Horsham Hospital

BackgroundBovine tuberculosis (bTB), caused by Mycobacterium bovis, is the most significant infectious disease of UK cattle. Badgers (Meles meles) can also be infected by M. bovis and may act as a source of infection for cattle. Management of infection risks could be supported by the availability of sensitive blood tests for bTB in badgers. We explored whether metabolomic changes in peripheral blood could be used for the diagnosis of bTB in wild, naturally infected badgers.MethodsFlow infusion electrospray - high-resolution mass spectrometry (FIE-HRMS) was used to assess the peripheral blood of trapped wild badgers (n = 148) for metabolite changes linked to bTB infection status. Infection status was established by culture, Dual Path Platform (DPP) and interferon (IFN-γ) blood tests or mycobacterial culture. Data were analysed by multivariate and receiver operating characteristic (ROC) curve analyses.ResultsMetabolite shifts were identified in badger blood samples associated with their corresponding infection status. Biochemical pathway analyses suggested that sphingolipid and glycerophospholipid metabolism was enriched in bTB badgers. However, some individual metabolites changes appeared to differ depending on badger sex.ConclusionOur data shows that metabolomic assessment of peripheral blood can indicate bTB infection status. However, larger sample sizes are required to establish if our metabolites have potential as diagnostic biomarkers.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12917-025-05144-6.

Background/Objectives: Cardiac involvement in systemic sclerosis (SSc) ranges from subclinical to severe. While pulmonary artery hypertension (PAH) is well-documented, the mechanism of left ventricular (LV) ischemia remains unclear. Oxygen-sensitive cardiovascular magnetic resonance (OS-CMR) imaging offers a novel approach to assessing myocardial oxygenation and ischemia. This study evaluated the changes in myocardial deoxygenation in response to stress using LV OS-CMR in SSc patients without known cardiac disease. Methods: We prospectively recruited SSc patients without prior cardiac disease or risk factors, and age- and sex-matched healthy volunteers (HVs). All participants underwent transthoracic echocardiography (TTE) and 3T CMR, including native T1 mapping, rest/stress OS-CMR, stress perfusion, and late gadolinium enhancement (LGE). The primary outcome was a change in the LV OS-CMR signal intensity (SI) after adenosine stress. Results: Thirty-three participants (23 SSc, 10 HV) were enrolled. SSc patients had significantly lower global LV OS-CMR SI compared to HV (13.4 ± 6.5 vs. 19.5 ± 3.6, p = 0.011). OS-CMR SI change ≤ 10% was observed in at least one segment in 20 (87%) SSc patients and globally in 12 (52%). LGE was present in 5 (22%) patients, and 18 (78%) had ≥1 abnormal T1 mapping segment. LV global longitudinal strain (GLS) was reduced in SSc patients compared to the HVs (−19.04 ± 3.86 vs. −21.92 ± 3.72, p = 0.045). All HVs had normal CMR and TTE findings. Conclusions: SSc patients without known cardiovascular disease or PAH demonstrated subclinical LV ischemia with an impaired myocardial oxygenation response to stress. They further demonstrated LV myocardial deformation abnormalities and LV diffuse fibrosis when compared to an age-matched control group. Our findings support the presence of early coronary microvascular dysfunction and LV myocardial fibrosis in this population, which may explain the adverse cardiovascular risk seen in this population, independent of the presence of PAH.

We respectfully disagree with Subbiah et al. in their criticism of our study.1 To overcome the lack of dedicated International Classification of Diseases codes for Parkinson disease (PD) psychosis, we accrued patients with PD and included several patient characteristics of psychosis. Although residual confounding is always possible in observational research, we disagree that we compared groups with vastly different baseline characteristics. We accrued both pimavanserin users and nonusers among long-term care residents with PD to minimize selection bias at the design stage. In addition, we used inverse probability of treatment weighting (IPTW) to control for confounding at the analytic stage. After IPTW, pimavanserin users and nonusers were well balanced for observed patient characteristics, including other antipsychotic use.

Introduction: The need for increased utilization of hospice in the dying patients has been recognized in multiple fields including cardiology recently. The aim of this study to examine the trends in location of deaths in acute myocardial infarction (AMI) related deaths in the United States from 2003 to 2019. Methods: The CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) was used to access the National Vital Statistics System data from 2003 to 2019. AMI related deaths in patients ≥ 25 years of age were identified from multiple causes of death. Joinpoint regression was used to examine changes in trend, annual percentage change (APC), and average annual percentage change (AAPC). Location of death was categorized as home, medical facility, hospice facility, nursing home/long term care (NH/LTC) and other/unknown. Results: Of AMI related deaths, 23.62% occurred at home, 0.94% at hospice facility, 39.64% at medical facility and 13.30% at NH/LTC. From 2003-2019, the number of deaths has increased at hospice facility (AAPC 24.7[95% CI, 18.1 to 31.6]) and decreased at both medical facilities (AAPC -3.1[95% CI, -3.5 to -2.8]) and NH/LTC (AAPC -4.3[95% CI, -4.6 to -3.9]). The number of deaths initially decreased at home till 2009 (APC -1.9[95% CI, -2.5 to -1.3]) followed by increase till 2019 (APC 1.5[95% CI, 1.2 to 1.8]). Conclusion: Although there was an increasing trend in AMI related mortality at hospice and home locations, rates of utilization of hospice facility remain very low.

Background: Atrial fibrillation (AF) is the most prevalent arrhythmia in the United Sates. Obesity is a known adverse prognostic factor for several cardiovascular diseases. We aimed to evaluate clinical outcomes in patients hospitalized with AF with history of bariatric surgery versus morbid obesity. Methods: We conducted a retrospective analysis of adult discharges from the National Inpatient Sample (NIS) between 2016 and 2018. ICD Codes were used to identify primary AF hospitalizations. These were further divided into two groups 1. Body mass index (BMI) >/= 35; 2. History of bariatric surgery with BMI < 35. Prevalence estimates were weighted using NIS-provided discharge-level weights to reflect national estimates. Weighted multivariable logistic regression was used to assess the association of history of bariatric surgery vs morbid obesity on various other clinical outcomes in primary AF hospitalizations. These models were adjusted for several patient-level and hospital-level characteristics. Results: There were 7,340 primary AF related hospitalizations with history of bariatric surgery and 159,105 primary AF hospitalizations with morbid obesity. There was no significant difference in adjusted all-cause mortality, use of mechanical circulatory support, cardiac arrest, cardiogenic shock, invasive mechanical ventilation, pressors use or inflation-adjusted cost between the two groups. However, admissions with morbid obesity (in comparison to history of bariatric surgery) were associated with higher rates of acute kidney injury, disposition to short/long term care and length of stay. Conclusion: Our study did not show any difference in mortality and various other outcomes between the two groups. However acute kidney injury, disposition to short/long term care and length of stay were significantly higher for the admissions with morbid obesity.