Venous leg ulcers (VLUs) are often accompanied by chronic pain, which is frequently managed through pharmacological treatments, including opioids, which can have undesirable effects and complications. Recent evidence advocates for the integration of non-pharmacological therapies to improve pain management and patient outcomes.

This study reviewed the literature for non-pharmacological interventions to manage chronic pain in individuals affected by VLUs.

An integrative literature review enabled inclusion and integration of diverse study methodologies. Studies were critically appraised.

16 studies met the eligibility criteria; eight were appraised as methodologically moderate, two as strong and six as weak. Non-pharmacological interventions included electrical stimulation therapy, compression therapy, social and peer support, virtual reality, light therapy, music therapy, aromatherapy and traditional Chinese medicine.

Effective non-pharmacological therapies for managing chronic pain in VLUs exist and these can improve quality of life and overall wellbeing. Compression bandaging, electrical stimulation and virtual reality are the most effective and feasible for implementation. Research that adopts complex study methodologies would be most appropriate to evaluate the complexity of VLU care and provide a higher quality evidence base on which to expand and better support a holistic approach to VLU pain management.

Ethnic disparities in stroke incidence and recurrence are well-known but there is conflicting evidence regarding post-stroke care and recovery. In the UK, stroke-survivors are recommended a six-month specialist review but fewer than half receive this review, potentially exacerbating health inequities. Using data from the Sentinel Stroke National Audit Programme (SSNAP) from inception to August 2023 across four regions in England with varying ethnicity profiles we conducted a retrospective descriptive analysis to assess ethnic differences in six-month care and outcomes for stroke-survivors. A total of 80,413 (26.2%) stroke-survivors attended their 6-month review (whites: 26.5%, Black patients: 27.9%; Asian patients: 26.1%; Mixed patient: 27.6%; other: 23.5% other; unknown: 23.1%) with a higher proportion of reviews taking place via telephone for Black and Asian patients (X = 955.7, p = 0.001). After adjustment, non-White patients were significantly more likely to be followed up at 6 months (Black patients OR 1.29 (95%CI 1.21-1.38), Asian patients OR 1.10 (95% CI: 1.04-1.15). The odds of having a further stroke (Black OR 1.49 (95% CI: 1.21-1.84), Asian OR 1.25 (95% CI 1.03-1.52)) or other illness requiring hospital readmission (Black OR 1.25 (95% CI: 1.12-1.40), Asian OR 1.15 (1.05-1.27)) were significantly higher in Black and Asian patients following adjustment for age and stroke severity. At six months lipid therapy was significantly lower in Black patients (OR 0.79 (95% CI: 0.72-0.87)). Black and Asian stroke-survivors experience worse outcomes and lower use of secondary prevention despite similar clinic attendance. Culturally sensitive interventions are needed to reduce post-stroke complications.

Left ventricular (LV) global longitudinal strain (GLS) and left atrial reservoir strain (LASr) are established predictors of adverse outcomes in heart failure with reduced ejection fraction (HFrEF), but the prognostic value of their combined assessment has not been fully elucidated.

This retrospective study included 341 patients hospitalized with decompensated HFrEF who underwent speckle-tracking echocardiography for assessment of LV GLS and LASr. Receiver operating characteristic (ROC) analysis with Youden index optimization was applied to determine optimal strain cutoff values and develop a combined strain classification model. Cox proportional hazards models were used to identify parameters associated with all-cause mortality. LV GLS was analyzed using absolute values.

During a median follow-up of 59 months, 238 patients (70%) died. In univariable analysis, both LV GLS and LASr were associated with mortality. After multivariable adjustment, both remained independently associated with mortality (GLS: adjusted HR 0.945, 95% CI 0.902-0.991, p = 0.019; LASr: adjusted HR 0.972, 95% CI 0.953-0.992, p = 0.006). ROC analysis identified optimal cutoff values of 7.3% for LV GLS and 9.0% for LASr. Patients with concomitant marked impairment of both strain parameters exhibited the highest mortality risk, whereas those with the least impaired ventricular and atrial strain had the most favorable outcomes. Patients with pronounced impairment of either parameter alone demonstrated intermediate survival.

In patients hospitalized with HFrEF, both LV GLS and LASr were independently associated with all-cause mortality. Their combined assessment may identify distinct risk phenotypes and provide enhanced risk stratification beyond either parameter alone.

Chronic viral infections are ubiquitous in humans, with individuals carrying multiple viruses that can reactivate during physiological stress, including severe illness¹. Notably, SARS-CoV-2 infection has been shown to reactivate chronic viruses such as Epstein-Barr virus and cytomegalovirus, yet the full extent, temporal dynamics and immunological impact of viral reactivation in COVID-19 remain incompletely understood^2-7. Here, leveraging multi-omic longitudinal data from 1,154 hospitalized patients with COVID-19 from the Immunophenotyping Assessment in a COVID-19 Cohort (IMPACC) study, we reveal significant reactivation of Herpesviridae and Anelloviridae during acute COVID-19, with distinct temporal dynamics for different viruses, and demonstrate that reactivation correlates with disease severity, host immune effects and clinical outcomes. Although our results do not establish causation between virus reactivation and clinical outcomes, we highlight the prevalence of chronic viral reactivation during acute COVID-19 and long COVID. Our findings challenge the prevailing view that chronic viral reactivation is primarily a consequence of immunosuppression, demonstrating that reactivations occur frequently in immunocompetent individuals during severe illness and in association with increased systemic inflammation. Additionally, we demonstrate persistence of viral reactivation in convalescence, and report an association of Anelloviridae with long COVID. This study provides immune, transcriptomic and metabolomic signatures of viral reactivation that could inform future strategies to prognosticate and treat acute COVID-19 and long COVID.

Previous meta-analyses have suggested that intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) reduces the risk of adverse outcomes compared with angiography-guided PCI in patients with coronary artery disease. However, several large-scale randomized controlled trials published recently have provided new evidence, necessitating an updated evaluation.

This updated meta-analysis aimed to compare the clinical effects of IVUS-guided PCI versus angiography-guided PCI in patients with complex coronary artery lesions.

Randomized controlled trials (RCTs) comparing IVUS-guided PCI with angiography-guided PCI in patients with complex coronary anatomy were systematically searched in PubMed/MEDLINE, EMBASE, and the Cochrane Library. A random-effects model was used to calculate risk ratios (RRs) with 95% confidence intervals (CIs). Sensitivity analyses and publication bias assessments were performed. The primary outcome was cardiac death. Secondary outcomes included all-cause death, myocardial infarction, stent thrombosis, any repeat revascularization, target lesion revascularization, and target vessel revascularization.

A total of 12 RCTs comprising 7089 patients were included, with a weighted mean follow-up of 18.0 months (range 12-24 months). Compared with angiography-guided PCI, IVUS-guided PCI was not associated with significant reductions in cardiac death (RR 1.02, 95% CI 0.76-1.38, P = 0.870), all-cause death (RR 0.97, 95% CI 0.77-1.22, P = 0.800), or myocardial infarction (RR 0.90, 95% CI 0.71-1.15, P = 0.370). However, IVUS guidance significantly reduced definite stent thrombosis (RR 0.31, 95% CI 0.12-0.77, P = 0.010), any repeat revascularization (RR 0.67, 95% CI 0.51-0.88, P = 0.007), target lesion revascularization (RR 0.73, 95% CI 0.55-0.97, P = 0.031), and target vessel revascularization (RR 0.70, 95% CI 0.52-0.95, P = 0.039). These revascularization benefits were attenuated and no longer statistically significant after trim-and-fill adjustment for potential publication bias.

In patients undergoing PCI for complex coronary artery lesions, IVUS-guided PCI did not reduce the incidence of cardiac death, all-cause death, or myocardial infarction compared with angiography-guided PCI. It was, however, associated with lower rates of definite stent thrombosis and repeat revascularization, although these benefits were sensitive to potential publication bias and largely driven by contemporary trials. These results support the selective use of IVUS-guidance for treatment of complex coronary lesions and call for further studies to optimize its use.

Occlusion of the culprit artery (OCA) is observed in a substantial proportion of non-ST-segment elevation myocardial infarction (NSTEMI) patients, showing a poor clinical prognosis. NSTEMI management remains challenging, potentially due to pathophysiological mechanisms across different clinical phenotypes. This study investigated the morphological features of culprit plaque in NSTEMI with vs. without OCA.

In all, 324 NSTEMI patients who underwent optical coherence tomography (OCT) imaging were enrolled in this study. Patients were divided into an OCA group (n=105; 32.4%) and a non-OCA group (n=219; 67.6%). Compared with the non-OCA group, the OCA group had significantly higher rates of plaque rupture (67.6% vs. 42.5%; P<0.001), lipid-rich plaque (81.0% vs. 67.1%; P=0.01), thin-cap fibroatheroma (48.6% vs. 25.1%; P<0.001), thrombus (88.6% vs. 66.7%; P<0.001), macrophage accumulation (92.4% vs. 76.7%; P<0.001), and cholesterol crystals (48.6% vs. 27.4%; P<0.001) on OCT. Symptom-to-catheter time was found to be an independent predictor of 2-year major adverse cardiovascular events for OCA patients.

The underlying plaque morphologies were different between OCA and non-OCA patients. The OCA had a higher rate of plaque rupture, with more features (e.g., lipid-rich plaque, thin-cap fibroatheroma, thrombus, macrophage accumulation, cholesterol crystals) resembling ST-elevation myocardial infarction-like plaques. Symptom-to-catheter time was an independent predictor of major adverse cardiovascular events in the OCA group.

The international burden of neonatal brain injury (NBI) remains significant with enormous potential for therapeutic intervention. Recent large trials have demonstrated no neuroprotection with either erythropoietin or darbepoetin for term or pre-term brain injury. Neuroprotective strategies with strong evidence are currently limited to antenatal steroids, antenatal magnesium, and supportive care for pre-term NBI and therapeutic hypothermia for term hypoxic-ischemic encephalopathy. Of the pharmacologic strategies currently being investigated clinically, the agents with the highest likelihood of success and closest to clinical implementation include melatonin, topiramate, and stem cell-based therapies. More therapies to prevent or treat NBI are urgently needed.

This overview provides a summary of the commonly used vasoactive agents and the various clinical scenarios in which they are used in the neonatal intensive care unit (NICU). The lack of well-designed clinical trials in this vulnerable population means that these agents continue to be administered without sufficient evidence-based knowledge on their dosing, safety, efficacy and long-term effects. The lack of age appropriate cardiotonic formulations remains an ongoing challenge. Future trials of cardiotonic drugs need to incorporate echocardiography and other objective monitoring tools in their design with robust assessments of short and longer-term outcomes.

Hypertensive disorders affect 15% of US pregnancies, significantly contributing to maternal and neonatal morbidity. This paper explores the profound hemodynamic adaptations of pregnancy and how their failure leads to conditions like preeclampsia and gestational hypertension. Diagnosis relies on blood pressure thresholds (≥140/90 mm Hg), with management focusing on preventing severe sequelae. Labetalol and nifedipine are established as first-line treatments due to their safety and efficacy, while angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are strictly contraindicated due to fetotoxicity. Low-dose aspirin is recommended for high-risk patients. Ultimately, early recognition and evidence-based pharmacologic intervention are critical for improving obstetric outcomes.

The risk of venous thromboembolism following major trauma is high without pharmacologic prophylaxis. The timing of initiation is controversial. It can be delayed, interrupted for procedures, or never initiated due to concern for bleeding from injury sites. Current evidence supports initiation of pharmacologic prophylaxis within 24 hours of admission to reduce the risk of venous thromboembolism. Initiation within 24 hours of admission appears to be safe with low risk of bleeding from injuries, including progression of intracranial hemorrhage.