Youth with perinatally acquired HIV (PHIV) are at risk for cardiovascular disease (CVD) despite combination anti-retroviral therapy (cART). Longitudinal data on the impact of HIV and cART on lipid metabolism and CVD risk in PHIV youth is limited. We investigated lipid and lipoprotein levels in PHIV youth and matched controls over time and examined associations with cART and metabolic syndrome (MetS) markers.

We included 32 PHIV and 36 controls at three time points: 2013, 2018 and 2023. In 2023, we assessed lipid profiles cross-sectionally in a larger cohort of 53 PHIV participants and 45 controls. Measurements included lipoprotein (a) (Lp(a)), apolipoprotein B (ApoB), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), reduced high-density lipoprotein cholesterol (HDL-C) and total cholesterol (TC) and markers related to MetS risk.

The median age was 21.7 years (IQR 16.7-25.2) for PHIV participants and 21.2 years (16.8-22.3) for controls in 2023 for longitudinal assessment. No significant differences in lipid or lipoprotein levels were observed over time (p values > 0.05). TG levels were significantly higher in PHIV participants at second assessment (p = 0.043), but other levels were comparable (p values > 0.05). Higher Lp(a) levels were associated with higher LDL-C and ApoB levels, however associations were significantly weakened among PHIV participants. Furthermore, protease inhibitor (PI) use was associated with elevated TC, TG and LDL-C. During cross-sectional assessment median age was 17.4 years (IQR 12.7-22.4) and 19.1 years (IQR 15.0-21.8) for PHIV youth and controls. Lipid and MetS markers were comparable between groups (p values > 0.05).

PHIV youth on cART showed similar lipid and lipoprotein levels over time compared to matched controls. Lp(a) associations with lipid markers were weakened for PHIV youth and PI use was associated with lipid alterations. Our results imply that while lipid profiles, including Lp(a), are important components of cardiovascular health monitoring, the increased CVD risk observed in PHIV youth may be more substantially influenced by disease-specific or broader pathophysiological mechanisms related to HIV-infection and treatment.

Dutch clinical trial registration: Overview of Medical Research in the Netherlands (OMON) (ID: NL-OMON53727).

Prenatal diagnosis of coarctation of the aorta (CoA) remains challenging due to the high false-positive rate of traditional echocardiographic markers. This study aimed to assess the diagnostic value of a novel sonographic marker, the "Y sign," defined as the confluence of the aortic and ductal arches on the sagittal view, in predicting postnatal CoA. In addition, we evaluated the reproducibility and detectability of the "Y sign" in a large cohort of structurally normal fetuses.

A retrospective review was conducted of 9,000 fetal echocardiograms performed between January 2020 and June 2025 at a tertiary perinatology center. Fetuses with isolated suspicion of CoA were included if the aortic isthmus diameter measured in the sagittal arch view was at least 2.5 SD below the gestational age-adjusted normative mean. The presence or absence of the "Y sign," representing the branching morphology of the aortic and ductal arches, was assessed using dynamic sagittal cine imaging. Interobserver agreement for the 'Y sign' was assessed by two blinded maternal-fetal medicine specialists reviewing 200 normal fetuses (18-24 weeks), using Cohen's kappa.

Ten fetuses met the inclusion criteria. The "Y sign" was absent in 8 fetuses, 7 of whom were postnatally confirmed to have CoA, yielding a sensitivity of 100%, specificity of 67%, and positive predictive value of 87.5%. The "Y sign" was clearly visualized in 2 fetuses, both without postnatal CoA. Among the 7 CoA-confirmed cases, bicuspid aortic valve was present in 5 (71.4%). In one "Y-negative" fetus without postnatal CoA, a shelf-like protrusion in the descending aorta was noted, though it lacked hemodynamic significance. Of 200 healthy fetuses, the 'Y sign' was concordantly positive in 169 and negative in 18 cases; 13 were discordant. Interobserver agreement was substantial (κ = 0.76), supporting reproducibility.

The absence of the "Y sign" appears to be a sensitive and reproducible marker for prenatal CoA prediction. Although its specificity is moderate, the "Y sign" offers a practical, qualitative alternative to complex angle-based measurements, and may serve as a valuable adjunct in prenatal screening protocols, particularly when integrated with other structural and biometric parameters.

Integrating large language models (LLMs) with virtual patient platforms offers a novel approach to teaching clinical reasoning. This study evaluated the performance and educational value of combining Body Interact with two AI models, ChatGPT-4 and DeepSeek-R1, across acute care scenarios.

Three standardized cases (coma, stroke, trauma) were simulated by two medical researchers. Structured case summaries were input into both models using identical prompts. Outputs were assessed for diagnostic and treatment consistency, alignment with clinical reasoning stages, and educational quality using expert scoring, AI self-assessment, text readability indices, and Grammarly analysis.

ChatGPT-4 performed best in stroke scenarios but was less consistent in coma and trauma cases. DeepSeek-R1 showed more stable diagnostic and therapeutic output across all cases. While both models received high expert and self-assessment scores, ChatGPT-4 produced more readable outputs, and DeepSeek-R1 demonstrated greater grammatical precision.

Our findings suggest that ChatGPT-4 and DeepSeek-R1 each offer unique strengths for AI-assisted instruction. ChatGPT-4's accessible language may better support early learners, whereas DeepSeek-R1 may be more aligned with formal clinical reasoning. Selecting models based on specific teaching goals can enhance the effectiveness of AI-driven medical education.

To assess the impact of glycated hemoglobin A1c (HbA1c) in individuals without diabetes and at the extremes of cardiovascular risk factor (CVRF) burden on the incidence of atherosclerotic cardiovascular disease (ASCVD) and all-cause mortality.

We studied 20,360 U.S. adults, initially free of diabetes and ASCVD from the CARDIA, MESA, ARIC, and FOS cohorts, all with available HbA1c data. The mean (standard deviation) age was 57.1 (9.1) years [56.2% women and 21.9% Black]. Using multivariable Cox proportional hazard regression, ASCVD and all-cause mortality were analyzed over a median 16.7-year follow-up across categories of CVRF burden (0, 1, 2, or 3 of dyslipidemia, smoking, and hypertension) and HbA1c levels (< 5.0%, 5.0-5.4% [reference], 5.5-5.9%, and 6.0-6.4%).

During follow-up, 3592 ASCVD events (17.6%) and 6627 deaths (32.6%) occurred. The hazard ratios (HRs) and 95% confidence intervals (CIs) for HbA1c levels of 5.5-5.9% and 6.0-6.4% for ASCVD were 1.17 (1.09-1.26) and 1.59 (1.42-1.78), respectively. The corresponding HRs for mortality were 1.14 (1.07-1.20) and 1.35 (1.24-1.47). HbA1c < 5.0% was also associated with an elevated mortality risk (HR, 95% CI 1.17, 1.07-1.28). Among individuals with 0 CVRFs, the HRs for ASCVD risks ranged from 1.26 (1.02-1.55) for HbA1c 5.5-5.9% to 1.68 (1.12-2.54) for HbA1c 6.0-6.4%. For those with 3 CVRFs, the corresponding HRs were 1.22 (0.88-1.69) and 2.00 (1.35-2.97). Similar findings were observed for all-cause mortality. Subgroup analysis revealed that HbA1c ≥ 5.5% was associated with an increased mortality risk in non-Black individuals but did not reach statistical significance in Black individuals (P interaction < 0.001).

HbA1c testing in individuals without diabetes may help identify those at higher risk for ASCVD and mortality, even at the extremes of CVRF burden.

Sudan's pediatric cardiac surgery services improved over the past decade, especially after the 2022 national free program. However, conflict in April 2023 halted all services. There is a scarcity of scholarly literature concerning pediatric cardiac surgery in low-income African countries such as Sudan. This study documents the achievements made before the conflict.

This was a prospective observational study conducted at the Sudan Heart Center. Data were collected from hospital medical records between January and December 2022. All patients who underwent surgical intervention during that period were included, while those who did not undergo surgery were excluded. Standardized Quality Performance Indicators (QPIs) were applied to evaluate outcomes. The primary outcome was overall mortality. The secondary outcome included ICU stay, hospital stay, and postoperative complication rates.

A total of 229 patients underwent pediatric cardiac surgery, with males representing 57.2%. The median age; 3 years (IQR 0-6) and the median weight; 12 kg (IQR 7-17.5). Ventricular septal defect repair 25% and tetralogy of Fallot repair 21.8% were the most common operations, complex surgeries such as Fontan, Rastelli, and arterial switch surgeries were also performed. The measured mortality rate was 12.2%, the median ICU stay; 3 days (IQR 1-5) and hospital stay; 7 days (IQR 5-11). Observed complications included central line-associated bloodstream infection 7.4%, surgical site infection 2.6%, urinary tract infection 1.7% and ventilator-associated pneumonia 0.9%. Peritoneal dialysis was used in 5.2% of patients, and neurological complications occurred in 4.8%. Diaphragmatic paralysis and chylothorax were observed in 1.3% and 1.7% of patients, respectively. No patient required permanent pacemaker (PPM) implantation.

Sudan's pediatric cardiac surgical services, though limited in resources, had developed to a level similar to that of other low-income African countries. The 2023 armed conflict has likely erased these gains by shutting down all cardiac services. To restore and sustain such programs, international long-term support is required in crisis-affected regions.

Fatty acid oxidation disorders (FAODs) are a group of rare diseases caused by deficiencies in the function of enzymes or proteins involved in the mitochondrial oxidation of fatty acids. This study aimed to analyze the incidence, disease spectrum, gene profile, and clinical phenotypes of FAODs in the southeastern coastal region of China. Between January 2016 and June 2024, acylcarnitine, genetic mutation, and clinical manifestation data were collected from patients diagnosed with FAOD through newborn screening. A total of 210,913 newborns were screened, identifying 36 cases of FAODs, with an overall incidence of 1 in 5,859. Primary carnitine deficiency (PCD) was the most prevalent FAOD, with an incidence of 1 in 9,587, followed by multiple acyl-CoA dehydrogenase deficiency (MADD). Moreover, we identified 32 mutations, including 5 novel variants. Patients with PCD who carried homozygous variants (R254*) of the SLC22A5 gene demonstrated significantly lower average free acylcarnitine levels than those with compound heterozygous variants (2.45 ± 1.27 µmol/L versus 4.42 ± 1.13 µmol/L, p < 0.05). In patients with MADD, rescreening revealed lower levels of characteristic acylcarnitines (C6, C8, C10, C12, and C14) compared with initial screening values, with 42.3% returning to normal levels. During long-term follow-up (approximately 6 years), all patients remained under clinical surveillance initiated based on their NBS diagnosis. One patient with PCD developed severe retinal detachment at age 5. Three patients with long-chain FAOD (two VLCADD, one CPT-IID) died following infections that triggered metabolic crises (ages 5 and 8 months, respectively). These fatal outcomes occurred despite early diagnosis and initiation of standard management protocols prompted by the NBS results. No other severe complications were observed in the surviving cohort. Our findings highlight the importance of developing screening protocols and clinical management strategies to improve outcomes for affected newborns.

The loss of cardiovascular health (CVH)-a strong predictor of future health-begins early in life and disproportionately affects racial/ethnic minorities. We sought to quantify the contribution of household disadvantage to racial/ethnic disparities in CVH among US youth.

We analyzed data from 6690 youth (60.3% non-Hispanic White [NHW], 14.9% non-Hispanic Black [NHB], and 24.8% Hispanic/Latinx) ages 2-18 years old from the 2013-2018 National Health and Nutrition Examination Surveys. CVH was measured using the American Heart Association's Life's Essential 8 guidelines to combine 8 factors (diet, physical activity, nicotine exposure, sleep, BMI, blood glucose, blood pressure, and blood lipids) into one score ranging from 0 to 100 (higher is better). The contributions of six household-level determinants of health: parental education, marital status, household income, household food insecurity, overcrowding, and home ownership, to differences in CVH by race/ethnicity and sex were quantified using Kitagawa-Blinder-Oaxaca decomposition tests.

CVH scores were higher among NHW girls (mean [SD] 78.3 [10.6]) and boys (78.2 [10.8]) than their NHB and Hispanic/Latinx counterparts. No significant difference in CVH was observed between NHW and NHB boys. NHW girls had CVH scores 2.5-point higher than NHB girls (mean difference [MD] = 2.45; 95% CI: 0.91, 3.98). Cumulatively, all six household determinants explained 67% of girls' CVH gap. Disparities in household income alone accounted for 41% of this difference (b = 1.00; 95% CI: 0.10, 1.90). NHW boys and girls had 1.6- and 1.5-point higher CVH scores than their Hispanic/Latinx same-sex counterparts. The combined six household determinants explained over 75% of these differences. For Hispanic/Latinx boys, differences in household food insecurity explained 36% of their mean CVH difference (b = 0.59; 95% CI: 0.12, 1.06), while differences in household income accounted for 67% of the CVH gap for Hispanic/Latinx girls (b = 1.00; 95% CI: 0.14, 1.85).

NHB and Hispanic/Latinx youth had lower CVH scores than their NHW counterparts, with differences in household income and food security accounting for most of their CVH gap. These findings suggest racial and ethnic disparities in CVH in youth and future CVD risk are one more negative consequence of childhood poverty.

Guideline-directed medical therapy (GDMT) improves survival and quality of life in patients with heart failure with reduced ejection fraction (HFrEF). However, real-world adherence to these guidelines remains suboptimal. This study aimed to evaluate prescribing adherence to GDMT in HFrEF patients using a global guideline adherence scoring tool.

This retrospective study included adult patients with HFrEF (left ventricular ejection fraction ≤ 40%) attending the Heart Failure Clinic at the National Heart Centre in Oman between January and June 2022. GDMT adherence was assessed based on 2021 European Society of Cardiology guidelines. Adherence levels were categorized as good (all indicated GDMT at ≥ 50% of target dose), moderate (more than half at ≥ 50%), or poor (less than half or < 50%). Descriptive statistics and chi-square tests were used to identify associations.

Of the 259 patients included (mean age 57 ± 13.6 years, 70% male), 71% had good adherence, 22% moderate, and 7% poor. Target dose attainment varied by drug class: 78% for beta-blockers, 63% for ACEI/ARB/ARNI, 96% for MRAs, and 100% for ivabradine. Suboptimal GDMT (< 50% target dose) was significantly associated with hypertension (P = 0.004), dilated cardiomyopathy (P = 0.015), chronic kidney disease (P = 0.001), and older age (P = 0.004).

Prescribing adherence to GDMT in Oman is consistent with international data. Suboptimal titration was significantly linked to older age and comorbidities, suggesting that perceived frailty and clinical complexity may influence physician prescribing patterns. Efforts to improve individualized, patient-centered GDMT titration are warranted.

Coronary atherosclerosis is a leading cause of coronary heart disease (CHD), particularly among postmenopausal women who experience significant hormonal changes that influence lipid metabolism and inflammatory processes. We aimed to investigate the correlation between monocyte-to-HDL-cholesterol ratio (MHR), estradiol and the severity of coronary lesions in postmenopausal patients with CHD.

This study included 360 postmenopausal women diagnosed with CHD. The Gensini score (GS) was obtained from coronary angiography, and patients were divided into three groups according to the severity of coronary lesions assessed by GS - patients with mild coronary lesions (Gensini score < 20), patients with moderate coronary lesions (20 ≤ Gensini score < 40) and patients with severe coronary lesions (Gensini score ≥ 40). We used ordinal logistic regression to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the association between estradiol, MHR, and coronary lesion severity. For assessing the value of estradiol and MHR in predicting the severity of CHD, we adopted the generalized area under the receiver operating characteristic (ROC) curve method.

The severe lesion group had the lowest estradiol levels and the highest MHR (all p < 0.001). MHR showed a weaker negative correlation with estradiol levels. After adjusting for confounding factors, estradiol was significantly negatively correlated with the severity of CHD (OR = 0.93, 95%CI = 0.91-0.96), while MHR was significantly positively correlated with the severity of CHD (OR = 1.15, 95%CI = 1.01-1.29). Interaction analysis showed significant interaction between estradiol levels and MHR (p < 0.001). The area under the curve (AUC) of MHR and estradiol in predicting the severity of CHD in postmenopausal women for the ROC analysis was 0.806 (95%CI = 0.745-0.866) and 0.661 (95%CI = 0.592-0.730), respectively. The AUC of MHR combined with estradiol was 0.826 (95%CI = 0.774-0.877).

Both estradiol and MHR are independently correlated with and can be used to predict the severity of CHD in postmenopausal women. The combination of estradiol and MHR has a higher predictive value for the severity of CHD.

Not applicable.

The benefits and risks of sleep medications among patients with hypertension and sleep disturbance remain unclear. This study aims to investigate the potential benefits and risks of sleep medications in this population.

This was a prospective cohort study among US adults, using hypertension and medication data from the National Health and Nutrition Examination Survey (NHANES). Linear regression assessed the efficacy of sleep medications in controlling blood pressure. Cox regression explored associations between sleep medications and mortality.

This study included 4836 participants taking antihypertensive medication with sleep disturbance. Compared with non-users, benzodiazepine users had an adjusted estimated systolic blood pressure (SBP) difference of -2.22 mmHg (95% CI, -3.70 to -0.74; P = 0.003), while benzodiazepine-like agents (Z-drugs) users had a more pronounced difference of -3.33 mmHg (95% CI, -5.85 to -0.81; P = 0.010), with diazepam, clonazepam, and zolpidem demonstrating significant antihypertensive effects. The median follow-up time was 82.3 months, and 809 all-cause deaths occurred. Sleep medications (hazard ratio [HR]: 1.14; 95% CI, 0.97 to 1.33; P = 0.120) and benzodiazepine users (HR: 1.05; 95% CI, 0.87 to 1.26; P = 0.639) were not associated with an increased risk of all-cause mortality, while Z-drug users were linked to a higher risk (HR: 1.39; 95% CI, 1.04 to 1.85; P = 0.025) compared to non-users. No significant association was found with cardiovascular mortality.

Sleep medication use is associated with lower blood pressure and is not significantly associated with an elevated mortality risk among hypertensive participants with sleep disturbance.