Echocardiographic measurements of left ventricular free wall (LVFW) and interventricular septum (IVS) thickness are essential for diagnosing hypertrophic cardiomyopathy (HCM).

To evaluate agreement between different imaging views and modes for assessing LV wall thickness in cats. We hypothesized that there is clinically relevant bias between methods, and that results cannot be used interchangeably.

Two-hundred eighty cats; 140 controls and 140 with subclinical HCM.

Retrospective, single-center, and cross-sectional study. End-diastolic IVS and LVFW thickness was evaluated by 2-dimensional (2D) and time-motion mode (M-mode) echocardiography, from right parasternal long-axis (RPLax) and right parasternal short-axis (RPSax) views: method-1 (M1), RPLax using 2D; M2, RPLax using M-mode; M3, RPSax using 2D; and M4, RPSax using M-mode. Using 2D images, the thickest portion of the LV wall was measured. Methods were compared using repeated measurement ANOVA on ranks and the Bland-Altman method with bias and 95% limits of agreement (95% LOA).

In controls, IVS thickness was not different among the 4 methods (P = .67; bias 0.04-0.10 mm, 95% LOA -1.09 to 1.28 mm); whereas LVFW thickness was (P < .001) using M-mode compared to 2D (bias 0.22-0.30 mm; 95% LOA -0.81 to 1.25 mm). In HCM cats, thickness of the IVS (bias -1.07 to -1.13 mm; 95% LOA -3.05 to 0.84 mm) and LVFW (bias 0.22 to -.27 mm; 95% LOA -2.09 to 2.03 mm) was different among methods (P < .001).

Two-dimensional and M-mode echocardiographic methods in the assessment of LV wall thickness cannot be used interchangeably, particularly in cats with HCM.

Antihypertensive medication use is highly prevalent among older adults, with treatment patterns evolving over time. This study examines trends in antihypertensive medication use in the general population and among treated hypertensive individuals aged 66-79 years, based on two nationwide German population-based surveys conducted in 2008-2011 and 2021-2023. Data were derived from the German Health Interview and Examination Survey for Adults (DEGS1; n = 1733) and the Study on Health of Older People in Germany (Gesundheit 65+; n = 680). Both surveys provide comparable information on antihypertensive drug classes-angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), diuretics, beta-blockers, and others-as well as blood pressure (BP) control (<140/90 mmHg) assessed using standardized oscillometric measurements. The prevalence of antihypertensive medication use in the general population remained relatively stable between 2008-2011 (68.7%) and 2021-2023 (64.5%). However, treatment patterns changed, with decreased use of diuretics and ACE inhibitors and increased use of ARB. Among treated hypertensive individuals, BP control remained largely unchanged at approximately two-thirds (69.1% vs. 63.6%). Notably, there was a shift from single-pill combination therapy toward monotherapy, accompanied by a decline in BP control among women (73.8%-58.0%). Overall, approximately two-thirds of adults aged 66-79 years in Germany use antihypertensive medication. Over the past decade, BP control has not improved among treated hypertensive men and has worsened among women. Furthermore, the use of single-pill combination therapies remains low and has declined among treated hypertensive individuals.

Systemic hypertension (SH) is increasingly recognized in dogs and is associated with aortic valve cusp remodeling. Therefore, the present study was planned with the objective of establishing baseline echocardiographic reference values for aortic cusp diameters in healthy dogs and to evaluate cusp remodeling associated with SH. Echocardiographic measurements were performed in 46 healthy dogs (26 large breed, 20 small-medium breed) and 80 clinically ill dogs, classified according to systolic blood pressure (BP) as normotensive (≤139 mmHg), prehypertensive (140-159 mmHg), hypertensive (160-179 mmHg), or severely hypertensive (≥180 mmHg), with 20 animals in each group. Two-dimensional echocardiography was used to assess left (LAC-d), right (RAC-d), and noncoronary cusp diameters (NCC-d); mean cusp diameter; and aortic root dimensions (diameters at aortic annulus, sinus of Valsalva, sino-tubular junction, and proximal ascending aorta). Cusp asymmetry was determined using an asymmetry index (≥10% variation) and subjective variation (≥2 mm). Hypertensive dogs demonstrated enlargement of all cusps compared with controls, with cusp diameters correlating positively with systolic BP (LAC-d: r = 0.39; RAC-d: r = 0.37; NCC-d: r = 0.33; p < 0.001). The LAC-d and RAC-d exhibited the best diagnostic performance (sensitivity 80%-82.5%, specificity 76.9%-78.6%). Hypertensive dogs also had increased cusp asymmetry, particularly RAC asymmetry in severe hypertension (40% vs. 10.9% in healthy dogs; p = 0.004). Sinus of Valsalva diameter was the strongest predictor of cusp enlargement. Echocardiographic measurement of aortic cusps provides novel reference values for healthy dogs and demonstrates hypertension-associated cusp remodeling. The LAC-d and RAC-d are reliable markers for identifying and monitoring hypertensive cardiac changes.

Prehypertension is defined as blood pressure (BP) between 120-139/80-89 mmHg. It affects around 40% of adults, increasing their risk of developing hypertension and cardiovascular disease-related conditions. The "Risk rEduction interVEntion for Raised blood preSsurE" (REVERSE) feasibility study investigated whether self-monitoring of BP was acceptable and feasible for managing prehypertension. As part of REVERSE, a willingness-to-pay (WTP) analysis assessed the economic value of the BP self-monitoring intervention. A WTP questionnaire asked participants how much and why they would be willing to pay for a BP machine and for additional support and training around BP self-monitoring. The associations between the total WTP amount (for the BP machine plus the additional support and training) and participants' sociodemographic and clinical characteristics were investigated using generalized linear modelling (GLM). WTP data was collected from 66 participants (median age: 58.50 years; females: 59.09%). Most of the participants (72.73%) lived in areas of low socioeconomic deprivation. The median total WTP amount was £41.37 in 2024 prices (interquartile range: £36.20-£93.09). The BP machine functions/facilities, the amount reflecting potential benefit, and being a reasonable value were the most cited reasons behind the valuations. The GLM regression showed that higher WTP values were associated with the functions/facilities and potential benefit of the BP machine. We believe this to be the first study to provide insights around the economic value of BP self-monitoring in prehypertension. Further research based on larger, and more representative, samples is needed to validate these findings. Trial registration number: ISRCTN13649483.

Colonic luminal pH is a fundamental feature of the gut environment, shaped largely by the composition and activity of the gut microbiota. Diets rich in fermentable fiber lower the colonic pH primarily through their microbial fermentation, which produces short-chain fatty acids (SCFAs) as metabolic by-products. While the local effects of colonic pH on microbiota composition and intestinal function are increasingly well defined, its systemic consequences remain poorly understood. This review explores the determinants of colonic pH and its dynamic interactions with the gut microbiota, with a particular focus on how these processes may influence and be influenced by host physiology beyond the gastrointestinal (GI) tract. Since dietary fiber and its acidic metabolites confer protection against hypertension, there is growing interest in whether fiber-induced colonic acidification contributes to blood pressure regulation. Notably, participants with hypertension exhibit a higher (more alkaline) colonic minimum pH compared to those with normal blood pressure, further supporting the potential link between luminal acidity and blood pressure control. Particular attention has been given to proton-sensing G protein-coupled receptors (GPCRs), namely, GPR4, GPR65 and GPR68, which are increasingly implicated in regulating immune and cardiovascular functions. Emerging evidence suggests that gene-environment interactions involving GPR65 and GPR68 may influence blood pressure regulation through pH-sensitive pathways; GPR65 primarily via immune modulation, and GPR68 through vascular mechanisms. Therefore, understanding how colonic pH impacts these pathways may uncover novel therapeutic targets for hypertension.

Neurologists, as specialists in a high-stress field, which hold lots of mental and emotional stressors. The complexity of neurological conditions, the extended working hours, and the emotional burden of managing chronic or terminal patients contributes to a stressful work environment. Globally, studies have shown that healthcare professionals, particularly those in specialties of high demand like neurology, are at risk of depression and burnout. This study aims to assess the prevalence of depressive symptoms among neurologists in Egypt. Help identify the risk factors that contribute to these depressive symptoms. A cross-sectional survey was conducted among Egyptian neurologists working in both public and private healthcare institutions. Participants in the study completed the Patient Health Questionnaire-9 (PHQ-9) to assess the severity of depressive symptoms. Data on demographics, job satisfaction, shift duration, workload and overall job satisfaction were also collected and analyzed using descriptive and inferential statistics. Out of 138 neurologists surveyed, nearly half (43.5%) reported moderate to severe depressive symptoms. Those with a prior diagnosis of depression were especially affected-more than 8 in 10 (82.4%, 95% CI 66.2%-91.7%) reported significant symptoms, compared to just over a third (37.5%, 95% CI 28.8%-47.1%) of those without a known history (p < 0.001). Higher depression scores were also linked to early career stage and longer working hours. Over half of the neurologists with less than three years of experience (53.1%) and those working more than 80 h per week (56.3%) screened positive for moderate to severe depression. These findings highlight a high burden of depressive symptoms among Egyptian neurologists, particularly those early in their careers or with a prior history of depression, emphasizing the urgent need for targeted mental health interventions and systemic workplace reforms.

Dry eye disease (DED) is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles. Affecting up to 60% of individuals worldwide, DED imposes a significant physical, psychosocial, and economic burden. Its diagnosis remains challenging owing to heterogeneous clinical presentations, poor correlation between signs and symptoms, and limited access to advanced diagnostic tools. This study aimed at exploring real-world clinical practices in the diagnosis and management of DED across Europe and Central Asia by gathering experts' perspectives.

A panel of experts comprising 15 specialists from tertiary referral centers across 10 countries convened to discuss diagnostic workflows and treatment strategies for DED.

The consensus emphasized that symptom questionnaires, slit-lamp examination, tear break-up time, and corneal and conjunctival staining represent the cornerstone of diagnosis. Tear osmolarity testing was used less frequently, primarily owing to cost and limited resource availability. Most cases managed in specialized centers were moderate-to-severe, underscoring the need for comprehensive and multidisciplinary evaluation. Treatment practices emphasized a stepwise approach, with first-line therapy comprising conventional measures such as environmental and behavioral modifications, tear substitutes, and lid hygiene. Cyclosporine A (CsA) eye drops were reserved for patients with an insufficient response to first-line therapy or with clinically significant ocular surface inflammation. In these cases, experts indicated that concomitant short-term glucocorticosteroids with CsA may be used initially, followed by CsA monotherapy for long-term disease control. Regular follow-up and patient education were considered essential to support treatment adherence and efficacy. Interdisciplinary collaboration, particularly with rheumatologists and mental health professionals, was regarded as critical for managing systemic comorbidities and addressing psychosocial impacts.

This consensus highlights the value of sharing experts' experience to harmonize care standards and optimize clinical outcomes. Early recognition of ocular surface inflammation, timely initiation of immunomodulatory therapy, and integrated multidisciplinary care are essential for improving patient quality of life across diverse healthcare settings.

Delirium is a severe neuropsychiatric syndrome common in older adults and linked to adverse outcomes, especially when prolonged and in the presence of cognitive deficits. While preventive multicomponent strategies are well established, the effectiveness of interventions for treating delirium in older adults remains unclear.

To evaluate the efficacy of non-pharmacological and pharmacological interventions for treating delirium after onset in older adults (≥65 years), with delirium duration as primary outcome and length of stay as secondary.

We conducted a systematic review and meta-analysis of randomised controlled trials evaluating interventions for treating delirium across settings, excluding ICU-only studies. MEDLINE, Cochrane, Web of Science and PsycINFO were searched through October 2024. Comparators included usual care, placebo or other drug treatments. Random-effects meta-analyses with subgroup analyses by setting and drug type were performed. Sensitivity analyses excluded high risk-of-bias studies. PROSPERO registration: CRD42024500346.

Seventeen trials (3765 randomised patients) were included. Non-pharmacological multicomponent interventions (k = 6, n = 2634) reduced delirium duration by -1.79 days [95% confidence interval (CI): -3.08 to -0.51] compared to usual care, with high heterogeneity (I2 = 97%). Effects were significant in medical and mixed settings. Pharmacological interventions (k = 7, n = 259) showed no significant effect (mean difference: -0.58 days; 95% CI: -1.24 to 0.08), and subgroup analyses revealed no differences. Neither intervention type significantly reduced length of stay.

Non-pharmacological multicomponent interventions may reduce delirium duration in older adults, but evidence is limited by heterogeneity and the few studies focused on treatment. Pharmacological and single-component interventions showed unclear benefit, underscoring the need for more high-quality trials in this population.

Delirium is common in hospitalised older adults and is associated with mortality. Whether this prognostic association varies by baseline cognition is uncertain. We evaluated the association between delirium and 90-day mortality and whether baseline cognitive status modified this relationship.

We conducted a prospective, multicentre cohort study of adults aged ≥65 years admitted to 43 hospitals in five countries (Brazil, Angola, Chile, Colombia and Portugal; June 2022-December 2023). Delirium was assessed using the Confusion Assessment Method; cognitive status was measured using an informant-based Clinical Dementia Rating (CDR). Mortality within 90 days of admission was ascertained from hospital records, structured telephone follow-up by blinded assessors and registry linkage. We used mixed-effects survival models with random intercepts (state/province and study centre) and sequential adjustment for sociodemographic, clinical and hospital-related factors. Effect modification by CDR was examined with stratified analyses.

Among 2556 patients (mean age 79 ± 9 years; 56% women), delirium occurred in 957 (37%). Delirium frequency rose with worsening cognition (CDR 0: 16%; CDR 0.5: 27%; CDR 1: 59%; CDR 2-3: 77%; P < .001). Delirium was associated with higher 90-day mortality (adjusted HR = 3.45; 95% CI = 2.83-4.20). The relative association with mortality was greatest in no dementia and attenuated in moderate-severe dementia. At 90 days, cumulative mortality was 54% with delirium vs. 15% without in CDR 0 (HR = 4.40; 95% CI = 3.15-6.16) and 36% vs. 17% in CDR 2-3 (HR = 2.22; 95% CI = 1.34-3.66). Patients with delirium also experienced more in-hospital complications (nosocomial infection, functional decline and prolonged stay).

Although delirium was more frequent among patients with dementia, its relative association with 90-day mortality was strongest in those with no baseline dementia. The results provide a strong rationale for intervention trials to determine whether delirium prevention and management strategies can reduce mortality, particularly among patients without known dementia.

Smartphone addiction is an emerging behavioral concern among adolescents affecting their well-being. Nurse-led interventions grounded in behavioral theories like the Health Belief Model (HBM) offer promising strategies for prevention and reduction smartphone addcition. This investigation aimed to evaluate the effects of a nurse-led educational intervention, based on the HBM, on reducing smartphone addiction among adolescents.

Randomized controlled trial was conducted with 200 adolescents aged 13-16 in Egypt. Participants were randomly assigned to either study group (n = 100), which received five structured nurse-led educational sessions based on HBM constructs, or a control group (n = 100), which received no additional education beyond the standard curriculum. Data were collected pre- and post-intervention using validated tools (Smartphone Addiction Inventory, knowledge assessments, and HBM-based scales). Statistical analyses included paired t-tests and linear regression.

The intervention group demonstrated a significant decrease in smartphone addiction levels, from 85% at baseline to 32% post-intervention (p < 0.001). All HBM subscale scores (perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy) significantly improved in the intervention group (p < 0.05). Regression analysis identified age, sex, parental education, economic status, and daily smartphone use as significant predictors of addiction risk (p < 0.001).

A nurse-led, HBM-based educational intervention was effective in reducing smartphone addiction, improving adolescents' knowledge and health beliefs. These findings underscore the value of theory-driven, school-based programs in addressing adolescents' digital overuse.

Pediatric nurses are well-positioned to lead preventive educational interventions on smartphone addiction into routine school health services during critical adolescent stage.