Momentum Research

Background:Heart failure (HF) affects approximately 64.3 million people worldwide. Despite notable progress over the past two decades in advancing the understanding of heart failure in Africa–a condition often more lethal than many cancers–important knowledge gaps persist. These include outdated data on access to care and a lack of information regarding the incidence, aetiology, availability, and affordability of HF medications.Objectives:To prospectively characterise the contemporary incidence, epidemiology, clinical presentation, and health outcomes of acute HF among a large, representative cohort of patients presenting to hospitals across diverse communities in Africa.Methods:The Sub-Saharan Africa Survey of Heart Failure (THESUS-HF II) is a pragmatic, multicentre, observational cohort study coordinated by the Pan-African Society of Cardiology (PASCAR). All 27 PASCAR member countries were invited to participate, along with over 5,000 clinicians from the PASCAR database. The survey comprises two components. First, a platform collecting data on each hospital’s catchment population, human resources, presence of specialised cardiology services, availability of diagnostic tools, and access to essential heart failure treatments. Second, a prospective observational study capturing all acute heart failure presentations to participating hospitals over seven weekdays within an 8-week period (from the start of surveillance). Data were collected on clinical characteristics and outcomes to discharge, 30 days, and six months. The study commenced in mid-2024 and includes approximately 50 hospitals across 16 countries spanning all major regions of the African continent.Conclusions:When completed, THESUS-HF II will be the largest and most comprehensive study of acute HF to date in Africa. It will provide invaluable insights into the contemporary characteristics and burden of acute HF in Africa, whilst indicating what is needed to improve health care planning and, ultimately, patient outcomes.

Abstract Despite its prevalence and significant social, psychological and health impacts, vitiligo is an understudied condition. We present early insights into clinical features associated with vitiligo progression using the Vitiligo Registry and Bioresource (VOICE) developed at the specialist vitiligo service at a large London trust. The VOICE registry is a rapidly growing resource for patients with vitiligo treated at the UK’s first specialist vitiligo service (established 2018; current n = 546). The registry integrates clinical features, psychological impacts, family history and vitiligo treatments including phototherapy. In the 259 people with ≥ 12-month follow-up data available, we present a first look at the baseline demographics and clinical features of our cohort, including Vitiligo Extent Score (VES), disease duration, lesion location and recent vitiligo spread (new growth and/or new vitiligo lesions in the previous 6 months). We examine the associations between these clinical features and disease progression at 12 months, estimated using univariate logistic regression models. Disease progression was defined using an approach that considered both relative and absolute changes in VES. The 259 patients included had a mean age of 40 years (SD 11.5), 52% were female and the median baseline VES score was 2.31. At 12 months, 74 (29%) of these 259 patients had evidence of disease progression. Age [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.00–1.03; P = 0.06, per year increase] and sex (OR 1.67, 95% CI 0.97–2.92; P = 0.07, female vs. male) were not associated with progressive disease. In contrast, disease progression was associated with several clinical features, in particular longer disease duration at initial assessment (OR per year 1.02, 95% CI 1.00–1.04; P = 0.04), lesion location on the hands and face (OR for visible lesions on the face or hands vs. elsewhere 5.11, 95% CI 1.46–32.4; P = 0.03) and patient-reported recent vitiligo spread (OR 2.33, 95% CI 1.19–4.88; P = 0.02). Encouragingly for patients, there was no evidence of an association between baseline vitiligo extent as measured by VES and disease progression (OR for continuous baseline VES score, per 1-unit percentage increase 1.01, 95% CI 0.99–1.02, P = 0.36). Extensive disease is not untreatable disease! The VOICE registry provides insights into the demographics, clinical features and disease progression of patients with vitiligo using specialist clinical data not available in routine health records. The registry will support future research into risk stratification, targeted management and therapeutic intervention strategies to improve the clinical care of people with vitiligo.

Semiconductor-superconductor hybrid nanocircuits are of high interest because of their potential applications in quantum computing. Semiconductors with strong spin-orbit coupling and large g factor are particularly attractive since they are the basic building blocks of novel qubit architectures. However, for the engineering of these complex circuits, the building blocks must be characterized in detail. We have investigated a Josephson junction where the weak link is a two-dimensional electron gas (2DEG) hosted in an InAs/InGaAs heterostructure grown on a GaAs substrate. We employed the epitaxially grown Al layer as a superconducting contact to form an rf SQUID, and also to create a microwave resonator for sensing the Josephson inductance. We determined the gate-dependent current-phase relation and observed supercurrent interference in out-of-plane magnetic fields. With the application of an in-plane magnetic field, we induced asymmetry in the interference pattern, which was found to be anisotropic in the device plane. Published by the American Physical Society 2025

Acute heart failure (AHF) impacts millions globally, with outcomes varying based on socio-economic status (SES). SES measured by annual household income, years of education and medical insurance coverage. Each patient's income and education level relative to the median or mean, respectively, in the country was calculated, and categorized into tertiles (0, 1 or 2 from lowest to highest). SES scores (0-5) were computed as the sum of these levels plus insurance coverage (0=no or 1=yes). Patients' baseline characteristics, outcomes (HF readmission, death and their composite) and the effect of high-intensity care (HIC) vs. usual care (UC) were examined by SES scores 0-2, 3 and 4-5. Lower SES patients, who were younger, predominantly female, Black and non-European, had fewer comorbidities such as atrial fibrillation, diabetes and ischaemic heart disease and exhibited milder HF, indicated by a lower NYHA class, lower creatinine and higher cholesterol before discharge. Despite having milder HF and less comorbidities, after adjusting for baseline characteristics, patients with higher SES had numerically better outcomes, though differences were not statistically significant. 180-day hazard ratios (HRs) for HF readmission or death were 0.75 (95% CI 0.48-1.16) for SES scores of 3 and 0.85 (95% CI 0.58-1.23) for scores of 4-5, compared to 0-2. Higher SES patients had numerically better treatment effect from HIC, with HRs of 0.69 for SES 0-2, 0.72 for SES 3 and 0.50 for SES 4-5. In this post hoc analysis of the STRONG-HF study, lower SES was associated with milder acute HF but similar 180-day outcomes. Higher SES patients benefitted more from HIC.

Tetanus toxoid injection is important as one mandatory vaccine for pregnant women to prevent maternal and neonatal tetanus. This study purposed to examine the barriers of not receiving tetanus toxoid vaccine among women of reproductive age in Nepal. This study used the secondary data using “Multiple Indicators Clusters Survey” round 6 in 2019. Total sample of this study are 2,494 women of reproductive aged 15 to 49 years. The data analysis was done for univariate, bivariate, and multivariate using binary logistic regression. The results in this study revealed that increasing child ever born (CEB) as the main predictor for not receiving TT vaccine, following by higher educational level and wealth index. In conclusion, the TT vaccine is a critical intervention to prevent maternal and neonatal tetanus. Understanding the determinants of TT vaccination coverage, ensuring accessibility to the vaccine, and addressing knowledge gaps among pregnant women are essential for improving TT vaccination rates during pregnancy

Anemia is one of the most frequent comorbidities in patients with heart failure (HF), which potentially can interfere with the effect of guideline-recommended HF medical therapy and can be associated with the use of neurohormonal blockers. The aim of this analysis was to determine the prevalence and changes of anemia status in the STRONG-HF study, its association with clinical endpoints, and possible interaction of the presence of anemia with the efficacy and safety of high-intensity HF treatment. The design and main results of the study have been previously described. Patients were randomized within 2days prior to anticipated hospital discharge after HF worsening in a 1:1 fashion to either high-intensity care (HIC) or usual care (UC). Baseline characteristics, clinical and safety outcomes, and treatment effect of HIC vs. UC on the primary and secondary outcomes were compared in groups based on baseline anemia. In addition, dynamics of hemoglobin during the study follow-up and predictors of incident anemia at 90days were investigated. The proportion of anemia in 1077 STRONG-HF patients at enrollment was 27.2%, while at 90days, it changed to 32.1%. The primary composite outcome occurred in 18.2% of patients without baseline anemia, and 22.5% of patients with baseline anemia (unadjusted HR 1.27; 95% CI 0.90-1.80), a difference that did not reach statistical significance. However, patients with baseline anemia had significantly less improvement of EQ-VAS questionnaire values from baseline to day 90 (adjusted LS-Mean difference -2.34 (-4.37, -0.31), P = 0.02). During the study, anemia developed in 19.4 and 14.6% in HIC and UC groups, respectively. The opposite phenomenon-recovery of anemia-occurred in 27.6 and 28.8% in HIC and UC groups (P = 0.1379). The predictors of incident anemia at 90days were male sex, geographical region other than Europe, ischemic etiology, higher glucose, and elevated uric acid at baseline. The percentages of optimal doses of renin-angiotensin system inhibitors, beta-blockers, and mineralocorticoid receptor antagonists were not different between anemic and non-anemic patients. High-intensity care strategy did not increase rate of incident anemia at 90days and reduced the rate of primary and secondary endpoints regardless of baseline hemoglobin. Hemoglobin level and status of anemia have a dynamic nature in the acute HF patients in the post-discharge period dependent on multiple factors. High-intensity HF treatment is safe and beneficial regardless of baseline hemoglobin level and presence of anemia. The improvement of quality of life is significantly lower in anemic HF patients implying specific attention to correction of this condition.

AimsInflammation has emerged as a potential key pathophysiological mechanism in heart failure (HF) in general and acute HF (AHF) specifically, with inflammatory biomarkers shown to be highly predictive of adverse outcomes in these patients. The CORTAHF study builds on both these data and the fact that steroid burst therapy has been shown to be effective in the treatment of respiratory diseases and COVID‐19. Our hypothesis is that in patients with AHF and elevated C‐reactive protein (CRP) levels without symptoms or signs of infection, a 7‐day course of steroid therapy will lead to reduced inflammation and short‐term improvement in quality of life and a reduced risk of worsening HF (WHF) events.Methods and resultsThe study, which is currently ongoing, will include 100 patients with AHF ages 18–85, regardless of ejection fraction, screened within 12 h of presentation. Patients will be included who have NT‐proBNP > 1500 pg/mL and CRP > 20 mg/L at screening. Exclusion criteria include haemodynamic instability and symptoms and signs of infection. After signed consent, eligible patients will be randomized according to a central randomization scheme stratified by centre 1:1 to either treatment once daily for 7 days with 40 mg prednisone orally or to standard care. Patients will be assessed at study day 2, day 4 or at discharge if earlier, and at days 7 and 31 at the hospital; and at day 91 through a telephone follow‐up. The primary endpoint is the change in CRP level from baseline to day 7, estimated from a mixed model for repeated measures (MMRM) including all measured timepoints, in patients without a major protocol violation. Secondary endpoints include the time to the first event of WHF adverse event, readmission for HF, or death through day 91; and changes to day 7 in EQ‐5D visual analogue scale score and utility index. Additional clinical and laboratory measures will be assessed.ConclusionsThe results of the study will add to the knowledge of the role of inflammation in AHF and potentially inform the design of larger studies with possibly longer duration of anti‐inflammatory therapies in AHF.

The authors declared no competing interests for this work.