Central line-associated bloodstream infections (CLABSIs) remain a major cause of healthcare-associated mortality, prolonged hospitalization, and increased healthcare costs, especially in resource-poor settings where surveillance data are scarce. This study aimed to determine CLABSI incidence, risk factors, causative organisms, and antimicrobial resistance (AMR) patterns across adult intensive care units (ICUs).

A prospective longitudinal study was conducted amongst 200 adult ICU patients with central line (CL) in-situ for >2 calendar days. CLABSI surveillance followed definitions by The Centers for Disease Control and Prevention, National Healthcare Safety Network. Microbiological identification and antimicrobial susceptibility testing were performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines.

The overall CLABSI incidence was 19.25/1,000 catheter days. CLABSI patients demonstrated significantly extended hospitalization (20.22 vs 9.09 days, p<0.001) and CL duration (16.17 vs 7.85 days, p<0.001). Femoral lines had the highest infection rate (42.85%). The median time from CL insertion to the onset of CLABSI was 7.5 days. Gram-negative organisms predominated (75%), with Acinetobacter species being most frequent (36.1%), followed by Candida species (22.23%). Comorbidities such as hypertension, type 2 diabetes mellitus, tuberculosis, and drug abuse showed no significant association with CLABSI. Antimicrobial resistance (AMR) was extensive; all isolates were resistant to most antibiotic classes, including penicillins, cephalosporins, and carbapenems. In contrast, colistin retained 100% susceptibility. CLABSI was associated with significantly higher mortality (69.4% vs. 47%; p = 0.014) and a lower rate of discharge/transfer to a healthy setting (p = 0.0112) compared to non-CLABSI patients.

The study demonstrates high CLABSI incidence and alarming levels of AMR, underscoring the urgent need for strengthening infection prevention practices and antimicrobial stewardship in ICUs.

Numerous cases of mucormycosis appeared among COVID-19 patients, predominantly in Asian countries. This study aimed to investigate the clinical profile, in-hospital outcome, and one-year prognosis of COVID-19-associated mucormycosis (CAM).

All patients who developed CAM in Shiraz, South Iran, between July and October 2021 were included in this study. We collected data on presentations, comorbidities, risk factors, and outcomes.

Sixty-two patients with CAM were analyzed; the mean age was 59.3 years, and 58.1% were male. Diabetes mellitus was present in 80.6% (11.2% uncontrolled), hypertension in 54.8%, and chronic kidney disease in 11.3%. All patients had sinonasal involvement; ophthalmic, cutaneous, cerebral, gastrointestinal, pulmonary, and renal involvement occurred in 41.9%, 8.1%, 6.4%, 6.4%, 1.6%, and 1.6%, respectively. In-hospital and one-year mortality were 40.3% and 48.3%. Concurrent CAM and COVID-19, hypertension, older age, and radiologically severe COVID-19 lung involvement were associated with higher mortality. In multivariable analysis, age ≥60 years predicted in-hospital (OR: 5.47; 95% CI: 1.53-19.56) and one-year mortality (OR: 7.65; 95% CI: 1.90-30.84). Long-term mortality was also associated with ≥3 risk factors (OR: 4.12; 95% CI: 1.09-15.52) and lung severity index >30 (OR: 9.35; 95% CI: 1.01-86.63).

These findings emphasize the critical role of age in immune responses to opportunistic infections and highlight the impact of multiple comorbidities and severe lung damage on long-term prognosis in CAM.

Chronic kidney disease (CKD) is a growing public health concern, yet evidence on its incidence is limited in China.

Using data from the China Kadoorie Biobank (CKB), which recruited 512,723 participants aged 30 to 79 years from 10 areas across China, we analyzed 5 major CKD subtypes: diabetic kidney disease (DKD), hypertensive nephropathy (HTN), glomerulonephritis (GN), chronic tubulointerstitial nephritis (CTIN), and obstructive nephropathy (ON). Total CKD included the aforementioned subtypes, CKD due to other reasons, or chronic kidney failure. Outcomes were ascertained through linkages to local death and disease registries and health insurance databases until December 31, 2018. Poisson regression model was used to assess secular trends and population variations.

Over a mean of 9.5 years of follow-up, 5662 total CKD cases were identified. The crude incidence rate (per 100,000 person-years) of total CKD was 119.7 (95% confidence interval: 116.6-122.8) between 2009 and 2018, with an annual increase of 8.9% (7.9%-10.0%) after adjusting for age, sex, and study area. The crude incidence rates were highest in GN, whereas biggest increases were observed in ON, DKD, and HTN. Total CKD incidence rate was similar between urban and rural areas; however, those of different subtypes varied: DKD or CTIN were higher in urban areas, and ON was significantly higher in rural areas. Males, older adults, and participants with hypertension or diabetes mellitus were at higher risks.

Despite the underestimation of CKD incidence because of outcome ascertainment methods, the incidence of total CKD and its subtypes increased in the CKB population during 2009 to 2018. Measures should be taken against major driving factors, such as diabetes mellitus, hypertension, and kidney stones.

Real-world data on the effect of polyethylene glycol loxenatide (PEG-Loxe) in patients with Type 2 diabetes mellitus (T2DM) with normal body mass index (BMI) are lacking. Therefore, this study aims to observe the effect of PEG-Loxe on the weight of patients with T2DM with different BMIs.

This single-center, retrospective real-world study included patients with T2DM, aged ≥ 18 years, and receiving PEG-Loxe/sodium-glucose cotransporter 2 inhibitor (SGLT2i). The primary endpoint was change in body weight after 24 weeks of treatment. Secondary endpoints included proportion of patients with body weight reduction < 5.0% and < 10%, changes in BMI, and glycosylated hemoglobin (HbA1c).

Overall, 487 patients treated with SGLT2i or PEG-Loxe were identified; after propensity score matching, 68 patients were included in each group. After 24 weeks, the mean change in body weight and BMI was -1.2 (-2.3, -0.1) and -0.4 (-0.8, -0.1) in the PEG-Loxe group and -2.4 (-3.5, -1.3) and -0.7 (-1.1, -0.4) in the SGLT2i group. A ≥ 5% and ≥ 10% weight loss was noted by 32.4% and 8.8% of patients in the PEG-Loxe group, with a mean change in HbA1c (%) of -1.48 (-1.98, -0.99). Weight loss (≥ 5%) in obese patients (BMI > 28 kg/m²) was greater (PEG-Loxe: 53.3%, SGLT2i: 57.1%) compared to patients with 24 ≤ BMI < 28 kg/m² (PEG-Loxe: 25.7%, SGLT2i: 41.4%) and BMI < 24 kg/m² (PEG-Loxe: 27.8%, SGLT2i: 28%).

PEG-Loxe resulted in weight loss and glycemic control in patients with T2DM. The weight loss was negatively correlated with baseline BMI without excessive weight loss in normal BMI, supporting PEG-Loxe's use in this group. Trial Registration: Chinese Registry of Clinical Trials: ChiCTR2400087532.

Mucormycosis is a rare infection, with incidence rising gradually over decades. However, during the COVID-19 pandemic, a blitzkrieg increase in cases was unprecedented. This phenomenon has remained unexplained, even though many theories have been postulated. Since the disease was rare previously, the implication of many clinical and pathological factors in its relation is still unclear and needs to be explored. This study was conducted with the aim to identify the clinico-histopathological factors associated with rhino-orbital mucormycosis (ROM) and to analyze their role in predicting survival.

A retrospective analytical study was conducted in a tertiary healthcare center from April 2020 to March 2024 on 63 diagnosed cases of ROM. The various clinical factors (age, gender, comorbidities) and histopathological parameters (fungal load, predominant inflammation, grade of inflammation, tissue necrosis, presence of granuloma, angioinvasion, or perineural invasion) were evaluated for their significance in predicting survival.

The study showed a male preponderance and the commonest clinical comorbidity noted was diabetes mellitus. Clinically, the patients without orbital involvement had significantly greater survival. The evaluation of pathological parameters revealed that the cases with granuloma formation had better survival, while those with involvement of >2 cell types and lesser tissue necrosis had greater intervals between diagnosis and death.

In patients with ROM, orbital involvement has a more sinister impact on survival. Various histopathological characteristics can predict prognosis and possibly aid as a guide for implementing more aggressive management plans to improve survival.

Lean diabetes mellitus (DM), defined as the presence of DM in patients with low-normal body mass index (BMI), is an emerging concept associated with poorer cardiovascular and all-cause outcomes. We aimed to describe the clinical characteristics of aortic stenosis (AS) patients with concomitant lean DM, an understudied metabolic profile, and to evaluate its clinical relevance.

In this retrospective cohort study involving 315 moderate and severe AS patients, identified from an echocardiographic database at a tertiary medical centre between September 2011 and December 2015, patients were stratified based on obesity (BMI ≥ or <23 kg/m²) and DM status. Outcomes were analysed over a follow-up period of 3.0 ± 2.1 years.

The mean age was 72.2 ± 13.1 years old, and 52.4% were female. Among the 315 patients with moderate and severe AS, 47 (14.9%) were lean DM, 24.4% were lean without DM, 30.0% were non-lean with DM, and 33.7% were non-lean without DM. Compared with non-lean DM patients, AS patients with lean DM were older (p < 0.001), and had a greater burden of cardiovascular co-morbidities, such as hypertension (p < 0.001) and coronary artery disease (p < 0.001). Lean DM was associated with an increased hazard of major adverse cardiovascular events (MACEs) on multivariable analysis (adjusted hazard ratio 1.81, 95% confidence interval 1.01-3.27, p = 0.046), after adjusting for demographics, co-morbidities, left ventricular ejection fraction, and AS severity.

The presence of lean DM in moderate and severe AS patients portends a higher risk of MACE, and represents a high-risk phenotype that may warrant closer surveillance and earlier intervention.

Conventional didactic education may be limited in addressing the psychosocial complexities of Type 2 Diabetes Mellitus (T2DM). Nurse-led multicomponent psychoeducational interventions provide a potential approach by integrating clinical and psychosocial support. This study aims to evaluate the glycemic and psychosocial outcomes of these interventions through a systematic review and meta-analysis.

A systematic search was conducted across PubMed, Scopus, and EBSCOhost following PRISMA 2020 guidelines. Methodological quality was assessed using the Cochrane Risk of Bias tool. A meta-analysis using a random-effects model was performed for the primary outcome (HbA1c), while psychosocial outcomes were synthesized narratively in accordance with SWiM guidelines.

Fifteen primary studies involving diverse global cohorts were synthesized. Nine of the 15 trials showed statistically significant HbA1c reductions favoring the intervention group. Meta-analysis of 13 trials (n=3,568) revealed a pooled HbA1c reduction of -0.69% (95% CI: -1.00 to -0.37; P < 0.0001). Sensitivity analysis, excluding two outliers, indicated a stable mean difference (MD) of -0.51% (95% CI: -0.69 to -0.32; P < 0.00001) and substantially reduced heterogeneity in long-term subgroups (I-squared decreased from 96% to 23%). Beyond glycemic outcomes, the synthesis suggests that interventions combining emotional validation with structured behavioral action particularly those utilizing motivational interviewing and cognitive-behavioral techniques show potential in reducing diabetes distress and enhancing self-efficacy.

Current meta-analytical evidence suggests that nurse-led multicomponent interventions may help bridge the gap between clinical requirements and humanistic needs, showing potential improvements in both HbA1c and psychosocial well-being. Based on these synthesized findings, this review presents the Education, Validation, and Action (EVA-Diabetes Care Model) framework as an exploratory conceptual model, positing that emotional validation may support sustained behavioral modification. Future well-powered, prospective, multicenter randomized controlled trials are required to empirically validate the clinical efficacy and long-term sustainability of the EVA-Diabetes Care Model protocol.

Metformin is the first-line oral antihyperglycemic agent for type 2 diabetes mellitus (T2DM), with over 150 million individuals worldwide receiving treatment annually. Although synthesized in 1922, its clinical adoption began in the 1950s, and decades of widespread use have firmly established its efficacy in glycemic control and metabolic improvement. Nevertheless, growing evidence indicates that metformin exerts pleiotropic effects beyond glucose homeostasis-modulating neurocognitive function, gastrointestinal physiology, reproductive endocrinology, and cellular aging pathways. Many of these effects remain incompletely characterized, mechanistically ambiguous, or clinically inconsistent across populations. This review systematically synthesizes recent (2014-2024) preclinical and clinical evidence from PubMed and Google Scholar to critically evaluate the contested physiological and pathophysiological actions of metformin. We distinguish robustly replicated findings from preliminary or contradictory observations, clarify dose- and context-dependent mechanisms (e.g., mitochondrial vs. lysosomal AMPK activation), and highlight knowledge gaps impeding safe, personalized application. Emphasis is placed on reconciling mechanistic insights with real-world therapeutic outcomes-particularly regarding long-term safety, interindividual variability in pharmacokinetics (e.g., OCT/MATE transporter polymorphisms), and the need for prospective studies integrating multi-omics profiling and extended follow-up.

Laparoscopic resection of liver segment 6 has gradually become widely applied. Nevertheless, several intraoperative challenges persist, primarily concerning adequate visual exposure, restricted operative workspace, and precise hemorrhage management under laparoscopy. These difficulties are particularly pronounced in patients with concurrent liver cirrhosis, where surgical risk is markedly amplified. The liver hanging maneuver (LHM), originally devised for extensive right hemiliver tumor resections. In recent years, LHM technology has evolved into several versions and has been applied in laparoscopic liver resection surgeries but remain limited.In this study, a new modified form of the LHM was employed in two patients presenting with liver cirrhosis and segment 6 hepatocellular carcinoma (HCC), facilitating efficient laparoscopic liver resection (LLR). This modified approach was designated as the right liver hanging maneuver (RLHM). The surgical procedure went smoothly, and the short-term outcomes were satisfactory. Therefore, this method is presented herein.

Two patients preoperatively diagnosed with HCC secondary to hepatitis B-related cirrhosis underwent laparoscopic segment 6 resection. One case involved decompensated cirrhosis with Child-Pugh grade B hepatic function, whereas the other case was a 72-year-old individual with multiple comorbidities, including hypertension, coronary heart disease, and diabetes mellitus. During the procedure, the RLHM technique, in conjunction with intraoperative ultrasonography, enabled rapid and complete tumor excision. Intraoperative blood loss in both cases remained below 100 mL, no transfusion was necessary, and postoperative outcomes were favorable.

This report highlights the advantages of the RLHM technique for liver cirrhosis patients with Segment 6 HCC. It is suggested to conduct further extensive research to confirm safety and feasibility.

Telemedicine (TM) in general practice has declined following the pandemic. One reason is deemed to be the lack of clear evidence regarding the quality of care provided by TM. Therefore, the aim of this review, was to systematically present the existing evidence concerning the use of TM applications in general practice.

This structured review includes randomized controlled trials (RCT) and observational studies with a control group. The literature search targeted the time period from 2011 to 2025, screened by two researchers who focused in particular on medical efficacy, economic effects, and patient experiences.

The searches in the PubMed and Cochrane databases yielded 488 publications (30 June 2025). After filtering out duplicates and performing multi-step screening (title, abstract and full text), 22 studies were included in the final analysis. Over 50% of these studies found positive significant effects in the clinical outcomes. Over 80% of the included studies entailed asynchronous applications and 95% of the studies observed a time period of 12 months or less. The studies focused primarily on chronic somatic diseases, including diabetes mellitus type 2, hypertension and heart failure.

Our findings demonstrate that there is evidence supporting the use of telemedicine in general practice. However, the majority of the studies focused on diseases that are not among the most common reasons for encounter and had a rather short follow-up observation period. The fact that the studies were not initiated by the specialty itself is the most likely explanation for these findings. There was no evidence that TM causes (significant) worsening of outcomes in the conditions addressed in the included studies.