The growing burden of non-communicable diseases (NCDs) among aging people living with HIV (PLHIV) represents a major public health challenge, yet data to guide integrated care in Haiti remain limited. To address this gap, we conducted a retrospective cohort study of PLHIV aged 40 years and older receiving care at two hospitals in northern Haiti. Using electronic medical record data from routine HIV clinical visits between July 1 and September 30, 2015, we compared NCD prevalence at ART initiation and after ≥12 months of follow-up. We also identified baseline risk factors associated with incident NCDs, with a secondary analysis focused specifically on predictors of incident renal insufficiency. Among 318 participants, 65.7% had one or more NCD at ART initiation, increasing to 70.8% after ≥12 months. The prevalence of hypertension rose from 37.1% to 47.2% and diabetes from 7.9% to 12.6%, while overweight/obesity remained stable (14.5% to 15.7%). In contrast, renal insufficiency prevalence decreased from 31.1% to 22.6%. In the adjusted analysis, female sex was the sole independent predictor for developing at least one incident NCD (AOR: 3.29; 95% CI: 1.40-7.72). In the secondary analysis for incident renal insufficiency, female sex (AOR: 5.88; 95% CI: 1.78-19.50) and elevated systolic blood pressure (AOR: 1.052; 95% CI: 1.005-1.101) were the only significant predictors. A high proportion of older PLHIV in northern Haiti are affected by NCDs. These findings underscore the need for integrated care models, particularly for older women living with HIV, who appear to be at the highest risk for developing new NCDs.

The triglyceride-glucose (TyG) index is a surrogate marker of insulin resistance, but its prognostic value across guideline-defined cardiovascular risk strata remains unclear.

In this retrospective cohort study, 23,592 patients undergoing percutaneous coronary intervention (PCI) were stratified into non-high-risk (VHR0), high-risk (VHR1), and very-high-risk (VHR2) groups based on contemporary atherosclerotic cardiovascular disease criteria. The TyG index was evaluated as continuous and categorical (tertiles) variables. Primary endpoint was a 3-year composite of cardiovascular death, non-fatal myocardial infarction, or stroke (CV events).

During a median follow-up of 3.1 years, elevated TyG was independently associated with increased risks of CV events only in the VHR2 group (adjusted HR 1.51 for T3 vs. T1, 95% CI 1.10-2.08, p = 0.011). In VHR2 patients, adding TyG to a baseline risk model significantly improved reclassification (NRI 0.1251, p = 0.035) and discrimination (IDI 0.0028, p = 0.002). No significant associations were found in VHR0 or VHR1 groups.

The TyG index independently predicts 3-year cardiovascular events specifically in very-high-risk patients after PCI and provides incremental prognostic utility, supporting its use for refined risk stratification and personalized secondary prevention in this high-risk population.

Haemodialysis patients face a markedly elevated risk of foot lesions because of coexisting diabetes mellitus (DM), peripheral arterial disease (PAD) and uremia-related impairment of wound healing. Structured outpatient strategies and the optimal place of basic fibroblast growth factor (bFGF) within a stepwise algorithm remain poorly defined. To report complete healing and its durability in haemodialysis patients treated with bFGF for foot lesions, and to propose a stepwise limb-salvage algorithm with prespecified escalation criteria in which bFGF precedes dehydrated human amnion/chorion membrane (dHACM) or surgery. Retrospective observational case series of 20 haemodialysis patients receiving bFGF (trafermin; Fiblast Spray) for foot lesions across three outpatient wound-care programmes. Wound status was documented by area, depth, tissue exposure and WIfI classification; perfusion was assessed in every patient by toe-brachial and ankle-brachial indices, duplex ultrasonography and angiography, independently of any pre-existing recorded diagnosis. Complete healing was defined a priori as 100% re-epithelialization confirmed on two consecutive visits at least 2 weeks apart. Tier entry criteria and escalation triggers were prespecified, using a wound-area reduction below 50% at 4 weeks as the principal threshold. The broader haemodialysis population (n = 212) served as contextual comparator. Mean age was 75.0 ± 7.3 years (range, 59-92); there were six men and 14 women. DM was present in 15 patients (75.0%) and registry-recorded PAD in 8 (40.0%), against 56.6% and 17.9% in the broader population; objective testing identified hemodynamically significant PAD in 12 patients (60.0%), all of whom were revascularized. Mean baseline wound area was 5.5 ± 3.4 cm (2), and WIfI stages 1-4 comprised 5, 8, 6 and 1 patients. Twelve patients (60.0%) were managed with bFGF alone, five (25.0%) required dHACM and three (15.0%) required surgery. Complete healing was achieved in 18 of 20 patients (90.0%) at a mean of 8.9 ± 4.4 weeks, with no amputation of any level. Over a median follow-up of 13.0 months (range, 6-28), recurrence at the same site occurred in two patients (10.0%); amputation-free survival at 12 months was 100% and overall survival 95%. The bFGF-treated cohort carried a disproportionate burden of DM and PAD, supporting targeted early biologic intervention in this highest-risk subgroup. Within a stepwise algorithm combining objective perfusion assessment with prespecified escalation criteria, 90% of wounds healed completely without amputation, providing a practical limb-salvage framework for this vulnerable population.

Diabetic foot ulcers (DFUs) are a devastating complication of diabetes that markedly affects quality of life and generates significant socioeconomic and healthcare burdens. When DFUs fail to respond to standard of care (SOC), advanced therapies including Cellular, Acellular and Matrix-like Products (CAMPs) are often employed. A novel composite CAMP comprising ovine forestomach matrix and high molecular weight hyaluronic acid, termed 'OFM-HA' has been developed for the treatment of chronic wounds and evaluated in a prospective multi-centre controlled trial. For this trial, 143 subjects were randomized to receive OFM-HA plus SOC or SOC alone for the treatment of chronic full thickness wounds of the foot in people with diabetes meeting prespecified eligibility criteria. The primary endpoint was the proportion of wounds healed by 12 weeks. Secondary endpoints included healing time, percentage area reduction, adverse events and changes in pain and quality of life. For the modified intent-to-treat population, 46% (31/68) of the OFM-HA plus SOC group healed by 12 weeks compared to 24% (17/72) in the SOC alone group (p = 0.008). Kaplan-Meier analysis favoured OFM-HA plus SOC over 12 weeks (log-rank p = 0.023). No unexpected safety-related occurrences were observed. OFM-HA plus SOC increased 12-week closure in this selected population. Interpretation is limited by post-randomization exclusions, differential withdrawal and an adjusted comparison close to the significance threshold (p = 0.045).

People with type 1 diabetes are burdened by musculoskeletal hand and shoulder diagnoses and vascular late complications. We aimed to explore associations of musculoskeletal diagnoses, 30-year HbA1c and vascular complications with pain, fatigue, depression, and quality of life (QoL) in an increasing group of long-term survivors of type 1 diabetes.

This exploratory, observational study included 104 participants with type 1 diabetes ≥ 45 years' duration who completed questionnaires assessing pain (RAND-36 bodily pain), fatigue (Fatigue Questionnaire), depression (Patient Health Questionnaire), overall QoL (WHOQoL-BREF) and diabetes-specific QoL (Audit of Diabetes-Dependent QoL). We used linear regression to estimate associations between hand and shoulder diagnoses, 30-year HbA1c ≥ 64 mmol/mol (8%) and vascular complications with PROs.

Compared to 30-year HbA1c and vascular complications, combined hand and shoulder diagnoses showed the strongest estimated association with bodily pain; [B (95% confidence interval)] [-17.4 (-32.8, -2.1)], followed by 30-year HbA1c ≥ 64 mmol/mol [10.9 (-21.9, 0.1)], microvascular complications alone [-11.3 (-24.8, 2.1)], and micro- and macrovascular complications combined [-5.9 (-21.9, 10.2)]. Vascular complications, particularly microvascular, were associated with worse overall QoL and diabetes-specific QoL.

Musculoskeletal hand and shoulder diagnoses show stronger associations with bodily pain than vascular complications, while vascular complications appear more important for QoL in this cohort of long-term survivors with type 1 diabetes. Estimates where however uncertain due to limited sample size.

Multidomain patient-reported and self-reported instruments are often summarized using total scores, even when their domains represent conceptually distinct aspects of health behavior, emotional functioning, or self-management. Such scoring practices may obscure clinically meaningful domain-specific information if the instrument has not been shown to behave as a unidimensional reflective scale. This study culturally adapted the IMEVID questionnaire for use in Peru and evaluated its psychometric properties and score interpretation in adults with type 2 diabetes.

We conducted a cross-sectional methodological study in 180 adults with self-reported type 2 diabetes in Peru. IMEVID underwent cross-cultural adaptation and expert-based content validity assessment. Psychometric evaluation included expert agreement for content validity, item and domain descriptive statistics, floor and ceiling effects, internal consistency estimates, Kaiser-Meyer-Olkin measures and Bartlett's tests based on Pearson and polychoric correlation matrices, exploratory factor analysis, confirmatory factor analysis, and hypothesis-driven Spearman correlations among domains. Cronbach's alpha was used for domains with three or more items, while inter-item Spearman correlations were used for two-item domains.

The adapted IMEVID showed high expert-based content validity agreement across clarity, coherence, relevance, and sufficiency criteria, with an overall mean agreement of 0.96 and acceptable overall internal consistency (α = 0.82). Domain-level internal consistency varied across the instrument, with Cronbach's alpha ranging from 0.43 to 0.78 and two-item domain correlations ranging from 0.26 to 0.74. Factorability assessment differed according to the correlation matrix: the Pearson matrix showed acceptable sampling adequacy (KMO = 0.757), whereas the polychoric matrix yielded a very low KMO value (KMO = 0.14), likely influenced by sparse response patterns and marked ceiling effects in selected domains. Exploratory factor analysis was more consistent with a seven-factor solution aligned with the original IMEVID domains. Confirmatory factor analysis showed poor fit for the one-factor model (CFI = 0.677; TLI = 0.648; RMSEA = 0.104; SRMR = 0.151) and substantially better fit for the seven-domain model (CFI = 0.946; TLI = 0.936; RMSEA = 0.044; SRMR = 0.093). All standardized factor loadings in the seven-domain model were statistically significant.

The Peruvian adaptation of IMEVID showed high content validity agreement, acceptable overall reliability, and preliminary structural support for the original seven-domain organization. The findings were more consistent with a multidomain lifestyle assessment tool than with a strictly unidimensional reflective scale. Domain scores may provide complementary information about distinct aspects of lifestyle and self-management. However, the structural findings should be considered preliminary, particularly given the very low polychoric KMO and the moderate sample size. Further validation is needed in larger clinically characterized samples.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a heterogeneous condition with diverse etiologies and clinical presentations. Yet, a consensus of subtypes is lacking in MASLD. Based on latent class analysis of significant MASLD-related clinical variables, we identify five subgroups with distinct genetic, clinical, and risk profiles, which are well recapitulated in an independent cohort. Polygenic risk score and genetic variant analysis reveal genetic contributions across all subgroups. In particular, two subgroups, male-predominant cardiorenal (C2) and female-predominant with obesity and mood disorders (C3), are associated with high prevalence of type 2 diabetes, obesity, and sleep apnea. The latter also has relatively high usage of antidepressant medicine. On the other hand, the polygenic MASLD (C4) is characterized by the lowest incidence of metabolic comorbidities and ischemic heart disease. Nevertheless, this subgroup overall has the highest rate of liver transplant, which is likely driven, in part, by the combinatorial genetic effects of high-prevalent risk alleles in TM6SF2 and MBOAT7 together with low-prevalent protective allele in HSD17B13. Finally, the polygenic MASH subtype C5 shows increased risk of developing advanced fibrosis and acute renal failure. Together, our study provides key insights into MASLD heterogeneity, highlighting the opportunity for personalized therapies.

Diabetes self-management education and support requires scalable digital solutions, making mobile health (mHealth) interventions increasingly vital. Despite their proven clinical efficacy, the real-world translation and scalability of these interventions are severely hindered by fragmented and opaque reporting. To address this methodological gap, the World Health Organization developed the mHealth evidence reporting and assessment (mERA) checklist to standardize reporting transparency.

This study aimed to systematically evaluate the reporting completeness of published randomized controlled trials (RCTs) on mHealth interventions for adult diabetes using the mERA checklist; identify critical reporting gaps; analyze how these deficiencies undermine feasibility, scalability, and sustainability; and propose targeted strategies for future optimization.

A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-compliant systematic review was conducted. Five major databases (PubMed, Embase, Web of Science, MEDLINE, and the Cochrane Library) were systematically searched for relevant RCTs published from inception to July 2026. Data extraction and reporting completeness assessments were conducted using the 16-item mERA core checklist. Nonparametric and categorical analyses were used to evaluate factors associated with reporting completeness.

A total of 144 RCTs conducted across 49 countries were included in the final analysis. The mean overall mERA reporting score was 6.74 out of 16 (SD 2.71). While basic characteristics such as intervention delivery (n=128, 88.9%) and technology platform (n=117, 81.3%) were well reported, critical system-level domains were largely omitted. Specifically, interoperability (n=12, 8.3%), data security (n=28, 19.4%), compliance with guidelines (n=41, 28.5%), and intervention fidelity (n=53, 36.8%) were severely underreported. Additionally, reporting completeness was significantly higher in studies published between 2016 and 2026 (P=.01) and in multicomponent interventions compared to single-component ones (P=.04).

Empirical research on mHealth interventions for adult diabetes exhibits systemic structural flaws in reporting, particularly concerning system integration, data security, and regulatory compliance. These omissions significantly undermine the transparency, reproducibility, and real-world scalability of digital diabetes care solutions. Future trials must rigorously adopt standardized reporting frameworks such as the mERA checklist to bridge the gap between clinical efficacy and large-scale public health policy translation.

Placental-derived cellular, acellular, and matrix-like products (CAMPs) are widely used as adjuncts to standard care for diabetic foot ulcers (DFUs), but trials differ in product class, comparator, and healing window. We estimated the effect of adjunctive placental-derived CAMPs on complete wound closure at a single, clinically meaningful 12-week endpoint. The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420261399700) and reported per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020, with search reporting guided by PRISMA-S. PubMed/MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched through 21 June 2026 for randomised or quasi-randomised trials comparing a placental, amniotic, chorionic, amnion-chorion, placental membrane, or umbilical cord-derived product plus standard care against standard care or a non-placental control in adults with active DFUs. The primary outcome was complete wound closure at 12 weeks. Risk ratios (RRs) were pooled in a random-effects model (inverse-variance, restricted maximum likelihood [REML], Hartung-Knapp). Risk of bias was assessed with the Cochrane Risk of Bias 2 tool (RoB 2) for the 12-week outcome and certainty with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Prespecified sensitivity analyses included odds ratios, leave-one-out, product-class subgroups, and exclusion of high-risk-of-bias studies. Of 474 records, 14 randomised articles were retained; 9 standard-care-controlled comparisons (944 participants) provided extractable 12-week complete-closure data for the primary analysis. Complete closure occurred in 298 of 505 product-treated participants (59.0%) versus 157 of 439 controls (35.8%). Adjunctive CAMPs increased the likelihood of closure (RR 1.70, 95% confidence interval [CI] 1.31-2.20). Heterogeneity was moderate (I² = 51.9%) and the prediction interval crossed the null (0.93-3.11). The effect was robust to leave-one-out analysis (RR 1.59-1.81), an odds-ratio model (odds ratio [OR] 3.36, 95% CI 1.68-6.71), and exclusion of the single high-risk-of-bias trial (RR 1.73, 95% CI 1.29-2.33). Certainty was moderate, downgraded once for inconsistency. Adjunctive placental-derived CAMPs improve 12-week complete closure of DFUs compared with standard care, with moderate certainty. The wide prediction interval indicates that the average benefit may not be reproduced by every product, population, or setting, underscoring the need for product-specific, standard-care-anchored trials and for coverage policy grounded in endpoint-specific randomised evidence. Trial Registration: Registration number: CRD420261399700.

To systematically evaluate the clinical effect of intravitreal ranibizumab (IVR) and laser photocoagulation on diabetic macular edema (DME).

A systematic search was conducted of five English databases from the establishment of each database to 31 January 2024, and a meta-analysis was performed using Review Manager 5.3 software.

A total of 1,040 patients were included across 10 articles, where 531 patients had been treated with IVR and 509 with laser photocoagulation. The results of the meta-analysis showed that visual acuity improvement in the IVR group was better than in the laser photocoagulation group. The difference was statistically significant (best corrected visual acuity [BCVA], Mean Difference (MD) = 5.69, 95% confidence interval [CI]: 4.51, 6.86, P < 0.001). There was no significant difference in BCVA based on Logarithm of the Minimum Angle of Resolution (logMAR) value (MD = -0.07, 95%CI: -0.15, -0.01, P = 0.07). The improvement of macular edema in IVR was better than in the laser photocoagulation group (central macular thickness, MD = -30.93, 95% CI: -35.18, -26.68, P < 0.001). There were more adverse reaction events in the IVR group than in the laser photocoagulation group, and the difference was statistically significant (odds ratio = 8.82, 95% CI: 3.06, 25.43, P < 0.001).

Intravitreal ranibizumab remains superior to laser photocoagulation in improving vision and reducing macular edema in DME, albeit with higher adverse events. These findings support IVR's continued relevance in contemporary practice, particularly where newer anti-vascular endothelial growth factor agents are unavailable.