Vitamin D deficiency, commonly defined as a serum 25-hydroxyvitamin D [25(OH)D] level below 20 ng/mL (50 nmol/L), is a hidden but potentially high-impact public health problem in Ethiopian adults, despite the country's abundant year-round sunlight. Emerging studies indicate that certain populations, including pregnant women, patients with tuberculosis or HIV, and urban residents, experience high rates of deficiency, yet nationally representative data are virtually nonexistent. The lack of robust prevalence data, combined with limited laboratory capacity and low clinical awareness, has left this issue largely invisible in Ethiopia's health policy agenda. This narrative review synthesizes the existing evidence on vitamin D deficiency among Ethiopian adults through a literature search of PubMed/PMC, Web of Science, Google Scholar, and African Journals Online (AJOL). It identifies key determinants, including reduced sun exposure, dietary insufficiency, and dark skin pigmentation, and examines potential health consequences, such as impaired bone health, increased fracture risk, and altered immune and metabolic function. Drawing on successful fortification and supplementation programs from other sub-Saharan African countries, the review also outlines feasible, context-specific strategies for Ethiopia, including staple food fortification, targeted supplementation for high-risk groups, and public health campaigns promoting safe sun exposure. The review also highlights important evidence gaps, particularly the need for population-based surveys, standardized vitamin D assays, and longitudinal studies to better define the burden of deficiency and inform national policy. These findings provide an evidence-informed foundation for future research, clinical practice, and public health planning in Ethiopia.

Primary bone sclerosing epithelioid fibrosarcoma (SEF) is a rare, yet aggressive, condition associated with considerable mortality and prone to misdiagnosis or delayed diagnosis, making precise radiologic identification essential.

The systematic review was conducted in accordance with PRISMA standards. PubMed, Scopus, Web of Science, and Embase were searched through March 2025. The inclusion criteria consisted of English-language human studies with radiologic descriptions of primary bone SEF. Two independent reviewers conducted screening and data extraction. The risk of bias was evaluated utilizing the Joanna Briggs Institute critical appraisal tools for case reports and series.

Out of 190 identified papers, 18 met the inclusion criteria, describing 26 patients. The predominant findings in X-rays and computed tomography scans were lysis and destruction (88.46%), well-defined margins (81.81%), and soft tissue involvement (53.84%). magnetic resonance imaging (MRI) data revealed T1-weighted images exhibiting hypo- to isointense signals, while mixed hyper- and hypointense signals mostly characterized T2 sequences. SEF predominantly affected irregular bones (46.2%), followed by long bones (38.5%), with sclerotic rims being most prevalent in long bones (60%). Bone SEF predominantly manifested as pain alone in 40% of cases, and only 33.3% of the patients were initially classified as SEF. Accurate initial diagnosis of SEF was more frequently reported in studies that performed MRI.

This systematic review elucidates the varied imaging features of bone SEF across several bone types. When these characteristics elicit suspicion in primary imaging, it is probably wise to prioritize MRI, and early biopsy contemplated to guarantee a timely and precise diagnosis.

Patients surviving acute myocardial infarction (AMI) complicated by ventricular arrhythmias (VAs) are at high risk of early post-discharge readmissions due to multiple complications. These readmissions worsen clinical outcomes and add substantial financial strain to the U.S. healthcare system. This study investigates the prevalence, causes, and predictors of 30-day readmissions following hospitalization for AMI complicated by VAs.

Hospitalizations for AMI complicated by VAs were identified from the 2016-2017 Nationwide Readmissions Database. Independent predictors of 30-day readmission were analyzed using multivariable survey-weighted logistic regression in the R statistical software (version 4.5.0). Among 93 588 index hospitalizations, 8154 (8.7%) resulted in 30-day readmissions. In-hospital mortality occurred in 16.43% of index admissions and 5.92% of readmissions. Significant predictors of readmission included older age (OR: 1.01; P < 0.001), female sex (OR: 1.13; P = 0.002), prior heart failure (OR: 1.28; P < 0.001), peripheral vascular disease (OR: 1.18; P = 0.002), COPD (OR: 1.43; P < 0.001), atrial fibrillation (OR: 1.24; P < 0.001), diabetes (OR: 1.29; P < 0.001), previous MI (OR: 1.12; P = 0.009), end-stage renal disease (ESRD) (OR: 1.52; P < 0.001), stroke (OR: 1.52; P < 0.001), and hospital stay >4 days (OR: 1.94; P < 0.001). Higher income quartiles were associated with lower readmission risk. The mean index charges were $151 722, whereas charges per readmission were $64 122.

AMI complicated by VAs is associated with high 30-day readmission rates, driven mainly by noncardiac and select cardiac causes such as heart failure and atrial fibrillation. Enhanced monitoring of high-risk groups may improve outcomes and reduce healthcare costs.

Multimorbidity (i.e., the co-existence of two or more long-term health conditions [LTCs]) is increasing in high-TB-burden countries. Few studies have estimated the prevalence of multimorbidity in patients with TB, and none in TB-HIV. This retrospective cohort study used HIV clinic data from the Infectious Diseases Institute in Kampala, Uganda, to determine the prevalence and patterns of multimorbidity in patients with TB-HIV at the time of TB diagnosis, and its effect on TB treatment outcomes.

Adults living with HIV and diagnosed with TB between 1 January 2014 and 14 November 2024 were included. Clinical, laboratory, and prescription records were used to categorise LTCs. The prevalence and patterns of multimorbidity were examined and their effect on WHO-defined TB treatment outcomes was assessed using regression models.

Among 993 included patients, 76.1% (95% confidence interval: 73.4%-78.8%) had multimorbidity and 34.3% (31.4%-37.4%) had three or more LTCs. Anaemia (52.1%) and undernutrition (34.3%) were most prevalent. Multimorbidity was associated with a 3.70% (-0.35%-7.74%, P = 0.07) absolute increase in the adjusted risk of an unsuccessful treatment outcome.

Multimorbidity was highly prevalent at TB diagnosis in this cohort of people with TB-HIV, highlighting the complexity of care required alongside prescription of anti-TB therapy.

Respiratory diseases exhibit substantial heterogeneity in clinical phenotypes and underlying pathobiology that cannot be fully captured by conventional lung-centred frameworks. Accumulating evidence implicates a role for the microbiome-gut-lung axis in respiratory disease pathogenesis. Within this bidirectional axis, gut-derived microbial metabolites and structural components can modulate pulmonary immunity, whereas respiratory infection and exposures can reciprocally influence the gut microbiota. Dysregulation of the microbiome-gut-lung axis may influence respiratory disease susceptibility, progression, and clinical presentation. In this Review, we outline core mechanisms of gut-lung crosstalk, including metabolite-driven immunomodulation, pattern recognition receptor signalling and reciprocal immune-ecological remodelling. We synthesize phenotype-specific evidence linking the axis to major chronic inflammatory airway diseases (asthma, chronic obstructive pulmonary disease, cystic fibrosis and bronchiectasis) and acute respiratory disorders (pneumonia and sepsis-associated acute respiratory distress syndrome), emphasizing mechanistic and clinical evidence. We discuss the translational promise of gut-lung signatures as biomarkers and treatable traits and review current therapies with microbiome effects and emerging microbiome-targeted interventions. Finally, we address key challenges and propose future research priorities to advance clinical management leveraging the gut-lung axis.

Diabetic foot (DF) is a dangerous complication of diabetes mellitus (DM). Modern treatment modalities and good organization of care can improve prognosis.

To analyze results of DF treatment in a tertiary care setting and the degree of implementation of international guidelines in practice.

We conducted a retrospective analysis of 90 patients treated for DF ulcers/wounds in our center (May-December 2023). Thirty-five patients received only outpatient care. The median age was 65 (37-90) years, 96% had type 2 DM.

Median wound duration was 29 (1-1461) days. Previous treatment was conducted by a family doctor in 30%, at a local wound clinic in 7%, by other medical specialists in 27%, or by the patient/relatives in 29%. At this stage off-loading devices were prescribed for 37%, and 35% were referred to a vascular surgeon. Limb ischemia occurred in 44 patients (49%), revascularization was conducted for 16 patients. At 6 months, healing rates were 48%. Minor or major amputation rates were 4% and 5%, respectively; 6% died, 29% stayed unhealed, and 8% were lost to follow-up. Multivariable analysis revealed independent predictors of non-healing (ethnic group and impossibility of revascularization) and of amputation (previous major amputation, presence of osteomyelitis, and white blood cell count).

To prevent diabetes-related amputations, healthcare professionals must prioritize preventive care, provide regular podiatry services for high-risk patients, ensure early specialist treatment for any foot ulcer, implement international guidelines at all levels of DF care, and increase the capacity of secondary wound clinics and access to revascularization.

Background Hypertension and type 2 diabetes mellitus (T2DM) frequently coexist, substantially increasing cardiovascular morbidity and mortality. Insulin resistance is a key mechanism linking these conditions. The triglyceride-glucose (TyG) index, derived from fasting triglyceride and glucose levels, has emerged as a simple surrogate marker of insulin resistance. While TyG has been associated with blood pressure in non‑diabetic populations, its relationship with systolic blood pressure (SBP) and diastolic blood pressure (DBP) among patients with established T2DM remains less clearly defined. Methods A cross‑sectional study was conducted among 219 patients with T2DM (149 [68.0%] males, 70 [32.0%] females) attending a tertiary care hospital in Kerala, India. Of these, 109 (49.8%) had good glycemic control and 110 (50.2%) had poor glycemic control. Demographic, anthropometric, and biochemical data were collected using standardized procedures. SBP and DBP were measured using a standardized protocol. The TyG index was derived from fasting triglyceride and glucose values. Pearson's correlation and multiple linear regression analyses (adjusted for age, gender, and BMI) were performed to examine associations between TyG and blood pressure components. Results A total of 219 patients with T2DM (149 [68.0%] males, 70 [32.0%] females) were included, of whom 109 (49.8%) had good glycemic control and 110 (50.2%) had poor glycemic control. The mean SBP was 140.0 ± 18.0 mmHg, and the mean DBP was 97.1 ± 11.4 mmHg. The mean TyG index was 10.10 ± 0.44. Pearson's correlation analysis demonstrated a weak but statistically significant positive association between TyG and DBP (r = 0.149, p = 0.027), while no significant correlation was observed with SBP (r = 0.035, p = 0.612). In regression analysis adjusted for age, gender, and BMI, TyG remained independently associated with DBP (B = 3.52, p = 0.047) but not with SBP. Conclusion In patients with T2DM, the TyG index demonstrated a weak but significant association with diastolic blood pressure, whereas no relationship was observed with SBP. These findings suggest that TyG may provide complementary insights into the metabolic determinants of diastolic hypertension. However, given the modest strength of association and low explanatory power, larger prospective studies are required to validate its predictive utility.

To summarise existing evidence regarding the values, preferences, and perceived treatment burden of adults with type 2 diabetes when considering initiation of glucagon-like peptide-1 receptor agonists (GLP-1 RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i), finerenone, or tirzepatide.

Systematic review.

Medline, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were searched from database inception to 7 January 2025 (updating a previous systematic review that captured literature up to 23 May 2020).

Quantitative or qualitative studies were included if they reported patient reported values, preferences, or treatment burden among adults with type 2 diabetes and compared initiation of GLP-1 RA, SGLT-2i, tirzepatide, or finerenone with each other or with other glucose-lowering treatments.

Paired reviewers independently screened studies, extracted data, and assessed risk of bias. Certainty of evidence was evaluated using GRADE. Findings were synthesised narratively.

Thirty four studies (15 656 patients) were included, 17 of which were new since the previous 2021 review (8360 patients). Of the newly included studies, 10 evaluated GLP-1 RA, seven evaluated SGLT-2i, and one evaluated tirzepatide; no studies evaluated finerenone (because several studies compared multiple drug classes, these categories are not mutually exclusive). Across comparisons, patients consistently reported glycaemic efficacy, cardiovascular risk reduction, and simplicity of administration as their priorities. Oral once-daily regimens and once-weekly injectable treatments with easy-to-use devices were generally preferred. Weight loss was valued but was typically secondary to glycaemic and cardiovascular benefits. SGLT-2i and GLP-1 RA were often preferred over dipeptidyl peptidase 4-inhibitors (DPP-4i), thiazolidinediones, and insulins, but no consistent preference emerged for SGLT-2i over GLP-1 RA. Tirzepatide was favoured over semaglutide in a single study, largely due to greater haemoglobin A_1c reduction and lower hypoglycaemia risk. Certainty of evidence for all comparisons was low or very low certainty.

Adults with type 2 diabetes prioritise treatment effectiveness and convenience among glucose-lowering treatments. Current evidence does not support a clear preference between SGLT-2i and GLP-1 RA, and data for finerenone are absent. These findings underscore the importance of shared decision making informed by individual patient priorities.

CRD42023429170.

Diabetes mellitus is a global health issue with escalating metabolic dysfunction, clinical heterogeneity, and rising microvascular and macrovascular consequences. Traditional diabetes diagnosis, risk assessment, treatment selection, and complication surveillance rely on periodic clinical measures and population-level risk models, which may not fully capture dynamic, individualized disease pathways. Precision diabetes treatment is being transformed by Artificial intelligence (AI), including machine learning (ML), deep learning (DL), and multimodal data analytics. This review critically examines AI-driven approaches to diabetes management, including early disease prediction, diagnostic support, glycemic monitoring, treatment-response prediction, and the prevention and detection of diabetes-associated complications. The US Food and Drug Administration (USFDA) has sanctioned multiple AI/ML-based medical devices for automated retinal screening, clinical diagnostic assistance, and patient self-management applications. For clinically meaningful patterns and disease progression prediction, AI-enabled analysis of continuous glucose monitoring data, retinal images, electronic health records, wearable device signals, laboratory parameters, and multi-omics datasets is prioritized. The use of AI for detecting diabetic retinopathy, kidney disease, cardiovascular disease, neuropathy, and foot disorders is also highlighted.Data quality, algorithmic bias, interpretability, privacy, cybersecurity, model drift, regulatory monitoring, clinical validation, and equitable access prevent widespread application despite promising results. This study offers a thorough and critical assessment of the developing roles of AI, specifically ML and DL, in the prediction, diagnosis, and management of diabetes and its related complications. Real-world validation, standardized evaluation frameworks, trustworthy AI, and effective human- AI collaboration will drive advancement. AI could transform diabetes management into predictive, tailored, continuous, and complication-preventive care.

Diabetic nephropathy (DN) is a major microvascular complication of diabetes mellitus (DM) driven by immune activation and chronic inflammatory cascades. Human regulatory B (Breg) cells modulate immune homeostasis and are downregulated in glomerulonephritis. We aim to evaluate B cell subsets counts in type 2 DM patients with and without nephropathy in comparison to normal control individuals. Sixty participants comprising twenty-four patients with type 2 DM without kidney injury, twenty-four patients with DN diagnosed via KDIGO guidelines, and twelve matched healthy controls underwent clinical, biochemical, and flow cytometric evaluations. CD19+ B cell subsets count, including Breg cells (CD19+CD24hiCD38hi) and memory B cell counts (CD19+CD24+CD38-) were quantified using multi-parametric flow cytometry. B cell count was significantly lower in patients with DN compared to DM and healthy control groups. Moreover, Breg and memory B cell counts were significantly lower in the DN group compared to the DM group. However, no significant difference was observed regarding B cell subsets between the DM and healthy control groups. Breg cells could predict DN (AUC = 0.720, p = 0.017) at a cut-off of ≤13.5% with 95% sensitivity and 95% specificity. In conclusion, Breg cells serve a vital role in suppressing aberrant immune reactivity, meaning that their insufficiency can trigger heightened autoimmune processes. Ultimately, the Breg subpopulation holds substantial promise as a significant biomarker for predicting both the onset and progression of DN with no correlation with the severity of DN.