Ectoine, a bioactive molecule, has gained significant attention in industrial applications due to its exceptional stabilizing properties. This natural cyclic amino acid derivative, produced by halophiles, plays a crucial role in protecting cells against extreme environmental conditions. The emerging demand for ectoine has urged sustainable production on a large scale. This review describes a comparative analysis of optimization conditions in microbial fermentation as well as recent trends in recombinant technology. The current production state of ectoine primarily relies on bacterial fermentation using halophilic organisms. Genetic engineering techniques show great potential that can surpass ectoine production over traditional fermentation methods. Introducing ectoine biosynthetic pathways into non-halophilic host organisms enables more efficient and controlled production processes. Additionally, the current state of downstream processes for the recovery of ectoine is also discussed. As the demand for ectoine continues to grow, integrating cost-effective raw materials and advanced biotechnological approaches along with efficient down-stream processes are highly demandable. Single-step purification and Artificial Intelligence - Machine Learning (AI - ML) based fermentation systems shows great potential to combat with aroused challenges in ectoine sustainability. These advanced approaches will be crucial for meeting industrial-scale production requirements and unlocking its potential in diverse applications. These approaches align with Sustainable Development Goals (SDGs): SDG 3.4 (Non-communicable Diseases and mental health), SDG 3.9 (Environmental Health), and SDG 3.b (Essential medicines and vaccines).

Mental disorders, including substance use disorders (MSUD) frequently co-occur with other Non-Communicable Diseases (NCDs). This leads to increased morbidity, premature mortality, and reduced quality of life. In India, services for MSUD are usually delivered separately from NCD care. This study aimed to develop a theory-informed and context-specific set of implementation strategies as part of Model M0 for integration of screening and management of MSUD into existing NCD care in public health facilities in Faridabad district of Haryana. This work addresses a major service gap in the public health system and provides a structured, practical approach for integration.

Implementation Mapping, updated Consolidated Framework for Implementation Research, Expert Recommendations for Implementing Change (ERIC) taxonomy, Theoretical Domains Framework and Capability, Opportunity, Motivation - Behavior model were used to design and tailor implementation strategies. Mixed-methods formative assessment was carried out. The stakeholders (actors) included the health system leaders (policy makers and state and district health authorities), facility-level healthcare professionals, and patients/service users and caregivers. The barriers, facilitators, and determinants were identified. Co-creation meetings were held with stakeholders. A set of ERIC strategies were operationalized through contextually appropriate actions and materials.

A comprehensive, theory-informed implementation model (Model M0) integrating 51 ERIC strategies across domains such as capacity building, clinical workflow optimization, stakeholder engagement, and data systems strengthening was created. Multiple co-creation meetings conducted with various stakeholders at the level of state, district, and health facility benefited from and incorporated the perspectives and inputs from them. Strategies were mapped to specific change objectives and stakeholders, including patients/service users and caregivers, health care professionals, and health system leaders (policy makers and state and district health authorities). Specific actions and target actors (stakeholders) for each of the strategies were identified. The model M0 included the set of implementation strategies; the interventions (innovations), implementation materials (practical tools and protocols) and indicators to assess process, implementation, patient/clinical, and service outcomes.

This study demonstrates the feasibility of applying a structured implementation science approach to design context-sensitive strategies for integrating services for MSUD into existing NCD care in public health facilities in Faridabad district of Haryana. The implementation Model M0 offers a clear roadmap for how integration can be carried out in routine practice. The recommended way forward is to pilot, review, and refine this model. This will be followed by scale-up within the district and evaluation. The approach may also be useful for other low- and middle-income countries aiming to strengthen integrated care for MSUD within NCD programs.

https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MTEzMTg4&Enc=&userName=, identifier CTRI/2024/08/072748.

Non-communicable diseases (NCDs) are increasing rapidly across Sub-Saharan Africa, yet spatial inequalities in mortality across disease groups remain insufficiently characterized for effective regional health planning.

We examined mortality from cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes across seven East African Community countries from 2000 to 2019. Using WHO Global Health Observatory estimates, we constructed a balanced panel of 560 country-disease-year observations and fitted a multivariate Bayesian spatio-temporal shared-component model in INLA with environmental and socioeconomic covariates.

Socioeconomic context showed the strongest associations with mortality risk. GDP per capita was positively associated with NCD mortality, while healthcare expenditure, urbanization rate, and population density showed inverse associations. Environmental variables were weaker and statistically uncertain at country scale. Spatial patterns showed elevated cardiovascular and respiratory mortality risk in eastern areas, a west-to-east gradient for diabetes, and relatively uniform cancer mortality. Shared spatial effects identified persistent multi-disease high-risk clustering centered on Rwanda, Uganda, and Tanzania.

NCD mortality risk in the EAC is spatially structured and associated with contextual socioeconomic and environmental conditions, underscoring the importance of geographically targeted prevention strategies and spatially informed health-system planning.

Obesity and its related metabolic diseases, such as metabolic dysfunction-associated steatotic liver disease (MASLD), represent a major global health challenge. Mitochondrial dysfunction is a key driver in their pathogenesis. This review explores the emerging role of mitochondrial transfer, a novel mode of cellular communication that can occur via tunneling nanotubes, extracellular vesicles, or as free mitochondria, in these conditions. Increasing evidence suggests that mitochondrial transfer may contribute to tissue homeostasis and metabolic adaptation, and that disruption of this process may participate in the pathogenesis of obesity and MASLD. In parallel, therapeutic strategies aimed at restoring mitochondrial function by enhancing endogenous mitochondrial transfer or through mitochondrial transplantation are beginning to emerge. This review summarizes current knowledge of the mechanisms underlying mitochondrial transfer, discusses roles in obesity and MASLD, and evaluates the therapeutic potential and translational challenges of targeting mitochondrial transfer in obesity and obesity-related metabolic disease.

Chronic kidney disease has become a global pandemic, with its burden felt mostly in developing countries where there is a deficiency or outright lack of policy and funding for chronic kidney disease prevention and treatment. In Nigeria, its prevalence stands at about 13%, with the majority living in rural settings, far flung from nephrologists. The recent success achieved in integrating chronic kidney disease into primary healthcare has yet to receive significant funding from many governments, including Nigeria. Sustaining efforts towards disease prevention remains unachievable, with renal teams only embarking on one-off community outreaches that often fail to diagnose the disease.

In this article, the authors propose an adaptation of the nephrology clinic extension-mentorship model, which is designed to enable community-based kidney care that is anchored on nephrology teams acting as the fulcrum and basic functional unit. The model focuses on setting up semi-autonomous, quasi-renal clinics in local government areas in communities across Nigeria that will serve as platforms for sustained community engagement and participation in kidney care. The model also systematically entrenches continual screening and diagnosis of chronic kidney disease amongst at-risk groups within and outside the health centre premises through the provision of laboratory equipment and personnel that are specific for the purpose.

Patients with breast cancer (BC) with comorbid obesity or type 2 diabetes (T2D) experience poorer survival. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are approved to treat these comorbidities; however, their associations with BC survival and recurrence remain unclear.

To evaluate the association between GLP-1 RA use and 10-year all-cause mortality and recurrence-free survival (RFS) over the 10-year follow-up period, as well as 5- and 10-year all-cause mortality and RFS probabilities among patients with BC.

This retrospective cohort study used TriNetX US Collaborative Network data from women (≥18 years) with BC from 68 health care organizations who received a diagnosis between April 1, 2006, and April 1, 2023. Propensity score matching balanced characteristics. Data were analyzed between September 16 and October 3, 2025.

GLP-1 RA use (≥2 prescriptions) during the 6 months before and any time after the index diagnosis; nonuse (0 entries).

The primary outcome was all-cause mortality, and the secondary outcome was RFS. Cox proportional hazards regression model-estimated hazard ratios (HRs) were restricted to 10 years. Kaplan-Meier estimators were used to calculate 5- and 10-year all-cause mortality and RFS probabilities. Prespecified subgroup (postmenopausal) and landmark (6- and 12-month) analyses were conducted.

The study comprised 841 831 eligible patients with BC (mean [SD] age, 69.1 [12.2] years). After exclusions and 1:1 propensity score matching, 3 cohorts were identified: 1610 patients for GLP-1 RA use vs nonuse (patients with obesity [body mass index ≥30]), 2323 patients for GLP-1 RA use vs insulin or metformin (patients with T2D), and 4052 patients for GLP-1 RA use vs sodium-glucose cotransporter 2 inhibitors (patients with T2D). Among patients with obesity, GLP-1 RAs were associated with lower hazard of all-cause mortality (HR, 0.35; 95% CI, 0.21-0.58; P < .001) and RFS (HR, 0.44; 95% CI, 0.30-0.64; P < .001) over a 10-year follow-up period. Among patients with T2D, GLP-1 RAs vs insulin or metformin were associated with lower hazard of all-cause mortality (HR, 0.09; 95% CI, 0.06-0.15; P < .001) and RFS (HR, 0.33; 95% CI, 0.21-0.50; P < .001). No significant differences were observed between GLP-1 RA and sodium-glucose cotransporter 2 inhibitor groups. Subgroup and landmark analyses yielded similar findings.

In this cohort study of patients with BC, findings suggested a potential association between GLP-1 RA use and improved outcomes among patients with BC who have obesity and related metabolic conditions. These findings support further evaluation of GLP-1 RA therapy in randomized clinical trials.

Type 2 diabetes mellitus (T2DM) and depression frequently co-occur, but the specific clinical factors driving this association remain incompletely understood, particularly in Middle Eastern populations.

This study is aimed at investigating the association between T2DM and depression and identifying which clinical factors (complications, glycemic control, and treatment modality) are most strongly associated with depression risk in a Syrian patient cohort.

A case-control study enrolled 225 patients with T2DM and 226 nondiabetic controls. Depression was assessed using the Hamilton Depression Rating Scale (HDRS) and the Depression, Anxiety, and Stress Scales (DASS-21). Associations were analyzed using chi-square tests and binary logistic regression, with adjustment for age and sex in subgroup analyses.

Depression prevalence was significantly higher in the T2DM group (68.4% by HDRS and 68.9% by DASS-21) than in controls (40.3% and 41.6%, respectively). A T2DM diagnosis was associated with approximately threefold increased odds of depression (OR = 3.22, 95% CI [2.19-4.74] for HDRS; OR = 3.12, 95% CI [2.11-4.58] for DASS-21). Microvascular complications were associated with a marked increase in depression odds (OR = 17.05 - 17.89). Achieving glycemic control was strongly protective (OR = 0.116 - 0.125). Complex insulin-based regimens were associated with greater depression severity, even when the binary presence of depression did not differ significantly by treatment type.

In this Syrian cohort, T2DM was associated with a threefold higher odds of depression, but this risk was not uniform. The presence of microvascular complications was the strongest associated factor. These findings support the implementation of routine depression screening in diabetes care, particularly for patients with complications or complex treatment regimens, and highlight that intensive diabetes management may also contribute to depression prevention.

Tuberculosis (TB) remains a leading cause of infectious disease mortality worldwide, and the rising prevalence of diabetes mellitus (DM) represents a major obstacle to TB control. DM increases susceptibility to TB, worsens disease severity, delays treatment response, and is associated with poorer outcomes, largely through disruption of host immunity.

We conducted a systematic review of studies published between 1974 and May 31, 2023 that examined immunological mechanisms through which DM alters TB pathogenesis. In total, 81 eligible studies involving animal models, human participants, or combined approaches were identified and synthesised across different stages of TB.

Across studies, DM was associated with broad dysregulation of innate and adaptive immune responses, altered cytokine signalling, impaired granuloma structure and function, and reduced control of Mycobacterium tuberculosis (Mtb). Distinct immune profiles emerged between TB disease with DM and latent TB infection with DM, with heterogeneity partly explained by differences in study design, metabolic status, and disease stage. Importantly, emerging evidence indicates that pre-diabetes and intermediate hyperglycaemia may also compromise TB immunity and contribute to disease progression.

Our findings highlight DM as a key immunometabolic modifier of TB pathogenesis. They also suggest that earlier metabolic optimisation and host-directed therapeutic strategies could be explored as potential approaches to improve outcomes in this growing high-risk TB-DM population.

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023431040.

Postoperative sepsis is a serious complication of rectal cancer surgery and contributes to increased morbidity and mortality. This study aimed to identify risk factors and etiologies associated with postoperative sepsis in patients undergoing rectal surgery. A retrospective cohort study was conducted at a single center, including patients with rectal cancer who underwent surgery between November 2018 and February 2023. Tumors located <5 cm from the anal verge were treated with abdominoperineal resection (APR). Recorded variables included age, sex, surgical approach, tumor location, comorbidities (cardiovascular disease, diabetes, obesity), and loco-regional septic complications (fistula, abscess). A P value < 0.05 was considered statistically significant. A total of 226 patients underwent APR or low anterior resection (LAR). APR was associated with higher odds of early (OR = 1.84, 95% CI, 0.52-6.53; P = 0.14), late (OR = 2.75, 95% CI, 0.81-9.39; P = 0.13), and overall septic complications (OR = 2.38, 95% CI, 0.96-5.91; P = 0.06) compared with LAR; however, these differences were not statistically significant. After LAR, anastomotic leakage was the leading cause of postoperative sepsis (4.67%), including five early (<7 days) and three late (>7 days) fistulas. In the APR group, two patients developed late pelvic abscesses. Parastomal hernia was the most common late complication after APR. Postoperative loco-regional sepsis was more frequent in patients older than 50 years and in those with comorbidities, although no statistically significant association was observed overall. The median hospital stay was 11.7 days.

Wound healing poses a persistent clinical challenge, especially in chronic wounds like diabetic foot ulcers and pressure injuries. Highly concentrated carbon dioxide (CO₂) therapy has emerged as a non-invasive approach to promote healing, but its effectiveness remains uncertain.

To evaluate the efficacy of highly concentrated CO₂ therapy, via bathing and non-bathing methods, on wound healing outcomes.

This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD420251035698). Six databases were searched, identifying 10,348 records. Five randomized controlled trials met the inclusion criteria, involving participants with wounds treated using highly concentrated CO₂ through bathing or non-bathing methods. Two reviewers independently extracted data and assessed risk of bias using the Cochrane RoB 2.0 tool. Meta-analyses were conducted with fixed- or random-effects models, and the certainty of evidence was evaluated using the GRADE approach.

Five trials (N = 127 wounds/participants) were included. Meta-analysis of two trials indicated that CO₂ therapy increased the likelihood of complete ulcer healing (RR = 5.33; 95% CI [0.23-126.05]; I ² = 81.3%), though the evidence was very uncertain due to heterogeneity and imprecision. Another meta-analysis of two trials found moderate improvement in microvascular perfusion (SMD = 0.61; 95% CI [0.23-0.99]; I ² = 0%), rated as low certainty. Individual studies reported improvements in skin temperature, VEGF, TNF-α, and wound area reduction.

Highly concentrated CO₂ therapy shows promise in enhancing wound healing. However, further large-scale, high-quality trials across diverse settings are needed to validate its clinical applicability.