Search Results (50,845)

Background/Objectives: Modifiable lifestyle factors are established determinants of venous thromboembolism risk, but their relationship with the severity and early course of acute pulmonary embolism (PE) is poorly characterized, and no validated Romanian-language instrument captures these domains in the acute PE setting. This protocol describes a prospective observational study with two distinct components: (i) a measurement component that develops and validates the Pulmonary Embolism Lifestyle and Nutrition Questionnaire (PE-LNQ), a composite patient-completed instrument, and (ii) a clinical component that analyzes the associations between lifestyle factors, routine clinical and laboratory data, and the severity and early outcomes of acute PE. Methods: Phase 1 comprises cross-cultural adaptation, content validation, piloting, and COSMIN-based psychometric evaluation. Its primary endpoints are test–retest reliability (ICC ≥ 0.70) and confirmation of ≥ 75% of a priori construct-validity hypotheses, including convergent validity against measured anthropometry and routine biomarkers. Phase 2 enrolls consecutive adults with CTPA-confirmed acute PE in a staged design (minimum 220 patients single-center; approximately 400 with a planned multicenter extension). The primary clinical endpoint is intermediate-/high-risk PE (vs. low risk) by sPESI/PESI, with the ordinal PESI class (I–V) as the key secondary endpoint. Severity data and a pre-specified panel of routine admission laboratory parameters are extracted from the medical record without study-specific sampling; patients are followed for in-hospital, 3-, and 6-month adverse events. The confirmatory analysis is multivariable logistic regression; ordinal, survival, incremental-value, and biomarker analyses are pre-specified as secondary or exploratory. Expected Results: The PE-LNQ is expected to show adequate reliability and validity, and less favorable lifestyle profiles to be associated with higher severity class and more early adverse events. Conclusions: This study will deliver a validated, freely reusable instrument and clarify the prognostic relevance of modifiable lifestyle factors, supporting their integration into risk assessment and secondary prevention. Full article

Background: Anti-Müllerian hormone (AMH) is a key biomarker of ovarian reserve, reflecting the quantity of the remaining follicular pool. While chronological age is the primary determinant of AMH concentrations, emerging evidence suggests that vitamin D, vitamin B12, folate, and iron metabolism parameters may also influence ovarian function through mechanisms involving steroidogenesis, DNA synthesis, and oxidative stress regulation. However, clinical findings regarding these associations remain inconsistent. Objective: The aim of this study was to evaluate the relationships between serum AMH concentrations and biomarkers of vitamin D status, vitamin B12, folate, ferritin, and lipid profile in women of reproductive age, and to compare the strength of these associations with that of chronological age. Methods: This retrospective, observational, cross-sectional study included 264 women who underwent AMH testing at Atlas University Hospital. Demographic and laboratory data including AMH, age, vitamin D, vitamin B12, folic acid, ferritin, and lipid parameters were extracted from electronic medical records. Bivariate correlations were assessed using Pearson’s and Spearman’s coefficients on both untransformed and Box–Cox power-transformed data, and were repeated as first-order partial correlations conditioning on chronological age. Statistical significance was set at p < 0.05. Results: The mean age was 34.61 ± 5.75 years, and median AMH was 0.96 ng/mL (Q1–Q3: 0.34–2.34). Age showed a moderate-to-strong, significant inverse correlation with AMH (Pearson’s r = −0.508, Spearman’s rho = −0.547; p < 0.001), and the linear component of this association strengthened after Box–Cox transformation (Pearson’s r = −0.553; p < 0.001). In contrast, vitamin D, vitamin B12, folic acid, ferritin, and lipid parameters (triglycerides, HDL, LDL, total cholesterol) showed no statistically significant and no clinically meaningful correlation with AMH, with all coefficients remaining below 0.20 regardless of transformation (all p > 0.05). After adjustment for age, every coefficient attenuated further towards the null (all |r_partial| < 0.10; all p ≥ 0.127), the largest being that of 25-hydroxyvitamin D (r_partial = 0.094, 95% CI −0.027 to 0.213). A sensitivity power analysis confirmed 80% power to detect an age-adjusted partial correlation of |r| = 0.172 and 91% power at |r| = 0.200. Conclusions: Age remains the principal determinant of ovarian reserve, while vitamin D, vitamin B12, folic acid, ferritin, and lipid parameters show no statistically significant or clinically meaningful association with AMH. These findings suggest that any biological influence of these micronutrients on ovarian reserve, if present, is markedly overshadowed by age-dependent follicular decline. Prospective studies incorporating longitudinal AMH measurements and standardized nutritional assessment are needed to further clarify these relationships. Full article

Background: In the 1960s and 1970s, several authors reported that manipulation of diet by excluding certain additives and natural chemical substances led to apparent clinical benefit for patients with adverse food reactions involving the skin, gastrointestinal tract, respiratory tract, and central nervous system. Methods: Over the past 48 years, patients of all ages presenting to the Royal Prince Alfred Hospital Allergy Unit with adverse food reactions were offered an elimination diet low in natural salicylates, biogenic amines, and glutamate, and free of additives such as preservatives and colors, for two to six weeks. Those who became asymptomatic were offered testing with a “N-of-1” double-blind, placebo-controlled (DBPC) challenge protocol. Results: There were 14,119 patients who elected to undertake either the strict elimination diet (10,074) (71.4%), the moderate approach (2760) (19.5%), or the simple approach (1285) (9.1%). Of these, 6645 (47.1%) became asymptomatic within two to six weeks; 628 (4.4%) reported no improvement; and 6846 (48.5%) were lost to follow-up. Of those who improved, 4963 (35.2%) returned for interpretation of their challenges, and 2429 had undertaken open food challenges; 3326 had completed the DBPC capsule challenge protocol, and 1830 completed both DBPC capsule and food challenges. Although individual reactivity was idiosyncratic, a highly reproducible pattern was evident across the entire group. The proportion reacting to each of the active chemical challenges versus placebo was highly significant (p < 0.001). Conclusions: In many patients with food intolerance, idiosyncratic dietary triggers can be reliably identified with a standardized elimination diet and DBPC challenge protocol. Long-term symptom control can be achieved by appropriate dietary modification. Full article

Midwifery philosophy promotes optimising physiological processes for all women. However, when complications arise, women may be offered increased monitoring and/or admission to hospital. Research demonstrates negative experiences associated with this. Virtual care presents the opportunity for more individualised care and has shown higher satisfaction with comparable outcomes to standard care, at similar or lower cost. Virtual pregnancy care is established in many countries, but implementation has been slow in Australia. The aim of this review is to evaluate the safety and effectiveness of antenatal virtual care models that incorporate telemonitoring of maternal and/or fetal wellbeing. A systematic search of the literature published since 2010 was conducted. Quantitative and mixed-methods studies were reviewed to provide a summary of contemporary evidence. Evidence on virtual care (with telemonitoring) delivered in the antenatal period was synthesised. Postpartum virtual care models were outside the scope of this review. Twenty-five publications were included. Studies examined diverse telemonitoring interventions, often supported by telehealth consultations with health professionals. Compared with standard care, including hospital admission, virtual models were associated with higher maternal satisfaction, reduced costs and service use, and were not associated with increased adverse perinatal outcomes. Further implementation research is needed to support broader adoption and ensure women can access flexible models of care. Full article

Background/Objectives: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are foundational therapy for heart failure with reduced ejection fraction (HFrEF), irrespective of diabetes. We evaluated recorded SGLT2i adoption and diabetes-related differences among adults with an electronic health record (EHR)-defined HFrEF phenotype at a Jordanian public hospital. Methods: This retrospective Hakeem cohort included 1750 adults. The frozen HFrEF phenotype was internally validated in an independent non-overlapping sample, and SGLT2i ascertainment was verified by complete-cohort medication review. Comparable annual analyses covered 2022–2025, when medication-source completeness exceeded 90%. Secondary analyses examined first recorded use after a 180-day lookback, concurrent four-class guideline-directed medical therapy (GDMT) in 2025, measured-eGFR threshold cohorts, and prespecified Firth regression among patients with type 2 diabetes (T2DM). Additional sensitivity analyses included a stable four-year cohort, a time-to-first-record analysis with explicit censoring, expanded model diagnostics with a time-to-event sensitivity analysis, and a strict directly documented-coverage GDMT analysis. Results: Sixty-four patients had verified recorded SGLT2i use (3.66%; 95% CI 2.83–4.65). Use was 11.41% (64/561) with T2DM and 0% (0/1189; exact 95% CI 0–0.31) without diabetes. Annual prevalence increased from 0.15% in 2022 to 5.13% in 2025 (absolute increase 4.98 percentage points), while remaining 0% without diabetes. In the stable four-year cohort sensitivity analysis, prevalence similarly increased from 0.21% to 5.34%. In the verified 12-month fixed-horizon cohort, 27/1268 patients (2.13%) had a first recorded use within one year; the 322-day median was conditional on the 50 patients who eventually had a first post-index record and was not interpreted as a cohort-wide waiting time. Only 24/936 patients (2.56%) had all four foundational classes concurrently active in the primary 2025 analysis. The inverse nondialysis-CKD estimate was treated as exploratory because only four treated patients had nondialysis CKD. Conclusions: Recorded adoption improved but remained low and strongly concentrated among patients with T2DM. Multicenter linkage of prescribing, eligibility, dispensing, persistence, and reimbursement data is needed to identify implementation mechanisms. Full article

Exclusive breastfeeding (EBF) for the first six months of life is recommended by the World Health Organization, but its association with executive function (EF) in early childhood remains uncertain. This study examined whether EBF during the first six months of life and breastfeeding duration were associated with EF in early childhood and explored relevant child and family characteristics. We conducted an analytical cross-sectional study among 316 children aged 24–35 months attending the Well-Child Clinic, Health Promotion Hospital, Regional Health Promotion Center 7 Khon Kaen, Thailand. EF was assessed using the Minnesota Executive Function Scale (MEFS). The continuous MEFS Standard Score was used as the primary outcome and analyzed using multivariable linear regression. Post hoc exploratory analysis using the 55th percentile threshold and sensitivity analysis using the normative 50th percentile were also conducted. In the primary analysis, EBF was not statistically significantly associated with the MEFS Standard Score (adjusted β = −0.96, 95% CI: −2.13 to 0.21; p = 0.108). Child age was inversely associated with the MEFS Standard Score (adjusted β per 1-month increase = −0.29, 95% CI: −0.46 to −0.11; p = 0.002), whereas maternal education at the bachelor’s degree level or above was positively associated with EF (adjusted β = 2.44, 95% CI: 1.18 to 3.71; p < 0.001). Family functioning was not statistically significantly associated with EF in the primary continuous-score analysis (overall p = 0.319). The absence of a statistically significant association between EBF and EF was consistent across the alternative categorical outcome definitions. In contrast, the association with family functioning was only observed in the post hoc 55th percentile analysis and was not robust across outcome definitions. Breastfeeding duration as a continuous measure was not statistically significantly correlated with the MEFS Standard Score. In the post hoc exploratory analysis using the 55th percentile threshold, breastfeeding for >0 to 6 months was associated with higher odds of higher EF performance compared with no breastfeeding, whereas breastfeeding for >6 months was not. This pattern did not indicate a consistent dose–response association. These findings provide no statistically significant evidence of an association between EBF and EF in this sample, while maternal education was associated with EF performance. The findings regarding family functioning should be regarded as exploratory and hypothesis-generating. Full article

Urinary tract infections (UTIs) are a major cause of hospital-acquired infections, and up to 80% of these are linked to urinary catheters. The biofilm formation of uropathogenic E. coli plays a critical role in the development of catheter-associated urinary tract infections (CAUTIs). This study aimed to develop a silicone elastomer material incorporating green-synthesized zinc oxide nanoparticles for potential urinary catheter applications and assess its antibiofilm efficacy against uropathogenic Escherichia coli (UPEC). E. coli was identified by the BD Phoenix^TM system and 16S rRNA gene sequencing. ZnO NPs were synthesized through a green method using Crataegus azarolus leaf extract as a biological reducing and stabilizing agent. NPs were incorporated into a silicone matrix at different concentrations (0 wt%, 0.5 wt%, 1 wt% and 1.5 wt%) to produce ZnO-functionalized silicone elastomer specimens for potential urinary catheter applications, and then their antibiofilm activity was assessed through a 96-well microtiter assay. NPs and nanocomposites were characterized through various spectroscopic techniques using XRD, FTIR, and FESEM. In the 1.5 wt% ZnO NPs–silicone elastomer specimen, biofilm formation by E. coli ATCC 25922 and the clinical isolate were significantly reduced by 86.94% and 78.40%, respectively, compared to the control silicone elastomer specimen for potential urinary catheter application. The present findings suggest that green synthesized ZnO NPs provide a promising and biocompatible approach to reducing UPEC biofilm formation when incorporated into silicone elastomer specimens for urinary catheter application. Furthermore, this method may help reduce CAUTIs in clinical settings. Full article

Background/Objectives: Wastewater treatment plants (WWTPs) are recognized point sources of pharmaceutical residues and antimicrobial-resistant bacteria. This challenge is explicitly addressed in the 2024 recast of the Urban Wastewater Treatment Directive (UWWTD), which introduces risk-based obligations for micropollutant removal. Methods: Here, five antibiotics (azithromycin, clarithromycin, erythromycin, ciprofloxacin and sulfamethoxazole) were retrospectively (2017–2018) assessed in influent and effluent of four WWTPs and in their receiving waters (riverine and marine outfalls), including the Vistula Estuary. Measured incoming load (MIL) was compared with predicted incoming load (PIL), a cost-efficient proxy derived from outpatient consumption data. Results: The screening-level PIL–MIL consistency check showed closer agreement in catchments without major hospital inputs. In WWTPs, ciprofloxacin showed consistently high apparent aqueous-phase removal in both campaigns (>95%), sulfamethoxazole showed moderate removal (64–85%), while macrolides exhibited highly variable and sometimes apparent negative removal, yielding effluent concentrations up to 3989 ng L⁻¹ (azithromycin) and 2866 ng L⁻¹ (clarithromycin). Receiving waters generally contained < 10 ng L⁻¹ of the investigated antibiotics, but a low-dilution-capacity river showed a clear WWTP influence. Presumptive cefotaxime-resistant Escherichia coli, used as proxies for emerging ESBL/AmpC-associated resistance, reached ~5% and 20% of CFU downstream of WWTP discharges. Environmental (ERA) and AMR-related (AMR-RA) risk quotients (RQs) were mostly <0.1. However, RQs for azithromycin approached or exceeded unity in Gdańsk and Puck Bay. Coastal recipients are more vulnerable despite high dilution, since marine predicted no-effect concentrations (PNECs) for antimicrobials are lower than those for freshwater. Conclusions: The study supports the value of retrospective baseline data and site-specific screening frameworks for risk-based prioritization under the recast UWWTD. Full article

Background: COVID-19-associated acute kidney injury (AKI) is common in severe disease, but its long-term kidney implications are heterogeneous and incompletely defined. Objective: To synthesize recovery phenotypes and longitudinal outcomes, reconcile conflicting evidence on whether COVID-associated AKI differs from other-cause AKI, and set out implications for surveillance and management. Methods: The evidence base was assembled through a targeted PubMed/MEDLINE search for COVID-19 and kidney dysfunction (January 2020 to August 2026), hand-searching of reference lists, and direct retrieval of pivotal longitudinal cohorts and clinical practice guidelines. Longitudinal cohorts and comparative studies were prioritized. Findings: AKI severity, duration, kidney replacement therapy, lower baseline estimated glomerular filtration rate (eGFR), and incomplete early recovery consistently identify patients at greatest risk. Longitudinal studies disagree on whether COVID-AKI confers more risk than AKI from other illnesses: early cohorts reported steeper eGFR loss, whereas a later 9624-patient cohort found lower adjusted major adverse kidney events. This divergence reflects differences in kidney reference point, outcome construction, ascertainment, and handling of competing death rather than genuine contradiction. Population studies show long-term kidney failure is concentrated after hospitalization and severe disease. Candidate biomarkers remain investigational. Conclusions: Post-COVID kidney risk is severity- and phenotype-dependent rather than universal. Follow-up is most defensible after hospitalized AKI, incomplete recovery, advanced chronic kidney disease (CKD), dialysis, or transplantation and applies existing post-AKI guidance rather than a COVID-specific schedule. Survivors who meet Kidney Disease: Improving Global Outcomes (KDIGO) criteria for CKD at three months, namely a GFR below 60 mL/min/1.73 m² or a persistent marker of kidney damage, become eligible for guideline-directed therapy, though no trial has enrolled on recent AKI. Prospective studies should test whether structured follow-up improves outcomes. Full article

Sarcopenia is an independent predictor of adverse outcomes in hospitalized patients, associated with increased mortality, prolonged length of stay, and functional decline, yet it remains underdiagnosed owing to inconsistent diagnostic criteria and the practical challenges of assessing acutely ill patients. This narrative review summarizes current evidence on sarcopenia in hospitalized patients, with emphasis on diagnostic approaches, nutritional requirements, and optimal nutritional support strategies. Sarcopenia is particularly prevalent among critically ill patients and is driven by the convergence of systemic inflammation, immobility, and anabolic resistance. Diagnosis remains challenging: no ICU-specific framework exists, and the recent Global Leadership Initiative of Sarcopenia consensus established a unified, setting-independent conceptual definition as a foundation for future operational criteria, with ICU-specific frameworks yet to be developed. Bedside tools, including handgrip strength, bioelectrical impedance analysis, and ultrasound, retain strong prognostic value despite imperfect agreement with reference imaging. Nutritional intervention is a key component of management; however, large-scale trials have demonstrated that higher energy or protein delivery does not universally improve outcomes and may be harmful in selected critically ill patients. A gradual increase in energy and protein delivery according to the phase of illness, with protein targets of ≥1.2–1.5 g/kg/day, is recommended; leucine-enriched supplementation may help counteract anabolic resistance, although direct evidence in non-ICU hospitalized patients remains limited. Early mobilization is an essential complement, as nutrient provision without a mechanical stimulus cannot reverse immobility-induced muscle loss. A practical clinical algorithm integrating screening, nutritional target-setting, route selection, and reassessment is proposed to guide decision-making in this population. Future research should focus on improving the accuracy and feasibility of muscle assessment tools in critically ill patients to enable the timely diagnosis of sarcopenia and nutritional intervention, alongside the development of validated multi-marker panels and adequately powered trials examining the combined effect of nutrition and exercise in this population. Full article

Hotels contain diverse functional environments, yet longitudinal evidence on viable bacterial contamination and its response to COVID-associated hygiene changes remains limited. This retrospective serial cross-sectional study analyzed 544 environmental samples from five audits of a German hotel conducted in 2016, 2018, 2019, 2022, and 2023. Pre-pandemic audits (2016, 2018–2019) were compared with 2022–2023 audits across four functional environments: guest rooms, child-oriented areas, wellness/water facilities, and food-service operations. Outcomes included culture positivity, contamination severity, polymicrobial and priority-microorganism detection, persistent hotspots, and organism distributions. Modified Poisson models adjusted for functional environment and used cluster-robust inference. All statistical analyses were performed in R (version 4.5.1). High contamination declined from 54.2% pre-COVID to 19.3% in 2022–2023 (aPR, 0.36; 95% CI, 0.25–0.54; p < 0.001), an adjusted reduction of 34.1 percentage points (95% CI, 21.5–46.6). Culture positivity remained unchanged (63.4% vs. 60.1%; aPR, 0.96; 95% CI, 0.83–1.12; p = 0.634), whereas polymicrobial contamination decreased (aPR, 0.61; 95% CI, 0.39–0.96; p = 0.032; adjusted reduction, 8.3 percentage points; 95% CI, 1.0–15.7). Priority-microorganism detection was unchanged (aPR, 1.06; 95% CI, 0.67–1.67; p = 0.804), despite a shift toward S. aureus and P. aeruginosa. Culture positivity remained approximately 90% in child-oriented and food-service areas. Eight of 15 recurring surface categories remained persistent hotspots, including wet-room floors, frequently touched controls, paddling-pool features, and food-service machinery. The Bacillus cereus group decreased from 12.6% to 2.5%, whereas Staphylococcus aureus and Pseudomonas aeruginosa were each detected in 0% versus 5.8% of samples (q < 0.001). Audits in 2022–2023 showed lower contamination intensity without corresponding reductions in overall culture positivity or priority-microorganism prevalence. Complementary burden-, complexity-, and organism-based indicators are needed for environmental-hygiene evaluation. Full article

Background: Small bony canals in the anterior maxilla are relevant to dental implant planning, but their reported frequency depends on anatomical definitions and imaging methods. This exploratory study describes recorded canal findings and selected measurements in an Asir hospital sample. Methods: Cone-beam computed tomography examinations of 75 patients were reviewed retrospectively. Two examiners collected one shared dataset after an initial calibration exercise. Findings were summarized descriptively with Wilson 95% confidence intervals. Results: A canal finding was recorded in 34 of 75 patients (45.3%; 95% confidence interval, 34.6–56.6%) and in 21 of 55 documented right-side assessments (38.2%; 95% confidence interval, 26.5–51.4%). Six patients had findings recorded on both sides; the total number of assessed left sides was not documented. Mean opening-to-buccal-plate and opening-to-nasal-floor distances were 7.84 and 10.13 mm. Incomplete bilateral assessment, an insufficiently specified main-versus-accessory canal definition, and the absence of quantitative observer-reliability testing limit interpretation. The small sample does not support firm conclusions about demographic associations. Conclusions: These findings provide preliminary descriptive information about anterior maxillary canals, not definitive estimates of anatomical prevalence or laterality. Future studies require complete bilateral assessment, explicit anatomical criteria, and quantitative reliability testing. Full article

Background/Objectives: Noonan syndrome (NS) is characterized by marked phenotypic variability. Although the classical phenotype includes short stature, craniofacial dysmorphism, skeletal abnormalities, and congenital heart defects, some patients present with subtle or atypical manifestations, making clinical recognition challenging. Methods: This retrospective case series included six pediatric patients with molecularly confirmed NS managed at the Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital-Research Institute, Lodz, Poland. Medical records were reviewed for auxological data, phenotypic features, endocrine and skeletal assessment, cardiovascular findings, associated conditions, and multidisciplinary management. The aim of this study was to characterize the phenotypic diversity of NS in pediatric endocrine practice, with particular emphasis on growth patterns, endocrine and skeletal manifestations, and atypical clinical presentations. Results: The six patients demonstrated markedly heterogeneous clinical presentations. One boy exhibited the classical phenotype with severe short stature and pulmonary valve stenosis, whereas a girl with typical NS features maintained relatively preserved growth around the 3rd percentile. Another patient presented with progressive resorption of permanent incisor roots and a coexisting pathogenic NBN variant. A boy with LZTR1-associated NS and Klinefelter syndrome (47,XXY) demonstrated a blended phenotype and height between the 25th and 50th percentiles. Two girls lacked characteristic NS dysmorphism and presented predominantly with growth impairment, accompanied by markedly low bone mass in one case and a prolonged diagnostic pathway in the other. GH deficiency was not identified in the evaluated patients, and rhGH therapy was initiated in three patients. Conclusions: NS encompasses a broad clinical spectrum, ranging from classical phenotypes to atypical presentations dominated by growth, skeletal, or dental abnormalities. Neither the absence of characteristic dysmorphism nor relatively preserved growth excludes the diagnosis, while coexisting genetic conditions may further modify the phenotype. Awareness of this heterogeneity is essential for appropriate recognition and individualized multidisciplinary care. In selected children with otherwise unexplained growth or atypical clinical findings, consideration of NS and genetic evaluation may help establish a unifying diagnosis and potentially shorten the diagnostic pathway. Full article

Visiting patients and medical staff share the same air in outpatient departments of general hospitals. In South Korea, 11 of 15 general hospitals operate with a fixed ratio of 20% outdoor air and 80% recirculated air even during peak visiting hours, causing the recirculation of indoor airborne pathogens. In this study, we propose a scheduling strategy in which air conditioning is adjusted proactively according to the number of visiting patients. The number of visiting patients was measured over five weeks with a people counter. The count showed a regular pattern: an increase in the morning, a decrease at lunch, and a sharp rise in the afternoon. Based on this pattern, we designed a pre-delay schedule for the air conditioning system in which the air intake rate is increased before the increase in visiting patients and maintained for some time after the decrease. The efficacy of this strategy was verified through mock-up room evaluations and full-plane CFD simulations. In the mock-up room tests, the pre-delay operation effectively suppressed particle accumulation in all three conditions. In the CFD simulations, the pathogen count in the waiting room during peak visiting patient hours decreased from the existing 12 particles/10⁶ to 8.4 (−30.0%) with the scheduled operation and 6.8 (−43.3%) with the proposed pre-delay operation. Thus, the proposed method can be applied in existing facilities without modifying an installed central air conditioning system because primarily the air intake rate is adjusted within the airflow range that the existing central air conditioning system can deliver, without adding or modifying equipment. Full article

The purpose of this review article is to discuss the current treatment modalities and ongoing clinical trials regarding cardiac amyloidosis (CA), specifically transthyretin cardiac amyloidosis (ATTR-CA). Amyloidosis refers to the extracellular deposition of insoluble amyloid fibrillar proteins. When these proteins are deposited in the heart’s myocardium, it is referred to as cardiac amyloidosis. CA can be divided into two main groups: light chain cardiac amyloidosis (AL-CA) and transthyretin cardiac amyloidosis (ATTR-CA), which can be further subdivided into wild-type transthyretin amyloidosis (ATTRwt) and hereditary transthyretin amyloidosis (ATTRv). ATTR-CA is an increasingly recognized cause of heart failure in the setting of progressive restrictive cardiomyopathy, particularly among older adults, males, and individuals of African descent, with remarkable advances in the therapeutic landscape. TTR stabilizers, including Tafamidis (approved in 2019) and Acoramidis (approved in 2024), have demonstrated significant reductions in mortality and cardiovascular hospitalizations. Gene silencing therapies, including Vutrisiran (approved in 2025), represent a new drug group that targets TTR production at the RNA level. Meanwhile, CRISPR-based gene editing with nexiguran ziclumeran (nex-z or NTLA-2001) and amyloid-depleting monoclonal antibodies offer the prospect of one-time curative treatments and active fibril clearance, respectively. However, despite these advances, substantial knowledge gaps persist: no head-to-head trials have compared stabilizers to silencers, optimal combination therapy regimens remain undefined, and the role of conventional guideline-directed medical therapy in ATTR-CA has only been supported by observational data. Full article