Sinistral portal hypertension is caused by various pancreatic pathologies, including neoplasms. Bleeding from the collateral circulation due to sinistral portal hypertension obscures the operative field during laparoscopic distal pancreatectomy. A female patient in her 40s presented with a mucinous cystic neoplasm complicated by sinistral portal hypertension that was successfully managed with splenic arterial embolization followed by laparoscopic distal pancreatectomy. The intraoperative blood loss was minimal, and the patient did not require blood transfusions during the perioperative period. Preoperative splenic arterial embolization is feasible, safe, and effective in avoiding massive hemorrhage from the collateral circulation due to sinistral portal hypertension during laparoscopic distal pancreatectomy.

Stroke is a leading cause of disability among hypertensive adults, with notable sex differences in risk and outcomes. Neutrophil percentage-to-albumin ratio (NPAR) is an easily obtainable composite index of systemic inflammation with prognostic value in cardiovascular disease, but its utility for primary stroke prevention in hypertension remains unclear. We therefore examined the association of NPAR with first stroke in hypertensive adults and tested for sex-specific effects. We analyzed 13 848 participants from the China Stroke Primary Prevention Trial. NPAR was calculated as the neutrophil percentage (%) × 100/albumin (g/dL). Cox proportional hazards models evaluated the association between NPAR and first stroke, and subgroup analyses assessed sex-specific effects. During a median follow-up of 4.5 years, 371 participants (2.7%) experienced stroke. The risk of stroke was significantly higher in Q2, Q3, and Q4 than in Q1 (HR 1.76, 95% CI 1.31-2.36, p < 0.001 [Q2], HR 1.54, 95% CI 1.14-2.08, p = 0.005 [Q3], and HR 1.57, 95% CI 1.17-2.12, p = 0.003 [Q4] in the adjusted model). The result remained consistent when the Q2 to Q4 groups were combined and compared with the Q1 group. Subgroup analysis revealed a significant sex difference, with higher NPAR associated with increased stroke risk in women but not in men (p = 0.035). These findings suggest that higher NPAR independently predicts stroke risk in patients with hypertension, with a substantially stronger association in women, and highlight sex-specific inflammatory mechanisms and the potential of NPAR as a biomarker for female-focused prevention strategies.

Tobacco use, second-hand tobacco smoke (SHS) exposure and alcohol consumption are well-established carcinogens and major public health concerns. In the European Union (EU), tobacco and alcohol use are the leading preventable causes of cancer and four other major noncommunicable diseases (NCDs), significantly contributing to NCD-related morbidity and mortality. Despite declining prevalence, consumption of these substances is still high in the region, especially among the most deprived. There is strong evidence that quitting smoking, minimising exposure to SHS and eliminating or reducing alcohol intake substantially lowers the risk of cancer. Comprehensive public health strategies at both the individual and population level are crucial to prevent cancer and other NCDs. Scientific evidence leads to two recommendations for individual action on tobacco in the European Code Against Cancer, 5th edition: (1) 'Do not smoke. Do not use any form of tobacco, or vaping products. If you smoke, you should quit'; and (2) 'Keep your home and car free of tobacco smoke'; and one on alcohol: (3) 'Avoid alcoholic drinks'.

Comorbidities among people living with HIV/AIDS (PLHA) are increasing as life expectancy improves with antiretroviral therapy (ART). Understanding the prevalence and associated factors of these conditions in Guyana is essential for improving clinical outcomes. To evaluate the prevalence of comorbidities among PLHA in Guyana and to identify the most prevalent comorbidities and associated risk factors from January 2017 to December 2022.

A retrospective cross-sectional study was conducted using data from 1066 patients across 10 HIV care and treatment centers in regions 3, 4, and 10. Data were collected using a standardized tool, coded according to the International Classification of Diseases, 11th revision, and analyzed using SPSS.

Overall, 57.2% had at least one comorbid condition, with hypertension (29.5%), obesity (12.8%), and diabetes mellitus type II (7.4%) being the most prevalent. Significant factors associated with comorbidity included age (P < 0.001), ethnicity (P = 0.047), same-sex relations (P = 0.027), ART use (P < 0.001), and adherence level (P < 0.001).

Comorbidities are common among PLHA in Guyana and have important implications for HIV management. Recommendation: Implementation of routine screening and management protocols for common comorbidities in PLHA is crucial for improving patient care in Guyana.

The global prevalence of human immunodeficiency virus (HIV) has led to a significant rise in the chronic use of antiretroviral (ARV) drugs, both for HIV management and pre-exposure prophylaxis (PrEP), to meet the set Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets. Although antiretroviral therapy (ART) has remarkably increased the life expectancy of people living with HIV (PLHIV), it has also been associated with metabolic complications, particularly in glucose and lipid metabolism. Notably, the development of type two diabetes mellitus (T2DM), accounting for 90-95 % of diabetes cases, often stems from an asymptomatic prediabetic state, frequently left undiagnosed. In this narrative review, we address the limited understanding of how prediabetic individuals respond to chronic exposure to antiretroviral therapy. The scope of this review focuses on selected markers of pancreatic metabolic dysfunction, the interplay between modern ARV therapies and prediabetes will be examined. In efforts to enhance and further expand the understanding of potential risks and outcomes of ARVs on metabolically compromised individuals. Through a comprehensive synthesis of existing literature and novel findings from the animal model, in vitro studies and clinical studies, we aim to provide valuable insights for both the scientific and clinical communities, contributing to the optimization of HIV treatment strategies and the mitigation of associated metabolic complications. Based on the available literature, it is evident that more research is needed to better understand the interaction between prediabetes and ART in HIV-infected individuals, to simultaneously reach the set UNAIDS 95-95-95 HIV/AIDS targets and combat the rising trend of noncommunicable diseases in HIV-infected populations.

Chronic kidney disease (CKD) is a major public health concern in India, with a disproportionate impact on underserved populations. Shifting epidemiological patterns indicate increasing metabolic risk in tribal communities. This study sought to assess the prevalence of CKD and explore its associated determinants among tribal communities in Kerala, South India.

A community-based cross-sectional study was conducted among 2029 tribal adults aged ≥ 30 years across 3 districts in Kerala, selected through multistage random sampling. Data collection involved structured interviews, anthropometry, point-of-care blood tests, and spot urine analysis. Based on Kidney Disease: Improving Global Outcomes (KDIGO) 2024 criteria, CKD was defined using estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR). Multivariable logistic regression was employed to identify factors independently associated with CKD.

A total of 2029 individuals were included in this study (1209 females and 820 males) from 18 distinct tribal communities. The mean age was 50.1 (± 13.1) years. The prevalence of CKD was 22.6% (95% confidence interval [CI]: 20.7%-24.7%), higher in females (24.2%, 95% CI: 21.8%-26.8%) than in males (20.4%, 95% CI: 17.8%-23.2%). Most cases were in early risk stages, reflecting a significant subclinical burden. CKD was positively associated with older age, hypertension, diabetes, lower education, and low body mass index (BMI).

This is the first large-scale population-based study to report a high prevalence of CKD among indigenous tribal communities in India. Effective CKD control in the indigenous communities in India necessitates an equity-focused strategy addressing both clinical and social determinants. The findings underscore the need for culturally adapted screening and prevention interventions integrated within primary health care systems.

Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), represents a major non-communicable chronic disease with increasing global prevalence. Dietary polyphenols from plant-based foods have demonstrated potent anti-inflammatory, antioxidant, and immunomodulatory properties that may play a crucial role in preventing and managing chronic inflammatory conditions. While dietary modifications are frequently advocated in the management of IBD, the intrinsic role of dietary preferences for polyphenol-rich plant foods remains insufficiently understood. By exploring these links, researchers can develop targeted dietary plans that offer new ways to prevent IBD onset and improve treatment outcomes. This study utilized genome-wide association study (GWAS) summary statistics pertaining to 65 plant-based food preferences (sample size ranging from 115,868 to 159,579) and two subtypes of IBD from the most recent FinnGen database (Release 11): UC (n = 438,538) and CD (n = 434,250). The principal causal inference was performed using inverse variance weighted (IVW) in the two-sample Mendelian randomization (MR), with additional analyses conducted using MR-Egger and weighted median methods. To ensure robustness, we conducted extensive sensitivity analyses, incorporating Cochran's Q test, the MR-Egger intercept test, the MR-PRESSO test, and leave-one-out analysis. The directionality of the identified associations was confirmed through Steiger filtering. Additionally, we utilized multivariable Mendelian randomization (MVMR) to evaluate the direct effects of dietary factors on IBD. Colocalization analysis was also employed to identify shared genetic architecture between preferences for polyphenol-rich edible plants and both UC and CD. Following the application of the Bonferroni correction, this MR analysis identified significant genetic associations between preferences for polyphenol-rich plant foods and IBD risk. For CD, preferences for orange juice (rich in flavonoids such as hesperidin and naringin, OR: 0.329, 95% CI: 0.146-0.743, p = 0.007) and lentils/beans (abundant in polyphenols and flavonoids, OR: 0.178, 95% CI: 0.048-0.658, p = 0.010) demonstrated strong protective effects. Using MVMR techniques, we found that UC risk increased among those with aniseed preferences (OR: 3.942, 95% CI: 1.075-14.451, p = 0.039), while individuals who favored melon (rich in cucurbitacins and antioxidants, OR: 0.168, 95% CI: 0.031-0.910, p = 0.039) showed decreased likelihood of developing CD. Through colocalization analysis, we identified shared genetic signals between UC and aniseed preference (PP.H4 = 99.52%), supporting their biological connection. These findings suggest that the anti-inflammatory and antioxidant properties of dietary polyphenols may mediate protective effects through modulation of gut microbiota, enhancement of intestinal barrier function, and regulation of immune responses. Our study provides robust genetic evidence for causal relationships between preferences for polyphenol-rich plant foods and IBD risk, highlighting the potential role of dietary polyphenols in preventing non-communicable chronic inflammatory diseases. These biological insights suggest new directions for improving disease screening and developing targeted dietary interventions for IBD prevention and management.

Parkinson's disease (PD) is a heterogeneous neurodegenerative disorder, with age at onset (AAO) influenced by genetic and environmental factors. This study aimed to (i) examine temporal trends in PD AAO over the past four decades in a large tertiary care cohort; and (ii) identify independent associations between AAO and a comprehensive set of demographics, cardiovascular/dysmetabolic, lifestyle, and environmental variables.

We conducted a retrospective observational study of 13,220 individuals diagnosed with PD between 1998 and 2024 at a tertiary referral center in Italy, excluding genetically confirmed cases. Demographic, clinical, and exposure data were collected via questionnaires and interviews. Temporal trends in AAO were analysed in relation to national population ageing. Independent predictors of AAO were identified using multivariable linear regression with cross-validation and multiple imputation. Age- and sex-stratified analyses were also performed.

AAO increased over time in parallel with demographic ageing (R² = 0.94), without evidence of additional temporal acceleration (P = 0.852). An earlier AAO was independently associated with a positive family history of PD (β = -2.96, P < 0.0001), pollutant exposure (β = -3.50, P < 0.0001), and higher education level (β = -0.52, P < 0.0001). In contrast, type 2 diabetes mellitus (β =  + 2.63, P < 0.0001) and hypertension (β =  + 2.24, P < 0.0001) were associated with later onset. Among women, later menarche was linked to delayed AAO (β =  + 0.60, P < 0.0001).

While demographic ageing largely accounts for the temporal increase in AAO, modifiable exposures, particularly cardiovascular/dysmetabolic comorbidities and environmental toxins, can significantly influence disease timing, though causal interpretation is limited by accumulation bias.

Metabolic dysfunction-associated steatohepatitis (MASH) is the most common chronic liver disease worldwide, with a particularly high incidence among individuals with type 2 diabetes and obesity. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as effective weight loss agents, with growing evidence suggesting potential benefits in MASH. This study aimed to evaluate the efficacy and safety of GLP-1RAs in improving the histologic features of MASH.

This study is a meta-analysis of randomized controlled trials evaluating the effect of FDA-approved GLP-1RAs in patients with biopsy-confirmed MASH, up to May 2025. The primary outcomes were resolution of MASH without worsening of fibrosis and a ≥1 improvement in fibrosis stage without worsening of MASH at 12-18 months. Secondary outcomes included ≥1-point improvements in the nonalcoholic fatty liver disease activity score, changes in liver histologic features, and the incidence of serious adverse events.

A total of 6 randomized controlled trials with 1555 patients (1082 GLP-1RA and 473 placebo) with MASH were included. At 18 months, a significantly greater proportion of patients in the GLP-1RA group achieved MASH resolution without worsening fibrosis compared with the placebo group (OR: 4.16, 95% CI: 2.33-7.42, p<0.001). A subgroup analysis excluding studies with patients with cirrhosis showed a significant benefit on fibrosis regression (OR: 2.02, 95% CI: 1.56-2.62, p=0.01). GLP-1RAs significantly improved nonalcoholic fatty liver disease activity scores and liver histologic features, including balloon degeneration, lobular inflammation, and steatosis, compared with placebo. The pooled serious adverse event rate for GLP-1RAs was comparable to placebo.

In patients with noncirrhotic MASH, GLP-1RAs appear to be associated with both MASH resolution without fibrosis worsening and ≥1-stage fibrosis regression without MASH worsening.

Diabetic nephropathy (DN) is a prevalent and significant complication associated with diabetes mellitus (DM). Although several risk factors have been established, there is still a need to explore additional indicators for the early detection and intervention planning of DN. Red cell distribution width (RDW) has been noted to play a role in cardiovascular events and metabolic syndrome. This study aimed to explore the potential association between RDW and DN in patients with type 2 DM (T2DM).

Data were gathered from 2011 through 2018 through NHANES, and we performed a cross-sectional study that included 3,704 T2DM patients. Logistic regression, curve fitting, and interaction effects were utilized to examine the relationship between RDW and diabetic nephropathy.

The mean RDW values were significantly elevated in patients with diabetic nephropathy compared to those without diabetic nephropathy (p < 0.001). Logistic regression analysis indicated a positive correlation between RDW and DN, even after adjusting for the confounding variables (odds ratio: 1.16, 95% confidence interval: 1.12 - 1.21, p < 0.001). Furthermore, after accounting for all confounding variables, curve fitting demonstrateed a linear relationship between RDW and DN (p for non-linearity = 0.658). RDW was positively correlated with DN.

In conclusion, our research suggests that there is a link between higher RDW levels and the presence of DN, indicating that RDW may serve as a valuable biomarker for the early identification, prevention, and strategic intervention of this serious complication.