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Timing of mechanical ventilation and its association with in-hospital outcomes in patients with cardiogenic shock following ST-elevation myocardial infarction: a multicentre observational study
No full textObjective: To evaluate the association between the timing of invasive mechanical ventilation (MV) initiation and clinical outcomes in patients with cardiogenic shock (CS) secondary to ST-elevation myocardial infarction (STEMI).
Design: Retrospective analysis of a multicentre registry.
Setting: Data were obtained from the Gulf-Cardiogenic Shock registry, which includes hospitals across six countries in the Middle East.
Participants: 1117 patients diagnosed with STEMI and CS. Of these, 672 (60%) required MV and were included in this analysis.
Primary and secondary outcome measures: The primary outcome was in-hospital mortality. Secondary outcomes included comparisons of baseline characteristics, Society of Coronary Angiogram and Intervention (SCAI) shock stage, and clinical parameters among groups based on time to MV.
Results: Participants were categorised by time from shock diagnosis to MV: early (≤15 min), intermediate (30 min) and late (≥60 min). Median times were 15 min (IQR 10-20), 30 min (IQR 25-35) and 60 min (IQR 45-70), respectively. Baseline characteristics were comparable across groups. Increased delay in MV was associated with a higher mortality risk during the first 60 min post-diagnosis, beyond which the risk plateaued. Delayed MV was an independent predictor of in-hospital mortality (OR 2.14, 95% CI 1.36 to 3.38, p\u3c 0.001).
Conclusions: Early initiation of MV in patients with STEMI complicated by CS was associated with lower in-hospital mortality. These findings highlight the importance of timely respiratory support, warranting further investigation in prospective or randomised controlled studies.
Keywords: Coronary intervention; Ischaemic heart disease; Mortality; Myocardial infarction; Ventilators, Mechanical
Clinical outcomes and safety of sotatercept in pulmonary arterial hypertension: A systematic review and meta-analysis of randomized controlled trials
No full textIntroduction: Pulmonary arterial hypertension (PAH) remains a life-threatening condition characterized by high morbidity and mortality. However, recent therapeutic advancements have offered a paradigm shift in terms of therapeutic goals.
Methods: We conducted a systematic review and meta-analysis of RCTs assessing clinical outcomes and safety of sotatercept when compared to placebo in PAH. Searches of Pubmed and Cochrane Central databases were performed through April 2025. The primary outcome was all-cause mortality. Secondary outcomes included improvements in 6MWD, WHO functional class, hemodynamics, NT-proBNP, and serious adverse events. Data were pooled using a random-effects model, with certainty of evidence assessed via GRADE methodology.
Results: Three RCTs comprising 601 patients were included. There was a non-significant trend toward reduced mortality (RR 0.49; 95 % CI 0.16 to 1.46; p = 0.11). Sotatercept was associated with significant improvements in 6MWD (MD 37.99 m; 95 % CI 6.47 to 69.52; p = 0.04) and WHO functional class (RR 2.04; 95 % CI 1.79 to 2.31; p = 0.002). Hemodynamic improvements included reductions in PVR (MD -237.73 dyn·s/cm5; 95 % CI -367.02 to -1.8.43; p = 0.02) and mPAP (MD -14.88 mmHg; 95 % CI -24.76 to -4.99; p = 0.02). Serious adverse events were similar (RR 0.79; 95 % CI 0.51 to 1.23; p = 0.15).
Conclusion: Sotatercept significantly improves functional and hemodynamic outcomes in PAH, with a favorable safety profile. While mortality benefits remain uncertain, these findings support its clinical utility as an emerging therapy in PAH.
Keywords: Mortality; Pulmonary arterial hypertension; Sotatercept
Lung Cancer Screening Eligibility, Uptake, and Adherence in Puerto Rico, 2022
No full textImportance: Lung cancer screening (LCS) with yearly low-dose computed tomography reduces lung cancer mortality, but uptake remains low. Puerto Rico, a U.S. territory, faces significant barriers to LCS implementation, but data on LCS eligibility and use are limited.
Objective: This study aimed to estimate the number of individuals eligible for LCS in Puerto Rico and assess the prevalence of LCS use and up-to-date status compared with U.S. Hispanic and non-Hispanic populations.
Design setting and participants: This cross-sectional study analyzed data from the 2022 Behavioral Risk Factor Surveillance System, a population-based telephone survey. Adults eligible for LCS per 2021 U.S. Preventive Services Task Force guidelines (aged 50-80 years, ≥20 pack-year smoking history, current or recent smokers) from Puerto Rico and the United States were included.
Exposures: Participants were categorized into three groups: Puerto Rico residents, U.S. Hispanic, and U.S. non-Hispanic populations.
Primary outcomes and measures: The primary outcomes and measures were self-reported receipt of initial LCS (ever had chest CT for screening) and being up to date with LCS (i.e., chest CT in the past year). Multivariable Poisson models estimated adjusted prevalence ratios for LCS outcomes.
Results: After population weighting, 94,955 individuals were eligible for LCS in Puerto Rico, compared with 12.8 million in the U.S., representing 7.9% and 11.9% of their respective populations. The prevalence of self-reported LCS use was 28.4% in Puerto Rico, 27.6% among U.S. Hispanics, and 31.5% among U.S. non-Hispanics. Being up to date with LCS was lower among Puerto Rico residents (9.8%) than among U.S. Hispanics (17.3%) and non-Hispanics (18.1%). Multivariable models found Puerto Rico residents were less likely to be up to date with LCS than were U.S. non-Hispanics (adjusted prevalence ratios, 0.54; 95% CI 0.29-0.99).
Conclusions and relevance: Fewer than 10% of eligible individuals in Puerto Rico self-reported being up to date with LCS, indicating they are almost half as likely to self-report as eligible individuals in the United States, highlighting significant gaps in care. Implementing high-quality LCS in Puerto Rico is critical to reducing lung cancer mortality and providing equitable lung cancer care.
Keywords: Cancer disparities; Hispanic or Latino health; Lung cancer screening; Puerto Rico
Trends in Labor After Cesarean Delivery Access in the US
No full textThis cross-sectional study examines county-level trends in labor after cesarean delivery access across the US from 2016 to 2021
RSV Vaccine Effectiveness Against Hospitalization Among US Adults Aged 60 Years or Older During 2 Seasons
No full textImportance: Respiratory syncytial virus (RSV) vaccines for adults aged 60 years or older became available in 2023. One dose is recommended for all adults aged 75 years or older and those aged 60 to 74 years at increased risk of severe RSV; however, duration of protection is unknown.
Objective: To evaluate RSV vaccine effectiveness against RSV-associated hospitalization among adults aged 60 years or older during 2 RSV seasons.
Design, setting, and participants: A total of 6958 adults aged 60 years or older were included in this test-negative, case-control study if they were hospitalized with acute respiratory illness at any of 26 hospitals in 20 US states during the October 1, 2023, to March 31, 2024, or October 1, 2024, to April 30, 2025, RSV seasons and had respiratory virus testing within 10 days of illness onset. Case patients tested positive for RSV only; control patients tested negative for RSV, SARS-CoV-2, and influenza. Demographic and clinical data were obtained through patient interview and electronic health records.
Exposures: Receipt of 1 RSV vaccine dose at least 14 days before illness onset.
Main outcomes and measures: Multivariable logistic regression was used to compare the odds of RSV vaccination among hospitalized cases and controls. Models were adjusted for age, sex, race and ethnicity, geographic region, and calendar month and year. Vaccine effectiveness was estimated as (1 - adjusted odds ratio) × 100%. Analyses were stratified by timing of RSV vaccine receipt (same vs prior season) relative to illness onset.
Results: Of 6958 adults aged 60 years or older, 821 (11.8%) were RSV cases and 6137 (88.2%) were controls. A total of 1438 patients were Black (20.1%) and 4314 were White (62.0%); 3534 were female (50.8%). Median age was 72 years (IQR, 66-80 years) and 1829 adults (26.3%) were immunocompromised. A total of 63 cases (7.7%) and 966 controls (15.7%) were vaccinated. Estimated vaccine effectiveness against RSV-associated hospitalization was 58% (95% CI, 45%-68%) during 2 seasons and 69% (95% CI, 52%-81%) for same-season vaccination vs 48% (95% CI, 27%-63%; P = .06) for prior-season vaccination. Estimated vaccine effectiveness during 2 seasons was significantly lower among immunocompromised adults (30%; 95% CI, -9% to 55%) than immunocompetent adults (67%; 95% CI, 53%-77%; P = .02) and among those with cardiovascular disease (56%; 95% CI, 32%-72%) vs without (80%; 95% CI, 62%-90%; P = .03).
Conclusions and relevance: Respiratory syncytial virus vaccines prevented RSV-associated hospitalization during 2 seasons, although effectiveness was lower in patients with immunocompromise and cardiovascular disease than in those without these conditions. Ongoing monitoring is needed to determine the optimal RSV revaccination interval
Evaluation and management of obstructive sleep apnea in adults hospitalized for medical care: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment
No full textIntroduction: The purpose of this systematic review is to provide supporting evidence for a clinical practice guideline on management of obstructive sleep apnea in medically hospitalized adults.
Methods: The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify randomized controlled trials and observational studies that addressed interventions for the management of obstructive sleep apnea in medically hospitalized adults. Statistical analyses were performed to determine the clinical meaningfulness of critical and important outcomes. Finally, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence for making recommendations.
Results: The literature search resulted in 5,159 studies out of which 27 studies provided data suitable for statistical analyses. The task force provided a detailed summary of the evidence along with the certainty of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations.
Keywords: OSA; PAP; hospital; inpatient; obstructive sleep apnea; positive airway pressure; sleep-disordered breathing
Circumferential endoscopic submucosal dissection of a 14-cm long-segment Barrett\u27s esophagus with multifocal adenocarcinoma: a case report
No full textBackground and aims: Barrett\u27s esophagus (BE) is a recognized precursor to esophageal adenocarcinoma (EAC), with an annual progression risk of up to 7% in cases involving high-grade dysplasia (HGD). Endoscopic therapy is the standard treatment for dysplastic BE and early-stage EAC, typically involving ablation techniques, such as radiofrequency ablation and cryotherapy, for flat BE and endoscopic resection methods, including EMR and more recently endoscopic submucosal dissection (ESD), for nodular lesions.
Methods: This article describes the case of a patient with an ultralong segment of BE (14 cm) and multifocal EAC who was successfully treated with circumferential ESD.
Results: A complete en bloc resection of a 16-cm segment was achieved. Histopathologic analysis confirmed the presence of BE with HGD and multifocal EAC (T1b). Although the patient developed an esophageal stricture postprocedure, it was effectively managed endoscopically.
Conclusions: The patient is currently doing well and remains under routine endoscopic and radiographic surveillance. Circumferential ESD represents a safe and effective approach for the endoscopic resection of extensive BE and early EAC and should be considered a viable alternative to surgical intervention
Emotion identification and emotion sensitivity following interpersonal and non-interpersonal traumatic experiences: Results from the AURORA study
No full textSocial cognition is an important mechanism linking trauma to psychopathology; however, current models fail to explain individual differences in social cognition after trauma exposure. We investigated whether the interpersonal nature of trauma exposure helps to explain variability in social cognitive outcomes. Our sample was derived from the AURORA study, a national initiative involving intensive follow-up of trauma survivors for one year. We analyzed data from 2241 participants (Mage = 35.12, 64% female, 54% Black) who experienced an assault (n = 262) or a motor vehicle collision (n = 1979). Social cognition was assessed with the Multiracial Emotion Identification Task and the Belmont Emotion Sensitivity Test. Overall emotion identification accuracy declined over time among participants who experienced interpersonal trauma (β = -.10, p = .03), but not non-interpersonal trauma (β = .00, p = .83). These results may help to enhance the prediction of psychopathological outcomes following trauma exposure
Association of Maternal Prepregnancy BMI With Offspring Cardiometabolic Outcomes in Childhood
No full textObjective: This study aimed to evaluate associations of maternal prepregnancy BMI with offspring BMI and blood pressure in childhood, specifically for infants born preterm.
Methods: In this observational cohort study of children in the Environmental Influences on Child Health Outcomes (ECHO) Cohort, we utilized four levels of maternal prepregnancy BMI and child BMI. Children were categorized as being born extremely, very, or moderately preterm; late preterm; or term.
Results: In total, 13,810 children from 44 ECHO cohorts were included in these analyses. After adjusting for maternal education, maternal age at delivery, and singleton birth, a monotonic dose relationship was noted between child BMI z-scores and maternal prepregnancy BMI level. For child blood pressure outcomes, only extremely preterm children born to mothers with healthy weight and obesity and very/moderately preterm children born to mothers with healthy weight had higher odds of elevated blood pressure/hypertension compared with their term counterparts.
Conclusions: High maternal prepregnancy BMI was associated with a stepwise increase in offspring BMI in childhood. Preterm children had a higher probability of elevated blood pressure/hypertension than term children. These findings highlight a possible window of opportunity to modify lifestyles and behavior of at-risk children prior to adolescence to positively impact adolescent cardiometabolic health.
Keywords: blood pressure; childhood outcomes; prepregnancy BMI; preterm birth