CRITICAL CARE

Knowledge gaps exist regarding the health implications of sleep-disordered breathing (SDB) identified in pregnancy and/or after delivery. Therefore, the objective of this study was to determine whether SDB in pregnancy and/or after delivery is associated with hypertension (HTN) and metabolic syndrome (MS). This study examined a subgroup who underwent SDB assessments during their first pregnancy (n = 1,964) and a repeat SDB assessment after delivery (n = 1,222). Two SDB definitions were considered: 1) apnea-hypopnea index (AHI) ⩾ 5 and 2) oxygen desaturation index (ODI) ⩾ 5. ODI ⩾ 5 in pregnancy was associated with both an increased risk for HTN and MS. Similar associations were observed for persistent ODI ⩾ 5 after delivery. An AHI ⩾ 5 in pregnancy was associated with an increased risk of MS. An ODI ⩾ 5 in pregnancy was significantly associated with both HTN and MS. Participants with persistent elevations in AHI and ODI during pregnancy and at 2–7 years after delivery were at the highest risk for HTN and MS.

Sleep-Disordered Breathing in Pregnancy and Postpartum: Impact on Hypertension and Metabolic Syndrome Risk

GYNAECOLOGY - IVF

Vaginal delivery causes lasting pelvic floor changes, while Cesarean delivery is linked to reduced levator hiatus area.

First Vaginal Delivery Has Lasting Impact on Pelvic Floor Anatomy

An 8-year prospective study of 183 women found that the levator hiatus area progressively increased in those with at least one vaginal delivery but decreased in women who delivered exclusively by Cesarean section (CS). Additional vaginal births after a first vaginal delivery did not further enlarge the hiatus during straining (Valsalva), suggesting the first delivery has the greatest long-term impact on pelvic floor anatomy.

Study shows first delivery mode influences long-term pelvic floor anatomy up to 8 years after childbirth.

Obstetrics & Gynecology

An 8-year prospective cohort study found that women with at least one vaginal delivery experienced a gradual increase in levator hiatus area, a marker of pelvic floor anatomy, whereas those who delivered exclusively by Cesarean section showed a decrease over time. Notably, an additional vaginal birth after the first vaginal delivery did not further enlarge the hiatus during Valsalva maneuver, suggesting the initial mode of delivery has the greatest long-term influence on pelvic floor changes.

CARDIOLOGY

High SOFA scores after Morrow surgery predict worse long-term cardiac outcomes in HOCM patients, study finds.

High SOFA Scores After Morrow Surgery Predict Poor Long-Term Outcomes

A study of 380 patients with hypertrophic obstructive cardiomyopathy (HOCM) found that severe postoperative multi-organ dysfunction, defined by a SOFA score ≥11, significantly increased the risk of major adverse cardiac and cerebrovascular events (MACCEs), heart failure hospitalization, atrial fibrillation ablation, and cardiovascular death. Researchers suggest using SOFA scores for postoperative risk stratification and long-term patient management.

One in four women with GDM develop postpartum hypertension, supporting universal blood pressure screening after delivery.

Postpartum Hypertension Common After Gestational Diabetes

A prospective cohort study found that 26.4% of women with gestational diabetes mellitus (GDM) developed hypertension within five months postpartum, highlighting a substantial early cardiovascular risk. Older maternal age, Black or mixed ethnicity, higher early-pregnancy weight and blood pressure, and pregnancy-related hypertensive disorders increased risk. The findings support universal postpartum blood pressure screening, as many women also had obesity, dysglycemia, dyslipidemia, and renal dysfunction, creating opportunities for early cardiovascular prevention.

OA Doppler may offer a simple, low-cost way to detect angiogenic imbalance in near-term pregnancy, study finds.

OA Doppler Shows Promise for Detecting Angiogenic Imbalance in Pregnancy

A study of 203 near-term pregnancies found that ophthalmic artery (OA) Doppler parameters, particularly the peak systolic velocity (PSV) ratio, were significantly associated with the sFlt-1/PlGF ratio, a key marker of angiogenic imbalance linked to preeclampsia. An OA-PSV ratio <0.61 correctly identified 90.5% of women with normal sFlt-1/PlGF levels, highlighting OA Doppler as a promising, non-invasive and affordable screening tool.

Fetal MRI correlates well with TVS for cervical length but TVS remains the gold standard in pregnancy.

Fetal MRI Accurately Assesses Cervical Length in Pregnancy

A retrospective study found that fetal MRI-derived cervical length measurements strongly correlated with transvaginal ultrasound (TVS), the current gold standard, in pregnant women. MRI demonstrated 100% sensitivity and 100% negative predictive value for ruling out a second-trimester short cervix, suggesting it may help exclude cervical shortening when MRI is performed for other clinical indications. However, researchers emphasize that TVS remains the preferred method for cervical assessment until larger validation studies are completed.

Persistent hCG may sustain EMV after pregnancy, supporting targeted monitoring and less invasive management.

Persistent hCG Linked to Enhanced Myometrial Vascularity

A retrospective case series suggests that persistent enhanced myometrial vascularity (EMV) after pregnancy is linked to prolonged circulating human chorionic gonadotropin (hCG), likely produced by residual trophoblastic tissue. Researchers found EMV often resolved as hCG normalized, supporting expectant management in stable patients. Monitoring hCG levels and Doppler peak systolic velocity (PSV) may help distinguish self-resolving cases from those requiring intervention while reducing hemorrhage risk.

A 1-month cochlear implant score predicts long-term hearing outcomes, supporting early patient assessment.

One-Month Test Predicts Cochlear Implant Success

A longitudinal study of 530 adult cochlear implant recipients found that the greatest improvement in speech recognition occurs within the first three months after device activation, with performance trajectories largely established by one month. A 1-month CNC word recognition score of ≥44% accurately predicted successful hearing outcomes at 12 months. Researchers also found that sustained device use through six months was linked to better long-term hearing, highlighting the value of early assessment and continued patient engagement.

Vocal fold atrophy may serve as a potential marker of Alzheimer's and related dementias, new study suggests.

Vocal Fold Atrophy May Signal Alzheimer's and Related Dementias

A study comparing 13 patients with Alzheimer's disease and related dementias (AD/ADRD) to 26 age-matched controls found significantly greater vocal fold atrophy and reduced mucosal wave amplitude in those with dementia. The findings suggest that endoscopic assessment of vocal fold changes could serve as a potential laryngeal marker of neurodegeneration, although larger studies are needed to confirm its clinical value.

ENDO-DIABETOLOGY

Obesity is linked to worse long-term symptoms and higher revision surgery risk after sinus surgery, study finds.

Obesity Predicts Poor Long-Term Outcomes After Sinus Surgery

Among 664 patients undergoing endoscopic sinus surgery for chronic rhinosinusitis, elevated BMI was associated with worse baseline symptoms, progressive postoperative symptom deterioration over 5 years, and increased revision risk, particularly in patients with nasal polyps. BMI therefore warrants consideration in preoperative counseling and long‐term postoperative surveillance.

ABSTRACT

Objectives
Whether body mass index (BMI) influences long‐term clinical outcomes after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) remains unclear. We investigated whether BMI is associated with baseline symptom severity, longitudinal postoperative symptom trajectories, and time to revision surgery or biologic use.


Methods
We conducted a longitudinal cohort study of adult CRS patients undergoing ESS at a tertiary care center with 5‐year follow‐up. Preoperative BMI was categorized as normal weight (< 25.0 kg/m2), overweight (25.0–29.9), and obese (≥ 30.0). Outcomes were baseline 22‐item Sinonasal Outcome Test (SNOT‐22) scores, longitudinal SNOT‐22 trajectories analyzed via multivariable linear mixed‐effects models, and time to revision surgery or biologic use via multivariable Cox regression.


Results
Among 664 patients, 35.4% were normal weight, 35.5% overweight, and 29.1% obese. Obese patients had significantly higher baseline SNOT‐22 scores (β, 6.70; 95% CI, 2.56–10.85). A significant BMI‐by‐time interaction (p = 0.033) revealed that obese patients' symptoms worsened at a greater rate over time, increasing by 0.82 points per year versus normal‐weight patients. Elevated BMI predicted higher revision surgery risk (hazard ratio [HR], 2.41; 95% CI, 1.11–5.22), particularly in patients with nasal polyps (HR, 5.30; 95% CI, 1.45–19.35). Preoperative BMI was not associated with subsequent biologic use (HR, 1.67; 95% CI, 0.64–4.36).


Conclusion
Elevated BMI was associated with worse baseline symptoms, progressive postoperative symptom deterioration, and increased revision risk. Although baseline SNOT‐22 differences were below the minimal clinically important difference (MCID), cumulative longitudinal divergence exceeded the MCID by year 3, indicating that BMI should inform preoperative counseling and postoperative monitoring.


Level of Evidence
3.

ORTHOPAEDICS

Longer delays to pediatric ACL surgery increase cartilage injury risk and highlight healthcare access disparities.

Delays in Pediatric ACL Surgery Increase Cartilage Injury Risk

A cohort study of 443 children undergoing anterior cruciate ligament reconstruction (ACLR) found that nearly 39% experienced surgery delays exceeding 120 days after their first orthopedic visit. Non-Hispanic Black and Hispanic race/ethnicity, public insurance, and lower neighborhood opportunity were independently associated with longer delays. Each additional day of delay modestly increased the risk of severe cartilage injury, highlighting the need to address healthcare access disparities and streamline surgical pathways for pediatric ACL injuries.

RCT shows local infiltration analgesia alone provides effective pain relief after ACL reconstruction surgery.

LIA Alone Provides Effective Pain Relief After ACL Reconstruction

A double-blind randomized controlled trial involving 100 patients undergoing anterior cruciate ligament reconstruction (ACLR) found that adding an adductor canal block (ACB) to local infiltration analgesia (LIA) did not improve postoperative pain control, opioid use, quadriceps function, or early recovery. Patients receiving LIA alone achieved comparable outcomes, suggesting routine ACB may offer no additional clinical benefit while increasing procedure time, cost, and resource use.

PULMONOLOGY

ACBT and walking with huffing improved sputum clearance and quality of life during bronchiectasis flare-ups.

ACBT Matches Walking With Huffing for Bronchiectasis Exacerbations

A randomized trial involving adults hospitalized with bronchiectasis exacerbations found that the active cycle of breathing technique (ACBT) and walking with huffing provided comparable improvements in sputum clearance and health-related quality of life. OPEP therapy showed minimal benefit, while ACBT was associated with a longer time to the first exacerbation after discharge, although this finding requires further confirmation.

RHEUMATOLOGY

Low hydroxychloroquine exposure increases cardiovascular risk in lupus, emphasizing adherence and therapeutic levels.

Low Hydroxychloroquine Levels Raise Heart Risk in Lupus

A prospective study of 248 adults with systemic lupus erythematosus (SLE) found that patients with very low hydroxychloroquine (HCQ) blood levels and poor long-term medication adherence had a significantly higher estimated 10-year risk of atherosclerotic cardiovascular disease (ASCVD). Those who remained in or transitioned to low-exposure groups over one year had the greatest cardiovascular risk, highlighting the importance of maintaining therapeutic HCQ levels and adherence to improve long-term heart health.

OPHTHALMOLOGY

Retinal OCTA changes may help detect and monitor neurodegenerative and neurovascular disorders, study suggests.

Retinal OCTA Shows Promise as a Biomarker for Neurological Disorders

A systematic review and meta-analysis of 13 studies found that patients with neurodegenerative and neurovascular disorders consistently showed reduced retinal vessel density and enlarged foveal avascular zone (FAZ) on optical coherence tomography angiography (OCTA). These retinal microvascular changes may serve as non-invasive biomarkers for detecting and monitoring neurological disease, although larger standardized studies are needed.

Sleep-disordered Breathin...

Sleep-disordered Breathing in Pregnancy and after Delivery: Associations with Cardiometabolic Health