The COVID-19 pandemic intensified stress for many couples and families, leading to increased depression symptoms and challenges with coping. This longitudinal study examined on actor- and partner-level dyadic associations between depressive symptoms and trauma coping self-efficacy (TCSE) among 535 heterosexual cisgender couples. Data were collected online across April (N = 535), July (N = 363), and November 2020 (N = 238). Results indicated significant temporal stability and longitudinal associations for both depression and TCSE within partners across time. Higher depression symptoms in one partner were linked to higher symptoms in the other, while greater TCSE was associated with lower depression symptoms in both male and female partners. Notably, lower depression symptoms were also linked with higher TCSE across all time points. Findings highlight the bidirectional nature of mental health and coping in couples during crisis and suggest early interventions may strengthen TCSE may help buffer against depressive symptoms over time.

To explore patterns of D-dimer assay ordering for the diagnosis of pulmonary embolism (PE) and evaluate its clinical usefulness at Dubbo Health Service.

Retrospective audit of patients presenting to Dubbo Health Service between 1 January and 31 December 2024 who underwent D-dimer testing. D-dimer and CTPA ordering patterns were categorised according to their alignment with the guideline-recommended investigation sequence, which informed interpretation of test utilisation in the clinical context.

A total of 245 D-dimer results were included (119 positive, 126 negative). In 79.2% of cases, investigation sequences followed the guideline-recommended order of testing. The diagnostic yield of CTPA among patients who underwent D-dimer testing was 4.9%.

Ordering patterns were broadly consistent with published reports of increasing utilisation of D-dimer testing and CTPA. Discordant pathways most commonly involved positive D-dimer results without subsequent CTPA, or CTPA performed despite a negative D-dimer.

Patterns of D-dimer ordering were variably aligned with guideline-recommended pathways, which may limit the clinical usefulness of the test in some cases. Improved documentation of pre-test probability and targeted education regarding appropriate test selection and interpretation may enhance the integration of D-dimer testing into diagnostic workflows.

This study aimed to evaluate the safety, clinical efficacy, and economic benefits of day-case endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) in a Chinese population, and to compare these indicators between the day-surgery and traditional inpatient models.

This retrospective cohort study enrolled 80 CRS patients who underwent ESS. Patients were divided into a day-case group (n = 36) and an inpatient group (n = 44). Furthermore, perioperative indicators, hospitalization costs, follow-up costs, subjective symptoms (visual analogue scale [VAS] scores), and objective endoscopic findings (Lund-Kennedy scores) were assessed between the two groups over four weeks post-discharge period.

The day-surgery group demonstrated significantly shorter preoperative waiting times (2.97 ± 0.96 hours vs 18.03 ± 4.47 hours, p < 0.001) and hospital stays (0.52 ± 0.18 days vs 3.64 ± 0.90 days, p < 0.001) compared with the inpatient group. Similarly, hospitalization costs were also lower in the day-case group (11,861.56 ± 3024.71 Yuan vs 29,061.75 ± 4603.45 Yuan, p < 0.001, 1 USD = 7.2 CNY). There were no significant differences in surgical duration, Wong-Baker Faces Pain Score, follow-up costs, or the rate of postoperative adverse events between the two groups. Both groups showed significant and comparable improvements in VAS and Lund-Kennedy scores from baseline through four weeks post-discharge.

Day-case endoscopic sinus surgery is comparable to inpatient surgery in terms of short-term safety and clinical improvement, while significantly shortening hospital stay and reducing hospitalization costs. However, given that this study is a retrospective study and may have selection bias, the above results should still be interpreted with caution.

Immunoglobulin (Ig) therapy is the first-line treatment and often the single option for a substantial number of diseases. Still, Ig supply and use have experienced restrictions, aggravated during the COVID-19 pandemic. This study assessed the clinical and economic implications of Ig use under restrictive conditions in neurological diseases and immunodeficiencies in Spain.

Hospitalization cases in neurological disorders and immunodeficiencies in which Ig is the main therapeutic option, identified by ICD-10 codes, were retrieved from the Spanish Minimum Basic Data Set for 2019 and 2022. Comorbidities and outcomes were analyzed along with hospitalization rates and characteristics, like the length of stay (LoS) and costs, among others. Therapeutic plasma exchange (TPE) use was evaluated as the alternative treatment of choice in the conditions analyzed.

In 2022 compared to 2019, hospitalizations due to relapses remained stable in patients with neurological conditions. Comorbidity and complications increased significantly in this group, as well as LoS, mofrtality (p < 0.05 for all), and TPE rates (p = 0.003). These changes were not identified for immunodeficiencies, which only experienced a decrease in hospitalization rates (p < 0.001). Hospital costs increased in both groups (7.97% in neurological conditions and 2.41% in immunodeficiencies).

In a period in which access to Ig may have been limited, neurological patients, but not patients with immunodeficiencies, show an increase in LoS and mortality, as well as an increased TPE. These results suggest that modifying the management strategy of patients with neurological disorders requiring Ig due to restrictive conditions could have negatively impacted their clinical outcomes.

Severe pertussis complicated by refractory hyperleukocytosis poses a critical therapeutic challenge in young infants, particularly when initial exchange transfusion fails to mitigate escalating leukocytosis. We report a 1.5-month-old, 4.3-kg infant with severe pertussis and marked hyperleukocytosis (white blood cell [WBC] count 57.52 × 10⁹/L) unresponsive to conventional exchange transfusion. Paradoxically, WBC count increased to 48.07 × 10⁹/L with lymphocyte count rising to 12.69 × 10⁹/L post-exchange transfusion, necessitating emergency leukapheresis. After leukapheresis, the WBC count decreased to 25.87 × 10⁹/L and lymphocyte count to 4.71 × 10⁹/L; concurrently, peak flow velocity across the pulmonary valve declined from 2.09 to 0.90 m/s, reflecting hemodynamic improvement. With continued supportive care, the infant's WBC count gradually normalized and clinical recovery. This case illustrates that leukapheresis is a viable and effective therapeutic option for infants with severe pertussis complicated by refractory hyperleukocytosis when initial exchange transfusion is ineffective, providing clinical evidence for its use in neonates following unsuccessful exchange transfusion.

HEARTS in the Americas is the largest-scale implementation of the WHO's global initiative, with 33 countries participating, 28 having adopted standardized clinical pathways, and about 10 000 primary healthcare facilities engaged. Despite progress, fragmented care, limited availability of validated blood pressure devices, restricted access to essential medicines, and weak quality assurance systems continue to hinder hypertension control and cardiovascular risk management. In response, PAHO and participating countries co-developed the HEARTS Quality Framework. Grounded in regional implementation, this model synthesizes global evidence and lessons from Latin America and the Caribbean. Co-designed by Ministries of Health, care providers, and international experts, it translates HEARTS strategies into actionable system-level objectives. Clearly defined outcome indicators and implementation targets promote institutionalization, quality improvement, and primary healthcare strengthening- supporting HEARTS scale-up and equitable outcomes. With appropriate contextualization, the HEARTS Quality Framework provides a practical roadmap for countries beyond the Region to advance primary healthcare-based chronic disease care.

Assessing aortic stenosis (AS) haemodynamics under stress may distinguish physiological responses beyond traditional severity metrics.

We aimed to evaluate symptomatic patients with moderate AS and preserved left ventricular ejection fraction (LVEF) using invasive and non-invasive assessments at rest and during stress, hypothesising that the stress aortic valve index (SAVI) would show only modest agreement with echocardiographic parameters of AS severity but would be associated with clinical outcomes.

We prospectively enrolled 52 patients with moderate AS and preserved LVEF but who were symptomatic without an alternative explanation. The SAVI, quantifying the relative reduction in maximal flow, was measured but remained blinded. Comprehensive assessment included echocardiography (at rest, bicycle and dobutamine stress), calcium scoring, and clinical outcomes. Patients were managed according to current standards without knowledge of the SAVI and followed for ≥1 year.

Invasive transvalvular gradient increased from 25±9 mmHg at rest to 42±14 mmHg during dobutamine. The aortic-to-left ventricular pressure ratio declined from 0.82 (interquartile range [IQR] 0.78-0.88) at rest to a SAVI of 0.70 (IQR 0.63-0.79) under stress. Resting aortic valve area (AVA) did not predict stress haemodynamics, underscoring physiological heterogeneity. Notably, 25/52 (48%) of patients demonstrated a SAVI ≤0.70, comparable with a severe AS cohort studied separately. Blinded SAVI scores independently predicted the need for clinical aortic valve (AV) intervention (hazard ratio 5.7; p=0.007), whereas AVA and sex-specific calcium thresholds did not.

Stress haemodynamic assessment in moderate AS unmasks a subgroup, not identified by conventional metrics, who are at significantly higher risk for AV intervention. Patients with abnormal stress physiology despite only moderate AS at rest may benefit from AV intervention, supporting this pilot study as the basis for a future randomised trial.

As transcatheter aortic valve implantation (TAVI) is increasingly used in younger and lower-risk patients, it is important to understand the risk of valve thrombosis in TAVI prostheses and how this may contribute to bioprosthetic valve dysfunction and thromboembolic events. Subclassification of valve thrombosis by incidence or timing is challenged by differences in sensitivity and heterogeneity among the imaging modalities used for its detection. The long-term implications of valve thrombosis - particularly regarding stroke risk and prosthesis longevity - remain uncertain and debated. Current treatment options for valve thrombosis include temporary anticoagulation therapy, thrombolysis, and, in some cases, reintervention. To address these concerns, ongoing research is focused on improving the detection and treatment of valve thrombosis through standardised imaging protocols and the use of intensified antithrombotic regimens that balance the thrombotic and bleeding risks. Prevention of valve thrombosis remains a challenge requiring a better understanding of patient- and procedure-related risk factors. These insights will be essential to individualise antithrombotic therapy and improve prosthesis design. This review outlines current evidence on the mechanisms, prevalence, clinical relevance, and management of TAVI thrombosis and highlights ongoing clinical trials investigating this condition.

BackgroundAcute coronary syndrome (ACS) remains a leading cause of mortality globally. Dual antiplatelet therapy (DAPT) is standard after percutaneous coronary intervention (PCI). While ticagrelor has demonstrated favorable myocardial effects in preclinical studies, limited clinical data compared its impact on left ventricular (LV) remodeling versus clopidogrel.ObjectiveTo evaluate and compare the effect of ticagrelor and clopidogrel on LV remodeling among ACS patients post-PCI.MethodsEligible participants were adults (≥18 years) with confirmed ACS who were prescribed ticagrelor or clopidogrel for at least 3 months after PCI and had complete echocardiographic data at baseline and within one-year follow-up. Patients with missing follow-up imaging, switching between antiplatelets, contraindications to DAPT, or noncompliance were excluded. Echocardiographic parameters-LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV ejection fraction (LVEF)-and B-type natriuretic peptide (BNP) were assessed, and multivariable regression models adjusted for confounders.ResultsA total of 137 patients met criteria (87 on ticagrelor, 50 on clopidogrel). Ticagrelor was associated with an adjusted LVEDV reduction of 8.17 mL compared with clopidogrel (95% CI -15.84 to -0.50; P = .039), an LVESV reduction of 8.09 mL (95% CI -13.88 to -2.29; P = .007), and a greater LVEF improvement of 4.05% (95% CI 2.41-5.70; P < .001). The reduction in BNP was also greater with ticagrelor by 73.56 pg/mL (95% CI -144.08 to -3.05; P = .043).ConclusionTicagrelor was associated with more favorable LV remodeling parameters compared with clopidogrel in this cohort. These findings warrant confirmation in randomized trials.

Patients with mild acute ischemic stroke (AIS) (NIHSS score ≤5) remain at substantial risk for early neurological deterioration (END) and poor functional outcomes despite receiving standard dual antiplatelet therapy (DAPT). Tirofiban, a rapid-onset glycoprotein IIb/IIIa receptor inhibitor, may reduce this risk; however, evidence in patients with mild AIS is limited.

To determine whether administration of intravenous tirofiban for 48 h followed by DAPT improves the proportion of patients with excellent functional outcomes (modified Rankin Scale [mRS] score 0-1) at 90 days compared with administration of DAPT alone in patients with mild noncardioembolic AIS within 48 h of onset.

The TiMIS trial is a prospective, multicenter, open-label, blinded-endpoint (PROBE), randomized controlled study. A total of 688 patients aged 18-80 years with noncardioembolic acute mild ischemic stroke within 48 h of symptom onset will be enrolled across 20 centers in China. Participants are randomized 1:1 to intravenous tirofiban for 48 h sequentially followed by DAPT or DAPT alone. The primary outcome is the proportion of patients with excellent functional outcomes at 90 days. Secondary outcomes include END, changes in the NIHSS score, good functional outcome, mRS score shift, incidence of new ischemic stroke and composite cardiovascular events, and safety endpoints (symptomatic intracerebral hemorrhage, all-cause mortality and severe bleeding events).

This trial provides crucial evidence on whether early intravenous tirofiban with sequential DAPT offers superior benefits over standard care in patients with mild AIS, potentially guiding future antithrombotic strategies.

ClinicalTrials.gov (NCT07095790).