Introduction Stenotrophomonas maltophilia (S. maltophilia)is an emerging opportunistic Gram-negative bacillus associated with high morbidity and mortality. However, data on its epidemiology in Portugal are limited. This study evaluated the clinical characteristics, risk factors, and outcomes of patients with S. maltophilia colonization and infection. Methods This retrospective, single-center cohort study was conducted on adult patients with S. maltophilia isolated from clinical specimens between 2020 and 2024. Patients were classified as infected or colonized, with infected cases further divided into survivors and non-survivors. Clinical, microbiological, and treatment data were analyzed using univariate and multivariate methods to identify risk factors for 30-day mortality. Results Among 97 patients, 62.9% had S. maltophilia infection and 37.1% were colonized. Infected patients more frequently had cardiovascular disease (31.1% vs. 13.9%) and immunosuppression (24.6% vs. 11.1%). Targeted antimicrobial therapy was administered to 78.7% of infected patients, primarily with co-trimoxazole. Mortality was higher in infected patients (32.8% vs 8.3%, p=0.003). Non-survivors had significantly higher rates of septic shock (66.7% vs. 12.2%, p < 0.01), recent antibiotic exposure (100.0% vs. 73.2%, p = 0.011), and cardiovascular disease (55.0% vs. 19.5%, p = 0.08). Multivariate analysis identified a lack of appropriate therapy (odds ratio (OR) 20.78, 95% CI 1.35-318.6), cardiovascular disease (OR 11.85, 95% CI 1.39-100.49), and septic shock (OR 13.18, 95% CI 1.10-157.37) as independent predictors of 30-day mortality. Conclusion S. maltophilia infections, especially in critically ill patients, are associated with high mortality, especially in patients with septic shock, recent antibiotic exposure, and cardiovascular disease. Lack of appropriate antibiotics is also an independent risk factor for mortality. Early diagnosis, prompt targeted therapy, and optimal management of comorbidities are crucial to improving outcomes.

Statin-associated muscle symptoms (SAMS) are a common side effect of statin therapy, which is widely used to manage cardiovascular diseases (CVDs). These symptoms, which can range from mild muscle discomfort to more severe complications, may lead some patients to discontinue statin therapy, potentially affecting cardiovascular risk management. We present the case of a 67-year-old male patient with multiple cardiovascular comorbidities, including peripheral artery disease (PAD), who developed SAMS after resuming rosuvastatin. Management included statin discontinuation, supportive care with intravenous fluids, and transition to a non-statin lipid-lowering agent (proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor). This case highlights the diagnostic and therapeutic challenges of managing SAMS in a patient with complex cardiovascular comorbidities, particularly focusing on distinguishing myopathy from ischemic symptoms and navigating statin reintroduction versus alternative lipid-lowering strategies.

Stress and fatigue are two of the most important contributing factors to the declining physical and mental well-being of patients suffering from chronic illnesses. This research aims to identify the direct relationship between stress and fatigue to improve treatment guidelines and patient care.

This observational study was conducted from February to April 2025 in Islamabad, Pakistan. The study included adults over 18 years of age, individuals who provided consent, and those diagnosed with chronic illnesses such as diabetes, cardiovascular disease, autoimmune disorders, or cancer. A questionnaire was used to collect data comprising the Perceived Stress Scale and Fatigue Severity Scale. Analysis was performed through IBM SPSS Statistics for Windows, Version 26 (Released 2018; IBM Corp., Armonk, New York, United States).

Around 181 participants (47%) were male, 165 (43%) were female, and 40 individuals (10%) preferred not to disclose their gender. The largest age group was 26-35 years, with 240 individuals (62%), followed by 69 participants (18%) aged 36-45 years. The most commonly reported condition was hypertension, affecting 125 individuals (32%), followed by cardiovascular disease in 114 participants (29%) and diabetes in 57 (15%). A statistically significant moderate positive correlation between stress and fatigue (r = 0.481, p < 0.01) was obtained.

A strong positive correlation exists between perceived stress and fatigue severity among individuals with chronic diseases, influenced by factors like sleep duration and time since diagnosis.

Dyslipidemia, a risk factor for cardiovascular disease (CVD), is common among people living with the human immunodeficiency virus (HIV). The interaction between HIV, dolutegravir (DTG)- based antiretroviral therapy (ART), and lifestyle factors contribute to dyslipidemia, increasing CVD risk. Rwanda has made significant progress in expanding access to ART, achieving high coverage and viral suppression rates. However, comprehensive data on dyslipidemia among people living with HIV (PLWH) in Rwanda is lacking. Therefore, this study aimed to fill this gap by examining the prevalence, types, and correlates of dyslipidemia among PLWH.

This cross-sectional study with 264 participants analyzed serum lipid profiles to estimate the prevalence of dyslipidemia and specific lipid abnormalities. Demographic and lifestyle factors were collected using a questionnaire. Differences in categorical variables between HIV-positive and HIV-negative groups were assessed using chi-square or Fisher's exact tests. Continuous variables were compared using the Wilcoxon rank-sum test. Multivariable logistic regression models, stratified by HIV status, identified factors independently associated with dyslipidemia, reported as adjusted odds ratios (aOR) and 95% confidence intervals (CI). Statistical significance was defined as p-value < 0.05.

Dyslipidemia (NCEP ATP III criteria) was present in 74.2% of participants, significantly higher among PLWH (82.7%) than HIV-negative group (59.4%). Hypoalphalipoproteinemia and hyperbetalipoproteinemia were more common in PLWH (72.6% and 53.0%) vs HIV-negative (57.3% and 3.1%). Male gender reduced odds of dyslipidemia in both groups; smoking significantly increased risk among PLWH (aOR 8.8; 95% CI 1.73-44.59), while alcohol consumption was protective (aOR 0.2; 95% CI 0.07-0.55). DTG- based ART duration > 6-12 months increased odds of dyslipidemia vs ≤ 6 months (aOR 4.8; 95% CI 1.11-20.93).

The study found a high prevalence of dyslipidemia among PLWH on ART, linked to ART duration, age, smoking and sex, highlighting the need for regular screening, lifestyle interventions, and tailored HIV care.

The pathogenic potential of non-criteria antiphospholipid antibodies (aPLs), such as anti-β2-glycoprotein I (aβ2GPI) IgA, remains undefined. Additionally, the role of antiplatelet therapy in thrombotic antiphospholipid syndrome (APS) is controversial. Diagnosing APS is challenging when consensus aPLs are negative. Arterial recanalization via antiplatelet therapy in thrombotic APS has not been reported so far.

A 65-year-old woman presented with acute basilar artery occlusion. Dual antiplatelet therapy (aspirin + clopidogrel) achieved complete arterial recanalization within 11 days. High-Resolution Magnetic Resonance Imaging excluded atherosclerosis, dissection, or arteritis. Cardiac evaluations ruled out cardioembolism. Laboratory tests revealed persistent isolated high-titer aβ2GPI IgA (>150 U/mL) with negative consensus aPLs. Thrombotic workup excluded hereditary or other secondary thrombophilia, supporting a diagnosis of non-criteria APS. Long-term aspirin monotherapy maintained vascular patency and prevented stroke recurrence over 5 years.

This case highlights the thrombogenic role of aβ2GPI IgA in seronegative APS and demonstrates the potential efficacy of antiplatelet therapy, a strategy not prioritized in current APS guidelines favoring anticoagulation therapy, in reversing arterial occlusion and preventing recurrence in non-criteria APS. It underscores the need to re-evaluate diagnostic criteria and therapeutic strategy for seronegative APS with non-criteria aPLs.

Purpose: To investigate the conventional ultrasound and contrast-enhanced ultrasound (CEUS) imaging features of pseudoangiomatous stromal hyperplasia (PASH). Methods: Retrospective analysis of clinical and imaging data of 29 patients diagnosed with PASH from June 2014 to June 2023. Results: The median age of the patients was 39 years. Linear/cystic hypoechoic areas could be detected within the lesion in 12 cases (41.4%), and in 17 cases, the lesions had extensive conventional ultrasound findings with no significant features. The ultrasound-measured lesion diameters were smaller than those measured in surgically resected lesions, and the statistical difference was highly significant (p < 0.01). Fifteen cases underwent CEUS examination, with 7 lesions (46.7%) demonstrating uniform enhancement and 8 lesions (53.3%) exhibiting nonuniform enhancement. Within the enhanced regions, perfusion defects were observed, all of which were of the patchy type. The areas of patchy perfusion defects corresponded to the linear/cystic hypoechoic regions observed in the conventional sonographic images of the lesions. The use of CEUS provided additional diagnostic clarity compared with conventional ultrasound. Specifically, the specificity for identifying PASH lesions increased from 35.7% with conventional ultrasound to 64.3% with CEUS, highlighting the value of CEUS in enhancing the diagnostic accuracy for PASH lesions. Conclusion: This study suggests that linear/cystic hypoechoic areas on sonography may serve as crucial clues for the ultrasound diagnosis of PASH. The presence of diffuse patchy perfusion defects in CEUS contributes to the accurate diagnosis of PASH.

Identifying modifiable risk factors is crucial for dementia prevention, a global health concern. Depression is considered a risk factor for dementia, but the temporal dynamics across the life course remain inconclusive. Therefore, we aimed to systematically assess the relationship between the timing of depression assessment and risk of all-cause late-life dementia.

We conducted an umbrella review and meta-analysis to assess incident dementia in individuals with non-current history of depression. PubMed and Ovid Embase, MEDLINE, and PsycInfo were searched from inception up to February 17, 2025. Systematic reviews with meta-analyses investigating the association between depression and incident late-life dementia were included. From eligible reviews, we also extracted data from studies reporting dementia risk as hazard ratios (HRs), analysing the timing of depression measurement using random-effects models for meta-analysis. This study is registered with PROSPERO, CRD42021249706.

Of the 7763 records identified, nine reviews were eligible for inclusion of the umbrella review. One review was judged to be of moderate quality, while the others were either low (n = 3) or critically low (n = 5). For our meta-analyses, 18 studies reporting depression onset in later life (n = 901,762 participants, n = 7595 incident dementia cases) and seven studies on depression assessed during midlife (n ≥ 2,501,269 participants, n ≥ 276,929 incident dementia cases) were included. All studies in the meta-analyses were deemed to be of good quality, with no strong evidence of publication bias. Pooled HRs indicated depression present in late-life (HR 1.95, 95% CI: 1.68-2.26; I ² = 77.5%) and midlife (HR 1.56, 95% CI: 1.12-2.18; I ² = 97.5%) significantly increased risk of all-cause dementia.

The findings suggest that depression across the life course may increase dementia risk; however, substantial heterogeneity and review quality should be considered when interpreting the strength of this evidence. A life course approach to the treatment and prevention of depression may help reduce the burden of dementia, but this will require scaling up access to effective mental health care for vulnerable populations. Further research is needed to clarify if the stronger late-life association reflects depression as an immediate risk factor or an early manifestation of neurodegenerative processes.

National Institute for Health and Care Research, UK Research and Innovation, and Saudi Arabian Cultural Mission.

Metabolic syndrome (MetS) is associated with various diseases, yet its connection with aortic aneurysm (AA) is not well understood. The role of chronic inflammation as a mediator in this relationship also remains unclear. This study explores the combined effects of MetS and inflammation on AA risk.

Data from 312,505 UK Biobank participants were analyzed to assess the relationship between MetS and AA. Cox proportional hazards regression models evaluated the association, while restricted cubic splines, mediation analyses, interaction assessments, and joint analyses explored the impact of inflammatory indicators, including the low-grade chronic inflammation (INFLA) score.

Over a mean follow-up of 14.6 years, 2,382 participants developed AA. MetS was associated with a higher AA risk (HR: 1.27; 95% CI: 1.16-1.39) in fully adjusted models. Each additional MetS component increased AA risk by 16%. Inflammatory markers, including the INFLA score, significantly mediated this relationship. Joint analyses revealed a stronger association in MetS patients with high INFLA scores (HR: 1.68; 95% CI: 1.45-1.95).

MetS and its components notably elevate AA risk, with inflammation playing a key mediating role. These findings underscore the importance of targeted prevention strategies, particularly for MetS populations with high chronic inflammation.

Cognitive frailty (CF) is strongly associated with major adverse cardiovascular events, yet its assessment requires specialized equipment, limiting clinical practicality. This study aimed to develop and validate a nomogram model for predicting CF in patients with acute coronary syndrome (ACS) to enhance early identification and intervention.

Patients with ACS (N=547) were enrolled and randomly split into a training set (70%) and a testing set (30%). The training set was used to construct the nomogram, while the testing set was used for validation. Model performance was evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) to assess discrimination, accuracy, and clinical utility, respectively.

The nomogram included six predictors: education level, age, systolic blood pressure (SBP), Charlson Comorbidity Index (CCI), Short Physical Performance Battery (SPPB), and nutritional status. The model demonstrated strong discriminatory power, with an area under the ROC curve of 0.854 (95% CI: 0.741-0.861) in the training cohort and 0.733 (95% CI: 0.500-0.898) in the testing cohort. Calibration analysis confirmed high accuracy, and DCA indicated significant net benefits across both cohorts, supporting its clinical applicability.

The nomogram effectively predicts CF in ACS patients by considering education, age, SBP, CCI, SPPB, and nutritional status, serving as a visual aid for healthcare providers to facilitate the early identification and intervention of CF. Future research is needed to validate the nomogram's efficacy in diverse populations and explore standardized assessment methods that enhance its clinical applicability in mitigating CF in ACS patients.

Ischemic heart disease (IHD) is one of the leading causes of mortality and disability among the older adults. Studies have shown that air pollution (AP) exacerbates the risk of cardiovascular diseases, particularly IHD, posing significant health threats to older adults and increasing disease burden. Recently, with the rapid advancement of industrial technology, environmental pollution has become increasingly prominent. Therefore, it is of utmost significance to investigate the impact of AP on IHD burden, especially on vulnerable populations such as older individuals.

Global Burden of Disease (GBD) Study 2021 data was used to analyze and quantify contemporary global burden of IHD in individuals aged 60 and above due to AP and for trends for the time period between 1990 and 2021 using disease burden indicators such as deaths, DALYs, YLDs, YLLs and corresponding age-standardized rates (ASRs). Specifically, we are in patterns of disease burden of IHD in various subgroups stratified by age, sex, Sociodemographic Index (SDI), and GBD regions and countries. SDI-based analyses were conducted to explore the association between socioeconomic development and IHD burden attributable to AP. In addition, we employed the Bayesian Age-Period-Cohort (BAPC) model to provide future estimates of IHD burden attributable to AP for persons aged ≥60. This study provides a comprehensive overview of disease burden patterns of AP-related IHD from multiple perspectives.

Between 1990 and 2021, global IHD burden attributable to AP in individuals aged 60 and above rose in terms of deaths, DALYs, YLDs and YLL, while there was a decline in ASRs. Overall, the disease burden in the older adult population remains high, with older age groups experiencing the greatest burden and the most significant decrease in ASRs. Men consistently faced a higher burden than women. Except for high-SDI regions, the burden increased across all other SDI regions, while ASRs declined across all SDI categories. Regions such as East Asia and South Asia significantly contributed to the global burden, with marked regional differences in ASRs. High-income regions saw a more pronounced decrease in ASRs, whereas low-SDI regions, such as East Asia and South Asia, exhibited slower reductions. China and India together account for over half of the global burden. ASR of IHD attributable to AP generally decreased as SDI increased. Projections for 2036 suggest that the disease burden will continue to rise, while ASRs will gradually decline, with men continuing to bear a higher burden than women.

Although the ASRs of IHD due to AP in individuals aged 60 and older have generally decreased, the absolute number of cases continues to rise. The burden of IHD varies significantly across different genders, age groups, GBD regions, SDI regions, and countries, with older age groups and males exhibiting higher ASRs. In GBD regions such as East Asia and South Asia, as well as in low-SDI regions and developing countries, inadequate healthcare infrastructure and limited AP control exacerbate the impact of AP, resulting in a disproportionately heavy burden. As the global older adult population continues to grow, the health risks associated with AP-induced IHD are expected to worsen, posing an increasing public health challenge. Public health policies should reduce exposure to AP in men and address lifestyle-related factors in this group. In disease-burdened areas, health care systems need to be improved, air quality control policies need to be strengthened, and more efficient health management practices for older individuals need to be adopted. Public health awareness and informing individuals about risks of AP are also necessary for avoiding future disease burdens. Projections for 2036 are for a significant increase in IHD cases and global public health policies should be directed towards reducing AP and developing efficient health care infrastructure to address future challenges.