The healthcare system in Sudan has collapsed as a result of the civil conflict, prompting worries over the management of cardiovascular disease (CVD). Using public data, this analysis compiled epidemiological data for heart diseases in Sudan between 1970 and 2025. A search of MEDLINE/PubMed, the Cochrane Library, Scopus, Web of Knowledge and Google Scholar, as well as WHO reports and public databases that satisfied the inclusion criteria yielded a comprehensive collection of literature on CVD in Sudan. CVDs and associated risk factors are prominent due to the country's diverse geography, poor-quality healthcare system as a result of prolonged conflict, significant population movement, the climate crisis and socio-economic determinants. CVD monitoring in Sudan demands enhanced healthcare systems, data collection methodologies, public awareness, research, supportive legislation, active community participation in health promotion and greater access to technology.

Coronary heart disease (CHD) stems from functional and organic coronary artery stenosis (CAS). This study explored associations of the systemic immune-inflammation index (SII) and high-sensitivity C-reactive protein to high-density lipoprotein cholesterol ratio (hsCRP/HDL-C) with CAS severity in older patients with CHD.

This retrospective analysis recruited 786 older patients with CHD, with their clinical data and laboratory parameters collected. Patients were allocated into training and validation sets (7:3, randomization) or into mild, moderate, and severe stenosis groups according to Gensini scores (GS). Correlations of SII and hsCRP/HDL-C with GS, influencing factors for moderate-to-severe CAS, and their diagnostic value in older patients with CHD or complicated with hypertension and/or diabetes were assessed using Spearman's, univariate/multivariate logistic regression, and receiver operating characteristic curve analyses, respectively.

Elevated SII and hsCRP/HDL-C were observed in patients with moderate-to-severe stenosis, which demonstrated certain correlations with GS, and were independent risk factors (IRFs) for moderate-to-severe CAS in older patients with CHD in both sets. The comparable regression coefficients between the two sets suggested good model consistency and no significant multicollinearity. The area under the curve of the combination of SII and hsCRP/HDL-C for predicting CAS severity was outperforming either marker alone. Hypertension significantly affected the discriminating performance of SII. SII remained stable in the hypertensive population, but its efficacy decreased evidently in the non-hypertensive population.

SII and hsCRP/HDL-C are IRFs for moderate-to-severe CAS in older patients with CHD, and their combination yields good predictive performance. Regression coefficients were well consistent between the two datasets.

Rheumatic heart disease (RHD) requires long-term secondary antibiotic prophylaxis to prevent disease progression, yet sustained patient engagement remains challenging in many low- and middle-income countries. Within Uganda's first integrated decentralized RHD control program, Accelerating Delivery of Rheumatic Heart Disease Preventive Services in Uganda (ADUNU), we applied a human-centered design (HCD) approach to co-develop strategies for improving engagement in care. Using two Group Level Assessment sessions (with n = 43 stakeholders) and three design focus group discussions (n = 23 stakeholders), participants identified and prioritized feasible implementation strategies. Strategies were synthesized into four domains: community integrated follow-up, structured patient health education and counselling, provider capacity and service delivery improvement, and strengthening stock planning for medicine availability. These co-developed strategies directly address barriers related to missed appointments, limited understanding of RHD, provider-patient interactions, and medicine stockouts within decentralized primary care settings. This participatory approach generated contextually grounded strategies, ready for prospective testing within decentralized RHD programs.

Gut microbial dysbiosis has been linked to both high blood pressure and neurodegeneration, but its involvement in hypertensive patients with amnestic mild cognitive impairment (aMCI) has not been well characterized in this specific population.

In this cross-sectional investigation, we enrolled 205 older Chinese adults: 52 healthy controls, 83 hypertensive individuals with normal cognition (HTN-CN), and 70 hypertensive subjects with aMCI (HTN-aMCI). Gut microbiota composition was profiled by 16S rRNA sequencing, and serum levels of 27 inflammatory mediators were quantified by multiplex immunoassay.

Compared to the HTN-CN and control groups, the HTN-aMCI group showed not only a greater richness of gut microbes but also a markedly segregated microbial community structure. The HTN-aMCI microbiota was characterized by significant depletion of short-chain fatty acid (SCFA)-producing genera (Roseburia, Blautia, Faecalibacterium) and enrichment of opportunistic pathogens (Streptococcus, Clostridium_sensu_stricto_1, Enterococcus). Co-occurrence network analysis revealed disrupted microbial interactions in HTN-aMCI, and functional prediction showed enhanced lipopolysaccharide biosynthesis and reduced SCFA metabolism. HTN-aMCI patients had elevated pro-inflammatory cytokines (IL-1β, IL-6, IL-8, IL-17, IP-10, RANTES). Notably, after FDR correction, Blautia abundance correlated negatively with inflammatory markers and positively with cognitive scores, whereas pathobionts showed opposite patterns (all q < 0.05).

These findings indicate that hypertensive individuals with aMCI harbor a specific gut microbial dysbiosis marked by loss of SCFA producers, expansion of pathobionts, and disrupted microbial networks, which together associate with systemic inflammation and cognitive decline. Our results support the notion that targeting gut microbiota might represent a potential therapeutic avenue for hypertension-related cognitive impairment.

Obesity, diabetes, and cardiovascular disease often co-exist in people with chronic kidney disease, placing them at high risk for adverse health outcomes. Availability of highly effective medications that span cardiovascular-kidney-metabolic (CKM) conditions, but limited uptake in real world settings, calls for a new transformative practice paradigm. We sought to identify key gaps, barriers, and facilitators to implementing a standardized CKM-focused comprehensive medication management (CMM) intervention, including needs/solutions among various care team members involved in CKM care in diverse health systems across the United States.

This was a qualitative study guided by the Consolidated Framework for Implementation Research (CFIR) deployed in five health care systems across the United States. Clinical pharmacists, pharmacist administrators, primary care and specialty (nephrology, cardiology, endocrinology) physicians, and advanced practice professionals were interviewed using open-ended questions that were informed by results from three mainly quantitative online surveys.

A total of 26 interviews were conducted with 42 participants. Practitioners and administrators reported many similar challenges to successfully implement CMM for people with CKM including lack of standardized CMM practice and workflow across the health system, electronic medical record integrated tools to identify and track patients with CKM, automatic pharmacist referrals, broad clinical practice agreements, and holistic CKM performance metrics, as well as pharmacist time constraints and limited reimbursement. Participants also highlighted CMM-CKM practice facilitators including recognition across most health care professionals that CKM should be a system priority, requiring strong supportive professional relationships among physician and/or administrator champions, and tools, knowledge, and resources that could be shared with others.

Successful implementation of a transformative, holistic CMM-CKM interprofessional team-practice will require a tailored implementation strategy for each health system including consolidated tools such as a CMM-CKM Change Package, integrated with coaching, field experts, and peer-to-peer learning.

Chronic lower-extremity ulcers remain a major therapeutic challenge. Conventional treatments-including compression therapy, debridement, dressings, antibiotics, pharmacologic agents, hyperbaric oxygen, and skin grafting-frequently fail to provide durable closure, largely due to limited modulation of the wound-healing cascade. Autologous platelet-rich plasma (PRP) is gaining interest as a regenerative adjunct capable of delivering concentrated endogenous growth factors. We report a 58-year-old woman with more than 20 previous skin grafting procedures for recurrent lower-leg ulcers, arising from self-inflicted trauma and secondary infections. Multidisciplinary care of a 15 cm × 18 cm ulcer incorporating debridement, targeted antibiotics, and mainly PRP, administered in six sessions, contributed substantially to ulcer reduction and finally to complete wound healing. PRP has shown promise in enhancing wound closure rates, healing time, and tissue quality. However, the absence of standardized protocols for preparation, dosing, and application, as well as inconsistent outcome reporting, limits its broader adoption. This case underscores the potential role of PRP as a central component in managing complex, refractory ulcers, particularly when behavioural and infectious factors impede healing. Standardized protocols and robust clinical trials are warranted to clarify its role in chronic wound care.

Ambulatory blood pressure monitoring (ABPM) is the gold-standard non-invasive test for diagnosing arterial hypertension; however, it remains understudied in pediatric heart transplant recipients (HTRs). We evaluated the role of ABPM in diagnosing and managing hypertension.

We conducted a single-center retrospective evaluation of pediatric HTRs transplanted between 2010 and 2023 (inclusive) with ≥ 1 post-transplant ABPM. Clinic blood pressures (CBPs) temporally linked to each ABPM were used to categorize patients into blood pressure phenotypes: normotensive (including well-controlled hypertension, if on anti-hypertensive therapy), sustained, white coat (WCH), and masked hypertension (MH). Demographic, clinical, and echocardiographic characteristics were compared across hypertensive phenotypes, with longitudinal changes evaluated using serial ABPMs.

Data were available for 33 pediatric HTRs (61% female [20/33], median age at first ABPM 7.3 [5.3-10.4] years, 0.7 [0.2-2.6] years post-transplant). At the initial ABPM, 82% (27/33) were normotensive and 18% (6/33) were hypertensive, with 79% (26/33) on ≥ 1 antihypertensive medication. Of those with hypertensive CBPs, 60% (6/10) had a normal ABPM indicating WCH. At subsequent ABPM, 48% (10/21) normotensive patients remained normotensive, while 43% (9/21) developed hypertension. Among the 6 patients with WCH, 5 (83%) developed subsequent hypertension by ABPM. Median left ventricular mass was higher in hypertensive patients (160.9 g, 64.3-172.3 g) compared with WCH (54.4 g, 36.9-100.7 g) and normotensive patients (66.9 g, 45.4-94.3 g) (p = 0.032).

ABPM provides important hypertension insights for pediatric HTRs, especially with abnormal CBPs. Progression from WCH to manifest hypertension was common. ABPM should therefore be utilized prior to implementing or modifying anti-hypertensive therapy.

Heart failure (HF) remains a pressing health concern, with rising prevalence globally. Subjectivity and ambiguity in the definition of HF and its antecedent stages have limited research, global surveillance, and prevention programs. To address this, several cardiac societies and foundations convened to standardize the definition of HF in 2021 and designated stage B or pre-HF to identify individuals at risk of developing HF. In subsequent years, substantial progress and changes have been made in aspects of preventing HF, improving HF diagnosis and management, and recognizing the importance of the affected individual's voice. Global differences and disparities in HF are better understood, as are causes and comorbidities leading to differences in care, which are also influenced by access to care. This consensus document presents the Second Universal Definition of Heart Failure, aiming to standardize terminology and facilitate a uniform approach for clinicians, researchers, health systems, and policymakers. In this definition, the classification of HF phenotypes moves away from rigid left ventricular ejection fraction cutoffs, instead grouping HF into reduced, preserved, and improved ejection fraction categories to better reflect clinical realities. A universal classification of HF causes is also proposed. The document also addresses the dynamic trajectories of HF-improvement, remission, and recovery-and highlights the impact of social determinants and geographic variation on HF risk and outcomes. By providing a comprehensive, standardized framework for HF definition and classification, this document seeks to improve prevention, early detection, and management of HF worldwide, ultimately enhancing patient care and advancing global cardiovascular health.

Initiation of resuscitation (IOR) in intensive care units (ICUs) is a high stakes and ethically complex decision, in which nurses are often the first professionals to recognise cardiac arrest and act. Although resuscitation guidelines provide standardised algorithms, nurses' real-world IOR decisions are shaped by intertwined clinical, ethical, organisational and sociocultural factors.

This study aimed to explore and explain the IOR decision-making process among Iranian ICU nurses.

This qualitative study used Strauss and Corbin's grounded theory methodology. Fourteen participants, including ICU nurses, nurse managers and physicians, were recruited through purposive and theoretical sampling from university hospitals in Iran. Data were generated through 16 in-depth semi-structured interviews and field notes. Analysis followed constant comparative methods with iterative open, axial and selective coding supported by memo writing. Methodological rigour was ensured through adherence to Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines and Lincoln and Guba's criteria for trustworthiness.

Nurses' main concern was living in a 'limbo between duty and outcome', reflecting tension between legal-professional mandates for IOR and realistic expectations regarding prognosis and post-resuscitation quality of life. The core category, patient-centred self-protection, explained how nurses balanced ethical intent, anticipated patient benefit and self-preservation within contexts characterised by legal ambiguity, cultural-religious values, hierarchical dynamics and structural constraints. Three interrelated strategies-rule-driven, ethics-driven and defensive-led to consequences ranging from moral distress and disengagement to professional moral-existential fulfilment.

IOR decision-making in ICUs is dynamic, context-dependent and morally complex, requiring nurses to continuously negotiate competing expectations under uncertainty.

Context-sensitive CPR guidelines, legal clarity, ethical support, effective leadership and simulation-based education may strengthen nurses' moral agency, reduce defensive practice and promote humane, patient-centred resuscitation in critical care settings.

Digital health literacy (DHL) is a critical component for the effective self-management and secondary prevention of hypertension. However, the multi-level determinants of DHL in community settings are not yet fully understood. This study aimed to assess the status of DHL and identify its key sociodemographic, psychosocial, and health system determinants among adults with hypertension in China.

A cross-sectional survey was conducted (October 2024-January 2025) across 1 tertiary general hospital and 3 community health service centers in Changzhou, China. Data were collected from 660 hypertensive adults using a structured questionnaire, including the eHealth Literacy Scale (eHEALS), and scales for physician-patient interaction, perceived internet health information quality, and perceived family support. Determinants were analyzed using multivariate logistic regression and a random forest model to rank factor importance.

Nearly half of the participants (49.45%) demonstrated low DHL. Multivariate logistic regression indicated that older age (specifically ≥75 years: OR = 13.33, 95% CI = 1.73-99.88), limited internet use (<1 h/day: OR = 2.50, 95% CI = 1.04-5.88), and concerns regarding data privacy (OR = 3.42, 95% CI = 1.01-11.58) were significant predictors of low DHL. Additionally, higher perceived quality of internet health information (OR = 0.72, 95% CI = 0.67-0.78), better physician-patient interaction (OR = 0.92, 95% CI = 0.86-0.99), and greater family support (OR = 0.37, 95% CI = 0.25-0.55) were associated with lower odds of low DHL. The random forest model identified the perceived quality of internet health information as the most influential predictor, followed by age and data privacy.

DHL levels among individuals with hypertension in the community are suboptimal. These findings highlight the potential importance of a multilevel approach to supporting DHL. Efforts to improve the perceived quality of internet health information and strengthen social support systems may be beneficial, and primary care providers could play an important role in guiding patients' use of digital health resources.