Effect of Handheld Echocardiography by Trained Advanced Practice Providers on Heart Failure Management and Readmissions.

Clinical Characteristics and Surgical Outcomes of Pyogenic Vertebral Osteomyelitis Caused by Carbapenem-resistant Enterobacteriaceae.

To quantify the incidence rate (IR) of diabetes in people living with HIV (PLWH), assess disparities relative to HIV-negative individuals and clarify the associations of antiretroviral therapy (ART) exposure and treatment duration with diabetes incidence. We searched PubMed up to July 20, 2025, for prospective cohort studies including PLWH aged ≥18 with ≥6 months of follow-up and reported diabetes incidence. Two reviewers independently assessed study quality using the Newcastle-Ottawa Scale and extracted data. A random-effects model estimated pooled incidence rates and subgroup differences. Meta-regression was performed to evaluate study-level associations between ART duration and diabetes incidence. Thirty-one studies contributed 1 230 314 person-years (PY) of follow-up. The IR in PLWH was 12.98 cases per 1000 PY (95% CI: 10.97-14.98). No significant difference was observed between PLWH (12.97 cases per 1000 PY) and HIV-negative individuals (12.67 cases per 1000 PY; p = 0.9597), although this comparison was based on a limited number of studies. However, incidence among PLWH on ART (14.05 cases per 1000 PY) was significantly higher than in those not on ART (7.42 cases per 1000 PY; p = 0.0179). Each year of ART exposure was associated with an increase of 0.354 cases per 1000 PY in univariable meta-regression (p = 0.008). In multivariable meta-regression, the association between ART duration and diabetes incidence remained significant after adjustment for mean age (p = 0.038), while age was also independently associated with higher incidence (p < 0.001). Diabetes incidence in PLWH is substantial and varies across regions and diagnostic definitions. Evidence comparing PLWH with HIV-negative individuals remains limited. ART exposure and longer ART duration are associated with higher diabetes incidence, highlighting the importance of routine metabolic screening in long-term HIV care.

Three diseases primarily affecting the exocrine pancreas-chronic pancreatitis, cystic fibrosis and pancreatic ductal adenocarcinoma-are all associated with a high incidence of diabetes. Together, they may account for more cases of diabetes than autoimmune type 1 diabetes. All forms of pancreatogenic (type 3c) diabetes are characterised by impaired insulin secretion but maintenance of significant islet beta cell mass, even in the presence of virtually complete destruction of the exocrine component of the gland. Pancreatic ductal injury and associated fibrosis are common features in chronic pancreatitis, cystic fibrosis and ductal adenocarcinoma. Increased peri-ductal fibrosis is also seen in type 2 and type 1 diabetes. Here, we review the literature regarding a potential common aetiological role of pancreatic fibrosis in the pathogenesis of type 3c, type 2 and type 1 diabetes. A vicious profibrotic signalling cycle involving injured ducts, pancreatic stellate cells and macrophages with increased levels of pancreatic tissue TGF-β at the core has increasingly been recognised as an essential driver of pancreatic exocrine fibrosis. We propose a second diabetogenic perpetual cycle comprising paracrine signalling between activated pancreatic stellate cells, macrophages and the islets themselves, leading to potentially reversible beta cell failure. The antifibrotic agents pirfenidone and nintedanib, thought to work primarily through suppression of TGF-β function, are used routinely in clinical practice for non-pancreatic indications, with a first trial in pancreatitis underway. Trials evaluating these licensed therapeutics that include primary diabetes-related endpoints and measures aiming to elucidate the underlying mechanisms of action merit consideration in type 3c diabetes and ultimately in type 2 diabetes and in combinatorial regimens in type 1 diabetes.

Invasive pulmonary aspergillosis (IPA) and pulmonary mucormycosis (PM) stand as the most prevalent invasive mold pulmonary infections. The incidence of IPA and PM has progressively increased. Untimely or inappropriate intervention amplifies mortality rates in patients affected by IPA and PM. There exist numerous commonalities between the two with regard to the population susceptible to the disease and imaging characteristics. This renders it challenging to differentiate them in certain clinical practices, resulting in issues such as the inappropriate selection of treatment plans. Early and expeditious differential diagnosis of invasive pulmonary mold infections and prompt identification of severe cases are critical challenges in clinical practice. A retrospective cohort study encompassed IPA and PM patients admitted to Beijing Chao-Yang Hospital from 2017 to 2022. Patients in the cohort were categorized into PM and IPA groups. A comprehensive analysis of clinical characteristics, laboratory parameters, and chest radiology findings was conducted. Subsequently, a comparative assessment of the prognosis between the two patient groups was carried out. All patients with invasive pulmonary mold infection were classified based on prognosis, and independent risk factors for poor prognosis were identified. Subsequent to these findings, exploration of novel disease assessment tools was undertaken, and their diagnostic efficacy was evaluated. In comparison to IPA, PM patients exhibited a younger age profile, with a higher incidence of diabetes and solid organ transplantation. PM occurrences postinfluenza infection were less frequent than IPA. Radiologically, consolidation and bronchial lumen stenosis were more prevalent in PM patients. Additionally, the diagnosis of PM patients relied more on pathological confirmation. No significant disparities were noted regarding ICU stays, mechanical ventilation ratios, and 90-day mortality between PM and IPA. Postinfluenza infection and the neutrophil-to-lymphocyte ratio (NLR) were identified as independent risk factors for ICU stays in PM/IPA patients. Postinfluenza infection and elevated hemoglobin A1c (HbA1c) levels were independent risk factors for mechanical ventilation. NLR, HbA1c levels, and postinfluenza infection collectively enhanced the predictive capacity of existing assessment tools for adverse outcomes in PM/IPA patients. PM patients exhibit distinctions from IPA in certain clinical characteristics, laboratory parameters, and chest radiology findings. Nevertheless, both PM and IPA patients experienced higher 90-day mortality and ICU utilization. The combination of NLR and HbA1c with existing disease assessment tools proves effective in prognosticating the disease, particularly during influenza epidemic seasons.

Background: Sodium/glucose cotransporter-2 inhibitors (SGLT2is), such as dapagliflozin and empagliflozin, are currently a standard therapy for heart failure (HF) patients. We report the real-world use of SGLT2is in a monocentric cohort of HF patients with reduced ejection fraction (HFrEF) and improved ejection fraction (HFimpEF), comparing patient characteristics and outcomes with those observed in large-scale randomized clinical trials (RCTs). Methods: We retrospectively analyzed a cohort of 370 stable patients with HFrEF or HFimpEF who initiated therapy with dapagliflozin or empagliflozin between June 2019 and November 2023. Baseline data, including medical history, concomitant diseases, therapy, laboratory tests, echocardiographic results and cardiopulmonary exercise tests (CPETs), were collected at the start of the therapy with SGLT2is. After a median period of 18 months, follow-up data on treatment adherence, adverse events, hospitalizations, and mortality were also reviewed. A comparison was made between patients taking dapagliflozin and those taking empagliflozin and then individual populations were compared with those from the trials. Results: Among 370 patients (81% HFrEF, 19% HFimpEF), 276 received dapagliflozin and 94 empagliflozin. Empagliflozin patients were older, had higher NYHA class and LVEF, and higher incidence of diabetes, while dapagliflozin users had greater use of sacubitril/valsartan and mineralocorticoid receptor antagonists. Both groups were older than the RCT cohorts. Dapagliflozin patients had LVEF comparable to DAPA-HF, while empagliflozin patients had higher LVEF than EMPEROR-Reduced. HF hospitalizations were more frequent in the real-world groups, but mortality was lower than in RCTs. The composite outcome of death and worsening HF was higher in the real-world dapagliflozin cohort vs. DAPA-HF but similar between the real-world empagliflozin cohort and EMPEROR-Reduced. Conclusions: In this real-world cohort, the use of empagliflozin was associated with cardio-nephro-metabolic comorbidities and dapagliflozin being prescribed more frequently for patients with isolated cardiac symptoms. While outcomes were generally favorable, they differed from those seen in RCTs, highlighting the importance of real-world data in understanding the practical application of these therapies.

The Association Between Genetic Polymorphism in the Receptor for Advanced Glycation End-Products and Metabolic Dysfunction-Associated Steatotic Liver Disease.

BACKGROUNDChina has the highest incidence of diabetes among all Asian countries, and environmental factors have a significant impact on the onset of diabetes. Lead is one of the important legacy environmental pollutants that disrupts endocrine function. Both lead and diabetes have damaging effects on the nervous system, while the gut microbiota is considered an important mediator of brain damage.AIMTo determine the effects and underlying mechanisms of environmental lead exposure and diabetes on neural function.METHODSA mouse model of lead exposure and diabetes was used. Lead levels were measured using inductively coupled plasma mass spectrometry, and blood glucose levels were assessed. Immunofluorescence was used to analyze brain damage in mice. The Morris water maze was used for evaluating neural function. Neurotransmitters including vanillylmandelic acid, 5-hydroxyindoleacetic acid, 3,4-dihydroxyphenylacetic acid (DOPAC), and homovanillic acid (HVA) were quantified with high performance liquid chromatography. Proteomics analysis was conducted on hippocampal brain tissue, and gut microbiota analysis was performed on colonic fecal samples. PI3K and COX2 proteins were detected by Western blotting, and then glutathione (GSH) levels in brain tissue were measured.RESULTSMice in the lead-exposure diabetic model exhibited significantly elevated lead and blood glucose levels, with the most severe neural damage observed. The neurotransmitters DOPAC and HVA were markedly increased. Proteomics revealed that differential proteins were primarily involved in neural and metabolic pathways. Correlation analysis between the top 20 gut microbiota and differential proteins identified Sutterella as the most associated gut microbe with proteins. The levels of COX2, PI3K, and GSH in the mouse brain provided preliminary validation of these findings.CONCLUSIONThe coexistence of lead exposure and diabetes has an interactive effect on neural damage. This interaction appears to affect the abundance of the gut microbe Sutterella, which, through inflammation, influences the expression of related differential proteins in the brain, ultimately resulting in neural damage.

Experimental studies suggested potential adverse effects of preservative food additives, but epidemiological data are lacking. We aim to investigate associations between exposure to these compounds and type 2 diabetes incidence in the NutriNet-Santé prospective cohort (n = 108,723; 79.2%women; mean age=42.5 (SD = 14.6); France, 2009-2023). Dietary intakes are assessed using repeated 24h-dietary records. Exposure is evaluated through multiple composition databases and ad-hoc laboratory assays in food matrices. Associations between cumulative exposures to preservatives and diabetes incidence are characterised using multi-adjusted Cox models. The sum of total preservatives encompasses 58 substances. Among those, 17 are consumed by at least 10% of the study population and thus individually investigated. Thirteen (12 after multiple test correction) widely used individual preservatives are associated with higher diabetes incidence (n=1131cases): potassium sorbate, potassium metabisulfite, sodium nitrite, acetic, citric and phosphoric acids, sodium acetates, calcium propionate, sodium ascorbate, alpha-tocopherol, sodium erythorbate, and rosemary extracts. These findings call for their safety re-evaluation and support recommendations to favour fresh and minimally processed foods without superfluous additives. Trial registration: The NutriNet-Santé cohort is registered at clinicaltrials.gov (NCT03335644).

Long-term ozone exposure and risks of diabetes and hypertension: Mediated by inflammatory, lipid and oxidative stress biomarkers in a prospective cohort.

Background: Coronary artery diseases are at toll in Pakistan with very high incidence of mortality and morbidity. This purpose of this study is to explore the potential gender base disparities with in-hospital outcomes and risk factors influencing outcomes among Pakistani population undergoing percutaneous coronary intervention. Method: This is a cross sectional study having sample size of 560 patients with myocardial infraction who underwent primary PCI at a tertiary care hospital in Pakistan. Patient’s data, risk factors, angiographic findings, and complications were noted and analyzed. Results: Female patients have high incidence of diabetes, hypertension and hematoma formation following PCI as compare to male. However, there was no statistical significance among all those outcomes myocardial infarction, cardiogenic shock, heart failure, stroke, death, stent thrombosis, bleeding events, or tamponade. Conclusion: Although female patients had a greater risk profile and were more likely to develop hematomas, there were no significant gender differences in most in-hospital outcomes following primary PCI. The study underlines the importance of improving the quality of care and closing the gender gap in STEMI therapy in Pakistan.

Objective: To examine prospective associations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test positivity, coronavirus disease 2019 (COVID-2019) symptom severity, and COVID-2019 hospitalization with incident clinical diabetes among aging women. Methods: A cohort study was conducted using data from 34,405 eligible Women's Health Initiative participants who completed ≥1 COVID-2019 surveys (Survey 1: June-December 2020; Survey 2: June 2021-February 2022) and were followed up for an average of 1.86 (±0.49) years, yielding 399 incident diabetes cases. Results: SARS-CoV-2 test positivity was associated with diabetes risk in the age-adjusted Cox regression model (hazard ratio [HR] = 1.76, 95% confidence interval [CI]: 1.10, 2.82), but not when fully adjusted (HR = 1.43, 95% CI: 0.88, 2.31). Diabetes risk was higher among those with 1-2 COVID-19 symptoms (HR = 1.39, 95% CI: 1.09, 1.77) and those with 3± COVID-2019 symptoms (HR = 1.53, 95% CI: 1.06, 2.22) compared with those without COVID-2019 symptoms in fully-adjusted models, irrespective of self-reported SARS-CoV-2 testing. COVID-2019 hospitalization was associated with 2-3 times the risk of clinical diabetes in age-adjusted (HR = 2.95, 95% CI: 1.52, 5.72) and fully-adjusted (HR = 1.90, 95% CI: 0.97, 3.72) models. Conclusions: Age-adjusted self-reported SARS-CoV-2 test positivity was associated with a higher incidence of diabetes. Reporting of COVID-2019 symptoms and being hospitalized for COVID-2019 were each associated with higher incidence of diabetes in aging women, after controlling for demographic, socioeconomic, lifestyle, and health characteristics.

To investigate the association between hormone therapy use and severe outcomes due to COVID-19 in perimenopausal and postmenopausal women. Using the Rochester Epidemiology Project, we retrospectively searched for the records of women aged 40-65 years who had a documented case of COVID-19 between March 12 and September 29, 2020. We further identified those who were perimenopausal or postmenopausal. The rates of emergency department visits, hospitalizations, and deaths were compared by hormone therapy use. Logistic regression models were used to assess the odds of the combined outcome based on hormone therapy use. Among the 689 patients included in this study, the median age was 56 years, and 77.5% were White. Compared with patients currently using hormone therapy, those with past/never use of hormone therapy were significantly older, had more risk factors for severe COVID-19, and had a higher incidence of diabetes. A total of 102 emergency department visits/hospitalizations/deaths occurred among both groups. Participants with current hormone therapy use had similar rates and risk of emergency department/hospitalization/death outcomes as those without hormone therapy, even after adjusting for age and severe COVID-19 risk factors. Severe COVID-19 outcomes were not significantly different between women with current versus past/never use of hormone therapy. Our study adds to the data suggesting no harm with hormone therapy use in women with severe symptoms of COVID-19.

Background/Objectives: Dynapenia, characterized by an age-related decline in muscle strength, has recently gained attention as a major public health concern. While prior studies identified individual risk factors, little is known about how these factors cluster differently by sex. This study investigated sex-specific risk factors and their combinations associated with dynapenia among Korean middle-aged and older adults. Methods: We analyzed 22,850 participants aged ≥ 40 years from the 2014–2019 Korea National Health and Nutrition Examination Survey. Dynapenia was defined as handgrip strength < 28 kg in men and <18 kg in women. Sex-stratified multivariable logistic regression identified independent predictors, and association rule mining (ARM) detected synergistic risk factor combinations. Results: Dynapenia was more prevalent in women (13.9%) than in men (8.5%). Advancing age, physical inactivity, lack of resistance exercise, and a high incidence of diabetes and stroke were consistent risk factors in both sexes. However, ARM revealed distinct clustering patterns: behavioral factors predominated in men, whereas socioeconomic disadvantage and metabolic comorbidities were more relevant in women with dynapenia. Conclusions: These findings emphasize the need for sex-specific prevention strategies for dynapenia, promoting resistance exercise among men and addressing both inactivity and socioeconomic barriers in women.

This study aimed to compare short- and long-term surgical outcomes between robotic sacrocolpopexy (RSC) and laparoscopic sacrocolpopexy (LSC), performed with concomitant total hysterectomy, in patients with symptomatic pelvic organ prolapse (POP). This retrospective cohort study included 167 women who underwent RSC (n = 113) or LSC (n = 54) with hysterectomy for uterine prolapse at Kawasaki Medical University between March 2020 and December 2024. Perioperative parameters, complications (Clavien-Dindo classification), and POP recurrence were assessed. The POP-Q was used for anatomical evaluation. Long-term outcomes such as recurrence, urinary incontinence, and mesh erosion were monitored over a median follow-up of 30 (RSC) and 52.5 (LSC) months. The patients in the RSC group were significantly younger and had a higher incidence of diabetes. RSC had longer operative times (median 175 min vs. 152 min; p < 0.01) but comparable blood loss, complication rates, and hospital stay. POP-Q showed greater cervical elevation in the RSC group at one month (p < 0.05). The long-term recurrence rate was low and similar between the groups (RSC, 2.7%; LSC, 3.7%; p = 0.71). Mesh erosion, urinary incontinence, and organ prolapse were rare and did not differ significantly between the groups. RSC with concomitant hysterectomy is a safe and effective alternative to LSC with comparable short- and long-term outcomes. Despite longer operative times, RSC offers anatomical benefits without increasing the risk of postoperative complications or recurrence.

This study explored the cognitive status of community-dwelling Indian older adults. Our objective was to observe the association of age-related cognitive change with other physiological health parameters like, glycated hemoglobin (HbA1c), and vitamin B12 in older adults in India. Urban community dwelling, consenting older adults (55–85years, n = 123), with no clinical history of cognitive or neurological problems participated in the study. The participants underwent a detailed demographic documentation and cognitive assessment comprising of tests from different cognitive domains and blood-based assessment of glycated hemoglobin (HbA1c) and vitamin B12. As expected, performance in all cognitive domains declined with increasing age. HbA1c levels correlated inversely with processing speed and executive function. Vitamin B12 levels did not correlate with performance on any cognitive test. Interestingly, geriatric depression correlated inversely with visuospatial abilities. A stepwise multiple regression revealed that HbA1c and geriatric depression contributed to 28 % variance on Montreal Cognitive Assessment while age did not qualify as a significant contributor. Using Petersen’s criteria, Mild Cognitive Impairment (MCI) was observed in 17 % of participants. Participants classified as MCI had higher levels of HbA1c and geriatric depression, and lower performance in all cognitive domains compared to non-MCI participants. In conclusion, although cognitive performance declined with age, HbA1c and geriatric depression had a greater role in cognitive decline than age. With a high incidence of diabetes in India, this study highlights the prevalence of metabolism-linked changes in cognition, which are often ignored in community dwelling older adults in India.

Six elders, representing six different indigenous cultures, three of whom have academic appointments, were asked to provide their perspectives on diabetes addressing etiology, risk factors, increasing prevalence and co-morbidities. The rapid increase of this chronic disease has impacted the systems of care and financial management within Indian Health Service, the United States healthcare system established for federally-recognized American Indians and Alaska Natives. Indigenous people of North America not only have the highest incidence of diabetes in the world but also are experiencing early disease onset with rates increasing in those &lt; 18 years of age. Giving voice to the very people affected by this disease is critical to develop a culturally relevant solution. Using a storytelling method and qualitative analysis, four themes emerged from the elders’ perspectives: a) before contact with Europeans, diabetes was not found among the indigenous peoples; b) outside influence on food choices and activity patterns have been major factors in the rise of diabetes; c) disconnection from cultural roots yielding a state of imbalance or loss of harmony is manifest in negative health outcomes, such as wide-spread diabetes; and d) hope that a solution lies in the core values and knowledge of indigenous cultures. These narratives and themes can be used to guide the practice of non-indigenous health care providers working with indigenous people.

Chronic kidney disease (CKD) has now reached epidemic proportions in many parts of the world, primarily due to the high incidence of diabetes and hypertension. By 2040, CKD is predicted to be the fifth-leading cause of years of life lost. Developing strategies to prevent CKD and to reduce its progression to kidney failure is thus of great public health significance. Hypertension is known to be both a cause and a consequence of kidney damage and an eminently modifiable risk factor. An increased risk of hypertension, especially among women, has been linked to chronic exposure to the ubiquitous food contaminant cadmium (Cd). The mechanism is unclear but is likely to involve its action on the proximal tubular cells (PTCs) of the kidney, where Cd accumulates. Here, it leads to chronic tubular injury and a sustained drop in the estimated glomerular filtration rate (eGFR), a common sequela of ischemic acute tubular necrosis and acute and chronic tubulointerstitial inflammation, all of which hinder glomerular filtration. The present review discusses exposure levels of Cd that have been associated with an increased risk of hypertension, albuminuria, and eGFR ≤ 60 mL/min/1.73 m2 (low eGFR) in environmentally exposed people. It highlights the potential role of 20-hydroxyeicosatetraenoic acid (20-HETE), the second messenger produced in the kidneys, as the contributing factor to gender-differentiated effects of Cd-induced hypertension. Use of GFR loss and albumin excretion in toxicological risk calculation, and derivation of Cd exposure limits, instead of β2-microglobulin (β2M) excretion at a rate of 300 µg/g creatinine, are recommended.

Background/AimsThis study evaluates the clinical significance of the gastric emptying time (GET) in patients with functional dyspepsia (FD).MethodsThis retrospective study included 89 patients who visited the clinic with indigestion between 2021 and 2022. FD was diagnosed and categorized into 3 subtypes: postprandial distress syndrome, epigastric pain syndrome, and overlap type, following the Rome IV criteria. GET was assessed using 99mTc scintigraphy. The stomach remnant was measured 1 and 2 hours after ingesting a technetium-99m labeled egg, and the time required for the remnant to decrease by half (T1/2) was calculated.ResultsOf the 89 patients studied, 46 were diagnosed with FD. The remaining 43 patients, who did not meet the Rome IV criteria, were included as the control group. Patients with FD exhibited a higher incidence of smoking, a higher body mass index, and a higher incidence of diabetes than the non-FD group. GET and T1/2 did not show significant differences between the 2 groups (P = 0.240 and P = 0.126, respectively). However, the FD group exhibited a smaller gastric retention rate than the non-FD group at all time points. In the subtype analysis, GET and T1/2 were not significantly different among the 3 subtypes (P = 1.000 and P = 0.173, respectively). Diabetes mellitus, current smoking status, elevated body mass index, and younger age were significantly associated with FD.ConclusionGET did not significantly differ among FD patients or its subtypes, despite a lower gastric retention rate in FD patients.

Introduction: Sedentary lifestyle is a significant factor that increases the risk of diabetes.Sports and physical activity play a critical role in the management and prevention of diabetes.Regular exercise helps control blood sugar levels by improving insulin sensitivity. Aim:The aim of this study is to examine the diabetes awareness levels of students who have received elderly care training, both those who engage in sports and those who do not.Method: This descriptive study was conducted with the participation of 160 students, aged 18 and older, who are enrolled in the Elderly Care Program at a university located in the Black Sea Region.The participants include both professional and amateur athletes, as well as sedentary individuals.The data collection tools used were a sociodemographic form and the Adult Diabetes Knowledge Scale.Descriptive statistics (frequency, mean, standard deviation, minimum, maximum) were used in the data analysis. Result:The results revealed that there were gaps in the students' knowledge and awareness of diabetes.Although both the physically active and sedentary groups possessed some level of diabetes knowledge and awareness, uncertainties and knowledge deficiencies were still observed.It was found that elderly care students, who will work actively with the elderly population, which has a higher incidence of diabetes, do not have sufficient levels of knowledge regarding the relationship between exercise, diabetes awareness and diabetes knowledge. Conclusion:The results of this study are expected to help students understand the importance of physical activity and emphasize the role of exercise and care in the prevention and management of diabetes, particularly in the elderly.Consequently, it is recommended to reduce the societal impact of diabetes and raise individuals' health awareness.