Congenitally corrected transposition of the great arteries is a rare congenital heart defect that may remain undiagnosed well into adulthood. We present the case of a 71-year-old male with dextrocardia and exertional dyspnoea, initially diagnosed with severe pulmonary hypertension. Further evaluation revealed an underlying congenitally corrected transposition of the great arteries. This case highlights the importance of considering CHD in older adults with unusual cardiac findings.

The escalating global prevalence of antibiotic-resistant Helicobacter pylori strains has undermined conventional eradication therapies, heightening the burden of associated conditions such as gastritis, peptic ulcers and gastric malignancies. Emerging non-antibiotic alternatives, including natural and synthetic compounds, probiotics and vaccine candidates, offer potential solutions to combat these infections effectively. Natural and synthetic compounds provide promising anti-H. pylori effects, primarily through bacterial membrane disruption, urease inhibition, virulence gene suppression and biofilm prevention. in vitro and in vivo studies support the robust activity of natural agents, while synthetic counterparts demonstrate potent bactericidal and anti-adherence capabilities, though rigorous clinical validation is still required. Probiotic strains enhance eradication rates when combined with antibiotics, reduce treatment-related adverse effects, modulate gut microbiota and attenuate gastric inflammation and carcinogenesis. Vaccine development encompasses whole-cell, subunit and DNA platforms targeting key virulence factors, showing immunogenicity and protective efficacy in preclinical models, yet is limited by variable clinical translation and insufficient large-scale trials. Despite promising advancements, challenges persist, including inconsistent efficacy and a need for more rigorous human studies. Future efforts should emphasize combinatorial therapies, refined delivery systems, and thorough safety evaluations to integrate these strategies into clinical practice, fostering sustainable management of H. pylori in a post-antibiotic era.

Common perinatal mental health conditions are especially prevalent in low- and middle-income countries (LMICs) and are associated with numerous adverse effects. While complex interventions have been developed and tested, there has been limited exploration of how these interventions can be implemented and sustained at scale. This scoping review aims to explore the strategies discussed for scaling, spreading and sustaining complex perinatal mental health interventions in LMICs. We conducted a systematic search in APA PsycINFO, Cinahl, Medline (EBSCOhost), Embase, MIDIRS (Ovid Online) and ProQuest for reports published between January 2010 and November 2023, using search terms related to scaling innovations, perinatal mental health and LMICs. We also conducted a grey literature search using the websites of organisations that focus on maternal mental health. We identified 42 information sources. Using thematic synthesis, scale, spread and sustainability strategies regarding workforce diversity, integration of health services, tool and method development, adaptation, training, supervision and support and stakeholder engagement were identified. The study identified persistent gaps in the literature around how interventions move beyond early adaptation and implementation phases. These included the need for more consistency and shared understanding around terminology and increased interdisciplinary collaboration, especially drawing on fields such as implementation science. The findings from this review open new avenues for research and policy on expanding perinatal mental health interventions in LMICs, with an emphasis on long-term sustainability and interdisciplinary perspectives.

Studies frequently view Black populations as homogenous, disregarding important diversity within this population. Furthermore, nativity can be key to distinguishing health risks among this population. Yet few researchers have examined these distinctions using body roundness index (BRI), a measure of central adiposity. We assessed the relationship between nativity and BRI among non-Hispanic Black people in the United States (US) using cross-sectional data from the 2011–2018 National Health and Nutrition Examination Survey (NHANES). BRI was calculated using height, weight, and waist circumference. Nativity was categorized as US-born and foreign-born. Multilinear regression analysis was used to evaluate the relationship between BRI and nativity, controlling for demographic characteristics and Healthy Eating Index scores. The average age and BRI score of participants were 44.74 ± 0.46 and 5.36 ± 0.04, respectively. Among eligible participants (3341), 9.6% were foreign-born (n = 322). In multivariate regression models adjusting for covariates, men had significantly lower BRI scores than women (4.67 ± 0.04 versus 5.96 ± 0.05; β = −1.25; t61 = 24.60; P < 0.0001), and BRI increased with age (β = 0.02; t61 = 9.17; P < 0.0001). US-born Black people had significantly higher BRI scores compared to their foreign-born counterparts (5.40 ± 0.04 versus 5.00 ± 0.09; β = −0.36; t61 = −3.99; P = 0.0002). Results suggest that nativity is associated with central adiposity, with potential implications for cardiometabolic disease risk.

We describe a prolonged outbreak of Salmonella enterica serotype Poona (S. Poona) sequence type (ST) 308, which comprised 13 cases occurring intermittently in North West England between 2016 and 2021. Whole genome sequencing (WGS) results indicated potential exposure to a single source but a lack of good quality data from routine surveillance questionnaires initially made it challenging to identify the cause. Continuing identification of cases in young children in a small geographical area prompted further public health actions, including trawling interviews which identified that ten cases attended the same nursery. As part of enhanced case finding in this nursery, childcare staff were asked to submit faecal samples. One asymptomatic staff member was positive for S. Poona and had worked at another nursery, attended at the time by the first S. Poona child case in this outbreak. Further investigations revealed that the case had previously undergone a cholecystectomy. We report an outbreak caused by persistent carriage and shedding of S. Poona in an asymptomatic individual working with vulnerable groups, which necessitated introduction of risk management measures similar to that for Typhoidal Salmonella. We also demonstrate the utility of combining epidemiological and WGS data in the public health response to Salmonella outbreaks.

The present study aimed to explore sleep diary-derived parameters and sleep measures as mediators of the effects of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TSC) on psychological outcomes. A secondary analysis of a two-arm randomized controlled trial of a group-based TSC for major depressive disorder was conducted. The participants included 152 adults (mean age = 34.0; 79.6% female) who were randomized into either the TSC or care-as-usual group. Mediation analysis indicated that reduction in insomnia symptom severity (standardized indirect effects: −0.06 to −0.17), sleep disturbance (−0.04 to −0.22), and sleep-related impairment (−0.04 to −0.17) was significantly mediated by sleep diary-derived sleep parameters. The treatment effects on depressive symptoms (standardized indirect effects: −0.05 to −0.10), anxiety symptoms (−0.04 to −0.07), fatigue (−0.05 to −0.09), functional impairment (−0.06 to −0.09), and quality of life (0.04 to 0.08) were sequentially mediated by sleep parameters and insomnia symptom severity. However, the severity of insomnia symptoms alone (magnitudes of standardized indirect effects: 0.09–0.17) but not sleep parameters alone (0.00–0.07) mediated the treatment effects on psychological outcomes, indicating that sleep parameters need to influence subjective sleep measures to sequentially affect psychological outcomes. These results underscore the critical roles of subjective sleep measures in clinical improvements within a sleep-targeted intervention.

In low-prevalence settings, the epidemiological yield of screening strategies for controlling vancomycin-resistant enterococci (VRE) outbreaks has not been fully established. We retrospectively analysed a prolonged VRE outbreak at a 536-bed tertiary-care hospital in Japan from 2010 to 2021 to evaluate sequential screening strategies across epidemic phases and to identify risk factors for VRE acquisition. Hospital-wide, admission-based, antimicrobial exposure-based, passive, and haemodialysis-targeted screening strategies were implemented over time. Screening yields were compared longitudinally, and a retrospective case–control study was performed using data from the initial hospital-wide screening phase. Molecular epidemiology was assessed by pulsed-field gel electrophoresis (PFGE). In total, 169 VRE-positive patients were identified, including seven infections and 162 asymptomatic carriers. Hospital-wide screening in the early epidemic phase showed the highest positivity rate (0.91%), whereas targeted strategies consistently yielded lower rates (0.09–0.34%). Haemodialysis, specific oral care practices, and prior exposure to carbapenems, glycopeptides, and piperacillin/tazobactam were independently associated with VRE acquisition. PFGE revealed substantial genetic diversity, suggesting sustained nosocomial transmission with repeated introductions. Early broad-based screening may be epidemiologically efficient in the initial phase of VRE outbreaks in low-prevalence settings, followed by adaptive refinement for long-term control.

Mental health disorders are prevalent among adolescents and evidence suggests that stigma, poor mental health literacy (MHL) and access are key barriers to help-seeking for mental health difficulties in adolescence and throughout life. The study purpose is to assess existing mental health knowledge, stigma and help-seeking behaviour among adolescents in Uganda. A total of 889 secondary school students in Kampala completed standardised self-report questionnaires. The results reveal low-to-moderate levels of mental health knowledge (MAKS, range 12–60, M = 16.35, SD = 5.18, AMHLQ, range 33–138, M = 64.01, SD = 12.98), stigma (RIBS, range 4–20, M = 12.30, SD = 3.52) and prejudice towards people with mental illness (PPMI-TR, range 133–19, M = 73.85, SD = 13.38). Knowledge correlated with stigma (r = 0.166 and r = 0.135, p < 0.01), and with one’s capacity to assess own mental health (SELF-I range 5–25, M = 12.34, SD = 4.4). Adolescents are open to seek help from mental health professionals but reluctant to seek it from most accessible help sources like schoolteachers. The findings provide insights for future mental health-promoting and anti-stigma interventions for adolescents.

Implementation of a 24-hour antimicrobial prophylaxis guideline for patients with delayed sternal closure significantly reduced broad-spectrum post-operative antimicrobial use without increasing surgical site infection risk in 75-patient cohort. The median duration of prophylaxis decreased from 120 to 45 hours, and surgical site infection rates were 3% pre-intervention versus 0% post-intervention.

We present a neonate with a large vein of Galen malformation and an unusual drainage of the large vein returning blood from the upper half of the body into the right atrium (superior vena cava) into the left atrium. Remarkably, the infant showed no signs of cyanosis, heart failure, or pulmonary hypertension. We suggest this rare anomaly may have provided in-utero protection by offloading blood flow and reducing strain on the fetal heart and lungs.

The COVID-19 pandemic has highlighted limitations in case-based surveillance due to inconsistent testing and reporting. Wastewater-based epidemiology (WBE) has emerged as a complementary surveillance approach for tracking SARS-CoV-2 transmission, capturing both symptomatic and asymptomatic infections. The aim of this study was to evaluate the effectiveness of WBE in estimating the effective reproduction number ($ {R}_t $) of SARS-CoV-2 in Georgia, USA. We used a Generalized Linear Mixed Model (GLMM) to analyse viral concentration data from multiple wastewater treatment plants (WWTPs) collected between 1 June 2022 and 15 December 2022. After controlling for flow rates and site-level heterogeneity, model residuals were transformed into a non-negative incidence-like series used to estimate wastewater-based $ {R}_t $. Wastewater-based $ {R}_t $was compared with case-based $ {R}_t $estimates using Spearman correlation. The two $ {R}_t $ estimates showed concordant temporal patterns across most sites, with stronger correlations in areas with higher case counts (Spearman correlations ranging from 0.39 to 0.84, $ p<0.001 $). Wastewater-based $ {R}_t $ tracked increases and decreases in transmission over similar time scales as case-based estimates, while exhibiting reduced sensitivity to short-term changes in clinical testing and reporting behaviour. These findings suggest that WBE can support estimation of transmission trends and complement traditional case-based surveillance for public health monitoring.

The Edinburgh Postnatal Depression Scale (EPDS) has been translated into over 60 languages, and for 40 years this 10-item EPDS has remained unchanged. Meanwhile many societies during these decades have undergone cultural changes, including the use of language, the development of more diverse family structures and increased access to social media and now artificial intelligence. Perhaps an EPDS-R (revised) is now needed, and now is the time for action? The challenges that must be overcome to create a revised EPDS are the subject of this Guest Editorial, which also describes its origins in Edinburgh almost 50 years ago.