Background: Iron deficiency (ID) is prevalent in congestive heart failure (CHF), worsening outcomes. While European guidelines recommend screening using ferritin and transferrin-saturation (TSAT), inconsistent diagnostic criteria, especially regarding functional deficiency (ferritin 100-299 µg/L + TSAT <20%) and hyperferritinemia, limit prognostic accuracy. This study evaluated iron status definitions, including guideline criteria and a combined Ferritin-TSAT model, for predicting 365-day mortality in hospitalized CHF patients. Methods: This retrospective analysis used MIMIC-IV data from 1,839 CHF patients. Iron status within 24h of admission was categorized using: 1) Guideline ID vs. non-ID; 2) Ferritin categories; 3) TSAT categories; 4) Combined Ferritin-TSAT model (Low: guideline ID; Intermediate: ferritin 100-299 + TSAT ≥20%; High: ferritin ≥300 µg/L). Adjusted Cox models assessed mortality associations. Results: Guidelines-defined iron deficiency (33.65% prevalence) independently associated with higher 1-year mortality (56.1% vs. 29.4%; adjusted HR 4.36, 95%CI 3.35-5.34). The combined Ferritin-TSAT model showed significant prognostic value, differentiating true iron deficiency (reference) from hyperferritinemia (adjusted HR 0.50 vs. iron deficiency) and intermediate group (adjusted HR 0.36 vs. ID), indicating varying risk relative to the most deficient group. This combined model better distinguished hyperferritinemic and iron-replete subgroups than the binary guideline definition. Conclusion: Iron status, including deficiency and hyperferritinemia, independently predicts 1-year mortality in CHF. While guideline iron deficiency is a strong predictor, a combined Ferritin-TSAT classification offers finer risk stratification by identifying distinct phenotypes (true deficiency, hyperferritinemia, intermediate). Nuanced iron-status assessment could improve prognostic evaluation and guide personalized therapies (e.g., IV iron for deficiency, investigation for hyperferritinemia) to enhance CHF outcomes. Prospective validation is needed.

Background: Iron deficiency (ID) is prevalent in congestive heart failure (CHF), worsening outcomes. While European guidelines recommend screening using ferritin and transferrin-saturation (TSAT), inconsistent diagnostic criteria, especially regarding functional deficiency (ferritin 100–299 μg/L + TSAT < 20%) and hyperferritinemia, limit prognostic accuracy. This study evaluated iron status definitions, including guideline criteria and a combined Ferritin-TSAT model, for predicting 365-day mortality in hospitalised CHF patients. Methods: This retrospective analysis used MIMIC-IV data from 1839 CHF patients. Iron status within 24 h of admission was categorised using: (1) Guideline ID vs. non-ID; (2) Ferritin categories; (3) TSAT categories; (4) Combined Ferritin-TSAT model (Low: guideline ID; Intermediate: ferritin 100–299 + TSAT ≥ 20%; High: ferritin ≥ 300 μg/L). Adjusted Cox models assessed mortality associations. Results: Guidelines-defined iron deficiency (33.66% prevalence) independently associated with higher 1-year mortality (56.1% vs. 29.4%; adjusted HR 4.36, 95% CI 3.35–5.34). The combined Ferritin-TSAT model showed significant prognostic value, differentiating true iron deficiency (reference) from hyperferritinemia (adjusted HR 0.50 vs. iron deficiency) and intermediate group (adjusted HR 0.36 vs. ID), indicating varying risk relative to the most deficient group. This combined model better distinguished hyperferritinemic and iron-replete subgroups than the binary guideline definition. Conclusions: Iron status, including deficiency and hyperferritinemia, independently predicts 1-year mortality in CHF. While guideline iron deficiency is a strong predictor, a combined Ferritin-TSAT classification offers finer risk stratification by identifying distinct phenotypes (true deficiency, hyperferritinemia, intermediate). Nuanced iron status assessment could improve prognostic evaluation and guide personalised therapies (e.g., IV iron for deficiency, investigation for hyperferritinemia) to enhance CHF outcomes.

International travel is increasingly common, and it remains a clinical context in which preventable morbidity may occur if not adequately addressed through a comprehensive pre-travel consultation. This article provides a structured, evidence-informed framework for counseling people living with human immunodeficiency virus (HIV) who travel internationally, emphasizing the need for individualized assessment and proactive risk mitigation. We outline key domains relevant to travel health in people living with HIV, including legal and structural barriers, general health evaluation, vaccination planning, malaria prevention, sexual health, and strategies for managing expected and unexpected events during travel. Persistent HIV-related entry, stay, and residence restrictions in some countries may influence itinerary planning, disclosure, and access to healthcare abroad. From a clinical perspective, the cornerstone of safe travel is sustained viral suppression on antiretroviral therapy, with careful planning to ensure uninterrupted medication supply, adherence across time zones, and preparedness for loss or theft of medications. Drug-drug interactions are an important consideration, particularly when prescribing malaria chemoprophylaxis or antibiotics. Vaccination strategies should include routine and travel-specific immunizations, with attention to immune status, and the possibility of reduced immunogenicity requiring serological assessment or additional vaccine doses to obtain optimal response. Travel may increase sexual risk-taking and exposure to sexually transmitted infections (STIs), warranting targeted counseling on prevention, post-exposure strategies, and access to testing and treatment. Destination-specific precautions, such as malaria prevention, must combine rigorous mosquito avoidance measures with appropriate chemoprophylaxis compatible with antiretroviral therapy (ART) regimens. Overall, HIV-informed travel counseling should be considered a standard component of comprehensive HIV care, integrating medical, pharmacological, behavioral, and structural considerations to support safe travel and reduce avoidable complications.

Background Congestive heart failure (CHF) is a chronic syndrome with high mortality rates, necessitating risk stratification tools. Existing models are complex and may not incorporate crucial inflammatory and nutritional biomarkers. The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score and modified HALP (mHALP) score, which reflect nutritional status and systemic inflammation, emerged as potential prognostic tools. This study aimed to evaluate the predictive performance of HALP and mHALP scores for 90-day mortality in CHF patients. Methods This retrospective study utilized the MIMIC-IV database for 1000 adult CHF patients. HALP was calculated as [Hemoglobin (g/L) * Albumin (g/L) * Lymphocytes (/L)] / Platelets (/L), and mHALP by multiplying these components. The primary outcome was 90-day all-cause mortality. Univariate and multivariate logistic regression analyses were performed, and models were assessed using Receiver Operating Characteristic (ROC) analysis and Youden’s Index. Results Non-survivors (13.2%) had significantly lower median HALP (19.69 vs. 27.18) and mHALP (583,920.75 vs. 1,151,898.94) scores compared to survivors. In univariate analysis, HALP had an AUC of 0.63 and an OR of 0.25 for 90-day mortality, while mHALP showed a higher AUC of 0.68 and an OR of 0.22. After confounder adjusting, both log-transformed HALP (OR: 0.44) and mHALP (OR: 0.57) remained significant predictors of mortality. mHALP demonstrated better overall predictive performance. Conclusion Both HALP and mHALP scores are significantly associated with 90-day mortality in CHF patients, with mHALP exhibiting superior prediction. Easily calculable scores, derived from routine laboratory tests, offer a cost-effective, early risk stratification in CHF, potentially aiding in tailoring interventions.

Background and Clinical significance: This case describes a patient with a complex medical history who develops an active Mycobacterium tuberculosis (MTB) infection. The complex multidrug regimen has led to significant drug–drug interactions (DDIs) and adverse effects. This case highlights an urgent need for standardized guidelines on dose adjustment and therapeutic monitoring for opioid substitution therapy (OST) and antiretroviral therapy (ART) during MTB treatment to prevent adverse health outcomes and ensure clinical success. Case Presentation: A 43-year-old man with medical history including human immunodeficiency virus (HIV), chronic hepatitis C virus (HCV), psychotic disorder, and opioid dependence maintained on buprenorphine (24 mg/day) presented with acute psychosis and respiratory symptoms. During hospitalization, he was diagnosed with MTB infection and was started on an empirical rifampicin-based anti-MTB regimen. His clinical course was complicated by reduced buprenorphine efficacy caused by rifampicin, which precipitated opioid withdrawal symptoms. Conclusions: The successful clinical stabilization with resolution of withdrawal syndrome, reduced agitation, and normalization of vital signs, including heart rate and blood pressure of this patient, was achieved through targeted management of pervasive DDIs. A strategic ART switch and careful buprenorphine dose titration during rifampicin therapy was the key factor. This case highlights that co-managing HIV, MTB, and opioid use disorder presents a significant challenge where unaddressed DDIs directly threaten treatment efficacy, a patient’s safety, and adherence, and may result in increased toxicity. The case underscores the critical need for proactive DDI assessment, interdisciplinary collaboration, and guideline development for medication optimization in people living with HIV receiving OST.