Introduction: Phantom tumor or evanescent tumor refers to an interlobar pleural effusion that occurs in patients with decompensated heart failure and resembles a lung tumor or mass that disappears after appropriate treatment. Its frequency is unknown.Objective: This entity was described based on a case report, emphasizing the proper use of the clinical method.Case report: The case of a 74-year-old male patient with a past medical history of hypertension and ischemic heart disease is presented. He presented with paroxysmal nocturnal dyspnea, orthopnea, pinpoint pain in the side extending to the right costal margin, fever of 38°C, crackles toward the lung bases, painful hepatomegaly, and edema in both lower limbs. The diagnosis of this presentation, the evanescent tumor or phantom tumor, is achieved through correct use of the clinical method supported by serial chest radiographs and is confirmed by the resolution of the effusion after initiating diuretic treatment.Conclusions: The relevance of this case lies in describing the difficulty of diagnosis, despite the potential complications of a late diagnosis, and demonstrating the need for accurate and effective application of the method.

Introduction: facial paralysis is an acute condition at the peripheral level that sets in abruptly. It produces a decrease or absence of mobility of the muscles that innervate the affected hemiface. It can be of central or peripheral origin. Depending on this, the rehabilitation treatment should be adjusted, taking into account the particularities of the affected persons and paying special attention to the emotional aspect.Objective: to identify the degree of satisfaction with the rehabilitation treatment of people with Bell's Palsy at the Dr. Carlos Juan Finlay Teaching Hospital. Methods: a cross-sectional descriptive study was carried out with a sample of 50 clinical histories. The variables used were sex, age, personal pathologic antecedents, symptoms and signs observed and the patient's evolution. Results: a clinical evolution with a very satisfactory result was observed in 64 % of the totality. The symptoms of facial asymmetry and deviation of the labial commissure after treatment were those that most frequently had a positive response. Conclusions: it was possible to identify that the clinical evolution achieved in more than half of the studied sample was very satisfactory. As secondary findings it was found that the most frequent pathological antecedents were arterial hypertension, diabetes mellitus and ischemic heart disease.

BackgroundProlonged hospital stay (LOS) is a major problem among patients admitted with heart failure (HF). A heightened cost of patients’ care, accompanied by a prolonged LOS, is associated with overutilization of the health facility resources, resulting in an increased health care budget in low-resource settings. Information on the factors influencing the LOS among patients admitted with HF in Tanzania is scarce. This study aimed to identify factors contributing to prolonged LOS among patients with HF.MethodsA cross-sectional study was conducted at the Jakaya Kikwete Cardiac Institute in Dar es Salaam, Tanzania, from May to June 2024. It included 327 participants recruited using simple random sampling. Data were collected through a self-administered questionnaire and analysed using SPSS version 27. Descriptive analysis was performed for the demographic and clinical characteristics to determine mean, standard deviation, frequency and percentages. Bivariate analysis was done to determine the association between the factors and the length of hospital stay. Furthermore, multivariable logistic regression for variables with p ≤ 0.2 was performed to rule out the confounding factors. A p-value < 0.05 was used to determine statistical significance.ResultsAmong the 327 participants, 196 (59.9%) were female. The mean age of participants was 48.6 years with a standard deviation (SD) of ± 17.4 years. The mean length of stay was 11 days, with 167 (51.1%) staying 10 days or more (i.e. 3rd quartile in the population sample). Participants from rural areas were 2 times more likely to have longer hospital stays compared to those from urban areas (AOR = 2.12, 95% CI: 1.317–3.424, p = 0.002). Participants with hypertensive heart disease (HHD) as a comorbidity with HF were 2.8 times more likely to have prolonged LOS compared to heart muscle disorders (HMD) (AOR = 2.805, 95% CI: 2.08–5.09, p = 0.042). In addition, participants with underweight were 2 times more likely to have a prolonged length of hospital stay compared to those with normal weight (AOR = 2.051, 95% CI: 1.006–3.439, p = 0.007). Furthermore, participants with treatment complications were 2.2 times more likely to have a prolonged LOS compared to those with no complications (AOR = 2.237, 95% CI: 1.05–4.79, p = 0.038).ConclusionThe findings show prolonged hospital stays for patients with HF and associated factors that need to be addressed. This underscores the need to adhere to the guidelines of the underlying conditions and comorbidities during treatments. Also, a close follow-up of nutrition status and developing strategies for those patients from rural areas may shorten the hospital stay.

Objective: To describe the pattern of cardiovascular diseases in elderly inpatients at Thai Binh General Hospital from 2019 to 2023. Methods: A retrospective, cross-sectional study was conducted by reviewing all medical records of inpatients aged ≥60 years hospitalized with cardiovascular diseases between 01/01/2019 and 31/12/2023. Results: Over the 5 years, 47,731 hospitalizations of elderly patients due to cardiovascular conditions were recorded (50.9% male; 49.1% female). The overall mean age was 67.1 ± 15.2 years and increased gradually. The three most common disease groups were: other forms of heart disease (I30–I52) with 19,730 cases (in which arrhythmias accounted for 43.8% and heart failure 39.7%), hypertensive diseases (I10–I15) with 8,749 cases (70% essential hypertension), and ischemic heart diseases (I20–I25) with 7,102 cases (39.5% myocardial infarction and 36.6% angina pectoris). Among arrhythmias, atrial fibrillation and atrial flutter were the most common, accounting for 5,287 of 8,645 cases (61.2%). Conclusion: In elderly inpatients with cardiovascular diseases at Thai Binh General Hospital during 2019–2023, the most prevalent conditions were arrhythmias, heart failure, hypertension, and ischemic heart disease.

Objective: To describe the pattern of cardiovascular diseases in elderly inpatients at Thai Binh General Hospital from 2019 to 2023. Subjects and Methods: A retrospective, cross-sectional study was conducted by reviewing all medical records of inpatients aged ≥60 years hospitalized with cardiovascular diseases between 01/01/2019 and 31/12/2023. Results: Over the 5-year period, 47,731 hospitalizations of elderly patients due to cardiovascular conditions were recorded (50.9% male; 49.1% female). The overall mean age was 67.1 ± 15.2 years and showed a gradual increase. The three most common disease groups were: other forms of heart disease (I30–I52) with 19,730 cases (in which arrhythmias accounted for 43.8% and heart failure 39.7%), hypertensive diseases (I10–I15) with 8,749 cases (70% essential hypertension), and ischemic heart diseases (I20–I25) with 7,102 cases (39.5% myocardial infarction and 36.6% angina pectoris). Among arrhythmias, atrial fibrillation and atrial flutter were predominant, accounting for 5,287 of 8,645 cases (61.2%). Conclusion: In elderly inpatients with cardiovascular diseases at Thai Binh General Hospital during 2019–2023, the most prevalent conditions were arrhythmias, heart failure, hypertension, and ischemic heart disease.

Patients with myasthenia gravis (MG) exhibit significant heterogeneity based on age at disease onset. However, existing retrospective studies in China remain confined to single-center settings with limitations in sample size adequacy. The aim of this study was to compare clinical characteristics, treatment responsiveness, and long-term postintervention status of patients with MG across different onset ages. This was an observational, cross-sectional, multicenter, retrospective study. We reviewed the medical records of patients diagnosed with MG who were hospitalized in 3 MG centers of China from January 2012 to December 2022. Demographic information, clinical characteristics, and therapeutic data were extracted from the electronic medical record system, and responsiveness to treatment was followed up. Patients were classified into 3 age subgroups: juvenile MG (age at onset <18 years), early-onset MG (onset ≥18 and <50 years), and late-onset MG (onset ≥50 years). Time to minimal manifestation (MM) or better status was assessed using Kaplan-Meier curves and Cox proportional hazards regression models. Among 2,574 patients with MG meeting inclusion criteria, 1,023 (39.7%) had juvenile MG, 568 (22.1%) had early-onset MG, and 983 (38.2%) had late-onset MG. Juvenile MG showed a peak onset at 0-4 years (61.9%), predominantly affecting female individuals (58.3%) and presenting mainly with ocular symptoms (90.2%). While most juvenile patients responded well to treatment, pubertal onset (OR 5.2 [95% CI 2.75-9.98]), thymic hyperplasia (OR 11.4 [95% CI 5.64-22.99]), and positive acetylcholine receptor antibodies (OR 3.1 [95% CI 1.65-5.65]) were risk factors of secondary generalization. In adults, late-onset MG was more common than early-onset MG, with male predominance (53.0%) and greater comorbidity burden (40.6%), including hypertension, diabetes mellitus, and coronary heart disease. The proportion of patients with late-onset MG (66.7%) achieving MM or better status was lower than that of patients with early-onset MG (74.7%) (p < 0.001). Multivariable analysis identified late-onset MG (HR 0.8 [95% CI 0.69-0.91]), thymic abnormalities (HR 0.8 [95% CI 0.67-0.91]; HR 0.7 [95% CI 0.61-0.88]), and generalized MG (HR 0.8 [95% CI 0.71-0.96]) as factors associated with poorer outcomes. This large cohort study highlights distinct clinical and prognostic differences in MG by age at onset. Pubertal-onset juvenile MG and late-onset MG represent vulnerable groups, with late-onset MG demonstrating poorer prognosis.

Background: Pregnancy complicated by maternal heart disease remains a leading cause of morbidity and mortality for both mothers and neonates. However, information regarding the factors influencing cardiovascular events in neonates and mothers within 6 months postpartum is limited. This study aimed to identify predictors of adverse maternal and neonatal outcomes in pregnancies of women with pre-existing heart disease. Methods: The study conducted a retrospective cross-sectional analysis of all pregnancies with a history of heart disease from January 2017 to January 2024, using secondary data from medical records at Dr M. Djamil Padang Hospital, Indonesia. We analysed the data using the χ2/Fisher’s exact test and logistic regression. Results: A total of 110 pregnant women with heart diseases were hospitalised during the study period, with an average age of 30.52 ± 6.00 years. The most common types of heart disease were valvular heart disease (28%), chronic hypertension (24%) and congenital heart disease (23%). In 27.2% of cases, adverse maternal outcomes included mortality (10%), heart failure (8.2%), arrhythmia (4.5%), rehospitalisation (3.6%) and thromboembolic event (0.9%). Meanwhile, 57.3% of cases had neonatal adverse outcomes, including mortality (5.4%), low Apgar score (16.4%), prematurity (28.2%), low birthweight (6.4%) and congenital heart disease (0.9%). The multivariate analysis discovered that moderate-to-severe left heart obstruction (OR 14.184; 95% CI [2.725–73.836]; p=0.002) and reduced ejection fraction &lt;40% (OR 16.211; 95% CI [1.712–153.507]; p=0.015) were the main factors that led to adverse maternal outcomes. Meanwhile, cyanotic congenital heart disease (OR 8.449; 95% CI [1.030-69.328]; p=0.047) was the most important determinant of adverse neonatal outcomes. Conclusion: This study revealed that moderate-severe left heart obstruction and reduced ejection fraction &lt;40% were the most significant factors influencing adverse maternal outcomes. Meanwhile, cyanotic congenital heart disease was the most important determinant of adverse neonatal outcomes.

ABSTRACTBackgroundDespite early interest in the effects of dietary fats on cardiovascular diseases (CVDs), substantial controversy remains regarding the evidence linking different types of fatty acids to CVDs. This study aimed to examine the association between dietary fat intake, CVD risk, and serum lipid biomarkers.MethodsThis cross‐sectional study included data from 4200 adult participants (1218 patients with CVDs and 2982 healthy participants) from the Persian Cohort Study. Data on heart disease (hypertension, myocardial infarction, and ischemic heart disease) were collected. Dietary intake was assessed using a validated food frequency questionnaire (FFQ), and the intake of different fatty acids was evaluated using Nutritionist‐IV software. Serum lipid profiles were analysed using enzymatic and chromatographic methods.ResultsHigher monounsaturated fatty acids (MUFA) intake showed an inverse association with CVDs (OR = 0.931, 95% CI: 0.867–0.998, p = 0.045). Adjustments for age, gender, smoking, alcohol consumption, physical activity, BMI, and caloric intake did not alter this association. No significant associations were observed for other dietary fats.ConclusionThe findings suggest an inverse association between MUFA intake and CVD risk. Further longitudinal studies are warranted to confirm these results.

Astragaloside IV (AS-IV) is an active component of Astragalus membranaceus, which has a prominent role in cardiovascular diseases. AS-IV has been reported to alleviate vascular endothelial dysfunction and promote angiogenesis. However, its function in hypertensive heart disease (HHD), a key underlying mechanism for cardiovascular morbidity and mortality, remains to be defined. The objective here is to investigate the inhibiting effect of AS-IV on HHD. HHD mice were induced by N(omega)-nitro-L-arginine methyl ester (L-NAME, LN), followed by AS-IV treatment. LN caused arterial endothelial dysfunction and cardiomyocyte injury in mice, while AS-IV ameliorated the pathological changes. Moreover, LN reduced the viability of arterial endothelial cells and cardiomyocytes and diminished the migration and angiogenic capacity of arterial endothelial cells, which were alleviated by AS-IV. AS-IV ameliorated LN-induced loss of retinoic acid receptor RXR-alpha (RXRA) and promoted the transcription of sirtuin 3 (SIRT3) via the RXRA/peroxisome proliferator-activated receptor gamma (PPARG) heterodimer. Knockdown of RXRA resulted in a loss of the therapeutic effect of AS-IV, and the progression of HHD caused by knockdown of RXRA was reversed by PPARG or SIRT3 overexpression. Hence, we propose that AS-IV promotes the expression of RXRA in HHD and mediates the transcription of SIRT3 through RXRA/PPARG, thereby ameliorating endothelial dysfunction and cardiomyocyte injury. KEY MESSAGES: AS-IV inhibits LN-induced HHD in mice and cardiomyocyte injury. AS-IV promotes endothelial cell migration and angiogenesis. AS-IV inhibits the loss of RXRA expression induced by LN. RXRA/PPARG heterodimer regulates the transcriptional expression of SIRT3. The therapeutic effect of AS-IV on HHD is dependent on RXRA/PPARG/SIRT3 signaling.

Intracerebral hemorrhage (ICH) and hypertensive heart disease (HHD) are major contributors to global mortality and disability. While both conditions share common risk profiles, most existing studies have examined them in isolation, limiting understanding of their co-occurrence patterns and shared determinants. This study aimed to systematically assess the global co-burden of ICH and HHD in adults aged ≥35years, identify their shared and distinct risk factors, and develop an integrated risk index to inform comprehensive prevention strategies. Data were obtained from the Global Burden of Disease (GBD) 2021 study for populations aged 35 and older across 204 countries and territories. We analyzed age-standardized prevalence (ASPR) and disability-adjusted life years (DALYs) for ICH and HHD, standardized using the GBD global reference population. Based on the quartile distribution of these metrics, countries were categorized as ICH-dominant, HHD-dominant, or consistent. Machine learning models and negative binomial regression identified comorbidity-associated risk factors. Sequential population attributable fractions and composite risk indices were computed to assess the burden attributable to selected risk factors. Global burden analysis revealed significant disparities, with low-SDI regions bearing a disproportionately higher burden. Classification based on DALYs identified 37 countries as ICH-dominant, 30 as HHD-dominant, and 137 as consistent. ASPR-based classification yielded 46 ICH-dominant, 50 HHD-dominant, and 108 consistent countries, indicating a metric-dependent divergence. Risk factor analysis identified four key drivers for DALYs: iron deficiency, high-sodium diet, low calcium diet, and low polyunsaturated fatty acids intake. For ASPR, low bone mineral density was a shared factor for both diseases, while iron deficiency was specific to ICH. The sequential PAF of these risk factors accounted for 77.64% of global ICH DALYs and 29.87% of HHD DALYs, and 28.85% of ICH ASPR and 7.66% of HHD ASPR. The weighted composite risk index further confirmed substantial geographical heterogeneity in the co-burden.

BackgroundPediatric cardiovascular diseases (CVDs), including congenital heart anomalies (CHAs), rheumatic heart disease (RHD), and related conditions, remain a significant health challenge in Indonesia, especially given the country’s diverse geography and disparities in healthcare access. We aim to analyze national and provincial trends in the burden of pediatric CVDs in Indonesia from 1990 to 2023 using Global Burden of Disease (GBD) data.MethodsWe conducted a retrospective observational analysis using the GBD 2023 dataset, focusing on the prevalence, mortality, and disability-adjusted life years (DALYs) of pediatric cardiovascular diseases across age groups. Trends were assessed by sex and province. The Estimated Annual Percentage Change (EAPC) was calculated for each CVD subcategory and age group by fitting a log-linear regression model to the natural logarithm of annual rates. To evaluate nonlinear temporal patterns, generalized additive models (GAMs) were applied with penalized smoothing splines for year. Poisson or negative binomial regression models were used to model mortality counts, with the latter selected when overdispersion exceeded 1.5.ResultsFrom 1990 to 2023, Indonesia showed an overall decline in DALY rates for CHAs, decreasing from 120,809.85 to 68,324.17 per 100,000, and for non-congenital CVDs, from 42,118.56 to 29,842.73 per 100,000. The most notable improvements occurred among infants and toddlers, whereas adolescents showed stagnant or rising burdens, particularly for ischemic heart disease (IHD), hypertensive heart disease (HHD), and aortic aneurysm. CHAs remained the leading contributor, with neonatal prevalence and mortality in 2023 reaching 1511.53 and 1341.68 per 100,000, respectively. Despite the overall national decline, positive EAPC values (p < 0.001) were observed for these adult-type cardiovascular conditions within the transitioning adolescent population. Regionally, the eastern provinces showed consistently higher mortality—CHA from 23.20 to 15.58 per 100,000 and non-congenital CVDs from 6.07 to 5.23 per 100,000.ConclusionCHAs remain the leading cause of pediatric CVD in Indonesia, especially among neonates, while adolescents face rising adult-type cardiovascular conditions. National improvements are uneven, with eastern provinces experiencing higher burdens due to limited access to care. These inequalities highlight the need for targeted prevention, early detection, and strengthened long-term management to ensure equitable and sustainable child cardiovascular health.

BACKGROUND: The onset and progression of hypertension may damage target organs, particularly the heart. This disease is asymptomatic during its early stages. According to Russian guidelines for the treatment of hypertension, left ventricular myocardial hypertrophy is the primary marker of asymptomatic heart disease. Earlier signs may include functional changes in the left atrium, which is detected by speckle tracking echocardiography with longitudinal strain assessment. AIM: This study aimed to assess the efficacy of speckle tracking echocardiography with longitudinal strain assessment in detecting early signs of left myocardial dysfunction in patients with hypertension. METHODS: Segmental and global left atrial and ventricular longitudinal strain was evaluated in patients with hypertension with or without left ventricular hypertrophy and a control group. The longitudinal strain was assessed by analyzing curves of segmental longitudinal strain peaks and rates. Following echocardiography in three standard apical views, software was used to convert data into bull’s eye diagrams. This enabled a comprehensive assessment of global and regional left ventricular contractility using numeric and color parameters. Segmental left ventricular and left atrial longitudinal strain was evaluated using 17 and 6 segments, respectively. RESULTS: No significant differences were found in global left ventricular longitudinal strain parameters between patients with hypertension without echocardiographic signs of left ventricular hypertrophy and healthy individuals. Patients with hypertension (both with and without left ventricular hypertrophy) showed a significant decrease in left atrial longitudinal strain compared to healthy individuals. CONCLUSION: Decreased left atrial longitudinal strain may be the earliest sign of asymptomatic heart disease in hypertension. Impaired longitudinal strain in the left ventricular basal segments is associated with left ventricular hypertrophy in patients with hypertension.

Background: The global epidemic of metabolic diseases demands novel theoretical frameworks for understanding their pathogenesis. The functional–metabolic continuum (FMC) concept, first articulated by Gozhenko in 2010, offers an integrative model connecting stress physiology, metabolic regulation, and cardiovascular disease. Objective: To present a comprehensive review of the FMC concept—its evolutionary foundations, pathophysiological mechanisms, clinical manifestations, and therapeutic implications—with particular emphasis on the standardized regulatory–metabolic response that evolved to support physical function. Key Concepts: The FMC postulates that health depends on temporal and quantitative coupling between metabolic mobilization of energy substrates by neuroendocrine systems and their utilization by somatic functions, especially muscular activity. Evolution shaped a standardized regulatory–metabolic response—uniform in direction and magnitude—that was inseparably linked with physical function. This response is stereotypical and cannot be flexibly downregulated; regulatory activation invariably produces standard metabolic mobilization, regardless of whether physical activity will actually occur. Modern conditions disrupt this coupling via two principal mechanisms: (1) psychoemotional stress activates neuroendocrine systems and mobilizes substrates in the ancestral "fight-or-flight" pattern, yet social constraints prevent the physical activity that would consume these substrates; (2) dietary excess supplies substrates in quantities chronically exceeding utilization capacity, especially when combined with sedentary lifestyles. Both mechanisms result in chronic or recurrent hyperglycemia and hyperlipidemia, damaging vascular endothelium through glycosylation, oxidative stress, inflammation, and lipid accumulation. Endothelial dysfunction represents the central pathogenetic link between metabolic derangements and clinical cardiovascular disease. Our studies of circulating desquamated endothelial cells demonstrate progressive endothelial damage across a continuum—from apparently healthy individuals through isolated arterial hypertension and ischemic heart disease to comorbid states—correlating with the severity of metabolic disturbance. Therapeutic Implications: Restoration of the FMC through physical activity (consumption of mobilized substrates) or dietary approaches (reduction of substrate availability) represents pathogenetically grounded therapy. Temporal coupling is critical: physical activity should follow stress exposure or meals to consume mobilized substrates before they exert pathological effects. Time-restricted eating and avoidance of late-evening meals reduce substrate availability during circadian phases when utilization capacity is minimal. Conclusions: The FMC concept provides a novel integrative approach to understanding metabolic diseases as consequences of a mismatch between ancient physiology (a standardized regulatory–metabolic response inseparably linked with physical function) and modern conditions (psychoemotional stress without muscular work, dietary excess with sedentary lifestyle). Recognizing that regulatory activation invariably evokes standard metabolic mobilization, independently of functional need, explains why modern stressors become pathogenic. Restoration of functional–metabolic balance through targeted interventions may prevent or halt progression of metabolic diseases.

Lung adenocarcinoma may occasionally present with radiographic features resembling organizing pneumonia (OP), resulting in diagnostic uncertainty, delayed recognition, and the risk of inappropriate management. We present a case of a 77-year-old man with diabetes mellitus, hypertension, and ischemic heart disease who developed bilateral pulmonary infiltrates. Radiological findings initially suggested OP; however, histopathological examination revealed a moderately differentiated mucinous adenocarcinoma favoring a primary lung tumor. This case underscores a significant diagnostic pitfall and highlights the necessity of histological confirmation when encountering atypical radiologic features.

BackgroundHypertensive heart disease remains a growing global health challenge, especially in regions with limited socioeconomic development. Understanding how its prevalence, mortality, and disability burden have changed over time is crucial for guiding prevention and control strategies. This study analyzed global trends from 1990 to 2021, examined differences by sex and development level, and projected future patterns to 2046.MethodsUtilizing data from the Global Burden of Disease (GBD) study, we examined patterns in the occurrence, death rates, and DALYs of hypertensive heart disease from 1990 to 2021; analyzed the time-based patterns of the average annual percentage change (AAPC) through joinpoint regression models; and evaluated the effects of aging, demographic expansion, and epidemiological shifts in hypertensive heart disease burden by integrating frontier and decomposition studies. An assessment of hypertensive heart disease burden and Bayesian age-period-cohort (APC) modeling techniques were employed to forecast future patterns.ResultsFrom 1990 to 2021, the worldwide incidence of hypertensive heart disease increased from 4,626,598 to 12,505,436 cases, accompanied by a 0.53% AAPC; the number of hypertensive heart disease-related deaths increased from 713,935 to 1,332,099 cases, with a −0.79% AAPC; and the number of DALYs increased from 15,473,830 to 25,462,185 years, with a −0.95% AAPC. The incidence in females was marginally greater than that in males, yet there were comparable decreases in deaths and DALYs for both sexes. There was a notable increase in prevalence in regions with high SDIs, whereas areas with low SDIs experienced greater disease burdens. The increasing worldwide burden of hypertensive heart disease is attributed primarily to aging and population growth. According to the APC model, the worldwide incidence of hypertensive heart disease is expected to increase from 2022 to 2046, with further decreases in deaths and DALYs.ConclusionsThis study systematically reveals the increasing trend in the incidence of hypertensive heart disease globally between 1990 and 2021 and confirms the significant impact of sex and socioeconomic development level on its burden. Forecasts to 2046 indicate that the prevalence will continue to rise, although mortality may decline, achieving the research objective of exploring the global and regional epidemiological characteristics and future trends of hypertensive heart disease.

Current medical language models, adapted from large language models, typically predict ICD code-based diagnosis from electronic health records (EHRs) because these labels are readily available. However, ICD codes do not capture the nuanced, context-rich reasoning clinicians use for diagnosis. Clinicians synthesize diverse patient data and reference clinical practice guidelines (CPGs) to make evidence-based decisions. This misalignment limits the clinical utility of existing models. We introduce GARMLE-G, a Generation-Augmented Retrieval framework that grounds medical language model outputs in authoritative CPGs. Unlike conventional Retrieval-Augmented Generation based approaches, GARMLE-G enables hallucination-free outputs by directly retrieving authoritative guideline content without relying on model-generated text. It (1) integrates LLM predictions with EHR data to create semantically rich queries, (2) retrieves relevant CPG knowledge snippets via embedding similarity, and (3) fuses guideline content with model output to generate clinically aligned recommendations. A prototype system for hypertension and coronary heart disease diagnosis was developed and evaluated on multiple metrics, demonstrating superior retrieval precision, semantic relevance, and clinical guideline adherence compared to RAG-based baselines, while maintaining a lightweight architecture suitable for localized healthcare deployment. This work provides a scalable, low-cost, and hallucination-free method for grounding medical language models in evidence-based clinical practice, with strong potential for broader clinical deployment.

Immune responses play a critical role in myocardial injury, yet the specific contribution of B lymphocyte-dependent mechanisms to Angiotensin Ⅱ (Ang Ⅱ)-induced cardiac hypertrophy remains largely undefined. We hypothesized that B cells promote pathological remodeling by regulating chemokine production and monocyte recruitment. To investigate this hypothesis, wild-type (WT) and B cell-deficient (µMT) mice were infused with Ang II (1.5µg/g/day) for 2 or 4 weeks. Blood pressure measurement, echocardiography, flow cytometry, and histopathology were performed to assess cardiac remodeling and inflammation. We found that following Ang II treatment, B lymphocytes selectively produced CCL7, which facilitated the mobilization and recruitment of Ly6C⁺ monocytes into the myocardium, leading to inflammation, tissue injury, and hypertrophy. In contrast, genetic ablation of B cells markedly reduced CCL7 production, limited monocyte infiltration, and attenuated cardiac hypertrophy, despite similar blood pressure responses. Consistently, mice with a B cell-specific deficiency of CCL7 exhibited comparable protective effects. Our findings demonstrate that B lymphocytes critically amplify Ang Ⅱ-induced cardiac hypertrophy by producing CCL7 and promoting monocyte recruitment. This B cell-dependent mechanism operates independently of hypertension and identifies B cell-mediated inflammation as a potential therapeutic target in hypertensive heart disease.

Background: Chronic kidney failure is one of the 12 leading causes of death worldwide. Chronic kidney disease (CKD) is a condition in which kidney function begins to decline progressively over months or even years. Chronic kidney disease (CKD) is closely related to degenerative processes resulting from damage to the body's organs. Degenerative diseases associated with an increased incidence of CKD include diabetes mellitus, hypertension, and coronary heart disease. Chronic kidney disease (CKD) is a progressive and irreversible renal dysfunction that causes uremia, requiring hemodialysis to maintain life. This is related to knowledge and family support in improving the quality of life of chronic kidney disease patients undergoing hemodialysis. Objective: To determine the relationship between knowledge and family support in chronic kidney disease patients undergoing hemodialysis at Bhayangkara Hospital, Class I, Indonesian National Police Health Center. Method: This study was quantitative with a cross-sectional approach. The sample size was 40 people, with a total sampling technique, and the data were tested using chi-square. Results: The results showed a relationship between knowledge and family support with quality of life with a p-value of 0.012 and a p-value of 0.002. Conclusion: There is a relationship between knowledge and family support with quality of life in chronic kidney disease patients undergoing hemodialysis at Bhayangkara Hospital, Class I, Indonesian National Police Health Center.

Background This study aims to develop a Machine Learning (ML) model to predict the initial diagnosis of Amyotrophic Lateral Sclerosis (ALS). Methods To predict ALS, a stacked model combining four ML algorithms—logistic Regression, Decision Tree, Random Forest, and Extreme Gradient Boosting—was implemented. The analysis utilized healthcare administrative data from Catalonia, encompassing 2,924,590 elderly individuals from 2014 to 2021, which were linked to socioeconomic factors and medication records. Results The stacked model successfully predicted first-time ALS diagnoses, achieving an AUC of 0.86, with an accuracy of 0.86, specificity of 0.88, and sensitivity of 0.84. The most influential predictors included immunization encounters, South American origin, general medical and special examinations, hypertensive heart disease, and counseling. Other relevant features were sciatica, heart failure, liver metastases, healthcare use patterns, and chronic conditions such as hypertension, kidney disease, and hypercholesterolemia. These features reflect early clinical symptoms and healthcare usage patterns relevant to ALS detection. Conclusions Machine Learning models, particularly stacked approaches, show promising results in predicting ALS diagnoses using administrative health data. Continued research is necessary to improve detection strategies and support their integration into healthcare systems.

Hypertensive heart disease is a major cause of heart failure (HF), this study evaluate the global burden and trends of HF attributable to hypertensive heart disease from 1990 to 2021. We collected detailed information on prevalence, years lived with disability of HF attributable to hypertensive heart disease from the Global Burden of Disease study 2021 across 204 countries and territories. Numbers, age-standardized rates and average annual percent change of HF attributable to hypertensive heart disease prevalence and years lived with disability were compared by age, sex, and socio-demographic index. In 1990 and 2021, hypertensive heart disease related HF affected more than 4.6 million and 13 million individuals globally, demonstrating an age-standardized prevalence rate of 125.4 [95% uncertainty Interval (UI) 99.0 to 158.0] and 148.3 per 100,000 (95% UI 117.3 to 186.3) and an age-standardized years lived with disability rate of 11.2 (95% UI 7.2 to 15.7) and 13.2 (95% UI 8.4 to 19.1) per 100,000, respectively. Notably, from 1990 to 2021, the global age-standardized prevalence and years lived with disability rates increased consistently, with an average annual percent change of 0.53 (95% CI 0.52 to 0.54) and 0.54 (95% CI 0.53 to 0.55), respectively. The global burden of HF attributable to hypertensive heart disease has risen.