.5), which primarily originates from the burning of fossil fuels and biomass, is considered the most harmful air pollutant. In the 2023 World Air Quality Report, India was ranked as the third most polluted country out of 134 nations based on its average yearly PM2.5 levels.

    Ambient air pollution has been associated with a range of pediatric morbidities, including adverse birth outcomes, asthma, cancer, and an increased risk of chronic diseases. Most studies investigating the association between ambient air pollution and adverse birth outcomes have primarily been conducted in high-income countries. Despite the alarming rise in air pollution levels in India, there has been a paucity of research exploring its impact on adverse birth outcomes.

    To address this knowledge gap, the researchers investigated the impact of ambient air pollution on adverse birth outcomes at the national level, focusing on low birth weight and preterm birth, and used different geospatial models to highlight vulnerable areas. The analysis provided evidence of the association between in-utero exposure to PM2.5 and adverse birth outcomes by leveraging satellite data and large-scale survey data. The individual-level analysis revealed that an increase in ambient PM2.5 is associated with a greater likelihood of low birth weight and preterm birth. Climatic factors such as rainfall and temperature were also linked to adverse birth outcomes. Children residing in the Northern districts of India appeared to be more susceptible to the adverse effects of ambient air pollution.

    According to the authors, the geostatistical analysis underscores the need for targeted interventions, particularly in Northern districts. In addition, the National Clean Air Program should be intensified, with stricter emission standards and enhanced air quality monitoring. Climate adaptation strategies, such as developing heat action plans and improving water management, should be incorporated into public health planning to mitigate the effects of extreme temperatures and irregular rainfall. Public health initiatives should be implemented to raise awareness of the risks of air pollution and climate change, particularly among pregnant women. 

    Source:

    Journal reference:

    Jana, A., et al. (2025). In-utero exposure to PM2.5 and adverse birth outcomes in India: Geostatistical modelling using remote sensing and demographic health survey data 2019–21. PLOS Global Public Health. doi.org/10.1371/journal.pgph.0003798.

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  • Surgery vs Radiation in Early Glottic Cancer

    Surgery vs Radiation in Early Glottic Cancer

    TOPLINE:

    In a study of patients with T1 glottic squamous cell carcinomas, a group who received transoral microlaryngeal surgery alone had a higher risk for recurrence than a group who received radiotherapy alone, while 5-year overall survival rates remained similar between the two groups. Patients with T1b tumors had lower survival rates and higher rates of laryngectomy than those with T1a tumors.

    METHODOLOGY:

    • Radiotherapy is the standard treatment for T1 glottic squamous cell carcinomas, but microlaryngeal surgery has emerged as an alternative, prompting researchers to assess their comparative effectiveness.
    • This retrospective observational study included data of 777 patients (12% women; median age, 69 years) with T1a (n = 652) and T1b glottic squamous cell carcinomas (n = 125) from the Swedish Head and Neck Cancer Register, who were treated between 2008 and 2019.
    • Overall, 367 patients (47.2%) underwent microlaryngeal surgery alone, 382 (49.2%) received radiotherapy as a single-modality treatment, while 28 (3.6%) received both treatments.
    • Study outcomes were 5-year overall survival and risk for recurrence (defined as reappearance more than 6 months after diagnosis) or laryngectomy.

    TAKEAWAY:

    • Overall survival at 5 years was higher in patients with T1a tumors than in those with T1b tumors (78.5% vs 66.2%; P = .005).
    • Compared with radiotherapy alone, microlaryngeal surgery alone showed no significant difference in 5-year overall survival among patients with T1a (79.8% vs 77.5%; P = .53) and T1b (63.8% vs 65.9%; P = .610) tumors. The 5-year survival rate was 72.7% in patients who received both surgery and radiotherapy (all T1a), which was not significantly different from what was seen for those who received radiotherapy alone.
    • Most recurrences (80% for T1a and 91% for T1b; 90.5% local) occurred within 3 years, with median times to recurrence of 17.9 months (T1a) and 15 months (T1b).
    • At 3 years, recurrence rates were significantly higher after surgery alone than radiotherapy alone — 19.0% vs 6.4% for T1a tumors, and 56% vs 10% for T1b tumors (P < .001 for both comparisons).
    • The 3-year cumulative incidence of laryngectomy was significantly higher in the T1b vs T1a group (P = .01). Laryngectomy occurred in 5.0% and 5.2% of patients with T1a tumors after surgery alone and radiotherapy alone, respectively, compared with 16.0% and 10.6% among patients with T1b tumors.

    IN PRACTICE:

    “The results indicated a significant difference in 5‐year overall survival in favor of T1a vs T1b tumors and that microlaryngeal surgery should be used with caution in patients who have T1b cancer,” the authors wrote.

    SOURCE:

    The study was led by Hedda Haugen Cange, MD, PhD, Sahlgrenska University Hospital, Goteborg, Sweden. It was published online on June 26, 2025, in Cancer.

    LIMITATIONS:

    The study was limited by its retrospective, observational design. Data were missing on factors like voice quality, quality of life, and comorbidities, which limited comprehensive assessment. Additionally, the small sample size for T1b tumors reduced the study’s statistical power.

    DISCLOSURES:

    The study was funded by Laryngfonden. One author reported serving on a Merck Sharp and Dohme End Point Review Committee outside the submitted work.

    This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

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