Hospital Montecelo

Spin refers to reporting strategies that highlight the benefits of an experimental treatment or divert attention from nonsignificant primary outcomes. To assess spin in randomized clinic trials (RCTs) on pharmaceutical efficacy in multiple sclerosis (MS) and explore associated factors. A systematic literature search was conducted in MedLine (PubMed), EMBASE, and Cochrane using database-specific thesauri ("Multiple Sclerosis" and "Drug Therapy") to identify relevant studies. We included multiple sclerosis phase 3 and 4 randomized controlled trials with parallel, superiority designs that were published between 2013 and 2024 reporting nonsignificant primary outcomes. Spin was assessed in title, abstract conclusion, results, discussion, and conclusions. A descriptive analysis was followed by exploratory bivariate logistic regression. Independent variables included trial phase, sample size, drug type, comparison, follow-up time, registration, Consolidated Standards of Reporting Trials (CONSORT) mention, risk of bias (RoB2), journal quartile, first author affiliation, and conflict of interest. Forty articles met inclusion criteria. Spin appeared in at least one section in 25 articles (62.5%) and in 3 or more in 19 articles (47.5%). The most frequent locations were abstract conclusions, discussion, and conclusions. Spin was significantly associated with smaller sample size (odds ratio [OR] = 7.00, 95% confidence interval [CI] = 1.29-37.91, p = 0.024), non-Q1 journals (OR = 4.38, 95% CI = 1.03-18.63, p = 0.046), and first author affiliation outside Europe or the United States (OR = 5.09, 95% CI = 1.15-22.62, p = 0.032). Spin is common in MS randomized controlled trials with nonsignificant primary outcomes and may mislead clinical decisions. ANN NEUROL 2026;99:316-327.

Surgical site infections (SSIs) are one of the most frequent and preventable complications in perioperative care, representing a priority challenge for patient safety and quality of care. Nursing plays a central role in the implementation of preventive measures, from hand hygiene to the application of surgical bundles, clinical surveillance, and patient and family education. This study developed a systematic review of the literature published between 2019 and 2025 in international and regional databases (PubMed, CINAHL, Scopus, Web of Science, SciELO, and LILACS), selecting twenty articles that met inclusion criteria. The findings show that nursing interventions, especially perioperative bundles, clinical auditing, and educational strategies, reduce SSI rates by 20% to 45%, improve adherence to protocols, and strengthen the culture of surgical safety. Likewise, structural barriers were identified in low- and middle-income settings, such as resource limitations and insufficient training. In conclusion, the evidence confirms that nursing is a key factor in reducing SSIs, providing sustainability to preventive strategies, and consolidating surgical patient safety in various hospital settings.

Obstetric hemorrhage remains one of the leading causes of maternal mortality worldwide, despite advances in preventive and therapeutic strategies. Advanced surgical techniques (TEQUIAV), such as compression sutures, intrauterine tamponade, arterial ligation, and uterine embolization, represent effective options for preserving the uterus and controlling bleeding when medical treatment fails. This systematic review aimed to analyze recent evidence on the role of nursing staff in implementing and supporting TEQUIAV for the prevention and control of obstetric hemorrhage. A comprehensive search of international databases (PubMed, Scopus, Cochrane, LILACS, and SciELO) was conducted between 2019 and 2025, selecting 20 articles with medium and high methodological quality according to the 2020 PRISMA guidelines. The results showed that nursing plays a decisive role in preoperative preparation, surgical instrumentation, intraoperative hemodynamic monitoring, and postoperative follow-up. Furthermore, ongoing training, clinical simulation, and the formal inclusion of nursing staff in institutional protocols were identified as improving maternal safety and outcomes. In conclusion, strengthening nursing technical competencies and leadership is essential to optimize the effectiveness of TEQUIAV and reduce morbidity associated with obstetric hemorrhage.

BackgroundIn patients with long-standing persistent (LSPer) atrial fibrillation (AF), the efficacy of catheter ablation remains limited, with long-term freedom from atrial arrhythmias typically reported at around 30% following a single procedure. Moreover, clinical evidence regarding the use of novel pulsed-field ablation (PFA) technology in this patient population is currently limited.PurposeWe aimed to analyze the efficacy and safety of PFA in patients with LSPer AF compared to early-persistent AF (Eper AF).MethodsAll consecutive patients undergoing persistent AF ablation with the Farapulse PFA system at 16 Italian centers with follow-up information were included. A standard protocol-directed pulmonary vein isolation (PVI) with 8 application per PV was applied with additional lesions performed at the operator’s discretion. EPer AF was defined as AF that is continuous and sustains for >7 days (but < 12 months) and requires intervention, while LSPer AF was defined as AF that is continuous for >12 months in duration.ResultsOf 434 patients, 35.5% had LSPer AF, 20.9% were female, and the mean age was 64±9 years. A more extensive lesion set than PVI was performed in 58.3% of cases, with 18.4% being redo-AF procedures. In patients with LSPer AF a 3D mapping system (45.5% vs 31.4%, p=0.005) and an intracardiac echography (33.1% vs 21.1%, p=0.009) were employed more frequently than in patients with EPer AF, while a more extensive lesion set than PVI only was used in a similar way (59.7% vs 57.5%, p=0.685). No differences were found between groups in terms of PFA deliveries outside PVs (20[14-28] vs 18[14-22], p=0.126), total number of PFA deliveries (48[32-54] vs 46[32-54], p=0.0616), skin-to-skin time (75[65-95] min vs 79[65-95] min, p=0.326) or time to PVI (19[15-24] min vs 19[12-25] min, p=0.549), whereas fluoroscopy time was longer (22[17-25] min vs 17[13-24] min, p<0.001). PVI was achieved in all patients. During a median follow-up of 309[194-384] days, 87 (20%) of patients experienced an arrhythmic recurrence after the 90-day blanking period. The proportion of patient with LSPer AF who experienced a recurrence was similar to the ones with EPer AF (20.1% for LSPer AF vs 20% for EPer AF, odd ratio=1.01, 95%CI: 0.62 to 1.65, p=0.0974); LSPer AF was not associated to recurrences (hazard ratio=1.06, 95%CI: 0.68 to 1.66, log-rank p=0.785). No major complications (including death, renal failure, oesophageal complications, PV stenosis, persistent phrenic nerve injury) were reported.ConclusionIn our experience, the use of the Farapulse PFA system for long-standing persistent AF demonstrated safe and effective outcomes, similar to those observed in patients with early persistent AF.

BackgroundSodium–glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of heart-failure admission among high-risk patients. However, most patients with valvular heart disease, including those undergoing transcatheter aortic-valve implantation (TAVI), have been excluded from randomized trials.MethodsWe conducted this randomized, controlled trial in Spain to evaluate the efficacy of dapagliflozin (at a dose of 10 mg once daily) as compared with standard care alone in patients with aortic stenosis who were undergoing TAVI. All the patients had a history of heart failure plus at least one of the following: renal insufficiency, diabetes, or left ventricular systolic dysfunction. The primary outcome was a composite of death from any cause or worsening of heart failure, defined as hospitalization or an urgent visit, at 1 year of follow-up.ResultsA total of 620 patients were randomly assigned to receive dapagliflozin and 637 to receive standard care alone after TAVI; after exclusions, a total of 1222 patients were included in the primary analysis. A primary-outcome event occurred in 91 patients (15.0%) in the dapagliflozin group and in 124 patients (20.1%) in the standard-care group (hazard ratio, 0.72; 95% confidence interval [CI], 0.55 to 0.95; P=0.02). Death from any cause occurred in 47 patients (7.8%) in the dapagliflozin group and in 55 (8.9%) in the standard-care group (hazard ratio, 0.87; 95% CI, 0.59 to 1.28). Worsening of heart failure occurred in 9.4% and 14.4% of the patients, respectively (subhazard ratio, 0.63; 95% CI, 0.45 to 0.88). Genital infection and hypotension were significantly more common in the dapagliflozin group.ConclusionsAmong older adults with aortic stenosis undergoing TAVI who were at high risk for heart-failure events, dapagliflozin resulted in a significantly lower incidence of death from any cause or worsening of heart failure than standard care alone. (Funded by Instituto de Salud Carlos III and others; ClinicalTrials.gov number, NCT04696185.)

Objective: this study analyzed long-term therapeutic failure after bariatric surgery and validated a 10-year predictive risk model. We aimed to integrate clinical and postoperative variables to identify failure-associated factors and establish a clinically useful threshold for follow-up. Methods: A retrospective observational cohort study was conducted including 96 patients (78.1% women, mean age 41.3 years, BMI 44.6 kg/m²) who underwent gastric bypass (n = 75) or sleeve gastrectomy (n = 19). Therapeutic failure was defined as <50% excess weight loss or recurrence of comorbidities. A logistic regression model was developed including baseline BMI, %EWL at 1 year, BMI reduction, type 2 diabetes (T2DM), and hypertension (HTN). Model performance was assessed using ROC curves and the Hosmer-Lemeshow test. Results: failure rates increased from 18 % to 32 % over 10 years. Risk factors: higher baseline BMI (OR = 1.24), T2DM (OR = 3.77), and HTN (OR = 3.83). One-year BMI loss was protective (OR = 0.72). The model showed strong predictive capacity (AU C = 0.858), with an optimal threshold of 28.6 % (sensitivity 84.6 %, specificity 80.6 %, NPV 93.1 %). Gastric bypass had lower failure rates (28 % vs. 38 %) and better predictive performance (AUC = 0.89 vs. 0.78). Conclusions: the model effectively predicts long-term failure, with gastric bypass demonstrating superior outcomes. We recommend prioritizing this procedure for patients with higher BMI or comorbidities.

Abstract Background A comprehensive understanding of pulmonary vein (PV) reconnection and residual potentials (RAP) within the antral scar during repeat atrial fibrillation (AF) ablation, facilitated by advanced mapping and ablation technologies, is currently lacking. Optimizing radiofrequency (RF) deliveries after failed PV isolation (PVI) may enhance ablation efficiency. Purpose This study aims to assess both the acute and long-term outcomes focusing on PV gaps (PVGs) and RAPs, utilizing advanced mapping and ablation technologies during repeat PV ablation in patients (pts) with paroxysmal AF. Methods Repeat AF-CHARISMA study, a prospective, single-arm cohort study, included consecutive pts from 13 centers undergoing repeat ablation of paroxysmal AF. The Lumipoint (Boston Scientific) map-analysis tool was used sequentially on each PV component. All patients were followed-up for at least 12 months after the procedure. The ablation endpoint was PVI and electrical quiescence in the antral region. Long-term outcome was the recurrence of AT/AF over follow-up. Results One-hundred pts were included (69% after failed RF procedure, 31% after failed cryoablation procedure). A total of 276 PVGs (192 after RF ablation, 2.8±1.8/pt; 84 after cryoablation, 2.7±1.9/pt, p=0.665 vs RF) and 44 RAPs (43 after RF ablation, 0.6±1.1/pt; 1 after cryoablation, 0.03±0.2/pt, p=0.002 vs RF) were detected. In the majority of cases (75%), only PVGs were present whereas, in 21%, both PVGs and RAPs were detected (2 pts had only RAPs). In 2 pts no PVG nor RAP were identified. PVGs were most common at anterior sites (103, 37.3%), followed by posterior sites (75, 27.2%) and carina sites (49, 17.8%). PVG location sites did not differ between prior ablation approach. Only 1 pt after cryoablation showed a RAP (at carina site), whereas the 44 RAPs after RF were fairly distributed across different sites. Acute procedural success was 100%, with all PVs successfully isolated and RAPs completely abolished in all study pts. After the blanking period, over a follow-up of 480±211 days, 18 pts (18%) suffered an AT/AF recurrence (time to recurrence: 245±80 days). Previous ablation approach (HR=0.66, 95%CI: 0.2 to 2.0 for previous cryoablation, p=0.46), number of PVGs (1.05, 0.8 to 1.3, p=0.67) or number of RAPs (0.41, 0.1 to 1.2, p=0.12) were not associated to AT/AF recurrence. No major complications or adverse events occurred. Conclusion A structured ablation workflow for repeat catheter ablation, incorporating consistent high-density mapping and improved diagnostic tools to guide the procedure, demonstrated safety and efficacy in treating paroxysmal AF irrespectively of previous ablation approach. Residual potentials within the antral scar were more frequently detected after RF ablation compared to cryoablation.