Non-communicable diseases (NCDs) are rapidly emerging as major causes of morbidity and mortality across the Horn of Africa, compounding persistent infectious diseases, humanitarian crises and fragile health systems. This Perspective examines how sustainable, nationally led health partnerships can strengthen health systems to address this growing burden. Drawing on regional evidence and the Wolverhampton-Somaliland Global Health Partnership as an illustrative case study, it argues that partnership effectiveness depends on local ownership, institutional capacity strengthening, integration within primary health care, reliable data systems and sustainable financing. Although partnerships have supported governance, workforce development, service integration, access to medicines and surveillance, many remain fragmented, donor-dependent and insufficiently embedded within national systems. The case study demonstrates how these principles have been translated into implementation activities within a fragile and resource-constrained setting, while acknowledging that their long-term impact remains to be evaluated. Future NCD partnerships should therefore be developed as nationally aligned, long-term health-system-strengthening platforms capable of supporting resilience in fragile and crisis-affected settings.

Citrin deficiency is a rare autosomal recessive metabolic disorder caused by pathogenic variants in the SLC25A13 gene. Pregnancy in affected women is uncommon and presents unique challenges because conventional obstetric management may conflict with metabolic requirements. The coexistence of gestational diabetes mellitus (GDM) introduces additional complexity. A 25-year-old, gravida 2 para 0+1 woman with genetically confirmed citrin deficiency (homozygous SLC25A13 c.1763G>A mutation) was managed jointly by obstetric and inherited metabolic disease (IMD) teams. Her pregnancy was complicated by severe nausea and vomiting during the first trimester and subsequent GDM diagnosed using capillary glucose monitoring rather than an oral glucose tolerance test. Representative fasting glucose values were 6.3-6.8 mmol/L, with postprandial values up to 10.7 mmol/L. Specialist dietary modification and insulin therapy were instituted following multidisciplinary review. A personalised metabolic plan emphasised avoidance of prolonged fasting, restriction of excessive carbohydrate intake, maintenance of adequate energy intake, and avoidance of routine glucose-containing intravenous fluids. At 38+5 weeks' gestation, she underwent emergency caesarean section for failure to progress in labour under spinal anaesthesia. A healthy infant weighing 3074 g was delivered with Apgar scores of 9, 10 and 10 at 1, 5 and 10 minutes, respectively. Postoperative pain management was challenging because the specialist metabolic plan advised caution with paracetamol. Following inadequate analgesia with ibuprofen and dihydrocodeine, paracetamol was cautiously introduced at reduced doses and subsequently increased to 500 mg four times daily, with additional opioid analgesia as required. Daily plasma ammonia and liver function monitoring was undertaken during the five-day postoperative admission; ammonia values remained within the laboratory reference range, with no hyperammonaemia (range <10-32 µmol/L) or significant hepatic biochemical deterioration. This case highlights the complexity of managing pregnancy in women with citrin deficiency, particularly when complicated by GDM. It also demonstrates a practical approach to postoperative analgesia following caesarean delivery using cautious dose escalation and biochemical surveillance.

Coccidioidomycosis is an endemic fungal infection of the southwestern United States that may rarely produce mass-like pulmonary abnormalities mimicking malignancy. We describe a 70-year-old Hispanic woman with poorly controlled type 2 diabetes mellitus (HbA1c >14%) who presented after three days of generalized weakness, nonproductive cough, abdominal pain, nausea, vomiting, and progressive difficulty ambulating. CT demonstrated a 7.3 × 5.4 cm wedge-shaped necrotic right middle lobe mass with multiple bilateral pulmonary nodules. CT-guided biopsy of the mass demonstrated granulomatous inflammation with fungal elements, while subsequent serologic testing and bronchoalveolar lavage PCR supported pulmonary coccidioidomycosis. Her hospitalization was complicated by acute respiratory distress syndrome requiring invasive mechanical ventilation, prone positioning, and neuromuscular blockade; non-liposomal amphotericin B-associated acute tubular necrosis requiring hemodialysis; ventilator-associated Klebsiella pneumoniae pneumonia; and persistent encephalopathy with multifocal MRI abnormalities highly suggestive of central nervous system dissemination despite nondiagnostic cerebrospinal fluid studies. This case highlights how pulmonary coccidioidomycosis can mimic malignancy. It illustrates the multifactorial deterioration that may occur in susceptible hosts, emphasizing early tissue diagnosis, careful interpretation of suspected dissemination, and individualized antifungal and critical care management.

Spinal cord infarction is a rare cause of acute myelopathy and may be difficult to recognize when it occurs outside a traumatic or perioperative setting. We report a 68-year-old man with hypertension, type 2 diabetes mellitus, dyslipidemia, and active smoking who presented with sudden severe low back pain followed within one hour by rapidly progressive bilateral lower-limb weakness and sensory loss. Neurologic examination showed severe paraparesis, absent lower-limb reflexes, impaired pain sensation below T10, and relative preservation of proprioception. Aortic computed tomography angiography excluded dissection, and spinal magnetic resonance imaging demonstrated T2 hyperintensity with diffusion restriction in the anterior gray matter from T10-T11 to the conus medullaris, consistent with acute infarction in the anterior spinal artery territory. The patient received antiplatelet therapy, high-intensity statin therapy, venous thromboembolism prophylaxis, bladder management, and early rehabilitation. At follow-up, left lower-limb strength improved to 4/5, while right lower-limb plegia, neurogenic bladder, and wheelchair dependence persisted. This case emphasizes the importance of recognizing the characteristic clinical pattern of anterior spinal artery syndrome, urgently excluding aortic and compressive causes, obtaining diffusion-weighted spinal imaging, and initiating multidisciplinary supportive and rehabilitative care.

Introduction The co-occurrence of hearing and vision impairment, known as dual sensory impairment, is thought to impose a larger functional burden than either impairment alone. The purpose of this study was to identify characteristics that are independently related to dual sensory impairment and investigate its relationship with functional limitations across five domains of daily living in comparison with isolated sensory impairment. Methods This retrospective, cross-sectional study utilized data from the 2023 National Health Interview Survey (NHIS), using sampling weights, strata, and clusters to produce nationally representative estimates. A population of 29,522 adults was included in the analysis. Vision and hearing impairments were identified through self-reported difficulties, and individuals with both were classified as having dual sensory impairment. Five domains of functional impairment were evaluated: communication, social participation, independent errand performance, ambulation, and self-care. Multivariable logistic regression, while controlling for demographic and clinical covariates, was conducted to identify factors associated with dual sensory impairment and to assess the relationship between sensory impairment status and functional limitation, with results presented as adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results Of the 29,522 participants, 1,858 (5.6%) exhibited dual sensory impairment. This group was significantly older and had higher rates of obesity and smoking, as well as poorer self-rated health and lower life satisfaction, compared to individuals without sensory impairment. Dual sensory impairment was independently associated with older age, smoking history, hypertension, stroke, coronary artery disease (CAD), cancer, chronic obstructive pulmonary disease (COPD), dementia, anxiety, and depression (all p < 0.05); the association with diabetes mellitus was no longer statistically significant after adjustment. Throughout all five functional areas, dual sensory impairment exhibited the strongest association with impairment in comparison to solely visual or hearing impairment, encompassing ambulation (aOR: 3.87), self-care (aOR: 3.55), communication (aOR: 6.03), independent errands (aOR: 3.81), and social participation (aOR: 4.08) (all p < 0.001). Conclusion Dual sensory impairment is prevalent among a significant number of adults in the United States and is associated with considerably higher odds of functional limitation across multiple domains compared with isolated visual or hearing impairment.

Fournier's gangrene (FG) is a fulminant and life-threatening polymicrobial necrotizing fasciitis of the perineal, perianal, and genital regions. It typically affects patients with significant comorbidities, particularly poorly controlled diabetes mellitus, and is associated with high mortality rates. We describe the case of a 57-year-old male patient who presented with a one-month history of severe perineal pain, initially misdiagnosed as uncomplicated hemorrhoidal disease. Upon admission, the patient exhibited systemic inflammatory response syndrome and a large, purulent perianal mass. The patient underwent an emergency radical surgical debridement followed by three serial surgical washouts and strict glycemic control. Ultimately, successful delayed primary closure was achieved without the need for fecal diversion or complex reconstructive flaps. His postoperative course was favorable, with complete preservation of sphincter function. This report underscores the importance of considering early radical debridement and demonstrates that a staged conservative surgical approach can yield excellent functional and cosmetic outcomes in extensive perineo-scrotal defects.

Knee osteoarthritis (KOA) is a common chronic degenerative joint disease and a leading cause of pain, disability, and impaired quality of life. Cardiovascular comorbidities (CVCs), particularly hypertension, dyslipidemia, and diabetes, frequently coexist with KOA and may influence both disease burden and treatment options, especially the use of non-steroidal anti-inflammatory drugs (NSAIDs). This study aimed to determine the prevalence of CVCs in patients with KOA and evaluate their association with pain, functional impairment, and therapeutic management.

We conducted a cross-sectional study including consecutive patients with radiographically confirmed KOA attending the Rheumatology A outpatient clinic at El Ayachi Hospital, Rabat-Salé, Morocco. Adults with inflammatory arthritis, previous major knee surgery, or post-traumatic osteoarthritis were excluded. Data collected included age, sex, disease duration, pain assessed by the visual analog scale (VAS), functional disability measured by the Lequesne index, cardiovascular comorbidities (hypertension, dyslipidemia, diabetes, coronary or vascular disease), and current treatments. Patients were divided into two groups according to the presence or absence of at least one cardiovascular comorbidity. Comparisons were performed using the chi-square test or Student's t-test, with p < 0.05 considered statistically significant.

A total of 158 patients were included (mean age 62.3 ± 10.5 years; 125 (79.1%) women), with a median disease duration of seven years (IQR 4-12). Overall, 98 (62.0%) had at least one cardiovascular comorbidity. Hypertension was the most frequent (n=85; 53.8%), followed by diabetes mellitus (n=46; 29.1%) and dyslipidemia (n=41; 25.9%). Patients with CVCs had higher pain scores than those without (VAS: 6.8 ± 1.7 vs. 6.0 ± 1.8; p = 0.01). In contrast, they had significantly greater functional impairment (Lequesne index: 12.4 ± 4.2 vs. 10.3 ± 4.6; p = 0.004). Systemic NSAID use was significantly lower in patients with CVCs (31/98 (31.6%) vs. 33/60 (55.0%); p = 0.01), whereas no significant differences were observed for intra-articular corticosteroid injections or viscosupplementation.

Cardiovascular comorbidities are highly prevalent in patients with KOA and are associated with greater functional disability and reduced use of systemic NSAIDs. These findings emphasize the need for routine cardiovascular risk assessment and individualized therapeutic strategies to optimize the management of patients with knee osteoarthritis.

In animal models of diabetic kidney disease (DKD), ursodeoxycholic acid (UDCA) reduces albuminuria and improves histological changes associated with DKD. The purpose of this study was to investigate the potential renoprotective role of UDCA in people with type 1 diabetes (T1D) and DKD.

In this single-centre, double-blind, placebo-controlled crossover trial, participants with T1D and DKD with residual albuminuria (urine albumin to creatinine ratio, > 3 mg/mmol) on a maximum tolerated, stable dose of renin-angiotensin system (RAS) blockade with estimated glomerular filtration rate (eGFR) ≥ 30 ml/min were included. Participants were randomly allocated to UDCA (500 mg BID) or placebo for 24 weeks, with a 4-week washout period in between. The primary endpoint was the change in urine albumin excretion rate (UAER), measured from timed urine collections after 24 weeks of treatment with UDCA compared with placebo.

Thirty-one participants were included, of whom 21 were men; the median age (interquartile range [IQR]) was 54.2 (22.7-75.3) years. The baseline median (IQR) UAER was 26 (12.3-189.0) μg/min for UDCA and 32.1 (19.9-88.2) μg/min for placebo. The median (IQR) posttreatment UAER was 36.2 (14.9-174.0) μg/min for UDCA and 38.5 (17.6-194.0) μg/min for placebo, with no significant difference in UAER between treatments (p-value = 0.4).

In this first-ever human study investigating the potential renoprotective effect of UDCA treatment for 24 weeks in people with T1D and DKD, we did not observe a significant reduction in UAER. Further studies are required to evaluate the role of UDCA in DKD.

https://www.clinicaltrialsregister.eu/ctr-search/trial/2015-003609-41, identifier 2015-003609-41.

Contrast-associated nephropathy is a complication of cardiovascular procedures. Although contrast volume is a risk factor for acute kidney injury, its impact on medium- to long-term renal function remains unknown. This study aimed to investigate this association in patients undergoing repeated percutaneous coronary interventions (PCI).

This retrospective single-centre study included patients undergoing repeated PCIs between 2003 and 2023, with intervals of ≥7 and ≤ 365 days between procedures. Renal function was classified by "Kidney Disease: Improving Global Outcomes" (KDIGO) staging system. The maximum allowable contrast dose (MACD) was retrospectively calculated as individual threshold. Primary endpoint was progression to a higher KDIGO stage at readmission. Secondary endpoints included changes in estimated glomerular filtration rate (eGFR).

In total 6714 patients were included (mean age 67.2 years; 80.2% male; KDIGO stage analysis available for 6611; median interval between procedures 127 days). Baseline mean eGFR was 74.4 mL/min/1.73 m². Median contrast volume was 220 mL, and median MACD 300 mL. At readmission, mean eGFR was 72.2 mL/min/1.73 m², 1700 Patients (25.7%) showed KDIGO stage progression. Neither contrast volume nor MACD exceedance was associated with renal deterioration. However, predispositions (diabetes mellitus, arterial hypertension, age), clinical presentation (STEMI, NSTEMI) and the vascular access route were significantly associated with adverse renal outcomes.

Contrast volume and MACD exceedance during PCI was not associated with deterioration of medium- to long-term renal function.

[Table: see text].

D-psicose (DPS) is a rare sugar with reported metabolic benefits, but its effects on diabetes-associated liver abnormalities and related gut-liver changes remain insufficiently defined. Here, DPS was evaluated in mice with Type 2 diabetes mellitus induced by a high-fat diet and streptozotocin. Low- and high-dose DPS interventions were assessed through serum biochemistry, liver histology, inflammatory cytokine measurements, intestinal barrier evaluation, hepatic molecular analysis, 16S rRNA gene sequencing, targeted quantification of tryptophan metabolites, and untargeted serum metabolomics. Relative to untreated diabetic mice, DPS-treated animals showed improved serum lipid profiles, lower ALT and AST activities, reduced circulating inflammatory cytokines, and less hepatic lipid deposition. DPS treatment was also accompanied by improved intestinal morphology, increased ZO-1 and Occludin expression, and lower circulating lipopolysaccharide concentrations. In the high-dose group, gut microbial community composition differed from that of untreated diabetic mice, with relative increases in Akkermansia and Lactobacillus. In parallel, DPS treatment was associated with increased serum tryptophan and indole-3-propionic acid concentrations, lower kynurenine concentrations and Kyn/Trp ratios, reduced hepatic TDO2 expression, increased AhR expression, and lower NF-κB p65 phosphorylation. Overall, DPS improved metabolic and liver-related abnormalities in diabetic mice and was accompanied by coordinated changes in intestinal barrier-related indices, gut microbial composition, tryptophan metabolites, and hepatic AhR/NF-κB-related markers. As microbiota-directed and AhR-targeted intervention experiments were not conducted, these observations remain associative and do not demonstrate a causal gut microbiota-tryptophan-AhR mechanism. Moreover, as these observations were obtained in a single HFD/STZ-induced mouse model, their relevance to the heterogeneity and natural course of human T2DM-associated MASLD requires confirmation in additional preclinical models and clinical studies.