To evaluate the clinical differences in the presentation of vulvar lichen sclerosus in pre- and postmenopausal women, aiming to provide insights to improve disease management and promote the health and well-being of affected patients.

This was a retrospective analytical study involving 287 women diagnosed with vulvar lichen sclerosus, conducted between January 2009 and December 2023 at Erasto Gaertner Hospital, in Curitiba, Brazil. Clinical, epidemiological, and therapeutic management aspects were assessed and compared between pre- and postmenopausal patients.

Most cases (87%) occurred in women over 50 years of age, showing a strong association with menopause. Systemic arterial hypertension and type II diabetes mellitus were the most frequent comorbidities. Complaints of vulvar atrophy and anatomical deformities predominated among women over 50 years. Pruritus was the most common symptom in both groups, while dyspareunia was more prevalent among younger women. High-potency topical corticosteroid therapy was effective in more than half of the patients in both groups. Additionally, contrary to previous literature, 2% testosterone cream showed significant clinical improvement in the younger group. Progression to in situ neoplasia was observed in 11 cases, and progression to invasive neoplasia occurred in 6 cases.

Differences in clinical presentation according to hormonal status reinforce the importance of individualized management strategies. Further studies with larger samples are necessary to optimize treatment approaches and improve quality of life for women affected by this chronic, mutilating, and often neglected dermatosis.

Idiopathic rapid gastric emptying (IRGE), also called idiopathic dumping syndrome, is a rare gastrointestinal (GI) motility disorder marked by an abnormally accelerated gastric emptying with no history of gastric surgery, diabetes mellitus, or other structural anomalies of the stomach or small intestine. This disorder has a similar presentation to classic dumping syndrome. Yet, it happens in patients with an intact stomach and pylorus, with no evidence of previous gastric surgeries. Due to its similarity with other endocrine hypoglycemic syndromes and functional GI disorders, IRGE remains misdiagnosed and/or underreported. Thus, it is a significant diagnostic challenge for physicians. We present a case of a 21-year-old female with a chronic history of postprandial diarrhea, carbohydrate intolerance, and symptomatic postprandial hypoglycemia. She had no history of prior gastric surgery, and her investigations, including endoscopy and radiology, demonstrated normal findings. Gastric emptying scintigraphy (GES) revealed 100% gastric emptying at 60 minutes (retained meal value of less than 70% at 30 minutes or less than 30% at 1 hour is indicative of rapid gastric emptying). Based on these findings and after exclusion of other differential diagnoses, a diagnosis of IRGE was established. This case highlights the importance of identifying IRGE as a distinct clinical entity that causes postprandial hypoglycemia and GI symptoms. Early recognition can help in timely diagnosis and targeted therapy.

Type 2 diabetes mellitus (T2DM) poses a significant global health challenge, impacting millions of people worldwide. While many studies focus on HbA1c levels, there remains a need to evaluate glycemic variability and postprandial glucose (PPG) excursions. Therefore, this study was conducted to assess and compare the safety and effectiveness of nutritional therapy and alpha-glucosidase inhibitors in achieving rapid PPG stabilization in an Indian subpopulation of patients with T2DM.

This short-term open-label study included T2DM patients uncontrolled on metformin and sulfonylurea. The study enrolled 60 participants (40 males, 20 females) with a mean age of 54.06 ± 6.04 years, with the majority being 30-60 years of age (85%). All patients were given intermittent medical nutritional therapy (low glycemic index (LGI) diet) and alpha-glucosidase inhibitors (AGIs; acarbose, voglibose) to manage postprandial glycemia. A rotational design ensured that each group experienced all interventions in varying sequences for a comprehensive analysis of their effects. Glycemic responses were assessed using finger-stick capillary glucose measurements and continuous glucose monitoring (CGM) to evaluate postprandial and 24-hour glycemic variability.

Postprandial mean glucose levels were significantly reduced with all interventions (p<0.05), with the highest reduction observed with acarbose. Between AGIs, the adverse effects were similar between medications. The 24-hour mean glucose levels, mean amplitude of glycemic excursion, and area under the curve for 24-hour glycemic fluctuations were significantly lower with interventions, especially acarbose.

We conclude that AGIs and LGI diets effectively reduce postprandial glucose, especially in Indian T2DM patients consuming high-carbohydrate diets with a high glycemic load.

Purpose This study aimed to assess the prevalence of insomnia in adults with type 2 diabetes mellitus and its association with glycated hemoglobin. Methods In this cross-sectional study, patients attending a diabetes clinic completed the Insomnia Severity Index and the Hospital Anxiety and Depression Scale (HADS). Glycated hemoglobin values were self-reported by participants based on their most recent laboratory result. Logistic and linear regression analyses evaluated demographic and psychological predictors of insomnia and the relationship between insomnia and glycated hemoglobin. Results The prevalence of clinically significant insomnia symptoms was 37.7%. Higher HADS total scores were independently associated with insomnia, while age, sex, and glycated hemoglobin were not significant predictors. Insomnia status was not significantly associated with glycated hemoglobin levels (coef.=0.04; p=0.28). However, age, sex, and glycated hemoglobin each independently predicted total HADS score (all p<0.01), suggesting a multifaceted interplay among demographic, metabolic, and psychological factors. Conclusions Insomnia affects over a third of adults with type 2 diabetes mellitus, but was not independently associated with glycated hemoglobin. Routine sleep and mental health screening, especially in younger patients, could improve well‑being and type 2 diabetes mellitus management.

Background and objectives Lower respiratory tract infections (LRTIs) are a major cause of morbidity and mortality worldwide, with growing diagnostic challenges due to evolving bacterial profiles and antimicrobial resistance. This study aimed to evaluate the clinico-microbiological spectrum of bacteria isolated from bronchoalveolar lavage (BAL) samples in patients with suspected LRTIs and to analyze their antimicrobial susceptibility patterns at a tertiary care hospital in Odisha, India. Methods A retrospective observational study was carried out over three years, during which BAL samples from adult hospitalized patients with clinically diagnosed LRTIs were processed using established microbiological techniques. Bacterial identification and antimicrobial susceptibility testing were performed following standard microbiological procedures. Demographic data and comorbidities were also evaluated. Results Of 390 BAL samples, 222 (56.9%) yielded significant pathogenic growth. A male predominance and a high prevalence of comorbidities, particularly diabetes mellitus, were noted among the patients. Gram-negative bacteria constituted the majority of isolates, with Klebsiella pneumoniae as the most frequently isolated pathogen. Gram-negative isolates showed a high rate of resistance to β-lactams, cephalosporins, and fluoroquinolones, while Gram-positive cocci remained uniformly susceptible to vancomycin and linezolid. Conclusions The study highlights a predominance of Gram-negative pathogens in LRTIs and confirms BAL as an effective diagnostic modality. Continuous regional surveillance and prospective multicentric studies incorporating molecular resistance profiling are essential to guide rational empirical therapy and strengthen antimicrobial stewardship.

Endogenous Cushing syndrome (CS) is associated with increased risk of morbidity and mortality, and infections are among its major complications. The aim of this study was to evaluate the predictive value of cortisol-related indices, blood cell-derived inflammatory indices, and the prognostic nutritional index (PNI) for perioperative infection and to identify risk factors.

A total of 113 patients with confirmed CS were included: 71 pituitary CS, 37 adrenal CS, and 5 ectopic CS. ROC analysis was performed to evaluate predictors of infection. Multivariable models were constructed, and the best-performing model was selected as the final model.

Thirty-five CS patients (31%) developed infection. ROC analysis demonstrated that 1-mg DST (AUC = 0.852) and PNI (AUC = 0.845) were the strongest predictors of infection. In the final model, 1-mg DST ≥ 17.2 µg/dL (OR: 9.741; 95% CI: 2.801-33.883; P < 0.001), PNI ≤ 51.4 (OR: 9.569; 95% CI: 2.683-34.122; P < 0.001), the presence of diabetes mellitus (OR: 3.963; 95% CI: 1.128-13.925; P = 0.032), and presence of bone fracture(s) or a T-score ≤ -3 (OR: 3.574; 95% CI: 1.003-12.730; P = 0.049) were identified as independent risk factors for infection.

Perioperative infection was associated with elevated cortisol and lower PNI levels in patients with CS. Assessment of 1-mg DST and PNI, in conjunction with diabetes mellitus status and bone health, may enhance the identification of high-risk patients and guide targeted preventive strategies.

To assess the effects of a telehealth-enhanced integrated county-township-village management model (hereafter referred to as the telehealth management model) on metabolic indicators and chronic complications of rural-dwelling individuals with diabetes mellitus (DM), seeking an effective chronic disease management approach for regions with limited medical resources.

An exploratory quasi-experimental study was conducted in Dafang County, Guizhou Province. Three townships were assigned to the management group, while the remaining townships constituted the control group. The management group participated in a 12-month diabetes intervention using a telemedicine platform for comprehensive care, while the control group received standard outpatient follow-up. Key indicators measured before and after the intervention included fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hPG), haemoglobin A1c (HbA1c), blood lipids, blood pressure, body mass index (BMI), the incidence of new chronic complications, and the pass rate on a diabetes knowledge assessment. Statistical analyses, including descriptive analyses for patient characteristics, multivariable regression for associations and adjusted effects, subgroup and restricted cubic spline analyses for heterogeneous and nonlinear relationships, and a propensity score matching combined with difference-in-differences (PSM-DID) approach to estimate the causal effect of the intervention, were performed.

In this study including 215 patients (88 in the management group and 127 in the control group), compared with the control group, the management group showed significant improvements after 12 months, including lower FBG (8.97 vs. 10.77), 2hPG (13.30 vs. 16.96), HbA1c (7.84 vs. 9.45), triglyceride (TG, 1.84 vs. 2.43), and BMI (23.94 vs. 26.09) levels and higher high-density lipoprotein cholesterol (HDL-C, 1.26 vs. 1.10) levels (all P < 0.05). They also had fewer new chronic complications (8.0% vs. 29.9% in the control group; P < 0.001). Multivariate analysis and PSM-DID analysis demonstrated an association between the management group and improved glycaemic control, and a reduction in the incidence of new complications.

Compared to standard of care, the telehealth management model improved patients' metabolic indicators, decreased complication risks, and strengthened primary health care services. This model provides a replicable example for the scalable implementation of integrated diabetes management in similar underdeveloped regions.

DM is a chronic metabolic disorder with a globally increasing prevalence. IFG, a major subtype of prediabetes, is highly prevalent amongthe Chinese adult population and represents a critical window for therapeutic intervention. The ZJU index is a comprehensive metabolic indicator that reflects systemic insulin resistance and metabolic burden status. However, its association with bidirectional glycemic outcomes specifically in individuals with IFG remains unclear. This study aimed to investigate the impact of the baseline ZJU index on the progression to diabetes, as well as on the reversion to normoglycemia.

This multicenter retrospective cohort study analyzed data from 11,243 individuals with IFG enrolled in a health screening program between 2010 and 2016. The ZJU index, calculated using a standardized formula, served as the primary exposure variable. We employed Cox proportional hazards regression and logistic regression models to examine the association between the ZJU index and glycemic status transition. RCS was used to explore nonlinear relationships, and a threshold effect analysis was conducted to identify potential inflection points. Subgroup and sensitivity analyses were performed to assess the robustness of the associations.

Higher baseline ZJU index quartiles were significantly associated with a decreased likelihood of reversion to normoglycemia and an increased risk of diabetes progression. In the fully adjusted Cox model, each one-unit increase in the ZJU index was associated with a 3% lower hazard of reversion to normoglycemia and a 12% higher hazard of progression to DM. RCS analysis revealed a linear inverse association with reversion and a nonlinear positive association with progression, with an inflection point at a ZJU index of 38.499. Subgroup and sensitivity analyses confirmed the robustness and consistency of these associations across diverse population strata and data handling methods.

In individuals with IFG, a higher ZJU index demonstrates​ a linear inverse association with reversion to normoglycemia and a non-linear positive association with progression to incident DM. Accordingly, the ZJU index can serve as​ a practical tool for risk stratification and precision management, guiding preventive strategies for those at high risk of DM.

The Zhejiang University (ZJU) index is an established surrogate marker for metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to investigate the association between ZJU index and hyperuricemia in patients with type 2 diabetes mellitus (T2DM).

We performed a retrospective cross-sectional analysis of 1772 adults with T2DM at the Affiliated Hospital of Jiangsu University. The ZJU index was derived from clinical metabolic variables, and participants were classified by hyperuricemia status. Associations between the ZJU index and hyperuricemia were examined using multivariable regression, restricted cubic spline modeling, and subgroup analyses.

Patients with hyperuricemia exhibited significantly worse metabolic profiles, including higher ZJU index levels (P<0.001). The ZJU index demonstrated a significant positive association with the prevalence of hyperuricemia (OR = 1.036, 95%CI: 1.017-1.056, P<0.001) and serum uric acid levels (β=1.187, 95%CI: 0.595-1.780, P<0.001), with a graded increase observed across quantiles (P for trend<0.001). Restricted cubic spline analysis further indicated a linear relationship. The association showed overall consistency across subgroups, while a stronger effect was evident in participants with coronary heart disease.

The ZJU index is associated with hyperuricemia in T2DM and may reflect interlinked hepato-metabolic pathways that drive hyperuricemia.

Hypertension and Type 2 Diabetes Mellitus (T2DM) interact to increase cardiorenal risk. This study evaluated the cardiorenal efficacy of dapagliflozin combined with valsartan in patients with coexisting T2DM and hypertension.

This retrospective cohort study included 245 patients admitted between January 2023 and December 2024. Propensity score matching yielded 102 patients in the Monotherapy Group (valsartan 80 mg/day) and 102 in the Combination Group (valsartan 80 mg/day + dapagliflozin 10 mg/day). Outcomes assessed at baseline and 24 weeks included blood pressure, glycemic parameters (FPG, 2hPG, GluCV, PGE, LAGE, MAGE), inflammatory and cardiac biomarkers (hs-CRP, TNF-α, IL-6, IL-33, sST2, sICAM-1), echocardiographic measures (LVEF, LVEDD, LVESD, LAD, IVSd), NT-proBNP, renal function (eGFR, UACR, SCr, BUN), and fibrosis markers (PIIINP, C-IV, LN, TGF-β1).

At 24 weeks, the Combination Group showed greater reductions in systolic (134.86 ± 6.37 vs. 139.68 ± 6.82 mmHg) and diastolic blood pressure (83.12 ± 4.58 vs. 86.29 ± 4.79 mmHg), FPG (6.79 ± 1.02 vs. 7.58 ± 1.10 mmol/L), 2hPG (9.71 ± 1.68 vs. 11.24 ± 1.84 mmol/L), and glycemic variability indices (all P < 0.001). Inflammatory and cardiac biomarkers declined more markedly (P < 0.05). Significant improvements were also observed in LVEF (60.12 ± 4.68% vs. 56.75 ± 4.96%), NT-proBNP, eGFR, UACR, and fibrosis markers (all P < 0.05). Multivariate analysis showed combination therapy independently predicted better outcomes (OR = 2.417, 95% CI: 1.315-4.443, P = 0.004).

The addition of dapagliflozin to valsartan was associated with superior cardiorenal outcomes compared to valsartan monotherapy in patients with T2DM and hypertension, as evidenced by enhanced improvements in blood pressure, glycemic control, inflammation, cardiac function, and renal parameters.