UMass Memorial Health Care

La endocarditis infecciosa ha sufrido cambios epidemiológicos importantes durante el curso de este siglo. De una mortalidad de casi el 100%, la enfermedad pasó a ser curable en un alto porcentaje de los casos. La introducción de los antibióticos y de la cirugía cardiovascular valvular han sido los bastiones de esta mejora notable en el pronóstico. A pesar de esta contribución monumental, las infecciones causadas por microorganismos resistentes a los antibióticos y la endocarditis infecciosa protésica mantienen a la endocarditis infecciosa en la categoría de enfermedad devastadora. En esta revisión se describen esquemas antibióticos actuales, indicaciones quirúrgicas para la cirugía cardiovascular valvular y las operaciones de aplicación reciente en la endocarditis infecciosa, así como sus resultados.

Lung biopsy has traditionally played a fundamental role in addressing diagnostic uncertainty and guiding management of fibrotic interstitial lung disease (fILD). Multiple lung biopsy procedures are available for evaluating fILD, including bronchoscopic techniques such as transbronchial biopsy and transbronchial lung cryobiopsy, as well as surgical lung biopsy, which is now almost exclusively conducted using minimally invasive video-assisted thoracoscopic surgery. The various evolving -considerations for and against lung biopsy have led to substantial ambiguity regarding the optimal timing and choice of biopsy method. The rationale for performing a lung biopsy in fILD is multifaceted, shaped by its potential to enhance diagnostic confidence and inform therapeutic decisions, weighed against procedural risks, and further nuanced by patient values and preferences. The objective of this state-of-the-art document from a multidisciplinary group of experts and patient representatives is to summarize the rationale for and against lung biopsy in the evaluation and management of fILD. Amid ongoing technological innovations, we further emphasize that future research should prioritize the development and validation of minimally invasive and noninvasive modalities that may serve as either alternatives or adjuncts to biopsy in the diagnostic evaluation of fILD.

Objectives: Postpartum depression is a major global mental health concern, yet epidemiological evidence from the Baltic region remains limited. This study aimed to estimate the prevalence of depressive symptoms among postpartum women attending postpartum outpatient care in Latvia and identify associated sociodemographic and clinical factors. Methods: A cross-sectional study was conducted at the outpatient department of the largest maternity hospital in Latvia from May 2024 to June 2025. All women aged 18 years or older, who attended a routine postpartum gynaecological visit 4 to 6 weeks after delivery and screened positive on the Patient Health Questionnaire-9 (PHQ-9) (≥5 points), completed a sociodemographic and clinical questionnaire and the Edinburgh Postnatal Depression Scale (EPDS). Descriptive statistics were used in the study, and logistic regression was used to examine factors associated with postpartum depressive symptoms. Results: A total of 272 women aged 18 to 49 years (mean age 30.66 ± 5.59) participated. PHQ-9 results indicated that 43.02% of respondents met the threshold for a positive screen (≥5 points) and were included in the further analysis. Using a cut-off EPDS ≥11, the point prevalence of clinically significant depressive symptoms among women who screened positive on the PHQ-9 was 11.4%. In univariate analyses, postpartum depressive symptoms were most strongly associated with comorbid mental disorders (OR = 4.55; 95% CI 1.85-11.18; p = 0.001), caesarean section (OR = 3.05; 95% CI 1.18-7.92; p = 0.022), stress (OR = 2.49; 95% CI 1.04-5.94; p = 0.04) and obstetric complications (OR = 2.78; 95% CI 1.01-7.64; p = 0.048) during pregnancy. In the multivariate model, only three independent predictors remained: comorbid mental disorder (aOR = 9.54; 95% CI 2.72-33.49; p < 0.001) and caesarean section (aOR = 5.80; 95% CI 1.66-20.21; p = 0.006) were associated with higher odds of postpartum depression, while first-time motherhood was associated with a substantially lower likelihood of depressive symptoms (aOR = 0.14; 95% CI 0.04-0.49; p = 0.002). Sociodemographic characteristics, including age, education, employment, and income, were not significant predictors. Conclusions: The point prevalence of clinically significant depressive symptoms among Latvian postpartum women screening positive for depression appears similar to other European settings. Comorbid mental disorders and caesarean section were the strongest predictors of depressive symptoms, while primiparity showed a protective effect. Sociodemographic factors did not independently contribute to risk. As the first study of its kind in Latvia and conducted within a clinical setting that captures a large and diverse proportion of postpartum women, these findings highlight the context-specific nature of postpartum depression and underscore the need for further longitudinal research to inform effective screening and intervention strategies.