The World Health Organization (WHO) has designed a package of essential non-communicable disease (PEN) strategies to improve the detection and management of non-communicable diseases. However, the implementation of the PEN in rural health facilities in Sidama National Regional State is at an early stage, and the readiness of rural primary healthcare units (PHCUs) to implement the strategy is unknown. We, therefore, propose to apply the strategy in the catchment areas of Dobe-Toga Health Center, a rural PHCU in Sidama National Regional State, Ethiopia, and improve non-communicable diseases care among adults aged ≥45 years.

We primarily aim to evaluate the effectiveness of a WHO PEN-based care model, which we will implement in a rural setting, in controlling blood pressure and glucose levels among older adults. It will also determine the prevalence of undiagnosed hypertension, pre-diabetes, and diabetes. Additionally, the study seeks to assess the readiness of rural PHCUs to implement the WHO PEN approach and examine the relationship between NCD diagnoses and community-based health insurance (CBHI) membership.

The study will be conducted in the catchment areas of Dobe-Toga Health Center from April 2024 to February 2025 and includes multiple components. One component is a cross-sectional readiness assessment of PHCUs in Sidama National Regional State, which will be undertaken involving 41 health centers and 4 primary hospitals, triangulated by qualitative data collection. The remaining study components will be conducted exclusively in the catchment areas of Dobe-Toga Health Center in two phases. In Phase 1, cross-sectional surveys will be conducted to determine the prevalence of undiagnosed hypertension, type 2 diabetes mellitus, and pre-diabetes in a randomly selected sample of 3,301 older adults. Additionally, the participants' willingness to pay (WTP) for HbA1c tests will be assessed, and CBHI-related surveys will be conducted. In Phase 2, the individuals diagnosed with these conditions will be linked to the health center and enrolled in a WHO PEN-based care model. The effects of the care model in controlling blood pressure and glucose will be examined. Furthermore, the participants' adherence to self-care practices will be determined.

This study aimed to adapt international clinical practice guidelines for the rehabilitation of acute spinal cord injury (SCI) in Iran.

This study was conducted based on guideline adaptation methods (the ADAPTE (ADaptation and eVALuation of a prE-existing guideline) framework). After an organizing committee was created and health topics selected, we searched PubMed, Scopus, and Cochrane Library from January 2011 to April 2021 to find guidelines regarding acute/subacute rehabilitation of SCI patients. The quality of the clinical practice guidelines was examined using the Appraisal of Clinical Guidelines for Research & Evaluation II. Recommendations were made by the committee and categorized according to population, intervention, professions, outcomes, and health care setting. The decision-making process was based on a systematic evaluation of each recommendation, utilizing a combination of quality for supporting evidence or against each recommendation, as well as consideration of feasibility, acceptance, and adoptability for the healthcare context of Iran.

Our selection yielded 1 high-quality guideline containing 4 recommendations that underwent an adaptation process. Rehabilitation should be implemented as soon as patients are hemodynamically and neurologically stable and can tolerate the intensity. We suggest establishing specialized rehabilitation centers with trained personnel and proper equipment, providing tele-rehabilitation, education, and encouraging caregivers to help with early rehabilitation. Negotiating with insurance companies is imperative to cover the cost of long-term occupational therapy and rehabilitation. We suggest conventional over-ground training rather than treadmill training due to the lack of facilities. Individuals with acute/subacute cervical SCI should be offered functional electrical therapy. We find that additional training in unsupported sitting has no clear benefit associated with it when compared to the current standard rehabilitation.

Implementation of international guidelines for SCIs and rehabilitation is a process that involves feasibility, acceptability, relevance, and adaptability when considering developing countries. The recommendations presented in this study have the potential to significantly improve the care provided to patients with SCI, not only in Iran but also could help guide developing countries in the healthcare arena.

The increase in the prevalence of chronic noncommunicable diseases (NCDs), together with physical inactivity in the workplace, poses a public health challenge that requires structural responses from workplace promotion. Various international organizations have highlighted that the workplace is a privileged setting for intervening in sedentary lifestyles and promoting protective behaviors. In this regard, during the working day, physical activity has been shown to be an effective strategy for health and functional performance, as demonstrated by scientific evidence in relation to institutional policies and corporate commitments linked to health and sustainability.

Vascular endothelial dysfunction is a central pathophysiological mechanism underlying a broad spectrum of metabolic diseases, including type 2 diabetes mellitus, atherosclerosis, obesity, and non-alcoholic fatty liver disease. As a metabolically active interface, the endothelium regulates vascular tone, inflammation, oxidative stress, and nutrient exchange; its impairment contributes to the initiation and progression of these disorders. This review synthesizes current understanding of the molecular mechanisms linking endothelial dysfunction to metabolic disease progression. Particular focus is placed on emerging nanotechnology-based strategies designed to restore endothelial function. These include a diverse array of nanoparticles (NPs)-such as liposomes, polymeric carriers, metallic NPs, and non-metallic inorganic NPs-engineered for endothelial targeting, anti-inflammatory action, angiogenesis modulation, and oxidative stress reduction. Finally, we outline the major challenges facing clinical translation, including endothelial heterogeneity, insufficient cell-specific delivery validation, barriers for emerging biotherapies, and unresolved issues in long-term safety, manufacturability, and regulatory feasibility. Nanomedicine holds significant potential to revolutionize metabolic disease management by enabling precise, endothelium-centered diagnosis and therapy.

Steroid-induced hyperglycemia is a significant concern for patients with diabetes who undergo ultrasound-guided sacroiliac joint (SIJ) injections, because corticosteroids impair insulin sensitivity and elevate blood glucose levels. Chromium, a trace mineral essential for glucose metabolism, has been suggested to enhance insulin sensitivity and stabilize blood glucose levels. While previous studies indicate that chromium supplementation may reduce hyperglycemia and analgesic use, further research is needed to confirm its efficacy in patients with diabetes who are receiving steroid therapy.

Our study aimed to evaluate the effects of oral chromium supplementation on steroid-induced hyperglycemia and pain management in patients with diabetes who are undergoing SIJ injections.

A double-blinded, randomized controlled trial.

This study was conducted at Fayoum University Hospitals (June 2024 through May 2025).

We randomized 60 patients with diabetes who underwent an SIJ injection. They were randomized into 2 groups: the Chromium Group (n = 30) received 200 μg of oral chromium daily for 45 days postintervention, while the Control Group (n = 30) followed standard diabetes management. Primary outcomes included random blood sugar and hemoglobin A1c levels, while secondary outcomes assessed were hypoglycemic medication use, analgesic consumption, pain scores, and adverse effects.

Our study found that oral chromium supplementation significantly improved glycemic control and reduced the need for hypoglycemic drugs and analgesics in patients with diabetes who underwent steroid therapy. Starting from the postintervention sixth day, there were significant reductions in blood sugar levels and a 40% decrease in hypoglycemic drug use from the first postintervention week (P < 0.05). Analgesia consumption decreased by 30%, with improved pain perceptions noted in Visual Analog Scale pain scores at postintervention months one, 3, and 6 (P < 0.05). These results indicate that chromium is efficacious for managing both glycemia and pain, leading to enhanced treatment outcomes.

Limitations include the relatively small total number of patients, which might limit the ability to generalize the findings to all populations that have diabetes or detect smaller but clinically meaningful effects. The supplementation period of 45 days may not be long enough to observe potential long-term effects of chromium on blood sugar levels or fully assess any delayed adverse effects.

Chromium supplementation improves glycemic control and reduces analgesic dependence in patients with diabetes who had an SIJ injection. Chromium supplementation therapy is a safe and cost-effective adjunct to standard diabetes management.

Photobiomodulation has shown promising results in accelerating wound healing and modulating inflammation.

To evaluate the feasibility of photobiomodulation therapy in treating lower limb wounds in people with diabetes.

This was a 12-week prospective, pilot, multicenter, nonrandomized clinical trial. The 25 participants were divided into the intervention group, in which a laser was applied once a week and hydrogel was applied daily, and the control group, in which hydrogel was applied daily. Participants older than 18 years with a diagnosis of diabetes mellitus and with lower limb wounds smaller than 100 cm² were included. Participants with lupus, pyoderma gangrenosum, and Stevens-Johnson syndrome were excluded. Comparisons between the groups were performed using the Mann-Whitney U test, and comparisons between different time points were performed using the Friedman test. The Fisher exact test was used to assess associations between groups and qualitative variables.

No statistically significant difference in wound area was observed when comparing the 4 time points evaluated between groups. However, there was a significant difference when comparing the 4 time points in the intervention group. No significant difference between groups was observed in the expression of the cytokines investigated.

Application of photobiomodulation at an intensity of 2 J/cm² once a week did not produce measurable changes in cytokine gene expression. However, significant reduction in wound area and improvement in tissue repair were observed in patients treated with photobiomodulation.

Traditional randomized controlled trials of efficacy often lack generalizability due to strict inclusion criteria and controlled environments. Real-world evidence trials offer a complementary approach by evaluating the effectiveness of interventions in routine clinical practice.

To prospectively assess the effectiveness of trilayer and single-layer amniotic tissue grafts in treating diabetic foot ulcers and venous leg ulcers using a hybrid platform design compared with historical controls.

This multicenter, umbrella design study includes 2 parallel prospective cohorts with 2 intervention arms each and a shared retrospective standard of care control group. Subjects will be randomized to receive either intervention product 1 or intervention product 2 in addition to standard of care. Retrospective controls will be selected from the US Wound Registry using coarsened exact matching, comparing the primary end point of complete wound closure at 12 weeks and the secondary end point of wound area reduction. Change in quality of life as assessed using a patient-reported outcome measure and pain scores will be evaluated in the subjects in the prospective arm.

This protocol outlines a pragmatic, patient-centered approach to evaluating advanced wound care therapies in real-world settings.

Diabetic foot ulcers (DFUs) significantly affect patients and health care systems, often resulting in amputation and high morbidity.

To evaluate whether cellular, acellular, and matrix-like products (CAMPs) are more effective than the standard of care in reducing lower limb amputation (LLA) risk and improving survival in DFU patients.

This retrospective cohort study used a proprietary database to identify patients with type 1 or type 2 diabetes and foot ulcers. Two cohorts were compared: those receiving debridement and those receiving CAMPs. Propensity score matching (PSM) balanced baseline characteristics. The primary outcome was 5-year LLA risk and amputation-free survival.

Before PSM, the CAMPs cohort (n = 2273) had higher rates of comorbidities compared with the debridement-only cohort (n = 31,050). After matching, cohorts were well-balanced (n = 2272 each). Treatment with CAMPs significantly reduced the risk of LLA compared with debridement alone, with a 4.9% absolute risk reduction (95% CI, -7.4 to -2.4%; P < .0001) and a 24% relative risk reduction (risk ratio, 0.763; 95% CI, 0.664-0.876). Kaplan-Meier analysis demonstrated improved 5-year amputation-free survival in the CAMPs cohort (75.7% vs 71.3%).

CAMP therapy significantly reduces LLA risk and improves amputation-free survival in DFU patients.

Pregnancy induces a hypercoagulable state peaking at delivery and reverting postpartum. This prospective cohort study evaluated the longitudinal progression of endogenous thrombin potential in 102 high-risk pregnant women in relation to the development of preeclampsia or gestational diabetes mellitus. Samples were collected from gestational weeks 8-15, with follow-ups every 2-12 weeks, and thrombin generation was assessed using Calibrated Automated Thrombography. Eleven women developed preeclampsia, and 19 developed gestational diabetes mellitus. Endogenous thrombin potential values were significantly elevated in patients who developed preeclampsia (2220 ± 357 nM*min, p < 0.001) or gestational diabetes mellitus (2298 ± 377 nM*min, p < 0.001) compared to the rest of the cohort (1995 ± 337 nM*min), with high levels evident from the first trimester-well before clinical symptoms. Notably, preeclampsia patients on acetylsalicylic acid therapy did not show further increases in endogenous thrombin potential, and acetylsalicylic acid intake in gestational diabetes mellitus patients effectively moderated endogenous thrombin potential progression. These findings suggest that higher early-pregnancy endogenous thrombin potential reflects an underlying hemostatic imbalance associated with the subsequent development of preeclampsia and gestational diabetes mellitus. Furthermore, acetylsalicylic acid appears to exert effects beyond its anti-inflammatory properties by moderating endogenous thrombin potential, providing new insights into the early pathophysiology and therapeutic modulation of high-risk pregnancies.

Digital twins (DTs) offer a paradigm for health care by enabling data-driven, simulation-capable representations of individual health trajectories. However, DT development remains limited by the scarcity of standardized, temporally structured, and multidomain data suitable for modeling chronic disease progression. Most existing DT studies rely on narrowly scoped or proprietary datasets, restricting generalizability. Public health datasets, such as the Midlife in the United States study, provide rich biopsychosocial information but are underused due to structural complexity and lack of semantic integration frameworks.

This study aimed to develop and evaluate an ontology-guided, agent-orchestrated framework for constructing offline, simulation-capable, and progression-aware DTs from public health datasets. Using diabetes as a case study, the framework integrates agent-based orchestration, medical ontologies, and large language model (LLM)-assisted semantic reasoning with machine learning to support explainable feature structuring, risk prediction, and predictive "what-if" progression analysis.

A 6-stage DT framework was developed and applied to Midlife in the United States wave 2 (baseline) and wave 3 (follow-up) data. Ontology- and LLM-assisted feature selection identified predictors across biological, behavioral, psychosocial, and socioeconomic domains. Cleaned and harmonized data were used to train predictive models (random forest, eXtreme gradient boosting, and logistic regression) to estimate diabetes onset at follow-up. A state-transition simulator was implemented to model between-wave progression dynamics, quantify transitions across low-, medium-, and high-risk states, and evaluate predictive "what-if" scenarios such as weight reduction and lifestyle improvement. Model performance was assessed using accuracy, F1 score, area under the receiver operating characteristic curve (AUC), and calibration metrics.

From 9976 candidate variables, ontology- and LLM-guided selection retained the top 200 relevant predictors spanning biological, behavioral, psychosocial, and socioeconomic domains. Predictive modeling achieved strong discrimination, with random forest (AUC=0.82, accuracy=0.76) and eXtreme gradient boosting (AUC=0.81, accuracy=0.75) outperforming logistic regression (AUC=0.78). The state-transition simulator reproduced realistic progression patterns: 33.9% (1414/4174) of participants changed risk states between waves, and the high-risk group increased from 10.8% (451/4174) to 32.2% (1344/4174). Next-state prediction accuracy reached 92.5%. Predictive "what-if" analyses showed that with a simulated 10% weight reduction, model-estimated diabetes cases decreased by 98 (from 576 to 478). A placebo test (0% weight change) produced less than 0.3% difference in risk distribution, confirming model stability.

This study presents a foundational, ontology-guided, and agent-orchestrated framework for constructing offline, simulation-capable, and progression-aware DTs from public datasets. By combining semantic reasoning, multidomain predictors, and predictive "what-if" progression simulation, the framework transforms static population data into longitudinal, interpretable representations of individual health trajectories. The proof-of-concept application to diabetes demonstrates that public health data can support robust and explainable DT models for exploratory risk analysis and hypothesis generation, without implying causal intervention effects or direct clinical decision support.