Obesity and diabetes are risk factors for developing osteoarthritis and associated with worse outcomes following total hip (THA) and total knee arthroplasty (TKA). Glucagon-like peptide-1 receptor agonists (GLP-1as) improve glycaemic control and promote weight loss. The aim of this study was to assess the impact of GLP-1a treatment on 90-day surgical complications following THA and TKA.

A systematic review was undertaken according to PRISMA guidelines. Studies were included if they reported at least one outcome of interest following primary THA or TKA. In all the studies which were included, a GLP-1a was prescribed for the management of type 2 diabetes mellitus or for weight loss in obese patients. The primary outcome was the 90-day surgical complication rate in the combined THA and TKA cohort. The 90-day surgical complications were defined as: periprosthetic joint infection (PJI), wound dehiscence, periprosthetic fracture (PPF), haematoma, nerve injury, or surgical site infection (SSI). Secondary outcomes included 90-day medical complications and readmission rates, all-cause revision, healthcare costs, and length of stay.

A total of 78 studies were reviewed, and ten matched cohort studies with a total of 96,356 patients (30,350 THAs and 66,606 TKAs) were included. The mean age of the patients was 61.9 years; 60.1% female (n = 57,939). Two studies had a serious risk of overall bias and eight had a moderate risk. The confidence of evidence according to the GRADE assessment was very low for all but one outcome measure (healthcare cost: moderate). The rate of 90-day surgical complications was lower in the GLP-1a cohort (pooled risk ratio (RR) 0.73). The use of a GLP-1a lowered the 90-day medical complications and readmission rates (RR 0.78 and RR 0.79 (I² = 61.6%), respectively). At two years, the revision rate ranged from 1.7% to 3.3% for the GLP-1a cohort and 1.7% to 4.5% for the controls. Sub-group analysis showed a stronger association in the THA group, in which the use of a GLP-1a was associated with significantly lower rates of 90-day surgical complications (RR 0.63), 90-day medical complications (RR 0.55), and 90-day readmissions (RR 0.82). In contrast, the use of a GLP-1a in the TKA group was only sigificantly associated with a lower 90-day readmission rate (RR 0.77).

GLP-1a treatment before THA and TKA potentially reduces the 90-day surgical and medical complications and 90-day readmission rates in high-risk diabetic and obese patients. The use of a GLP-1a may also be associated with substantial cost savings.

There has been an increase in the prevalence of erectile dysfunction (ED) in the general population especially among hypertensive patients. This seems to be neglected problem in low-income countries especially our environment with huge attendance consequences. Measures to address the risk factors are advocated as to reduce the burden of the disease and its financial impact on the economy. It is an important public health problem by the National Institute of Health Consensus Development Conference Panel. It has been found to be more associated with chronic medical conditions such as hypertension and diabetes mellitus.

This study assessed erectile dysfunction and its associated risk factors among adult hypertensive patients attending a tertiary care centre, with a view to screening for erectile dysfunction, advocating for lifestyle modification in order to reduce the burden of the disease.

It was a hospital-based cross-sectional comparative design which involved two hundred and thirty-six adult male patients recruited via a systematic random sampling technique. Data collection was done using a semi-structured researcher-administered pretested questionnaire to obtain information on the socio-demographic characteristics, past medical history, behavioural characteristics, clinical assessment and erectile dysfunction assessment using Sexual Health Inventory for Men (SHIM). Data was analyzed with SPSS (version 23). Chi square test, fisher's test and logistic regression were used for analysis.

The mean age of respondents was 42.1±15.17 years. Out of the 41.1% young age category; 40.7% and 41.5% were hypertensive and non-hypertensive respectively. An overall prevalence of erectile dysfunction of 44.1% with higher prevalence in hypertensive (54.2%) than non-hypertensive (33.9%) respondents was noted. There was a significant difference when ED was compared in the two groups (hypertensive and non-hypertensive) (p<0.05). The study also revealed that body mass index has a significant association with erectile dysfunction (P<0.05). The logistic regression showed that blood pressure (SBP and DBP) and BMI were predictors of erectile dysfunction (p=0.010), (OR=2.026, 95% CI=1.180-3.479) and (p= 0.048), (OR=0.688, 95% CI= 0.372-1.271).

In as much as smoking and the class of anti-hypertensive medications used by the respondents had no significant association with erectile dysfunction, hypertension and obesity were independently associated with erectile dysfunction. Alcohol use was also significantly associated with erectile dysfunction, but such as an associated vanished on elimination of cofounders.

Aim: To evaluate the clinical significance of serum L-selectin (sCD62L) levels as a biomarker of retinal damage in patients with type 2 diabetes mellitus (T2DM) by correlating its concentration with the stages of diabetic retinopathy (DR) and clinical and morphological parameters of the retinal state.

Materials and Methods: A total of 124 patients (124 eyes) were examined: 95 patients with T2DM (ranging from mild non-proliferative to proliferative DR) and 29 age- and sex-matched controls. Diagnostic techniques included BCVA assessment, SD-OCT (Topcon 3D OCT-1000), and serum ELISA for L-selectin determination.

Results: A significant 2.5-fold increase in serum L-selectin levels was identified in the T2DM cohort compared to controls ([mean ± standard error] 31.2 ± 8.6 ng/mL vs. 12.5 ± 3.5 ng/mL; p < 0.001). A progressive upward trend in marker concentration was observed relative to pathology severity: from (median [interquartile range]) 24.7 (20.4-29.0) ng/mL in mild non-proliferative DR (p < 0.001 vs. control group [12.5 (10.1-14.9)] ng/mL) to 39.5 (35.1-43.9) ng/mL in the proliferative stage (p < 0.001 vs. control group). Positive correlations were found between L-selectin levels and HbA1c (rs = 0.816, p < 0.001), as well as central retinal thickness (rs = 0.467, p = 0.002).

Conclusions: CD62L is a significant biomarker of systemic inflammation and vascular dysfunction in T2DM, reflecting the severity of diabetic retinopathy and the risk of blood-retinal barrier disruption.

Diabetes mellitus management requires considerable patient self-efficacy, knowledge, and support for social determinants of health. These needs become particularly acute during pregnancy. Mobile health (mHealth) tools are a promising approach to enhance patient engagement with the health care system, education, and health promotion and may be particularly helpful during the period of rapid skills acquisition, which is a hallmark of experiencing diabetes during pregnancy. Therefore, we developed SweetMama, a web-based mHealth app designed to support and provide information to low-income pregnant individuals with gestational diabetes mellitus (GDM) or type 2 diabetes mellitus (T2DM).

This study aimed to understand the user experiences of low-income pregnant people who were randomized to use SweetMama during a feasibility trial.

This mixed methods secondary analysis of data from a feasibility randomized controlled trial (RCT) included participants randomized to SweetMama, an interactive, web-based mHealth app with multiple motivational and educational features that help reduce barriers to care, offer health education, and aim to improve diabetes self-care for low-income pregnant people. In the parent trial, English-speaking pregnant individuals with GDM or T2DM were randomized to use SweetMama during pregnancy or usual care. SweetMama users experienced an individualized curriculum from enrollment through 6 weeks postpartum. Upon exit, users completed 2 qualitative interviews (during the delivery hospitalization and at the postpartum visit) and surveys assessing standardized usability metrics. The surveys included the System Usability Scale (SUS), the Usefulness, Satisfaction, Ease of Use (USE) scale, and the mHealth App Usability Questionnaire (MAUQ) to assess usability. Qualitative data were analyzed using constant comparative techniques.

Of 30 SweetMama users, 60% (n=18) had GDM, 83.3% (n=25) had publicly funded prenatal care, and the majority identified as non-Hispanic Black (n=17, 56.7%) or Hispanic (n=11, 36.7%). Scores on the SUS (median 85.0/100, IQR 70.0-88.8; ≥71% indicates acceptable or higher usability), USE (overall median 84.5/100, IQR 81.0-91.4), and MAUQ (median 84.1/100, IQR 79.0-91.3) indicated favorable usability assessments, particularly for the "ease of learning" domain. Qualitative interviews supported these findings: participants described the app as easy to navigate, well organized, and helpful for staying on track, citing features such as clear visual design, timely text reminders, and actionable tips. Users valued motivational elements and content specificity, while recommending increased customization and enhanced esthetics.

In this user experience evaluation of a web-based mHealth app for low-income pregnant individuals with diabetes, participants found the tool to be user-friendly, visually appealing, informative, and motivating. Constructive feedback for application improvement for use in a future larger trial of clinical effectiveness was collected.

Describir el proceso de desarrollo y las características principales de los Protocolos Nacionales de Atención Médica (PRONAM), una estrategia nacional para estandarizar la práctica clínica en el primer nivel de atención en México. Material y métodos. Proceso metodológico liderado por el Consejo de Salubridad General, que incluyó priorización de temas, integración de grupos multidisciplinarios de expertos, revisión de evidencia científica, construcción de consensos, revisión técnica e interinstitucional, aprobación y publicación.

Se desarrollaron seis protocolos clínicos dirigidos al primer nivel de atención: hipertensión arterial sistémica, diabetes mellitus tipo 2 y síndrome metabólico, sobrepeso y obesidad, enfermedad renal crónica, los primeros 1 000 días de vida y vacunación a lo largo del curso de vida. Más de 80 especialistas participaron en su elaboración. Conclusión. Los PRONAM constituyen una herramienta nacional para fortalecer la atención de primer nivel y promover la estandarización de la práctica clínica basada en evidencia en México.

Estimar la cobertura efectiva de servicios en el primer nivel de atención para diabetes en población sin seguridad social (PobSinSS) en México, aplicando una metodología geoespacial integrada para identificar desiertos de atención. Material y métodos. Estudio ecológico que utiliza datos secundarios de infraestructura, servicios y población. Se implementó el método de áreas de captación flotantes en tres pasos modificado con el modelo de Huff (MH3SFCA) basado en tiempos de viaje (least cost path) para estimar accesibilidad espacial y población potencial usuaria (PPU). La cobertura efectiva se estimó vinculando PPU necesitada con servicios prestados. Se identificaron desiertos por accesibilidad geográfica, capacidad y cobertura efectiva.

De 65.5 millones de PobSinSS, 5.6% vivía a más de 30 minutos de una unidad médica, 296 000 (0.4%) enfrentaban desiertos por cobertura geográfica (>13 km) y 340 000 (0.5%) por capacidad. La PPU con accesibilidad a unidades con capacidad fue de 65.1 millones (99.4%). La cobertura efectiva de tratamiento para diabetes fue de 13.2% y la de control metabólico, de 4.4%. Conclusión. Aunque los desiertos geográficos y por capacidad son casi nulos, la cobertura efectiva para diabetes es baja, incluso en áreas de alta accesibilidad, lo que evidencia barreras funcionales y la necesidad de evaluar el desempeño del sistema para guiar políticas de equidad.

This study investigated the association between vitamin D levels and type 2 diabetes mellitus (T2DM) among Indigenous adults of the Tupiniquim and Guarani ethnicities residing on a reserve on the southeastern Brazilian coast.

This cross-sectional study, conducted between 2020 and 2022, included 946 Indigenous individuals (aged ≥20 years, both sexes) from the Tupiniquim and Guarani ethnic groups. T2DM was defined by a self-reported diabetes diagnosis, the use of glucose-lowering medications, or, in the absence of such reports, a fasting plasma glucose level ≥126 mg/dL, a 2-hour plasma glucose level ≥200 mg/dL following an oral glucose tolerance test, or a glycated hemoglobin level ≥6.5%. Hypovitaminosis D was defined as a serum 25-hydroxyvitamin D [25(OH)D] level <30.0 ng/mL. Associations were estimated using multiple logistic regression models.

The mean age of the participants was 41.3 ± 14.9 years; 56.8% were women, and 90% belonged to the Tupiniquim ethnic group. After adjusting for confounders, serum 25(OH)D levels were inversely associated with T2DM. Each 1-ng/mL increase in 25(OH)D was associated with lower odds of T2DM (OR = 0.96; 95% CI: 0.94-0.98). Individuals with hypovitaminosis D had higher odds of T2DM than those with adequate vitamin D levels (OR = 1.77; 95% CI: 1.20-2.62).

Vitamin D deficiency was independently associated with the presence of T2DM. The high prevalence of hypovitaminosis D underscores the importance of screening strategies and considering supplementation protocols, even among Indigenous populations with high solar exposure.

Diabetes is a major health concern in Malaysia, yet no comprehensive review has assessed the quality of care for these patients. This study aims to systematically review published evidence on type 2 diabetes mellitus (T2DM) management in Malaysian primary health care (PHC), focusing on the achievement of glycated haemoglobin (HbA1c), blood pressure (BP), and LDL-cholesterol (LDL-C) targets (ABC control).

A scoping review was conducted, involving a comprehensive search of four databases (PubMed, Embase, Scopus, and MyMedR) and grey literature for publications up to December 2024. Studies were included if they reported on at least one ABC indicator among the general adult T2DM population in Malaysian PHC settings. The scoping review followed the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines. EndNote was used for deduplication, and Rayyan was utilised for the screening process. Data were extracted and synthesised narratively.

A total of 109 publications were included. Publications increased post-2010 but remained geographically concentrated in urban states. Large-scale studies heavily relied on the National Diabetes Registry. HbA1c was the most reported indicator. Findings revealed no evidence of improvement in HbA1c and BP control over two decades; achievement rates were 30-45% for HbA1c (<7.0%) and 20-50% for combined BP target (<130/80 mmHg). Conversely, LDL-C control (≤2.6 mmol/L) showed a modest improvement, with achievement rates rising from approximately 30% to 50% over a decade.

Despite a substantial increase in research, the HbA1c and BP control for T2DM in Malaysian PHC has remained static and suboptimal, highlighting a persistent gap between clinical guidelines and real-world outcomes. The modest improvement in LDL-C suggests that progress is achievable. These findings underscore the need for a balanced policy focus on all three ABC indicators, strategies to overcome systemic barriers, and continued investment in the national registry to guide evidence-based improvements in diabetes care.

Comorbid insomnia and obstructive sleep apnea (COMISA) is increasingly recognized as a distinct clinical entity, yet its relationship with cardiovascular disease (CVD) remains incompletely understood. We aimed to investigate the association between COMISA and CVD in a large clinical sleep cohort.

Using data from the TURKAPNE registry, we analyzed 12,715 adults referred for sleep evaluation and classified participants into four mutually exclusive sleep phenotypes: neither OSA nor insomnia (n = 910), insomnia only (n = 388), OSA only (n = 8,142), and COMISA (n = 3,275). The prevalence of CVD was compared across groups. Multivariable logistic regression models were used to examine associations between COMISA and CVD after adjustment for age, sex, body mass index, education level, smoking status, airway disease, diabetes mellitus, and psychiatric comorbidity.

The prevalence of COMISA was higher among individuals with CVD compared with those without CVD (31.6% vs. 22.7%; p < 0.001). In contrast, the distribution of insomnia alone and OSA alone showed only minor differences by CVD status. In multivariable analysis, CVD was independently associated with COMISA (odds ratio 1.108, 95% confidence interval 1.006-1.220; p = 0.038), although the magnitude of this association was modest. Female sex, diabetes, airway disease, psychiatric disease, lower educational status, and current smoking were also independently associated with COMISA.

In this large registry-based cohort, COMISA was more prevalent among individuals with CVD, supporting the concept that it represents a clinically distinct phenotype with an increased cardiometabolic burden. However, the modest effect size suggests that COMISA is influenced by a broader interplay of behavioral and metabolic factors.

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a rare immune-mediated disorder that primarily targets the myelin sheaths of peripheral nerves, leading to limb weakness and sensory disturbances. Established treatments for CIDP include glucocorticoids, intravenous immunoglobulin, and plasma exchange. Immunoadsorption (IA) has emerged as a promising alternative to plasma exchange and has shown favorable efficacy in patients who respond inadequately to first-line therapies.

A 37-year-old man presented with progressive numbness and weakness of the limbs. He was a hemodialysis patient with type 2 diabetes mellitus and recurrent buttock furuncles. Subsequent electrophysiological testing indicated demyelinating lesions in 2 peripheral nerves.

The diagnosis of CIDP was based on clinical symptoms and electrophysiological examinations.

IA was selected as the initial monotherapy and long-term maintenance therapy.

This case demonstrated that IA was well tolerated and associated with sustained clinical improvements.

The use of IA for both initial and maintenance therapy may represent an optimal individualized treatment for patients with CIDP undergoing hemodialysis.