Introduction: Hypertensive disorders in pregnancy (HDP) and gestational diabetes mellitus (GDM) represent two significant maternal cardiometabolic disorders closely related to each other. This study aims to identify predictive risk factors for gestational hypertension in patients with GDM within our population. Methods: This cohort study was conducted at the Department of Obstetrics and Gynecology, Policlinico "G. Martino" of Messina from January 2012 to December 2019. It included 684 pregnant women diagnosed with GDM by Oral Glucose Tolerance Test (OGTT) according to Italian guidelines. A detailed medical history was taken for each patient to identify potential predictive risk factors for HDP. Patients with pre-existing hypertension or diabetes were excluded. Results: Among 684 women with GDM, 69 (10.1%) developed hypertensive disorders of pregnancy (HDP). Women with HDP had a significantly higher pregestational BMI (30.1 ± 7.7 vs. 26.5 ± 5.6 kg/m², p = 0.001) and a higher prevalence of obesity (51% vs. 34%, p = 0.0001). Post-load glucose at 60 min was higher in the HDP group (178 ± 34 vs. 164 ± 32 mg/dL, p = 0.0001), with more women exceeding the diagnostic threshold (>180 mg/dL: 56% vs. 35%, p = 0.001). Multivariate analysis confirmed that pregestational obesity and higher 60-min glucose levels during OGTT were the strongest independent predictors of HDP. Conclusions: Obesity and glycemia above the cut-off after 1 h during OGTT are predictive risk factors for hypertensive disorders in patients with GDM.

Background: The extent of coronary artery disease (CAD) is a major determinant of prognosis in patients with myocardial infarction (MI). While structured exercise is known to be cardioprotective, the association between habitual daily physical activity and angiographic CAD extension remains insufficiently characterized. Methods: In this prospective observational study, 269 patients were hospitalized with acute MI underwent coronary angiography. Habitual daily physical activity during the four weeks preceding admission was assessed using 10-point self-reported daily preadmission effort questions to help the patients to report a final effort score. CAD extension was classified as single-, double- or triple-vessel disease. Differences in daily effort across CAD categories were evaluated using the Kruskal-Wallis test. Independent predictors of CAD extension were identified using ordinal logistic regression adjusted for age, sex, smoking, hypertension, diabetes mellitus, hyperlipidemia and body mass index. Results: Daily preadmission effort decreased progressively with increasing CAD severity (mean scores: 7.44 in single-vessel, 4.93 in double-vessel and 3.69 in triple-vessel disease; p < 0.0001). In multivariable ordinal logistic regression analysis, older age, hypertension, diabetes mellitus and hyperlipidemia were independently associated with greater CAD extension. Higher daily preadmission effort was strongly and independently associated with lower CAD severity; each one-point increase in effort score was associated with a 46% reduction in the odds of more extensive CAD (odds ratio 0.54, 95% confidence interval 0.45-0.64; p < 0.0001). Conclusions: Greater habitual daily physical activity prior to myocardial infarction is independently associated with less extensive coronary artery disease. Assessment of daily preadmission effort may provide clinically useful information regarding coronary disease burden and highlights the potential importance of everyday physical activity in cardiovascular prevention. These findings should be interpreted with caution given the use of a non-validated, self-reported measure of physical activity and the observational study design.

Background/Objectives: Diabetic retinopathy (DR) is a major microvascular complication of type 1 diabetes mellitus (T1DM) and remains an important cause of preventable visual impairment. Region-specific data on the incidence and clinical predictors of DR among patients with T1DM in Saudi Arabia remain limited. This study aimed to determine the incidence of DR and identify associated demographic and systemic risk factors among patients with T1DM at a tertiary care center in Riyadh, Saudi Arabia. Methods: This retrospective cohort study included 449 patients with T1DM aged ≥9 years who were followed at King Abdulaziz Medical City, Riyadh, between 2015 and 2025. Patients were selected using a consecutive non-probability sampling technique. Data were extracted from the BESTCare 2.0A electronic medical record system and supplemented, when required, by phone-based interviews to verify selected clinical and demographic variables. Patients were classified as controls without DR or cases with DR, including non-vision-threatening DR and vision-threatening DR (VTDR), according to the International Clinical Diabetic Retinopathy Severity Scale. Multivariable logistic regression, Cox proportional hazards models, and temporal trend analysis were performed, with statistical significance set at p < 0.05. Results: The overall incidence rate of DR was 92.66 per 1000 person-years, with similar rates among males and females. In multivariable logistic regression, older age at T1DM diagnosis, longer diabetes duration, hypertension, hyperlipidemia, and albuminuria were independently associated with DR. Mean HbA1c and HbA1c variability were not independently associated with DR after adjustment. In Cox regression, older age at T1DM diagnosis was associated with higher hazards of both DR and VTDR, while hypertension was associated with VTDR. Among patients with DR, younger age at T1DM diagnosis was associated with higher odds of proliferative disease in exploratory severity analysis. Conclusions: DR was common among patients with T1DM in this tertiary-care cohort and was mainly associated with disease duration, age at diagnosis, and systemic vascular comorbidities. These findings support the importance of routine ophthalmologic screening and integrated management of systemic risk factors in patients with T1DM.

Background: Certain metabolites of the tryptophan-kynurenine (Trp-KYN) pathway, which are primarily cleared via tubular transport, have been linked to end-stage kidney disease (ESKD). Uromodulin-a protein expressed exclusively in the kidneys-is a key regulator of renal structure and function, as well as a direct marker of tubular health. This preliminary study explores the hypothesis that serum uromodulin correlates with Trp-KYN metabolites, potentially revealing new pathophysiological pathways in patients undergoing kidney replacement therapy (KRT). Given the link between serum uromodulin, Trp-KYN metabolites, and tubular function, we examined their correlation in KRT patients. Furthermore, we assessed how various clinical and dialysis parameters influence serum uromodulin levels. Methods: A total of 64 stable patients from a single dialysis center receiving hemodialysis (HD) or hemodiafiltration (HDF) were enrolled. Pre- and post-dialysis concentrations of uromodulin, Trp, KYN, kynurenic acid (KYNA), 3-hydroxykynurenine (3-OHKYN), and their reduction ratios (RRs) were established. High-performance liquid chromatography (HPLC) was used to estimate the KYN pathway metabolite levels, whereas uromodulin concentration was measured using an immunoenzymatic assay. Results: Detectable serum uromodulin was found in only 30 patients. This group was predominantly male (p < 0.001) and characterized by shorter dialysis vintage (p < 0.001), a higher prevalence of residual kidney function (RKF) (p = 0.001) and diabetes mellitus (p = 0.028), higher pre-dialysis serum phosphorus levels (p = 0.015), and more frequent use of loop diuretics (p = 0.004). Furthermore, univariate analysis revealed significantly higher pre-dialysis (p = 0.004) and post-dialysis (p = 0.025) serum Trp concentrations in the uromodulin-positive group. Pre-dialysis serum uromodulin concentration correlated positively with pre-dialysis Trp level (p < 0.001) and negatively with the pre-dialysis KYN/Trp ratio (p = 0.008), but not with other metabolites that are also subject to tubular transport mechanisms. Post-dialysis uromodulin levels correlated positively only with post-dialysis Trp level (p = 0.005). Patients treated with HDF had significantly higher RR for uromodulin than those treated with HD (p = 0.01). Conclusions: The presented data indicate that serum uromodulin levels are correlated with RKF. Additionally, the presence of detectable serum uromodulin may indicate reduced immunological activation, leading to diminished activity within the Trp-KYN pathway.

Objective: Peripheral arterial occlusive disease (PAOD) is characterized by impaired tissue perfusion, chronic ischemia, and increased platelet reactivity. Hyperbaric oxygen therapy (HBOT) is used as adjunctive treatment in advanced PAOD, but its effect on platelet function remains insufficiently studied. This study examined the association between HBOT and platelet aggregation. Methods: This prospective observational study included 90 patients with Fontaine stage IV PAOD and chronic ulceration, assigned to an HBOT group (n = 60) or waiting-list control group (n = 30). Patients were predominantly male; mean age was 66.82 ± 9.42 years in the study group and 63.00 ± 8.31 years in controls, and diabetes mellitus was present in 55.0% and 63.3%, respectively. Prior revascularization included open surgery in 33.3% and 30.0%, endovascular treatment in 36.7% and 43.3%, and no option for revascularization in 30.0% and 26.7%, respectively. HBOT was administered over 4 weeks (20 sessions, 2.0-2.5 ATA). Platelet aggregation was measured by impedance aggregometry using arachidonic-acid-induced aggregation (ASPI), adenosine-diphosphate-induced aggregation (ADP), and thrombin-receptor-activating peptide-induced aggregation (TRAP) agonists. Changes were analyzed using generalized estimating equation models adjusted for antiplatelet therapy, diabetes mellitus, smoking, and C-reactive protein (CRP). Results: Significant group × time interactions were observed for all platelet activation pathways, indicating greater reductions in the HBOT group than controls: ASPI (β = -290.5; p < 0.001), ADP (β = -243.6; p < 0.001), and TRAP (β = -330.9; p < 0.001). No significant change was observed in controls. HBOT was associated with reduced pain intensity, while CRP and platelet-to-lymphocyte ratio (PLR) remained stable. Ulcer size showed no significant change after 4 weeks. Conclusions: In patients with PAOD, HBOT was associated with reduced platelet reactivity independent of antiplatelet therapy. Further randomized studies are needed to determine its clinical significance.

Background: Foreign citizenship and low socioeconomic status are key determinants of health inequalities and may influence maternal and neonatal outcomes. This study aimed to assess maternal health during pregnancy and the main adverse maternal and neonatal outcomes related to labour and childbirth among women living in Trentino (Northern Italy), comparing women with Italian and foreign citizenship. Methods: A retrospective epidemiological study was conducted using data from the Birth Assistance Certificate (CedAP) database of the Autonomous Province of Trento. This study included all women who gave birth in Trentino between 2012 and 2016. Associations between citizenship and adverse outcomes were assessed using multivariable logistic regression models adjusted for potential confounders. Results: The analysis included 23,165 women, of whom 25.9% had foreign citizenship. Women with foreign citizenship showed a significantly higher risk of gestational diabetes mellitus compared with Italian women and an increased risk of extremely preterm birth (<28 weeks of gestation), particularly among women from Central and South America, Asia and Eastern Europe. Regarding labour and mode of delivery, women with foreign citizenship had a higher risk of caesarean section, especially among women from Central and South America and Africa. In terms of neonatal outcomes, infants born to women with foreign citizenship showed a higher likelihood of requiring phototherapy and admission to the neonatal intensive care unit. Conclusions: Significant differences were observed between immigrant and Italian women in both social determinants and maternal and neonatal perinatal outcomes. Identifying factors associated with adverse outcomes during pregnancy may help improve targeted maternal care and reduce health inequalities for both mothers and newborns.

Background: With the global rise in the ageing population and type 2 diabetes mellitus (T2DM), elderly individuals are increasingly prone to complications like sarcopenia and frailty, which are conditions linked to muscle loss and functional decline. These syndromes contribute significantly to morbidity and healthcare burden but remain underestimated in older adults with diabetes. Indian data regarding their prevalence and correlation with glycemic control is limited. Materials and Methods: This hospital-based observational study was conducted over 22 months at Kasturba Medical College, Manipal, involving 160 diabetic patients aged ≥60 years. Clinical features, comorbidities, and diabetes-related complications were recorded. Frailty was assessed using the Edmonton Frailty Scale (EFS), and sarcopenia risk was evaluated using the SARC-F questionnaire. Descriptive statistics and Spearman's correlation were used for analysis. Results: The mean age of participants was 69.98 ± 5.86 years, with 63.1% being male. Fatigue was the most common clinical presentation at 10.6%, while cardiovascular disease was the leading complication at 28.1%. Frailty or pre-frailty was identified in 35% of the population, and 36.9% were at risk for sarcopenia. A strong correlation was found between frailty and sarcopenia risk (p < 0.001). Conclusions: Frailty and sarcopenia are common and closely linked in elderly diabetes, though not significantly associated with glycemic control as both hypoglycemia and hyperglycemia could contribute to frailty.

Background/Objectives: Angiopoietin-like proteins 4 and 8 (ANGPTL4 and ANGPTL8) are key regulators of lipid metabolism and inflammatory processes, with a potential role in the pathogenesis of type 2 diabetes mellitus (T2DM) and its complications. This monocentric observational study evaluated serum levels of ANGPTL4 and ANGPTL8 in 160 participants (93 patients with T2DM and 67 controls without carbohydrate disturbances) and their associations with peripheral and cardiac autonomic neuropathy. Methods: This is a monocentric, cross-sectional, observational study conducted at the Endocrinology and Metabolic Disorders Clinic of Alexandrovska Hospital in Sofia, involving 160 participants and approved by the Ethics Committee of Medical University-Sofia, with all subjects providing written informed consent in accordance with the Declaration of Helsinki. The main methods included detailed clinical and anthropometric assessments, diagnosis of peripheral neuropathy via the Neuropathy Disability Score (NDS), evaluation of cardiac autonomic neuropathy using heart rate variability analysis and Ewing cardiovascular reflex tests, comprehensive laboratory investigations with fasting blood samples, measurement of serum ANGPTL4 and ANGPTL8 levels by ELISA kits, and statistical analysis performed with IBM SPSS version 25, using parametric and non-parametric tests, correlations, logistic regression, and ROC curves. Results: ANGPTL4 levels were significantly lower in patients with T2DM (12.6 ± 23.1 ng/mL vs. 21.5 ± 29.3 ng/mL; p = 0.033). In a multivariate model, higher values remained associated with lower odds of T2DM (OR per 1 SD = 0.634; p = 0.0424). ANGPTL8 demonstrated moderate discriminatory ability for cardiac autonomic neuropathy (AUC = 0.678; p = 0.007) in unadjusted analysis, but the association did not persist after covariate adjustment. ANGPTL4 showed inverse correlations with body weight, basal metabolic rate, and GGT. Conclusions: The results support the role of ANGPTL4 as a potential biomarker in metabolic disturbances and complications in T2DM, while ANGPTL8 remains mainly insignificant after correction for potential confounding factors.

Background: Chronic hemodialysis (HD) patients face symptoms that significantly impact their quality of life and health outcomes. Longitudinal research on the dynamics of symptom severity and the integration of individual patient characteristics into cluster analyses is limited, hindering understanding of cluster evolution over time. Objective: The objective of this study was to characterize and compare symptom clusters across body systems based on frequency and severity at three time points in chronic HD patients. Methods: This prospective longitudinal study collected self-reported data on 23 symptoms using validated measures from 69 chronic HD patients (age range: 24-87 years) at three time points over a year. Symptoms were rated on a 0-10 scale. Symptom progression and clustering were analyzed using heat maps and principal component analysis. Results: Among 69 HD patients, a substantial symptom burden was identified at baseline, with fatigue, overall perceived health, worry or distress, and sleep disturbance reported as the most severe (mean scores > 4.0 on a 0-10 scale). Hierarchical clustering yielded a five-cluster solution; however, longitudinal analysis revealed poor structural stability in patient symptom profiles over 12 months (ARI < 0.70), indicating significant symptomatic reorganization. Gastrointestinal cluster showed a statistically significant reduction in severity over time (β = -0.914, p = 0.003); fatigue and overall perceived health remained a high burden. Subgroup analyses demonstrated that patients using central venous catheters reported significantly higher severity in pain, fatigue, and nausea compared to patients with arteriovenous fistulas, while Diabetes mellitus was uniquely associated with increased dyspnea (p < 0.001). Conclusions: Chronic HD patients experience a dynamic and multidimensional symptom burden, with significant variations in severity, progression, and clustering of symptoms over time. The observed temporal instability of symptom clusters and the heterogeneity of individual trajectories emphasize the importance of routine, longitudinal symptom assessment and flexible, patient-centered management strategies by nephrology nurse specialists, which may support value-based healthcare approaches.

Background: Diabetes mellitus (DM) management is influenced by both physiological and psychosocial factors. Personality traits and psychiatric symptoms may affect glycemic control, but their exact relationship remains unclear. This study aimed to evaluate the association between glycemic control, personality traits, and psychological symptoms such as depression, anxiety, and stress in patients with DM. Methods: A total of 174 adult patients with Type 2 DM (T2DM) were included. Glycemic control was assessed via HbA1c values over one and five years. Personality traits were measured using the Personality Belief Questionnaire-Short Form (PBQ-SF), and psychiatric symptoms were evaluated with the Symptom Checklist-90-Revised (SCL-90-R). Patients were grouped based on HbA1c levels: good (<7%), moderate (7-9%), and poor (>9%) control. Results: Significant differences were found in several personality traits, including obsessive-compulsive, histrionic, paranoid, passive-aggressive, antisocial, and schizoid traits, between groups, with higher scores in patients with moderate glycemic control compared to those with poor control. No significant relationship was observed between psychiatric symptoms and glycemic control. The proportion of patients meeting the predefined HbA1c follow-up frequency threshold was lowest in the poor control group. Conclusions: General psychiatric symptoms did not show significant differences across glycemic control groups. Several maladaptive personality traits differed between groups in univariate analyses; however, after adjustment for potential confounders, only passive-aggressive personality traits remained independently associated with HbA1c levels. These findings indicate a possible association between specific personality characteristics and glycemic control, although no direct clinical utility can be inferred from the present data. Further longitudinal studies are required to clarify these relationships.