Bordetella pertussis (BP) infection remains a major public health concern because of its substantial clinical and epidemiological impact. Although nucleic acid amplification tests (NAATs) are widely used for pertussis diagnosis, their real-world performance in routine clinical laboratories has not been systematically evaluated. This study implemented an external quality assessment (EQA) program to assess laboratory proficiency and identify potential sources of analytical variability.

An EQA panel comprising five samples (four positive and one negative) was prepared using 10-fold serial dilutions of BP (2.0 × 10²-2.0 × 10⁵ copies/mL). The panel was distributed to participating laboratories, and performance was evaluated based on qualitative agreement with the expected results.

A total of 69 laboratories participated, including 63 (91.30%) hospital-based laboratories and 6 (8.70%) independent clinical laboratories, generating 345 test results. All laboratories achieved acceptable performance (scores ≥ 80). The overall concordance rate was 98.84% (341/345). Four false-negative results were identified, all of which occurred in the lowest-concentration sample (200 copies/mL).

Pertussis NAATs demonstrated generally reliable diagnostic performance among participating laboratories in Chongqing, China. However, challenges remain in detecting low-copy-number specimens near the analytical sensitivity threshold. Continuous quality monitoring, standardized workflows, optimized nucleic acid extraction procedures, and regular performance verification are essential to ensure accurate pertussis diagnosis and support effective public health surveillance and outbreak response.

Diabetes mellitus (DM), a prevalent chronic metabolic disorder with a global prevalence over 10.5%, features persistent hyperglycemia-induced micro-/macro-vascular lesions and severe complications. Conventional DM management suffers from high risks of cross-infection or hypoglycemia, poor compliance, and failure to address the multi-faceted needs of integrated diagnosis and nonspecific treatment for complications. Microneedles (MNs), a minimally invasive platform that painlessly penetrates the stratum corneum to access interstitial fluid (ISF) or deliver therapeutics, has emerged as a transformative solution for DM care. Despite significant progress in developing MN-based systems for glucose monitoring, insulin delivery, and treatment of complications, challenges remain in achieving precise drug release, high loading capacity, long-term stability, and clinical translation. This review comprehensively summarizes the latest advances in MN-based platforms for DM management, covering three major glucose detection modalities with improved sensitivity and portability, gastrointestinal and glucose-responsive transdermal MNs for insulin delivery, fully integrated close-loop MN platforms, and MN applications in diabetic wound healing and other complications (ketoacidosis diagnosis, vascular disorders, neuropathy, depression). By addressing the critical gaps in scattered research, this work holds great significance for advancing minimally invasive, integrated, and patient-centered treatment models, ultimately improving the prognosis and quality of life for DM patients worldwide.

Type-II diabetes mellitus (T2DM) is commonly associated with obesity and is generally treated with long-term medications. Bariatric surgery has demonstrated positive metabolic outcomes, including glycemic improvement and decreased use of antidiabetic medications. Remission can, however, not be permanent, and relapse of diabetes can occur in the follow-up period.

To assess T2DM remission, relapse, and postoperative glycemic outcomes after bariatric surgery in patients with obesity.

This retrospective observational study was conducted at the General Surgery Department, Hayatabad Medical Complex, Peshawar, Pakistan, between September 2022 and August 2025. A total of 93 patients who presented with obesity were included. The data on demographic characteristics, BMI, glycemic parameters, the use of antidiabetic medications, remission, and relapse were obtained from the hospital records. Follow-up was defined as the time from bariatric surgery to the last available postoperative clinic visit or laboratory assessment. Complete diabetes remission was defined as HbA1c <6.5% maintained for at least three months without glucose-lowering medication.

The average age was 43.6 ± 9.8 years. The mean BMI was 44.2 ± 5.9 kg/m² prior to surgery and 33.1 ± 5.2 kg/m² at the most recent follow-up. The average HbA1c dropped to 6.4 ± 0.9% from 8.3 ± 1.4%, while fasting blood glucose decreased from 176.8 ± 42.5 mg/dL to 121.6 ± 28.4 mg/dL. A total diabetes remission was reached in 56 patients (60.2%), and partial improvement of glycemic levels in 21 patients (22.6%).

Bariatric surgery was associated with significant improvement in glycemic control, reduction in BMI, and decreased requirement for antidiabetic medications during available follow-up. Although a substantial proportion of patients achieved diabetes remission, relapse was observed in some cases, highlighting the need for long-term metabolic monitoring.

Leukocyte chemotactic factor 2 (LECT2) amyloidosis (ALECT2) is a form of renal amyloid deposition that can present with features resembling diabetic kidney disease. We report the case of a woman with long-standing type 2 diabetes mellitus and hypertension who developed progressive renal dysfunction over three years, with her estimated glomerular filtration rate declining from approximately 28 to 10 mL/min/1.73 m² despite stable glycemic control and no identifiable nephrotoxic exposures. Laboratory evaluation revealed minimal albuminuria and unremarkable monoclonal studies, including serum protein electrophoresis, urine protein electrophoresis, and serum free light chain testing. Given the discordance between the degree of proteinuria and the severity of renal function decline, a computed tomography-guided renal biopsy was performed. Histopathologic examination demonstrated Congo red-positive deposits with apple-green birefringence, and immunohistochemical staining confirmed ALECT2. No evidence of systemic amyloid involvement was identified. The patient's kidney function continued to decline, ultimately progressing to stage 5 chronic kidney disease, and she elected to pursue conservative management. This case illustrates the importance of tissue diagnosis in patients with atypical patterns of chronic kidney disease.

Skull base osteomyelitis (SBO) is a rare and potentially fatal deep-space infection most commonly arising from malignant external otitis in immunocompromised or diabetic patients. Vascular complications, including septic thrombosis of the internal carotid artery (ICA) and dural venous sinuses, are among the most severe and life-threatening sequelae, yet remain underreported in the radiological literature. We present the case of a 59-year-old male with type 2 diabetes mellitus who initially presented with severe, refractory left-sided otalgia, purulent otorrhea, and progressive lower cranial nerve palsies. He was diagnosed with left-sided SBO on MRI, characterised by extensive infiltration of the carotid, lateral pharyngeal, and perivertebral spaces, with osseous involvement of the clivus, left occipital condyle, the anterior arch of C1, and the left mastoid. Critically, MRI demonstrated encasement and non-opacification of the cervical segment of the left internal carotid artery, thrombosis of the left internal jugular vein with extension to the left sigmoid sinus, and ipsilateral otomastoiditis. This case illustrates the pivotal diagnostic value of multiparametric MRI, combining fluid-attenuated inversion recovery, diffusion-weighted, and post-gadolinium sequences, in characterising the full extent of SBO and its neurovascular complications, findings that are critical for guiding urgent multidisciplinary management.

 Hypertension is a major noncommunicable disease in Pakistan, and suboptimal blood pressure (BP) control remains a significant public health challenge, largely influenced by poor adherence to antihypertensive medications.

This study aimed to assess the prevalence of antihypertensive medication adherence and its association with BP control among hypertensive patients attending outpatient clinics in Khyber Pakhtunkhwa, Pakistan.

This analytical cross-sectional study included 436 hypertensive patients selected through consecutive sampling from tertiary care hospitals. Data were collected using a structured questionnaire and the validated Brief Medication Questionnaire. BP was measured using standardized procedures with a Medico Aneroid Sphygmomanometer AND-85 and the Omron M3 Comfort device (Omron Healthcare, Kyoto, Japan). BP control was defined as <140/90 mmHg. Data were analyzed using Statistical Package for the Social Sciences version 25 (IBM Corp., Armonk, NY). The chi-square test and multivariable binary logistic regression were used to assess associations and adjust for confounders.

Of 436 participants, 196 (44.95%) were adherent and 240 (55.05%) were nonadherent. BP was controlled in 178 (40.83%) patients and uncontrolled in 258 (59.17%). Controlled BP was significantly higher among adherent patients (67.35%) compared with nonadherent patients (19.17%) (P < 0.001). Nonadherence was independently associated with uncontrolled hypertension (adjusted odds ratio = 3.82; 95% confidence interval: 2.45-5.97; P < 0.001). Other significant predictors included age ≥60 years, diabetes mellitus, and longer duration of hypertension.

Medication nonadherence is a major independent and modifiable determinant of poor BP control among hypertensive patients in Khyber Pakhtunkhwa. Targeted adherence-enhancing interventions are urgently needed in outpatient clinical settings.

Cerebral amyloid angiopathy (CAA) is a small vessel disease marked by β-amyloid deposition within cortical and leptomeningeal vessels. It is associated with a range of hemorrhagic manifestations, including lobar intracerebral hemorrhage (ICH), cortical superficial siderosis, and convexity subarachnoid hemorrhage (cSAH). In addition to hemorrhagic complications, cerebral ischemic events may occur due to impaired vascular reactivity and reduced cerebral perfusion. The coexistence of ischemic and hemorrhagic strokes in patients with biopsy-confirmed CAA poses significant diagnostic and therapeutic challenges, particularly in relation to antithrombotic use. A 74-year-old woman with type 2 diabetes mellitus and dyslipidemia initially presented with transient focal neurological deficits and subsequently developed left parietal cSAH along with multiple acute infarcts involving the left parietal, temporal, and centrum semiovale regions, for which aspirin and rivaroxaban were initiated. Over the following years, she developed progressive cognitive decline. Three years after her ischemic event, she experienced a lobar ICH in the right frontotemporoparietal region and later suffered another ischemic stroke, prompting treatment with cilostazol. This case illustrates the coexistence of ischemic and hemorrhagic pathology in CAA. Recurrent lobar ICH is a characteristic feature of CAA; however, ischemic events may also occur during its course and can adversely affect prognosis. The lack of clear guidance regarding antithrombotic therapy further complicates management. In this context, cilostazol was selected due to its favorable safety profile in patients at high risk of hemorrhage. This approach underscores the importance of individualized treatment strategies in CAA.

Periodontal remodeling is a continuous, adaptive process essential for maintaining the structural and functional integrity of periodontal tissues. While external factors such as bacterial biofilm, excessive forces, and poor oral hygiene are recognized triggers of periodontal pathologies, they do not fully explain their persistent prevalence.

This opinion paper emphasizes the impact of systemic diseases on periodontal homeostasis and considers periodontal disease as a manifestation of systemic dysfunction rather than solely a bacterial local disease.

This paper is conceptually designed as a narrative review and synthesizes the molecular and cellular mechanisms through which systemic diseases converge to disrupt periodontal remodeling.

Emerging evidence underscores the critical role of systemic diseases, including chronic kidney disease, cardiovascular disease, liver dysfunction, and hematologic malignancies, in addition to studied uncontrolled diabetes mellitus, in destabilizing periodontal homeostasis. These systemic conditions are all associated with excess systemic inflammation that impairs regenerative capacity, mineralization, vascularity, and immune responses, fostering a subclinical environment prone to periodontal tissue pathologies with clinical impact. This opinion paper is conceptually designed as a narrative review and synthesizes the molecular and cellular mechanisms through which systemic diseases converge to disrupt periodontal remodeling, including periodontal pathologies as a consequence of systemic dysfunction rather than a purely bacterially induced local disease.

Clinically, this understanding demands intensified dental surveillance to uncover modifiers of susceptibility and interdisciplinary care for systemically compromised patients. Future research should identify early biomarkers of systemic impact and inform strategies that integrate oral and systemic health to reduce the periodontal disease burden.

To characterize duration-dependent topographic macular neurovascular unit (NVU) alterations in type 2 diabetes (T2DM) without diabetic retinopathy (DR) using 26×21 mm ultra-widefield swept-source OCT angiography (UWF-SS-OCTA) and evaluate its diagnostic utility for long-duration eyes.

This cross-sectional study included 295 eyes (69 controls; 226 T2DM without DR stratified by duration: <5, 5-10, ≥10 years). The superficial vascular density (SVD), deep vascular density (DVD), superficial macular vascular density (SMVD), and nerve-fibre-layer microvascular density (NFMVD) were quantified in the fovea (1 mm), inner (1-12 mm) and outer (12-21 mm) rings and their quadrants. Ganglion cell-inner plexiform layer (GCIPL) thickness was derived from the 26 × 21 mm OCTA scan. ANCOVA adjusted for age, sex, BMI, hypertension, IOP with false discovery rate correction, multivariable regression, and ROC/decision curve analyses were used.

Longer duration was associated with progressive GCIPL thinning and deep-predominant DVD reduction across nearly all macular zones (q<0.05); the DVD deficit was most pronounced in the outer ring. SVD showed nasal-temporal asymmetry; selective nasal inner loss in ≥10-year group. GCIPL-DVD coupling, present in controls, attenuated in ≥10-year group, indicating NVU decoupling. Duration independently predicted GCIPL (β=-0.21) and DVD (β=-0.27) after adjustment (P<0.01). DVD alone discriminated ≥10-year eyes from controls (AUC 0.723, 95% CI 0.63-0.81); addition of GCIPL did not improve AUC (0.724, P>0.05). Decision curve analysis confirmed net clinical benefit.

Preclinical NVU decoupling-predominantly in the deep capillary plexus and nasally asymmetric-already occurs in T2DM without fundoscopic DR and progresses with disease duration. Deep-layer UWF-SS-OCTA metrics may strengthen risk stratification before clinical retinopathy.

Preterm birth is a leading cause of infant mortality and morbidity, with very preterm infants (VPI) being particularly vulnerable to poor physical growth and developmental challenges. This study aimed to investigate the trends and factors influencing physical growth in VPI within the first 12 months of corrected age (CA).

A cohort study was conducted on 223 VPI admitted between November 2020 and July 2022 at a tertiary maternity and neonatal hospital in Shanghai, China. Multiple linear regression and logistic regression models were used to identify risk factors for weight, length, and head circumference growth outcomes within 12 months CA.

The results showed that maternal postnatal depression (p < 0.05), the presence of clinical hypothyroidism, gestational diabetes mellitus (GDM), preeclampsia in mothers and VPI with congenital heart diseases were risk factors for physical growth. Girls with greater gestational age and birth weight, a higher 1-minute Apgar score, and exclusive breastfeeding have better physical growth outcomes.

Targeted interventions addressing maternal mental health, pregnancy complications, and infant-specific risk factors are warranted to promote physical growth in VPI.