Cannabis use among older adults (≥ 65) in the US has increased substantially in recent years. However, physiologic changes associated with aging can complicate cannabis' effects in older populations, particularly as different modes of consumption have distinct pharmacokinetic effects. This study estimates the prevalence of different modes of cannabis use in this population and examines their associations with mental health outcomes.

We analyzed data from older adults aged ≥ 65 years with past-year cannabis use (N = 1515) from the pooled 2022-2024 National Survey on Drug Use and Health, a nationally representative survey of noninstitutionalized US adults. Four generalized linear models using Poisson and log link examined relationships between modes of cannabis use and cannabis use disorder (CUD), major depressive episode (MDE), serious psychological distress (SPD), and suicidal ideation (SI). The modes examined included smoking, ingested forms (eating/drinking or taking pills), inhaled concentrates (vaping or dabbing), and other routes (use of oral drops/lozenges or topicals). The models adjusted for survey year, sociodemographic characteristics, past-year cannabis use frequency, and other past-year substance use.

Smoking (66.0%) was the most common mode of cannabis use, followed by ingested forms (42.1%), inhaled concentrates (17.1%), and other routes (16.8%). Compared to males, females had higher prevalence of ingested forms and other routes, while males had higher prevalence of smoking and inhaled concentrates. In multivariable models, smoking (adjusted prevalence ratio [aPR] = 3.99; 95% CI: 1.92-8.28) and ingested forms (aPR = 1.46; 95% CI: 1.03-2.09) were associated with increased prevalence of CUD. No mode was associated with MDE, SPD, or SI.

Among older adults, smoking and ingested forms were associated with CUD, whereas no mode was associated with depression, distress, or suicidal ideation. These findings may inform targeted screening and harm reduction strategies for adults aged ≥ 65 years using cannabis.

Private psychiatric care comprises outpatient as well as private hospital care. The three major funders of private hospital care in Australia are private health insurers, the Australian federal government and, through out-of-pocket costs not covered by the preceding, individual patients. Three big companies, Medibank, BUPA, and nib, dominate the private health insurance market in Australia, resulting in high returns on equity, while private hospitals are being progressively squeezed, resulting in falling profits and a loss in 2024-25. Nonetheless, private health insurers have sought increased collective bargaining power to negotiate fees with private hospitals and care providers, such as psychiatrists, through the formation of buying groups, which would further concentrate the market. In 2021, Honeysuckle Health and nib received authorisation from the Australian Competition and Consumer Commission to act as a buying group for private health insurers with a smaller market share, and other payers. However, a subsequent appeal revealed potential risks to patient and clinician autonomy from buying group contract conditions. In 2026, Honeysuckle Health has applied for an interim and ongoing authorisation from the ACCC to continue as a buying group. We discuss the context and implications of this application for private hospital care, including psychiatry.

Temporal lobe epilepsy (TLE) frequently affects clinically-classified ictal consciousness, which the 2025 International League Against Epilepsy (ILAE) classification operationalizes through clinical assessment of awareness and responsiveness. It remains uncertain whether the spatial lateralization between the seizure-onset zone and the language-dominant hemisphere is associated with this classification.

We retrospectively analyzed 40 adults with TLE who underwent video-electroencephalography (EEG) evaluation and language-task functional magnetic resonance imaging (fMRI). Seizures were classified as focal with preserved consciousness (FPC) or focal with impaired consciousness (FIC). Patients were grouped as ipsilateral (seizure onset ipsilateral to language dominance) or contralateral. The primary analysis utilized Bayesian beta-binomial estimation, alongside secondary whole-brain functional network connectivity (FNC) comparisons.

Of 40 patients, 27 (67.5%) experienced FIC and 13 (32.5%) experienced FPC. FIC occurred in 86.7% of ipsilateral (13/15) patients compared to 56.0% of contralateral (14/25) patients. Bayesian estimation yielded a 97.4% posterior probability of a directional association between ipsilateral onset and a higher rate of FIC, although the magnitude carries considerable uncertainty (posterior median odds ratio [OR] = 4.10, 95% credible interval [CI]: .98-21.20). Absolute laterality index did not differ between FIC and FPC groups (Mann-Whitney U = 230, p = .115). Compared with healthy controls, FPC patients showed widespread FNC differences, whereas no significant control differences were detected in FIC patients. However, direct FIC-FPC comparisons did not reveal significant global task-evoked FNC differences.

Bayesian estimation supported an association between ipsilateral seizure onset relative to the language-dominant hemisphere and a higher probability of FIC classification. The absence of detectable task-evoked FNC differences between FIC and FPC patients did not provide evidence for clearly separable interictal language-network architectures.

Vision impairment and cognitive decline are common concerns among older adults with diabetes. Although visual difficulties have been associated with poorer cognitive function, the social and psychological pathways underlying this association remain insufficiently understood. This study aimed to examine the independent and serial indirect roles of social participation and perceived control in the association between vision impairment and cognitive function among Chinese older adults with diabetes.

Data were obtained from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey. A total of 1,072 Chinese adults aged 65 years or older with diabetes were included. Descriptive statistics were used to summarize participants' sociodemographic and health-related characteristics. Spearman's rank correlation analysis was conducted to examine the associations among vision impairment, social participation, perceived control, and cognitive function. A serial multiple mediation analysis was performed using Model 6 of the SPSS PROCESS macro version 4.0. Age, years of education, sex, place of residence, self-reported quality of life, and self-rated health were included as covariates. Indirect effects were estimated using 5,000 bootstrap samples and bias-corrected 95% confidence intervals. To assess the robustness of the mediation results to different covariate-adjustment strategies, sensitivity analyses were additionally performed using an unadjusted model without covariates and a fully adjusted model including all candidate covariates.

Vision impairment was significantly associated with poorer social participation, poorer perceived control, and lower cognitive function, and all study variables were significantly correlated with one another (p < 0.01). After adjustment for the mediators and covariates, greater vision impairment remained significantly associated with lower cognitive function (direct effect = -0.8085, SE = 0.1971, 95% CI: -1.1952 to -0.4218). The total indirect effect through social participation and perceived control was statistically significant (effect = -0.0783, SE = 0.0317, 95% CI: -0.1466 to -0.0215). The indirect pathway through social participation alone was significant (effect = -0.0484, SE = 0.0226, 95% CI: -0.0965 to -0.0089), whereas the indirect pathway through perceived control alone was not statistically significant (effect = -0.0260, SE = 0.0235, 95% CI: -0.0830 to 0.0090). The serial indirect pathway through social participation followed by perceived control was statistically significant (effect = -0.0038, SE = 0.0026, 95% CI: -0.0102 to -0.0002).

Greater vision impairment was associated with poorer cognitive function among Chinese older adults with diabetes. Social participation showed a significant independent indirect association, while perceived control alone did not. However, social participation and perceived control jointly formed a significant serial indirect pathway. These findings suggest that social participation and perceived control may be relevant to understanding the association between vision impairment and cognitive function. Given the cross-sectional design, the temporal sequence and causal direction of these relationships require confirmation in longitudinal studies.

Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are associated with a rare but serious risk of diabetic ketoacidosis (S-DKA). This study aimed to identify risk factors for S-DKA, develop a tool for its early detection, and assess the associated in-hospital severity.

A retrospective, multicenter cohort study was conducted across four hospitals from September 2019 to June 2024. After screening 35,633 SGLT2i-prescribed inpatients, a 1:3 propensity score matching was applied. The study included 432 patients in the development cohort (2019-2023) and 128 in a validation cohort (2023-2024). Lasso regression and logistic regression were used to identify S-DKA risk factors and construct a nomogram. The primary endpoint for severity was the need for intensive care.

Six independent predictive factors for S-DKA were identified: female, indications with diabetes, high HbA1c levels, fasting, infection and low BMI. The prediction nomogram demonstrated excellent discrimination, with an area under the curve (AUC) of 0.920(95% CI: 0.888 -0.952) in the development cohort and 0.735 (95% CI: 0.644 -0.826) upon validation. The model was well-calibrated. Furthermore, patients with S-DKA required intensive care at a significantly higher rate compared to those without.

S-DKA is associated with greater in-hospital severity, necessitating early identification. The developed nomogram provides a clinically valuable tool for predicting S-DKA risk, potentially aiding physicians in proactive patient management and improving outcomes.

Diabetic neuropathy is one of the complications of diabetes that occurs due to poor glycemic control. Brain-derived neurotrophic factor (BDNF) levels can increase when patients are first diagnosed with type 2 diabetes mellitus and can change in response to glycemic control conditions throughout the course of the disease. However, the correlation between glycemic control and BDNF remains unclear. The objective of this study was to investigate whether glycemic control can predict the BDNF levels in patients with diabetic neuropathy, based on diabetic duration.

A cross-sectional study was conducted on 8 patients with diabetic neuropathy who were treated at a clinic in Central Java. We use glycated hemoglobin (HbA1c) levels as a parameter of glycemic control, which were measured according to the National Glycohemoglobin Standardization Program. BDNF serum levels were evaluated using the Enzyme-Linked Immunosorbent Assay (ELISA) method in the laboratory. Analysis was performed using ANCOVA tests.

Together, HbA1c levels, diabetic duration, and interactions between diabetic duration and HbA1c explained 9.9% of variability in BDNF levels (p=0.046). However, HbA1c levels explained 8.1% of the variability in BDNF levels (p = 0.011), with only minor contributions from diabetic duration and interaction them.

The HbA1c levels significantly explained the variability in BDNF levels in patients with diabetic neuropathy regardless of diabetic duration.

Moderate-to-vigorous physical activity (MVPA) lowers the risk of type 2 diabetes (T2D). Identifying protein modules that mediate this association may help dissect these biological underpinnings, but they remain incompletely characterized.

We studied 28,842 diabetes-free UK Biobank participants with baseline plasma proteomics. Guideline-adherent MVPA was defined as ≥ 600 metabolic equivalent of task-minutes per week. We first evaluated associations of MVPA with incident T2D and 2910 plasma proteins, followed by mediation analyses of individual proteins. We then identified protein co-expression modules using multiscale embedded gene co-expression network analysis (MEGENA), tested module-level associations with MVPA, and mediation of incident T2D. Protein modules were further evaluated using module-level Mendelian randomization, whole-genome-sequencing genome-wide association studies, human pancreatic islet single-cell RNA sequencing, leave-one-out sensitivity analyses, and pathway enrichment analyses.

Over a median 13.60 years (IQR: [12.82, 14.35]), 1225 participants developed incident T2D. Guideline-adherent MVPA was associated with lower T2D risk and with 650 circulating proteins, of which 451 were Bonferroni-significant mediators. MEGENA analysis identified 171 robust modules, with 67 mediating the MVPA-T2D association. Twelve terminal modules, representing the finest-resolution functions, were selected for further analysis based on their significant mediated effects and enrichment in potential individual mediators. Genetic and functional analyses highlighted two modules: CKB-IGFBP2-centric module was positively associated with MVPA (β [95% CI] 0.196 [0.168, 0.224]) and genetically associated with lower T2D risk (OR [95% CI] 0.57 [0.43, 0.77]). Conversely, RIDA-PCBD1-centric module was inversely associated with MVPA (- 0.134 [- 0.162, - 0.108]) and genetically associated with higher T2D risk (1.54 [1.13, 2.09]). Compared to individual protein analyses, these modules captured unique pathways, supporting the CKB-IGFBP2-centered and RIDA-PCBD1-centered modules as antigen-presentation-enriched and complement/apoptic-cell-clearance-enriched modules, respectively. Finally, the constituent genes of both modules were enriched in T2D-related gene changes in pancreatic β-cells, with the antigen-presentation-enriched module showing additional enrichment across α-, δ-, and ductal cells.

MVPA may reduce T2D risk through two coordinated plasma protein networks rather than only through individual circulating proteins. Evaluating coordinated protein modules may provide a system-level biological framework for understanding how exercise protects against T2D.

The concurrent fungal emphysematous cystitis (EC) and bladder fungus balls in patients with urinary tract infection is rare. Diagnosis and management remain challenging because of nonspecific clinical manifestations, limited imaging features, and the lack of standardized treatment strategies.

A 62-year-old woman with poorly controlled type 2 diabetes mellitus (DM) presented with EC and bladder fungus balls caused by Candida tropicalis. Imaging revealed an intravesical mass surrounded by a large amount of gas. Conservative management, including antifungal therapy with fluconazole, insulin therapy, and continuous bladder irrigation with saline, was initially administered. However, persistent pain and intravesical gas required surgical intervention. Cystoscopy revealed multiple free-floating, oval, white fungal balls within the bladder, most measuring approximately 2.0 × 1.5 cm. Using a large-caliber endoscopic access sheath, transurethral cystoscopic irrigation was performed to fragment and evacuate the fungal balls. Postoperatively, the patient received systemic fluconazole therapy and bladder irrigation, resulting in recovery.

The coexistence of fungal EC and bladder fungus balls should be considered in patients with DM and refractory or severe urinary tract infections when computed tomography (CT) demonstrates intravesical gas surrounding a bladder mass. Although systemic antifungal therapy, bladder irrigation, and glycemic control are primary treatment options, surgical intervention may be necessary when fungal balls are resistant to irrigation or when clinical improvement is not achieved. Transurethral cystoscopic irrigation using a large-diameter endoscopic access sheath appears to be an effective and safe treatment approach.

Mucormycosis is a rare yet highly aggressive invasive fungal infection associated with significant mortality, particularly among patients with uncontrolled diabetes mellitus. Early diagnosis remains challenging because its clinical presentation may closely mimic bacterial necrotizing soft tissue infections, particularly in critically ill patients, while conventional diagnostic tests such as potassium hydroxide (KOH) smear have limited sensitivity.

We report a 64-year-old male with undiagnosed diabetes who presented with progressive decline in consciousness and extensive necrotic lesions over the occipital and periorbital regions. On admission, he was in septic shock with complications including acute kidney injury, arrhythmia, and multi-organ dysfunction. The initial working diagnosis was bacterial necrotizing fasciitis, supported by an initial false-negative KOH smear, resulting in empiric broad-spectrum antibiotic therapy and surgical debridement. Subsequently, wound cultures grew carbapenem-resistant Acinetobacter baumannii (CRAB), further reinforcing the presumed bacterial etiology and complicating clinical management. Necrotic tissue culture ultimately confirmed mucormycosis, and amphotericin B was initiated only after fungal culture confirmation. Despite combined medical and surgical interventions, the patient's condition deteriorated, and he died on the twelfth day of hospitalization. This case illustrates how diagnostic anchoring, limited sensitivity of initial mycological investigations, and bacterial co-infection contributed to delayed recognition of invasive mucormycosis and postponed appropriate antifungal therapy.

Mucormycosis in uncontrolled diabetes carries a poor prognosis when diagnosis and treatment are delayed. Clinicians should maintain a high index of suspicion for mucormycosis in diabetic patients presenting with rapidly progressive necrotic soft tissue infections despite negative initial fungal microscopy or the isolation of bacterial pathogens. Early deep tissue biopsy, repeat mycological investigations, and timely empirical antifungal therapy should be considered when clinical suspicion remains high.

The simultaneous existence of multidrug-resistant pulmonary tuberculosis (MDR-PTB) and type 2 diabetes mellitus (T2DM) represents a rising threat in high-burden countries such as India. Diabetes has been associated with impaired immune responses and delayed bacteriological clearance, thereby compromising treatment outcomes in patients with multidrug-resistant tuberculosis receiving all-oral longer regimens.

Impact of T2DM on clinical profile, radiological severity, drug resistance patterns, and sputum culture conversion in MDR-PTB.

This prospective observational study included 264 adults with microbiologically confirmed MDR-PTB treated at a tertiary care center in North India over a 12-month period. The participants were classified as diabetic, pre-diabetic, or non-diabetic according to the American Diabetes Association 2023 criteria. Clinical, radiological, microbiological, and drug susceptibility data were analyzed. Time to culture conversion and treatment outcomes were compared across groups using appropriate statistical tests.

Patients with diabetes were older and had higher rates of dyspnea and hemoptysis. Radiologically, they demonstrated significantly higher rates of bilateral lung involvement and lower zone involvement. A higher bacillary load and increased prevalence of inhA and katG mutations were observed among patients with diabetes. Mean time to sputum culture conversion was significantly prolonged in patients with diabetes (132.9 ± 22.3 days) compared with pre-diabetic patients (112.6 ± 7.6 days) and non-diabetic patients (96.9 ± 10.8 days) (P < 0.001).

T2DM adversely affects bacteriological response, radiological severity, and treatment outcomes in patients with MDR-PTB on all-oral longer regimens.