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Acute effects of low dose bisoprolol on lung function and blood pressure in COPD patients
(ERS Publications, 2025-08) Bradbury, T. F.; Martin, A.; Hancox, R. J.; Chang, C. L.; Beasley, R.; Wrobel, J. P.; McDonald, V. M.; Dobler, C. C.; Yang, I. A.; Farah, C. S.; Cochrane, B.; Hillis, G. S.; Scowcroft, C. P.; Aggarwal, A.; Ranasinha, C.; Galgey, S.; Jenkins, C. R. on behalf of the PACE in COPD Investigators
BACKGROUND AND OBJECTIVE: Recent observational data suggests that cardioselective β-blockers like bisoprolol are safe and beneficial for patients with chronic obstructive pulmonary disease (COPD). However, the acute effects of bisoprolol on lung and cardiovascular function in these patients is unclear, a gap that this study aimed to address. METHODS: This was a sub-analysis of pre-randomisation screening visit data from the ongoing Preventing Adverse Cardiac Events (PACE) in COPD randomised controlled trial. If all other eligibility criteria were met, participants were orally administered an unblinded 1.25 mg tablet of bisoprolol. Post-bronchodilator spirometry, heart rate and blood pressure were monitored at 0, 30 (cardiovascular parameters only), 60 and 120 min. For this sub-analysis, respiratory intolerance was defined as a decrease in forced expiratory volume in 1 min (FEV1)(L) ≥200 mL and ≥12% from the 0-minute FEV1(L) value; and cardiovascular intolerance was defined as systolic blood pressure (SBP) falling below 100 mmHg at 1 or 2 h. RESULTS: Of 359 consented participants, 292 conducted the test-dose procedure. Thirteen (4.5%) were respiratory intolerant and 6 (2.1%) were cardiovascular intolerant at 1 or 2 h. No participant was intolerant for both. There was no significant difference in FEV1 (L) or SBP at baseline At 120 min the intolerant group's mean FEV1 (L) had significantly decreased to 1.05 L (0.86–1.25; p<0.0001); the tolerant group experienced no change (1.10 L (1.05–1.14); p=0.33). CONCLUSION: The administration of 1.25 mg bisoprolol was acutely well tolerated in over 95% of COPD patients.
Surgical outcomes from haematoma evacuation for intracerebral haemorrhage in the INTERACT3 study
(Elsevier Ltd., 2025-08) INTERACT3 Investigators inclusing De Silva, A.
BACKGROUND: There is ongoing controversy as to whether surgical intervention to haematoma evacuation benefits patients with acute intracerebral haemorrhage (ICH). This study aimed to evaluate the association of surgical intervention to evacuate the haematoma and 6-month functional outcome in participants of the third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT3). METHODS: This was a secondary analysis of INTERACT3, which enrolled adults (age ≥18 years) spontaneous ICH patients within 6 h after onset. INTERACT3 was an international, multicentre, prospective, stepped-wedge, cluster randomised, blinded outcome assessed, clinical trial undertaken at 121 hospitals in 10 countries between December 12, 2017 and December 31, 2021. To limit heterogeneity in the results, we restricted analyses to participants in China. The primary outcome was poor functional outcome, defined by a score of 5-6 on the modified Rankin scale (mRS), at 6 months. Secondary outcomes include a mRS score of 4-6 and mortality at 6 months. Sensitivity analysis included propensity score matched analysis and the imputation of missing outcome variables. The effect of timing on surgical outcome was also evaluated. The INTERACT3 trial was registered at ClinicalTrials.gov (NCT03209258) and CHiCTR.org.cn (ChiCTR-IOC-17011787). FINDINGS: Of 5772 participants (mean age 62.0 ± 12.5 years) at 82 sites in China, 1411 (24.4%) received surgery in which craniotomy (72.6%) was the most common approach. After adjustment for confounding variables, surgery to evacuate the haematoma was associated with lower odds of a poor functional outcome (odds ratio 0.71, 95% CI 0.55-0.92; p = 0.010) and mortality (odds ratio 0.55, 95% CI 0.40-0.75; p = 0.0001) at 6 months. The association was consistent in propensity score matching analysis and sensitivity analysis by imputation. We did not detect significant differences in outcome between those who received surgery on the same day of hospital arrival compared to those who received surgery on the second or later days. In analysis limited to participants with supratentorial ICH and with a haematoma volume 30 mL or more, evacuation of the haematoma was associated with lower odds of poor functional outcome (n = 1234, odds ratio 0.68, 95% CI 0.46-0.99; p = 0.042) and mortality (n = 1291, OR 0.45, 95% CI 0.29-0.69; p = 0.0003). INTERPRETATION: This secondary analysis of the INTERACT3 indicates that evacuation of the haematoma is associated with better chances of surviving free of severe disability after acute ICH. With the evolution of instrument and techniques, further trial should address the role of haematoma evacuation in deep ICH patients, the time window and difference between mini-invasive techniques. FUNDING: Joint Global Health Trials (JGHT) funding scheme from the Department of Health and Social Care, the Foreign, Commonwealth & Development Office, the Medical Research Council and Wellcome Trust; the West China Hospital Outstanding Discipline Development 1-3-5 programme; National Health and Medical Research Council of Australia; Sichuan Credit Pharmaceutical; and Takeda (China).
Income-based inequalities in risk factors of NCDs and inequities of preventive care services amongst 202,682 adults: a cross-sectional study of South Asia Biobank
(BioMed Central, 2025-08) Andretti, B.; Atanasova, P.; Verdun, Z.; Wellappuli, N. T.; Pradeepa, R.; Vasudevan, S.; Tyagi, A.; Ahsan, A.; Hossain, M. M.; Shamim, A. A.; Akte,r F.; Mahmood, S.; Athauda, L.; Gamage, M.; Kaluarachchi, M.; Burgoine, T.; Brage, S.; Forouhi, N. G.; Goon, I.; Loh, M.; Katulanda, P.; Kasturiratne, A.; Khawaja, K. I.; Ahmad, S.; Mridha, M. K.; Jha, V.; Anjana, R. M.; Chambers, J. C.; Frost, G.; Sassi, F.; Miraldo, M.
BACKGROUND: There is scant research examining income-based inequalities in risk factors of non-communicable diseases (NCDs) and inequities of preventive care services across the South Asian population. METHODS: We conducted a cross-sectional study of 202,682 adults aged 18 or above in four South Asian countries: Bangladesh, India, Pakistan, and Sri Lanka. We combined South Asia Biobank (SAB) surveillance data with environmental mapping exposure and 24-h dietary recall to estimate income-based inequalities using concentration curves and concentration indices (CI) that measure the magnitude and directional inequality effects. We also computed the horizontal inequity index (HII) for need-standardised healthcare utilisation and advice by measuring the extent to which the distribution of health promotion advice matches the distribution of diet-related risk factor variables across the income distribution. We reported concentration index coefficients and standard errors. RESULTS: Inequalities in exposure and diet-related risk factors of NCDs were observed. Underweight was concentrated amongst the poor (CI = - 0.16, SE = 0.005, p < 0.001), while overweight and obesity were concentrated amongst the rich (CI = 0.11, SE = 0.003, p < 0.001). Non-recommended intake of fats (CI = 0.04, SE = 0.003, p < 0.001) and carbohydrates were concentrated amongst the rich (CI = 0.05, SE = 0.003, p < 0.001), while non-recommended intake of free sugars (CI = - 0.05, SE = 0.004, p < 0.001) and fruits and vegetables amongst the poor (CI = - 0.07, SE = 0.005, p < 0.001). Exposure to unhealthy outlets was concentrated amongst the rich (CI = 0.02, SE = 0.002, p < 0.001). There were persistent and pro-rich inequities in healthcare utilisation (HII = 0.02, SE = 0.002, p < 0.001) and advice for salt reduction (HII = 0.02, SE = 0.004, p < 0.001), fat reduction (HII = 0.02, SE = 0.004, p < 0.001), healthy weight (HII = 0.03, SE = 0.006, p < 0.001), and fruits and vegetables consumption (HII = 0.04, SE = 0.004, p < 0.001). CONCLUSIONS: These findings indicate the need to address and mitigate income-based inequalities in diet-related risk factors of NCDs and underscore the need of policies directed at mitigating NCDs risk exposure and achieving improved and equitable access to healthcare.
Ecology of healthcare in an urban and rural area of Gampaha district of Sri Lanka: a community-based prospective study on symptom prevalence and healthcare utilization
(London : BioMed Central, 2025-08) Withana, S.S.; Mendis, K.; Liyanage, U. P.; Nandasena, S.; Wickremasinghe, A. R.
BACKGROUND: The 55 million visits to government outpatient departments (OPD) in Sri Lanka in 2014, is estimated to increase to 100 million in 2027. The private OPD visits in 2014 was estimated at 50 million per annum. In primary care, there is a paucity of medical records, research on symptoms and healthcare seeking behaviour. We aimed to determine the symptom prevalence and healthcare seeking pattern of residents in Gampaha district, Sri Lanka. METHODS: A community-based prospective study using a participant-held symptom diary and interviews were conducted in two areas, Ragama (urban) and Mirigama (rural), in the Gampaha district of Sri Lanka during May-June 2018. For each area, three midwife areas were randomly chosen. Clusters of 15-20 households were selected from 5-6 random locations from each midwife area. RESULTS: 2046 individuals from 557 households participated. Majority were females (n = 1127, 55.1%). There were 1207 (59%) from Mirigama area. Among participants, 1919 (93.8%) reported symptoms. Phlegm (n = 4200, 7.0%), leg pain (n = 3943, 6.6%) and cough (n = 3153, 5.3%) were top symptoms among all symptoms reported; the musculoskeletal group (n = 18,081, 30.4%) predominated. 924 (45.1%) participants sought treatment, 763 out of 2046 participants (37.3%) sought allopathic treatment. Private sector visits were more (n = 515, 25.2%). The decision to seek private or public healthcare services was influenced by income. Persons with higher income preferred a private institution. Of the 46 (2.3%) hospital admissions, 42 (91.3%) were to public hospitals, of which, 19 (41.3%) were to teaching hospitals, and 4 (0.9%) to a private institution. CONCLUSIONS: The population had a high prevalence of symptom reporting (93.8%) and a high healthcare seeking behaviour (45.2%). Among those who sought allopathic treatment, the majority preferred private ambulatory care. 90% of hospital admissions (42/47) were to public hospitals. Provision of ambulatory care services should be prioritized in further development of the health services.
Microbial diversity in cutaneous leishmaniasis lesions and potential implications for disease progression and treatment outcomes
(London : Biomed Central, 2025-08) Gunathilaka, N.; Siriwardana, T.; Erathna, S.; Rodrigo, W.; Gunasekara, H.; Sumanasena, B.
OBJECTIVE: Beyond the parasitic infection in Cutaneous leishmaniasis (CL), secondary bacterial colonization can influence disease chronicity, delay healing, and reduce treatment efficacy. This study investigated the bacterial diversity in CL lesions, its association with lesion duration, and its potential impact on treatment outcomes among Sri Lankan patients. RESULTS: Fifteen bacterial species were identified, including both Gram-positive and Gram-negative organisms. Staphylococcus aureus was associated with the longest lesion duration (up to 12 months) and extended treatment (15 cycles of intralesional sodium stibogluconate and cryotherapy). In contrast, species such as Kocuria palustris and Acinetobacter baylyi were linked to shorter treatment durations. Multivariate analysis revealed that lesion type significantly influenced treatment duration (P < 0.05), while larger lesion size and diabetes showed marginal associations with prolonged therapy. The presence of opportunistic and antibiotic-resistant species, particularly S. aureus, suggests a potential contributory role of bacterial co-infections in CL progression and highlights the need to consider their presence in treatment planning. Integrating microbial profiling into clinical protocols may enhance treatment efficacy and inform personalized care strategies. However, the limited sample size and convenience-based recruitment may affect the generalizability of these findings, and the potential influence of bacterial colonization on treatment response warrants further investigation in larger cohorts.