Asthma and allergic diseases are highly prevalent among pregnant women, and inadequate control is associated with increased risks of adverse maternal and fetal outcomes. Importantly, concerns about drug safety often result in therapeutic hesitation and undertreatment. This review summarizes the latest evidence on the pharmacological and safety considerations of asthma and allergy therapies during pregnancy. First, we describe the physiological changes of pregnancy, including alterations in the respiratory, cardiovascular, gastrointestinal, and renal systems, that significantly affect drug pharmacokinetics and pharmacodynamics. Second, we assess the safety profiles of commonly used therapies, including inhaled corticosteroids, long-acting β-agonists, long-acting muscarinic antagonists, systemic corticosteroids, and biologic agents. Finally, we highlight the importance of self-management, asthma action plans, multidisciplinary coordination, and shared decision-making. All of these approaches improve adherence, disease control, and outcomes in pregnant women with asthma.
INTRODUCTION:Both percutaneous left atrial appendage occlusion (LAAO) and nonvitamin K antagonist oral anticoagulants (NOACs) are noninferior to warfarin for stroke prevention in high-risk patients with atrial fibrillation (AF). However, there is limited data comparing LAAO with NOACs. The CATALYST trial compares a dual-seal LAAO device (Amplatzer™ Amulet™) to NOACs in AF patients indicated for thromboprophylaxis. METHOD:CATALYST is a prospective, multicenter, randomized controlled, open-label trial with an adaptive statistical design. Up to 2,650 AF patients with CHA2DS2-VASc score ≥2 (men) or ≥3 (women) will be randomly assigned to LAAO or NOAC at 123 global sites. Patients randomized to NOACs take the appropriate labeled dose with compliance monitored at each visit, while LAAO patients receive dual antiplatelet therapy followed by aspirin monotherapy for ≥12 months postimplant. Patients are followed through 5 years, with postimplant cardiac imaging at 3- and 12-months. There are three co-primary endpoints: (1) ischemic stroke, systemic embolism, or cardiovascular death through 2 years, tested for noninferiority; (2) major or clinically relevant nonmajor bleeding through 2 years, tested for superiority; and (3) ischemic stroke or systemic embolism through 3 years, tested for noninferiority. The following secondary endpoints will be tested if the primary endpoints are met: (1) all-bleeding, tested for noninferiority; (2) followed by testing for superiority; (3) disabling or fatal strokes, tested for superiority; all through 2 years. CONCLUSIONS:CATALYST is evaluating the safety and effectiveness of a dual seal LAAO device compared to NOACs in patients with AF at increased risk of stroke. CLINICAL TRIAL REGISTRATION:URL https://clinicaltrials.gov; Unique Identifier NCT04226547.
Esophagogastroduodenoscopy is essential to evaluate symptoms of suspected eosinophilic esophagitis (EoE), assess endoscopic findings, obtain biopsy specimens for histopathologic evaluation, perform esophageal dilation, confirm the diagnosis, and monitor the condition. The American Society for Gastrointestinal Endoscopy (ASGE) previously provided consensus recommendations on the approach to endoscopy in EoE across topics of endoscopic diagnosis, endoscopic grading, and esophageal dilation. Because additional areas of endoscopy still required guidance, we performed an independent modified Delphi process focusing on pediatric considerations, disease assessment, and disease monitoring. A core group of EoE experts reviewed published guidelines and developed a set of patient-centered recommendation statements informed by literature review. A multidisciplinary group of adult and pediatric international EoE experts then voted on the statements over 2 Delphi rounds. All statements with 80% agreement were accepted for inclusion. This process yielded 28 consensus statements. Pediatric-specific statements covered when to suspect EoE and perform endoscopy, how to grade endoscopic severity, and when and how to perform esophageal dilation in children. Statements across all age ranges addressed the role of less-invasive monitoring, performing diagnostic endoscopy off treatment, the need to consider symptoms, endoscopic features, and histologic findings when assessing disease activity, treatment-based monitoring intervals, and the approach to esophageal biopsies during monitoring. Coupled with the original consensus work, we provide a comprehensive endoscopic approach to EoE as well as practical guidance for procedure-related aspects in the field to facilitate high-quality endoscopic care to patients with EoE. (Gastrointest Endosc 2026;103:396-417.)
OBJECTIVE:Adult spinal deformity (ASD) surgery patients maintain upright posture by using numerous compensatory mechanisms. The distribution of this compensation throughout the skeleton has not been fully investigated. METHODS:Patients with lumbar deformity curves undergoing fusion from T10 to the pelvis were included. Groups were stratified by Scoliosis Research Society (SRS)-Schwab sagittal deformity severity (mild, moderate, and severe). Compensation was determined based on the published values of asymptomatic individuals by Bao et al. (2018), with patients outside 1 standard deviation of the mean values deemed to be compensating. Adequate deformity correction was determined based on matching published sagittal age-adjusted score (SAAS) criteria. Means comparisons tests assessed differences between cohorts at each time point. RESULTS:In total, 379 ASD patients were included (mean age 66.7 ± 10.2 years, body mass index 28.4 ± 5.4 kg/m2, Charlson Comorbidity Index 1.20 ± 1.73). In total, 23.8% of patients had mild deformity, 19.2% moderate, and 57% severe. The severe deformity cohort generally demonstrated the highest rates of compensation across all regions at different time points. At baseline, the severe and moderate cohorts demonstrated predominantly lower limb-dominant compensation, with the highest frequencies of compensation seen at the knee and pelvis. In the mild cohort, knee compensation was relieved by 1 year when adequate correction was achieved. For the moderate cohort, hip and pelvic compensation were relieved first, with knee compensatory relief occurring by 2 years. For the severe cohort, pelvic compensation was relieved first, with global lower limb and thoracic compensation subsequently occurring. CONCLUSIONS:There is notable variation in how ASD patients compensate as the severity of their deformity progresses. There is also variation in how these patterns are altered postoperatively.
