The Role of Cardiovascular Magnetic Resonance Imaging in Athletic Individuals-A Narrative Review

Cardiovascular magnetic resonance imaging (MRI) is an advanced cardiac imaging modality that is often required when evaluating athletic individuals. Unrestricted imaging planes, excellent spatial resolution, and a lack of ionising radiation are some of the benefits of this modality. Cardiac MRI has been established as the gold standard imaging modality for morphological assessment, volumetric analysis, and tissue characterisation. Cardiac MRI without any doubt is an excellent diagnostic tool when evaluating athletes with symptoms or those individuals exhibiting equivocal findings at screening. It is also useful for athletes who fall within the grey zone and is especially important among athletes with a suspected or confirmed diagnosis. Cardiac MRI plays a strategic role when adopting a shared decision-making model in athletes with heart disease, tailoring and personalising medical care to the condition and the athlete’s wishes. The aim of this review is to provide a comprehensive yet practical overview of the role of cardiac MRI when evaluating athletes in clinic

Gasdermin D mutation protects against renal ischemia reperfusion injury

Pyroptosis, the most inflammatory form of cell death, is dependent on membrane pore formation governed by the assembly of cleaved Gasdermin D (GSDMD). We hypothesized that regulated necrosis pathways are crucial in the pathophysiology of acute kidney injury (AKI). Mice with an isoleucine‐to‐asparagine loss‐of‐function mutation in the Gasdermin D gene (GSDMDI105N/I105N) generated by ethylnitrosourea‐mutagenesis were subjected to bilateral renal ischemia–reperfusion injury (IRI) with bio‐molecular readouts performed at 24 h. IRI was also performed in mice pretreated with disulfiram. Whole‐body irradiation followed by syngeneic bone marrow transplantation generated chimeric mice prior to IRI. Mice homozygous for the GSDMD I105N mutation were protected from IRI, demonstrating lower serum creatinine and reduced histological injury, as well as decreased pro‐inflammatory cytokine expression and oxidative stress. Chimeric mice showed that this protection was predominantly governed by mutations in the parenchymal tissue, with a potential contribution from the hematopoietic compartment. Pharmacological inhibition of GSDMD pore formation using disulfiram protected against IRI. Manipulation of GSDMD is an attractive target to mitigate inflammation and cellular death following AKI

mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED): statistical analysis plan

Background Type 2 diabetes and prediabetes represent significant global health challenges, with physical activity (PA) being essential for disease management and prevention. Despite the well-documented benefits, many individuals with (pre)diabetes remain insufficiently active. General practitioners (GP) provide an accessible platform for delivering interventions; however, integrating PA interventions into routine care is hindered by resource constraints. Objectives The ENERGISED trial aims to address these barriers through an innovative GP-initiated mHealth intervention combining wearable technology and just-in-time adaptive interventions. Methods The ENERGISED trial is a pragmatic, 12-month, multicentre, randomised controlled trial, assessing a GP-initiated mHealth intervention to increase PA and reduce sedentary behaviour in patients with type 2 diabetes and prediabetes. The primary outcome is daily step count, assessed via wrist-worn accelerometry. The primary analysis follows the intention-to-treat principle, using mixed models for repeated measures. Missing data will be handled under the missing-at-random assumption, with sensitivity analyses exploring robustness through reference-based multiple imputation. The trial incorporates the estimand framework to provide transparent and structured treatment effect estimation. Discussion This statistical analysis plan outlines a robust approach to addressing participant non-adherence, protocol violations, and missing data. By adopting the estimand framework and pre-specified sensitivity analyses, the plan ensures methodological rigour while enhancing the interpretability and applicability of results. Conclusions The ENERGISED trial leverages innovative mHealth strategies within primary care to promote PA in individuals with (pre)diabetes. The pre-specified statistical framework provides a comprehensive guide for analysing trial data and contributes to advancing best practices in behavioural intervention trials for public health. Trial registration ClinicalTrials.gov NCT05351359. Registered on April 28, 2022

Influenza vaccination during early pregnancy and risk of major birth defects, US Birth Defects Study To Evaluate Pregnancy exposureS, 2014–2019

Purpose Studies of influenza vaccination during pregnancy and major birth defects generally provide reassuring findings. To maintain public confidence, it is important to continue evaluating the safety of maternal vaccination using well characterized, population-based data. This study extended previous research to examine associations between maternal influenza vaccination and selected birth defects using data from the Birth Defects Study To Evaluate Pregnancy exposureS, a US, multisite case-control study. Methods Mothers of case children (diagnosed with a birth defect) and control children (without a birth defect diagnosis) were identified from population-based birth defect surveillance programs and recruited to complete a telephone interview. Data from 2675 case and 1575 control mothers (participants) with deliveries during 2014–2019 were analyzed. Influenza vaccination exposure during the critical exposure period (one month before pregnancy through the first pregnancy month [B1P1] for spina bifida or through the third pregnancy month [B1P3] for other selected birth defects) was assessed controlling for several participant covariates. Logistic regression with propensity score adjustment was used to estimate adjusted odds ratios (aORs) and 95 % confidence intervals (CIs). Several secondary analyses were conducted. A probabilistic bias analysis examined the effect of exposure misclassification. Results The aOR observed between B1P1 influenza vaccination exposure and spina bifida was 0.9 (95 % CI: 0.4–2.0). The aORs for B1P3 exposure and other selected birth defects examined ranged from 0.4 to 1.3, with 95 % CIs including the null except those for cleft lip ± cleft palate (aOR: 0.6; 95 % CI: 0.4–0.9) and gastroschisis (aOR: 0.4; 95 % CI: 0.2–0.7). Results from secondary analyses were similar to the primary analyses, and those from probabilistic bias analysis were similar to respective primary and secondary analyses. Conclusion Findings showed no statistically significant positive associations between influenza vaccination and the selected birth defects, supporting public health efforts to promote optimal vaccination coverage among pregnant women

Comparison of mortality in people with type 2 diabetes between different ethnic groups: Systematic review and meta-analysis of longitudinal studies.

AIMS: Type 2 diabetes (T2D) is more common in certain ethnic groups. This systematic review compares mortality risk between people with T2D from different ethnic groups and includes recent larger studies. METHODS: We searched nine databases using PRISMA guidelines (PROSPERO CRD42022372542). We included community-based prospective studies among adults with T2D from at least two different ethnicities. Two independent reviewers undertook screening, data extraction and quality assessment using the Newcastle-Ottawa Scale. The primary outcome compared all-cause mortality rates between ethnic groups (hazard ratio (HR) with 95% confidence intervals). RESULTS: From 30,825 searched records, we included 13 studies (7 meta-analysed), incorporating 573,173 T2D participants; 12 were good quality. Mortality risk was lower amongst people with T2D from South Asian [HR 0.68 (0.65-0.72)], Black [HR 0.82 (0.77-0.87)] and Chinese [HR 0.57 (0.46-0.70)] ethnicity compared to people of White ethnicity. Narrative synthesis corroborated these findings but demonstrated that people of indigenous Māori ethnicity had greater mortality risk compared to European ethnicity. CONCLUSIONS: People with T2D of South Asian, Black and Chinese ethnicity have lower all-cause mortality risk than White ethnicity, with Māori ethnicity having higher mortality risk. Factors explaining mortality differences require further study, including understanding complication risk by ethnicity, to improve diabetes outcomes

Do mental and physical health trajectories change around transitions into sandwich care? Results from the UK household longitudinal study.

OBJECTIVES: Sandwich carers provide care to ageing parents or older relatives while simultaneously raising dependent children. There has been little focus on how mental and physical health trajectories change around becoming a sandwich carer - a gap this study aims to fill. STUDY DESIGN: Prospective longitudinal study. METHODS: We used 10 waves of data from the UK Household Longitudinal Study (2009-2020) - a high-quality longitudinal data. Sandwich carers were parents who lived with children under age 16 and took up unpaid care of a family member in the older generation. Sandwich carers were matched with parents who did not take up any adult care (i.e., non-sandwiched parents) with similar characteristics. We then employed piecewise growth curve modelling to model the trajectories in mental and physical health before, during and after becoming a sandwich carer and comparing these with non-sandwiched parents. RESULTS: Among parents, the uptake of caring for a family member was associated with a deterioration in mental health, especially for those who spent more than 20 h per week caring for a family member. The deterioration persisted for several years. Those who cared intensively also experienced greater physical health declines during the transition. We did not see evidence of gender difference in the above associations. CONCLUSIONS: It is essential for society to recognise the unique needs and challenges of sandwich carers and provide them with the necessary support systems, resources, and community networks to ensure their health is maintained. Targeted support is required for sandwich carers who care intensively

Cost Utility of Specialist Physiotherapy for Functional Motor Disorder (Physio4FMD)

Background and Objectives Functional motor disorder (FMD), a motor-dominant variant of functional neurologic disorder, is a disabling condition associated with high health and social care resource use and poor employment outcomes. Specialist physiotherapy presents a possible treatment option, but there is limited evidence for clinical effectiveness and cost-effectiveness. Physio4FMD is a multicenter randomized controlled trial of specialist physiotherapy for FMD compared with treatment as usual (TAU). The aim of the analysis was to conduct a randomized trial based on economic evaluation of specialist physiotherapy compared with TAU. Methods Eleven centers in England and Scotland randomized participants 1:1 to specialist physiotherapy or TAU (referral to community neurologic physiotherapy). Participants completed the EuroQoL EQ-5D-5L, Client Service Receipt Inventory, and Work Productivity and Activity Impairment Questionnaire at baseline, 6 months, and 12 months. The mean incremental cost per quality-adjusted life year (QALY) for specialist physiotherapy compared with TAU over 12 months was calculated from a health and social care and wider societal perspective. The probability of cost-effectiveness and 95% CIs were calculated using bootstrapping. Results The analysis included 247 participants (n = 141 for specialist physiotherapy, n = 106 for TAU). The mean cost per participant for specialist physiotherapy was £646 (SD 72) compared with £272 (SD 374) for TAU. Including the costs of treatment, the adjusted mean health and social care cost per participant at 12 months for specialist physiotherapy was £3,814 (95% CI £3,194–£4,433) compared with £3,670 (95% CI £2,931–£4,410) for TAU, with a mean incremental cost of £143 (95% CI £–825 to £1,112). There was no significant difference in QALYs over the 12-month duration of the trial (0.030, 95% CI –0.007 to 0.067). The mean incremental cost per QALY was £4,133 with an 86% probability of being cost-effective at a £20,000 threshold. When broader societal costs such as loss of productivity were taken into consideration, specialist physiotherapy was dominant (incremental cost: £−5,169, 95% CI £–15,394 to £5,056). Discussion FMD was associated with high health and social care costs. There is a high probability that specialist physiotherapy is cost-effective compared with TAU particularly when wider societal costs are taken into account. Trial Registration Information International Standard Randomised Controlled Trial registry, ISRCTN56136713

Knowledge, Attitudes, and Practices of Iraqi Parents Regarding Antibiotic Use in Children and the Implications

Background: Antibiotic misuse is a major global health issue, particularly in low- and middle-income countries (LMICs), where inappropriate use contributes to antimicrobial resistance (AMR). Inappropriate antibiotic use is exacerbated in LMICs by pressure from parents on physicians and pharmacists to prescribe and dispense antibiotics for their children, often for viral infections. There is currently limited knowledge of key issues in Iraq to improve future antibiotic use. Consequently, we explored knowledge, attitudes, and practices (KAPs) of Iraqi parents regarding antibiotic use in their children to provide future direction. Methods: A cross-sectional survey was conducted between November 2023 and September 2024 among 1878 parents in four districts of Iraq. A structured questionnaire assessed parents’ KAPs towards antibiotic-related uses and practices. Data were analyzed using descriptive statistics and Chi-square tests to examine the associations between demographic variables and KAP indicators. Results: Among the participants, 83% were aware that antibiotics are ineffective for viral infections, and 75% recognized potential side effects from antibiotics. Despite this knowledge, 63% of parents admitted to administering antibiotics to their children without a prescription, with 42% discontinuing treatment once symptoms improved. Factors including cost, dosage, and taste influenced antibiotic selection. Parents with higher education and income levels were more likely to engage in self-medication. Pharmacists were the primary source of antibiotic information for 52% of respondents. Conclusions: Despite adequate knowledge, inappropriate practices such as self-medication and discontinuing treatment early were prevalent. Targeted educational campaigns, particularly among parents with higher education levels and incomes, are necessary to mitigate AMR in Iraq

A composite subunit vaccine confers full protection against Buruli ulcer disease in the mouse footpad model of Mycobacterium ulcerans infection.

Buruli ulcer (BU) disease, a neglected necrotizing tropical skin infection caused by Mycobacterium ulcerans, is the third most common mycobacterial disease after tuberculosis and leprosy. Infections mostly occur in remote, rural areas of Central and West Africa, but also in Australia, Japan and Papua New Guinea. There is currently no vaccine against Buruli ulcer disease and all previous attempts using closely related bacteria and subunit proteins have been partially successful only. Here, we tested in mice a composite subunit formulation incorporating the Mycobacterium ulcerans toxin mycolactone as the immunomodulator, and the antigens Ag85A and Polyketide Synthase Enzyme Ketoreductase A (KRA), formulated with Quil-A adjuvant ('Burulivac'). Burulivac induced Ag85A and KRA antigen-specific antibodies, T cells and a mixed pro- and anti-inflammatory cytokine responses, which conferred absolute protection against Buruli ulcer disease in the mouse footpad model over a 14-week period of observation. This was superior to both live attenuated mycobacterial vaccines, that is, BCG and an avirulent M. ulcerans strain that lacks the mycolactone toxin (MuΔ). Interleukin 10 was found to be strongly associated with protection. We suggest that Burulivac is a promising vaccine candidate against Buruli ulcer disease that warrants further exploration