Gastrointestinal mucormycosis is a rare, life-threatening invasive fungal infection that is often diagnosed late because of nonspecific clinical and endoscopic findings. Khat or Qat (Catha edulis) leaves may harbor environmental fungi, including Mucor species, and chronic chewing may contribute to gastrointestinal mucosal injury. However, a possible association between Qat use and gastrointestinal mucormycosis has not been established. We report a case of a 60-year-old man with diet-controlled type 2 diabetes mellitus and long-standing Qat chewing who was admitted after an out-of-hospital cardiac arrest secondary to acute myocardial infarction. He had no history of malignancy, transplantation, neutropenia, or immunosuppressive therapy. Return of spontaneous circulation was achieved after 34 min of cardiopulmonary resuscitation, followed by temporary venoarterial extracorporeal membrane oxygenation. On hospital day 14, coffee-ground material was observed through the nasogastric tube, accompanied by a decline in hemoglobin from 14.0 to 9.5 g/dL. Esophagogastroduodenoscopy revealed a fungating, ulcerated lesion involving the gastric fundus and body. Histopathological examination demonstrated extensive necrosis, angioinvasion, and broad, ribbon-like, pauci-septate fungal hyphae with irregular branching, consistent with gastric mucormycosis. Intravenous liposomal amphotericin B was initiated at 8 mg/kg/day. Gastrointestinal bleeding resolved without surgery. Repeat endoscopy one month later showed marked healing, and follow-up biopsy revealed no residual fungal elements. The patient completed six weeks of antifungal therapy and achieved clinical and histopathological resolution. Fungal culture and molecular identification were not performed, precluding species-level confirmation.‏ In conclusion, this case describes gastric mucormycosis in a patient without profound immunosuppression but with severe physiological stress and chronic Qat exposure. Critical illness, gastric hypoperfusion, and mucosal disruption may have facilitated fungal invasion. Qat chewing is presented as a hypothesis-generating factor because of possible fungal contamination of leaves and repeated mucosal injury; nevertheless, causality cannot be inferred from a single case. Further microbiological and epidemiological studies are required to investigate this potential association.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major cause of chronic liver disease worldwide. Accurate non-invasive identification of advanced fibrosis is essential for risk stratification and management. The Fibrosis-6 (FIB-6) score is a recently developed serum-based index, but its performance in MASLD remains unclear.

In this retrospective cross-sectional study, 397 adults with MASLD who underwent FibroScan were included. FibroScan-derived liver stiffness categories were used as the surrogate comparator for fibrosis assessment. The diagnostic performance of FIB-6 was evaluated using ROC analysis for significant fibrosis (F2-F4), advanced fibrosis (F3-F4), and cirrhosis (F4), and compared with FIB-4, APRI, NAFLD fibrosis score (NFS), and AST-to-ALT ratio (AAR).

Among participants (mean age 47.8 ± 13.0 years; 49.4% male), significant fibrosis was present in 18.4%, advanced fibrosis in 7.6%, and cirrhosis in 4.8%. FIB-6 showed AUROC values of 0.643 for significant fibrosis, 0.749 for advanced fibrosis, and 0.760 for cirrhosis. Among 30 patients with FibroScan-defined advanced fibrosis, FIB-6 identified 29 of 30 cases (96.7%) and had an NPV of 99.4%. Among 19 patients with FibroScan-defined cirrhosis, all cases were identified (19/19), resulting in an NPV of 100% (95% CI: 83.2-100.0); however, these estimates should be interpreted cautiously because of the low prevalence of advanced disease. Outcome-specific optimal cut-offs were identified using the Youden index (1.88 for significant fibrosis and 1.84 for advanced fibrosis/cirrhosis). While FIB-4 and NFS showed slightly higher AUROCs, differences were not statistically significant.

FIB-6 demonstrates acceptable diagnostic performance, particularly for excluding advanced fibrosis and cirrhosis in MASLD. Although not superior to established scores, its high negative predictive value and simplicity suggest potential as a rule-out tool pending external validation.

Airflow obstruction detected on spirometry is a hallmark of chronic obstructive pulmonary disease (COPD) and is needed for the diagnosis of COPD. Sparse data in high-income countries (HICs) have reported high prevalence of underdiagnosed COPD with poor clinical outcomes. Data are missing for low-income and middle-income countries (LMICs) to inform the burden and clinical outcomes of underdiagnosed COPD.

In this multinational, prospective cohort study, spirometry data were systematically collected from adults (aged 35-70 years) in urban and rural communities across 25 HICs and LMICs. Adults with spirometry airflow obstruction with physician-diagnosed airway diseases were categorised as diagnosed COPD and those without physician-diagnosed airway diseases were categorised as underdiagnosed COPD. Individuals with normal spirometry and no known airway diseases were categorised as no COPD. Data on baseline characteristics were collected via standardised interview questionnaires and follow-up data were collected every 3 years on vital status and clinical events. We examined the association between COPD status with baseline characteristics and follow-up clinical events.

Between July 11, 2002, and July 28, 2025, we collected data on 119 252 participants (baseline median age 51 years [IQR 43-59], 71 039 [59·6%] females and 48 213 (40·4%) males) with technically acceptable spirometry. The prevalence of airflow obstruction was 9·5% (11 306/119 252), of which 89·2% (10 080/11 306) constituted underdiagnosed COPD. The prevalence of airflow obstruction varied across geographical regions (6·1% [n=521/8601] in southeast Asia to 20·4% [n=785/3846] in sub-Saharan Africa) and was higher in LMICs (9·8% [n=10 120/103 758]) than in HICs (7·7% [n=1186/15 494]), with a prevalence of 90·7% (9175/10 120) for underdiagnosed COPD in LMICs. Baseline characteristics associated with underdiagnosis were younger age (≤50 years), low symptom burden, high lung function, being current or never smokers, and living in an LMIC. Compared with no COPD, underdiagnosed and diagnosed COPD were associated with higher mortality (hazard ratio 1·53 [95% CI 1·44-1·63] for underdiagnosed and 2·09 [1·83-2·40] for diagnosed COPD), respiratory events (1·97 [1·82-2·12] for underdiagnosed and 3·70 [3·25-4·21] for diagnosed COPD), and cardiovascular events (1·20 [1·13-1·27] for underdiagnosed and 1·35 [1·17-1·56] for diagnosed COPD). This association was consistent across country-income levels, age groups, smoking status, and symptom burden.

The high prevalence of underdiagnosed COPD and related poor outcomes suggest that a large burden of COPD is under-recognised. Since underdiagnosed COPD is mainly early and mild disease, this presents missed opportunities for early intervention that can modify disease trajectory and improve long-term health outcomes.

AstraZeneca, Population Health Research Institute, Hamilton Health Sciences Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Canadian Institutes of Health Research's Strategy for Patient Oriented Research, Ontario SPOR Support Unit, and Ontario Ministry of Health and Long-Term Care.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent chronic liver disease and a multisystem cardiometabolic disorder. Cardiovascular disease (CVD) is a major cause of morbidity and mortality in this population. This review examines disparities in the recognition and management of coexisting cardiovascular and metabolic liver disease.

Shared metabolic and inflammatory pathways link liver disease with obesity, type 2 diabetes, hypertension, and CVD. Differences in measured disease prevalence across racial and ethnic groups must be interpreted separately from genetic susceptibility and in the context of structural inequities, diagnostic practices, and access to care. Socioeconomic disadvantage and sex- and gender-related barriers may further affect diagnosis and treatment. Resmetirom and semaglutide have expanded treatment options for selected adults with metabolic dysfunction-associated steatohepatitis (MASH), but unequal access to fibrosis assessment, insurance coverage, and longitudinal care may limit their benefits. An equity-centered cardio-hepatology framework should integrate early risk identification, stepwise noninvasive fibrosis assessment, individualized cardiovascular prevention, and access to indicated liver-directed therapies. Treatment and quality measures should reflect clinical eligibility rather than medication use alone. Inclusive research and coordinated long-term care are needed to evaluate whether these strategies narrow disparities.

Family-based interventions offer a promising solution to the pressing global health concern of childhood obesity by addressing the interconnected behaviours of parents and children. Nevertheless, limited evidence identifies which families benefit most when outcomes are evaluated at the parent-child dyad level.

To identify which parent-child dyads experienced clinically meaningful improvements in weight status over 1- and 2-year periods within the Feel4Diabetes study, a school- and community-based intervention targeting European families at risk for Type 2 diabetes.

Data were drawn from 2402 high-risk families across six European countries. For participants with overweight/obesity, improvement meant ≥ 5% parental weight loss and a ≥ 0.15-unit child BMI-z reduction. Multiple logistic regression models identified socio-demographic and contextual predictors of dyadic improvement.

After 2 years, 5.3% of families achieved improvements in both parent and child. Significant predictors of dyadic success included intervention group participation [OR = 2.56 (95% CI: 1.31-5.03)] and residing in high-income countries under austerity measures [OR = 2.44 (1.00-6.02)]. Girls were more likely to improve than boys, while full-time maternal employment was associated with lower odds of dyadic improvement.

Sustained benefits were observed in a subset of families, highlighting the need for tailored, context-sensitive family-centred obesity prevention strategies.

Although hypertension is a major contributor to cardiovascular complications, real-world blood pressure (BP) control in primary care and the role of hypertension specialists remain incompletely characterized. We evaluated BP control and associated factors using the Japan Medical Association Database of Clinical Medicine (J-DOME), a nationwide primary care registry. This cross-sectional study included patients with hypertension registered in 2024, categorized by treatment by specialists certified by the Japanese Society of Hypertension. Multivariable logistic regression identified factors associated with achieving office BP < 130/80 mmHg. Among 2663 patients (43.6% women; mean age, 71.4 years), 545 were treated by hypertension specialists. Mean BP was 134.4/74.8 mmHg, and the mean number of antihypertensive drugs was 1.6. Systolic BP was similar between specialist- and non-specialist-treated patients (135.1 vs. 134.2 mmHg; p = 0.28), whereas diastolic BP (76.1 vs. 74.5 mmHg; p = 0.0060) and the number of drugs (1.9 vs. 1.6; p < 0.0001) were higher in the specialist-treated group. Target BP achievement rate was lower in the specialist-treated group (30.8% vs. 37.3%; p = 0.0058), however, this difference was not observed among patients aged <75 years (33.2% vs. 35.4%; p = 0.55). The multivariable-adjusted model revealed that diabetes mellitus (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.08-1.61) and a higher number of drugs (OR per additional drug, 1.12; 95% CI, 1.04-1.22) were associated with higher target achievement, whereas overweight (OR, 0.70; 95% CI, 0.58-0.85), obesity (OR, 0.57; 95% CI, 0.42-0.77), and specialist treatment (OR, 0.77; 95% CI, 0.61-0.96) were associated with lower achievement. Office BP control remains suboptimal in Japanese primary care. Lower achievement among specialist-treated patients despite more drugs may reflect the concentration of difficult-to-control hypertension in specialist care. Continued efforts to improve hypertension management, particularly in patients with obesity, are warranted.

Multiple system atrophy (MSA) and Parkinson's disease (PD) exhibit distinct patterns of autonomic dysfunction, but differences in sudomotor function remain incompletely characterized. We investigated whether electrochemical skin conductance (ESC) measured by Sudoscan provides autonomic information complementary to ¹²³I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy. We retrospectively analyzed 15 patients with MSA (12 MSA-C, 3 MSA-P) and 48 with PD who underwent Sudoscan after excluding patients with diabetes mellitus or Sjögren's syndrome; MIBG data were available in 9 and 43 patients, respectively. The feet-hands ESC gradient was designated as the primary outcome for the present analyses. The gradient was significantly lower in MSA than in PD (median -3.5 vs. 10.9 μS, p < 0.001), and feet ESC was lower in MSA (63.7 vs. 77.7 μS, p = 0.005), whereas hands ESC did not differ significantly. A negative gradient was observed in 53% of patients with MSA and 8% with PD. MIBG myocardial scintigraphy showed relatively preserved cardiac sympathetic innervation in MSA compared with PD (delayed H/M ratio 3.67 vs. 1.49, p < 0.001). Exploratory analyses showed no significant correlations between the ESC gradient and disease duration, available clinical severity measures, or MIBG parameters. These findings suggest that Sudoscan and MIBG myocardial scintigraphy provide complementary information for autonomic phenotyping in parkinsonian disorders.

During the COVID-19 pandemic, empirical antimicrobials were frequently prescribed despite low documented rates of bacterial and fungal co-infections. While early pandemic data exist, evidence evaluating antimicrobial consumption and multidrug-resistant organism (MDRO) dynamics during subsequent pandemic surges remains limited. This study evaluated antimicrobial receipt, associated factors, and the prevalence of MDROs among hospitalised COVID-19 patients in Northern Malaysia.

This multicentre retrospective observational cohort study included adults (≥18 years) with confirmed COVID-19 admitted to ten government hospitals in Northern Malaysia between February 2020 and December 2021. Among 19,116 admissions, 480 cases were sampled, yielding 476 eligible patients. Study outcomes included antimicrobial receipt and MDRO prevalence. Monthly antimicrobial days of therapy (DOT) per 1,000 patient-days were compared with state-level COVID-19 hospital admissions. Predictors were analysed using a Poisson Generalized Linear Mixed Model.

Antibiotics were prescribed to 167 patients (35.1%), accounting for 381 prescriptions, predominantly β-lactam/β-lactamase inhibitors (54.1%). Most were empirical (92.9%), largely among non-ICU patients (72.2%) with pneumonia (82.9%). Antifungals were used in 13 patients (2.7%; 15 prescriptions), mainly empirical echinocandins (60.0%), and predominantly in ICU settings (66.7%). MDROs were detected in 8.4% (10/119) of patients with cultured specimens, representing patient-level MDRO prevalence. A significant positive correlation was observed between DOT and admissions (r = 0.701, p < 0.001, 95% CI [0.37-0.87]). Severe/critical COVID-19 stage, diabetes mellitus, chronic obstructive pulmonary disease and chronic kidney disease were consistently associated with antimicrobial prescription. Longer hospital stays, elevated neutrophil and C-reactive protein levels, smoking, and pre-hospital steroid/immunosuppressant use were additional predictors.

Antimicrobial use was predominantly empirical and influenced by disease severity and admission surges. Although MDRO detection remained low, severity-driven prescribing highlights the risk of unnecessary antimicrobial exposure during pandemic waves. These findings inform outbreak-responsive antimicrobial stewardship strategies and support antimicrobial utilisation surveillance to guide resource planning during future public health emergencies.

Antiretroviral therapy (ART) has substantially improved survival among people living with human immunodeficiency virus (HIV), resulting in an increasing need to manage age-related chronic diseases. This study examined patterns of multimorbidity clusters and their associated factors among people living with HIV using data from the Korean HIV/AIDS Cohort.

We analyzed data from 1,606 participants enrolled in the Korean HIV/AIDS Cohort from 2006 to 2023, excluding terminated cases. Participants were categorized as having no morbidity, a single morbidity, or multimorbidity. Variable cluster analysis was performed to identify disease patterns, and multinomial logistic regression was used to identify factors associated with multimorbidity.

Multimorbidity was present in 29.8% of participants, and five disease clusters were identified. Cluster 1 included osteoporosis, cerebral hemorrhage, peripheral vascular disease, and dialysis; Cluster 2 included hepatitis B, hepatitis C, liver cirrhosis, and cancer; Cluster 3 included metabolic syndrome, dyslipidemia, and fatty liver disease; Cluster 4 included hypertension, cerebral infarction, and diabetes mellitus; and Cluster 5 included nongonococcal urethritis, gonorrhea, and condyloma. Cluster 5 was more prevalent among participants aged ≤29 years and declined with advancing age, whereas Clusters 3 and 4 increased with age. Older age at HIV diagnosis, a longer duration since diagnosis, and higher HIV RNA levels were significantly associated with multimorbidity. Initiating ART within 31-90 days after diagnosis was associated with reduced odds of multimorbidity, although baseline differences in ART timing may have contributed to this finding.

Multimorbidity patterns shifted from infection-centered to metabolic and cardio-cerebrovascular disease-centered patterns with advancing age. Integrated management strategies that account for multimorbidity cluster characteristics are essential for people living with HIV.

During the COVID-19 pandemic, COVID-19-associated mucormycosis (CAM) emerged as a severe and often fatal complication, particularly among patients with diabetes mellitus. The increase in invasive fungal infections has been strongly linked to diabetes, COVID-19-related immune dysregulation, hyperglycaemia, and widespread corticosteroid use. This systematic review provides a descriptive synthesis of the relationship between COVID-19, mucormycosis, and diabetes, focusing on epidemiology, clinical features, management, and outcomes.

A systematic search of PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library was conducted for studies published between 1 April 2020 and 30 November 2025. Studies reporting CAM in diabetic patients were included. Eligible designs comprised case reports, case series, and observational studies. Study selection followed PRISMA 2020 guidelines, and findings were synthesized qualitatively, with stratification by evidence level (case reports/series vs. cohort and cross-sectional studies).

Thirty-six studies met the inclusion criteria. Diabetes was present in most CAM cases, with poor glycaemic control and diabetic ketoacidosis frequently reported. Corticosteroid therapy was identified as a major contributing factor. Rhino-orbital-cerebral mucormycosis was the most common presentation. Early antifungal treatment, surgical debridement, and strict glycaemic control were associated with improved outcomes, whereas delayed diagnosis and cerebral involvement were linked to increased mortality. Approximately 40% of the included studies were case reports or case series (Level 4 evidence), necessitating cautious interpretation of findings.

Diabetes significantly influences the development and outcomes of CAM. Judicious corticosteroid use, optimal glycaemic control, early diagnosis, and multidisciplinary management are essential to reduce morbidity and mortality. Although conclusions are limited by the predominance of lower-level evidence, consistent patterns highlight diabetes and corticosteroid exposure as major risk factors.