This study aims to examine the effect of COVID-19 history on pre-operative anxiety and intraoperative complications in elective cesarean section patients.

A total of 200 patients undergoing elective cesarean section were divided into two groups based on COVID-19 history: Group C (n = 100, with COVID-19) and Group K (n = 100, without COVID-19). Anxiety was assessed using the state-trait anxiety inventory (STAI) I and II. Vital signs were monitored peroperatively. Intraoperative complications and APGAR scores were recorded.

Pregnant women with a history of COVID-19 had significantly higher state anxiety (STAI-1) scores than those without (p = 0.017). No significant difference in intraoperative or post-operative complications was observed between the groups.

Anxiety levels were higher in pregnant women undergoing elective cesarean sections, especially those with a history of COVID-19. Managing increased anxiety is essential because of its potential effects on maternal and neonatal health outcomes.

Early postoperative seizure after revascularization for moyamoya vasculopathy remains incompletely characterized, particularly in Indonesia. This study described the incidence and exploratory clinical and hemodynamic patterns associated with early postoperative seizure after extracranial-intracranial bypass in an Indonesian single center cohort. This single center retrospective cohort included moyamoya disease (MMD) or moyamoya syndrome (MMS) patients who underwent extracranial-intracranial revascularization. Early postoperative seizure was defined as a clinically documented new onset epileptic event occurring intraoperatively after bypass completion or within 14 days. Clinical and computed tomography perfusion (CTP) variables were compared between MMD and MMS and, within MMS, between seizure and non-seizure groups using descriptive exploratory analyses. Forty patients were analyzed, including 19 with MMD and 21 with MMS. Early postoperative seizure occurred exclusively in the MMS group (6/21, 29%) and was not observed in MMD (0/19; p = 0.021). Compared with MMS, MMD demonstrated larger pre-bypass infarct volume (14.48 ± 8.54 vs. 5.06 ± 5.52 mL; p = 0.005) and hypoperfusion volume (54.39 ± 33.07 vs. 27.26 ± 25.76 mL; p = 0.028). In paired CTP analysis, hypoperfusion volume decreased from 41.48 ± 27.78 to 26.06 ± 21.51 mL (p = 0.023), and infarct volume decreased from 10.27 ± 7.89 to 5.48 ± 4.16 mL (p = 0.040). Within MMS, patients with postoperative seizure were older (52.00 [41.75 to 55.00] vs. 35.00 [26.00 to 42.00] years; p = 0.014), more frequently presented with dysarthria (67% vs. 20%; p = 0.040) and monoparesis (50% vs. 0%; p = 0.015), and were more commonly classified as having suspected atherosclerotic vasculopathy (100% vs. 33.3%; p = 0.012). Follow up CTP demonstrated lower relative post-bypass CBV in the seizure group (0.31 [0.14 to 0.48] vs. 1.16 [0.68 to 1.22]; p = 0.026), although this finding was interpreted cautiously because postoperative imaging was not temporally aligned with seizure onset. In this exploratory Indonesian moyamoya cohort, early postoperative seizures were observed only in the MMS subgroup. Older age, baseline focal neurological deficits, and MMS related etiologic heterogeneity may be relevant to postoperative seizure susceptibility.

Circulatory collapse at hospital arrival represents one of the most severe clinical presentations of ST-segment elevation myocardial infarction (STEMI) and is associated with poor prognosis. Statins exert pleiotropic effects beyond lipid-lowering, including anti-inflammatory, endothelial, microvascular and plaque-stabilising actions which may influence early clinical severity in myocardial infarction. We investigated the association between pre-admission statin therapy and circulatory collapse at hospital arrival in patients with STEMI undergoing primary percutaneous coronary intervention (PCI).

This retrospective single-centre study included 551 consecutive patients with STEMI undergoing primary PCI. Pre-admission statin therapy was defined as continuous statin use for ≥30 days before admission. The primary outcome was circulatory collapse at hospital arrival, defined using an operational definition of advanced haemodynamic compromise before primary PCI. Multivariable logistic regression and sensitivity analyses including propensity score adjustment and inverse probability of treatment weighting were performed.

Circulatory collapse occurred in 77 patients (14.0%) and was less frequent among patients receiving statins than among those not receiving statins (7.5% vs 16.6%, p=0.005). In the primary multivariable model, pre-admission statin therapy was associated with a lower risk of circulatory collapse (adjusted OR 0.23; 95% CI 0.10 to 0.50; p<0.001). This association remained consistent across sensitivity analyses, including exclusion of lactate-based classification without pre-PCI cardiopulmonary arrest or pharmacological/mechanical circulatory support, propensity score adjustment, inverse probability of treatment weighting and additional adjustment for background preventive medications. 30-day mortality did not differ significantly according to pre-admission statin therapy status.

Pre-admission statin therapy was associated with a lower risk of circulatory collapse at hospital arrival in patients with STEMI undergoing primary PCI. These findings suggest that chronic statin therapy may be associated with a less severe early haemodynamic phenotype at STEMI presentation, although residual confounding cannot be excluded.

Cross-sectional psoas muscle area (PMA), measured by computed tomography images, is a surrogate of the muscle mass. We aimed to evaluate the impact of PMA and length of stay (LOS) after complex open abdominal aortic aneurysm repair (OAAAR).

A retrospective review between January 2013 and January 2017 was conducted. The main outcome was to assess the PMA as a predictor of LOS. Demographics and clinical variables were collected, and Spearman's rank coefficient was used to define the correlation of PMA and LOS.

A total of 72 patients were studied with a mean age of 72 (standard deviation ± 10.3) years, and 54 (75%) were males. The median post-operative LOS was 10 (7-14) days; lower PMA was correlated with longer LOS (R = -0.47, p ≤ 0.001). Thirty-six patients (50%) had a PMA < 17 cm², which was associated with greater post-operative 30-day complications (p = 0.004). There was no difference in 30-day mortality between patients with PMA < 17 cm² and those with PMA > 17 cm² (p = 0.147).

Lower PMA was associated with longer LOS and a higher rate of 30-day complications; however, no statistically significant difference was found in mortality.

Quantifying skeletal muscle mass is essential for patients with heart failure; however, common modalities, such as bioelectrical impedance analysis, can be distorted by fluid retention. The total body muscle mass (TBMM), a creatinine-cystatin C-derived marker, has been proposed as a practical blood-based surrogate of muscle mass; however, its relationship with muscle mass and its prognostic value in acute heart failure remain uncertain. Therefore, we aimed to assess whether TBMM is associated with skeletal muscle mass indices in heart failure and postdischarge all-cause mortality in patients hospitalized for acute heart failure.

This single-center retrospective study included patients hospitalized for acute heart failure at Juntendo University Hospital (January 2015-December 2021). TBMM was calculated from body weight, serum creatinine, and cystatin C, and classified using prespecified sex-specific cut-offs (men, < 38.846; women, < 26.476).

Among the 550 patients, 271 had low TBMM. Over a median follow-up of 2.6 years, 134 deaths occurred (low-TBMM, 79; high-TBMM, 55). Patients with low TBMM showed significantly lower survival and a higher risk of postdischarge mortality after adjustment. Findings were consistent across the left ventricular ejection fraction strata (< 50% and ≥ 50%). TBMM correlated strongly with appendicular skeletal muscle mass index, estimated using both anthropometric and biomarker-based models.

In patients hospitalized for acute heart failure, TBMM was strongly correlated with estimated muscle mass and independently associated with postdischarge all-cause mortality. Therefore, TBMM may complement routine risk stratification and help identify patients with heightened vulnerability related to muscle impairment.

How specific physical illnesses differentially contribute to the persistent mortality gap in severe mental illness (including schizophrenia spectrum disorders, bipolar disorder, and major depressive disorder) remains poorly understood. Using a harmonised multi-country design, we aimed to analyse excess mortality across diagnoses and causes of death to identify high-burden and high-inequity mortality patterns to inform public health prioritisation and organisation of care.

In this population-based multi-country cohort study using national health registers, we identified people diagnosed with severe mental illness at age 15-65 years in five European countries (Denmark, Finland, France, Poland, and Sweden) during 2004-23 to establish excess mortality before age 75 years in relation to country-specific general population mortality. We defined cause-specific mortality using ICD-10. Random effects meta-analysis was used to pool mortality estimates representing country-specific relative mortality inequities (sex-standardised and age-standardised mortality ratios), absolute excess burden (sex-standardised and age-standardised death rates per 10 000 person-years), and the severity of premature mortality (potential years-of-life-lost before age 75 years). Subgroup analyses were conducted to test for potential effect modification.

Between Jan 1, 2004, and Dec 31, 2023, there were 4 861 795 people with severe mental illness, and 561 903 deaths from any cause. All-cause mortality was 2·6-fold higher in people with severe mental illness compared with the general population (pooled standardised mortality ratio [SMR] 2·64, 95% CI 2·25-3·11). Absolute excess mortality was highest in cardiovascular disease (schizophrenia spectrum disorders: standardised excess death rate 22·08 per 10 000 person-years, 95% CI 8·77-35·39; bipolar disorder: 8·36 per 10 000 person-years, 2·96-13·75; and major depressive disorder: 9·82 per 10 000 person-years, 3·18-16·45). Relative excess mortality was highest in respiratory diseases (schizophrenia spectrum disorders: SMR 6·49; 95% CI 5·52-7·64; bipolar disorder: 2·72, 2·04-3·63; and major depressive disorder: 3·48, 2·63-4·62), followed by endocrine and metabolic diseases (schizophrenia spectrum disorders: 5·09, 4·29-6·04; bipolar disorder: 2·60, 2·26-2·98; and major depressive disorder: 3·07, 1·84-5·12), and in gastrointestinal diseases (schizophrenia spectrum disorders: 3·47, 2·58-4·67; bipolar disorder: 2·34, 2·00-2·74; and major depressive disorder: 3·48, 2·63-4·62).

The mortality gap was characterised by distinct patterns of absolute excess mortality and relative inequality across causes of death and severe mental illness diagnoses. Considering both dimensions of excess mortality can inform public health priorities that are not apparent from either measure alone or from focusing on cause-specific numbers of deaths. Reducing premature mortality will therefore require an integrated public health approach that combines universal strategies with targeted interventions to address both high-burden causes of death and those characterised by the greatest relative inequalities.

2024 European Partnership on Transforming Health and Care Systems.

ESGE and ESGENA recommend that informed consent for gastrointestinal endoscopic procedures should include consent for sedation and cover best practice as outlined in the ESGE Position Statement for informed consent.Strong recommendation, very low certainty of evidence.

ESGE and ESGENA recommend pre-assessment, a specific sedation regimen, and enhanced periprocedural monitoring in high-risk patients undergoing gastrointestinal procedures with sedation, to reduce the risk of sedation-related adverse events.Strong recommendation, very low certainty of evidence.

ESGE and ESGENA recommend that pre-assessment, sedation regimen, and periprocedural monitoring should be determined by the complexity (duration, invasiveness) of the endoscopic procedure.Strong recommendation, very low certainty of evidence.

ESGE and ESGENA suggest that the management of sedation in patients on glucagon-like peptide-1 receptor agonists should be individualized. Conditional recommendation, very low certainty of evidence.

ESGE and ESGENA suggest offering the option of diagnostic colonoscopy and gastroscopy without sedation, based on the patient's and endoscopist's preference.Conditional recommendation, very low certainty of evidence.

ESGE and ESGENA recommend that sedation should be provided by a dedicated healthcare professional trained in sedation administration and patient monitoring.Strong recommendation, very low certainty of evidence.

ESGE and ESGENA recommend propofol for procedural sedation, as first line, depending on the country's human resources, service framework, and legislation.ESGE and ESGENA recommend midazolam for procedural sedation, in combination with opiates when analgesia is required.Strong recommendation, very low certainty of evidence.

ESGE and ESGENA suggest the provision of the ultrashort-acting sedative remimazolam in elderly patients and patients with cardiovascular and/or respiratory comorbidities.Conditional recommendation, low certainty of evidence.

ESGE and ESGENA suggest exercising caution when combining ultrashort-acting sedatives with other sedatives or analgesics.Conditional recommendation, low certainty of evidence.

ESGE and ESGENA suggest capnography monitoring for patients undergoing sedated gastrointestinal endoscopy who are at higher risk of hypoxemia.Conditional recommendation, very low certainty of evidence.

ESGE and ESGENA recommend that the use of reversal agents should be restricted to managing sedation-analgesia adverse events that do not improve with nonpharmacological intervention.Strong recommendation, very low certainty of evidence.

ESGE and ESGENA recommend that patients be monitored after endoscopy by trained and qualified staff until the return of the patient's baseline observations.Strong recommendation, very low certainty of evidence.

ESGE and ESGENA suggest using scoring systems and standardized discharge checklists to facilitate patient readiness for discharge. Assessments should include a detailed record of vital signs, pain levels, and psychomotor performance.Conditional recommendation, very low certainty of evidence.

ESGE and ESGENA suggest that the performing endoscopist holds the overall medicolegal responsibility for the patient's treatment, including safe recovery, but may delegate the assessment and discharge to trained and qualified personnel based on standardized discharge criteria.Conditional recommendation, very low certainty of evidence.

ESGE and ESGENA recommend that patients receive oral and written information regarding the post-endoscopy period. Contact details should be provided for potential delayed complications, emergencies, or readmission.ESGE and ESGENA recommend that patients undergoing sedated endoscopy have an accompanying person at discharge.Strong recommendation, very low certainty of evidence.

ESGE and ESGENA recommend performing emergency endoscopy under moderate sedation in hemodynamically stable patients. Alternatively, emergency endoscopy without sedation in cooperative patients is feasible.ESGE and ESGENA recommend sedation administration by an anesthesiology specialist in emergency endoscopy in patients at increased risk of aspiration, or with hemodynamic instability or significant comorbidities.Strong recommendation, very low certainty of evidence.

ESGE and ESGENA recommend consultation with anesthetic and obstetric teams involved in the pregnant patient`s care, together with the patient's choice for the appropriateness and choice of sedation during gastrointestinal endoscopy.Strong recommendation, very low certainty of evidence.

ESGE and ESGENA recommend improving and expanding educational offerings on sedation strategies and the principles of airway management, using structured training.Strong recommendation, low certainty of evidence.

ESGE and ESGENA recommend the development and implementation of a quality improvement program with performance indicators to monitor the quality of sedation practices in gastrointestinal endoscopy.Strong recommendation, very low certainty of evidence.

ESGE and ESGENA recommend a rational use of sedatives to reduce the environmental impact of endoscopy.Strong recommendation, moderate certainty of evidence.

The tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio is a noninvasive surrogate of right ventricular-pulmonary arterial coupling. Previous evidence focused mainly on in-hospital, 90-day, or 1-year outcomes; long-term prognostic value across heart failure phenotypes remains unclear.

This cohort included 440 chronic heart failure patients admitted between 2019 and 2021. Median age was 67 years; 31.1% were female; median follow-up was 41 months. Restricted cubic spline analysis assessed association between TAPSE/PASP and major adverse cardiovascular events (MACEs), defined as all-cause mortality, nonfatal myocardial infarction, nonfatal stroke, or heart failure rehospitalization. Kaplan-Meier and multivariable Cox regression analyses evaluated associations. Incremental value was assessed using C-statistics, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

During follow-up, 193 patients experienced MACEs. TAPSE/PASP showed an approximately linear inverse association with MACE risk, with an exploratory cut-off of 0.036. After adjustment including natriuretic peptides, each 0.01-unit increase in TAPSE/PASP was associated with lower MACE risk (HR 0.75, 95% CI 0.66-0.87; p = 6.02 × 10^-5), whereas TAPSE/PASP ≤0.036 was associated with higher risk (HR 1.98, 95% CI 1.37-2.85; p = 2.57 × 10^-4). Adding TAPSE/PASP modestly improved discrimination (C-statistic 0.80 vs. 0.77), reclassification (NRI 0.31), and IDI (0.04) (all p < 0.05). Associations were consistent across prespecified subgroups.

In chronic heart failure patients, lower TAPSE/PASP was independently associated with long-term MACE risk across LVEF-defined phenotypes. TAPSE/PASP may provide complementary prognostic information, but its clinical utility requires prospective external validation.

To synthesize qualitative evidence on factors influencing patients' participation in cardiac rehabilitation after a first acute myocardial infarction.

A search of eight databases was conducted from inception to May 2026. Included studies were quality assessed using JBI criteria, and findings were synthesized using a hybrid approach that combined meta-aggregation for data extraction with thematic synthesis for interpretive analysis.

The synthesis of 9 qualitative studies yielded 33 synthesized findings. These findings were organized into three key themes: (1) the complex process of identity transformation following a first acute myocardial infarction (2) the dynamic interaction between motivators and barriers affecting participation in cardiac rehabilitation and (3) the fundamental importance of support systems in shaping patient experiences.

Participation in cardiac rehabilitation among patients experiencing their first acute myocardial infarction is influenced by multiple factors. To enhance engagement, clinical healthcare providers should address identity disruption, strengthen intrinsic motivation, and facilitate peer and family support through tailored, multidisciplinary, and psychosocially integrated strategies.

Structured exercise is a key component of cardiac rehabilitation (CR) for patients with heart failure (HF), but access to center-based cardiac rehabilitation (CBCR) is often limited. Mobile health (mHealth) platforms enable remote, virtual, or hybrid cardiac rehabilitation (RVH-CR) delivery.

This study aimed to evaluate the effectiveness and safety of structured, exercise-focused RVH-CR supported by mHealth compared with usual care or CBCR in patients with heart failure with reduced ejection fraction (HFrEF) or in HF populations predominantly comprising patients with HFrEF.

We searched PubMed, Web of Science, MEDLINE via Ovid, Cochrane CENTRAL, and CINAHL Complete from inception to April 27, 2026. Randomized controlled trials comparing mHealth-supported RVH-CR with usual care or CBCR were included. The primary outcome was exercise capacity, assessed by peak oxygen uptake (VO2 peak) and 6-minute walk distance (6MWD). Secondary outcomes included health-related quality of life and safety. Data were pooled using random-effects meta-analysis stratified by comparator. Risk of bias was assessed with the Cochrane Risk of Bias Tool version 2, and evidence certainty was evaluated using GRADE (Grading of Recommendations Assessment, Development, and Evaluation).

Eight randomized controlled trials with 1368 patients were included. In the CBCR comparison, mHealth-supported RVH-CR showed a statistically significant greater improvement in VO2 peak than CBCR (mean difference [MD] 0.82, 95% CI 0.06-1.57; P=.03), although this finding was based on a limited number of trials. Compared with usual care, mHealth-supported RVH-CR was associated with improved 6MWD (MD 22.99, 95% CI 1.15-44.82; P=.04). Single-trial estimates suggested improvements in VO2 peak (MD 2.50, 95% CI 0.88-4.12) and Minnesota Living with Heart Failure Questionnaire scores (standardized MD -0.57, 95% CI -0.98 to -0.17; P<.01) versus usual care. The certainty of evidence ranged from low to moderate. No intervention-related deaths or serious adverse events were reported, but sparse events and short follow-up limited conclusions regarding safety.

The effects of structured RVH-CR supported by mHealth differed according to comparator type, but the certainty of evidence ranged from low to moderate. Compared with usual care, mHealth-supported RVH-CR was associated with improved 6MWD. Compared with CBCR, mHealth-supported RVH-CR showed a significantly greater improvement in VO2 peak in a limited number of trials, but superiority, equivalence, or noninferiority to CBCR cannot be concluded. Because usual care and CBCR are clinically distinct comparators, no single overall effect across comparator types should be inferred. Future studies should assess long-term outcomes and standardize structured exercise protocols across RVH-CR models.