Background and objectives This study validates the discriminative ability of a community-based assessment checklist (CBAC) compared with other point-of-care tools for community screening to identify individuals at high risk of diabetes and hypertension. The data for this study were collected during 2019-20 in selected areas of Mysuru city, Karnataka. Methods CBAC was administered to residents aged 30 yrs and above, without known cases of diabetes mellitus, hypertension, or cancer. Random capillary blood glucose (RCBG) and blood pressure (BP) were measured for comparison with the CBAC score. Screening performance was assessed using receiver operating characteristics (ROC) analysis and the area under the curve (AUC). Results CBAC was administered to 32,686 people, and 31,594 had complete data for CBAC and RBS, and 32,645 had both CBAC scores and BP values. The analysis showed a poor AUC of 0.62 (95% CI: 0.61-0.63) for identifying individuals at risk of diabetes with RCBG value of ≥140 mg/dL and an AUC of 0.61 (95% CI: 0.60-0.61) for individuals at risk of hypertension with BP values of (systolic ≥140 mmHg OR diastolic ≥90 mmHg). Youden's index indicated that the CBAC cut-off of >4, though optimal for both at-risk of diabetes and hypertension, was poor at 0.17 and 0.15, respectively. Interpretation and conclusions The discriminative ability of CBAC was found to be poor compared with other point-of-care tools. We propose that trained frontline health staff administer RCBG and BP tests alongside the CBAC to enable more efficient public health triaging.

The school-age period is crucial nutritional-wise owing to its health and developmental impact. In Tanzania, 11% of school-aged children are thin, while 34% are anemic, representing a significant burden of undernutrition with a potential to have a lasting impact on educational and early onset of non-communicable diseases. This study was designed to evaluate its implementation and effects on dietary adequacy among primary-school children in Kisarawe District, Tanzania. A school-based cross-sectional study was conducted among 300 students aged 10-14 years from 10 primary schools from 22/04/2025 to 25/04/2025. Dietary adequacy was assessed using two measures: Dietary diversity and Meal frequency. Descriptive statistics was used to summarize the status of implementation of the school feeding program, while regression analysis was used to identify the effect of the intervention. All ten schools implemented some components of the school feeding program with a significant limitation. Only 65% students were covered in the intervention. Forty-nine percent of students met the minimum dietary diversity score. Participation in a school feeding program was associated with a 45% higher likelihood of attaining minimum meal diversity (APR = 1.45; 95% CI: 1.00-2.12; p = 0.051), although this did not reach statistical significance threshold. Only 15.3% students reported consuming the minimum of three meals per day. School feeding programs were present in Kisarawe district but faced major infrastructural and logistical challenges, with none of the schools fully adhering to national guidelines. Strengthening infrastructure, ensuring reliable food supply, and expanding universal coverage are essential to maximize program impact.

Non-communicable diseases represent a major cause of morbidity and mortality in Jordan and place increasing demands on primary healthcare services. Community pharmacists (CPs) play an important role in providing health promotion and disease prevention (HPDP) services. However, limited evidence exists regarding factors influencing their involvement in these activities.

The study aimed to explore CPs' perceptions and experiences regarding the provision of HPDP services in Jordan and to identify factors influencing service delivery, including facilitators and barriers.

Between January and April 2025, face-to-face semi-structured interviews were conducted with CPs in Amman, Jordan, recruited through purposive and snowball sampling. Interviews were audio-recorded, transcribed verbatim, and analyzed in NVivo® QSR 14 using inductive thematic analysis following Braun and Clarke's six-step approach. Transcripts were independently coded by two researchers. The identified themes were subsequently deductively mapped to the Capability, Opportunity, Motivation-Behavior (COM-B) framework. Data collection and analysis were conducted concurrently, and data saturation was achieved when no new themes emerged.

Fifteen CPs participated. Four themes were identified: (1) Diverse and evolving roles of CPs in HPDP; (2) Barriers to providing HPDP services, including workload, limited patient engagement, lack of appreciation from pharmacy owners, and the absence of financial incentives; (3) Professional requirements and capacity building, including continuing professional development, undergraduate training, and physician collaboration; and (4) Impact of providing HPDP services on patients, pharmacists, and the healthcare system. Deductive mapping indicated that pharmacists' engagement in HPDP services was influenced by capability-, opportunity-, and motivation-related factors.

CPs in Jordan play an active role in HPDP services; however, their contribution is hindered by structural, educational, and motivational barriers. Addressing these barriers through targeted training, infrastructure development, enhanced pharmacist-physician collaboration, and public awareness initiatives is essential to strengthen pharmacist-led HPDP services and support their integration into broader public health strategies in Jordan.

Transcription Factor EB (TFEB) is widely recognized as a key transcription factor regulating lysosomal biogenesis and autophagy. Although the TFEB gene is highly expressed in the testes, the mechanism by which it affects male fertility remains unclear. Here, we report that spermatogonia-specific deletion of TFEB in mice results in a multifaceted reproductive phenotype, including impaired fertility, compromised sperm motility, and attenuated androgen production. Immunofluorescence results showed a significant decrease in the expression levels of TNP1, a marker for spermiogenesis. Under electron microscopy, we observed abnormalities in the mitochondria of the testes and sperm. Integrated transcriptomic and biochemical analyses identified a cluster of mitochondrial-associated genes, including Star, Slc25a48, Gss, and ROMO1, with functional enrichment pinpointing disruptions in steroidogenic flux and calcium homeostasis. In summary, our study identifies TFEB as a pivotal regulator of mitochondrial integrity in the testes, the loss of which drives male subfertility through metabolic and hormonal dysregulation.

Background and objectives India ranks third in global cancer incidence. Groundwater often carries undetectable contaminants such as arsenic, a highly toxic element, and chromium, a probable carcinogen. This systematic review aims to identify patterns of arsenic and chromium exposure in Indian population through groundwater and surface water, and the resulting health effects, including cancer and other non-communicable diseases. Methods A comprehensive search was conducted in PubMed, Embase, and Scopus for English-language studies from inception to January 8, 2025. Studies assessing health effects of arsenic or chromium in groundwater or surface were included. After screening the articles, data on key health risk indices: hazard quotient (HQ) and carcinogenic risk, were extracted and categorised by standard thresholds. Heat maps and violin plots were used to represent health risk levels across studies and regions. Joanna Briggs Institute (JBI) critical appraisal tool was used for quality assessment. Results A total of 1259 articles were identified, with 63 included studies. All reported studies presented a low risk of bias. Arsenic ingestion indicated non-carcinogenic risks in 49% of adult and 60% of child-focused studies. Chromium ingestion risks were lower, reported in 12% and 14% of adult and children-focused studies, respectively. Carcinogenic risk was higher for both metals, particularly through ingestion. Higher non-carcinogenic risk was reported from groundwater than surface water, especially via dermal exposure in children. Affected regions were Punjab, West Bengal, Haryana, Delhi, Uttarakhand, and Jammu and Kashmir. Interpretation and conclusions Groundwater arsenic contamination poses a major public health threat in India, while evidence on chromium ingestion risks are limited.

Obesity, type 2 diabetes mellitus and chronic kidney disease (CKD) are highly prevalent conditions that frequently coexist and result in an excess burden of cardiovascular disease (CVD), premature death and health-care resource utilization. The concept of cardiovascular-kidney-metabolic (CKM) syndrome highlights the overlap of pathophysiological mechanisms that underlie obesity, diabetes mellitus and CKD and, together with adverse socioecological factors, amplify CVD risk. This framework encourages a holistic approach that recognizes the interconnectedness between metabolic factors, CKD and CVD, and the importance of screening for these factors at a population level to identify windows for CVD prevention across the lifespan. CKD is a key risk factor, mediator and therapeutic target to reduce CVD burden. The approach to using guideline-directed medical therapies for CKM syndrome is facilitated by assessment of absolute risk using validated CVD calculators, enabling therapy to be tailored to match absolute risk for maximal net benefit. In addition, screening for adverse social drivers of health is necessary to identify structural barriers to optimal care and move towards a multidisciplinary approach to ensure alignment between healthy lifestyle, risk factor control and guideline-directed medical therapies for all individuals living with CKM syndrome.

The global prevalence of diabetic retinopathy (DR) is increasing in parallel with the rising burden of diabetes, posing a substantial public health challenge. Current automated DR screening systems often lack lesion-level interpretable, robustness against class imbalance, and reliable uncertainty estimation, limiting their applicability in real-world clinical settings. The study suggests a clinical-guided deep learning framework of diabetic retinopathy (CG-DRNet) that considers lesion-conscious attention, adversarial data augmentation, and Bayesian uncertainty measurement to achieve reliable and explainable DR severity detection with objective to allow early-stage detection, particularly mild nonproliferative diabetic retinopathy (NPDR), and reciprocate clinical diagnostic procedures. The proposed framework uses a multi-task deep learning framework and lesion-aware attention network to explicitly predict microaneurysms, hemorrhages, exudates, and neovascularization. The system consists of a conditional generative adversarial network (CWGAN-GP) that is employed to overcome extreme imbalance in classes by generating clinically realistic images of minority classes of the fundus. Monte Carlo dropout is used to model Bayesian uncertainty to estimate predictive confidence, and an uncertainty-informed semi-supervised strategy of learning is used to enhance data efficiency. Evaluation of the framework is carried out on publicly available fundus image datasets APTOS 2019, Messidor-2 and Clinical metadata with the use of PyTorch 2.0.1. The proposed CG-DRNet reached 93.8% accuracy on APTOS 2019 and 91.2% on Messidor-2 with only 2.6% difference between generalization and the original model, macro F1-score of 0.891, quadratic weighted kappa of 0.912, referable DR detection AUC of 0.963 and expected calibration error of 0.034. The framework was shown to have 84.7% sensitivity when detecting Grade 2 + with 67 ms inference time and therefore has been shown to be viable in clinical use.

Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis; however, its patency is limited, particularly in patients with diabetes mellitus (DM). This study aimed to obtain exploratory data on whether changes in the venous transcriptome are present at the time of AVF creation in patients with DM and whether these changes are related to the graft prognosis.

We conducted prospective transcriptome analyses using venous samples obtained during AVF creation from 22 patients (12 with DM and 10 without DM). RNA sequencing was performed, and clinical outcomes, including primary patency, were tracked for one year.

AVF patency was significantly lower in the DM group (median patency: 134 vs. 365 days, p＜0.05). Transcriptome profiling identified 285 differentially expressed genes, including those related to extracellular matrix organization, mitochondrial electron transport, TGF-β signaling, and the unfolded protein response. A network analysis highlighted hub genes, including MRPL27, MRPL23, and MRPL1, as potential biomarkers. A Cox regression analysis identified genes associated with the AVF prognosis, including PER3, SERINC2, COMMD10, TTC4, FKBP2, FN3KRP, KIF24, SNX32, MOB3C, SUV39H1, and TIGD6. Notably, a high COMMD10 expression, a core component of the commander complex, was associated with a shortened patency in patients with DM.

Our findings demonstrate that DM is associated with distinct transcriptomic alterations in the access veins at the time of AVF creation. This integrative approach provides novel insights into the molecular basis of DM-related AVF failure and the potential to identify novel therapeutic targets.

Urolithiasis in renal allografts is rare, but large or complex stones present unique surgical challenges due to altered pelvic anatomy and proximity to vascular and visceral structures. Percutaneous nephrolithotomy (PCNL) is the gold-standard treatment for staghorn calculi but is technically demanding in transplanted kidneys. This complexity is amplified in recipients of simultaneous pancreas-kidney (SPK) transplants, where both grafts drain into the bladder. We describe a man in his 40s with type 1 diabetes and end-stage renal disease who underwent SPK transplantation in 2018. He presented with intermittent haematuria, and imaging demonstrated an 18 mm partial staghorn calculus in the transplanted kidney located in the left iliac fossa. Antegrade access was obtained under fluoroscopic guidance, and the stone was fragmented. Stone fragments were extracted, achieving complete clearance. This case highlights the potential value of tailored access planning, image guidance and multidisciplinary involvement when considering stone clearance in anatomically complex transplant recipients.

Using two-sample Mendelian randomization (MR) based on GWAS data from the IEU OpenGWAS project and a retrospective clinical cohort, this study investigated risk factors for progression from type 2 diabetes mellitus (T2DM) to end-stage renal disease (ESRD) and developed a predictive model. The T2DM GWAS dataset (ebi-a-GCST010118; 2020) included 433,540 individuals (77,418 cases and 356,122 controls). Multivariable MR, with inverse variance weighted as the primary method, was used to evaluate the causal effects of metabolic and hematologic traits on ESRD, while MR-Egger and Cochran's Q test assessed pleiotropy and heterogeneity. MR-PRESSO was used for outlier removal. In parallel, 875 patients with T2DM were analyzed using univariable and multivariable logistic regression; 140 patients (16%) progressed to ESRD. MR showed that elevated body mass index (BMI) was a causal risk factor, whereas higher hematocrit was protective. In the clinical cohort, BMI, diastolic blood pressure, and creatinine were identified as independent risk factors, while albumin and hematocrit were protective. Sensitivity analyses showed no significant horizontal pleiotropy, and all instrumental variables were sufficiently strong (F-statistics >10). A logistic regression-based nomogram achieved an AUC of 0.88 (95% CI: 0.85-0.91) with good calibration and outperformed XGBoost, Random Forest, and support vector machine models. Elevated BMI and lower hematocrit increase ESRD risk in T2DM, and the nomogram may support early risk stratification and precision intervention.