Purulent pericarditis is a rare, but life-threatening condition occurring in roughly 27.7 cases of pericarditis per 100,000 population per year in developed countries. Gram positive cocci are the predominant causative pathogens with Staphylococcus aureus and Streptococcus species being the most common. Early recognition is essential in preventing complications such as cardiac tamponade, constrictive pericarditis, and effusive-constitutive pericarditis. Despite appropriate medical management including both drainage and antibiotics, mortality rates remain elevated and approximately 50% of cases are diagnosed postmortem.

An 84-year-old male with a history of myelodysplastic syndrome, permanent atrial fibrillation and heart failure with preserved ejection fraction presented to the emergency department with sharp, left-sided chest pain radiating to the right shoulder, worsened by inspiration. A computed tomography angiogram performed to evaluate for pulmonary embolisms revealed a large pericardial effusion. Electrocardiogram (EKG) demonstrated low-voltage tachycardia. Transthoracic echocardiography showed a large circumferential pericardial effusion with fibrinous strands. The patient underwent pericardiocentesis with drainage of 450 cc of purulent fluid, followed by placement of a pericardial drain. Fluid analysis revealed a pH of 6.9 and 15,095 nucleated cells/μL with 89% neutrophils. Pericardial fluid and blood cultures were positive for MRSA. The patient was initiated on intravenous vancomycin and transesophageal echocardiography was negative for infective endocarditis. He was subsequently transitioned to daptomycin to complete a four-week course of antibiotics. Repeat blood cultures were negative.

This case illustrates the diagnostic challenges and management considerations for MRSA-associated purulent pericarditis in a frail host. Early echocardiography and pericardiocentesis are critical in management. Despite source control and target antibiotics, mortality remains high in frail hosts.

Despite the proven efficacy of direct oral anticoagulants (DOACs) in preventing thrombus formation in atrial fibrillation (AF), thrombus formation may rarely occur even with appropriate anticoagulation. We report the case of a 70-year-old woman with a history of AF, initially on warfarin, who underwent percutaneous left atrial appendage closure with a Watchman FLX 27 mm device due to recurrent gastrointestinal bleeding. She subsequently developed multiple unprovoked deep venous thromboses, necessitating the reinitiation of rivaroxaban therapy. She presented to the hospital with complaints of lower abdominal pain. Although the CT abdomen and pelvis was not a dedicated cardiac study, the superior slices incidentally captured the inferior and posterior left atrium, revealing a lobulated soft-tissue density suspicious for thrombus. Labs included INR 1.8, APTT of 40, and D-dimer of 0.62. Transthoracic echocardiography could not visualize thrombus. Transesophageal echocardiography revealed a large mobile thrombus in the superior cavity of LA. The watchman device was well seated with no flow noted across the device. A hypercoagulability workup showed low levels of Protein S antigen at 21. She was placed on warfarin. Follow-up TEE in 3 months showed a decrease in the thrombus size. This case highlights the importance of evaluating an underlying hypercoagulable state when thrombus develops despite DOAC therapy. While DOACs prevent thrombus formation in atrial fibrillation, their failure should not be dismissed as incidental. Clinicians should pursue a hypercoagulability workup, especially when thromboembolic events appear disproportionate to the CHA₂DS₂-VASc score. Early identification of inherited or acquired thrombophilies can guide tailored and effective long-term management.

Intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) are the keystones of current treatment for acute ischemic stroke. Most IVT candidates harbor medium or distal arterial occlusions, while EVT targets large artery occlusions. However, both treatments often fail to achieve sustained recanalization, microvascular reperfusion, and optimal clinical outcomes. Supplementing IVT with antithrombotic therapies has not shown consistent benefit, and alternative lytics such as tenecteplase provide, at best, a marginal improvement in outcome compared with alteplase. This review summarizes current evidence on multiple dosing strategies of IVT, including repeat administration of IVT in non-EVT candidates and IVT or intra-arterial thrombolytics in combination with EVT. We discuss the physiologic, pharmacokinetic, and clinical rationale for these approaches, highlight results from key clinical trials, and identify knowledge gaps to guide future research. Emerging data support novel fibrinolytic agents, sequential IVT dosing, and adjunct intra-arterial thrombolysis as promising strategies to enhance reperfusion and functional recovery while maintaining safety.

The engagement of youth in the design of services that promote and increase the uptake of essential services to reduce HIV and other sexually transmitted infections is vital to sustaining these preventive services. The study objective is to identify strategies for sustaining HIV prevention services among Nigerian youth, in partnership with community-based organizations, through a crowdsourced open call and designathon in Nigeria.

From February to March 2024, Nigerian youth (ages 14-24) submitted ideas to an open crowdsourcing call on how community-based organizations in Nigeria might sustain HIV self-testing and youth-friendly preventive services for at-risk youth. The submissions were scored in each domain: relevance, novelty, scalability, replicability, potential for sustainability, and promotion of equity and fairness, with an integer score of 1 (low) to 3 (high)(S1). Ten teams were selected to participate in the 72-hour designathon. Both quantitative and qualitative analysis was conducted. The study used thematic analysis and the PEN 3-Cultural Model to categorize qualitative data into six themes. Descriptive statistics were used to calculate participants' demographic characteristics.

One hundred and seventy-eight participants submitted entries; 161 were online entries, and 17 were received via WhatsApp. The majority of participants were female (57.1%) and aged 19-23 years (55.0%), with a mean age of 21.7 (±4.1). Most participants were from the southwest of Nigeria (53.8%), had secondary education (68.9%), and were students (67.9%). About one-third of teams (31.1%) indicated collaborating with non-governmental organizations as a promising way to sustain preventive services. Six themes emerged: Adapted Intervention Design and Delivery, Youth Engagement and Education, Organization Setting, Socio-cultural and Community Context, Community Leadership Through Training and Financial Resources, and Sustainment Through Community Collaboration.

The crowdsourcing contest open call and designathon engaged youth from diverse backgrounds, and it is a practical way to generate solutions from key stakeholders affected by the community's prevailing health issues. Developing service delivery strategies that engage, educate, and collaborate with youth on HIV prevention could be sustainable. However, this will not be conclusive without implementing them over time to test their feasibility and sustainability.

BACKGROUND Coronary artery embolism (CAE) is an infrequent but clinically significant non-atherosclerotic cause of ST-elevation myocardial infarction (STEMI). It presents unique diagnostic and therapeutic challenges due to its varied etiologies and the frequent absence of significant coronary artery disease. While atrial fibrillation is the most recognized cardiac arrhythmia associated with coronary embolism, atrial flutter as an embolic source remains underreported. This report highlights the complexities of diagnosing and managing CAE manifesting as an atypical STEMI and sudden cardiac arrest in a patient with previously undiagnosed atrial flutter, emphasizing the critical importance of identifying underlying embolic sources, particularly atrial flutter, to guide appropriate therapy. CASE REPORT An 82-year-old woman with non-ischemic cardiomyopathy presented after an out-of-hospital ventricular fibrillation cardiac arrest. Her post-resuscitation electrocardiogram revealed an inferior STEMI. Emergency coronary angiography demonstrated abrupt embolic occlusions in the distal right coronary artery, without evidence of significant underlying atherosclerosis. Percutaneous coronary intervention was performed to restore blood flow. After the procedure, telemetry revealed new-onset atrial flutter, the presumed embolic source. Her hospital course was complicated by severe global hypokinesis out of proportion to the infarct territory and progressive respiratory failure, ultimately leading to a family decision to transition to comfort care. CONCLUSIONS This case underscores the critical need to consider coronary artery embolism in the differential diagnosis for STEMI, particularly in patients lacking significant atherosclerotic disease burden. The presence of arrhythmias, such as atrial flutter, should raise strong clinical suspicion for an embolic etiology. While a good outcome was not achieved in this specific case, early recognition of CAE remains crucial for guiding appropriate revascularization strategies and initiating prompt anticoagulation to prevent recurrent thromboembolic events in surviving patients.

Cell migration plays a critical role in various physiological and pathological processes, particularly in the development and repair of cardiac diseases. It is a complex, multi-step process involving different mechanisms and cell types. This review summarizes the roles of cardiac cell migration in cardiac immune responses, myocardial regeneration, and chronic inflammation. Specifically, we explore how cardiac cells promote repair and regeneration following myocardial injury through migration. In addition, the article reviews the impact of cell migration on processes such as angiogenesis and fibrosis, which are crucial for myocardial repair and pathological states. Due to the complexity of intercellular interactions, signaling pathways, and microenvironmental factors, understanding cardiac cell migration remains a significant challenge. Further research into these migratory mechanisms will help uncover their pathological roles in cardiac diseases and provide new therapeutic approaches for cardiac repair and regeneration. This review also highlights the migratory mechanisms of major cardiac cell types and examines the regulatory roles of chemokines in these processes. Furthermore, we discuss how cardiac cells engage in localized migration under different disease conditions, thereby contributing to the heart's self-repair.

The cardioprotective potential of Hymenaea rubriflora Ducke's stem bark hydroalcoholic extract (HR-HAc) has not yet been investigated. This study aimed to quantify HR-HAc's antioxidant capacity and evaluate its effects on blood pressure (BP) and vascular reactivity in spontaneously hypertensive rats (SHR).

SHR and normotensive Wistar Kyoto (WKY) rats received intravenous HR-HAc (2.5-60 mg/kg). Mean arterial pressure (MAP) and heart rate (HR) were measured with or without atropine and propranolol. Isolated aortas from SHR and WKY rats were exposed to HR-HAc (0.1-729 μg/ml), with or without endothelium and K+ channel blockers. Phenolic content and antioxidant activity were quantified using standard colorimetric and chromatographic methods.

In SHR rats, HR-HAc produced dose-dependent hypotension and bradycardia. MAP reduction in WKY rats was similar, while HR was unaffected. Atropine significantly attenuated HR-HAc-induced reductions in MAP and HR in SHR rats. HR-HAc induced potent endothelium-independent relaxation in SHR rat aortas, which was significantly reduced by tetraethylammonium or 4-aminopyridine. In WKY rats, vasorelaxant effects were endothelium-dependent.

HR-HAc lowers MAP and induces bradycardia in SHR via muscarinic receptors, while also promoting vasodilation through activation of voltage- and calcium-activated K+ channels. These distinct mechanisms highlight HR-HAc as a promising preclinical antihypertensive candidate.

Aortic aneurysms, including thoracic aortic aneurysms (TAA) and abdominal aortic aneurysms (AAA), represent a group of severe vascular lesions with insidious onset and high mortality. Currently, effective diagnostic markers and pharmacological interventions remain lacking in clinical practice. Extracellular vesicles (EVs), as key mediators of intercellular communication, have attracted increasing attention in the research on aortic aneurysms due to their high content of bioactive molecules, favorable biocompatibility, low immunogenicity, and inherent targeting capacity. This review systematically elaborated on the research progress on EVs in TAA and AAA, highlighting their significant role in the development and progression of aortic aneurysms. EVs play a crucial role by mediating core pathological processes, including endothelial dysfunction, phenotypic transformation of vascular smooth muscle cells, inflammatory immune responses, and extracellular matrix remodeling. Additionally, this review discussed the potential of disease-specific molecules carried by EVs as novel liquid biopsy markers for the early diagnosis of aortic aneurysms. Furthermore, this review evaluated the application prospects of EVs as natural drug delivery platforms and EV-based therapeutic strategies for aortic aneurysm through engineering modifications (such as targeting peptide modification and biomaterial integration). In particular, "cell-free" immunomodulatory therapies, which enhance targeting capacity to lesion sites through engineering modifications and focus strategically on regulating the phenotype and function of key immune cells (such as macrophages), are increasingly emerging as a cutting-edge direction with the greatest translational potential in this field. Despite challenges such as targeted delivery, the integration of engineering technologies with nanomedicine holds promise for opening new avenues for the precise prevention and treatment of aortic aneurysms through EV-based integrated diagnostic and therapeutic strategies.

Artificial intelligence (AI) is entering the study of hypertension, serving both primarily clinical purposes - to assist practicing physicians - and research objectives. Hypertension presents certain specific characteristics that should be carefully considered when using AI. The measured value of blood pressure is an extremely variable parameter that is difficult to standardize and measure with precision. At present, AI is able to provide very simple, clear, and well-documented answers to clinical questions regarding the management of patients with hypertension. Its role in research is perhaps somewhat less well developed. Several studies have been published on the use of AI in identifying patients with secondary hypertension, on the risk of future hypertension in normotensive individuals, and on the risk of heart failure and other complications of hypertension. A common issue with all these studies is the relative paucity of controlled clinical trials comparing AI with traditional procedures drawing on medical literature and clinical experience ("natural intelligence"), precisely designed to quantify the potential superiority of AI over natural intelligence on key end-points of real clinical value. This is similar to the approach currently taken when testing a new diagnostic or therapeutic procedure. Obviously, these considerations should be viewed as encouragement, not as a barrier, to continuing clinical research in the field of AI in hypertension. It is also important that scientific articles on AI published in medical journals be written using terms that doctors can understand, to ensure transparency and interpretability.

Accidental hypothermia is an underdiagnosed condition with a significant impact on public health. With the aim of providing the basis for a comprehensive care framework, 12 panelists from 3 Spanish scientific societies (SEDAR, SEMES and SEMICYUC) developed this multidisciplinary consensus document. Through a systematic search and the final synthesis of 281 articles including 1,704,632 patients, 37 recommendations were developed through a 2-round Delphi process, distributed across 8 application domains based on the organization of a rescue chain: prehospital prevention, initial evaluation, management and transport, hospital detection, care of the polytraumatized patient, hospital rewarming, cardiac arrest, and resuscitation. Robust consensus among panelists (>75% agreement) and excellent internal consistency (ω = 0.913) were achieved, providing a solid document that may serve as a basis for the implementation of standardized protocols.