Hyperandrogenism has been linked to increased preeclampsia risk, but its independent role remains unclear due to confounding by polycystic ovary syndrome (PCOS). This retrospective cohort study investigated whether non-PCOS hyperandrogenism is associated with hypertensive disorders of pregnancy (HDP) and adverse pregnancy outcomes in women undergoing frozen embryo transfer (FET), and whether hyperandrogenism synergizes with overweight/obesity to further increase these risks. We analyzed data from 1556 infertile women who underwent FET at Ruijin Hospital and delivered between January 2015 and December 2022. Participants were classified into four groups based on the presence of hyperandrogenism and overweight/obesity: controls (n = 1201), hyperandrogenism only (n = 116), overweight/obesity only (n = 209), and both hyperandrogenism and overweight/obesity (n = 30). Multivariable logistic regression models were used to evaluate associations with HDP and related adverse outcomes. In multivariable analyses, overweight/obesity was independently associated with an increased risk of gestational diabetes mellitus (GDM) (adjusted odds ratio [aOR] 1.62) and gestational hypertension (aOR 3.45), whereas the coexistence of overweight/obesity and hyperandrogenism was strongly associated with higher risks of preeclampsia (13.3%, aOR 7.53), preterm birth (23.3%, aOR 3.67), and cervical length shortening (CLS) (6.7%) compared to the controls. These results suggest that in women without PCOS undergoing FET, the coexistence of hyperandrogenism and overweight/obesity identifies a high-risk hypertensive phenotype characterized by a substantially elevated risk of preeclampsia. Moreover, our findings may indicate synergistic effects of endocrine and metabolic disturbances on pregnancy-related blood pressure dysregulation and could facilitate early risk stratification for HDP.

The aim of this study was to evaluate the association between indices of adiposity and 20-year cumulative incidence of type 2 diabetes (T2D) among apparently healthy adults participating in the ATTICA cohort study (2002-2022). The present analysis included data from 2000 individuals free of atherosclerotic cardiovascular disease (ASCVD) and T2D at baseline (age 43 ± 13 years; 51% women). Sociodemographic, anthropometric, lifestyle, clinical, and biochemical parameters were collected at baseline and follow-up examinations. Obesity-related anthropometric indices, in terms of total and central adiposity, along with dysfunctional adipose tissue-related indices, were measured. The 20-year cumulative incidence of T2D was 26.3% (95% CI [24.4%, 28.3%]). All indices were independently associated with the 20-year incidence of T2D, with an overall predictive accuracy of approximately 75%. With the exception of LAP (lipid accumulation product), all indices reflecting adipose tissue dysfunction demonstrated moderate discriminative accuracy for incident T2D (C-statistic varied between 0.70 and 0.80) over the 20-year follow-up period, in line with obesity-related anthropometric indices assessing total and central adiposity (C-statistic 0.70-0.80). Obesity-related anthropometric indices as well as dysfunctional adipose tissue-related indices were moderately predictive of long-term T2D onset, highlighting the complex role of increased body weight on glucose metabolism.

Spontaneous renal subcapsular haematoma caused by a renal artery pseudoaneurysm (RAP) arising in the context of acute pyelonephritis is an exceptionally rare event. This combination, infective arteriopathy leading to pseudoaneurysm formation with subcapsular haemorrhage, has seldom been reported and represents a clinically challenging diagnostic and therapeutic scenario. A 42-year-old woman with poorly controlled type 2 diabetes mellitus presented with right flank pain, fever and acute-on-chronic kidney disease. Imaging revealed bilateral pyelonephritis, a progressively enlarging right renal subcapsular haematoma (9.7 × 9.6 cm on computed tomography {CT} angiography) and a pseudoaneurysm arising from the inferior segmental branch of the right renal artery. She underwent successful selective right renal artery coil embolisation with subsequent clinical and biochemical improvement, without requiring nephrectomy. Infectious arteriopathy in the setting of acute pyelonephritis, particularly in immunocompromised diabetic patients, may culminate in mycotic pseudoaneurysm formation and spontaneous subcapsular haemorrhage. Early CT angiography and prompt endovascular intervention are pivotal to preserving the kidney and patient survival.

Background Differentiating pancreatic cancer from chronic pancreatitis remains clinically challenging due to the overlap of symptoms, biochemical abnormalities and imaging characteristics. Carbohydrate antigen 19-9 (CA 19-9) is a very common marker employed in the assessment of pancreatic cancer but is not sufficiently specific because it has been shown to be elevated in cases of inflammatory and obstructive pancreaticobiliary disease. A new and easy-to-obtain platelet-derived inflammatory marker, mean platelet volume to platelet ratio (MPR), may provide further utility in the differentiation of malignant and benign inflammatory pancreatic disease. Objective We aimed to assess the MPR value in the diagnosis of pancreatic cancer versus chronic pancreatitis in patients undergoing pancreatic surgery. Materials and methods This was a prospective diagnostic accuracy study carried out in the Department of Hepatobiliary, Pancreatic and Liver Transplant Surgery, Bangladesh Medical University, Dhaka, from September 2023 to August 2024. Adult patients who underwent pancreatic surgery for suspected pancreatic cancer or chronic pancreatitis were included. The final histopathological diagnosis of the surgical specimen was used as the reference standard. Patients who had an acute medical condition or psychiatric condition were excluded. A total of 35 patients were included (18 with pancreatic cancer and 17 with chronic pancreatitis). A structured checklist was used to obtain demographic, clinical and laboratory data. Preoperative laboratory parameters within seven days of surgery were used to calculate MPR, which is defined as mean platelet volume (MPV) divided by platelet count. The accuracy of diagnosis was determined by receiver operating characteristic curve analysis. Results There was no significant difference between the two groups in terms of age, sex, or body mass index (BMI). Chronic pancreatitis was significantly more likely to have endocrine and exocrine insufficiency. Significantly elevated concentrations of serum amylase, lipase, MPV, MPR, total bilirubin and CA 19-9, along with decreased platelet counts, were seen in individuals with pancreatic cancer. Chronic pancreatitis was more often associated with diabetes mellitus, whereas an American Society of Anaesthesiologists (ASA) score of 1 was associated with pancreatic cancer. MPR demonstrated high diagnostic performance, with an AUC of 0.908, sensitivity of 83.3%, specificity of 100.0%, a Youden index of 0.833, and a cutoff value of 0.053. MPV showed good discriminatory performance, CA 19-9 showed fair discriminatory performance, platelet count showed strong inverse discriminatory ability, and CEA had little diagnostic utility. Conclusions MPR may serve as a low-cost and easily available adjunctive preoperative marker for differentiating pancreatic cancer from chronic pancreatitis; however, its cutoff value and clinical applicability require validation in larger, multicentre prospective cohorts.

Background This retrospective real-world study evaluated saroglitazar 4 mg in Indian adults with type 2 diabetes mellitus (T2DM) and dyslipidemia. Methods Six hundred patients receiving saroglitazar 4 mg at Dr Aravind's Diabetes Centre, Bengaluru, were assessed at baseline, four months, and six months. Glycemic, lipid, hepatic, FibroScan, renal, and anthropometric parameters were analyzed using paired t-tests. Results Significant improvements were observed across all outcomes (p<0.0001). Fasting blood sugar (FBS) decreased by 101.81 mg/dL, postprandial blood sugar (PPBS) by 111.58 mg/dL, and HbA1c from 8.90% to 7.61%. Triglycerides reduced by 163.34 mg/dL, high-density lipoprotein cholesterol (HDL-C) increased by 9.25 mg/dL, and total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) decreased. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), controlled attenuation parameter (CAP) score, liver stiffness measurement (LSM), serum creatinine, estimated glomerular filtration rate (eGFR), and body weight also improved. Conclusion Saroglitazar 4 mg significantly improved glycemic, lipid, hepatic, renal, and weight-related outcomes over six months in patients with T2DM and dyslipidemia.

Introduction The placenta serves as the vital interface between mother and fetus, reflecting maternal and fetal health. Pregnancy-related disorders such as gestational diabetes, pregnancy-induced hypertension (PIH), preeclampsia, and eclampsia can cause structural and functional placental alterations, leading to adverse perinatal outcomes. Methods A prospective observational study was conducted over two months in the Departments of Pathology and Obstetrics and Gynecology. Thirty-seven placentas from 36 pregnancies were examined following informed consent. Gross morphology and histopathological features were evaluated using hematoxylin and eosin (H&E) staining and correlated with maternal clinical data. Results Mean placental weight was highest in diabetic pregnancies (716 g) and lowest in PIH and preterm premature rupture of membranes (PPROM) (450 g). The most frequent histopathological findings included increased syncytial knots (86.4%), fibrinoid necrosis (81%), hemorrhage (78.3%), chorangiosis (75.6%), and calcification (67.5%). Medial vessel wall thickening, avascular villi, and calcification were primarily associated with hypertensive disorders, indicating uteroplacental insufficiency. Similar but less severe lesions, such as hemorrhage and fibrinoid necrosis, were also noted in normal placentas. Conclusion Common placental lesions, particularly syncytial knot formation, fibrinoid necrosis, and chorangiosis, were observed across both normal and complicated pregnancies, with higher frequency and severity in maternal disorders. These findings underscore the placenta's diagnostic value as a sensitive indicator of maternal vascular and hypoxic changes, emphasizing its importance in understanding pregnancy complications and fetal outcomes.

Acute gangrenous cholecystitis is a severe complication of acute cholecystitis. We report a 70-year-old male with type 1 diabetes mellitus who presented with intractable vomiting without abdominal pain. CT imaging showed gallbladder wall thickening and concern for gallbladder perforation. Patient underwent a laparoscopic cholecystectomy, which revealed a gangrenous gallbladder with surrounding purulent drainage. The patient recovered after an extended hospital course. This case highlights the importance of considering atypical presentations of severe intra-abdominal pathology in diabetic patients.

Pontine infarction is a recognized subtype of posterior circulation stroke and can present with diverse clinical manifestations. It most frequently involves the anteromedial and anterolateral regions supplied by branches of the basilar artery. Clinical manifestations vary according to the anatomical boundaries of the affected perfusion territory and may present with an atypical constellation of signs and symptoms. We report an atypical case of acute left-sided upper pontine-pontomesencephalic infarction, presenting with severe sensory loss and cerebellar ataxia in a postmenopausal Indian female patient with a background of type 2 diabetes mellitus and hypertension. This case highlights that cerebellar features may manifest in the absence of a primary cerebellar lesion, particularly when such features are bilateral, emphasizing the importance of careful neuroanatomical localization.

Type 2 diabetes mellitus (T2DM) is a major global public health challenge, and depressive symptoms are common among patients with T2DM. These symptoms may impair quality of life, self-management behaviors, glycemic control, and long-term prognosis. Exercise is a promising non-pharmacological strategy, but the comparative effects of different exercise modalities on depressive symptom scores remain unclear.

This study aimed to evaluate and compare the effects of different exercise modalities on depressive symptom score changes in patients with T2DM.

PubMed, Embase, Cochrane Library, Web of Science, SPORTDiscus, and MEDLINE were searched from inception to April 2026. Randomized controlled trials involving adults with T2DM were included if they compared structured exercise interventions with usual care or non-exercise controls and reported depressive symptom outcomes. Standardized mean differences (SMDs) were used because different depression scales were applied across studies. Exercise modes were classified as aerobic exercise or walking training (AE), combined aerobic/resistance or walking/resistance training (COMB), mind-body exercise (MBE), aquatic aerobic training (AT), and control (CON). Pairwise random-effects meta-analysis and frequentist network meta-analysis were performed. SUCRA values were used to describe ranking probabilities, and CINeMA was used to assess the certainty of evidence.

The network meta-analysis showed that, compared with the control group, MBE showed a relatively clear reduction in depressive symptom scores (SMD = -1.09, 95% CI: -2.03 to -0.14). AE, COMB, and AT also showed potential improvement trends, although some confidence intervals were wide or crossed the null line. SUCRA rankings were highest for MBE (72.4), followed by AT (69.5), COMB (69.4), AE (33.4), and CON (5.6). However, the similar SUCRA values for MBE, AT, and COMB, together with limited direct evidence and uncertainty in some comparisons, suggest that these rankings should not be interpreted as definitive clinical superiority. The overall certainty of evidence was moderate to low.

Structured exercise interventions may improve depressive symptoms in patients with T2DM, with MBE appearing to be the most promising mode. However, these findings should be interpreted cautiously because of heterogeneity, wide confidence intervals, and limited direct evidence. More high-quality randomized controlled trials with larger samples and long-term follow-up are needed.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420261374583.

Demoralization syndrome (DS), characterized by helplessness, hopelessness, and diminished self-worth, is a common but underrecognized psychological distress in chronic diseases. Type 2 diabetes mellitus (T2DM) affects over 537 million adults worldwide, yet DS remains underexplored in this population.

A cross-sectional observational study using a convenience sampling method was conducted to recruit 852 patients with T2DM from a hospital in China between October 2023 and October 2024. Participants were divided into a training set (n = 598) and a temporal validation set (n = 254) based on the chronological order of the survey. Feature selection was conducted using LASSO regression. A risk prediction model was developed using multivariable logistic regression, and a nomogram was subsequently constructed. Bootstrap resampling and Decision Curve Analysis (DCA) were utilized for internal evaluation and clinical utility assessment.

LASSO and multivariable logistic regression identified eight independent influential factors for DS: educational level, two-hour postprandial plasma glucose, glycated hemoglobin A1c, diabetes self-management, the confrontation and avoidance dimensions of the medical coping modes questionnaire, resilience, and sleep quality. The model demonstrated excellent predictive accuracy, with an AUC of 0.898 in the training set (optimism-corrected AUC of 0.892 via Bootstrap) and 0.868 in the temporal validation set. DCA indicated a positive net clinical benefit across a wide range of threshold probabilities.

This well-calibrated and highly discriminative model, validated temporally, offers healthcare professionals a robust and practical tool for the early identification of DS and the optimization of clinical nursing decisions in T2DM patients.