Background: Heart failure (HF) is rising among younger adults in sub-Saharan Africa, yet data on their clinical profile and outcomes are limited. We compared clinical characteristics, etiology, and 1-year outcomes between younger and older HF patients in the Ibadan Heart Failure Project.
Methods: We included 1290 adults (≤50 y, n=430; >50 y, n=860) enrolled from 2016 through 2022. Baseline sociodemographic, clinical, laboratory, and echocardiographic data were collected. HF etiology was classified using ICD-10 codes. Medication use and 1-year outcomes, including rehospitalization, mortality, and a composite of rehospitalization and mortality, were assessed.
Results: Younger patients are predominantly females, more often single and employed, and presented with advanced HF signs, including paroxysmal nocturnal dyspnea, raised jugular venous pressure, S3 gallop, and cardiomegaly. Older patients had a higher prevalence of hypertension, diabetes mellitus, and peripheral edema. Hypertensive heart disease and cor pulmonale predominated in older patients (76% vs 44%), whereas younger patients more frequently had dilated cardiomyopathy (16% vs 7.4%), peripartum cardiomyopathy, and rheumatic heart disease (15% vs 6.2%). Guideline-directed therapy use was similar across ages. One-year mortality, rehospitalization, and composite outcomes did not differ significantly between age groups.
Conclusion: Younger HF patients in Nigeria present with severe nonischemic cardiomyopathies and advanced systolic dysfunction, whereas older patients have hypertensive and metabolic phenotypes. Despite these differences, 1-year outcomes were uniformly poor, reflecting the high burden of HF morbidity and mortality across all age groups in Nigeria.

Introduction: Medication adherence in patients with cardiovascular disease remains a significant challenge and directly affects treatment success, morbidity, and healthcare costs. Although many studies have examined clinical and individual factors that influence adherence, the role of regulatory agencies has received less attention. The Iranian Food and Drug Administration (IFDA) is the leading authority responsible for regulating drugs, Understanding the strategic functions of this agency, and aligning them with adherence factors can be crucial for improving patient outcomes and maintaining the sustainability of the healthcare system.
Methods: This study was conducted in 3 stages. First, regulatory activities of the IFDA were gathered from regulations, policy documents, organizational reports, and semistructured interviews. Second, the identified factors were validated by clinical and pharmaceutical experts, and monitoring activities were matched with medication adherence through a mapping matrix approach. Third, the importance-performance analysis (IPA) method was applied to evaluate systematic strengths and weaknesses, and the performance gap and normal weight were calculated.
Results: Twenty-eight strategic-level tasks of the organization were classified into 4 IPA quadrants. The “Immediate Focus” quadrant consisted of 8 tasks (28.6%) with the highest normal weight (50.7%) and an average performance gap of 2.69, indicating serious weaknesses in the areas of innovation and research, strategic planning of production/imports, quality monitoring, and currency policies. The “Continuing the Good” quadrant encompassed 6 tasks (21.4%, 25.1% weight) reflecting strengths in drug supply, continuous access, equitable distribution, drug information systems, and communications. The “Low Priority” (5 tasks, 17.9%) and “Overfocus” (9 tasks, 32.1%) quadrants reflected administrative or ineffective activities that allocated disproportionate resources.
Conclusion: The findings of this study suggest that the strategic-level tasks of the IFDA play a crucial role in promoting adherence to cardiovascular medication for patients. While good performance was observed in the areas of drug supply and access, significant deficiencies were identified in innovation, financial planning, quality monitoring, and patient education.

Atrial fibrillation (AF) is highly prevalent in patients undergoing cardiac surgery, and persistent AF poses significant challenges in postoperative rhythm management. This study investigated whether maintaining high-normal potassium levels (>4.4 mmol/L) during and after cardiopulmonary bypass (CPB) enhances SR restoration and stability in patients with persistent AF. A prospective observational study of 245 patients undergoing elective cardiac surgery was conducted, with potassium levels maintained above 4.5 mmol/L during CPB and supplemented postoperatively for 48 hours. Outcomes included SR conversion rates, hemodynamic parameters, and predictors of rhythm stability. Results showed that 87% of patients reverted to SR post-CPB, with 71% maintaining SR at 48 hours. Higher intraoperative potassium levels (mean, 4.54 vs 4.41 mmol/L; P=.02) significantly predicted successful cardioversion, whereas larger left atrial diameter (67.2 vs 53.8 mm; P<.001) correlated with AF persistence. Hemodynamic stability improved in patients with SR, with lower heart rates, higher mean arterial pressures, and reduced ICU stays (52.5 vs 58.8 h; P<.001). The study concludes that maintaining high-normal potassium levels during and after CPB facilitates SR restoration and short-term stability in patients with persistent AF, improving hemodynamics and reducing ICU dependency. Left atrial enlargement remains a key determinant of AF recurrence. These findings support perioperative potassium optimization as a feasible strategy to enhance postoperative outcomes, warranting further multicenter trials for validation.

Background: Myocardial infarction is a severe cardiovascular condition that necessitates prompt reperfusion therapies, particularly primary percutaneous coronary intervention (PCI), to prevent irreversible myocardial damage and associated complications. This study aimed to determine the average door-to-balloon (D2B) time in Iranian hospital emergency departments through a systematic review and meta-analysis.
Methods: Following the PRISMA guideline, the protocol for this study was registered in PROSPERO (CRD420251171966). A comprehensive search with no time restrictions was conducted through the end of September 2025 in data resources such as PubMed, Scopus, Web of Science, Google Scholar, SID, and Magiran. A random-effects model was used for the meta-analysis, and heterogeneity among studies was assessed using the I² index. Publication bias was evaluated with Begg test.
Results: Of 154 initial articles retrieved, 13 studies met the eligibility criteria and were included in the final analysis. The pooled mean D2B time was 85.05 minutes (95% CI, 75.32 to 94.78). A significant level of heterogeneity was observed among the included studies. Meta-regression analysis indicated a decreasing trend in D2B time over the years.
Conclusion: The results of this study indicate that the average D2B time in Iran aligns with global standards. However, significant variability among hospitals highlights systemic gaps in STEMI care. Addressing these gaps requires coordinated emergency-PCI teams, nationwide 24/7 services, ongoing training, and uniform quality standards.

Background: Data on the link between use of antihypertensive medications and the risk of developing or dying from cancer have uncertain credibility and certainty.
Objectives: We sought to evaluate the credibility of evidence from observational studies and the certainty of evidence from randomized controlled trials (RCTs) on the association between antihypertensive medication use and cancer risk, mortality, or survival outcomes.
Methods: Comprehensive searches were performed in PubMed, Embase, Scopus, and the Cochrane Database of Systematic Reviews from their creation through July 2024. The study included systematic reviews and meta-analyses of epidemiological research investigating the relationships between antihypertensive therapies and cancer risk, mortality, or survival outcomes. The credibility of evidence from observational studies was categorized as convincing, highly suggestive, suggestive, weak, or nonsignificant. Through the GRADE framework, the certainty of evidence from RCTs was categorized as high, moderate, low, or very low.
Results: A total of 109 meta-analyses were identified, with 90 originating from observational studies and 23 from RCTs. The observational studies provided highly suggestive evidence that calcium channel blockers (CCBs) and diuretics were associated with an increased cancer risk (equivalent odds ratio [eOR], 1.07; 95% CI, 1.04 to 1.10; and eOR, 1.15; 95% CI, 1.10 to 1.20, respectively). Evidence suggests that β-blockers are associated with an increase in cancer-specific survival (eOR, 0.78; 95% CI, 0.69 to 0.89). No association satisfied the standards for convincing evidence. Pooled analyses of RCTs determined that CCB use was associated with an increased cancer risk (eOR, 1.06; 95% CI, 1.01 to 1.12; moderate certainty).
Conclusions: No strong or consistent evidence was found to support a causal relationship between antihypertensive medications and cancer outcomes. The observed associations were of very small magnitude, suggesting limited clinical relevance.

Descending thoracic aorta tortuosity results from elongation of the descending aorta and is associated with aging. It acts as a risk factor for challenging endovascular procedures and has prognostic significance. It may, however, sometimes present as a vascular mass in the mediastinum, distorting nearby cardiac chambers, which may confuse physicians during transesophageal echocardiography.
We describe an elderly woman with severe descending thoracic aorta tortuosity presenting with a tubular vascular mass located behind the left atrium, exerting compression on it. Recognizing the potential echocardiographic presentation of aortic tortuosity can aid in the timely identification of this condition during transesophageal echocardiography.

Bilateral deep vein thrombosis (DVT) is a rare condition among adolescents and represents an uncommon pattern of venous thromboembolism. We report a case of bilateral DVT occurring in the setting of severe pulmonary hypertension and right-sided heart failure secondary to congenital heart disease associated with congenital rubella syndrome (CRS). A 19-year-old female patient, with a history of CRS characterized by the classical triad of unilateral cataract, sensorineural deafness, and congenital heart disease, was admitted to our hospital with shortness of breath, swelling in both legs, and abdominal discomfort. Doppler ultrasonography demonstrated partial thrombotic obstruction of the femoral, popliteal, and posterior tibial veins in both lower extremities. A diagnosis of DVT was established on the fourth day of hospitalization. This case highlights the importance of considering bilateral DVT in patients with CRS who present with lower extremity edema, particularly in the presence of cardiovascular complications.

Background: Agranulocytosis is a serious, life-threatening condition characterized by a severe reduction in the number of peripheral neutrophils (<0.5 × 10⁹/L). It is most commonly caused by chemotherapy drugs but can be induced by antibiotics. Ceftriaxone is a widely used and generally safe third generation antibiotic for conditions such as infective endocarditis. Ceftriaxone induced agranulocytosis is an extremely rare adverse reaction. Evidence suggests that this adverse reaction is dose dependent and typically occurs following prolonged courses or high cumulative doses of the antibiotic. Despite improvements in management that reduce the mortality rate to approximately 5%, prompt recognition and treatment remain vital.
Case Presentation: A 56-year-old man diagnosed with native valve infective endocarditis (Streptococcus mitis) was treated with 2 g/day of intravenous ceftriaxone. In the fifth week of treatment, after receiving a cumulative dose of 60 g, the patient developed severe agranulocytosis, reaching a neutrophil nadir of 0.1 × 10⁹/L. Ceftriaxone was promptly stopped and replaced with teicoplanin, and the patient received filgrastim (recombinant human granulocyte colony stimulating factor [rhG CSF]). The case was classified as a probable adverse drug reaction (Naranjo score, 6). Neutrophil recovery was complete by the seventh day, and the patient successfully underwent double valve replacement surgery.
Conclusion: Ceftriaxone induced agranulocytosis, albeit rare, is a potentially fatal complication of prolonged therapy. Regular complete blood count monitoring and prompt management—based on drug withdrawal, appropriate antimicrobial coverage, and rhG CSF administration—are essential for favorable outcomes.

I read with interest the published article titled “Reduced left ventricular global longitudinal strain in the coronary slow flow phenomenon: a systematic review and meta-analysis” in the latest issue of the journal Research in Heart Yield and Translational Medicine, authored by Seifi et al.1 The authors conducted a systematic review and meta-analysis of studies reporting left ventricular global strain in patients with the coronary slow flow phenomenon. I identified several shortcomings in this manuscript, primarily related to the study design and data analysis, which undermine its clarity, reliability, and reproducibility.