Ministries of health need to know and understand factors affecting medical treatment choices of population subgroups, to tailor official recommendations. This study aimed to identify, quantify and compare treatments used by patients with an acute respiratory infection with and without COVID-19 during the first year of the pandemic by accounting for important factors potentially affecting treatment outcomes. With an online questionnaire, retrospective information on treatments used during events of acute respiratory infections were gathered in Italy. Logistic regression was used to detect significant associations between treatments and a set of variables including socio-demographic data, comorbidities and risk factors. We explored differences in treatments used by subjects who developed symptoms of an acute respiratory infection, with and without COVID-19. Women generally took more treatments than men for both, common acute respiratory infections and COVID-19, although, for the latter condition the gender difference in the average number of treatments was smaller. Painkillers (incl. NSAIDs) followed by antibiotics were the most frequently used drugs by both disease groups while the use of macrolide antibiotics and steroids were typical for the COVID group. Logistic regression models for COVID-19 treatments showed significant positive associations between women and the use of food supplements, depression severity and the use of ibuprofen, as well as between both, age class 50-64 and cardiovascular pre-conditions with macrolide antibiotics. COVID-19 patients were largely following official recommendations issued by the Italian Ministry of Health, using less complementary and alternative medicines when compared to common acute respiratory infections. Particularly, official recommendations suggesting the use of allegedly anti-inflammatory macrolide antibiotics for COVID-19 seem to have been followed for patients with cardiovascular pre-conditions. Considering that macrolide antibiotics augment the risk for cardiovascular death and that cardiovascular diseases are known to be a risk factor for COVID-19 related death, treating COVID-19 patients with macrolide antibiotics was probably not a great idea.

Adjuvant intralesional administration of bevacizumab has shown promising effects in the management of recurrent respiratory papillomatosis (RRP). However, the optimal therapeutic parameters remain undefined. This prospective study aimed to compare the efficacy of two distinct intralesional bevacizumab administration protocols following surgical resection of RRP.

Between 15/09/2023 and 31/12/2024, adult patients with RRP were enrolled in a prospective research study. Participants were allocated to one of two bevacizumab administration protocols, delivered intralesional during direct microlaryngoscopy and CO₂ laser excision. Disease severity was assessed using the Derkay, Dikkers and Numerical scoring systems, as well as the Voice Handicap Index (VHI), at baseline and at 8-week intervals.

Both treatment regimens were associated with reduction in disease burden and improved voice outcomes. No statistically significant differences in disease control were observed between the two administration protocols.

This study indicates that both dosing regimens of bevacizumab were effective as an adjunctive therapy of recurrent respiratory papillomatosis. The higher intralesional doses of bevacizumab are relatively safe and well tolerated in adult patients with laryngeal RRP. Further studies with extended follow-up are warranted to define long-term efficacy and optimal dosing strategies.

Long COVID-19 is a medical condition associated with persistent physical, cognitive, and emotional symptoms. Despite its significant impact, there are still few psychological interventions-especially with transdiagnostic approaches- that have been rigorously tested in this population. The aim of the present protocol is to describe a randomized controlled trial to examine the effectiveness and acceptability of the online, group-delivered Unified Protocol (UP) for improving emotional, and cognitive outcomes in adults with long COVID-19. We expect greater improvements in emotional and cognitive outcomes for the UP group compared to controls. Additionally, exploratory analyses will assess changes in neurocognitive performance and hair cortisol/cortisone levels as potential correlates of treatment response.

90 individuals diagnosed with long COVID-19 will be randomized to an experimental group or a waiting-list control group (1:1 ratio). Participants in the experimental group will receive the UP across 12 online group sessions. Longitudinal assessments (pre-treatment, post-treatment and 3, 6 and 12 months follow-ups) will include psychological (e.g., anxiety and depressive symptoms) and cognitive outcomes (e.g., memory failures). Participants in the experimental group will also complete neuropsychological tests and will provide hair samples for the assessment of cortisol/cortisone levels.

Baseline characteristics will be described using descriptive statistics, and linear mixed-effects models will evaluate the effects of time, group, and their interaction on psychological and cognitive outcomes. Neuropsychological performance and hair cortisol levels will be analyzed over time in the experimental group. Associations between cortisol and psychological or cognitive measures will be explored through correlational analyses.

We expect positive outcomes after the intervention in acceptability and in emotional symptoms and cognitive complaints in individuals living with long COVID-19, the maintenance of the benefits in all follow-ups, and statistically significant changes in favor of the UP condition in comparison with the waiting-list control group. If effective, the UP could provide an accessible and evidence-based psychological treatment for this population, improving the quality of healthcare to individuals with long COVID-19.

clinicatrials.gov (registration identifier: NCT06928480; May 22, 2025).

Despite the lack of data from randomized controlled trials, studies have indicated that labor anesthesia may be associated with neonatal asphyxia, neonatal respiratory distress and adverse neonatal neurological outcomes. Therefore, we performed a two-sample Mendelian randomization analysis to explore the potential causal relationships between labor anesthesia methods and adverse neonatal outcomes.

We collected genome-wide association study (GWAS) data, including on spinal (n = 3,780), epidural (n = 3,970), and other labor anesthesia methods (n = 4,094), as well as neonatal asphyxia (n = 499,936), neonatal respiratory distress (NRDS) (n = 499,974) and cerebral palsy (n = 496,311), attention-deficit hyperactivity disorder (ADHD) (n = 495,160), and intellectual disability (n = 363,663). Data on different delivery analgesia methods that were sourced from the Integrative Epidemiology Unit (IEU) OpenGWAS project were used as exposure data. Neonatal asphyxia, neonatal respiratory distress and neurological adverse outcomes sourced from the FinnGen consortium R12 were used as the outcome data. A two-sample MR was used to evaluate the effects of different delivery analgesia methods on neonatal asphyxia, neonatal respiratory distress and three adverse neurological outcomes in newborns to determine the existence of a causal relationship between them. The inverse-variance weighted (IVW) method was used for MR analysis and a series of sensitivity analyses were conducted. The MR-Egger intercept test was used to assess directional horizontal pleiotropy. Heterogeneity was evaluated using the Cochran's Q statistic. Instrument strength was assessed using F-statistics, with values greater than 10 indicating a low risk of weak instrument bias.

Spinal, epidural, and other methods of labor anesthesia were not found to be strongly associated with neonatal asphyxia (OR = 0.707, 95% CI = 0.176-2.832, p = 0.624; OR = 3.222, 95% CI = 0.973-10.664, p = 0.055; OR = 0.732, 95% CI = 0.166-3.230, p = 0.681, respectively), NRDS (OR = 0.941, 95% CI = 0.381-2.321, p = 0.894; OR = 1.116, 95% CI = 0.505-2.465, p = 0.786; OR = 0.801, 95% CI = 0.329-1.950, p = 0.624), cerebral palsy (OR = 0.930, 95% CI = 0.442-1.959, p = 0.849; OR = 0.636, 95% CI = 0.318-1.271, p = 0.200; OR = 1.112, 95% CI = 0.544-2.271, p = 0.771, respectively), intellectual disability (OR = 1.586, 95% CI = 0.917-2.743, p = 0.099; OR = 0.809, 95% CI = 0.454-1.440, p = 0.471; OR = 0.774, 95% CI = 0.380-1.575, p = 0.479, respectively), or attention deficit hyperactivity disorder (OR = 0.827, 95% CI = 0.621-1.102, p = 0.195; OR = 0.998, 95% CI = 0.739-1.346, p = 0.988; OR = 1.136, 95% CI = 0.771-1.673, p = 0.519, respectively). The sensitivity analyses, performed with Cochran's Q test and the MR-Egger intercept, showed little evidence of substantial heterogeneity or directional horizontal pleiotropy.

Our MR study based on genetic data does not support the existence of a causal relationship between different labor anesthesia methods and neonatal asphyxia, neonatal respiratory distress or adverse neonatal neurological outcomes. Thus, labor pain relief methods can be selected based on the mother's needs and condition without increasing associated risks.

Engagement in a variety of lifestyle activities, such as intellectual stimulation, social interaction, and physical exercise, is thought to be a key contributor to cognitive reserve, helping the brain compensate for age-related or pathological changes. An open question is whether restrictions on lifestyle activities, even if relatively brief, might have detrimental effects on cognition. The COVID-19 pandemic led to unprecedented restrictions on the kinds of lifestyle activities that have been shown to be protective against age-related cognitive decline. In the present study, we captured changes in lifestyle and memory of older adults across the pandemic. Long-term memory was assessed using a task which allows for the estimation of both retrieval success and memory precision, the latter being particularly sensitive to age-related changes. Memory was assessed before the pandemic in person, and during the pandemic using an online version of the task. Experiment 1 first verified that younger adults' performance did not significantly differ between testing environments, validating pre- and post-pandemic comparison in older adults. Experiment 2 then demonstrated that while substantial declines in lifestyle engagement were observed during the pandemic in older adults, there was no significant correlation between these lifestyle changes and memory performance overall. However, when modelling retrieval success, lifestyle effects varied with dementia risk, consistent with cognitive reserve theory, as well as varying with depression. These findings highlight how different memory features are impacted by factors such as lifestyle, and support the proposal that heightened dementia risk may increase susceptibility to the impact of lifestyle changes.

There are wide inequalities in access to cardiovascular care, and risk factors such as obesity, high blood pressure, and physical inactivity are often not well managed. We aim to identify the most important questions about how digital technologies can help people and their carers prevent cardiovascular disease and improve access to care.

A priority setting partnership that aimed to generate a top 10 list of research priorities for the use of digital technology in the prevention and management of heart disease and heart conditions in the UK and Ireland, with equal input by people with lived experience and healthcare professionals. James Lind Alliance methodology was used. An initial open survey gathered research ideas, which were filtered, categorized into summary questions, and then checked against existing literature. An interim survey asked respondents to select up to 10 questions that they considered most important. The top 20 ranked questions were discussed at a final workshop. Ninety-nine respondents (62.2% with lived experience) submitted 422 questions. After removal of out-of-scope uncertainties and the creation of unanswered summary questions, 42 uncertainties were ranked by 133 respondents (73.7% with lived experience). The top 10 questions were agreed at the final workshop, and the top three were: How can technology help people to prevent and manage a heart problem if they have one? How can technology give individualised support to help people manage their heart health? and How accurate and reliable is technology to measure and manage heart health and heart risk factors?

Future funding should be directed towards research questions identified by patients and healthcare professionals.

Patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) often have cardiovascular comorbidities, including acute coronary syndrome (ACS) and coronary artery disease (CAD).

At baseline, 9% of patients had a history of ACS and this was associated with increased risk of adverse outcomes, while this was not the case for obstructive CAD without ACS. Further prospective studies are needed to corroborate these findings.

Ischemic heart disease (IHD) remains a leading cause of illness and death worldwide, posing a significant global health challenge. This study aims to examine the global impact of IHD over the past three decades, analyze regional and sociodemographic disparities, and predict future trends from 2022 to 2036.

Data from the GBD 2021 covering 371 diseases across 204 countries were analyzed. Regions were categorized based on the Sociodemographic Index (SDI) and disability-adjusted life years (DALYs). Future projections were made using an autoregressive integrated moving average model.

From 1990 to 2021, the global IHD incidence more than doubled, increasing by 102%, reaching 31.87 million cases in 2021. Women experienced a faster increase (106%) than men (98%). Men represented 56.35% of cases, while women accounted for 43.65%. The highest incidence was observed in individuals aged 50-69 years, with age-standardized incidence rates of 372.90 per 100 000, higher in men (450.39) than women (301.5). IHD-related deaths in 2021 totaled 8.99 million, a 68% increase since 1990, with men accounting for 55.64%. Global DALYs were 188.36 million, with men contributing 61.04%. Regional disparities were notable, with the Middle SDI region seeing the highest growth in IHD burden. Future projections indicate a 0.30-fold increase in IHD incidence from 2022 to 2036, with more pronounced growth in women.

IHD remains a major global health issue, with increasing rates in low-income and middle-income countries. Targeted interventions focused on prevention, early detection, and management, particularly for women and older populations, are essential to addressing this growing burden.

Despite device improvements for transcatheter aortic valve replacement (TAVR) and increased operator expertise, unfavorable aortic root anatomy might subtend worse procedural and clinical outcomes. The aim of the study is to assess procedural and clinical outcomes of transfemoral TAVR in patients with and without unfavorable aortic root anatomy and receiving Evolut PRO/PRO+ or SAPIEN 3 Ultra devices in contemporary clinical practice.

Patients enrolled in the multicenter OPERA-TAVI registry were considered. Patients were compared using propensity score matching according to the presence or absence of unfavorable anatomical characteristics of the aortic root [bicuspid aortic valve (BAV), moderate-to-severe left ventricular outflow tract calcifications, horizontal aorta]. Primary endpoints were Valve Academic Research Consortium (VARC)-3 device success and early safety. The secondary endpoint was a composite of 1-year all-cause death, disabling stroke and heart failure rehospitalization.

Among a total of 1815 patients, 629 patients (34.7%) had at least one unfavorable characteristic. After adjustment, 624 matched pairs of patients were compared.VARC-3 device success (85.3% vs. 92.0%, P < 0.001) and early safety (72.9% vs. 79.6%, P = 0.006) were lower in patients with unfavorable characteristics. The secondary composite endpoint was higher in patients with unfavorable anatomical characteristics (Kaplan-Meier estimates 15.3 vs. 12.0%; Plogrank = 0.019). Among patients with unfavorable anatomical characteristics, BAV alone was associated with early safety [odds ratio 2.15, 95% confidence interval 1.04-4.70, P = 0.05].

Patients undergoing transfemoral TAVR had lower rates of device success and early safety in the presence of unfavorable anatomical characteristics, along with worse 1-year clinical outcomes. However, BAV was associated with higher early safety in this context.

Given the aging of population in western countries, nonagenarians have been increasing. Subsequently, the number of nonagenarians affected by severe aortic stenosis and requiring transcatheter aortic valve replacement (TAVR) is expected to increase. Next-day discharge (NDD) after TAVR has been explored in several studies, demonstrating its feasibility and safety but no data in elder populations have been reported so far.

The aim of this study was to evaluate the safety of NDD following TAVR in nonagenarians. From November 2011 to May 2024, a total of 104 nonagenarian patients underwent transfemoral TAVR at our institution and 32 of them (31.7%) were discharged the day after the index procedure. NDD patients were compared to patients discharged later. The primary endpoints were device success and early safety according to Valve Academic Research Consortium-3 (VARC-3) criteria.

After propensity score matching, 29 well balanced pairs of patients were selected. At 30 days, NDD patients showed a higher early safety (93.1% vs. 69.0%; P = 0.04) and similar device success compared to those discharged later (89.7% vs. 100%; P = 0.48). No differences in all-cause death (3.4% vs. 17.2%; P = 0.20) and rehospitalization (13.8% vs. 13.8%; P = 1.00) were reported in NDD and no-NDD patients at 1 year.

In conclusion, NDD after TAVR has been shown to be a safe and effective strategy also in nonagenarian recipients, in which a shorter length of stay may help to avoid hospitalization-related complications.