Non-communicable diseases (NCDs) are increasingly prevalent in humanitarian settings, yet modifiable and environmental risk factors among displaced populations remain poorly characterized. Refugees in protracted settlements face elevated exposure to risks such as unhealthy diets, physical inactivity, substance use, and indoor air pollution. This study assessed the prevalence and socio-demographic patterns of key NCD risk factors among adult refugees and asylum seekers in the Kalobeyei Integrated Settlement, northern Kenya.

A cross-sectional mixed-methods study was conducted with 488 adults selected through multi-stage sampling. Structured household surveys assessed modifiable (tobacco and alcohol use, physical activity, diet, salt intake) and environmental (cooking and lighting fuel) NCD risk factors. Bivariate and multivariate logistic regression identified significant associations. Additionally, 18 key informant interviews and 3 focus group discussions were conducted and analyzed thematically.

Nearly all participants (99.6%) reported at least two NCD risk exposures, and 88% had three or more. Lifetime alcohol use was reported by 16.2%, with low education independently associated (OR = 3.51, p = 0.017). Tobacco use (6.1%) occurred only among Christians or those with no religion. Only 33.8% met World Health Organization (WHO) physical activity guidelines, with these same groups more likely to be active (OR = 5.82, p < 0.001). Low fruit and vegetable intake was widespread, while high salt use (22.8%) was more common among Muslims and older adults. Nearly all households (98.2%) relied on polluting cooking fuels, and over half used polluting lighting sources, disproportionately affecting non-Muslims. Compared to national benchmarks (Kenya STEPwise Survey, 2015), refugees in Kalobeyei reported lower substance use but substantially higher physical inactivity, dietary inadequacy, and environmental exposure. Religious affiliation functioned as a contextual marker for broader sociocultural, gendered, and infrastructural dynamics shaping risk profiles.

Refugees in Kalobeyei experience a high burden of overlapping NCD risk factors, shaped by structural inequalities, service access deficits, and sociocultural context. Addressing these risks requires multisectoral, culturally responsive strategies that integrate health, nutrition, energy, and protection systems in protracted humanitarian settings.

Dysmorphic RBC (DysRBC) as a marker of glomerular abnormalities is expected to have added value in screening for glomerular abnormalities along with other examinations, including renal tubular epithelial cells (RTECs) and pathological casts (PathCasts) that indicate tubular abnormalities in lupus nephritis (LN). Therefore, this study intended to assess the diagnostic performance of urinary cell and cast characteristics, including DysRBC, RTECs, and PathCast, as measured by the urine flow cytometry in lupus nephritic children.

Urine samples from 317 patients (50.47% female and 49.53% male) were collected. The diagnostic value was evaluated using receiver operating characteristic (ROC) analysis.

The ROC analysis demonstrated that all parameters exhibited acceptable discriminatory performance, including %DysRBC (AUC = 0.954, p < 0.001), RTEC (AUC = 0.580, p = 0.001), and PathCast (AUC = 0.664, p = 0.001).

DysRBC, RTECs, and PathCast may have added value in the diagnosis of LN in children, notably with excellent diagnostic value in distinguishing LN in %DysRBC. This promising result warrants evaluation with a large-scale site study.

Objective: To evaluate the prevalence of systemic chronic diseases among patients undergoing endodontic therapy in a University Department of Endodontology and to assess their potential implications for treatment planning and prognosis. Methods: A retrospective cross-sectional study analysis was performed on clinical records of patients aged > 18 years treated at the Department of Endodontics, University of Bologna. Data collected included demographic information, presence of chronic systemic diseases, endodontic disease and medication history. Descriptive statistics were used to estimate prevalence rates. Results: More than one third of patients (35%) presented with at least one systemic chronic disease or multiple comorbidities. Cardiovascular diseases (19.8%) were the most prevalent. Polypharmacy was observed in 32% of patients. Patients aged 40 years and older showed a significantly higher prevalence of systemic conditions compared to younger individuals. Conclusions: The study supports the finding that a high percentage of patients undergoing endodontic therapies present systemic chronic diseases, multiple comorbid conditions and polypharmacy. It is important to assess these factors and to customize endodontic treatment and decision-making. These realities are likely to become even more pronounced in the coming years, as global population aging continues apace.

Patient safety issues have become a priority in health policy and health systems governance. This priority has drawn attention to health professionals' licensing and effectiveness of the nursing curriculum in preparing students with the appropriate patient safety competencies. Despite their crucial role, there is a notable gap in the literature regarding the comprehension and competency of nursing students in patient safety within Iran.

This multicenter cross-sectional correlational study aimed to investigate the relationship between cultural competence, patient safety culture, and safe nursing care (SNC) among nursing students in southern Iran.

A total of 238 nursing students enrolled in clinical internship courses between November 2024 and February 2025 at three medical universities in Fars Province, Iran, were recruited using a census sampling approach. Data were collected through four instruments: (a) a demographic questionnaire; (b) the Hospital Survey on Patient Safety Culture, which measures perceptions of safety culture; (c) the Inventory for Assessing the Process of Cultural Competence, which evaluates cultural competence across five domains; and (d) the SNC tool, which assesses nursing performance in clinical skills, teamwork, and patient safety.

The students reported moderate to high levels of cultural competence (75.73 ± 17.2), moderate perceptions of patient safety culture (116.02 ± 21.25), and moderate to good performance in SNC (245.29 ± 59.16). Correlational analysis revealed statistically significant and positive associations among the three constructs, with patient safety culture strongly correlated with SNC (r = 0.68, p < .001) and moderately correlated with cultural competence (r = 0.50, p < .001). In the SNC model (Adjusted R ² = 0.46), academic year remained the strongest predictor (B = 44.536, 95% CI [33.201, 55.870], p < .001), highlighting the critical role of academic progression in enhancing safe care performance.

These findings underscore the need to integrate structured cultural competence and patient safety education into nursing curricula while expanding clinical learning opportunities in diverse healthcare environments. Furthermore, experiential training in multicultural settings may foster a deeper understanding of cultural and safety principles, thereby improving the quality of care at both individual and organizational levels.

Patients undergoing percutaneous coronary intervention (PCI) remain at substantial residual inflammatory risk, potentially driven by clonal hematopoiesis of indeterminate potential (CHIP), a novel pro-inflammatory contributor to atherogenesis. However, the clinical implications of CHIP-inflammation interplay in secondary prevention remain insufficiently understood. We aimed to investigate the joint impact of CHIP and systemic inflammation on prognosis among PCI patients.

This cohort included PCI patients receiving guideline-directed lipid-lowering and dual antiplatelet therapies. CHIP mutations were identified by targeted sequencing with a mean sequencing depth of 985 × . Systemic inflammation was assessed using 12 routine inflammatory indices. Cox proportional hazards models were used to assess the impact of CHIP and inflammatory indices on 5-year all-cause mortality, the primary outcome. Major adverse cardiac and cerebrovascular events (MACCE) comprised all-cause mortality, nonfatal myocardial infarction, ischemic stroke, stent thrombosis, and unplanned revascularization.

Among 3640 PCI patients, 799 (21.95%) carried CHIP mutations. During a median follow-up of 5.06 years, CHIP was independently associated with increased risks of all-cause (hazard ratio (HR), 1.76; 95% confidence interval (CI), 1.20-2.57) and cardiac mortality (HR, 2.19; 95% CI, 1.31-3.65). Notably, this association was significantly modified by systemic inflammatory burden, as reflected by aggregate index of systemic inflammation (AISI), monocyte-lymphocyte ratio (MLR), systemic immune-inflammatory index (SII), and systemic inflammatory response index (SIRI) (adjusted P_interaction < 0.05). Specifically, CHIP conferred no excess mortality risk in low-inflammatory states, as reflected by SII (HR, 0.92; 95% CI, 0.52-1.66), whereas elevated inflammation significantly amplified CHIP-related mortality risk (HR, 3.36; 95% CI, 1.94-5.82), even among small-clone carriers (variant allele fraction 0.5-2%). Although no overall association was observed between CHIP and 5-year MACCE, significant associations emerged under elevated levels of SII (HR, 1.31; 95% CI, 1.05-1.64) and SIRI (HR, 1.38; 95% CI, 1.10-1.72). Moreover, incorporating CHIP into the GRACE score, a traditional risk assessment tool, yielded a modest yet significant improvement in long-term mortality prediction after PCI (ΔC-index, 3%; 95% CI, 0.9-6.6%).

Hematopoiesis-related genetic alterations conferred excess prognostic risk, primarily in the presence of elevated hematological inflammation, underscoring the potential benefit of inflammatory burden management in PCI patients harboring CHIP.

Diabetes is a chronic medical disorder caused by insufficient production of the hormone insulin by the pancreas. Although there are various treatment options available for controlling diabetes, including non-peptide-based medications, the majority of these have adverse effects and are limited in comparison to peptide-based drugs. Protein drugs offer numerous benefits, including weight loss, significant reductions in blood glucose levels, and an extremely low risk of hypoglycemia. This article discusses treatment modalities, presents existing therapies, provides an in-depth comparison of peptide-based and other drugs, examines current development and barriers, offers some recommendations, and outlines future research directions for peptide drugs in the treatment of T2DM. In recent days, several computational tools and AI models, including ESMFold, ProteinMPNN, Schrödinger, and AutoDock Vina, have played an essential role in peptide-based drug discovery. Therefore, this article also highlights the significance of AI drug discovery, diverse AI models, and other computational tools to enhance peptide-based drug discovery and development.

Pediatric tuberculosis (TB) remains a critically underrecognized contributor to global childhood morbidity and mortality, with the highest burden concentrated in low-resource settings. Although children comprise a minority of overall TB cases, mortality is disproportionately high, particularly among those under five years of age, driven largely by delayed diagnosis, inadequate linkage to care, and limited access to effective treatment. The continued rise of pediatric multidrug-resistant TB (MDR-TB), especially in regions with low sociodemographic development, further highlights persistent gaps in current control strategies. This review synthesizes key aspects of pediatric TB pathogenesis and host immune responses that predispose young children to rapid disease progression and severe outcomes, including immune immaturity and paucibacillary infection. We summarize pulmonary and extrapulmonary disease manifestations and identify populations at heightened risk, including children with HIV, malnutrition, type 1 diabetes mellitus, and congenital or treatment-related immunosuppression. Ongoing challenges in diagnosis and treatment are discussed, including limitations of existing microbiologic and immunologic tests, specimen collection constraints, regimen toxicity, and barriers to adherence. Prevention remains central to reducing pediatric TB mortality. We highlight the sustained importance of bacille Calmette-Guérin (BCG) vaccination in preventing severe disease and death, the context-dependent variability in vaccine effectiveness, and the structural and socioeconomic determinants of vaccine coverage. We conclude that integrating equitable vaccine delivery, scalable preventive therapy, and child-adapted diagnostic strategies is essential to meaningfully reduce the global pediatric TB burden.

Background: Diabetic foot ulcers (DFUs) and lower-extremity amputations (LEAs) complicating diabetes mellitus are significant contributors to morbidity, mortality, and disease burden. There is insufficient evidence, however, linking podiatric care to mortality and healthcare resource use. There is, concurrently, inadequate access to podiatric care, particularly in Asia. This study evaluated the clinical and healthcare use outcomes of patients with DFUs who received podiatric care. Methods: A longitudinal study involving patients in Diabetic Foot in Primary and Tertiary (DEFINITE) Care followed over a period of 2 years reviewed the effectiveness of podiatric care with regard to 1-year outcomes using multiple logistic and zero-inflated negative binomial regressions, adjusting for covariates. Clinical outcomes were minor and major LEA, mortality, and LEA-free survival rates; healthcare use outcomes were the number of admissions, number of visits to clinics and emergency departments, and length of stay. Results: Eligible patients (n = 2798 [65.5%]) completed at least 12 months of follow-up. Comparisons were made with patients without access to podiatric care. The overall mean ± SD patient age was 65.7 ± 12.7 years. Most patients receiving podiatric follow-up were of Malay or Indian ethnicities and had poor diabetic control and chronic kidney disease. There were more admissions (p < 0.01) and visits to the emergency department (p < 0.01) and hospital outpatient clinics (p < 0.01), but a shorter length of stay (incidence rate ratio, 0.833; p < 0.01), without any reported differences regarding visits to public primary care clinics (p = 0.68). There were more minor LEAs (p < 0.01) but fewer deaths (p < 0.01) and greater LEA-free survival (odds ratio, 1.26; p = 0.02). Conclusions: Podiatric care improved clinical outcomes for patients with DFU, particularly in terms of LEA-free survival, with a positive impact on healthcare utilization. This is a crucial contribution to the limited evidence on podiatric care in diabetic limb salvage in Asian populations.

Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications. While considerable attention has been paid to the management of GDM during pregnancy, women's perceptions of GDM, knowledge of associated risk factors and health behaviours before and between pregnancies are less well understood, despite their importance for informing diabetes prevention programmes.

To explore women's knowledge of GDM risk factors, perceptions of GDM and preconception health behaviours.

Individual semi-structured interviews were undertaken with 23 women with GDM in the third trimester of pregnancy. Data were analysed using a template analysis based on preconception knowledge, risk communication, and perceptions and behaviours.

Women often had limited knowledge of GDM before pregnancy, with many first learning about the condition during antenatal screening. Perceptions of risk were largely weight or BMI centred, with less recognition of other factors. Although participants commonly described intentions to improve diet quality and increase physical activity prior to conception, these intentions were rarely translated into sustained behaviours. Reported barriers included time constraints, caregiving responsibilities, financial costs and limited access to clear, culturally appropriate guidance. Pregnancy preparedness varied by parity: women approaching a first pregnancy focused on general preparation and navigating the healthcare system, whereas women with a prior GDM experience planned around potential recurrence, including early self-management and glucose monitoring.

Findings support two priorities: (1) strengthening communication and education at the time of GDM screening and diagnosis so that results and next steps are clear, supportive and person-centred; and (2) providing universal, general preconception support delivered proportionately to need, alongside targeted interconception pathways for women at higher absolute risk, following GDM. The findings do not imply universal GDM-specific preconception education for all women; rather, they indicate a need for needs-based communication during pregnancy and targeted interconception support delivered with clear signposting to resources.

An advisory group of seven women has been involved in this project. Four online sessions were conducted (between October 2023 and July 2024) to develop the research question, study materials, recruitment plans, interview schedules and participant retention plan.