Search Results (1,177)

Background/Objectives: Fluid overload in critically ill patients is linked to adverse outcomes. While resuscitation strategies are well established, guidance for the de-resuscitation phase remains limited. This study aimed to identify clinical factors associated with diuretic response and achieving negative fluid balance (FB) in critically ill patients. Methods: We conducted a single-center, retrospective cohort study of ICU patients who received intravenous furosemide between 2017 and 2023. A CHAID (Chi-square Automatic Interaction Detector) decision tree identified clinical variables associated with fluid removal after the first dose, and a mixed-effects model analyzed repeated measurements. Results: The cohort comprised 1764 patients over 6632 ICU days. Mean arterial pressure (MAP) was the strongest predictor of negative FB. MAP ≤ 75 mmHg yielded minimal negative FB (−33 ± 1054 mL/24 h); MAP 75–90 mmHg yielded intermediate negative FB (−467 ± 1140 mL/24 h); and MAP > 90 mmHg produced the greatest negative FB (−899 ± 1415 mL/24 h; p < 0.001). Secondary associations varied by MAP: creatinine at low MAP, blood urea nitrogen at mid-range MAP, and SOFA score at high MAP, all inversely related to negative FB. In mixed-effects analyses, each 1 mmHg MAP increase was associated with 23.3 mL greater fluid removal (p < 0.001). Independent factors linked to reduced negative FB included vasopressor use (noradrenaline), elevated creatinine, and higher SOFA scores. Conclusions: In this cohort, MAP was significantly associated with the likelihood of achieving a negative fluid balance during de-resuscitation. Conversely, vasopressor use, renal dysfunction, and higher illness severity were linked to reduced diuretic responsiveness. These findings support individualized de-resuscitation strategies. Full article

Background/Objectives: It is well established in the modern literature that newborns delivered from multiple gestations are more predisposed to low birthweight in comparison to their singleton equivalents. In this study, we sought to explore the potential of first-trimester biochemical (PAPP-A and free β-hCG) and biophysical indices (uterine artery Doppler) to predict low birthweight in one or both twins. Methods: This is a retrospective cohort analysis of 400 twin viable pregnancies presenting for routine first-trimester assessment in four fetal medicine centers between 2014 and 2025. The examination included the recording of maternal demographic characteristics and medical history, the assessment of markers of aneuploidy and the fetal anatomy, the measurement of mean arterial pressure, the assessment of uterine arteries and the measurement of serum concentration of PAPP-A and free β-hCG. The evaluated outcomes included BW ≤ 3rd centile and BW ≤ 10th centile in one or both twins based on local population birthweight reference charts. Results: The study cohort consisted of 400 twin pregnancies. BW ≤ 3rd centile in one or both twins was reported in 1.5 and 3.8% of cases, respectively, and there was no association of BW ≤ 3rd centile with any of the studied parameters. BW ≤ 10th centile in one or both twins was reported in 14.8 and 9.8% of the cases, respectively. PAPP-A MoM values were significantly lower in cases complicated by BW ≤ 10th centile in one and in both twins, remaining statistically significant even after the appropriate multiple logistic regression. PAPP-A MoM demonstrated statistically significant but low prognostic value for BW ≤ 10th centile in either one or both twins. Conclusions: Low PAPP-A levels were associated with BW ≤ 10th centile in one and both twins and its significant value as a risk marker was demonstrated. Higher PAPP-A MoM halves the risk of having at least one twin with low BW. Other maternal biophysical and biochemical indices did not seem to be predictive of low birthweight. Full article

Background and Objectives: Preeclampsia (PE) complicates 2–8% of pregnancies globally, with a higher incidence in developing countries. This condition poses significant risks to maternal and fetal health, contributing substantially to maternal and perinatal mortality, particularly in cases of early-onset PE, which is associated with severe complications. This review aims to synthesize current evidence regarding the predictive utility of ophthalmic artery Doppler for preeclampsia. Current strategies focus on early prediction and prevention to mitigate adverse outcomes and reduce the economic burden of hypertensive disorders in pregnancy. The International Federation of Gynecology and Obstetrics (FIGO) recommends first-trimester screening combining maternal risk factors, mean arterial pressure, serum placental growth factor (PlGF), and uterine artery pulsatility index (UtA-PI). High-risk women are advised to take low-dose aspirin (150 mg daily) until 36 weeks of gestation. Materials and Methods: This review explores an innovative predictive tool for PE: ophthalmic artery (OA) Doppler. Results: As a non-invasive and easily accessible method, OA Doppler provides valuable insights into intracranial vascular resistance, offering potential advantages in early risk assessment, particularly for preterm PE, the most severe form of the disease. Conclusions: Our findings suggest that OA Doppler may serve as a promising adjunct in PE screening, enhancing the early identification of high-risk pregnancies and improving clinical outcomes. Further research is warranted to validate its role in routine prenatal care. Full article

Background: Acute respiratory distress syndrome (ARDS), recognized as an inflammatory and life-threatening lung injury, is typified by severe hypoxaemia, lack of heart-related pulmonary edema, and bilateral lung infiltrates. Glucocorticoids are anti-inflammatory and immunoregulatory agents that are considered a viable treatment for ARDS. This study sought to contrast the effects of methylprednisolone, hydrocortisone, and dexamethasone at equivalent doses in ARDS. Methods: About 195 ARDS patients were allocated at random to take methylprednisolone (1 mg/kg/day), hydrocortisone (350 mg/day), or dexamethasone (13 mg/day). The primary and secondary outcomes over 28 days following the initiation of glucocorticoid therapy involved mortality, ventilator-free days, duration of hospitalization, duration of intensive care unit (ICU), total number of patients requiring invasive mechanical ventilation, and changes in the means of arterial oxygen partial pressure to inspired oxygen fraction (PaO₂/FiO₂) and oxygen saturation percentage to inspired oxygen fraction (SpO₂/FiO₂) ratios. Results: Over the 28-day follow-up, regarding mortality, there was a significant difference between dexamethasone and hydrocortisone, as well as between methylprednisolone and hydrocortisone. However, methylprednisolone exhibited the lowest mortality. There were no significant differences among study groups in ventilator-free days, hospitalization duration, ICU duration, and requirement for invasive mechanical ventilation. On the other hand, methylprednisolone had the lowest means of both durations of hospitalization and ICU, and the lowest requirement for invasive mechanical ventilation. Each study group exhibited a significant increase in both PaO₂/FiO₂ and SpO₂/FiO₂ ratios at follow-up time. However, dexamethasone showed the highest means of both PaO₂/FiO₂ and SpO₂/FiO₂ ratios at follow-up time. There was a significant difference in PaO₂/FiO₂ and SpO₂/FiO₂ ratios at follow-up assessment between dexamethasone and hydrocortisone. Conclusions: At equivalent doses, treating ARDS with methylprednisolone may be more successful than using dexamethasone and hydrocortisone. Full article

Background and Objectives: Cognitive deficits are common in obstructive sleep apnea (OSA), and both intermittent hypoxemia and cardiovascular comorbidity may contribute to poorer outcomes. Arterial hypertension (HTN) has been suggested as a potential modifier of cognitive function in OSA, but findings remain inconsistent. This study examined whether HTN influences baseline cognition or cognitive improvement after continuous positive airway pressure (CPAP) therapy in moderate-to-severe OSA and identified predictors of poorer post-treatment cognitive status. Materials and Methods: This prospective study involved 71 adults with newly diagnosed moderate-to-severe OSA (AHI ≥ 15). Participants underwent baseline polysomnography, Montreal Cognitive Assessment (MoCA) testing, and P300 assessments. Cognitive impairment was defined as MoCA < 26 and HTN by antihypertensive therapy, documented diagnosis, or repeatedly elevated blood pressure. All participants initiated auto-adjusting CPAP and were reassessed after three months for adherence, residual respiratory indices, MoCA, and P300 parameters. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were used to identify independent predictors of poorer cognitive outcomes. Results: CPAP therapy significantly improved apnea severity, daytime sleepiness, global cognition, and P300 latency, while P300 amplitude did not change significantly. After three months, hypertensive and normotensive patients showed similar MoCA scores, respiratory outcomes, and P300 amplitude; P300 latency remained marginally longer in hypertensive individuals. Across multivariate models, lower mean nocturnal oxygen saturation and reduced CPAP adherence independently predicted poorer cognitive outcome at follow-up. CPAP adherence demonstrated greater discriminative ability than mean nocturnal oxygenation. Conclusions: In adequately treated moderate-to-severe OSA, HTN did not significantly affect baseline cognition or short-term cognitive recovery with CPAP. Although P300 latency remained slightly prolonged in hypertensive individuals, this difference was marginal and not accompanied by cognitive deficits. Nocturnal oxygenation and CPAP adherence emerged as the strongest predictors of post-treatment cognitive status, underscoring the importance of sustained and effective therapy. These findings suggest that effective CPAP adherence and improved nocturnal oxygenation are crucial for cognitive recovery in OSA patients, regardless of hypertensive status. Full article

Background: Pre-eclampsia causes endothelial dysfunction and altered vascular reactivity, which may increase perioperative risk, particularly under the physiologic stress of general anesthesia (GA). However, the evidence regarding its independent effects under uniform GA conditions is limited. This study assessed the association between pre-eclampsia and intraoperative hemodynamic stability as well as postoperative complications in women undergoing cesarean section under GA. Methods: This retrospective cohort study screened 1242 women who underwent GA for cesarean delivery between January 2017 and July 2024. After applying exclusion criteria, 959 patients were included: 169 with and 790 without pre-eclampsia. The intraoperative blood-pressure and heart-rate trends, vasopressor use, operative variables, and postoperative complications were analyzed. Predictors of postoperative respiratory complications were identified using logistic regression with Firth correction. Results: Patients with pre-eclampsia showed consistently higher mean arterial pressures throughout induction and emergence, whereas trends in heart rate were similar. Postoperative morbidity was higher in the pre-eclampsia group (11.8% vs. 5.3%), with increased respiratory complications (3.6% vs. 1.1%) and longer hospital stays. Pre-eclampsia independently predicted postoperative respiratory complications in univariable (odds ratio [OR] 3.27, 95% confidence interval [CI] 1.13–8.90, p = 0.03), multivariable (OR 3.13, 95% CI 1.09–8.98, p = 0.03), and Firth’s analyses (OR 3.21, 95% CI 1.11–8.77, p = 0.03). Conclusions: Pre-eclampsia was associated with persistent intraoperative hypertension and higher risks of postoperative respiratory morbidity under GA. These findings support the need for individualized hemodynamic control, cautious fluid management, and increased postoperative respiratory surveillance in patients with pre-eclampsia. Full article

This paper proposes a low-cost measurement system that can be used to perform simultaneous blood pressure (BP) and breathing (BR) measurements. Regarding BP measurements, the main parameters that are accessed include systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure blood pressure (MAP), and heartbeat rate (HR). Concerning BR measurements, the main parameters that are accessed include the inspiration period and amplitude (IPA), the expiration period and amplitude (EPA), and the breathing rate (BR), as well as the statistical and standard deviation of all these parameters. The dual measurement capability of the proposed measurement system is very important since blood pressure and breathing parameters are not statistically independent and it is possible to obtain additional and valuable clinical information from the information provided by both biomedical variables when measured simultaneously. The analysis of the correlation between these variables is particularly important after performing intensive physical exercises, since it enables cardiac rehabilitation assessment, pre-surgical risk evaluation, detection of silent ischemia, and monitoring of chronic diseases recovery, among others. Regarding the performance evaluation of the proposed biomedical device, a prototype of the measurement system was developed, tested, and calibrated. Several experimental tests were carried out to evaluate the performance of the proposed measurement system and to obtain the correlation coefficients between different blood pressure and breathing parameters. The tests were based on a statistically significant number of measurements that were performed with a population that integrated twenty students in two groups with different habits of physical exercise practice but subjected to a set of common physical exercises, with graduated intensity levels. Full article

Severe mitral regurgitation (MR) is one of the most common valvular heart diseases and is frequently associated with advanced left ventricular (LV) systolic dysfunction. Transcatheter edge-to-edge repair (TEER) offers effective symptom relief but may induce abrupt hemodynamic changes leading to afterload mismatch and acute LV failure. Levosimendan may help mitigate this complication by improving contractility, yet evidence supporting its use in this setting is scarce. Therefore, the aim of this study was to systematically evaluate the evidence on the effects of Levosimendan in patients with severe MR and LV dysfunction undergoing TEER. We performed a comprehensive search of PubMed, Embase, Scopus, and Google Scholar. Primary outcomes were postprocedural LV ejection fraction (LVEF) and systolic pulmonary artery pressure (sPAP). Secondary outcomes included procedural success, procedure duration, and in-hospital complications. Five studies comprising 315 patients (n = 141 Levosimendan, n = 174 controls) met the inclusion criteria. Pooled analysis showed no significant difference in postprocedural LVEF between Levosimendan-treated patients and controls (mean difference 0.45%, 95% CI [−1.46–2.35] p = 0.65) and no significant change from baseline. Similarly, postprocedural sPAP did not differ significantly. Procedural success was higher with Levosimendan, and procedure duration was shorter. These hypothesis-generating findings highlight the need for larger, prospective randomized trials to clarify the role of Levosimendan in this setting. Full article

Pulmonary hypertension associated with interstitial lung disease (PH-ILD) is a progressive condition with limited treatment options and associated with high mortality rates. Inhaled treprostinil (iTre) is the only approved therapy for PH-ILD and has been shown to improve exercise capacity and delay disease progression. However, the conventional outpatient titration schedule requires 8–16 weeks to achieve therapeutic dosing, which may delay clinical benefit in those with advanced disease. We conducted a retrospective study of six patients with severe PH-ILD admitted to a tertiary academic center for initiation of iTre using a rapid inpatient uptitration protocol. iTre was started at 3 breaths four times daily (QID) and increased by 2 additional breaths every 12–24 h as tolerated, aiming for ≥9–12 breaths QID within one week under close monitoring. All six patients achieved target dosing without dose reduction or interruption. At three-month follow-up, mean pulmonary artery pressure decreased from 42 ± 5.5 to 35.2 ± 4.5 mmHg, pulmonary vascular resistance from 8.0 ± 1.2 to 6.0 ± 0.9 WU, and cardiac index increased from 2.05 ± 0.13 to 2.15 ± 0.12 L/min/m². No readmissions occurred within 90 days. This study demonstrates that rapid inpatient uptitration of iTre in severe PH-ILD is feasible and well-tolerated, with preliminary evidence of short-term hemodynamic improvement. Full article

Background/Objectives: Flexible bronchoscopy (FB) enables airway exploration and diagnosis of various respiratory pathologies, but the sedation and instrumentation required during the procedure raise oxygen demand while reducing ventilation, which can lead to hypoxemia. Conventional oxygen therapy (COT) may not adequately prevent desaturations in high-risk groups, as patients with moderate respiratory deficiency. High-flow nasal cannula (HFNC) can deliver heated, humidified oxygen at high flow rates, generating low-level positive airway pressure, improving oxygenation, reducing dead-space, and enhancing procedure tolerance. Prior studies have shown that HFNC can improve gas exchange and reduce desaturations during bronchoscopy. However, evidence remains limited for patients with moderate respiratory deficiency, who are particularly vulnerable. Evaluating the feasibility and safety of HFNC in this population is essential to guide safe procedural practice. Methods: A retrospective observational study including patients undergoing FB with HFNC support between January and May 2025. Inclusion criteria were BMI between 18 and 30; age > 18 years old; moderate respiratory dysfunction, defined by pulse oximetry, Pulmonary Functional Tests (PFTs) and Arterial Blood Gas (ABG) analysis. Exclusion criteria were intolerance/contraindication to HFNC. Procedures were performed under basic monitoring. Primary outcome was occurrence of severe hypoxemia (SpO2 < 90%). Secondary outcomes were needed for rescue maneuvers, interruption for conversion to other ventilatory strategies, and hemodynamic instability. Results: No severe desaturations were recorded, all procedures were completed without rescue maneuvers or other ventilatory strategies, and no hypoxemia occurred. Mean duration of the procedure was 9 min. Vital parameters were maintained within the normal ranges, with a mean SpO₂ during bronchoscopy of 98%. Conclusions: HFNC enables oxygenation and ventilation without adverse events in sedations for FB in patients with moderate respiratory deficiency. Full article

Background: Epicardial adipose tissue (EAT) is a metabolically active organ implicated in coronary artery disease (CAD); however, its role in aortic stenosis (AS) remains unclear. Advanced glycation end products (AGEs) and their receptor (RAGE) promote cardiovascular tissue inflammation. This study aimed to investigate whether inflammatory activity within the EAT, particularly involving the AGEs-RAGE axis, is associated with AS. Methods: We studied 42 patients (isolated AS, n = 15; AS with CAD, n = 15; and CAD alone, n = 12) undergoing surgical intervention, along with 10 autopsy controls. EAT volume was assessed via computed tomography and indexed to body surface area. Furthermore, macrophage infiltration (CD68) and RAGE expression in EAT samples were analyzed using immunohistochemistry and immunofluorescence imaging. Results: EAT volume index was significantly higher in all surgical groups than in the controls (p < 0.001). These surgical groups also had markedly increased CD68- and RAGE-positive cells compared with the controls (p < 0.001), with colocalization detected by means of immunofluorescence imaging. Additionally, the EAT volume index independently and positively correlated with CD68-positive cell counts (p = 0.021), and causal mediation analysis suggested that it promotes CD68-positive macrophage activation through pathways mediated by RAGE-positive cells (p = 0.024). Inflammatory cells did not correlate with AS severity (maximum aortic jet velocity, mean pressure gradient, aortic valve area). Conclusions: EAT in AS exhibits increased macrophage infiltration and RAGE expression. Therefore, the AGEs-RAGE axis may contribute to local inflammatory activity, and EAT can be a potential biomarker and therapeutic target in AS. Full article

At Animals Asia’s Vietnam Bear Rescue Center (VBRC), 40% of the current population has been diagnosed with systemic hypertension. Systemic hypertension lesions have led to fatal consequences in the form of aortic aneurysm and rupture. Historically, veterinarians were only able to diagnose systemic hypertension by identifying validated secondary structural heart and retinal lesions during annual health checks of anesthetized bears. In 2021, the VBRC began training bears for cooperative conscious blood pressure measurements to increase monitoring frequency and expedite the diagnosis of systemic hypertension in affected bears. The objective of this study was to evaluate a noninvasive method of blood pressure measurement in trained, cooperative Asiatic black bears. Indirect blood pressure measurements, using the oscillometric technique, were validated with direct arterial measurements in nine bears (6 male, 3 female, ages 13–22 years) undergoing anesthesia for annual health checks. Eleven trained bears at the VBRC without secondary lesions of systemic hypertension (6 male, 5 female, ages 7–23 years) were used to develop normal systolic ranges for Asiatic black bears using the indirect technique. Mean blood pressure measurements for this group of trained bears (n = 11) were 180.65 +/− 37 mmHg (95% CI: 126–255) systolic. These results suggest that indirect blood pressures may be a useful tool to monitor blood pressure in cooperative conscious bears at the VBRC. Full article

Background/Objectives: In low-resource settings, diagnostic delays and limited specialist access worsen health inequalities, making hypertensive disorders of pregnancy (HDPs) defined by new-onset blood pressure ≥ 140/90 mmHg after 20 weeks of gestation, with or without proteinuria, a major cause of maternal morbidity and mortality. This study evaluated the diagnostic effectiveness of a rural-applicable clinical model for detecting HDPs in a real-world population from Hospital General San Felipe (Tegucigalpa, Honduras). Methods: A cross-sectional diagnostic accuracy study was conducted on 147 consecutive pregnant women in February 2025. Clinical documentation from the initial appointment defined HDP. We modeled HDP risk using penalized logistic regression and common factors such maternal age, gestational age, blood pressure, BMI, primary symptoms, semi-quantitative proteinuria, and medical history. Median imputation was utilized for missing numbers and stratified five-fold cross-validation assessed performance. We assessed AUROC, AUPRC, Brier score, calibration, and operational utility at a data-driven threshold. Results: Of patients, 27.9% (41/147) had HDP. The model had an AUROC of 0.614, AUPRC of 0.461 (cross-validation averages), and Brier score of 0.253. The threshold with the highest F1-score (0.474) had a sensitivity of 0.561, specificity of 0.679, positive predictive value of 0.404, and negative predictive value of 0.800. HDP had higher meaning systolic/diastolic/mean arterial pressure (130.7/82.9/98.9 vs. 120.5/76.1/90.9 mmHg) and ordinal proteinuria (0.59 vs. 0.36 units). Conclusions: The model had moderate but clinically meaningful discriminative performance using low-cost, commonly obtained variables, excellent calibration, and a good negative predictive value for first exclusion. These findings suggest modification of predictors, a larger sample size, and clinical usefulness assessment using decision curves and process outcomes, including quick referral and prophylaxis. This approach aligns with contemporary developments in the 2023–2025 European Society of Cardiology (ESC) and 2024 American Heart Association (AHA) guidelines, which emphasize earlier identification and risk-stratified management of hypertensive disorders during pregnancy as a cornerstone of women’s cardiovascular health. Full article

(1) Background: Early stages of hypertension, including elevated blood pressure and stage 1 hypertension, are known to increase cardiovascular risk and mortality. Exercise is widely recommended for blood pressure management; however, the optimal exercise modality and the underlying vascular mechanisms remain uncertain. (2) Methods: This study investigated the effects of boxing training on clinical and vascular parameters in young adults with elevated blood pressure or stage 1 hypertension. Twenty-four participants (mean age 25.4 ± 4.9 years) were randomly assigned to a boxing training group or a control group. Over six weeks, the intervention group performed boxing training three times per week, consisting of ten three-minute rounds interspersed with one-minute rests, while controls completed flexibility and balance exercises. (3) Results: Boxing training produced significant group-by-time interactions for peripheral and central blood pressure, endothelial function, and carotid artery structure. Reductions were observed in systolic (~16 mmHg) and diastolic (~10 mmHg) blood pressure and in central systolic pressure (~mmHg). Vascular function improved, as indicated by greater brachial and popliteal flow-mediated dilation and increased forearm and calf blood flow, accompanied by enhanced nitric oxide bioavailability and reduced inflammation. (4) Conclusions: These findings suggest that boxing training is an effective and time-efficient exercise modality for improving vascular health and managing early hypertension in young adults. Full article

Balloon pulmonary angioplasty (BPA) has become an established treatment modality for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH), particularly in those with distal pulmonary artery lesions or significant comorbidities precluding pulmonary endarterectomy. BPA provides significant improvement in pulmonary hemodynamics, right ventricular function, exercise tolerance, and quality of life. Recent randomized controlled trials, including the RACE and MR-BPA trials, have demonstrated that BPA results in greater reduction in pulmonary vascular resistance and mean pulmonary arterial pressure compared to riociguat, although with a higher incidence of procedure-related complications. Ancillary follow-up data further suggest that a sequential strategy combining medical therapy and BPA may optimize outcomes and reduce adverse events. Advances in procedural techniques, imaging guidance, and patient selection have substantially improved the safety profile of BPA. International registries and expert consensus guidelines now support its incorporation into the multimodal management of CTEPH. This review synthesizes current evidence on the efficacy, safety, and practical aspects of BPA, while highlighting ongoing challenges, including long-term outcome data, standardization of treatment endpoints, and the role of combination therapy. BPA is poised to play an increasingly central role in personalized care strategies for CTEPH. Full article