Distinguishing viral versus bacterial lower respiratory tract infection (LRTI) is challenging. We previously developed a rapid, host response-based test (Biomeme HR-B/V assay) using peripheral blood samples to identify viral versus bacterial infection. We assessed the performance of this assay when using nasopharyngeal (NP) samples.

Patients with LRTI were enrolled, and a NP swab sample was run using the HR-B/V assay (assessing 24 gene targets) on the FranklinTM platform. The performance of the prior classifier at identifying viral versus bacterial infection was assessed. A novel predictive model was generated for NP samples using the same 24 targets. Results were validated using external datasets with nasal/NP RNA sequence data.

Nineteen patients (median age 62 years, 52.1% male) were included. When using the prior HR-B/V classifier on NP samples of 19 patients with LRTI (12 viral, 7 bacterial), the area under the receiver operator curve (AUC) for viral versus bacterial infection was 0.786 (0.524–1), with accuracy 0.79 (95% CI 0.57–0.91), positive percent agreement (PPA) 0.43 (95% CI 0.16–0.75), and negative percent agreement (NPA) 1.00 (95% CI 0.76–1). The novel model had AUC 0.881 (95% CI 0.726–1), accuracy 0.84 (95% CI 0.62–0.94), PPA 0.86 (95% CI 0.49–0.97), and NPA 0.83 (95% CI 0.55–0.95) for bacterial infection. Validation in two external datasets showed AUC of 0.932 (95% CI 0.90–0.96) and 0.915 (95% CI 0.88–0.95).

We show that host response in the nasopharynx can distinguish viral versus bacterial LRTI. These findings need to be replicated in larger cohorts with diverse LRTI etiologies.

Ketamine is a promising treatment for post-traumatic stress disorder (PTSD), but further research is required to extend early findings.

To determine the short-term efficacy and tolerability of intramuscular (i.m.) ketamine compared with i.m. fentanyl for treatment-resistant PTSD symptoms.

We completed a randomised double-blind psychoactive-controlled study with single doses of i.m. racemic ketamine 0.5 mg/kg or 1.0 mg/kg or i.m. fentanyl 50 μg (psychoactive control). Eligible participants were aged between 18 and 50 years old and had treatment-refractory PTSD. The primary efficacy measure was the Impact of Events Scale – Revised (IESR), and tolerability was measured with the Clinician-Administered Dissociative States Scale. Analysis of variance with dose and time as repeated measures was used to assess the effects of drug treatment on total IESR and Clinician-Administered Dissociative States Scale scores.

Thirty-three participants completed the study (26 females, mean age 34.5 years). Ketamine, particularly at 1 mg/kg, was associated with substantially reduced IESR ratings, with some effect remaining after 1 week. Ketamine was also associated with short-term dissociative and cardiovascular effects.

We provide preliminary support for the efficacy and tolerability of i.m. ketamine in a community sample of individuals with PTSD. Further work is required to establish the optimal dosing regimen and longer-term role of ketamine in treatment of PTSD, but our findings are encouraging given the well-known of treatments in this area.

This study outlines the development of a codesigned, coproduced intervention to address the high risk of diet-related non-communicable diseases (NCD) among South Asians (SA) in New Zealand. The objectives were to identify: (1) reasons, concerns and perceptions influencing dietary changes post-migration; (2) preferred formats and delivery modes for the intervention; (3) intervention design features; (4) community volunteers for coproduction; and (5) coproduce the intervention components.

Participatory Action Research.

SA communities in Auckland and Dunedin, New Zealand.

SA immigrants aged 25–59 years. Ten telephone or face-to-face interviews were conducted between 2018 and 2019. Following this, one codesign workshop (n 12) was conducted with the target population and community stakeholders in 2019.

Thematic analysis revealed factors such as children’s preference for boxed cereals and limited time for traditional breakfasts contributed to poor dietary habits. Concerns included meal timing and long-term weight gain, while perceptions such as all home-cooked food is healthy, influenced a lack of concern for long-term health. Preferred formats were educational comics and video clips, with digital platforms as the delivery mode. The workshop helped choose comic characters and identify community members to coproduce video content. The final intervention included eleven comics, eight videos, twelve audio clips and eighteen scientific snippets, organised into five dietary and one physical activity module.

A participatory approach proved feasible for codesigning a culturally tailored lifestyle intervention to address diet-NCD risks in the SA diaspora in New Zealand.

To examine the risk of perinatal mental illness, including new diagnoses and recurrent use of mental healthcare, comparing women with and without traumatic brain injury (TBI), and to identify injury-related factors associated with these outcomes among women with TBI.

We conducted a population-based cohort study in Ontario, Canada, of all obstetrical deliveries to women in 2012–2021, excluding those with mental healthcare use in the year before conception. The cohort was stratified into women with no remote mental illness history (to identify new mental illness diagnoses between conception and 365 days postpartum) and those with a remote mental illness history (to identify recurrent illnesses). Modified Poisson regression generated adjusted relative risks (aRRs) (1) comparing women with and without TBI and (2) according to injury-related variables (i.e., number, severity, timing, mechanism and intent) among women with TBI.

There were n = 12,724 women with a history of TBI (mean age: 27.6 years [SD, 5.5]) and n = 786,317 without a history of TBI (mean age: 30.6 years [SD, 5.0]). Women with TBI were at elevated risk of a new mental illness diagnosis in the perinatal period compared to women without TBI (18.5% vs. 12.7%; aRR: 1.31, 95% confidence interval [CI]: 1.24–1.39), including mood and anxiety disorders. Women with a TBI were also at elevated risk for recurrent use of mental healthcare perinatally (35.5% vs. 27.8%; aRR: 1.18, 95% CI: 1.14–1.22), including mood and anxiety, psychotic, substance use and other mental health disorders. Among women with a history of TBI, the number of TBI-related healthcare encounters was positively associated with an elevated risk of new-onset mental illness.

These findings demonstrate the need for providers to be attentive to the risk for perinatal mental illness in women with a TBI. This population may benefit from screening and tailored mental health supports and treatment options.

Preliminary evidence suggests that a ketogenic diet may be effective for bipolar disorder.

To assess the impact of a ketogenic diet in bipolar disorder on clinical, metabolic and magnetic resonance spectroscopy outcomes.

Euthymic individuals with bipolar disorder (N = 27) were recruited to a 6- to 8-week single-arm open pilot study of a modified ketogenic diet. Clinical, metabolic and MRS measures were assessed before and after the intervention.

Of 27 recruited participants, 26 began and 20 completed the ketogenic diet. For participants completing the intervention, mean body weight fell by 4.2 kg (P < 0.001), mean body mass index fell by 1.5 kg/m2 (P < 0.001) and mean systolic blood pressure fell by 7.4 mmHg (P < 0.041). The euthymic participants had average baseline and follow-up assessments consistent with them being in the euthymic range with no statistically significant changes in Affective Lability Scale-18, Beck Depression Inventory and Young Mania Rating Scale. In participants providing reliable daily ecological momentary assessment data (n = 14), there was a positive correlation between daily ketone levels and self-rated mood (r = 0.21, P < 0.001) and energy (r = 0.19 P < 0.001), and an inverse correlation between ketone levels and both impulsivity (r = −0.30, P < 0.001) and anxiety (r = −0.19, P < 0.001). From the MRS measurements, brain glutamate plus glutamine concentration decreased by 11.6% in the anterior cingulate cortex (P = 0.025) and fell by 13.6% in the posterior cingulate cortex (P = <0.001).

These findings suggest that a ketogenic diet may be clinically useful in bipolar disorder, for both mental health and metabolic outcomes. Replication and randomised controlled trials are now warranted.