Cough is a common and burdensome symptom in patients with progressive pulmonary fibrosis (PPF), yet existing evidence remains fragmented. This systematic review provides a synthesis of available evidence on cough in PPF, specifically examining its association with health-related quality of life (HRQoL), the instruments used to assess cough, current treatment evidence, and identifies priorities for future research.

We searched the Embase, PubMed, Cochrane, and Web of Science (WOS) databases from their inception to January 12, 2026, for studies focusing on the burden of cough in patients with PPF. We extracted information on study details, participant features, and outcome measures, and assessed the risk of bias in the included studies. A narrative synthesis was then performed to summarize the evidence.

Of 11,683 records, 9 studies met inclusion criteria. Cough was most frequently assessed using VAS and LCQ, while HRQoL was primarily measured with SGRQ and L-PF. Two studies highlighted wearable devices for objective cough monitoring. Antifibrotic therapy showed no consistent or statistically significant benefit on cough in descriptive synthesis. Qualitative studies revealed substantial cough‑related burden, including daily activity limitations, fatigue, and social embarrassment. Regarding economic impact, although no dedicated studies exist, one study indicated that cough severity was associated with workplace productivity loss.

Cough negatively impacts HRQoL in PPF, but evidence is limited by heterogeneous tools and lack of economic studies. Standardized assessment and targeted research on cough management and its economic impact are urgently needed.

Non-communicable diseases (NCDs) account for over 70% of deaths worldwide, and metabolic risk factors such as obesity, dyslipidemia, and hypertension greatly increase the incidence of NCDs. Lifestyle changes have exacerbated these conditions in Pakistan; therefore, a better knowledge of their underlying mechanisms is required. This study investigates the relationship between fibroblast growth factor 1 (FGF1) blood levels, the rs152524 gene polymorphism, and metabolic risk factors.

We conducted a hospital-based, cross-sectional study of 199 adults recruited from outpatient departments between September 2023 and June 2024. After written informed consent, demographic, medical, and biochemical data were collected. FGF1 rs152524 was genotyped using tetra-primer ARMS PCR and serum FGF1 levels were quantified by ELISA at the National Health Research Complex and Lahore College for Women University. Statistical analyses were performed using SPSS v.26; p < 0.05 was considered significant.

There were no significant differences in age or BMI between males and females. However, females demonstrated significantly higher median (IQR) of FGF1 levels [333 pg/ml (250-467) vs. 292 pg/ml (212-374); p = 0.011]. Fasting blood glucose, LDL-cholesterol and hypertension were the three main predictors of FGF1 levels, according to regression analysis. Within the participant population, 38.7% carried the AA genotype of rs152524. The allelic frequencies of reference A and alternative G alleles were 0.5955 and 0.4045 respectively. AA genotype was substantially associated with both hypertension (p < 0.001) and overweight/obesity (p = 0.002). The highest median (IQR) FGF1 blood levels 351(263-546) pg/ml were observed among AA genotype carriers. At the same time, a substantial rise in HDL-cholesterol 36(32-42) was found among carriers of the GG genotype.

This hospital-based study identified a potential association between the FGF1 rs152524 AA genotype and obesity and hypertension. The AA genotype was present in 38% of participants, with risk rising per 'A' allele, while the G allele appeared protective. These preliminary findings require validation in larger, population-based cohorts before clinical relevance can be assessed.

IntroductionIn sustainable development, time is a physically limited resource affecting economic and social sustainability. In healthcare systems, the time of healthcare staff is linked to economic constraints, while the time patients spend travelling and receiving treatment affects social sustainability, including access to healthcare services. Reducing time costs in healthcare may contribute to several of the 17 Sustainable Development Goals (SDGs) within Agenda 2030. This exploratory study aimed to: (i) probe whether a low-budget questionnaire combined with standardised data processing could estimate time costs for patients, their employers, and healthcare personnel associated with a healthcare visit; (ii) generate initial estimates of sustainability impacts of time costs, in physical and monetary terms.MethodsThe study explored whether this low-budget approach could generate results of sufficient quality to inform choices aimed at improving healthcare accessibility. Patients with diabetes attending a healthcare facility for therapeutic footwear completed a questionnaire regarding time spent travelling and treatment. Healthcare staff time was recorded. Results were analysed and presented in physical and monetary terms.ResultsThe questionnaire generated information that was processed into estimates of parameters of strategic importance for choices supporting sustainability and access in healthcare systems in urban and rural areas. For the 101 patients included, the total time used was 360.6 hours, of which 23% represented employers' time, 49% patients' private time, and 28% healthcare staff time. The total estimated monetary value of time consumed was SEK 142,911 (USD 13,466), with 33% related to employers' time, 13% to patients' time, and 54% to healthcare staff time. The estimated mean cost per visit ranged from SEK 1,233 (USD 116.2) to SEK 1,944 (USD 183.2).ConclusionsThe low-cost questionnaire and data-processing approach appears promising for estimating time costs for patients, employers, and healthcare staff, thereby supporting decisions aimed at improving healthcare accessibility and sustainability.

The progression of atherosclerosis (AS) is closely related to endothelial senescence and abnormal lipid metabolism in macrophages. Although metformin (Met) can exert vascular endothelial protective effects by inhibiting endothelial cell senescence, the drug exhibits limited capacity to regulate lipid metabolism. In contrast, evolocumab (Evol), a PCSK9-specific inhibitor, can lower LDL-C levels to reduce foam cell formation. This study takes pathological endothelial cells and macrophages as core targets. Leveraging the complementary between Met-mediated anti-endothelial senescence and Evol-regulated lipid metabolism, S2P peptide-modified PLGA nanocarriers (S-P@(Met + Evol) NPs) were constructed to achieve co-delivery of the two drugs, further enhancing the dual-targeting function of the nanomedicine. In vitro studies showed that S-P@(Met + Evol) NPs effectively reduced oxidative damage, inhibited vascular aging and enhanced macrophage cholesterol efflux. In vivo studies showed that this nanodrug significantly alleviated aging damage, lipid accumulation, and inflammatory responses, synergistically reduced plaque burden, enhanced plaque stability, and exhibited a good safety profile. In conclusion, this dual-cell targeted synergistic regulation strategy provides an effective approach for the treatment of AS.

This 14-day multicenter study assessed CT3 CGM accuracy and safety in 71 adults with diabetes. Key results: overall MARD 9.1% (median 7.1%), 82.4%-98.2% met %15/15-%30/30 criteria, 99.7% values in CEG zones A/B. CT3 showed strong performance, suitable for reliable 14-day wear.

Type 2 Diabetes Mellitus (T2DM) is a major global public health concern characterized by chronic hyperglycemia and associated complications, including dermatological manifestations. Skin disorders are common among patients with diabetes and are often linked to poor glycemic control and inadequate self-care practices. Self-efficacy is a key determinant of effective diabetes self-management and may influence the occurrence and severity of dermatological conditions.

This study aimed to examine the association between dermatological manifestations, skin care practices, and self-efficacy among adults with T2DM in the Qassim region, Saudi Arabia.

A cross-sectional study was conducted among adult patients (30-70 years) with T2DM in Saudi Arabia using a convenience sampling approach. Data were collected through an online structured self-administered questionnaire distributed via digital platforms. The questionnaire included three components: (1) sociodemographic and clinical characteristics, including glycemic indicators; (2) skin care practices; and (3) self-efficacy in diabetes self-management assessed using a 7-item scale. Data were analyzed using descriptive statistics and inferential tests to assess associations between variables.

Participants demonstrated suboptimal glycemic control, with a considerable proportion reporting HbA1c levels between 7.6-8.5% and ≥9.6%. The median (IQR) fasting blood glucose was 111.0 (99.0-125.0) mg/dL, and random blood glucose was 191.0 (163.0-212.0) mg/dL. Self-efficacy levels were significantly associated with most sociodemographic characteristics (p < 0.001). Significant associations were observed between self-efficacy and multiple dermatological manifestations, including ulcers, nail abnormalities, itching, tenderness, redness, paronychia, hyperpigmentation, rashes, and purulent lesions (p < 0.001). A significant association was also found with swelling (p = 0.040), while no significant association was identified with vascular impairment (p = 0.249).

Self-efficacy is significantly associated with dermatological manifestations among patients with T2DM. Strengthening patient education and behavioral interventions targeting glycemic control and skin care practices may enhance self-efficacy and reduce diabetes-related skin complications.

Global data show an increase in the rate of diabetic ketoacidosis (DKA) at type 1 diabetes (T1D) onset during the COVID-19 pandemic, but its effect on severity remain unclear. This study assessed pre-pandemic, pandemic, and post-pandemic DKA frequency in Polish children with new-onset T1D and evaluated the pandemic's impact on DKA incidence and severity.

This multicenter national retrospective study collected an anonymized list of all new-onset T1D cases in Polish children (<18y.o.) diagnosed based on clinical presentation (diabetes diagnosed based on random blood glucose >=200mg/dl and symptoms, no suspicion of other type of diabetes).

We analyzed 7192 children with a new-onset diabetes, and after applying the predefined inclusion and exclusion criteria, 6543 cases were ultimately included in the final analysis. Overall, 54.5% presented with DKA. Frequency increased from 47.9% in 2019 to 58.6% in 2020 (p<0.0001) and decreased to 54.0% in 2022. Observed pandemic DKA (56.8%) exceeded model predictions (47.5%; p=0.0041). The additional impact of COVID-19 was estimated at a +9.4 percentage-point increase, with a 95% CI of +9.1 to 9.6%, with DKA predicted and observed rates converging by the end of the pandemic. During the pandemic, children were also more likely to present with moderate or severe DKA compared with the rest of the study period, with a subsequent decrease in severity after the pandemic.

DKA frequency increased across the study period, with a peak during the pandemic. This findings should be interpreted in the context of global epidemiological data, where the prevalence of DKA at diagnosis of type 1 diabetes remains high and varies widely between countries, reaching around 50% in some populations. Therefore, coordinated country-level actions aimed at improving awareness of early diabetes symptoms are needed to reduce the persistently high rate of DKA.

To systematically evaluate the effects of exercise intervention on glucose metabolism and body composition in patients with type 2 diabetes mellitus (T2DM).

Relevant literature built up to May 8, 2026 was searched through Web of Science, PubMed, EMBASE, and Cochrane Library databases, and Meta-analysis was performed using RevMan 5.4 software, and the quality of the literature was evaluated using the Cochrane Risk of Bias Assessment Tool. A total of 16 randomized controlled trials involving 1401 samples were included.

Exercise intervention significantly reduced glycated hemoglobin in patients with T2DM (SMD = -0.46, 95% CI: -0.73 to -0.19, P = 0.0007). Subgroup analysis revealed that combined exercise produced greater improvements (SMD = -0.71, 95% CI: -0.95 to -0.47, P < 0.00001) compared to aerobic exercise alone (SMD = -0.32, 95% CI: -0.62 to 0.02, P = 0.04). Exercise intervention also significantly reduced fasting blood glucose (SMD = -0.52, 95% CI: -0.70 to -0.35, P < 0.00001). However, no statistically significant improvement was observed for the insulin resistance index (SMD = -0.18, 95% CI: -0.40 to 0.04, P = 0.11). Regarding body composition, exercise intervention resulted in a significant reduction in BMI after excluding an outlier study (SMD = -0.37, 95% CI: -0.61 to -0.12, P = 0.003) and significantly improved maximal oxygen uptake (VO₂max) (SMD = 0.58, 95% CI: 0.34 to 0.82, P < 0.00001).

Exercise intervention can effectively improve glucose metabolism and body composition in patients with T2DM, with mixed (aerobic combined with resistance) exercise showing superior effects on glycemic control compared to aerobic exercise alone. Exercise intervention serves as an important non-pharmacological intervention for the comprehensive management of T2DM.

Gestational diabetes mellitus (GDM) poses a serious threat to the health of both mothers and infants, and currently, methods for early and accurate prediction remain limited. This study aims to investigate the association between TyG levels in early pregnancy, TyG levels in mid-pregnancy, and their dynamic differences with the risk of developing gestational diabetes (GDM), thereby providing clinical guidance for the early prevention and control of GDM during pregnancy and the management of high-risk populations.

A prospective cohort study design was employed, enrolling 870 pregnant women. Variables were screened using univariate Cox regression, followed by the construction of a multivariate Cox proportional hazards regression model to analyze the independent association between the percentage increase in TyG levels and the change in TyG levels at different time points and the incidence of GDM.

Among the 870 study participants, 119 developed GDM, resulting in an incidence rate of 13.68%. Multivariate Cox regression analysis showed that, after adjusting for confounding factors such as age, BMI, and family history of diabetes, elevated TyG levels in early pregnancy, elevated TyG levels in mid-pregnancy, and a greater percentage increase in the difference between TyG levels in early and mid-pregnancy were all independent risk factors for GDM, with elevated TyG levels in mid-pregnancy posing the highest risk.

Elevated TyG indices during the first and second trimesters, as well as a progressive increase in TyG levels throughout pregnancy, are all independent risk factors for the development of gestational diabetes mellitus (GDM). These factors have certain reference value for evaluating GDM risk and provide a basis for the early prevention and management of gestational diabetes.

To assess serum 25-hydroxyvitamin D [25(OH)D] in relation to indicators of target organ damage in patients with diabetes.

This analysis included 372 adults with diabetes who underwent serum 25(OH)D testing in the Department of Endocrinology at Jen Ching Memorial Hospital from January 1 to December 31, 2025. Data on demographic characteristics, medical history, laboratory parameters, carotid ultrasonography, and electrophysiological examinations were collected. We performed multivariable regression models to examine the associations of serum 25(OH)D levels with peripheral nerve dysfunction, carotid plaque, urinary microalbumin (mALB), cerebral infarction, and coronary heart disease (CHD). Restricted cubic spline (RCS), threshold effect, and sensitivity analyses were further employed.

Serum 25(OH)D was inversely associated with peripheral nerve damage and carotid plaque. After adjustment for all prespecified covariates, the corresponding odds ratios were 0.941 (95% CI, 0.905-0.976; P = 0.001) and 0.942 (95% CI, 0.906-0.977; P = 0.002), respectively. Serum 25(OH)D levels were also inversely associated with log-transformed mALB (β = -0.035, 95% CI, -0.057 to -0.013; P = 0.002). In continuous-variable models, higher serum 25(OH)D was additionally associated with lower odds of cerebral infarction (OR = 0.896, 95% CI, 0.816-0.971; P = 0.013) and CHD (OR = 0.902, 95% CI, 0.835-0.966; P = 0.006) after full adjustment. RCS and exploratory threshold analyses suggested nonlinear associations of serum 25(OH)D with peripheral nerve damage and mALB. Sensitivity analyses yielded consistent results.

Among patients with diabetes, lower serum 25(OH)D levels were associated with peripheral nerve damage, carotid plaque, and higher mALB levels. These findings support an association between serum 25(OH)D and indicators of diabetes-related target organ damage, but prospective studies are needed to clarify the temporal and clinical significance of these associations.