Life

Background: Cardiac amyloidosis (CA) is characterized by progressive myocardial infiltration leading to restrictive cardiomyopathy and heart failure. While left ventricular assessment has traditionally dominated prognostic evaluation, right ventricular (RV) dysfunction and RV–pulmonary artery (PA) coupling have emerged as critical determinants of outcomes. Objectives: This review synthesizes current evidence on RV–PA coupling as a prognostic marker in cardiac amyloidosis, examining measurement methodologies, prognostic significance, pathophysiological mechanisms, and clinical applications. Methods: We comprehensively reviewed the recent literature on RV–PA coupling in CA, focusing on studies published from 2020 to 2025, including both AL and ATTR subtypes. We analyzed data from multicenter cohorts, prospective registries, and validation studies examining the relationship between RV–PA coupling indices and clinical outcomes. Results: RV–PA coupling, most commonly assessed using the tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio, consistently demonstrates strong independent prognostic value for mortality and heart failure outcomes in CA patients. Impaired coupling (TAPSE/PASP < 0.45 mm/mmHg) identifies high-risk patients with hazard ratios ranging from 1.98 to 4.17 for adverse outcomes. In a multicenter cohort of 283 patients, TAPSE/PASP < 0.45 mm/mmHg was independently associated with death or heart failure hospitalization (HR 1.98, 95% CI 1.32–2.96, p = 0.001) and significantly improved risk reclassification (NRI 0.46–0.49). In ATTR-specific populations receiving disease-modifying therapy, impaired coupling (TAPSE/PASP ≤ 0.382 mm/mmHg) predicted three-year mortality with an adjusted HR of 2.99. The coupling index provides incremental value over individual RV parameters by accounting for afterload conditions and demonstrates consistent prognostic performance across both AL and ATTR subtypes. Conclusions: RV–PA coupling represents a robust, easily obtainable prognostic marker that should be routinely assessed in CA patients for risk stratification and clinical decision-making. The TAPSE/PASP ratio can be calculated from standard echocardiographic examinations without additional cost or time, making it practical for widespread implementation. Future research should focus on standardizing measurement protocols, establishing disease-specific thresholds, evaluating coupling trajectories with novel therapies, and integrating coupling assessment into staging systems and management algorithms. The strong prognostic signal, pathophysiological relevance, and ease of measurement position RV–PA coupling as an essential component of comprehensive cardiac amyloidosis evaluation.

Antimicrobial resistance (AMR) can disseminate through effluents from seafood processing facilities (SPFs), posing environmental and public health risks. This study assessed changes in coliform load and antimicrobial resistance patterns in effluents from two SPFs in Tema, Ghana, before and after upgrades to effluent treatment systems between 2022 and 2024. A total of 19 effluent samples were collected per SPF in 2021–2022, 20 effluent samples each per SPF in 2024, and 8 potable water samples each per SPF in 2024. Median coliform counts declined significantly in both facilities (SPF-1: 920 to 35 MPN/100 mL; SPF-2: 280 to 9.5 MPN/100 mL; p < 0.001), representing a 96% overall reduction. Escherichia coli prevalence decreased markedly in SPF-2, although Pseudomonas aeruginosa emerged after treatment upgrades. Resistance to third-generation cephalosporins and multidrug resistance declined, particularly in SPF-1, but persisted across both facilities. Potable water used for seafood processing showed low but detectable coliform contamination. Despite substantial reductions in coliform bacterial load, the continued presence of resistant gram-negative bacteria highlights the need for sustained AMR surveillance, mandatory effective effluent treatment, and routine disinfection of potable water to protect public health.

Sarcopenia and physical frailty are interconnected geriatric syndromes that frequently coexist in older adults, sharing common pathophysiological pathways. However, their early detection in community settings is limited by resource constraints and by the lack of simplified, scalable diagnostic tools. This cross-sectional study aimed to estimate the prevalence and overlap of sarcopenia and frailty in a real-world public health screening programme and to evaluate the diagnostic performance of a pragmatic two-step algorithm. In September 2025, a total of 256 consecutive community-dwelling adults aged ≥65 years underwent standardized assessment using the SARC-F questionnaire, handgrip strength dynamometry, and selective bioelectrical impedance analysis (BIA). Sarcopenia was defined according to 2019 EWGSOP2 criteria, and frailty according to the Fried phenotype. Confirmed sarcopenia was identified in 37 participants (14.5%, 95% CI 10.7–19.1%) and frailty in 31 (12.1%, 95% CI 8.6–16.7%), with substantial overlap (77.4% of frail individuals also had sarcopenia; Cohen’s κ = 0.62). The two-step algorithm (Step 1: SARC-F ≥ 4; Step 2: handgrip strength and BIA only in screen-positive participants) demonstrated excellent accuracy for confirmed sarcopenia (AUC 0.913, 95% CI 0.871–0.955), with sensitivity 91.9%, specificity 81.3%, and a 53.9% reduction in BIA use. Factors independently associated with confirmed sarcopenia included older age, BMI < 22 kg/m², physical inactivity, and higher SARC-F score. A simple, function-centered two-step approach enables efficient and scalable identification of sarcopenia and frailty in community settings, supporting early preventive strategies to preserve physical function.