Search Results (1,268)

Background/Objectives: Nutrition-related parameters may be associated with COVID-19 severity, but their relationships with complementary pulmonary imaging measures remain incompletely characterized. This study aimed to examine associations between selected nutrition-related parameters, pulmonary imaging severity, and clinical outcomes in hospitalized adults with COVID-19. Methods: This secondary exploratory analysis included 555 adults from a prospective multicenter cohort. Dietary intake assessed during the first week of hospitalization and derived from medical history, serum albumin and total protein concentrations, and selected bioimpedance parameters were examined in relation to computed tomography severity score (CTSS), lung ultrasonography (LUS) parameters, and selected clinical outcomes. Results: First-week hospital dietary intake was weakly inversely associated with CTSS (ρ = −0.110; p = 0.038), LUSSB (ρ = −0.274; p = 0.002), and LUSSBmax (ρ = −0.329; p < 0.001). History-derived dietary intake was associated with LUSSB (ρ = −0.253; p = 0.007) and LUSSBmax (ρ = −0.239; p = 0.011), but not with CTSS (ρ = −0.091; p = 0.120). Lower serum albumin was weakly associated with higher CTSS (ρ = −0.252; p = 0.008), whereas total protein was not (ρ = −0.199; p = 0.300). In unadjusted analyses, first-week hospital dietary intake, albumin, and total protein were associated with selected escalation-of-care outcomes, but not with in-hospital death. Nominal BIA–LUSSC associations were observed, but none remained statistically significant after correction for multiple testing. Conclusions: Selected nutrition-related parameters showed weak and non-uniform associations with pulmonary imaging severity in hospitalized adults with COVID-19. The findings do not establish independent prognostic relationships, and the exploratory bioimpedance results require confirmation in larger, appropriately designed studies. Full article

Incarcerated women face elevated suicide risk at the intersection of chronic loss, cumulative trauma, and constrained environments. In prison, the death of a child constitutes a profound and overlooked traumatic bereavement. This conceptual manuscript examines how carceral environments restrict privacy, autonomy, family contact, mourning rituals, and social and clinical support, thereby adversely reshaping grief. The Dual Process Model of Coping and meaning-making frameworks are integrated to explain how incarceration may constrain oscillation between loss-oriented and restoration-oriented coping. Institutional functioning may resemble restoration-oriented behavior while lacking critical adaptive factors that define restorative coping. Restricted information, exclusion from rituals and relational validation, and punishment for grief-related behavior may obstruct narrative reconstruction, continuing bonds, and maternal identity reorganization. The model further considers how acute grief interacts with chronic stress, sustained threat responsivity, sleep disruption, and cumulative allostatic burden to intensify psychological and somatic distress without assuming a uniform neurobiological pathway. Social determinants of health, histories of victimization, substance use, and facility-level conditions are important sources of variation. Protective pathways are also specified, including family connection, peer support, cultural and spiritual practices, and clinical care. The paper concludes with testable propositions, a research agenda, and a framework for notification, stabilization, and continuing bereavement support. Full article

AI-mediated forms of guruship are proliferating across South Asia and beyond, yet they have scarcely begun to receive sustained scholarly attention. This article takes their emergence as an occasion to revisit the conceptual vocabulary through which guruship has been understood, asking what becomes of ‘guru logics’ after artificial intelligence. AI gurus are not merely technological curiosities; nor are they straightforward successors to human gurus. This article treats them as analytic provocations through which longstanding conceptions of guruship can themselves be reconsidered. Guru studies had already been grappling with many of the problems that AI now makes newly conspicuous: imitation and performativity; presence in absence; distributed and non-human personhood; the mediation of charisma; embodiment and its displacement; succession and charismatic continuity. AI therefore strains an existing conceptual repertoire while also showing what it can still do. The article develops the notions of ‘code-born syncretism’ and ‘ambient guruship’, alongside ‘Transhuman Guru Worlding’ and ‘guru cosmoi’, to explore what happens when the guru becomes generative and responsive. ‘Doctrine by interface’ further draws attention to the ways theological possibilities are shaped through the design and affordances of AI systems, while ‘simulation as method’ considers what experimental encounters with such systems might contribute to the ethnographic study of guruship. These concepts are developed through discussions of devotional recombination, embodiment, programmed continuity of the guru after death or exile, and the political economies within which AI gurus are made and encountered. The article takes up histories in which the guru has already exceeded the bounded human body, becoming distributed through multiple material and mediated forms, and examines how generative interaction and recombination rework these inherited guru logics, while letting these forms scale and personalise in novel ways. What emerges is therefore neither unprecedented rupture nor straightforward continuity, but a recursive transformation of existing forms of guruship through computational mediation. The article offers a conceptual framework and analytic repertoire for an emerging field of ethnographic inquiry rather than a completed ethnography of AI guruship. Its larger proposition is that AI gurus matter for more than what they might tell us about religion in an age of artificial intelligence. They also provide an unusual vantage point from which to return to the conceptual problems that have long animated guru studies and to ask what artificial intelligence allows us to see differently about guruship itself. Full article

This article offers a thematic classification of traditions attributed to the Companions (ṣaḥāba), the Successors (tābiʿūn), and early Islamic scholars and rulers concerning ring engravings, situating these inscriptions within the framework of aniconism in early Islamic culture. It should be stressed at the outset that the evidence examined here consists of later hadith compilations and ṭabaqāt (biographical) works rather than dated artefacts; the study therefore analyses how the Companions, Successors, and early authorities were remembered and portrayed within a textual tradition committed to writing in subsequent generations, not the objective material history of the earliest Muslim community. The study argues that such engravings were not merely expressions of individual preference, but rather constituted a cultural practice shaped by the aesthetic constraints generated by hadith literature’s cautious stance toward figural representation, a practice that became a shared, collective idiom. The inscriptions are examined under four thematic headings: religious expressions, reminders of death and the transience of worldly life, inscriptions conveying identity and moral counsel, and figural symbols. The expressions and symbols found on rings are then subjected to a sociological reading drawing on the concepts of collective memory, symbolic capital, and productive constraint, within the paradigm of material religion. The findings indicate that figural motifs were at least partially present in the early period, and that written inscriptions subsequently came to occupy a dominant position. This transformation demonstrates that the aniconism in hadith did not merely suppress visual imagery, but functioned as the generative force behind a distinctive symbolic idiom centered on the letter and the word. Furthermore, drawing on Birgit Meyer’s notion of sensational forms, it argues that the ring bound the sacred to sensory experience through legally regulated matter: the prophetic preference for silver over gold, copper, and iron; the Abyssinian stone; the turning of the bezel toward the palm; and the pressure of the seal into clay. Aniconism thus operated not only as a rule about images but as a regime governing the material, tactile, and even olfactory life of a wearable object. While scholarship on Islamic aniconism has focused primarily on monumental art, architecture, and manuscript illustration, this study redirects attention to ring inscriptions as an underexplored domain of material culture, showing that ring inscriptions, though largely overlooked, are informative witnesses to Islamic culture and theology at the most intimate scale of everyday devotional and political life. Full article

The spectrum of diseases in individuals with human immunodeficiency virus (HIV) receiving successful antiretroviral therapy has evolved over time. In the past, they developed opportunistic infections and malignancies, whereas today, cardiovascular disease is among the most common causes of illness and premature death. Traditional risk factors for atherosclerosis (hypertension, hyperlipidemia, smoking, diabetes, family history of heart disease) are more prevalent in people with HIV than in the general population. However, it is well established that HIV itself causes increased immune activation, chronic inflammation, vascular dysfunction, and a cluster of metabolic abnormalities that contribute to a faster-than-usual rate of biological aging and a higher risk of developing atherosclerosis, a risk not fully captured by current risk models. In the REPRIEVE study, treatment with pitavastatin was shown to reduce the rate of first cardiovascular events among individuals with HIV receiving antiretroviral therapy. Importantly, the beneficial effects of statins on atherosclerosis likely extend beyond lowering cholesterol to include effects on vascular function and on immune and metabolic systems altered by HIV. Even among individuals on statins, a considerable risk of cardiovascular disease remains. Here, We provide a narrative review of current evidence and an expert perspective on emerging approaches to residual cardiovascular risk after REPRIEVE. We review the current understanding of atherosclerosis pathogenesis in individuals with HIV, focusing on recent findings from the REPRIEVE trial. We outline current approaches to improving cardiovascular risk assessment across clinical, biological, and computational levels. We also examine a growing number of therapeutic options that address residual inflammation and atherogenic metabolic disturbance in individuals with HIV on long-term, effective antiretroviral therapy. Significantly, after REPRIEVE, we must move from prescribing statins to all individuals with HIV toward more individualized cardiovascular disease prevention strategies, integrating clinical information, a variety of biomarkers, imaging studies, and even molecular information to generate optimal individualized cardiovascular disease prevention regimens that reflect the complexity of this outcome in naturally diverse individuals. Full article

Background/Objectives: Severe acute respiratory syndrome (SARS) remains an important cause of hospitalization and mortality, particularly among vulnerable populations. Understanding the factors associated with previous hospitalization may support more effective prevention and vaccination strategies. This study aimed to analyze the epidemiological profile of previous hospitalization among patients with SARS in the state of Pernambuco, Brazil. Methods: A quantitative, retrospective, cross-sectional study was conducted using data from the Influenza Epidemiological Surveillance System (SIVEP-Gripe), including 79,852 adult patients (≥18 years) notified with SARS in Pernambuco between 2021 and 2024. Sociodemographic, clinical, and vaccination-related variables were analyzed to identify factors associated with previous hospitalization. Results: The prevalence of previous hospital admission (readmission history) was 6.6%. Patients with previous hospitalization had a significantly higher median age compared to those without previous hospitalization (66 vs. 63 years; p < 0.001). The prevalence of previous hospitalization was higher among individuals with chronic comorbidities, particularly hematologic diseases (prevalence ratio [PR] = 1.95; 95% confidence interval [CI]: 1.51–2.51; p < 0.001) and asthma (PR = 1.67; 95% CI: 1.42–1.96; p < 0.001). Influenza vaccination was associated with a lower prevalence of previous SARS hospitalization (PR = 1.29; 95% CI: 1.03–1.61; p = 0.023). In contrast, COVID-19 vaccination status showed no significant association with previous hospitalization. A history of previous SARS hospitalization was associated with a higher prevalence of death in subsequent hospitalizations (PR = 1.09; 95% CI: 1.01–1.18; p = 0.022). Conclusions: Older adults and individuals with chronic comorbidities showed a higher prevalence of previous SARS hospitalization in Pernambuco. The findings show an association between influenza vaccination and a lower prevalence of previous SARS hospitalization and highlight the importance of post-discharge follow-up and epidemiological surveillance. Full article

Background: Left ventricular thrombus (LVT) is a serious complication associated with cardiomyopathy and impaired left ventricular (LV) systolic function. Patients with a resolved LVT remain at risk for recurrence and subsequent thromboembolism. However, the factors influencing the recurrence of LVT are not yet fully understood. The aim of this study was to identify the risk factors and clinical outcomes related to LVT recurrence and to improve follow-up strategies and treatment options. Methods and results: We retrospectively investigated patients confirmed to have a resolved LVT by transthoracic echocardiography from January 2018 to April 2021 at Zhongshan Hospital Fudan University. All patients received anticoagulant therapy for more than 6 months and underwent at least two follow-up transthoracic echocardiograms. No statistically significant differences were observed in baseline characteristics between the LVT recurrence and non-recurrence groups, including gender, age, diabetes, hyperlipidemia, renal function, previous stroke history, other underlying medical conditions, ejection fraction, or left ventricular diameter. Patients in the recurrence group exhibited a higher prevalence of previous myocardial infarction and percutaneous coronary intervention compared to the non-recurrence group (84.6% vs. 61.1%, p = 0.03; 76.9% vs. 52.8%, p = 0.03). Additionally, patients in the recurrence group tended to have more ventricular aneurysms (50.0% vs. 22.2%, p = 0.008) and larger previous thrombus sizes (27.7 ± 12.6 vs. 21.4 ± 9.1 mm, p = 0.008) compared to those in the non-recurrence group. Multivariate logistic regression analysis indicated that the longitudinal diameter of the LVT was an independent risk factor for LVT recurrence (OR 1.058, 95% CI 1.003–1.115, p = 0.04). ROC curve analysis revealed an area under the curve of 0.647 for the longitudinal diameter of the LVT, with an optimal cut-off value of 23.5 mm, a sensitivity of 62%, and a specificity of 64%. After a follow-up duration of 3.0 ± 2.5 years, the incidence of non-fatal myocardial infarction and major adverse cardiovascular events (MACEs) in the recurrence group was significantly higher than that in the non-recurrence group [non-fatal myocardial infarction: 3 (11.5%) vs. 1 (1.4%), p = 0.02; MACE: 7 (26.9%) vs. 7 (9.7%), p = 0.01]. No statistically significant differences were found in bleeding events, systemic embolism, or all-cause death between the two groups. Conclusions: Our study indicates that a history of myocardial infarction, the presence of ventricular aneurysm, and a larger thrombus diameter are significant factors influencing LVT recurrence. Furthermore, the longitudinal diameter of the thrombus is identified as an independent risk factor for recurrence following resolution. The threshold for LVT diameter requiring extended anticoagulation and the required duration of anticoagulation need to be confirmed in future studies. Full article

Battlefield preservation is commonly understood as a matter of heritage management, historical education, or cultural tourism. This article argues that its origins and enduring significance lie elsewhere. Modern battlefield preservation emerged as a direct consequence of the transformation of warfare between the late eighteenth and twentieth centuries. Beginning with the French Revolution and the levée en masse, military service became increasingly associated with citizenship, national identity, and mass participation, while industrialization provided the logistical and technological foundations necessary for warfare on an unprecedented scale. As warfare expanded, so too did its human consequences, transforming military death from the experience of a relatively small warrior elite into a shared social reality affecting entire populations. Drawing upon military history, memory studies, sociology, religious studies, and heritage scholarship, this article examines how mass warfare generated new forms of collective bereavement, ritual commemoration, battlefield pilgrimage, and historical preservation. Through case studies ranging from the French Revolutionary and Napoleonic Wars to the Crimean War, Gettysburg, the World Wars, and the conflicts in Korea and Vietnam, it demonstrates how expanding mobilization, industrialized conflict, and rising casualty rates produced enduring landscapes of memory. The article argues that battlefield preservation developed through a cumulative historical process linking mass warfare, mass casualties, collective trauma, commemorative practices, and the creation of commemorative landscapes. Preserved battlefields are not merely remnants of past conflicts; they are cultural institutions through which societies negotiate memory, identity, and meaning. As traditional sources of collective authority weakened in modern societies, battlefields increasingly acquired functions associated with ritual, pilgrimage, and civil religion. The expansion of warfare produced an expansion of remembrance, and the preserved battlefield emerged as one of the most enduring cultural responses to the human consequences of modern conflict. Full article

Black tourism, a specific type of interest tourism, is defined as traveling to places that are associated with death, tragedy, and history as a form of suffering. In India, black tourism includes memorials, battlefields, and sites of socio-political conflict reflecting its complex history. The purpose of this study was to examine the growth and development of black tourism in India, focusing specifically on destinations related to historical tragedy and memory. The study uses a mixed-methods approach with primary data from structured questionnaires and semi-structured interviews at black tourism destinations in India, supported by secondary data. The study finds that tourists at India’s black tourism sites seek historical learning and emotional engagement, while highlighting challenges like infrastructure issues and limited local participation. Major challenges facing black tourism in India are inadequacy of infrastructure; limited interpretation of the site; ethical concerns; and lack of participation from the local population. The study found that preserving authenticity, respecting locals, and incorporating cultural rituals are essential for tourism. The study concluded that planned and sustainable development of black tourism in India will enhance historical awareness and socio-cultural understanding. Full article

The long-term prognosis of left ventricular noncompaction (LVNC) compared to dilated cardiomyopathy (DCM) remains inconclusive, as prior studies have frequently failed to adequately adjust for heart failure severity. We conducted a single-center, retrospective, comparative study enrolling 96 patients with dilated LVNC (dLVNC) and 437 patients with DCM diagnosed at Peking Union Medical College Hospital between January 2010 and December 2022. dLVNC was defined as meeting the Jenni criteria, with left ventricular ejection fraction (LVEF) ≤45% and increased left ventricular end-diastolic diameter (LVEDD). A 1:1 propensity score matching (PSM) was performed, with matching variables including sex, age, history of heart failure (HF) hospitalization, arrhythmia, LVEF, and LVEDD, resulting in 96 matched pairs. The primary endpoint was major adverse cardiovascular events (MACEs), comprising cardiovascular death or heart transplantation, HF hospitalization or cardiac resynchronization therapy implantation, severe arrhythmias, and systemic embolism. After a median follow-up of 5.46 (2.14–8.62) years in the dLVNC group and 5.26 (2.47–8.50) years in the DCM group, the Kaplan–Meier survival curves between the groups were highly overlapping and revealed no significant differences in MACEs (log-rank p = 0.88), all-cause mortality (log-rank p = 0.84), and individual components of MACEs. After adjusting for heart failure severity, dLVNC and DCM exhibit no substantial difference in long-term prognosis, and the morphological feature of excessive trabeculation itself does not independently increase the risk of adverse events. Full article

The Catholic view of suffering is fundamentally optimistic, rooted in the belief that God uses pain for a purposeful end. In this context, suffering refines character, builds endurance, and fosters hope. Rather than being meaningless, suffering is seen as both an ethical and metaphysical reality. The theology of the Cross provides the foundation for understanding suffering within Christian doctrine and practice. It shows that religious history centres on Christ, even when human expectations differ from the divine will. The Cross is viewed as the ultimate revelation of a God present in suffering, not in worldly power. This perspective challenges efforts to understand God solely through reason or merit and demonstrates that true wisdom may appear as folly to the world. The paradox of the Cross gains existential meaning by transforming an instrument of shame and death into a symbol of divine strength and victory in Christ. This paper argues that suffering serves a redemptive purpose, encourages spiritual growth, and reveals the divine will amid human experience, offering the promise of eternal victory. It also affirms the patristic tradition that suffering is inseparable from humanity’s fallen nature in Adam and from the redemption achieved through the Cross of Christ. Thus, the Cross represents the self-emptying of Christ, or kenosis, and stands as the purest expression of theology, which must remain undiluted. Full article

Endophytes are diverse microorganisms inhabiting plant tissues that can promote plant growth, enhance stress tolerance, or suppress pathogens. However, the ecological roles of endophytes after host senescence and death remain poorly understood. This review examines how a subset of endophytes helps maintain ecosystem function in living plants, senescent tissues, litter, and associated microbial environments. Mechanisms of endophyte-mediated plant protection in living plants include pathogen inhibition, host regulation, nutrient acquisition, and abiotic stress tolerance. We also investigate post-senescence persistence and potential roles in litter decomposition and nutrient cycling via microbial and functional legacies, priority effects, extracellular enzyme activities, and community reassembly. Vertical transmission and horizontal dispersal can move microorganisms among stages, whereas host filtering acts after arrival to determine which microorganisms establish within host tissues. However, a full same-strain life-history loop has not been established. We propose an open, non-linear ecological continuum for selected endophytes that connects endophytic colonisation, saprotrophic persistence, and potential new-host establishment. In the future, longitudinal, strain-resolved, multi-omics, and synthetic-community studies will be conducted to verify the cross-stage connections and offer a microbial framework for plant protection, litter management, and ecological restoration. Full article

Background: Enterococcus faecalis is the third leading cause of infective endocarditis (IE) and remains the predominant enterococcal species involved in this condition, particularly among older patients with multiple comorbidities and healthcare-associated exposure. Its diagnosis may be challenging because the disease often follows a subacute course and may initially present with atypical extracardiac manifestations. Case presentation: We report the case of a 76-year-old man admitted with a 5-day history of fever, chills, profuse diaphoresis, myalgia, abdominal pain, and progressive confusion. On admission, he was febrile, hypotensive, disoriented, and presented with neck stiffness, a grade IV aortic murmur, suprapubic tenderness, hepatomegaly, and hemorrhagic lesions of the left hand. Initial transthoracic echocardiography did not reveal valvular vegetations. Cerebrospinal fluid analysis showed inflammatory changes with marked granulocytic predominance, whereas the multiplex PCR panel for meningitis/encephalitis pathogens and conventional cerebrospinal fluid cultures remained negative. In contrast, all blood cultures yielded E. faecalis. Repeat cranial computed tomography demonstrated a focal parasagittal frontal lesion involving the rostrum and genu of the corpus callosum, consistent with septic embolic involvement. Transesophageal echocardiography performed on hospital day 5 confirmed aortic valve IE, showing vegetative lesions on all cusps, the largest measuring approximately 8 mm, and severe aortic regurgitation. The clinical course was further complicated by cardiac decompensation and acute inflammatory involvement of the left knee, with synovial fluid analysis demonstrating a neutrophil-predominant inflammatory effusion, although cultures remained sterile. The patient received ampicillin plus vancomycin, followed by ampicillin plus linezolid after vancomycin-associated renal impairment. Follow-up blood cultures became negative after 3 weeks of treatment, but persistent severe aortic valve involvement required referral for cardiac surgical evaluation. The patient was readmitted to the cardiology department and subsequently developed multi-organ system failure, resulting in death one week after discharge. Conclusions: This case highlights the diagnostic complexity of. E. faecalis IE when meningocerebral and osteoarticular manifestations dominate the initial presentation, emphasizing the importance of repeated blood cultures and early transesophageal echocardiography. Full article

Background/Objectives: Most cases of non-small cell lung cancer (NSCLC) are diagnosed at advanced stages, where prognosis remains poor. Machine learning (ML) offers new opportunities for patient stratification. This study aimed to identify distinct subgroups of patients with advanced-stage NSCLC using unsupervised ML techniques and to evaluate their association with survival outcomes and biomarker expression. Methods: 400 patients with advanced-stage NSCLC were analyzed using the k-prototypes algorithm. Clinical, demographic, and analytical variables, including smoking history and comorbidities, were incorporated. Identified clusters were compared in terms of molecular biomarkers and overall survival. A multivariable Cox proportional hazards model was performed to assess the association between cluster membership and overall survival. Results: Five patient profiles were identified. Cluster F, characterized by a predominance of women, relatively low smoking exposure, and a higher frequency of epidermal growth factor receptor (EGFR) mutations, showed the most favorable survival profile. Cluster S comprised mainly male heavy smokers with poorer performance status and high metastatic burden, whereas Cluster Y consisted predominantly of younger men without comorbidities but with frequent M1c disease. Clusters E and O showed intermediate outcomes and were characterized by older age with pleural effusion and by an older predominantly male smoking profile, respectively. In the multivariable Cox model, compared with Cluster F, a higher risk of death was observed for Cluster S (HR 1.62, 95% CI 1.01–2.60; p = 0.045) and Cluster Y (HR 1.55, 95% CI 1.09–2.21; p = 0.015), although the association for Cluster S should be interpreted cautiously. Differences in molecular biomarker distribution were also observed across clusters, particularly for EGFR mutations and programmed death-ligand 1 (PD-L1) expression. Conclusions: In this single-centre retrospective pilot study, unsupervised ML identified distinct patient profiles associated with differences in survival outcomes and molecular characteristics. These findings support the potential of data-driven approaches to characterize heterogeneity in advanced-stage NSCLC, although external validation is required before clinical application. Full article

Background: Cardiac arrhythmias in children and adolescents may present with nonspecific symptoms such as precordial pain, palpitations, and syncope. We evaluated the clinical characteristics and rhythm findings of symptomatic pediatric patients and examined cross-sectional associations between reported symptoms and selected rhythm diagnoses, with particular attention to the diagnostic and management yield of ambulatory Holter monitoring. Because symptom timing is not always captured during diagnostic monitoring, associations between reported symptoms and detected rhythm abnormalities must be distinguished from temporal symptom–rhythm correlation and causation. Methods: We conducted an observational study of 119 children and adolescents aged 1–18 years, who were evaluated at a tertiary pediatric hospital for symptoms potentially suggestive of cardiac rhythm abnormalities. Data included demographic characteristics, clinical symptoms, personal and family history, resting electrocardiography, ambulatory Holter monitoring, and exercise testing where clinically indicated. The primary analysis was cross-sectional. Because symptom timing during ambulatory monitoring was not recorded, the study was not designed to establish temporal symptom–rhythm correlation or causality. Descriptive analyses were performed for the final 119-participant cohort. Selected symptom–rhythm associations were evaluated using the contingency table methods with odds ratios (ORs), 95% confidence intervals (CIs), and Fisher’s exact tests where appropriate. Holm’s adjustment was applied to the prespecified family of reconstructed symptom–rhythm comparisons. Results were interpreted according to both statistical evidence and effect-size precision. Results: The cohort comprised 119 participants, including 75 females (63.0%) and 44 males (37.0%). The most frequently reported symptoms were precordial pain (105/119, 88.2%), palpitations (80/119, 67.2%), and syncope or lipothymia (39/119, 32.8%). A family history of sudden cardiac death was reported by 28 participants (23.5%). Forty-two participants (35.3%) had a normal resting ECG, while 77 (64.7%) underwent ambulatory Holter monitoring. Among those undergoing Holter monitoring, 65/77 (84.4%) had rhythm abnormalities detected exclusively by ambulatory monitoring and not identified on the resting ECG. Holter findings resulted in at least one documented management change in 38/77 participants (49.4%). Management categories were not mutually exclusive and included lifestyle or activity adjustment in 21 participants, initiation of antiarrhythmic therapy in 19, medication monitoring in 19, and targeted cardiac imaging, including cardiac magnetic resonance imaging, in 5. In this cross-sectional analysis, reported syncope/lipothymia was strongly associated with the presence of complete atrioventricular block (10/39 [25.6%] versus 1/80 [1.3%]; OR 27.24, 95% CI 3.34–222.29; Fisher’s exact p < 0.001; Holm’s adjusted p approximately 0.0004). The unadjusted association between syncope/lipothymia and the WPW-labelled diagnosis did not remain statistically significant after Holm’s adjustment. No statistically significant associations were identified between syncope/lipothymia and PSVT or VT. Conclusions: In this pediatric cohort, ambulatory Holter monitoring identified rhythm abnormalities not detected on resting ECG in a substantial proportion of monitored participants and resulted in documented changes in clinical management in approximately half of those monitored. Reported syncope/lipothymia was strongly associated with the presence of complete atrioventricular block in the reconstructed cross-sectional analysis. Because symptom timing during monitoring was not recorded, these findings do not establish that the detected rhythm abnormalities caused the reported symptoms or that symptoms predict future rhythm outcomes. Further studies using prospectively defined symptom–rhythm event recording and longitudinal follow-up are needed to evaluate temporal correlation and prognosis. Full article