Nevin Manimala

JACC Adv. 2025 May 30;4(6 Pt 1):101827. doi: 10.1016/j.jacadv.2025.101827. Online ahead of print.

ABSTRACT

BACKGROUND: Implantable cardioverter-defibrillators (ICDs) are recommended in various forms of heart failure, but little is known about outcomes in peripartum cardiomyopathy (PPCM).

OBJECTIVES: The authors compared long-term ICD-related outcomes in patients with PPCM vs non-PPCM nonischemic cardiomyopathy (NICM).

METHODS: Patients with PPCM and a control group of ethnicity-matched non-PPCM patients, with ICD implantation between 1996 and 2016 were identified. Device interrogation records were reviewed through 2018. Device therapy (shocks, antitachycardia pacing), device-related complications, and outcomes were analyzed.

RESULTS: Of 150 patients with PPCM, 20% (N = 30) underwent ICD implantation at median time from diagnosis of 7 months (IQR: 15 months) and left ventricular ejection fraction of 18% (IQR: 18%). Over 8 ± 6 years of ICD use (mean), 43% received appropriate device therapy (shock and/or antitachycardia pacing), similar to the NICM control group. Inappropriate device therapy occurred in 30% of patients with PPCM, most commonly due to supraventricular tachycardia. One-third of patients required at least one subsequent invasive ICD-related procedure other than generator replacement. After ICD implantation, 9 patients with PPCM (30%) had subsequent improvement of left ventricular ejection fraction to >50% and 4 of them had received appropriate ICD therapy. In comparison to the control group, there were no statistically significant differences in device therapy, despite longer ICD follow-up in the NICM control group (median 12 months vs 5 months, respectively, P < 0.05).

CONCLUSIONS: In this cohort of patients with PPCM and ICD, rates of appropriate device therapy were high. Over long-term follow-up, rates of inappropriate shocks and device complications were also substantial in both PPCM and NICM cohorts.

PMID:40570406 | DOI:10.1016/j.jacadv.2025.101827

Mult Scler Relat Disord. 2025 Jun 20;101:106594. doi: 10.1016/j.msard.2025.106594. Online ahead of print.

ABSTRACT

There is a long-held hypothesis that multiple sclerosis (MS) affects the central nervous system in a length dependent way reflecting the propensity of longer central axonal projections to accumulate damage, but evidence for this is lacking. To determine the prevalence of body part involvement in MS and relate this to the putative axonal length innervating each body part, we asked people with MS to indicate affected body parts on a somatic diagram. Axonal length for each body part was calculated from neuroanatomical literature. The survey was part of the TONiC-MS study. Records from 5925 respondents were analysed for involvement of eleven distinct body parts (either hand/ upper limb /lower limb, urinary bladder, neck, speech, vision, swallowing), and also balance. Participants had a wide range of age, disease duration, disease subtypes and disability levels. Body part involvement in the whole sample was highly correlated with axonal length (rho 0.933). At an individual level, a logistic regression including covariates of age, disease type and disability level demonstrated that the probability of body part involvement was substantially dependent on axonal length across all disease types. Our study supports the hypothesis that MS disability reflects a length-dependent central axonopathy.

PMID:40570401 | DOI:10.1016/j.msard.2025.106594

J Contam Hydrol. 2025 Jun 19;274:104656. doi: 10.1016/j.jconhyd.2025.104656. Online ahead of print.

ABSTRACT

This study examines the origins, distribution, and health impact of potentially toxic elements (PTEs) found in the surface sediments of Vembanad Wetland, a Ramsar site on India’s southwest coast. Sediment from 14 sampling locations was seasonally analysed for Fe, Mn, Cu, Ni, Co, Zn, Cr, Pb and Cd. The average concentration of PTEs (mg/kg) follows the order: Fe (35,668.07 ± 20,082.98) > Mn (307.5 ± 36.71) > Zn (155.96 ± 99.45) > Cr (119.94 ± 79) > Ni (92.66 ± 32.69) > Cu (42.29 ± 17.26) > Pb (21.67 ± 11.65) > Co (20.64 ± 14.32) > Cd (2.21 ± 0.78). Higher average contamination factor (CF), enrichment factor (EF) and geoaccumulation index were observed for Cd (CF = 4.17, EF = 7.73, Igeo = 2.18) and Zn (CF = 4.85, EF = 2.44, Igeo = 0.38), indicating substantial anthropogenic enrichment. The average values of pollution indices such as PLI (1.49), TRI (11.69), mCd (15.1), and RI (251.69) indicate moderate to significant pollution. Average modified hazard quotient (mHQ) values revealed that Ni (3.19), Cr (2.76), Cd (1.99), and Zn (1.64) posed notable ecological risks. A potential health concern from prolonged exposure was indicated by the increased average total carcinogenic risk (TCR) values for Ni (9.24E-2), Cr (6.57E-2), and Cd (3.62E-2) in children. Multivariate analyses (PCA, PCC, HCA) suggested common contamination sources, with PCA-MLR confirming industrial discharge and agricultural runoff as dominant contributors. This study uniquely integrates seasonal variability, advanced pollution indices, and health risk evaluation, highlighting the urgent need for targeted management strategies in these sensitive aquatic systems.

PMID:40570382 | DOI:10.1016/j.jconhyd.2025.104656

Obstet Gynecol. 2025 Jun 26. doi: 10.1097/AOG.0000000000005986. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effectiveness of influenza vaccination during pregnancy against influenza in infants during their first 6 months of life.

METHODS: We conducted a cohort study among pregnant individuals enrolled in Kaiser Permanente Northern California (KPNC) and their infants. We followed all infants from birth until the first occurrence of a polymerase chain reaction test result positive for influenza, the infant reached age 6 months, death, disenrollment from KPNC, or the end of the study on December 31, 2022. We used Cox regression to compare the hazard of influenza in infants whose mothers were vaccinated against influenza during pregnancy with those whose mothers were unvaccinated. Hazard ratios (HRs) were adjusted for calendar time, maternal sociodemographic and comorbidities. Vaccine effectiveness was calculated as 100% (1-adjusted HR). We evaluated the association between vaccination and infant influenza outcomes any time during pregnancy and by trimester of vaccination.

RESULTS: Of the 245,498 infants included in the study, 46.0% were born to vaccinated mothers. The incidence of influenza was lower among infants of vaccinated mothers than unvaccinated mothers (0.12% vs 0.30%). After adjusting for covariates, vaccination during pregnancy was associated with a reduction in infant influenza in any clinical setting by 44.4% (95% CI, 31.4-54.9%). Vaccination during the first trimester was associated with a reduction in infant influenza by 11.3%, a reduction of 51.5% during the second trimester, and a reduction of 59.3% during the third trimester. The differences in vaccine effectiveness estimates that compared the first and second trimesters (P=.02) and compared the first and third trimesters (P<.001 were statistically significant.

CONCLUSION: Influenza vaccination during pregnancy was associated with a reduction in infant influenza infection by 44.4%. The reduction in infant influenza infection was greater when vaccination occurred in the second or third trimester, compared with the first trimester.

PMID:40570349 | DOI:10.1097/AOG.0000000000005986

N Z Med J. 2025 Jun 27;138(1617):100-112. doi: 10.26635/6965.6909.

ABSTRACT

AIM: To characterise the appropriateness of community referrer-rated urgency among dermatology referrals.

METHOD: Using e-referral data from a month representative of volume and service provision in a tertiary dermatology service, referrer-rated urgency and triage priority assigned by two specialist dermatologists were compared to determine appropriateness. Descriptive analysis was conducted to quantify the proportion of appropriately and inappropriately assigned urgency in priority populations of women, Māori and Pacific peoples and paediatric patients.

RESULTS: One-third of general dermatology referrals, and nearly one in six referrals of suspected skin cancers, had an inappropriately assigned urgency. A quarter of general dermatology and most melanoma referrals had urgency lower than triage priority. Māori and Pacific patients were under-represented in the proportion of referrals received by ethnicity when comparing to national and provincial population estimates. However, no significant disparities in appropriateness of urgency across ethnicity were observed, and the same was seen for female and paediatric patients.

CONCLUSION: Our study adds to the limited research on the appropriateness of referrer-rated urgency. We have pointed out that artificial intelligence (AI) has significant potential to improve the prioritisation of referrals by identifying melanoma and severe skin diseases.

PMID:40570338 | DOI:10.26635/6965.6909

N Z Med J. 2025 Jun 27;138(1617):85-99. doi: 10.26635/6965.6905.

ABSTRACT

AIM: Community-acquired pneumonia (CAP) is inequitably experienced in populations globally, with multiple social and environmental factors contributing to the risk of CAP; thus, predicting communities at increased risk is difficult. The aims of this study were to determine the geographical distribution of adults with CAP requiring hospitalisation in Christchurch, and to examine the associations between CAP and socio-economic and area deprivation.

METHODS: A retrospective clinical records review was conducted of all adult patients hospitalised with CAP at Christchurch Hospital over a 12-month period. Geocoding residential addresses allowed for geospatial hotspot analysis using the Getis-Ord Gi* method. Comparison of the relative rates of CAP in different socio-economic deprivation deciles was assessed using New Zealand census data and the Index of Multiple Deprivation (IMD).

RESULTS: The dataset comprised 924 hospitalisations. CAP hotspots were located in the northeast and southwest of the city. CAP was not equally distributed across the deprivation quantiles (p <0.001); compared with the least deprived quintile, quintiles four and five had rate ratios (95% confidence interval [CI]) of 1.5 (1.3 to 1.8) and 1.6 (1.3 to 2.0), respectively. Patients with CAP who identified as Māori or Pacific peoples were significantly younger, and a higher proportion were resident in areas of highest socio-economic deprivation relative to patients who identified as NZ European.

CONCLUSION: This study identified hotspots within Christchurch with higher rates of CAP requiring hospitalisation and has contributed further New Zealand-based evidence on the influence of socio-economic disparities on health inequity.

PMID:40570337 | DOI:10.26635/6965.6905

N Z Med J. 2025 Jun 27;138(1617):76-84. doi: 10.26635/6965.6788.

ABSTRACT

BACKGROUND: Metabolic bariatric surgery (MBS) is an effective treatment for obesity and its related comorbidities.1 Publicly funded MBS in New Zealand is regionally limited with variable case volumes, potentially limiting surgical training.2 This retrospective study aims to evaluate if MBS safety and effectiveness are impacted by teaching within a low-volume unit.

METHODS: A retrospective outcomes analysis was carried out for all MBS cases of a single surgeon (public and private). Cases were compared based on primary operator status: consultant (COP) and trainee/fellow (TOF). Primary outcomes included multiple safety and effectiveness parameters including leaks, haemorrhage, 30-day morbidity and total weight loss (TWL).

RESULTS: Two-hundred and fifty patients satisfied inclusion criteria. Results are reported as COP and TOF. Primary operator: 87 (34.8%) and 163 (65.2%). There were no leaks, strictures or 30-day mortalities. Perioperative haemorrhage: 1 and 4. Thirty-day morbidity: 1 and 5. One-year TWL: 36.0% and 35.0%. Sleeve stenosis: 0 and 1. Thirty-day readmissions: 1 and 4. One-year readmissions: 4 and 9. Length of stay: 3 and 4 (p=<0.001).

CONCLUSION: MBS safety and effectiveness outcomes in low-volume practice performed by TOF were no different to COP within our study setting.

PMID:40570336 | DOI:10.26635/6965.6788

N Z Med J. 2025 Jun 27;138(1617):50-61. doi: 10.26635/6965.6807.

ABSTRACT

AIM: We examined equity in the provision of cochlear implant services for New Zealand Māori compared with other New Zealanders.

METHODS: The client databases of both Aotearoa New Zealand cochlear implant programmes were searched and an anonymised dataset was provided to the audit team. Ethics committee approval was not required. Ethnicity was categorised as Māori or non-Māori.

RESULTS: There is no significant difference between Māori and non-Māori with respect to acceptance for surgery rates and time from acceptance to surgery. Māori children and adults have a higher rate of proceeding to surgery than non-Māori ethnic groups. Average days to surgery for adult clients reduced over the period studied. Time to surgery was low for both child ethnic groups. When a measure of prioritisation (clinical priority access criteria [CPAC]) was incorporated into the evaluation, we found that Māori clients waited slightly, but not significantly less time per unit of CPAC scored.

CONCLUSION: We were able to demonstrate that once Māori clients accessed the cochlear implant programmes, they were implanted at a similar rate as non-Māori, and adult clients experienced equivalent waiting times even when adjusted for CPAC score. These favourable results suggest that our internal systems and pathways are promoting equity.

PMID:40570334 | DOI:10.26635/6965.6807

N Z Med J. 2025 Jun 27;138(1617):12-49. doi: 10.26635/6965.6926.

ABSTRACT

AIM: A rib fracture guideline was implemented at Whangārei Hospital with the aim of improving the care of patients and mitigating the risk of preventable additional morbidity. The aim of this study was to assess the impact of this guideline on the management and outcomes of patients.

METHODS: A single centre retrospective audit was performed comparing patients with rib fractures pre and post the implementation of the RIB-IMPROVE guideline. The primary outcome of interest was pneumonia. Patients with an abbreviated injury score (AIS) head or abdomen >2 were excluded. Binomial logistic regression was conducted for the primary outcome with adjustments for clinically plausible variables.

RESULTS: There were 418 patients identified, 241 in the pre-guideline and 177 in the post-guideline group. There was no difference in age, sex, ethnicity, number of rib fractures, injury severity score (ISS) or local anaesthetic block placement. The pneumonia rate was 13% vs 7% comparing the pre- and post-guideline groups, respectively. After adjustment for age, sex and ISS, the relative risk of developing pneumonia was 0.52 comparing the post- with the pre-guideline group (p=0.04). No statistical difference in secondary outcomes was seen, including the length of stay, 30-day readmission rate or 30-day mortality rate.

CONCLUSION: This study found that the risk of pneumonia was decreased by almost half after implementation of the RIB-IMPROVE guideline at Whangārei Hospital. This study highlights the effectiveness of a multidisciplinary guideline in the management of patients with rib fractures.

PMID:40570333 | DOI:10.26635/6965.6926

JMIR Infodemiology. 2025 Jun 26;5:e58302. doi: 10.2196/58302.

ABSTRACT

BACKGROUND: The outbreak of SARS-CoV-2 in 2019 was accompanied by a rise in the popularity of conspiracy theories. These theories often undermined vaccination efforts. There is evidence that the spread of misinformation about COVID-19 is associated with online social media use. Online social media enables network effects that influence the dissemination of information. It is important to distinguish between the effects of using social media and the network effects that occur within the platform.

OBJECTIVE: This study aims to investigate the association between the modularity of online social networks and the spread of, as well as attitudes toward, information and misinformation about COVID-19.

METHODS: This study used data from the social network structure of the online social media platform Vkontakte (VK) to construct an adjusted modularity index (fragmentation index) for 166 Russian towns. VK is a widely used Russian social media platform. The study combined town-level network indices with data from the poll “Research on COVID-19 in Russia’s Regions” (RoCIRR), which included responses from 23,000 individuals. The study measured respondents’ knowledge of both fake and true statements about COVID-19, as well as their attitudes toward these statements.

RESULTS: A positive association was observed between town-level fragmentation and individuals’ knowledge of fake statements, and a negative association with knowledge of true statements. There is a strong negative association between fragmentation and the average attitude toward true statements (P<.001), while the association with attitudes toward fake statements is positive but statistically insignificant (P=.55). Additionally, a strong association was found between network fragmentation and ideological differences in attitudes toward true versus fake statements.

CONCLUSIONS: While social media use plays an important role in the diffusion of health-related information, the structure of social networks can amplify these effects. Social network modularity plays a key role in the spread of information, with differing impacts on true and fake statements. These differences in information dissemination contribute to variations in attitudes toward true and fake statements about COVID-19. Ultimately, fragmentation was associated with individual-level polarization on medical topics. Future research should further explore the interaction between social media use and underlying network effects.

PMID:40570328 | DOI:10.2196/58302