In the early detection of psychosis, the differential diagnosis between autism spectrum disorder (ASD) and schizophrenia spectrum disorders (SSD) is clinically challenging due to substantial symptom overlap and potential comorbidity. Camouflaging and masking may further contribute to an underlying ASD remaining unrecognized in individuals at clinical high risk for psychosis. The present case report illustrates the long-term clinical course of a patient whose core autistic features were interpreted as treatment-resistant negative symptoms of schizophrenia for years. Only through ongoing clinical observation in an inpatient setting ASD was confirmed according to current gold standards diagnostic. This case highlights the critical need to consider ASD as a primary differential diagnosis in individuals presenting psychotic and psychotic-like experiences during early detection of psychosis. By raising clinical awareness of autistic phenomenology earlier identification may be facilitated, enable timely and appropriate support, and help affected individuals develop a coherent illness model for further therapeutic progress.

Neurolymphomatosis, resulting from direct infiltration of the peripheral nervous system by lymphoma, is a rare presentation of aggressive B-cell lymphoma and an uncommon cause of brachial plexopathy. We report a 32-year-old man who presented with a painful swelling around the right shoulder followed by rapidly progressive weakness, complete sensory loss, and marked muscle wasting confined to the right upper limb, associated with a 10-kg unintentional weight loss over five months. Neurological examination localized the lesion to the right brachial plexus. Radiographs and computed tomography demonstrated an infiltrative soft-tissue lesion with cortical destruction of the proximal humerus. Magnetic resonance imaging of the shoulder and brachial plexus revealed diffuse thickening and T2/STIR hyperintensity of the distal divisions, cords, and branches of the brachial plexus, with contiguous infiltration of the humeral marrow, surrounding musculature, and adjacent soft tissues, strongly suggesting lymphomatous infiltration. Subsequent bone marrow biopsy confirmed Stage IV high-grade B-cell lymphoma with a high proliferative index. The patient was treated with R-CHOP chemoimmunotherapy and demonstrated significant clinical and neurological improvement on follow-up, with marked reduction in shoulder swelling and substantial recovery of motor and sensory function. This case highlights the importance of considering neurolymphomatosis in patients presenting with rapidly progressive painful brachial plexopathy, particularly when associated with shoulder swelling, constitutional symptoms, and infiltrative imaging findings. Early clinicoradiological recognition and prompt tissue diagnosis are essential for timely initiation of lymphoma-directed therapy and favorable neurological outcomes.

Major depressive disorder (MDD) is more prevalent in women and has been linked to female reproductive timing. However, the genetic mechanisms underlying these associations remain unclear. Reproductive milestones are temporally structured and biologically interrelated, suggesting a shared genetic architecture that may influence MDD susceptibility.

Using large-scale genome-wide association study (GWAS)data, we analyzed five key female reproductive milestones and their genetic relationships with MDD. We applied linkage disequilibrium score regression (LDSC), Genomic Structural Equation Modeling (GenomicSEM), Mendelian randomization (MR), and colocalization analyses to characterize the shared genetic architecture between reproductive timing and MDD.

A single latent reproductive timing factor showed excellent model fit (CFI = 0.997, SRMR = 0.017, AIC = 41.5). MR analysis further indicated that genetically predicted higher Common Factor scores, reflecting older ages across all five reproductive milestones, were significantly associated with decreased MDD risk (IVW β = -3.05, 95%CI = - 3.825 to - 2.277, p = 1.10 × 10⁻¹⁴). Colocalization identified shared gene expression signals in the hypothalamus and heart-left ventricle, implicating neuroendocrine and cardiovascular pathways. Functional enrichment indicated involvement in synapse organization, cell adhesion, and calcium ion binding. Age at menarche (AAM) emerged as a promising early biomarker for MDD susceptibility.

A single latent reproductive timing factor effectively captures the shared genetic architecture across female reproductive milestones and their relationship with MDD risk. These findings deepen understanding of reproductive biology in mental health and offer potential targets for early risk identification and intervention in women.

Clinical trail number is not applicable.

Burnout, encompassing high emotional exhaustion (EE), high depersonalisation (DP), and low personal accomplishment (PA) as measured by the Maslach Burnout Inventory (MBI), remains poorly characterised among paediatric dentists. This systematic review and meta-analysis aimed to estimate prevalence of MBI-based burnout dimensions and associated factors, following a protocol prospectively registered with PROSPERO (CRD420251238894) and reported per PRISMA 2020 and MOOSE guidelines. Five databases (PubMed/MEDLINE, Scopus, Web of Science, EBSCOhost, and Cochrane Library) were searched from inception to November 30, 2025, supplemented by Google Scholar, institutional repositories, and author contacts, for quantitative observational surveys using the MBI in paediatric dentists, residents, or faculty. Two reviewers independently extracted study characteristics, MBI domain scores, composite burnout definitions, and associated factors, with discrepancies resolved by consensus; methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies (2020, nine items), and evidence certainty was graded using GRADE. Five cross-sectional surveys (n=915; Jordan, Egypt, Lebanon, United States, and Republic of Korea) met inclusion criteria. Random-effects meta-analysis (Freeman-Tukey transformation) showed pooled prevalence estimates of 45% for high EE (95% CI: 27%-64%), 36% for high DP (10%-67%), and 27% for low PA (10%-49%); two studies using equivalent two-domain criteria yielded a composite burnout prevalence of 16% (4%-34%). Heterogeneity was extreme (I² > 90%) across all outcomes, with very low certainty of evidence. Burnout, particularly EE, is frequently reported among paediatric dentists, though estimates are highly context-dependent, and harmonised, longitudinal, multi-country studies with concurrent mental health measures are needed.

Somalia continues to face multidimensional public health challenges driven by prolonged conflict, political instability, fragmented governance, climate-related disasters, displacement, poverty, and a fragile health system. The country carries a dual burden of communicable and non-communicable diseases (NCDs), alongside persistently high maternal and child mortality and recurrent nutrition and WASH emergencies. These pressures are intensified by workforce shortages, limited laboratory and surveillance capacity, unequal access to care, and heavy dependence on externally financed programmes. In this perspective, health-system resilience refers to Somalia's capacity to anticipate, absorb, adapt to, and recover from shocks while maintaining equitable delivery of essential services. We argue that resilience cannot be achieved through disease-specific or short-term humanitarian programmes alone; it requires stronger public stewardship, coordinated federal-state governance, sustainable financing, integrated primary health care, a retained and equitably distributed workforce, interoperable surveillance, and climate-resilient WASH and referral systems. The central recommendation is therefore a transition from fragmented, crisis-driven service delivery toward an accountable, primary-health-care-centred system that links communities, public and private providers, laboratories, referral facilities, and emergency response mechanisms.

Type 1 diabetes mellitus (T₁DM) is common and can cause cardiac complications. Subclinical myocardial involvement, particularly impaired diastolic function, is a concern in pediatric patients with T₁DM.

This study aimed to assess cardiac function, with a particular focus on diastolic indices, in children with T₁DM.

In this cross-sectional comparative study, children aged 6 - 12 years were divided into two groups: a case group with T₁DM and a control group of healthy children. Participants were recruited in 2023 from the Endocrinology Clinic at Amirkola Children's Hospital, Babol, Iran. All children underwent clinical evaluation, pubertal status assessment using the Marshall-Tanner criteria, electrocardiography, and echocardiography.

A total of 150 children were included, comprising 50 children with T₁DM and 100 controls. Overall, 52% of the participants were boys, and the mean age was 9.28 ± 1.85 years. Late diastolic tissue velocity (A') was significantly higher in the T₁DM group (P = 0.02), suggesting subclinical diastolic impairment. However, most other cardiac parameters, including all systolic indices, ejection fraction, fractional shortening, and electrocardiographic findings, were comparable between the groups (all P > 0.4). The T₁DM group also had higher mean weight, height, body mass index, and body mass index percentiles (all P < 0.05).

Children with T₁DM exhibited subtle diastolic dysfunction, reflected by elevated A', whereas systolic function and other cardiac parameters were comparable with those in controls. Given the cross-sectional design, limited sample size, and potential confounding by body mass index and selection bias, these findings should be interpreted cautiously. The standardized single-center methodology supports internal validity; however, multicenter longitudinal studies with larger, z-score-adjusted samples are needed to confirm these results and clarify their clinical implications.

Managing diabetes in children is challenging and requires continuous monitoring and structured self-care support. Artificial intelligence (AI)-driven digital tools may enhance self-management and improve health outcomes. This scoping review aimed to synthesize the existing evidence on AI-driven digital tools for pediatric diabetes self-management, focusing on their functionalities, benefits, and limitations.

From an initial pool of 97 articles published between January 2010 and March 1, 2025, 19 studies met the predefined inclusion criteria. A systematic search was conducted in PubMed, Scopus, Web of Science, CINAHL, PsycINFO, and Embase using predefined keywords. Two independent reviewers performed screening and data extraction. Methodological quality was appraised using the Cochrane Risk of Bias Tool, the Newcastle-Ottawa Scale, and the Critical Appraisal Skills Programme (CASP) Checklist. Qualitative and quantitative findings were synthesized thematically.

The 19 included studies addressed several overlapping application domains of AI-driven digital tools for pediatric diabetes self-management. Overall, 8 studies focused primarily on glucose prediction, glycemic monitoring, or pattern recognition; 4 studies evaluated insulin dosing optimization and clinical decision-support systems; 6 studies investigated personalized education, behavioral support, user engagement, or self-management learning interventions; 5 studies examined telemedicine, remote monitoring, or healthcare access; and 5 studies primarily addressed ethical, methodological, transparency, or implementation challenges.

AI-based digital tools have considerable potential to support diabetes self-management in children. Future research should prioritize long-term evaluations, the inclusion of diverse populations, and rigorous assessments of clinical outcomes, data privacy, and algorithm performance.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors, including dapagliflozin and empagliflozin, are widely used for glycemic control in type 2 diabetes but may affect the risk of urinary tract infection (UTI).

This study compared the incidence of UTIs among women with diabetes treated with dapagliflozin versus empagliflozin.

In this randomized, double-blind clinical trial, 149 diabetic women aged ≥ 18 years were assigned to receive dapagliflozin 5 mg (n = 79) or empagliflozin 10 mg (n = 70) daily for three months. Fasting blood sugar (FBS), glycated hemoglobin (HbA1c), and serum creatinine (Cr) were measured at baseline and after treatment. Urinalysis and urine culture were used to confirm UTIs. Data were analyzed using SPSS version 28.0, with P < 0.05 considered statistically significant.

The mean age was 62.7 ± 9.7 years, with no baseline differences between groups. UTIs occurred in 12 patients overall: 2 (2.5%) in the dapagliflozin group and 10 (14.3%) in the empagliflozin group (OR = 0.16; 95% CI, 0.03 - 0.74; P = 0.009). No significant intergroup differences were observed in FBS, HbA1c, or Cr levels.

Empagliflozin was associated with a higher short-term incidence of UTIs than dapagliflozin, despite similar metabolic outcomes. Monitoring for UTIs is recommended when prescribing SGLT2 inhibitors, particularly empagliflozin. Trial Registration: This trial is registered with the Iranian Registry of Clinical Trials (IRCT20250129064554N1).

Multi-vessel coronary artery disease (MVCD), defined as stenosis affecting ≥2 major coronary arteries, confers poor clinical outcomes in patients with coronary artery disease (CAD). Cytochrome P450 2C19 (CYP2C19) CYP2C19 participates in lipid metabolism and inflammatory regulation, which may be associated with individual variations in the severity of coronary artery lesions. This study aimed to explore the clinical and genetic factors associated with MVCD focusing on CYP2C19 polymorphisms and chronic metabolic diseases.

This single‑center cross‑sectional study enrolled 4124 patients with angiographically confirmed CAD, who were divided into single‑vessel CAD (n=846) and MVCD (n=3278) groups. Baseline clinical data and CYP2C19 genotypes were collected. The chi-square test, Hardy-Weinberg equilibrium test, and logistic regression analyses were performed for statistical evaluation.

Higher prevalences of hypertension, type 2 diabetes mellitus, and dyslipidemia were observed in MVCD patients. CYP2C19*2 (rs4244285, 681G>A) and *3 (rs4986893, 636G>A) allele frequencies were markedly elevated in the MVCD group. Logistic regression analysis confirmed that hypertension (odds ratio (OR)=1.485, 95% confidence interval (CI): 1.267‑1.740, p<0.001), T2DM (OR=2.441, 95% CI: 2.006‑2.970, p<0.001), dyslipidemia (OR=1.313, 95% CI: 1.097‑1.572, p=0.003), and CYP2C19 poor metabolizer (*2/*2, *2/*3 and *3/*3 genotypes) status (OR=1.744, 95% CI: 1.360‑2.237, p<0.001) was independently associated with MVCD. The combined impaired CYP2C19 metabolic phenotype (intermediate (*1/*2 and *1/*3 genotypes) plus poor metabolizers) was also independently correlated with MVCD (adjusted OR=1.285, 95% CI: 1.095-1.508, p=0.002).

Clinical metabolic comorbidities and the combined impaired CYP2C19 metabolic phenotype are associated with MVCD. These findings may provide valuable reference for risk assessment of severe CAD.

Melioidosis is a tropical infectious disease caused by Burkholderia pseudomallei. Although vascular involvement is rare, melioidosis-associated abdominal aortic pseudoaneurysm can rapidly progress and carries a high risk of rupture and mortality. Due to nonspecific early symptoms and the lack of specific guidelines, the optimal timing of surgery remains unclear.

A 62-year-old female farmer from Hainan Province, China, presented with persistent lower abdominal pain for over 10 days, followed by low back pain and fever (maximum 38.0 °C). She was diagnosed with type 2 diabetes mellitus based on persistent hyperglycemia and an HbA1c level of 14.8%. Emergency CTA revealed a focal pseudoaneurysmal lesion of the abdominal aorta at the L3 level, with periaortic inflammatory changes and suspected contained rupture, but no active contrast extravasation. As the patient was hemodynamically stable, empirical piperacillin/tazobactam therapy was initiated with close monitoring. Blood cultures on hospital day 5 suggested gram-negative bacilli, prompting a switch to imipenem/cilastatin. On day 6, cultures confirmed B. pseudomallei, susceptible to imipenem, ceftazidime, and TMP-SMX. Targeted antimicrobial therapy was continued with addition of TMP-SMX. The patient's fever, pain, and inflammatory markers improved significantly. Follow-up CTA on day 21 showed marked resolution of periaortic inflammation, and blood cultures became negative on day 28. Antimicrobial therapy was switched to ceftazidime on day 30, and open vascular reconstruction was performed on day 38.

In melioidosis-endemic regions, aortic infection should be considered in diabetic patients with fever and abdominal or back pain. For carefully selected patients with suspected contained rupture, hemodynamic stability, and good response to targeted antimicrobial therapy, delayed elective open reconstruction under strict surveillance and with emergency intervention capability may be a feasible strategy. However, this single case cannot establish the superiority of delayed surgery or define the optimal timing of intervention.