The practice of adding lead to opium to increase its weight resulted in lead poisoning among opium user, especially those who consume it orally. This study aims to examine patients with symptoms of lead poisoning who are opium users.

We retrospectively investigated the records of 20 Iranian patients who were opium users and presented with symptoms and signs of lead poisoning. Regarding the route of opium administration, 3 patients (15%) reported smoking only, 2 patients (10%) reported oral ingestion only, and the majority of cases (15 patients, 75%) reported combined use of smoking and oral ingestion. All were married and 85% were male, with a mean age of 57.8. The average duration of opium dependence was 19.7 years, with a mean daily consumption of 2.1 g. They reported severe abdominal pain, with or without central nervous system symptoms. Blood lead levels in the patients ranged from 30 to 833 µg/dL, with two patients exceeding 600 µg/dL. Chelation therapy was used for 80% of patients, resulting in 45% having full recovery, 40% partial recovery, and a fatality rate of 15%.

This case series emphasizes the importance of awareness among both opium users and medical staff regarding the risks related to lead poisoning due to contaminated opium. Patients should be informed about the potential contamination of opium, which can cause serious gastrointestinal and neurological symptoms, and even death. Healthcare providers should maintain a high index of suspicion for lead poisoning in opium-addicted patients presenting with compatible symptoms, ensuring early diagnosis and timely treatment, such as chelation therapy.

Type 2 diabetes mellitus (T2DM) is associated with both neuromuscular impairment and diabetic autonomic neuropathy, including cardiac autonomic neuropathy (CAN). However, the relationship between handgrip strength (HGS) and cardiac autonomic dysfunction remains insufficiently characterized. This study aimed to compare HGS and cardiac autonomic parameters between adults with T2DM and healthy controls and to examine factors associated with definite CAN.

This comparative cross-sectional study included 120 adults aged 30-65 years, comprising 60 participants with T2DM and 60 age- and sex-matched controls. HGS was assessed using a calibrated dynamometer, while cardiac autonomic function was evaluated using cardiovascular autonomic reflex tests and heart rate variability analysis. Correlation analysis and multivariable logistic regression were performed.

Participants with T2DM had significantly lower dominant, non-dominant, and relative HGS than controls (p<0.001). Cardiac autonomic assessment demonstrated reduced standard deviation of normal-to-normal RR intervals (SDNN) and root mean square of successive RR interval differences (RMSSD) and an increased low-frequency/high-frequency (LF/HF) ratio in the T2DM group (p<0.001 for all). Definite CAN was present in 20 (33.33%) participants with T2DM compared with four (6.67%) controls. HGS was positively associated with SDNN, RMSSD, and cardiovascular autonomic reflex indices and negatively associated with HbA1c, resting heart rate, and LF/HF ratio. Longer diabetes duration, higher HbA1c, and low HGS were independently associated with definite CAN. Low HGS showed the strongest association with definite CAN (adjusted OR=3.58, 95% CI: 1.13-11.31, p=0.030).

Adults with T2DM demonstrated lower HGS and greater cardiac autonomic dysfunction than healthy controls. Reduced HGS was independently associated with definite CAN after adjustment for relevant clinical factors. These findings suggest that HGS may have potential clinical value as a simple adjunctive measure when assessing autonomic involvement in adults with T2DM.

Acute coronary syndrome (ACS) is a leading cause of morbidity and mortality in middle-aged adults. However, there is a lack of data on its clinical profile, cardiovascular risk factors, angiographic characteristics, management, and outcomes in armed forces personnel. Thus, this study was conducted to evaluate the clinical characteristics, risk factors, angiographic profile, treatment strategies, complications, and outcomes of ACS among paramilitary forces personnel.

This study included 173 paramilitary forces personnel diagnosed with ACS. Demographic and service-related characteristics, cardiovascular risk factors, clinical presentation, Killip class, laboratory and echocardiographic parameters, time to revascularization, coronary angiographic findings, treatment strategies, procedural complications, and clinical outcomes were evaluated.

The mean age of participants was 46.5±7.52 years, and 98.8% (n=171) were male. The most frequent cardiovascular risk factors were smoking (n=99, 57.2%) and hypertension (n=94, 54.3%), followed by dyslipidemia (n=58, 33.5%) and diabetes mellitus (n=49, 28.3%). Anterior wall myocardial infarction was the most common presentation (n=74, 42.8%), followed by inferior wall myocardial infarction (n=64, 36.99%) and non-ST-elevation myocardial infarction (n=21, 12.1%). The mean ejection fraction was 45.6±7.49%, and regional wall motion abnormalities were seen in 76.9% (n=133) of patients. Pharmaco-invasive therapy was the preferred treatment strategy in 68.8% (n=119), with thrombolysis being done in 72.3% (n=125). Coronary angiography was performed in 88.4% (n=153) of cases. The most common angiographic finding was single-vessel disease (n=82, 53.6%), and the left anterior descending artery was the most frequently involved vessel (n=92, 61.7%). The majority (n=99, 78.0%) of patients who underwent percutaneous coronary intervention (PCI) had a single stent. The most common electrical complications were complete heart block (n=8, 4.6%) and ventricular tachycardia (n=7, 4.0%).  Conclusions: ACS in paramilitary forces personnel predominantly affected middle-aged men and was associated with a high prevalence of modifiable cardiovascular risk factors, especially smoking and hypertension. Main management strategies were pharmaco-invasive therapy and coronary intervention. Early identification of cardiovascular risk factors and prompt reperfusion may improve prognosis in this population.

Severe rhabdomyolysis may present with limited muscular symptoms despite substantial biochemical injury. We describe a case of suspected statin-associated rhabdomyolysis during prolonged rosuvastatin exposure. A 65-year-old man with advanced chronic kidney disease, poorly controlled type 2 diabetes mellitus, peripheral arterial disease requiring bilateral below-knee amputations, and previous rhabdomyolysis presented with generalized weakness, abdominal discomfort, and left flank pain. He had taken rosuvastatin for more than 10 years. Admission investigations demonstrated creatine kinase of 23,107 U/L, creatinine of 7.80 mg/dL, markedly elevated aminotransferases, and brown urine. Creatine kinase subsequently peaked at 38,747 U/L despite limited muscular complaints. Progressive azotemia and encephalopathy prompted hemodialysis. Rosuvastatin was discontinued, and supportive treatment was provided without immunosuppression. The reported myositis panel was negative, while magnetic resonance imaging (MRI) demonstrated mild, nonspecific muscle edema. By discharge, weakness and encephalopathy had resolved, strength was preserved on focused examination, and creatine kinase had decreased to 1,003 U/L. The patient was advised to avoid all statins. Outpatient hemodialysis, rheumatology follow-up, and serial creatine kinase measurements were arranged, with anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) antibody testing and muscle biopsy planned if creatine kinase remained persistently elevated after discharge. This case highlights the discrepancy between biochemical severity and muscular symptoms during long-standing statin exposure. Improvement after statin withdrawal and supportive care supported a suspected statin-associated process but did not establish causality or exclude an autoimmune mechanism. Continued clinical and biochemical follow-up was essential to document recovery and determine the need for further investigation.

Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), is an aggressive mature T-cell neoplasm that may present with nonspecific systemic and metabolic abnormalities. A 73-year-old man with type 2 diabetes mellitus presented with progressive weakness, altered mental status, recurrent hypoglycemia, and hypercalcemia, accompanied by acute kidney injury, pancytopenia, diffuse lymphadenopathy, and splenomegaly. A complete critical-sample evaluation during hypoglycemia was unavailable, and the mechanism of the parathyroid hormone (PTH)-independent hypercalcemia could not be established because PTH-related peptide and vitamin D metabolite measurements were unavailable. Core biopsy of a left axillary lymph node demonstrated a mature CD4-positive T-cell lymphoma with strong diffuse CD30 expression, reduced CD7, negative anaplastic lymphoma kinase and Epstein-Barr virus-encoded RNA studies, and a Ki-67 proliferation index exceeding 90%, supporting PTCL-NOS after exclusion of other supported mature T-cell lymphoma entities. Classification remained limited by the absence of an excisional biopsy and additional molecular studies. Prednisone cytoreduction was followed by cyclophosphamide, doxorubicin, and prednisone, with brentuximab vedotin planned but not documented as administered. The course was complicated by profound myelosuppression, Klebsiella pneumoniae pneumonia, and neutropenic septic shock. Formal response assessment was not possible because complete staging and adequate follow-up were unavailable. This case highlights the importance of prompt tissue diagnosis when unexplained metabolic abnormalities coexist with cytopenias and generalized lymphadenopathy. Although hypoglycemia and hypercalcemia occurred in association with PTCL-NOS, the available data do not establish a causal or paraneoplastic relationship.

Background Reverse total shoulder arthroplasty (rTSA) provides favorable clinical outcomes; however, postoperative functional recovery varies among patients. Although deltoid cross-sectional area (DA) has been linked to postoperative muscle strength, the associations between systemic body composition parameters, postoperative shoulder function, and local deltoid morphology have not been fully investigated in patients undergoing rTSA. This study aimed to investigate associations between preoperative body composition parameters, DA, and shoulder function before and one year after rTSA. Methods This study included 42 patients (42 shoulders) who underwent rTSA and had available preoperative and one-year postoperative assessments. The study population comprised 15 men (35.7%) and 27 women (64.3%), with a mean age of 78 ± 7 years and BMI of 24.7 ± 6.4 kg/m². The underlying diagnoses were massive rotator cuff tear in 12 patients (28.6%), cuff tear arthropathy in 12 (28.6%), and glenohumeral osteoarthritis in 18 (42.9%). Six patients (14.3%) had diabetes mellitus, and 14 (33.3%) had a history of smoking. Preoperative body composition was assessed using a bioelectrical impedance analyzer (InBody® 970, InBody Japan Inc., Tokyo, Japan), including appendicular skeletal muscle mass index (ASMI), phase angle (PhA), and extracellular water/total body water (ECW/TBW). DA at the midpoint of the total deltoid length was measured using preoperative magnetic resonance imaging (MRI; Philips, Amsterdam, the Netherlands). Shoulder function was assessed preoperatively and at one year postoperatively using the Constant-Murley score, abduction strength, visual analog scale (VAS), and range of motion. Associations of preoperative body composition parameters and DA with shoulder function were assessed using Spearman's rank correlation coefficient, with the Benjamini-Hochberg procedure applied to control the false discovery rate (FDR). Results Preoperative PhA was significantly positively correlated with abduction strength both preoperatively (r = 0.41, adjusted p = 0.02) and at one year postoperatively (r = 0.37, adjusted p = 0.04), whereas preoperative ECW/TBW was significantly negatively correlated with preoperative abduction strength (r = -0.37, adjusted p = 0.04). Preoperative PhA was also significantly negatively correlated with VAS at one year postoperatively (r = -0.40, adjusted p = 0.03), whereas preoperative ECW/TBW was significantly positively correlated with VAS at one year postoperatively (r = 0.40, adjusted p = 0.03). Preoperative DA was significantly positively correlated with abduction strength both preoperatively (r = 0.41, adjusted p = 0.02) and at one year postoperatively (r = 0.34, adjusted p = 0.02). Furthermore, preoperative DA was significantly positively correlated with ASMI (r = 0.64, adjusted p < 0.01) and PhA (r = 0.56, adjusted p < 0.01) and significantly negatively correlated with ECW/TBW (r = -0.35, adjusted p = 0.04). Conclusions Preoperative body composition parameters and deltoid morphology were associated with different aspects of shoulder function before and one year after rTSA. PhA and ECW/TBW were associated with selected measures of muscle strength and pain, whereas DA was associated with abduction strength. These findings suggest that systemic body composition and local deltoid morphology may provide complementary information regarding shoulder function in patients undergoing rTSA.

Transtibial amputation is frequently performed in patients with diabetes mellitus complicated by peripheral vascular and infectious diseases of the foot, and successful prosthetic rehabilitation depends as much on surgical technique as on the subsequent quality of socket fitting. Anterior beveling of the distal tibia, classically referred to as Farabeuf's angle, is intended to blunt the prominent anterior tibial crest and create a smooth, well-padded residual-limb tip capable of tolerating axial and shear loading within a prosthetic socket. We report the case of a 56-year-old man with insulin-treated type 2 diabetes mellitus who had undergone a left transtibial amputation for diabetic foot disease two years earlier and was fitted with a definitive prosthesis four months before presentation. He developed a small, clean, superficial wound at the tip of the residual limb; although he was advised to discontinue prosthesis use until complete healing, he continued to bear weight on the limb. Three months later, he presented with a 1-cm ulcer extending into the subcutaneous plane, with perilesional necrosis and local inflammatory changes but no purulent discharge, malodor, or fever. Neurovascular examination of the residual limb was preserved, and plain radiographs demonstrated a squared, non-beveled anterior margin of the distal tibial cut, consistent with an absent Farabeuf's angle. Management consisted of complete offloading of the prosthesis, local wound care, and refashioning of the socket to accommodate the prominent bony margin. This case illustrates that distal residual-limb ulceration in a transtibial amputee, even with preserved sensation, should prompt evaluation of both the skeletal anatomy created at amputation and the biomechanical fit of the prosthetic socket, and supports routine, structured socket assessment during prosthetic follow-up, particularly in patients with diabetes.

Type 2 diabetes requires sustained self-management across multiple behavioural domains, yet middle-aged and older adults may not follow a single high-versus-low pattern. This study aimed to identify latent profiles of self-management behaviours among middle-aged and older adults with type 2 diabetes and to examine factors associated with profile membership.

A hospital-based cross-sectional study was conducted at two hospitals in China from January to June 2026. A total of 706 adults aged 45 years or older with type 2 diabetes were included. Diabetes self-management behaviour was assessed using the Chinese version of the Diabetes Self-Care Scale (DSCS), and the six DSCS dimension scores were used as manifest indicators in latent profile analysis (LPA). Health literacy, social support, self-efficacy, illness perception, sociodemographic characteristics, clinical characteristics, and health-related variables were also assessed. One- to six-profile models were fitted and compared using information criteria, entropy, likelihood ratio tests, profile size, parsimony, and interpretability. Multinomial logistic regression was used to examine variables related to latent profile membership, with the high self-management profile as the reference category.

A five-profile solution was selected and showed high classification quality (entropy = 0.920). The profiles were labelled low self-management (15.7%), medium-low self-management with monitoring/foot care deficits (13.2%), exercise-deficit self-management (13.7%), medium-high self-management with good medication adherence (40.4%), and high self-management (17.0%). All six DSCS dimensions and the DSCS total score differed significantly across profiles (all P < 0.001). Lower educational attainment, insulin-containing therapy, and higher systolic blood pressure were mainly associated with membership in lower or domain-specific self-management profiles. Higher health literacy, self-efficacy, and illness perception scores were associated with lower odds of membership in the non-reference profiles, whereas social support showed profile-specific associations.

Middle-aged and older adults with type 2 diabetes showed distinct patterns of self-management behaviour across dietary control, exercise regularity, blood glucose monitoring, medication adherence, foot care, and management of hypo-/hyperglycaemia. A profile-based understanding of self-management may help nurses and clinicians identify patients who require comprehensive support and those who need targeted assistance in specific domains.

Type 2 diabetes mellitus (T2DM) requires ongoing self-care support to minimize preventable complications. Telehealth interventions have the potential to extend diabetes self-management education and support beyond conventional face-to-face care. However, the specific contributions of nursing roles, conceptual frameworks, and digital care architectures have not been comprehensively synthesized.

This scoping review aimed to map global evidence on telehealth interventions for T2DM self-care.

The review was conducted in accordance with Arksey and O'Malley's framework, JBI scoping review guidance, and the PRISMA Extension for Scoping Reviews. Electronic databases including PubMed/MEDLINE, EBSCOhost, Scopus, Taylor AND Francis Online, ScienceDirect, and Sage Journals, were systematically searched for empirical studies published between January 1, 2021, to June 26, 2026, examining telehealth, mHealth, telenursing, or digital self-care interventions for adults with T2DM involving nursing or nursing-relevant digital care component. Data were charted using the systematic table and synthesized through descriptive and thematic analysis.

A total of 26 studies were included, representing diverse models such as app-based self-management, messaging platforms, telemonitoring, virtual education, EHR-supported discharge pathways, virtual group visits, and comprehensive telehealth. Nursing roles were categorized as digital education, clinical monitoring, care coordination, behavioral coaching, medication and follow-through support, peer-support moderation, and digital onboarding. Of the 26 included studies, nine (34.6%) were classified as nurse-led, five (19.2%) as nurse-supported, seven (26.9%) as multidisciplinary/team-based, and five (19.2%) had insufficient reporting to isolate a nurse-specific intervention role. Interventions featuring structured nurse involvement, individualized feedback, theory-informed behavior-change strategies, and escalation pathways demonstrated the most consistent improvements in self-care behaviors and selected glycemic outcomes, particularly HbA1c and fasting blood glucose.

Telehealth interventions for T2DM self-care should be regarded as hybrid care models rather than solely technology-based tools. The synthesized evidence supports nurse-mediated, theory-informed, and equity-sensitive digital diabetes care, while underscoring the need for improved reporting on nursing scope, digital engagement, clinical escalation, fidelity, cost, and implementation context.

Pulmonary tuberculosis (TB) and type 2 diabetes mellitus (T2DM) are significant global health burdens that independently impair immune function. When present concurrently, they exacerbate disease severity, reduce treatment effectiveness, and increase mortality. Recent literature suggests a growing bidirectional relationship between these conditions. The purpose of this investigation is to evaluate how T2DM-induced immune dysregulation increases susceptibility to TB and worsens clinical outcomes. A literature review was conducted using PubMed, focusing on articles related to cytokine signaling, immune modulation, T2DM, and tuberculosis. T2DM contributes to impaired immunity primarily through hyperglycemia-induced suppression of cytokines, such as tumor necrosis factor-alpha (TNF-α) and various interleukins (IL-1β, IL-6, and IL-12). This dysregulation compromises macrophage and T-cell responses, increasing the risk of TB activation and reducing treatment efficacy. The rising incidence of both diseases in the United States highlights the urgent need to understand this mechanistic overlap to improve therapeutic strategies. T2DM serves as an independent risk factor for TB due to its immunosuppressive metabolic environment. Recognizing these mechanisms can inform clinical decisions and improve the management of co-affected patients.