To evaluate the effectiveness of Cytoflavin in conjunction with standard therapy compared to standard therapy alone in patients presenting during the acute phase of ischemic stroke (IS).

A systematic literature review and meta-analysis were conducted to assess the efficacy of Cytoflavin (containing inosine, nicotinamide, riboflavin, and succinic acid; STPF POLYSAN, Ltd., Russia) in adult patients diagnosed with IS. The analysis encompassed both randomized and non-randomized controlled trials, assessing outcomes such as hospital mortality, neurological deficit (measured using the National Institutes of Health Stroke Scale, NIHSS), and functional outcomes (assessed using the modified Rankin Scale and Barthel Index).

The incorporation of Cytoflavin into standard treatment protocols was associated with a statistically significant reduction in mortality rates when compared to standard therapy alone (hazard ratio [HR]=0.53; 95% confidence interval [CI] 0.37; 0.76, p<0.001). Furthermore, there was a notable improvement in the regression of neurological deficits during the acute phase of IS, as evidenced by higher NIHSS scores and better functional outcomes (Barthel Index) in patients receiving Cytoflavin.

The findings from this systematic review and meta-analysis indicate that the addition of Cytoflavin to standard therapy for ischemic stroke is associated with more favorable clinical outcomes, including decreased mortality, diminished neurological impairment, and improved functional outcomes at the end of the IS acute phase. It is imperative to consider the high heterogeneity in the functional scales data across studies when interpreting these effects.

In 25-40% of patients with thromboembolic stroke, current diagnostics fail to identify a cause. It has been shown that prolonged heart rhythm monitoring can detect atrial fibrillation (AF) as the underlying cause in one-third of these patients. Even though an implantable loop recorder detects AF in 37% of cases up to four years after stroke, several studies show no reduction in the number of recurrent strokes with anticoagulation treatment. It seems that a high degree of AF around the stroke, so-called high burden, has a more likely causal link, than AF detected months or years after stroke. Anticoagulation treatment may be more effective in high AF burden stroke patients. A less expensive, non-invasive detection method, applicable immediately after stroke, may be more suitable in practice. Furthermore, recent research shows promising results in the importance of determining electrocardiographic, anatomical and blood biomarkers indicative for an atrial myopathy and better detection AF.

Revascularization remains the cornerstone of treatment for CLTI. Conservative treatment represents an underexposed yet potentially appropriate alternative for selected elderly and frail patients. This population is characterized by high mortality rates, substantial perioperative risks, prolonged hospital stays, increased healthcare costs, and deterioration in functional status and quality of life following invasive interventions. Conservative treatment - including wound care, pain management, and when necessary, minor amputations - may offer an alternative for frail, elderly patients with CLTI. Emerging evidence suggests that, for selected patients, conservative treatment can result in acceptable wound healing rates and survival comparable to invasive strategies, without an increase in major amputation rates. Within the context of appropriate and value-based care, conservative treatment may better balance functional outcomes, healthcare utilization and patient preferences. Future research on prediction models to guide patient selection, cost-effectiveness analyses, and qualitative studies exploring patient-reported outcomes and experiences, should support evidence-based implementation of conservative treatment.

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disorder associated with accelerated atherosclerosis and increased cardiovascular morbidity. Atherogenic indices derived from routine lipid parameters have emerged as potential markers of cardiovascular risk; however, their relationship with disease activity in RA remains incompletely understood, particularly in Indian populations.

To evaluate the association between atherogenic indices and disease activity in patients with rheumatoid arthritis and to assess their potential utility as biomarkers of inflammatory burden and cardiometabolic risk.

This cross-sectional observational study included 100 patients with rheumatoid arthritis (RA) who met the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria and 50 years of age- and sex-frequency-matched control participants without rheumatoid arthritis or other inflammatory rheumatic diseases. Clinical, anthropometric, laboratory, and lipid profile data were collected. Disease activity was assessed using the Disease Activity Score in 28 joints with C-reactive protein (DAS28-CRP). Atherogenic indices, including Castelli's Risk Index-I (CRI-I), Castelli's Risk Index-II (CRI-II), Atherogenic Index of Plasma (AIP), Atherogenic Coefficient (AC), and non-high-density lipoprotein cholesterol (non-HDL-C), were calculated and analyzed in relation to disease activity measures.

Patients with RA exhibited significantly higher triglycerides, low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), Castelli's Risk Index-I (CRI-I), Castelli's Risk Index-II (CRI-II), Atherogenic Index of Plasma (AIP), and Atherogenic Coefficient (AC), together with lower HDL-C levels compared with healthy controls (all p<0.05). Atherogenic indices increased progressively across disease activity categories, with the highest values observed among patients with high disease activity (all p≤0.001). Among the evaluated indices, AIP demonstrated the strongest correlation with Disease Activity Score in 28 joints with C-reactive protein (DAS28-CRP) (r=0.45, p<0.001), followed by CRI-II (r=0.38, p<0.001). In multivariable logistic regression analysis, AIP remained independently associated with high disease activity (odds ratio (OR)=3.12, 95% CI: 1.42-6.85, p=0.004), together with erythrocyte sedimentation rate (ESR) and BMI.

Atherogenic indices are significantly associated with disease activity in rheumatoid arthritis, with AIP demonstrating the strongest relationship with inflammatory burden. These findings suggest that AIP may serve as a simple, inexpensive, and readily available marker for the integrated assessment of disease activity and cardiometabolic risk in patients with RA. Prospective multicenter studies are warranted to validate its clinical utility and prognostic significance.

Aberrant right subclavian artery is the most common congenital anomaly of the aortic arch and may present with dysphagia lusoria due to esophageal compression. Although bicuspid aortic valve disease is commonly associated with aortopathy, its coexistence with an aberrant right subclavian artery and a contralateral subclavian artery aneurysm is exceedingly rare. We report the case of a 33-year-old male presenting with exertional dyspnea, chest pain, presyncope, and intermittent dysphagia to solids. Echocardiography demonstrated severe bicuspid aortic stenosis with a mean gradient of 95 mmHg and a peak velocity of 7.6 m/s. Computed tomography angiography revealed a retroesophageal aberrant right subclavian artery and a 34 mm aneurysm of the left subclavian artery. Following multidisciplinary discussion, the patient underwent a single-stage hybrid procedure consisting of right carotid-subclavian bypass and translocation of the aberrant vessel via a supraclavicular approach, followed by mechanical aortic valve replacement through median sternotomy. The postoperative course was complicated by transient complete heart block, which resolved spontaneously before discharge. Follow-up imaging demonstrated a patent bypass graft and stable aneurysm size, while dysphagia resolved completely. This case highlights the importance of investigating dysphagia in young adults with congenital valvular disease and demonstrates the value of individualized hybrid surgical strategies in complex arch pathology. The management of a contralateral subclavian artery aneurysm in the setting of bicuspid aortic valve aortopathy remains a clinical dilemma without clear guideline thresholds.

Cardiovascular diseases are a leading cause of mortality globally. Community pharmacists can improve the impact of cardiovascular diseases by early identification of risk factors and provision of health promotion. However, patients' perceptions of community pharmacists are not well understood.

To understand how patients perceive the involvement of community pharmacists in preventing and controlling cardiovascular diseases.

Semi-structured interviews were conducted with 10 (n = 10) cardiovascular disease patients who utilise community pharmacy services in Maseru and Berea districts. Convenience sampling method was used to select participants. The questionnaire comprised questions to uncover patients' experiences, utilisation, and expectations of community pharmacists' services. Thematic analysis was employed.

Four themes were identified, namely 1) perceived role of a community pharmacist, 2) patient healthcare-seeking behaviour, 3) perceived community pharmacist care outcomes, and 4) future expectations. Generally, cardiovascular disease patients visited community pharmacists every month for medication refills and were less aware of other services. Overall, patients were appreciative of and were willing to support future community pharmacists' services. The patients expect community pharmacists to lead initiatives that educate people about cardiovascular diseases and standardise services across all pharmacy outlets.

Patients had limited awareness of other services provided by community pharmacists beyond dispensing medication, such as disease detection and health promotion. However, they valued the services provided by community pharmacists and were willing to utilise expanded services. This presents an opportunity for community pharmacists to raise awareness of their current scope of work and expansion of care.

The cumulative impact of multidomain adverse exposures on abdominal aortic aneurysm (AAA) risk and the underlying metabolic pathways remain insufficiently understood.

We analyzed 304,482 UK Biobank participants free of aortic aneurysm at baseline. Twenty-six exposures were grouped into five domains to derive domain specific and overall exposure scores. Associations with incident AAA were assessed using Cox models. To explore potential metabolic pathways, we applied a two stage NMR metabolomics framework combining multivariable linear regression, metabolite specific Cox models, and a 10-fold cross validated elastic net Cox model to generate a metabolite score. Mediation analyses and XGBoost models were also performed.

During a mean follow up of 14.9 years, 1,671 participants developed AAA. A higher overall exposure score was associated with an increased risk of incident AAA (per SD increase: HR, 1.08; 95% CI, 1.07-1.11). Among domain specific scores, the socioeconomic, social psychology, and lifestyle scores were independently associated with AAA, whereas the environmental pollution and living environment scores were not. Current smoking showed the strongest association among individual exposures (HR, 7.95; 95% CI, 6.81-9.27). Overall exposure burden was associated with broad metabolomic perturbations, and a 13-metabolite score was significantly associated with AAA (per SD increase: HR, 1.38; 95% CI, 1.35-1.41), mediating 5.78% of this association. Adding exposure and metabolite scores improved prediction beyond clinical factors alone.

Greater multidomain adverse exposure burden was associated with higher incident AAA risk, partly through metabolic signatures related to inflammation and lipoprotein metabolism, and may provide incremental value for AAA risk stratification.

Stroke, or cerebrovascular disease, stands as one of the leading causes of death worldwide, and the fourth leading cause in the West Bank, accounting for approximately 12.1% of all deaths. There is scarce information about the level of knowledge and awareness of stroke among Palestinians in the West Bank. This study aims to identify knowledge gaps to support the development of preventive strategies.

A cross-sectional survey was conducted across the West Bank between September and December 2024. A sample of 513 participants from various regions of the West Bank completed a self-report questionnaire assessing knowledge of stroke symptoms, risk factors, prevention, management, and sources of information. Data were analyzed using SPSS software.

Most participants (93.4%) correctly identified the brain as the organ affected by stroke, and 77.4% knew that stroke can reoccur. Only 5.3% knew the 4.5-h treatment window for stroke intervention. Hypertension was the most recognized risk factor (95.3%), followed by chronic stress (86.4%) and high cholesterol (79.3%). Confusion (92.0%), numbness (88.3%), facial deviation (83.8%) and vomiting (56.5%) were the most recognized symptoms, whereas 49.1% incorrectly identified nosebleeds as a stroke symptom. Regarding the response to stroke, 40% of the participants would call an ambulance, whereas 34% would take the patient to the hospital. Significant gaps in knowledge were associated with information sources, as participants relying on healthcare providers had significantly higher knowledge scores than those relying on the internet, friends, or other sources.

Significant gaps in knowledge were detected, particularly regarding treatment urgency and symptom recognition. Our findings emphasize the need for targeted public health campaigns, especially among high-risk groups in the West Bank.

This study aimed to investigate the knowledge, attitudes, and practices (KAP) regarding premature ventricular contractions (PVCs) among patients.

A cross-sectional study was conducted from March to June 2025 at Yichun People's Hospital, enrolling patients with a confirmed diagnosis of PVCs. Demographic information and KAP scores were collected and assessed using self-designed questionnaires. KAP scores were categorized as Poor (<60%), Moderate (60-79%), and Good (≥80%) of the maximum score according to the Bloom's criteria.

A total of 544 valid questionnaires were analyzed, yielding a valid response rate of 74.22%. Among the respondents, 294 (54.04%) were male, and more than half of the patients (305, 56.07%) reported not receiving any current treatment for PVCs. The knowledge, attitude, and practice scores were 11.34 ± 8.23 (range: 0-23), 26.62 ± 4.1 (range: 7-35), and 28.44 ± 7.36 (range: 8-40), respectively. Positive correlations were observed between knowledge and attitude (r = 0.429, p < 0.001), knowledge and practice (r = 0.380, p < 0.001), and attitude and practice (r = 0.568, p < 0.001). Structural equation modeling revealed that knowledge was positively associated with attitude (β = 0.445, p = 0.008) and practice (β = 0.235, p = 0.010), attitude was associated with practice (β = 0.527, p = 0.018). Furthermore, knowledge was indirectly associated with practice through attitude (β = 0.234, p = 0.009).

PVCs patients demonstrated poor knowledge, moderate attitudes, and moderate practice concerning PVCs. The identified pathways suggest that improving PVC-related knowledge may foster positive attitudes and, in turn, healthier management practices.

Timely recognition of acute coronary syndrome (ACS) symptoms is critical for early intervention and improved outcomes. This study assessed public awareness of ACS symptoms and its association with anticipated prehospital delay in Palestine.

A cross-sectional online survey was conducted between February and March 2026 among 1,293 Palestinian adults recruited through convenience sampling on social media platforms. A structured questionnaire assessed ACS symptom and risk-factor knowledge, anticipated help-seeking response to suspected ACS symptoms, and self-reported cardiovascular risk burden. Composite scores were pre-specified, and multivariable regression models were used to examine factors associated with knowledge and anticipated delay risk.

The mean knowledge score was 7.91 ± 2.96, with 33.1% demonstrating high knowledge. A marked knowledge-action gap was observed: although 90.1% identified ambulance activation as the correct action, only 56.2% reported that they would call an ambulance for chest pain lasting more than 5 min. Higher knowledge was weakly associated with a more appropriate anticipated response (β = 0.083, p < 0.001), whereas higher cardiovascular risk burden was associated with poorer anticipated response (OR = 1.22, 95% CI 1.01-1.48). Females had higher knowledge scores, while males reported more appropriate anticipated emergency responses.

This study identified suboptimal ACS knowledge and a gap between awareness and intended emergency response in an online convenience sample of Palestinian adults. Because the behavioral outcome was hypothetical, findings should be interpreted as anticipated response rather than actual prehospital delay. Interventions should combine symptom-awareness education with behavior-change strategies that promote immediate emergency medical service activation.