• Cardiovascular diseases among people living with HIV/AIDS in Ethiopia: A scoping review.
    2 weeks ago
    Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS) remains a significant burden in Ethiopia. People living with HIV/AIDS (PLWHA) are at increased risk of cardiovascular diseases due to both the virus and the side effects of antiretroviral therapy. Despite a growing body of research on cardiovascular diseases in PLWHA in Ethiopia, no review has synthesised the available evidence. This scoping review aims to summarise the existing literature on cardiovascular diseases among PLWHA in Ethiopia.

    This scoping review followed the Arksey and O'Malley (2005) framework, with enhancements from Levac et al. (2010). A systematic search was conducted across six electronic databases (PubMed, EMBASE, ProQuest, Global Index Medicus, and Web of Science) in November 2023 and updated in March 2026. Studies on cardiovascular diseases among PLWHA in Ethiopia were included. Two reviewers independently screened titles, abstracts, and full texts. A data extraction template was used, and findings were synthesised narratively. The selection process was documented using a PRISMA flow diagram.

    Twenty-six studies were included, with nearly two-thirds (61.5%, n = 16) focused on hypertension. The prevalence of hypertension among PLWHA in Ethiopia ranged from 11.0 to 41.3%. Factors associated with hypertension included male gender, old age, rural residence, alcohol consumption, smoking, family history, low physical activity, obesity, and HAART duration/type. Other cardiovascular conditions studied included ischemic stroke, dilated cardiomyopathy, ECG abnormalities, atherosclerotic cardiovascular disease, and pericardial effusion. Most studies were cross-sectional and institution-based.

    This review highlights the limited yet growing evidence on cardiovascular diseases among PLWHA in Ethiopia, with a predominant focus on hypertension. Future research should use more robust study designs, such as longitudinal and interventional studies, encompass a broader range of cardiovascular diseases, and include community-based studies to better understand the prevalence and burden of cardiovascular diseases among PLWHA in Ethiopia.
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  • The Effect of Different Types of Music on Pain and Anxiety during Wound Care Procedures in Patients with Venous Ulcers: A Randomized Controlled Trial.
    2 weeks ago
    To evaluate the effects of different types of music (instrumental Turkish music and Western music without lyrics) played during wound care on pain, anxiety, and patient satisfaction among individuals with venous ulcers.

    In this randomized controlled trial, 97 patients with venous ulcers were assigned to three groups: Western music ( n  = 32), Turkish music ( n  = 32), and Control ( n  = 33). Patients in the music groups listened to their assigned music during routine wound dressing, while all patients received individualized, evidence-based care. Pain and anxiety were measured using the Visual Analogue Scale (VAS) and the State-Trait Anxiety Inventory before, during, and after dressing, and patient satisfaction was assessed with the VAS post-procedure.

    The mean age was 56.5 ± 8.5 years; 61% were female ( n  = 59) and 39% male ( n  = 38). Between-group comparisons revealed a significant effect of music on anxiety ( F (2.94) = 27.771, P < 0.001, η2  = 0.371). These findings indicate that listening to music significantly reduced anxiety levels, with Turkish music producing a stronger effect than Western music. Music had a pain-reducing effect during dressing, with Turkish music significantly lowering pain compared to the control group ( F (4.188) = 9.039, P < 0.001, η2  = 0.161). Although pain levels decreased in the Western music group, this reduction did not reach statistical significance. Patient satisfaction was also higher in the music groups ( P < 0.001).

    In this study, Turkish music was particularly effective, demonstrating greater reductions in anxiety and pain, as well as higher patient satisfaction compared to both Western music and the control group. The findings emphasize the importance of cultural characteristics and patient preference in music-based interventions; they demonstrate that music is an effective nursing intervention that can be applied independently by nurses, is low-cost, and is non-invasive.
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  • Analgesic Efficacy of Shangdiao Music Combined with Diclofenac Sodium Suppositories after Mixed Haemorrhoid Surgery.
    2 weeks ago
    This study aimed to analyse the analgesic efficacy of Shangdiao music (a specific pentatonic modality) combined with diclofenac sodium suppositories after mixed haemorrhoid surgery.

    The clinical data of 130 patients who underwent mixed haemorrhoid surgery at our institution between January 2023 and January 2024 were retrospectively analysed. The participants were stratified into two groups according to postoperative analgesia protocols: a pharmacotherapy group ( n  = 70) receiving diclofenac sodium suppositories alone and a combined therapy group ( n  = 60) receiving diclofenac sodium suppositories combined with Shangdiao music. The treatment course was 7 days. Outcomes were as follows: postoperative pain conditions (Visual Analogue Scale [VAS]), urinary function, defecation function (Chinese version of the Patient Assessment of Constipation Quality of Life questionnaire [PAC-QOL]), negative emotions (Hospital Anxiety and Depression Scale - Anxiety Subscale [HADS-A] and Hospital Anxiety and Depression Scale - Depression Subscale [HADS-D]), quality of life (General Quality of Life Inventory-74 [GQOLI-74]) and incidence of adverse reactions.

    No significant differences in baseline characteristics were observed between the two groups ( P > 0.05; Cohen's d range: 0.00-1.00). Both groups demonstrated progressive reductions in VAS scores at 3, 5 and 7 days relative to their 12-hour and 1-day assessments, with the combined therapy group showing significantly greater reductions than the controls at all timepoints ( P < 0.001; Cohen's d : 1.78-3.91). At 7 days, both groups exhibited increased average urine flow rates and GQOLI-74 scores relative to their 1-day measurements, with the combined therapy group demonstrating significantly greater improvements than the controls. Similarly, PAC-QOL, HADS-D and HADS-A scores decreased in both groups at 7 days compared with baseline, with the combined therapy group exhibiting significantly greater reductions ( P < 0.001; Cohen's d : 0.93-1.86).

    The integration of Shangdiao music with diclofenac sodium suppositories remarkably enhances analgesia, accelerates the recovery of urinary/defecatory functions, mitigates negative psychological states and improves the quality of life of patients following mixed haemorrhoid surgery.
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  • Underestimated Environmental Risks for People with Arterial Hypertension - A Narrative Review of Issues that National Guidelines Should Consider.
    2 weeks ago
    International guidelines for the management of arterial hypertension fail to consider environmental pollutants as risk factors for the development of the disease and its cardiovascular complications. The reasoning behind this may stem from the failure to acknowledge compelling evidence from research on the cardiovascular effects of environmental pollution. In this narrative review, we summarize the effects of environmental air pollution and noise on individuals with arterial hypertension. We explore how these pollutants interact with other environmental and individual risk factors and discuss why such individuals should be considered a vulnerable group. We also discuss local studies to help national authorities adjust international recommendations to better fit the local context. In summary, national recommendations for managing hypertension should encompass more than just blood pressure goals and prescribed antihypertensive medications. Clinicians should recommend evidence-based behavioral changes related to environmental issues to individuals with arterial hypertension. These changes can help people with arterial hypertension control their blood pressure; delay adverse cardiovascular outcomes; and enhance the effectiveness of antihypertensive medications during episodes of poor air quality, environmental noise exposure, exposure to extremely cold or warm weather, or any combination of these risk factors. Guidelines must be adapted to account for environmental pollution, social factors, cultural norms, patient preferences, equity concerns, patient lifestyle, the healthcare system, and the economic situation in the region.
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  • The Relationship between Severe Earthquakes and Ventricular Arrhythmia in Turkey: A Retrospective Study.
    2 weeks ago
    Earthquakes are associated with an increase in cardiovascular events through various physiological and environmental mechanisms. However, data on their effects on ventricular arrhythmias (VA) are limited.

    The aim of our study is to investigate the effect of earthquakes on the incidence of VA and device response by examining implantable cardiac device records.

    The device records of patients with an implantable cardioverter defibrillator (ICD) or a cardiac resynchronization therapy with defibrillator (CRT-D) device, implanted for any reason, at least 1 month prior to the February 6, 2023, earthquake were reviewed by cardiologists for VA, antitachycardia pacing (ATP), and shock, and analyzed for VA, ATP, and shock. Statistical analysis was performed using the McNemar test.

    There were 163 participants with a mean age of 60.84 ± 12.74 years, and 69.9% were male. Seventy-one patients (43.6%) had a single ICD, 23 patients had a dual ICD (14.1%), and 69 patients (42.3%) had a CRT-D. When compared to the pre-earthquake period, a significant difference was observed in the incidence of VA in the acute period ( P = 0.008) and subacute period ( P < 0.001). The frequency of receiving ATP or shock significantly increased during the acute period ( P = 0.013) and the subacute period ( P < 0.001) compared to the pre-earthquake period.

    The findings suggest that major earthquakes may be associated with an increased incidence of VA and device therapy, particularly during the subacute period. These results emphasize the importance of carefully monitoring patients with implantable cardiac devices following major earthquakes.
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  • Clinical Indicators for Perimenopausal Hormone Replacement Therapy: An Evidence-Based Narrative Review.
    2 weeks ago
    Clinical guidance for perimenopausal hormone replacement therapy (HRT) varies across regions, creating uncertainty when clinicians need to balance safety with testing burden and cost. We conducted an evidence-based narrative review to summarize the clinical value of key indicators used in perimenopausal HRT decision-making. To gather relevant evidence, we searched PubMed, Web of Science, and Scopus for studies published from January 2014 to December 2025 using keywords related to perimenopause, HRT, biomarkers, clinical decision-making, and risk stratification. We focused on indicators from hormonal, skeletal, and cardiometabolic domains, as well as selected imaging and symptom measures. Traditional hormones such as follicle-stimulating hormone (FSH) and estradiol are useful for staging, but single measurements are limited by cyclic fluctuations. For bone health, combining bone mineral density with bone turnover markers (e.g., β-CTX and PINP) may improve the assessment of fracture risk and treatment response. For cardiometabolic safety, lipid profiles and inflammatory markers (e.g., C-reactive protein) support risk evaluation. Based on the literature, we propose a tiered evaluation framework: utilizing standard, widely available tests for routine assessment, while reserving advanced biomarkers for high-risk or unclear cases. This approach aims to support practical clinical assessment without replacing individualized clinical judgment, offering a highly cost-effective strategy tailored for resource-limited settings.
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  • Ethnic and Sex Differences in Salt Sensitivity amongst Normotensive Young Adult Nigerians: Implications for Hypertension Prevention.
    2 weeks ago
    High dietary salt intake is a well-established modifiable risk factor for hypertension and cardiovascular disease. Salt sensitivity - a blood pressure (BP) phenotype defined by exaggerated BP response to salt loading, remains underrecognised in normotensive populations despite its strong link to adverse cardiovascular outcomes. The burden and determinants of salt sensitivity amongst young Nigerians remain poorly understood.

    This study aimed to identify demographic and behavioural risk factors associated with salt sensitivity, explore potential ethnic and sex-related differences and determine the independent predictors of salt-sensitive (SS) BP response amongst normotensive young adult Nigerians.

    An interviewer-administered questionnaire was used to collect demographic and behavioural data. Participants underwent a 5-day salt-loading protocol. BP, serum and urinary electrolytes were assessed before and after salt-loading. Data were analysed using appropriate statistical tools and P values set at P < 0.05.

    Among the participants, 24% were SS. The prevalence of salt sensitivity was higher in Igbos (47.8%) compared to Yorubas (20.5%). SS individuals had significantly lower baseline systolic, diastolic and MA P values and reduced urinary sodium concentrations pre-salt loading, particularly among females. There were no statistically significant associations between salt sensitivity and body mass index, sleep duration or residential location ( P > 0.05).

    Salt sensitivity is common amongst normotensive young adult Nigerians, with clear ethnic and sex-related differences. The observed subclinical BP alterations and reduced sodium excretion suggest early renal or vascular dysregulation in SS individuals. These findings underscore the need for early identification and targeted prevention strategies to reduce future hypertension risk in this population.
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  • The association of early glomerular filtration kinetics and urinary urea excretion with subsequent renal replacement therapy under a delayed strategy in severe acute kidney injury.
    2 weeks ago
    In severe acute kidney injury (AKI), delayed renal replacement therapy (RRT) strategies allow many KDIGO stage-3 patients to avoid dialysis, but excessive postponement in those who ultimately require RRT may worsen outcomes. Early physiologically grounded markers to identify patients likely to need RRT are lacking. We evaluated whether combining early glomerular filtration kinetics and timed urinary urea excretion could improve discrimination of subsequent RRT initiation under a delayed strategy.

    TUBSAKI is a prospective bicentric ICU cohort including adults with KDIGO stage-3 AKI managed with a protocolized delayed RRT strategy. Blood and 24-hour urine samples were collected at diagnosis (D0) and day 1 (D1). Glomerular filtration dynamics were assessed using kinetic GFR (kGFR), and timed urinary urea excretion was assessed using UUEI. Discrimination for subsequent RRT was assessed using ROC curves and AUC. A combined logistic model (kGFR D0-D1 + UUEI D1) was internally validated by bootstrap, with sensitivity analyses adjusted for SOFA and KDIGO stage-3 oliguria.

    Among 110 patients, 31 (28%) required RRT. kGFR D0-D1 showed good discrimination (AUC 0.81 [0.72-0.89]), and UUEI D1 moderate discrimination (AUC 0.74 [0.63-0.82]). The combined model showed an AUC of 0.85 ([0.76-0.91]), optimism-corrected AUC 0.83, and acceptable calibration. Discrimination remained stable after adjustment for SOFA and oliguria. Incremental gain over kGFR alone was modest and not statistically significant.

    Early glomerular filtration kinetics and urinary urea excretion were associated with subsequent RRT initiation under a delayed strategy. The incremental clinical value of UUEI remained limited in this cohort, and external validation is required before clinical use.
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  • Metabolic profile in Prader-Willi syndrome patients followed at a single expert center of rare endocrine diseases.
    2 weeks ago
    Prader-Willi syndrome (PWS) is a rare imprinting disorder characterized by typical dysmorphic features, lack of satiety, infantile hypotonia, and later morbid obesity with complications, short stature, hypogonadotropic hypogonadism, skeletal and psychiatric problems. From the literature, it is well known that patients with PWS have a more favorable metabolic pattern than healthy controls.

    The aim of the study is to assess the metabolic profile of PWS patients followed at an Expert Center for Rare Endocrine Diseases compared with healthy controls and to look for relations between components of the metabolic syndrome (MetS), adipokines, and the compartments of body composition (BC-lean and fat mass).

    The current study is a cross-sectional evaluation of 25 patients with Prader-Willi syndrome (mean age 11.3 ± 8.2 years), with a total of 183.6 patient-years of regular follow-up (from the first visit to the center to the data collection cutoff date), compared with 24 age-, sex-, and BMI-matched healthy controls (mean age 11.3 ± 3.9 years). Each participant underwent anthropometric measurements, physical examination, biochemical and hormonal blood sampling, and whole-body DXA scan. Statistical analysis (SPSS 15.0 statistical package, Chicago, IL, USA) was performed to assess the relations between the metrics in the PWS group compared with controls.

    Patients with PWS showed a better profile of glucose homeostasis with significantly lower serum insulin concentration and calculated HOMA-IR index compared with the controls (p < 0.05). Taking into consideration age, sex, and body mass index (BMI) in the PWS group, the analysis showed strong positive correlations between waist circumference (WC) and systolic blood pressure (SBP) (r = 0.864, p < 0.001), and WC and diastolic blood pressure (DBP) (r = 0.534, p = 0.033). Partial correlation analysis with respect to age, sex, and pubertal development found significant positive WC correlations with insulin (r = 0.796, p = 0.006), HOMA-IR (r = 0.697, p = 0.025), LDL-cholesterol (r = 0.735, p = 0.002), uric acid (r = 0.735, p = 0.002), CRP (r = 0.600, p = 0.023), and leptin (r = 0.730, p = 0.005). Strong negative correlations existed between WC and SHBG (r = -0.772, p = 0.002) and HMW adiponectin (r = -0.998, p = 0.044). Additionally, a negative correlation of HMW adiponectin and SBP was demonstrated. 88% of the patients were treated with recombinant human growth hormone (rhGH). Bone mineral density adjusted for height (BMD/height) was significantly lower in patients with PWS (p < 0.05) compared with healthy controls. The analysis did not reveal significant relationships between BC compartments and metabolic and auxological parameters in the PWS group.

    Our study confirms that patients with PWS have a favorable metabolic profile compared with healthy controls matched by age, sex, and BMI. Syndromic participants who manifest greater accumulation of abdominal adipose tissue have a higher risk of hemodynamic changes and metabolic disturbances predictive of the development of cardiovascular diseases (CVD) in adulthood. WC could serve as a predictive marker for detecting higher metabolic risk in this syndromic group of patients, and both WC and HMW adiponectin for hypertension. In the future, on this basis, we could possibly implement both of these metrics in clinical practice.
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  • The mechanism and therapeutic prospect of HIF-1 α/BNIP3 pathway in regulating mitophagy in tubulointerstitial fibrosis.
    2 weeks ago
    Tubulointerstitial fibrosis (TIF) is a key pathological hallmark and a major determinant of end-stage renal disease (ESRD). The mechanisms of TIF remain unclear, and there are currently no specific drugs to slow or reverse its progression. Notably, due to the kidney's unique structure, the course of renal dysfunction is intimately connected with hypoxia. The signaling pathway formed by hypoxia-inducible factor 1α (HIF-1α) and its downstream target gene, B-cell lymphoma-2/adenovirus E1B 19-kDa interacting protein (BNIP3), exerts a pivotal effect during renal hypoxia. This pathway mediates mitophagy, inhibits apoptosis and inflammatory responses, maintains cellular energy balance, and thus profoundly influences the progression of TIF. This article focuses on the molecular mechanism by which the HIF-1α/BNIP3 pathway regulates mitophagy and affects TIF, and delves into its mechanisms in pyroptosis, oxidative stress, and ischemia-reperfusion injury, This work endeavors to establish a theoretical foundation and potential intervention targets for developing novel treatment strategies for TIF.
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