Depression is a highly prevalent and debilitating condition that frequently coexists with various physical illnesses, including cardiovascular, metabolic, neurological, oncological, pulmonary, and gastrointestinal diseases. This bidirectional relationship complicates diagnosis, exacerbates disease burden, and negatively impacts clinical outcomes, quality of life, and treatment adherence. The underlying mechanisms involve neuroinflammation, autonomic dysfunction, metabolic dysregulation, and behavioral factors. The pharmacological management of depression in patients with comorbid physical conditions requires careful selection of antidepressants to minimize adverse effects and drug interactions. Special considerations are necessary for patients with hepatic and renal impairment, as altered drug metabolism and clearance may increase the risk of toxicity or therapeutic inefficacy. Similarly, in pregnant and breastfeeding women, antidepressant selection must balance maternal benefits with fetal and neonatal safety. While SSRIs such as sertraline are generally preferred due to their relatively favorable safety profiles, medications like paroxetine and fluoxetine require caution due to potential teratogenic risks and higher infant exposure through breast milk. A comprehensive, multidisciplinary approach integrating psychiatric and medical care is essential to improve outcomes and ensure the safe and effective treatment of depression in individuals with chronic physical diseases and special populations.

Cardiac atrophy is the most common complication of prolonged application of the left ventricle (LV) assist device (LVAD) in patients with advanced heart failure (HF), obviously, it is a consequence of LVAD-induced mechanical unloading. Previous studies employing heterotopic heart transplantation (HTx) as a model of heart unloading after LVAD implantation discovered sex-linked differences in the course of unloading-induced in the healthy hearts. It remains to be clarified if sex-related differences are present in the failing hearts after heterotopic HTx. Therefore, we first compared the course of unloading-induced cardiac atrophy in the failing hearts in intact (without gonadectomy) male and female rats, and in animals after gonadectomy, to explore the influence of sex hormones on this process. Second, we examined if the animal's sex modifies the effects of increased isovolumic loading of the LV on the course of unloading-induced cardiac atrophy. Heterotopic abdominal heart transplantation (HTx) was used as a rat model of heart unloading. HF was induced by volume overload achieved by creation of aorto-caval fistula. Increased isovolumic loading was obtained by implantation of specially designed three-branch spring expander into the LV. The degree of cardiac atrophy was assessed as the whole heart weight (HW) ratio of the heterotopically transplanted to the native control heart. We found that decreases in HW after HTx were similar in intact male and female rats, similarly in intact and gonadectomized animals. Implantation of the expander significantly and comparably reduced decreases in HW in male and in female rats. We conclude that there are no sex-linked differences in the development of unloading-induced cardiac atrophy in the failing hearts. Our results also show that enhanced isovolumic heart loading obtained using the spring expander attenuates the development of unloading-induced cardiac atrophy in the failing hearts; the degree of attenuation is similar in both sexes. Key words Heart failure " Cardiac atrophy " Sex differences " Heterotopic heart transplantation " Mechanical heart unloading.

Highly sensitized patients with advanced lung disease, who are more often Black and Hispanic women, are at increased risk for waitlist death. In 2012, we implemented a protocol to cross any pre-transplant donor-specific antibody (DSA), so long as a prospective complement-dependent cytotoxicity (CDC) crossmatch was negative. We report long-term outcomes, including overall survival and chronic lung allograft dysfunction (CLAD)-free survival.

This was a single-institution retrospective cohort study of lung transplant recipients between October 1, 2012-December 31, 2022. We compared overall retransplant-free survival and CLAD-free survival between recipients with and without pre-formed DSA. Secondary outcomes included freedom from acute cellular rejection (ACR) and antibody-mediated rejection (AMR).

The study cohort included 427 recipients with a median duration of follow-up of 4.3 years (IQR = 2.1-6.9). Thirty-three (7.7%) recipients had pre-transplant DSA with a peak historical mean fluorescence intensity (MFI) of 4200 (IQR = 3000-6600, total range 2100-23 000). The median number of DSA per patient was 1 (IQR = 1-2, total range 1-8). There was no difference in adjusted overall survival between recipients with and without pre-formed DSA (HR = 1.39, 95% CI = 0.82-2.36, p = 0.22) or adjusted CLAD-free survival between recipients with and without pre-formed DSA (HR = 1.07, 95% CI = 0.65-1.75, p = 0.79). Recipients with pre-formed DSA did not have increased adjusted hazard of ACR (HR = 0.71, 95% CI = 0.29-1.75, p = 0.45) but did have increased adjusted hazard of AMR (HR = 5.02, 95% CI = 2.11-11.95, p < 0.001).

In this moderately-sized cohort, a protocol of accepting donor offers for lung transplant candidates with pre-formed DSA but negative CDC crossmatch was not associated with worse overall or CLAD-free survival, within the limitations of the sample size.

Cardiac rehabilitation (CR) is a secondary prevention programme aimed at reducing the mortality and frequency of recurrent cardiac events and contributes to improvement in quality of life of the patients suffering from cardiovascular diseases (CVD). While the healthcare system around the world has revolutionized, provision of CR services is still lacking in its implementation. According to statistics, < 54% of the countries actually provide CR and this percentage drops at an alarming rate of about 8% and 28% in low and middle income countries (LICs/LMICs) respectively, even though the need of this programme has increased exponentially. Pakistan is one of the low income countries facing many challenges in implementing successful healthcare programmes. One such field which is neglected and often overlooked is cardiac rehabilitation. Establishing and promoting CR programmes in low-middle income countries is crucial as it can alleviate the financial strain of prolonged hospital stays and help in prevention from dependency on families. This review highlights the dilemma regarding lack of CR programmes in Pakistan, as well as factors affecting the utilization and applicability of this programme.

The ESC-EHRA Atlas on Heart Rhythm Disorders was developed to comprehensively map arrhythmia care across the European Society of Cardiology (ESC) member countries. A survey of National Cardiac Societies, Working Groups, and other EHRA partners in ESC member countries was conducted to gather data from 2023 or the most recently available year on arrhythmia care organization and delivery. In total, 51 ESC member countries actively participated in the study, with a survey completeness rate of 91%. The median number of hospitals performing EP or CIED procedures was 3.3 per million people. The annual median numbers of ablation procedures for heart rhythm disorders, atrial fibrillation, and supraventricular tachycardia per million people were 432, 151, and 136, respectively. The annual median numbers of pacemakers, implantable cardioverter-defibrillators (ICD), and cardiac resynchronization therapy cardioverter-defibrillator (CRT-D) implantations per million people were 739, 195, and 54, respectively. The median number of hospitals performing remote monitoring of CIEDs per million people was 0.5, though this service was unavailable in 15 countries. Two main universal issues emerged among the obstacles to guideline implementation: a lack of heart rhythm allied professionals and general dissatisfaction with the country's reimbursement system. The first edition of the ESC-EHRA Atlas presents up-to-date information on arrhythmia care organization and delivery among ESC member countries and highlights significant discrepancies in patients' access to ESC-guideline-recommended therapies.

Aneurysmal subarachnoid hemorrhage (aSAH), a severe form of hemorrhagic stroke, poses significant diagnostic and management challenges, particularly in predicting and managing cerebral vasospasm and delayed cerebral ischemia. This study explores the predictive value of near-infrared spectroscopy (NIRS) in high-grade aSAH patients.

This observational study included 16 high-grade aSAH patients treated at a single institution from June 2020 to November 2023. Neuromonitoring incorporated daily transcranial Doppler and continuous NIRS, alongside routine computed tomography perfusion. The primary endpoint was the occurrence of major cerebral vasospasms detected by digital subtraction angiography preceded by a decrease in regional oxygen saturation as indicated by NIRS.

Among the participants, vasospasms were most prevalent in the internal carotid artery (56.3%), followed by the middle cerebral artery (50%). NIRS detected alterations in 43.8% of the cohort, with 25% occurring before vasospasm onset. A correlation between early NIRS alterations and specific vasospasm locations was identified.

Conclusions: While NIRS shows potential for continuous, non-invasive monitoring of cerebral oxygenation, its utility in predicting vasospasms is limited. The findings underscore the importance of integrating NIRS with other neuromonitoring modalities to enhance predictive accuracy and patient management in aSAH. Large-scale studies are necessary to establish protocols and intervention thresholds.

Xanthelasma palpebrarum (XP) is a yellow plaque lesion near the eyelid, which was previously found to be associated with dyslipidemia, metabolic syndrome, and cardiovascular disease. This study aimed to explore the clinical characteristics and potential mechanisms underlying its development by analyzing body mass index (BMI), lipid levels, blood glucose, and blood type in affected individuals. A case-control study was conducted involving 44 patients with XP between 2019 and 2023 and 44 age- and sex-matched healthy controls. Data collection included medical history, BMI, total cholesterol (TC), triglycerides (TG), blood glucose, and blood type. Patients were predominantly female (68.2%) and aged 45-50 years. Compared with healthy controls, patients exhibited significantly higher mean levels of TC and TG (P = .01 and P = .04, respectively). Elevated TC and TG levels were more common in the XP group (TC: 50.0% vs 15.91%; TG: 25.0% vs 6.82%). Hyperglycemia was also more frequent (15.91% vs 0%, P < .05). However, there were no significant differences in mean BMI, blood glucose levels, or overweight prevalence. Blood type distributions were similar between the 2 groups, and no statistically significant differences were found. Multivariate logistic regression analysis revealed that TC, TG, BMI, and blood glucose were not found as independent risk factors for XP. The findings suggest that while dyslipidemia is associated with XP, its development is likely due to the combined influence of lipid abnormalities and genetic predisposition rather than any single clinical factor.

This study evaluates the impact of an information-motivation-behavioral skills model (IMB model) health education intervention combined with feedback on rehabilitation outcomes for ischemic stroke patients with hemiplegia, targeting improvements in motor function, psychological state, disease awareness, and quality of life. A total of 152 ischemic stroke patients with hemiplegia were divided into an experimental group receiving the IMB-based intervention and a control group receiving standard education. Both interventions lasted 3 months. Rehabilitation outcomes were measured using indicators such as Fugl-Meyer assessment (FMA) for limb motor function, Activities of Daily Living (ADL) Scale, Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD) for psychological status, disease cognition, and compliance. The experimental group showed significantly better improvements across all indicators. FMA scores increased notably in the experimental group (58.12 ± 2.22) versus the control (53.65 ± 3.01, P < .001). Activities of Daily Living scores also improved more in the experimental group (79.36 ± 8.36) compared to the control (71.95 ± 7.71, P < .001). Psychological assessments indicated greater HAMA and HAMD score reductions in the experimental group (HAMA: 13.56 ± 2.74 vs 15.26 ± 2.09; HAMD: 15.21 ± 1.98 vs 18.36 ± 1.98, both P < .001). Disease awareness and compliance were higher in the experimental group (P < .05), and stroke-specific quality of life scores were also superior (192.36 ± 18.69 vs 179.36 ± 21.69, P < .001). Additionally, the experimental group experienced fewer complications like spasticity and contractures (P = .002). The IMB-based intervention with feedback shows notable benefits for ischemic stroke patients with hemiplegia, enhancing compliance, motor function, and quality of life. Future research should explore larger samples and longer follow-up to verify long-term effects.

This systematic review studied and compared the safety and efficacy of glucocorticoids (GCs) + cyclophosphamide (CTX) and GCs + tacrolimus (TAC) therapies for treating children with Henoch-Schönlein purpura nephritis (HSPN).

The data on GCs + CTX and GCs + TAC therapies for HSPN children were procured from the EMbase, China National Knowledge Infrastructure, the Cochrane Library, PubMed, and Wanfang from the inception to May 10, 2024.

This review included 5 studies (2 non-randomized and 3 randomized controlled trials), comprising 363 patients. Furthermore, the complete remission within 6 months in the TAC group (43.3%) was higher than that in CTX group (26.2%) and the total remission within 6 months in the TAC (76.7%) was higher than that in CTX groups (54.1%). Moreover, in terms of adverse reactions, the incidence of hypertension in TAC group was higher than that in CTX group, whereas the incidences of other adverse reactions such as liver function injury, hyperglycemia, myelosuppression and gastrointestinal discomfort in TAC group were lower than that in CTX group.

This systematic review indicated that for HSPN children, the TAC therapy may have relatively higher remission rate and fewer adverse reactions than the CTX therapy.

Coronary heart disease (CHD) is a widespread chronic condition. Its risk factors are numerous and complex, with smoking being a key factor. Recently, CHD risk in women has notably risen, partly due to increased smoking and lifestyle changes. This highlights the critical need for gender-specific CHD research. This study aims to assess CHD risk in smoking and nonsmoking women, identifying crucial biochemical markers influencing this risk. Our goal is to develop personalized risk assessment tools for improved clinical decision-making. We analyzed data from 41,482 female National Health and Nutrition Examination Survey participants (2011-2020), focusing on blood markers. Logistic regression models for smokers and nonsmokers were developed to predict CHD risk, assessed by the area under the curve of the receiver operating characteristic curve. We also created nomograms to translate biochemical indicator measurements into CHD risk probabilities, supporting clinical decisions. Univariate analysis showed significant correlations between age, biochemical markers, and CHD risk. The logistic regression models were highly predictive, with area under the curves of smoking CHD model and nonsmoking CHD model being 0.813 (95% confidence interval: 0.788-0.837) and 0.829 (95% confidence interval: 0.811-0.847), respectively. The nomograms effectively assessed risk across patient groups, confirmed by accurate calibration curves. This study presents distinct CHD risk assessment models for smoking and nonsmoking women, along with an innovative visual risk assessment tool. These insights underscore the role of gender in CHD risk and inform future public health strategies and clinical practices.