Same‐Day Discharge After Atrial Fibrillation Ablation. A Scoping Review of Nurse‐Led Care Model

ABSTRACT Background and Aims Atrial fibrillation (AF) is a common cardiac arrhythmia with a rising global incidence. Advances in ablation techniques have led to same‐day discharge (SDD) protocols, reducing hospital resource use. However, managing patients post‐ablation is crucial to avoid complications. This scoping review evaluates the role of nurse‐led interventions in managing patients undergoing AF ablation with SDD, focusing on patient safety, outcomes, and healthcare efficiency. Methods A review was conducted across databases like MEDLINE, Web of Science, Scopus, and Google Scholar in April 2024. Studies were included if they reported on nurse‐led management during hospitalization or post‐ablation follow‐up in adult patients. Results Ten clinical studies involving 4776 patients were reviewed. The studies showed that nurse‐led interventions effectively support SDD protocols, ensuring patient safety and improving outcomes. Interventions varied, including hotlines, follow‐up calls, and autonomous discharge decisions by nursing staff. Overall complication rates for SDD ranged from 0% to 18%, with most studies reporting ≤ 1.6%. Minor complications occurred in up to 3.5% of day cases, re‐hospitalization rates reached 2.1%, and unplanned overnight admissions for minor events were up to 7.3%. These rates were generally comparable to, or lower than, those for overnight stay (ONS) procedures. Conclusion Nurse‐led models facilitated early complication detection, enhanced patient education, and improved follow‐up care. The reported complication rates for SDD were low and comparable to ONS, supporting its safety, feasibility, and potential to reduce healthcare resource use. Further research should standardize protocols and assess their long‐term impact.

Immune Biomarkers in Fibromyalgia After a Qigong Programme: An Exploratory Randomized Controlled Study

ABSTRACT Background and Aims Qigong is an ancient Chinese psychosomatic system with a fascinating holistic approach to health, which exerts remarkable physical and mental benefits. Nevertheless, this method has been scarcely investigated in fibromyalgia, and although a significant amount of research has focused on the immune effects of qigong, its action on immune parameters of individuals with fibromyalgia has never been studied to date. Thus, the aim of the present study was, therefore, to explore the effects of a qigong programme on white blood cells and other immune parameters in individuals with this syndrome. Methods 39 individuals participated in the study, 16 in the experimental group and 23 in the control. Experimental individuals participated in a 4‐week qigong programme. Blood samples for the quantification of immune parameters (leukocyte count, number and percentage of specific leukocyte and lymphocyte subsets, as well as concentrations of immunoglobulins and complement) were drawn from all participants before the experiment commenced and after it concluded. Results The experimental group displayed a significantly lower value in the number of specific lymphocytes subsets such as CD3, CD4, CD8, CD16, CD45, as well as in the percentage of total lymphocytes. In addition, the experimental group exhibited a greater percentage of CD19 and a higher concentration of C3. Conclusion The practice of qigong for a short period of 1 month was associated with significant changes of diverse immunological biomarkers in individuals with fibromyalgia. These changes were characterized by a higher number of numerous lymphocyte subsets, while at the same time a lower concentration of C3 and of the percentage of some lymphocyte subtype in these individuals. While it is tempting to speculate the implications of the broad immunomodulation associated with qigong practice in fibromyalgia syndrome, further research into the immune effects of this Taoist mind‐body practice is needed.

Anxiolytic Medication Use in Low‐ Middle‐ and High‐Income Countries: A World Mental Health Surveys Report

ABSTRACT Background Anxiolytic medications, particularly benzodiazepines, are widely prescribed, giving impetus to long‐standing debates about how often these agents should be employed in clinical practice. There are, however, few cross‐country studies of the pharmacoepidemiology of these agents. We report on the frequency of anxiolytic medication use, reasons for use, and perceived effectiveness of use in general population surveys across 20 countries. Methods Face‐to‐face interviews with community samples totaling n  = 49,919 respondents in the World Health Organization World Mental Health (WMH) Surveys asked about anxiolytic medication use anytime in the prior 12 months in conjunction with validated fully structured diagnostic interviews. Treatment questions were administered independently of diagnoses to all respondents. Results A weighted 5.6% ( n  = 4079) of respondents reported anxiolytic medication use within the past 12 months; the vast majority comprised benzodiazepine use, and use was highest amongst respondents with a subthreshold major depressive episode (MDE) (25.2%) and a 12‐month MDE (19.8%). Rates were significantly higher in high‐income countries (HICs) than low‐ and middle‐income countries (LMICs) (8.5% vs. 2.2%, χ 2 1  = 559.6, p  < 0.001). Short‐acting benzodiazepines and z‐drugs were most commonly used for sleep (66.5% and 85.5%), while intermediate‐acting benzodiazepines and long‐acting benzodiazepines were most commonly used either for sleep (37.9% and 30.1%) or anxiety (33.3% and 32.0%). Across all conditions, anxiolytic medications were reported as very effective by 55.7% of users and somewhat effective by an additional 32.2% of users, with similar proportions in HICs and LMICs. Negative predictors of high perceived effectiveness were a 12‐month MDE and taking anxiolytic medication for comorbid anxiety and depression. Conclusion These data do not definitely answer the question of how often benzodiazepines should be prescribed in clinical practice, but they usefully inform discussions of how to optimize their use. It is noteworthy that anxiolytic medications, particularly benzodiazepines, are largely prescribed for anxiety and sleep, and that they are widely perceived to be either very or somewhat effective by users. However, more targeted prescription of these agents may be necessary; in particular antidepressant intervention should be prioritized in the pharmacotherapy of major depressive disorder.

Bioretention Performance Under Tropical Conditions: Experimental Analysis of Hydrological Controls and Design Implications

ABSTRACT Nature‐based solutions have proven effective in mitigating urban drainage problems, including floods and inundations. However, most research has focused on temperate climates, highlighting the need for studies in tropical regions, where data availability remains limited. The efficiency of runoff retention in bioretention systems is closely related to rainfall distribution. In tropical climates, precipitation tends to be more intense and concentrated, potentially influencing soil moisture, infiltration capacity, and overall system performance. This study evaluates the runoff retention efficiency of a bioretention cell located in a tropical urban area of Brazil. Over a 5‐month period, data from 50 natural rainfall events were collected and analysed to determine the system's water balance. Retention efficiency was assessed for four ponding depths. The results revealed that retention efficiency increased significantly with higher ponding depths, confirming the system's high performance at various storage levels. Approximately 78% of the monitored events achieved full (100%) retention efficiency at a ponding depth of 45 cm. The bioretention cell infiltrated up to 4.74 m of runoff, with an average infiltration layer of 0.78 m. Utilisation rates indicated that the system operated as designed, maintaining consistent infiltration capacity without evidence of clogging after 2 years of operation. Statistical analyses showed that runoff retention efficiency was mainly correlated with rainfall return period (−0.62), followed by total precipitation depth (−0.62), precipitation duration (0.46), average precipitation intensity (−0.44), and maximum precipitation intensity (−0.44). These findings enhance understanding of bioretention performance under tropical rainfall regimes and offer practical guidance for the design and implementation of sustainable urban drainage systems in similar climates.

Laboratory and Field Experiments on Soil and Rainfall Characteristics for Studying Water Erosion Processes

Coupling Parsivel 2 Measured Raindrop Size Distributions and Fall Velocity Estimates to Characterise Rainfall Simulators

ABSTRACT Rainfall simulators are essential tools in experimental water and soil management studies. As they enable the generation of precipitation with known energy characteristics, they are useful for understanding the dynamics of several erosion sub‐processes and investigating the relationship between rainfall features and soil erosion. The most critical aspect for the energy characterisation of simulated rainfalls is the assessment of the raindrop size distribution and impact velocity, which depends on the fall height and the raindrop diameter. In this paper, the characterisation of drip‐type and pressurised rainfall simulators is presented, based on disdrometric measurements carried out using a Parsivel 2 disdrometer and drop velocity estimates. In particular, the reliability of a relationship calibrated on literature fall velocity measurements and relating raindrop fall velocity, fall height and drop diameter, is tested for the drip‐type and pressurised rainfall simulators considered in the present investigation. This analysis demonstrated that the Parsivel 2 produces systematic underestimations of the fall velocity of the raindrops generated by both drip‐type and pressurised simulators, probably due to the characteristics of the Parsivel 2 (i.e., laser sensor, internal algorithm, design for the natural precipitation). Therefore, simulated rainfall can be characterised considering the drop size distributions detected by the Parsivel 2 , which enable accurate measurements of raindrop diameter, rainfall intensity and drop count, coupled with the proposed empirical relationship for calculating raindrop fall velocity. Specifically, for the drip‐type rainfall simulator, the use of this latter equation simplifies the calculation of raindrop fall velocity, while for pressurised simulators, it represents a robust alternative to the fall velocity measured by Parsivel 2 .

Epstein‐Barr Virus Transformed B Cells From Systemic Lupus Erythematosus and Multiple Sclerosis Patients Differ in EBV Lytic and Latency Marker Expression

ABSTRACT Epstein‐Barr virus (EBV) is an important environmental risk factor in the development of several autoimmune conditions, with the mechanisms still to be fully elucidated. EBV primarily infects memory B cells, transitioning between lytic (active) and latent (dormant) phases of infection. Our group has previously proposed two molecular mechanisms linking EBV pathogenesis to autoimmunity: one indicates that EBV lytic switching contributes to systemic lupus erythematosus (SLE) pathogenesis, while another posits that latency III is more crucial in the development of multiple sclerosis (MS). In this study, we tested the proposed molecular model using a cohort of EBV‐transformed lymphoblastoid cell lines derived from individuals with either SLE, MS or healthy controls. Measuring the expression levels of a panel of EBV genes, representing the different phases of the EBV lifecycle, we found compelling proof‐of‐concept evidence validating our proposed model. This discovery highlights promising signatures for further investigation, where the same approach can be explored across other EBV‐associated immune conditions, deepening our understanding of the virus's lifecycle dysregulation in autoimmunity etiology and ultimately aiding in the design of new treatments.

Impact of overweight, obesity, and gestational weight gain on fetal somatometry, birth weight, and pregnancy complications

Abstract Objective We aimed to investigate fetal somatometric changes and neonatal birth weight (NBW) in babies of women with overweight and grade I–III obesity compared to controls with normal weight. Methods We conducted a retrospective cohort study at a Mexican hospital between 2021 and 2023 in otherwise healthy pregnant women with different baseline body mass index (BMI) classifications: normal weight, overweight, grade I obesity, and grade II–III obesity. We used analysis of variance and Cohen's d to compare the area under the curve (AUC) of fetal biometric parameters, as well as NBW. Gestational weight gain (GWG) and obstetric complications were also analyzed. Subanalysis with two‐way analysis of variance was performed to contrast the effects of maternal BMI and GWG on fetal growth. Results A total of 253 pregnant women were included. Small effect sizes were observed for initial maternal BMI on the AUC of fetal biometry ( d  > 0.2); there was no significant effect on NBW. The AUC of amniotic fluid index decreased as maternal BMI increased ( P  = 0.048), and overweight women had a higher incidence of obstetric hemorrhage ( P  = 0.046). There was a significant effect of GWG on NBW ( P  = 0.039) and no interaction with baseline BMI ( P  = 0.744), with smaller babies in mothers with less‐than‐appropriate versus appropriate GWG ( P  = 0.050, d  = 0.31). Conclusion Maternal BMI can have a small effect on fetal somatometry but not on NBW, while GWG affect birth weight regardless of baseline BMI. Patients that were overweight had higher incidence of obstetric hemorrhage. Patients should receive timely prenatal interventions to ensure neither excessive nor insufficient GWG.

Prevalence of congenital anomalies in pregnancies complicated by type 2 diabetes: Systematic review and meta‐analysis

Abstract Objective The prevalence of congenital anomalies in pregnancies affected by type 2 diabetes remains uncertain. This study systematically reviews the literature and assesses the prevalence and potential risk factors associated with congenital anomalies in this population. Method We searched MEDLINE, Embase, Cochrane, LILACS, and Web of Science for studies published between January 1990 and May 2025 reporting on congenital anomalies in pregnancies complicated by pregestational type 2 or overt diabetes (diabetes first diagnosed at any time during pregnancy). The search included terms such as “congenital anomaly,” “birth defect,” “pregnancy outcome,” “type 2 diabetes,” and “non‐insulin dependent diabetes mellitus.” We included studies with at least 40 pregnancy outcomes, in any language (if minimally translatable), excluding case reports, congress abstracts, and studies focused on chromosomal or genetic syndromes. Search strategies were developed and executed by two librarians. Titles and abstracts were screened, and data were extracted from full‐text articles by at least two authors. Analyses were conducted using SPSS v25 and PERSyst‐MA (R package meta, v7.0–0). Reporting followed the MOOSE and PRISMA statements. Results Of 2316 records, 68 studies met inclusion criteria, representing 102 963 pregnancies and 96 015 outcomes (90 450 with pregestational type 2 diabetes; 5565 with overt diabetes). The overall prevalence of congenital anomalies was 6.1% (95% confidence interval: 5.1%–7.3%; prediction interval: 1.5%–21.6%; I 2  = 97%). Cardiac anomalies were most common (21.6%). Subgroup analyses did not yield significant findings; however, meta‐regression revealed an inverse association between maternal age and the prevalence of congenital anomalies and a direct association with HbA1c levels. Conclusion Type 2 diabetes in pregnancy was associated with a relevant prevalence of congenital anomalies. Lower maternal age and, as expected, higher HbA1c levels increased the risk of congenital anomalies. Regarding the inverse association between congenital anomalies and maternal age, further confirmatory studies are necessary.

Progesterone in pregnancy and neonatal outcomes: A systematic review and meta‐analysis of randomized controlled trials

Abstract Background Given the significant morbidity associated with premature neonates, the use of progesterone to prolong pregnancy has emerged as a promising intervention to mitigate this condition. A comprehensive understanding of the benefits and potential risks of progesterone therapy enables healthcare providers to develop targeted strategies aimed at improving perinatal outcomes. By optimizing the use of this treatment, we can promote safer and more effective interventions, ultimately enhancing the health and well‐being of both mothers and infants. Objective The aim of this study was to evaluate the safety and efficacy of progesterone therapy in neonates. Search Strategy A systematic review with meta‐analysis was performed using the electronic databases Cochrane Central, Embase, and PubMed, searching the following terms “pregnancy prolongation” and “vaginal progesterone” or “17‐α‐hydroxyprogesteron”. Selection Criteria Randomized clinical trials were investigated to compare the use of progesterone with placebo or no intervention to prolong pregnancy and reporting neonatal outcomes. Data Collection and Analysis The authors independently reviewed the titles, abstracts, and full texts based on predefined inclusion and exclusion criteria, resolving any discrepancies through discussion. Data extraction and methodological quality assessment were conducted by each author using a standardized approach. Ten outcomes were assessed. The meta‐analysis calculations were performed using the meta package in Rstudio, version 4.2.2 (R Foundation for Statistical Computing). Main Results We included 12 randomized studies with 1557 participants, of whom 888 (57.3%) were randomized to receive progesterone therapy. Neonates in the progesterone group had a lower risk of respiratory distress syndrome (risk ratio [RR], 0.61 [95% confidence interval (CI), 0.43–0.87], P  < 0.01), sepsis (RR, 0.51 [95% CI, 0.27–0.96], P  = 0.039), pneumonia (RR, 0.29 [95% CI, 0.11–0.74], P  < 0.01), retinopathy (RR, 0.38 [95% CI, 0.17–0.83], P  = 0.015), and ventilatory assistance (RR, 0.65 [95% CI, 0.46–0.91], P  = 0.012). Conclusion Our study was able to demonstrate the benefit of progesterone in significantly reducing the risk of adverse neonatal outcomes.