The mother's diet may have an impact on the quantity and/or quality of the milk produced. The aim of our study was to evaluate the nutritional profile of a group of diabetic women consulting at two months postpartum.

We conducted a descriptive observational cross-sectional study in women with type 1 and type 2 diabetes followed at the National Institute of Nutrition and Food Technology of Tunis. Each patient underwent an anamnesis, a clinical examination, and completed a food questionnaire.

Fifty-two patients were included in the study. The mean age of patients was 35.4±0.4 years, with extremes ranging from 23 to 44 years. The majority (80%) had type 2 diabetes, while 20% had type 1 diabetes, diagnosed before pregnancy. We noted exclusive and partial breastfeeding rates of 44% and 33%, respectively. Women who exclusively breastfed their babies had a lower caloric intake compared to women who did not breastfeed or partially breastfed their babies(p<0.001). Nearly half of the women had a hypercarbohydrate and hyperprotein diet, regardless of breastfeeding modality. Half of the non-breastfeeding women had a hyperlipidic diet, whereas only 25% of the breastfeeding women had an excessive lipid intake. Most patients had an insufficient intake of magnesium, potassium, vitamin B9, dietary fiber, and water.

These findings highlight the importance of nutritional education for all breastfeeding diabetic women.

Atrial fibrillation (AF) is the most frequent sustained cardiac arrhythmia. Data related to its clinical characteristics, management, and predictive factors of poor outcomes in elderly in Tunisia remain scarce. We aimed to evaluate the predictive factors of adverse outcomes in the elderly at 12 months follow-up among AF patients in Tunisia including thromboembolic (TE) events, hemorrhagic events, and all-cause death.

We conducted a national, prospective, and analytic multicentric study based on NATURE-AF with a 12-month follow-up period between March 1, 2017, and May 31, 2017. We evaluated the predictive factors of adverse outcomes of AF in the elderly (≥ 75 years old).

We included 915 patients with AF. We studied the elderly who represented 24% of the population. Females represented 52% of the elderly. Hypertension was present in 57% of the elderly, diabetes mellitus in 22.4%, dyslipidemia in 16%, obesity in 75.8%, chronic kidney disease in 22.8% and smoking in 13.2%. Prior TE accidents and hemorrhagic accidents happened in 12.8% and 3.7% respectively. The mean CHA2DS2-VASc score was 3.92±1.28. Vitamin-K-Antagonist was used in 59.8%. The mean TTR was 47.53±26.78. The rate control strategy was adopted in 68% of patients and beta-blockers were used in 37.9%. Hospitalization during the follow-up for adverse causes occurred in 13.4%. Adverse outcomes occurred in 19.6% including 3.2% TE events, 5% hemorrhagic events, and 11.4% deaths. After multivariate analyses, prior TE accidents (ORa=3.218; p=0.025; 95%CI [1.157-8.946]) and hospitalization during the follow-up (ORa=6.489; p=0.002; 95%CI [2.035-20.697]) were independent prognostic factors associated with adverse outcomes.

Prior TE accidents and hospitalization during the follow-up are predictive factors of adverse outcomes in elderly with AF. Identifying them is crucial to enhancing public health strategies and lowering healthcare costs.

Diabetes is a chronic disease with a high global prevalence, increasing from 200 million people in 1990 to 830 million in 2022, with a higher burden in low- and middle-income regions and high mortality in Mexico and Veracruz. These inequalities limit access to treatment and nutritional education, requiring technological solutions such as interactive kiosks based on artificial intelligence (AI) that contribute to the nutritional management of people with diabetes in marginalized communities.

This study aimed to design and evaluate an interactive kiosk based on AI that generates culturally relevant and personalized meal plans for people with diabetes in marginalized communities.

A low-cost prototype was developed, with a database of local foods and a multilayer perceptron trained with synthetic data based on national clinical guidelines. Performance was tested through an experimental evaluation that measured (1) the accuracy of nutritional recommendations compared with ideal meal plans (accuracy, precision, sensitivity, and F1-score); (2) performance, measured by recording response time with 1 to 50 simultaneous requests; and (3) usability, assessed using heuristic evaluation and the System Usability Scale (SUS).

The smart kiosk was experimentally evaluated in three dimensions: nutritional recommendations, system efficiency, and usability. The model achieved AI metrics of 87.3% overall accuracy, 90.5% precision, 92.1% sensitivity, and 91.3% F1-score. The average response time was 2.36 (SD 0.24) seconds in all load tests. A maximum time of 4 seconds was obtained in the simulation of 50 concurrent users. In the usability evaluation, an average score of 89 (SD 2.89) out of 100 was obtained on the SUS, which is considered excellent, along with a success rate of 98.3%.

The AI-based kiosk demonstrated technical feasibility, adequate performance, and satisfactory usability. Its ability to operate without the need for internet and its low cost make it an equitable option for diabetes self-management and a replicable model in public health.

Prediabetes, defined as elevated blood glucose levels below the diabetic threshold, is a worldwide concern. In Pakistan, it is highly prevalent. Preventing the progression of diabetes requires early identification of high-risk people. The Atherogenic Index of Plasma (AIP) has been proposed as an indicator of insulin resistance and cardiovascular risk. Our study content is to explore the relationship between AIP and metabolic indicators in patients with prediabetes.

A cross-sectional study was conducted at a tertiary care hospital after IRB approval. A total of 334 prediabetic individuals aged 18-60 years, with no history of diabetes or use of lipid/glucose-altering medications, were included. Anthropometric, biochemical, and demographic information was gathered, including fasting glucose, HbA1c (Glycated Haemoglobin), and lipid profiles. Different AIP quartiles were assigned to the participants. ANOVA, Chi-square, and multivariate regression with confounder adjustment were used in the statistical study.

Significant differences were observed across AIP quartiles. Higher AIP was associated with male gender, older age, higher BMI, lower HDL (High Density Lipoprotein), and elevated triglycerides. Fasting glucose and insulin increased with AIP, while HbA1c showed no significant variation. In multivariate analysis, HDL and triglycerides remained the strongest independent predictors of AIP.

AIP is significantly linked with worsening metabolic indicators in prediabetics, highlighting its potential as a simple, cost-effective screening tool. Adding AIP into routine evaluations could help early identification and prevention of diabetes and associated cardiovascular disease.

Rotavirus is a common cause of infectious gastroenteritis in infants and children. The role of rotavirus infections in adults has potentially been underappreciated and there is a paucity of data on incidence and outcome of acute kidney injury in adult patients.

We conducted a retrospective cohort study of adult hospitalized patients with microbiologically confirmed rotavirus infection. The primary outcome was occurrence of acute kidney injury related to rotavirus infection. Secondary outcomes were in-hospital mortality, duration of hospitalization and occurrence of sodium disorders.

314 hospitalized adult patients with rotavirus infection (mean age 73.2 (± 15.6) years, 39.5% with diabetes mellitus and 33.4% with chronic kidney disease (CKD)) were evaluated. 200 patients (63.7%) had community-acquired and 114 patients (36.3%) had nosocomial rotavirus infection. Acute kidney injury (AKI) occurred in 127 (40.4%) patients. AKI occurred more often in patients with community-acquired than nosocomial infection (110 (55.0%) vs 17 (14.9%), p < 0.001). In the multivariate logistic regression analysis, preexisting CKD (OR 3.29, CI 1.92-5.77, p < 0.001) and community-acquired route of rotavirus infection (OR 8.00 (CI 4.43-15.3, p < 0.001) were significantly associated with the development of AKI. 26 (8.3%) patients died in hospital. Patients with AKI had worse survival (HR 2.63 (CI 1.20-5.74) p = 0.01). In the multivariate Cox regression analysis only age, but not AKI, was still significantly associated with mortality (HR 1.06, CI 1.01-1.11, p = 0.01). Hyponatremia was detected in 60 (30.6%) of 196 patients with community-acquired infection. Dehydration occurred in only 5 (2.6%) patients.

Adult outpatients with rotavirus infection and certain risk factors (e.g., CKD) have a high risk of developing AKI. Patients should seek medical attention with a low threshold and, if necessary, undergo hospitalization to counteract volume depletion and the development of acute renal injury. Hyponatremia frequently occurs while dehydration is rare. Recommendations in outpatients at risk for AKI should focus on increasing salt intake rather than water intake.

Diabetic nephropathy (DN) is a common and serious microvascular complication of diabetes mellitus, primarily driven by persistent hyperglycemia-induced oxidative stress and chronic inflammation. Calebin A, a naturally occurring noncurcuminoid compound, has shown promising antioxidant and anti-inflammatory effects in various disease models. This study aimed to evaluate the nephroprotective effects and underlying mechanisms of calebin A in an experimental model of DN.

DN was induced in C57BL/6 mice using streptozotocin (STZ). Diabetic mice were treated with calebin A, curcumin, or metformin for 6 weeks.

Treatment with calebin A resulted in significant improvements in glycemic control, renal function, oxidative stress, inflammation, fibrosis, and renal histopathological alterations. Calebin A reduced oxidative stress and inflammation by activating the Nrf2 pathway and downregulating the NF-κB signaling pathway. Histological analyses supported these findings by demonstrating marked attenuation of STZ-induced renal damage following calebin A administration.

These results highlight the multitargeted nephroprotective effects of calebin A in DN. Further long-term and clinically oriented studies are warranted to validate these effects in chronic disease settings.

Over the past two decades, approaches to managing patients with coronary artery disease have improved substantially with advances in percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) surgery, pharmacological secondary prevention, anti-anginal agents and lifestyle interventions. Accordingly, clinical management choices in non-acute myocardial ischaemic syndromes (NAMIS) remain a timely and important topic. The risks and benefits of an invasive strategy combined with optimal medical therapy (OMT) versus a conservative strategy of OMT alone should be discussed with patients to facilitate shared clinical decision making. The findings from high-quality, randomized, controlled trials in the era of modern OMT form an essential platform for these informed conversations. In totality, the evidence from randomized, controlled trials supports OMT as the first-line therapeutic approach in patients with NAMIS, whereas selected patients at high anatomical risk or those with persistent anginal symptoms despite initial OMT often derive further symptom relief from invasive therapy with PCI. In patients with high-risk NAMIS, including those with multivessel disease and diabetes mellitus, CABG surgery improves survival, whereas the benefit is less clear for PCI. In this Review, we discuss the findings from contemporary trials evaluating outcomes in patients with NAMIS treated invasively or conservatively with OMT alone, and we conclude with proposed management pathways.

Volagidemab, a fully human IgG2 monoclonal antibody, is a competitive glucagon receptor (GCGR) inhibitor that blocks endogenous glucagon (GCG) activity. This study developed a population pharmacokinetics/pharmacodynamics (PopPK/PD) model and established the exposure-response (E-R) relationship for Volagidemab.

Data from healthy Chinese and US subjects administered a single subcutaneous (SC) dose of Volagidemab were analyzed. A PopPK/PD model characterized drug disposition and effect. E-R analyses evaluated the relationship between plasma GCG concentrations and fasting plasma glucose (FPG).

Volagidemab exhibited dose-dependent PK, characterized by a nonlinear distribution and linear elimination model incorporating a single transit absorption compartment. The PD response, defined as the log-transformed fold change in GCG, was well described by an E_max model. Body mass index (BMI) was identified as a significant covariate for apparent central volume of distribution (V_c). Empirical Bayes (EBE) estimates indicated no clinically meaningful differences in PopPK/PD parameters between Chinese and US subjects. E-R analysis demonstrated a linear relationship between GCG fold change and FPG. Baseline FPG was identified as a significant covariate influencing the slope, suggesting greater glucose reduction in individuals with higher baseline FPG. Simulations showed a distinct plateau in the E-R relationship, with minimal additional therapeutic effect observed between 35 and 42 mg.

This analysis confirms minimal ethnic differences in the PK/PD of Volagidemab between healthy Chinese and US subjects. The limited impact of covariates supports dose bridging, facilitating clinical development in China.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors, a widely used class of oral antidiabetic agents provide additional cardioprotective and renoprotective benefits, but their use during pregnant remains limited. This study aimed to evaluate the association between SGLT2 inhibitor exposure during pregnancy and the risk of congenital malformations.

This population-based cohort study utilized data from the National Health Insurance Service Database (2016-2022). Pregnancies with known teratogen exposure were excluded. SGLT2 inhibitor or insulin (as active comparator) use during the first trimester was defined as exposure. The primary outcomes were congenital malformations and heart defects. Propensity score matching controlled for confounders, and generalized linear regression estimated relative risks (RRs) with 95 % confidence intervals (CIs). Negative control outcomes were employed to assess residual confounding. Among 536,654 pregnancies, 121 pregnancies were exposed to SGLT2 inhibitors (mean [SD] age: 35.07 [4.26]), and 2007 to insulin (mean [SD] age: 34.89 [4.28]). Adjusted RRs (95 % CIs) for congenital malformations and heart defects were 0.88 (0.52-1.46) and 0.83 (0.44-1.58), respectively. In sensitivity analysis restricted to the organogenesis period (gestational weeks 4-10), risk of congenital heart defects was 2.79 (1.16-7.06). No residual confounding detected in negative control outcome.

In this study, SGLT2 inhibitor use during the first trimester was not associated with an increased risk of congenital malformations. Nonetheless, the observed increased risk of congenital heart defects during the organogenesis period highlights the importance of exposure timing and warrants cautious interpretation. These findings provide evidence to guide clinical decision-making regarding antidiabetic medication use during pregnancy.

Persistent wound stress is an important but easily neglected driver of chronic nonhealing wounds and organ dysfunction in patients with type 2 diabetes mellitus. This review summarizes how the diabetic internal environment, including hyperglycemia, insulin resistance, oxidative stress, vascular damage and immune dysregulation, reshapes the wound microenvironment and disturbs the orderly sequence of hemostasis, inflammation, proliferation and remodeling. We outline the clinical and pathophysiological features of type 2 diabetes mellitus and describe the pathological features of impaired wound healing, such as barrier disruption, microcirculatory disturbance, susceptibility to infection and long lasting inflammatory and oxidative states. We further discuss abnormalities in wound healing at tissue, cellular and molecular levels, with emphasis on impaired angiogenesis, neuropathy, imbalance of extracellular matrix turnover and dysregulated growth factors. On this basis, we highlight persistent wound stress as a central link that connects local lesions with systemic injury involving the cardiovascular system, kidneys, immune system and nervous system. Understanding this cycle from local wound to systemic injury and back to the wound provides a mechanistic framework for diabetic chronic wounds and suggests that effective management should address both the wound microenvironment and systemic metabolic and inflammatory stress.