Resumo Fundamento Tem surgido uma nova manifestação clínica chamada pós-COVID ou COVID longa (COVID p/l) após a fase aguda da COVID-19. COVID p/l pode levar à lesão miocárdica com problemas cardíacos subsequentes. Diagnosticar esses pacientes de forma rápida e simples é cada vez mais importante devido ao número crescente de pacientes com COVID p/l. Objetivos Comparamos os parâmetros de ecocardiografia com strain (ES) de pacientes que apresentaram dor torácica atípica e achados de sequelas de miocardite na ressonância magnética cardíaca [...] Resumo Fundamento Tem surgido uma nova manifestação clínica chamada pós-COVID ou COVID longa (COVID p/l) após a fase aguda da COVID-19. COVID p/l pode levar à lesão miocárdica com problemas cardíacos subsequentes. Diagnosticar esses pacientes de forma rápida e simples é cada vez mais importante devido ao número crescente de pacientes com COVID p/l. Objetivos Comparamos os parâmetros de ecocardiografia com strain (ES) de pacientes que apresentaram dor torácica atípica e achados de sequelas de miocardite na ressonância magnética cardíaca

Objectives: Percutaneous Patent Foramen Ovale (PFO) closure has become a standard treatment for secondary prevention following cryptogenic stroke. This study aims to compare the long-term clinical outcomes and stroke recurrence rates between the Amplatzer PFO Occluder and other commercially available devices, including Occlutech, Cardiofix, and Biostar. Methods: This retrospective study included 130 consecutive patients who underwent percutaneous PFO closure due to PFO-related stroke. The participants were divided into two groups: the Amplatzer group (n = 90, 69%) and the Other Devices group. Primary endpoints were Major Adverse Cardiovascular Events (MACE) defined as stroke recurrence, new-onset atrial fibrillation (AF), and mortality during the follow-up period. Results: The average follow-up period was 2200 days (median 1739 days, interquartile range: 1062–2616 days). No statistically significant differences were observed between the groups regarding baseline characteristics such as age, hypertension, or diabetes. The Amplatzer and other device groups showed similar rates for MACE, atrial fibrillation, and stroke recurrence. Kaplan–Meier analysis demonstrated no significant difference in event-free survival between the groups. This study demonstrates that the Amplatzer PFO Occluder and other commercial devices provide comparable long-term safety and efficacy profiles in patients undergoing PFO closure for cryptogenic stroke. Regardless of the device type used, long-term stroke recurrence rates remain low in both groups.

Maintaining minimum shared learning outcomes in practice-based basic science education is challenging when institutions differ in academic staffing, student cohort size, and laboratory resources. Using practical biophysics education as a disciplinary case, this cross-sectional, multi-source study assessed how medical schools in Türkiye and the Turkish Republic of Northern Cyprus address these constraints and proposed a resource-adaptable modular framework. Official curriculum documents and a 16-item online survey were used. Invitations were sent to 86 medical schools; 40 departments responded and 38 provided analysable data, and verified curriculum data were available for 72. Practical education was identified in 39 schools (54.2%), while 37 (51.4%) had a laboratory. Among schools providing practical education, the median annual teaching time was 10 h. Among responding schools providing practical education, defined learning objectives, a laboratory manual and post-practical assessment were reported by 21 of 22, 18 of 22 and 13 of 23 respectively. The student-to-academic-staff ratio was inversely correlated with practical teaching hours (Spearman’s rho = −0.420, p = 0.021; 95% CI −0.729 to −0.010, n = 30), an imprecise estimate whose confidence interval included zero when one extreme observation was excluded (rho = −0.375; 95% CI −0.713 to 0.052). The ratio was significantly higher in schools rating practical education as insufficient (p = 0.004; p = 0.008 without that observation). These findings informed six core and nine elective or advanced modules. The proposed framework may support shared competencies under varying institutional conditions but requires structured expert validation and multicentre pilot testing before its feasibility and effectiveness can be established.

Background/Objectives: This study aims to determine the indirect costs associated with the disease process in patients hospitalized for acute coronary syndrome and to analyze the sociodemographic and clinical factors influencing these costs. Methods: This prospective, single-center, observational cost-of-illness study evaluated 146 ACS patients at a tertiary cardiology clinic over an index episode extending from admission to 30 days after discharge, from a patient and household perspective that excludes direct medical costs. Excluding six patients (one death, five early retirements), 140 patients were analyzed. Productivity losses were measured with the iMTA Productivity Cost Questionnaire and valued using the Human Capital Approach; SCORE2, GRACE and MIDAS scores were also recorded. Costs are reported in 2025 international dollars (Int$, OECD PPP factor 16.20). Factors associated with total indirect cost were examined with a Gamma generalized linear model with a log link, containing five prespecified covariates: sex, occupational group, age, GRACE and MIDAS. Results: The mean age was 61 ± 12 years, and 69.9% of the cohort were male. The median total indirect cost per patient was 1007 Int$. In the actively employed subgroup, the median absenteeism cost was 1450 Int$, while the median household production loss for the entire cohort was 340 Int$. The multivariate Gamma GLM identified occupational status (p < 0.001) and female sex (p = 0.004) as variables independently associated with total indirect costs, whereas age and clinical/prognostic scores (GRACE, MIDAS) lacked statistical significance. Compared to patients outside the labor force, total costs were 4.8 and 4.1 times higher for white-collar and blue-collar workers, respectively. Conclusions: ACS imposes a significant short-term indirect cost burden at the patient and household levels, driven by absenteeism among actively employed patients and by household production losses among those outside the labor force. These findings indicate that the early post-discharge economic burden is patterned primarily by labor force position and by the distribution of unpaid domestic work rather than by clinical severity.

Background: We investigated the prognostic value of nutritional indices in patients with atrial fibrillation (AF) undergoing percutaneous left atrial appendage occlusion (LAAO). Methods: This two-center retrospective study enrolled 151 patients (median age 75, IQR: 69–80) undergoing LAAO. The Controlling Nutritional Status (CONUT) score, Geriatric Nutritional Risk Index (GNRI), and Prognostic Nutritional Index (PNI) were calculated preoperatively. Endpoints included all-cause mortality (primary), postoperative bleeding, and stroke. Associations with mortality were analyzed using multivariable Cox regression models. Results: Over a median follow-up of 8 months (IQR: 5–13), 28 patients (18.5%) died. In multivariable analyses (adjusted for age, sex, diabetes, and chronic kidney disease), each 1-point increase in the CONUT score was associated with a higher risk of all-cause mortality (HR 1.196, 95% CI 1.029–1.390; p = 0.020), whereas higher GNRI values were associated with a lower mortality risk (HR 0.956, 95% CI 0.915–0.998; p = 0.042). In contrast, PNI was not associated with mortality (p = 0.993). Nutritional indices did not significantly predict secondary outcomes like bleeding or stroke. Conclusions: These findings suggest that malnutrition is strongly and independently associated with mortality in high-risk AF patients receiving LAAO. The CONUT score demonstrates the most robust association in this population, highlighting the importance of metabolic reserves.

Background/Objectives: Radial artery spasm (RAS) is the most common periprocedural complication of transradial coronary angiography (TRA) and is identified clinically, from patient-reported forearm pain and operator-perceived catheter resistance, rather than by imaging. This study compared two sedation strategies used in routine clinical practice, namely fentanyl-midazolam moderate sedation (MS) and a propofol-integrated monitored anaesthesia care (MAC) regimen, with respect to procedure-related pain and the incidence of clinically detected radial artery spasm (cRAS). Methods: This single-centre, prospective, non-randomised, observational study enrolled 394 consecutive patients undergoing elective TRA (MS, n = 231; MAC, n = 163). cRAS was defined as at least two of five established criteria: three patient-reported pain items and two operator-perceived resistance items. No angiographic, ultrasonographic or physiological assessment of radial vasomotor tone was performed, and operators were not blinded. Co-primary endpoints were cRAS and post-procedural pain scores; the secondary endpoint was a composite of periprocedural complications. Factors associated with cRAS were analysed using multivariable logistic regression, including sensitivity analyses with decreasing dependence on patient-reported pain. Results: cRAS occurred in 59 patients (15%), 20.3% with MS and 7.4% with MAC (p = 0.001). VAS pain scores were lower with MAC (p < 0.001); complications did not differ (13.4% vs. 7.3%; p = 0.083). Female sex (odds ratio [OR] 3.60; 95% confidence interval [CI] 1.91–6.78), procedural duration (OR 1.04 per minute; CI 1.02–1.06) and MS rather than MAC (OR 3.69; CI 1.80–7.58) were independently associated with cRAS (all p < 0.001). The association persisted when the outcome was restricted to operator-assessed criteria (21.6% vs. 9.2%; OR 2.95; CI 1.55–5.59). Conclusions: The propofol-integrated regimen was associated with less procedural pain and less clinically detected spasm. These hypothesis-generating findings describe clinically apparent spasm and cannot establish prevention of true vasospasm. Within that limit, they support testing this strategy in a randomised trial with objective, blinded endpoints, particularly in women.