Mpox, a re-emerging orthopoxvirus infection, shares clinical similarities with smallpox but is typically less severe. However, immunosuppressed individuals, including those with uncontrolled HIV infection, are at risk for severe and atypical clinical presentations of mpox. We report the case of a 40-year-old Nigerian man living with HIV who was non-adherent to antiretroviral therapy (ART) and presented with extensive vesiculopustular eruptions that evolved into vegetative, ulcerated plaques accompanied by fever, lymphadenopathy, and significant weight loss. Laboratory evaluation showed profound immunosuppression (CD4 <20 cells/μL), and polymerase chain reaction (PCR) testing for mpox was positive. He required 14 weeks of inpatient care, including supportive therapy, broad-spectrum antimicrobials, and intensive wound management. Mpox-specific antiviral therapies were unavailable. Although he achieved clinical recovery, he developed post-inflammatory alopecia, dyspigmentation, and significant psychological distress. This case highlights the risk of severe and prolonged mpox in people living with advanced HIV, the importance of early recognition and microbiological confirmation via PCR, and the need for multidisciplinary supportive care, including infection control, wound and skin management, ART optimisation, and mental-health support. Mpox-specific antivirals should also be made more accessible for patients with severe disease.

Digital learning technologies have transformed medical education, with artificial intelligence (AI) and gamification emerging as two of the most active areas of innovation. While each has demonstrated value independently, their integration offers distinctive potential to personalise learning, sustain engagement, and produce durable educational outcomes. Yet the convergence remains empirically disjointed and theoretically underdeveloped. This pedagogically grounded critical review synthesises the evidence at the crossroads of AI and gamification in medical and health professional education, drawing on randomised trials, scoping reviews, meta-analyses, and case studies from PubMed, DOAJ, ERIC, and Web of Science. We propose an operational definition of AI-enhanced gamification and introduce an integration matrix linking five AI methods (reinforcement learning, Bayesian learner modelling, natural language processing, computer vision, recommender systems) to specific gamification elements and to learning mechanisms grounded in Self-Determination Theory, Flow Theory, constructivism, Vygotsky's Zone of Proximal Development, connectivism, the TPACK model, and the Behaviour Change Technique taxonomy. We map applications across health literacy, mental health psychoeducation, rehabilitation, and medical education, supported by ten real-world examples. We identify challenges in theoretical grounding, outcome measurement, validation, algorithmic bias, reproducibility, equity, and regulation, and close with a prioritised, feasibility-tagged research agenda for advancing AI-enhanced gamification as a credible digital learning innovation in medical education.

Gambling in older adults represents an emerging but still underrecognized mental health concern. Although gambling participation is increasingly observed in later life, the specific psychological, social, cognitive, and biological factors associated with gambling-related problems in older adults remain insufficiently characterized.

A systematic review was conducted in accordance with PRISMA guidelines. Empirical studies involving adults aged ≥55 years with Gambling were identified through searches of Web of Science, PubMed/MEDLINE, Scopus, PsycNET, ClinicalTrials.gov, and WHO ICTRP from January 15 to June 15, 2025.

From 40,263 identified records, 35 studies met the inclusion criteria. The included studies, published between 2000 and 2025, primarily investigated gambling behaviors, severity, psychosocial correlates, and associated mental health outcomes in older adults. Commonly identified correlates to gambling-related problems included loneliness, reduced social support, financial difficulties, male gender, stressful life events, and early gambling initiation. Gambling was frequently reported as a recreational activity but could become maladaptive when used as a strategy to regulate negative emotions or cope with social isolation. Psychiatric comorbidity, particularly depression and anxiety, was frequently observed in clinical and high-risk samples. Evidence regarding psychological interventions remains limited but suggests potential benefits.

Current evidence highlights substantial gaps in age-specific assessment and targeted interventions. Future studies should prioritize tailored psychological interventions addressing loneliness, emotional regulation, cognitive distortions, and life transitions in later adulthood.

Suicidal ideation and suicidal behaviour among university students are associated with multiple psychological factors, yet evidence from Indonesia remains limited, particularly studies examining emotion regulation difficulties, psychological well-being, and life satisfaction simultaneously. This study aimed to examine the associations of emotion regulation difficulties, psychological well-being, and life satisfaction with suicidal ideation and suicidal behaviour among university students in Indonesia.

This cross-sectional study was conducted from June to September 2024 among 420 university students from three state universities in Central Java and East Java, Indonesia. Participants were recruited using convenience sampling. Suicidal ideation and suicidal behaviour were assessed using the Beck Scale for Suicidal Ideation and the Suicidal Behaviors Questionnaire-Revised. Emotion regulation difficulties, psychological well-being, and life satisfaction were measured using the Difficulties in Emotion Regulation Scale-16, Ryff's Psychological Well-Being Scale, and the Satisfaction with Life Scale, respectively. Binary logistic regression analyses were performed using psychological total scores as continuous variables. The adjusted models controlled for age, sex, education level, GPA score, GPA satisfaction, parental socioeconomic status, place of residence, perceived family harmony, past physical medical history, and past mental health problem history.

Among the participants, 180 students (42.9%) were identified as having suicidal ideation, and 87 students (20.7%) were identified as being at risk of suicidal behaviour. In the adjusted continuous-variable models, higher emotion regulation difficulty scores were associated with higher odds of suicidal ideation (AOR = 1.07, 95% CI: 1.04-1.10) and suicidal behaviour (AOR = 1.04, 95% CI: 1.01-1.08). Higher life satisfaction scores were associated with lower odds of suicidal ideation (AOR = 0.93, 95% CI: 0.88-0.98) and suicidal behaviour (AOR = 0.93, 95% CI: 0.87-1.00). Higher psychological well-being scores were associated with lower odds of suicidal behaviour (AOR = 0.95, 95% CI: 0.92-0.99), but were not significantly associated with suicidal ideation after adjustment.

Greater emotion regulation difficulties and lower life satisfaction were associated with both suicidal ideation and suicidal behaviour, whereas lower psychological well-being was associated only with suicidal behaviour after adjustment. These findings suggest the importance of assessing multiple psychological factors in campus-based suicide prevention strategies and support the integration of mental health promotion into higher education policies in Indonesia.

Chronic subdural hematoma (CSDH) is increasingly common in older adults and in patients receiving antithrombotic therapy. Although burr-hole drainage is generally safe and effective, perioperative mortality remains a concern, and reliable preoperative predictors are incompletely defined. We aimed to identify independent preoperative predictors of in-hospital mortality after burr-hole drainage for CSDH, with explicit characterization of causes of death, comorbidity burden, and the discriminative performance of candidate predictors. This single-center retrospective cohort study included 121 consecutive adult patients surgically treated for CSDH between January 2015 and December 2024. Preoperative variables included demographics, Glasgow Coma Scale (GCS) score, hematoma thickness, midline shift (MLS), cerebral edema on CT, antithrombotic use, and a comprehensive set of comorbidities (chronic kidney disease, chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease, atrial fibrillation, diabetes mellitus, dementia, malignancy). Intensive care unit admission and postoperative complications were also recorded. The primary outcome was in-hospital mortality. Causes of death were systematically categorized. Associations were evaluated using Firth penalized logistic regression. Discriminative performance was assessed using receiver operating characteristic (ROC) analysis with bootstrap confidence intervals. A prespecified exploratory interaction analysis between cerebral edema and significant midline shift was performed. In-hospital mortality was 12.4% (15/121). The principal cause of death was cerebral herniation (9/15, 60.0%); extracranial complications (respiratory, septic, cardiac) accounted for 6/15 (40.0%). In the original multivariable Firth model, GCS ≤ 13 (adjusted OR 11.71, 95% CI 2.82-48.61, p < 0.001) and cerebral edema (adjusted OR 8.90, 95% CI 1.93-40.98, p = 0.005) were independently associated with mortality. In an extended model incorporating comorbidities, chronic kidney disease (OR 23.78, p = 0.025) and congestive heart failure (OR 42.39, p = 0.043) emerged as additional independent predictors, while cerebral edema (OR 61.89, p = 0.008) and GCS ≤ 13 (OR 5.80, p = 0.032) retained their associations. Combined model discrimination was excellent (Model 1: AUC 0.920; Model 2 with comorbidities: AUC 0.958). Subgroup analysis demonstrated a marked mortality gradient: 0% in patients with neither cerebral edema nor significant midline shift (n = 59), versus 72.2% in patients with both findings (n = 18). The exploratory interaction term (cerebral edema × midline shift ≥ 5 mm) was directionally consistent with synergy but did not reach statistical significance (OR 39.19, 95% CI 0.26-∞, p = 0.152), reflecting limited statistical power. Preoperative neurological impairment and cerebral edema are independently associated with in-hospital mortality after burr-hole drainage for CSDH. The coexistence of cerebral edema and significant midline shift identifies a clinically recognizable high-risk phenotype that may warrant heightened perioperative attention. Renal and cardiac comorbidities further contribute to mortality risk. These findings are hypothesis-generating and require validation in larger, prospective cohorts before incorporation into clinical risk stratification.Clinical trial number: not applicable.

This cross-sectional study investigated factors influencing self-care of hemodialysis (HD) patients with autogenous arteriovenous fistulas (AVFs) in primary hospitals in China. This cross-sectional study enrolled maintenance hemodialysis patients from blood purification centers in county-level primary hospitals affiliated with the Nephrology Specialist Alliance of the National Regional Medical Center in Shanxi Province between May and June 2024. Data were collected using a general information questionnaire and the Self-Care Ability Assessment Scale for MHD Patients with arteriovenous fistula (AVF), administered using the Wenjuanxing (an online survey platform commonly used in China) online survey platform. The analysis included 263 valid questionnaires (55.5% male; 52.5% >50 years old). The self-care ability score for arteriovenous fistula among 263 primary hospital MHD patients was 148.70 ± 17.89 (total score ranging from 38 to 190 points). The multivariable analysis indicated that diabetes mellitus (β=-5.187, P = 0.034), obtaining arteriovenous fistula-related knowledge through education provided by healthcare professionals (β = 7.288, P < 0.001), and regularly visiting medical institutions for arteriovenous fistula examinations (β = 9.397, P = 0.008) were independently associated with the arteriovenous fistula self-care ability among primary hospital MHD patients. AVF self-care ability among MHD patients in primary hospitals was moderate. Diabetes was a negative factor, while professional education and regular examinations were positive correlates. These findings provide preliminary evidence for intervention strategies in Chinese primary hospitals. However, due to the cross-sectional design and single-region sample, causality and generalizability to other populations are limited. Further research in diverse settings is required.

The global rise in Type 2 diabetes mellitus (T2DM) is increasingly driven by population aging; nearly one in four adults with diabetes is now aged 65 years or older. Older adults with T2DM, particularly, those on insulin, face heightened risks of hypoglycaemia, glycaemic variability and diabetes-related complications, contributing to functional decline, impaired quality of life and increased mortality. Conventional glycaemic assessment with glycated haemoglobin (HbA1c) inadequately captures clinically relevant glucose fluctuations, especially asymptomatic and nocturnal hypoglycaemia, which are common yet frequently unrecognised in this population. Continuous glucose monitoring (CGM) has emerged as a major advance in diabetes care, enabling real-time assessment of glucose trends and providing detailed metrics, such as time in range, that offer a more comprehensive picture of glycaemic control. Growing evidence links CGM use in older adults with T2DM to reductions in hypoglycaemia, improved glycaemic metrics and enhanced treatment satisfaction and quality of life. These benefits are, particularly, relevant in vulnerable subgroups, including adults aged ≥ 75 years, individuals with cognitive impairment or frailty and long-term care residents, where unrecognised hypoglycaemia and therapeutic inertia are especially prevalent. Despite growing guideline support, CGM adoption in routine care remains limited due to clinical, logistical, age-related and socioeconomic barriers. This narrative review summarises current evidence and clinical recommendations for CGM use in older adults with T2DM, focusing primarily on those aged ≥ 75 years and discusses implementation challenges and strategies to optimise its integration into individualised diabetes care.

Diabetic foot represents one of the most serious complications of diabetes mellitus. Short videos on diabetic foot are increasingly disseminated through TikTok and Bilibili apps, which have emerged as dominant sources of health-related content. However, the credibility and quality of information in these short videos have not been systematically evaluated. Our study aims to assess the quality and reliability of Chinese short videos on diabetic foot shared on TikTok and Bilibili. A cross-sectional study design was adopted, and a total of 244 short videos related to diabetic foot were collected from two platforms: TikTok and Bilibili. On December 15, 2025, information quality and reliability assessment was conducted using three validated evaluation tools: GQS for quality assessment, and the mDISCERN and JAMA benchmarks for reliability assessment. Meanwhile, user interaction indicators and video characteristics were extracted. Nonparametric tests were applied to compare differences across platforms and uploader types, and Spearman correlation was used to examine relationships among video characteristics, engagement metrics, and quality scores. Compared to Bilibili, TikTok demonstrated significantly higher engagement metrics (all P < 0.001). The quality of short videos was suboptimal on both platforms, with median GQS of 2.00 (1.00,3.00), mDISCERN of 2.00 (1.00,2.00), and JAMA score of 2.00 (2.00,2.00). TikTok videos achieved significantly higher GQS and JAMA scores than Bilibili (both P < 0.001). By uploader type, non-specialists achieved significantly higher GQS scores than specialists (median 3.00 vs. 2.00, P < 0.001). Content distribution was imbalanced: clinical manifestations (48.36%) and treatment (44.26%) were prevalent, whereas epidemiology (7.79%) and diagnosis (14.34%) were underrepresented; 51.23% of videos covered a single theme and 48.77% addressed multiple themes. Video duration was positively correlated with GQS (r = 0.59, P < 0.001) and mDISCERN (r = 0.26, P < 0.001) but not with JAMA, while engagement metrics showed only weak or non-significant correlations with all quality scores. Our study shows that the quality of short videos on diabetic foot is poor on TikTok and Bilibili, with significant content imbalances. Videos uploaded by professionals demonstrated better reliability than those from individual users. Engagement metrics were not reliable indicators of information quality. Thus, medical information short videos on these platforms must be carefully evaluated for scientific soundness, and platforms should strengthen content regulation to ensure accurate diabetic foot education.

Cardiac autonomic neuropathy (CAN) is a frequent but under-recognized complication of type 2 diabetes mellitus (T2DM) that is strongly associated with arrhythmia, silent myocardial ischemia, and cardiovascular mortality. The use of cardiovascular autonomic reflex tests (CARTs) to assess CAN is often limited in resource-constrained clinical settings. Therefore, symptom-based tools such as the Composite Autonomic Symptom Score-31 (COMPASS-31) have been proposed as screening approaches, but evidence on their feasibility remains scarce. This study assessed the feasibility, diagnostic accuracy, and agreement of the COMPASS-31 for identifying cardiovascular autonomic dysfunction assessed using standardized CARTs among adults with T2DM in Zanzibar.

A cross-sectional study was conducted among adults with T2DM attending the diabetes clinic at Mnazi Mmoja Hospital, Zanzibar. Participants were recruited using a systematic random sampling technique. Orthostatic symptoms were assessed using the COMPASS-31 questionnaire. Objective autonomic function was assessed using an automated CAN analyser implementing standardized CARTs, including resting heart rate variability, deep breathing test, Valsalva maneuver, heart rate response to standing, postural hypotension, and sustained handgrip test. Agreement between the COMPASS-31 orthostatic intolerance domain and CARTs findings was assessed using Cohen's kappa. Diagnostic performance measures included sensitivity, specificity, predictive values, likelihood ratios, and accuracy.

Among 364 participants, the COMPASS-31 orthostatic intolerance domains classified 260 (71.4%) as abnormal, while 291 (79.9%) demonstrated abnormal autonomic findings on CARTs assessment. Overall agreement was 86.0%, with substantial agreement beyond chance (κ = 0.62). Sensitivity and specificity of the COMPASS-31 domain were 85.9% and 86.3%, respectively, with positive and negative likelihood ratios of 6.27 and 0.16. Internal consistency of the orthostatic intolerance domain was good (Cronbach's alpha = 0.82). However, correlations between the orthostatic intolerance domain and CAN analyser findings were weak, and ROC analyses demonstrated poor discrimination (AUC 0.51-0.56).

The COMPASS-31 orthostatic intolerance domain showed substantial agreement and moderate screening performance for detecting CAN in adults with T2DM. These findings support its use as a practical symptom-based screening adjunct to identify individuals who may benefit from further objective autonomic testing, particularly in resource-limited settings.

Intraocular lens calcification is a rare but significant late complication that primarily affects hydrophilic acrylic intraocular lenses. Systemic metabolic disorders, particularly diabetes mellitus and end-stage renal disease, are recognized risk factors because they promote breakdown of the blood-aqueous barrier and alter calcium-phosphate metabolism, creating a favorable environment for intraocular calcification.

A 58-year-old woman with a more than 20-year history of diabetes mellitus and end-stage renal disease receiving dialysis presented with progressive visual decline in her left eye. Slit-lamp examination demonstrated marked opacification of a hydrophilic acrylic intraocular lens. The opacified lens was explanted and replaced with a retropupillary iris-claw intraocular lens. Scanning electron microscopy revealed dense rosette-like crystalline deposits on both intraocular lens surfaces with calcification thickness of 7.55-16.7 μm. Energy dispersive spectrometry demonstrated calcium and phosphorus (69.69% and 30.31%), consistent with hydroxyapatite. The patient's systemic evaluation demonstrated hyperphosphatemia and elevated parathyroid hormone levels. Following surgery, best-corrected visual acuity improved from 6/30 to 6/12.

This case highlights the critical role of systemic metabolic derangements in promoting secondary calcification of hydrophilic acrylic intraocular lens. Careful selection of intraocular lens materials, favoring hydrophobic acrylic or polymethyl methacrylate lenses, is recommended in high-risk patients to prevent this complication.