Background Chronic heart failure (CHF) is a leading cause of morbidity and mortality worldwide. Although vitamin D insufficiency has been implicated in its pathophysiology, its association with CHF severity remains uncertain. Therefore, this study primarily evaluated the association between serum vitamin D levels and CHF severity in hospitalized adults. Secondary analyses assessed the relationship with left ventricular ejection fraction, factors associated with severe CHF, and selected in-hospital outcomes. Methods This retrospective study included 276 patients with chronic heart failure managed at a tertiary care hospital in Pakistan. Demographic, clinical, laboratory, and echocardiographic data were retrieved from patients' medical records. Based on the New York Heart Association (NYHA) functional classification, patients were categorized into severe (Class III-IV) and non-severe (Class I-II) heart failure groups. Statistical analyses were carried out. Continuous variables were compared using the independent-samples t-test, categorical variables using the chi-square test, and the association between serum vitamin D levels and left ventricular ejection fraction (LVEF) was assessed using Pearson correlation analysis. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of severe chronic heart failure. Results Among the 276 patients, 168 (60.86%) had severe CHF and 108 (39.14%) had non-severe CHF. The mean ± standard deviation (SD) age was 63.52 ± 11.24 years, the mean serum vitamin D concentration was 21.16 ± 8.12 ng/mL, and the mean LVEF was 38.54 ± 9.82%. Overall, 208 (75.36%) patients had vitamin D insufficiency. Patients with severe CHF had significantly lower serum vitamin D levels and LVEF than those with non-severe CHF (p<0.001). Serum vitamin D levels demonstrated a moderate positive correlation with LVEF (r=0.48, 95% CI: 0.38-0.57; p<0.001). After multivariable adjustment, vitamin D insufficiency was the strongest independent predictor of severe CHF (adjusted odds ratio [AOR] 3.36, 95% CI: 1.88-6.02; p<0.001), while previous ischemic heart disease (AOR 1.81, 95% CI: 1.01-3.23; p=0.045) and diabetes mellitus (AOR 1.92, 95% CI: 1.08-3.42; p=0.026) also remained significant independent predictors. Patients with vitamin D insufficiency had significantly longer hospital stays, higher coronary care unit admission rates, and greater in-hospital mortality than those with normal vitamin D levels (p<0.05). Conclusions Lower serum vitamin D levels were significantly associated with increased chronic heart failure severity. Vitamin D insufficiency was highly prevalent and emerged as the strongest independent predictor of severe heart failure, while diabetes mellitus and previous ischemic heart disease were also independent predictors. Furthermore, vitamin D insufficiency was associated with poorer in-hospital outcomes. Assessment of vitamin D status may complement conventional clinical and echocardiographic evaluation for risk stratification in patients with chronic heart failure.

Cerebellar and medullary stroke can cause persistent nausea and vomiting that may be resistant to initial antiemetic monotherapy and interfere with oral intake and recovery. Evidence guiding management remains limited. We report a 48-year-old man with diabetes mellitus and acute-to-subacute infarcts involving the inferomedial right cerebellum and posterior right medulla who presented with 10 days of persistent nausea and vomiting accompanied by focal neurologic symptoms. Diabetic gastroparesis was considered, but abdominal imaging and gastric emptying scintigraphy did not support a contributory gastrointestinal cause. Ondansetron and metoclopramide provided only limited or temporary relief. Symptoms improved after sequential escalation to ondansetron, chlorpromazine, prochlorperazine, and amitriptyline; transdermal scopolamine was included in the discharge regimen. Nausea and vomiting were nearly resolved before discharge and fully resolved by three-month follow-up. Because multiple medications were introduced over a short interval and natural neurologic recovery may have contributed, the effect of any individual agent or combination cannot be determined. This case suggests that receptor-diverse pharmacotherapy may be considered when initial treatment fails while underscoring the need for further study of efficacy, safety, and medication sequencing.

Low-Molecular-Weight Heparin (LMWH) is a widely used anticoagulant in clinical practice during the COVID-19 pandemic. However, the risk of adverse reactions increases significantly in patients with multiple underlying diseases and immune dysfunction. This article reports a case of a patient with COVID-19 complicated with rheumatoid arthritis who had long-term oral prednisone (5 mg/d) for rheumatoid arthritis, who developed a rare giant hematoma (15cm×15cm) after LMWH administration, which rapidly progressed to sequential infections caused by multidrug-resistant organisms, including extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and carbapenem-resistant Acinetobacter baumannii (CRAB), within one day. This case describes the complexity and severity of adverse drug reactions under the superposition of multiple factors, and offers clinical insights for diagnosis and management.

A 61-year-old female patient was admitted to the hospital for treatment of "viral pneumonia and COVID-19". Her underlying diseases included rheumatoid arthritis (long-term oral prednisone 5mg/d), hypertension, and type 2 diabetes mellitus. After admission, the patient was given subcutaneous injection of LMWH (2500 IU, qd) for anticoagulation, combined with Simnotrelvir/Ritonavir for antiviral treatment. On the 9th day of medication, a giant hematoma of about 15cm×15cm appeared at the LMWH injection site; on the 10th day of medication, the hematoma rapidly developed into severe soft tissue infection, and the infection further spread to both waists. Etiological examination successively detected extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and carbapenem-resistant Acinetobacter baumannii (CRAB). The total length of hospital stay was 84 days (excluding 2 days of outpatient observation during inter-hospital transfers). During this period, the patient received multiple rounds of anti-infective treatment with meropenem, linezolid, minocycline, etc. and underwent 5 debridements, Vacuum Sealing Drainage (VSD), and skin grafting. After active treatment, the patient's infection was finally effectively controlled, and she was discharged smoothly after wound healing.

Under the superposition of multiple immunosuppressive factors such as COVID-19, long-term prednisone use and additional in-hospital glucocorticoid therapy, conventional-dose LMWH can induce an unusually large hematoma (15cm×15cm), with rapid disease progression (secondary infection within 1 day), which is prone to refractory MDROs infection. For such high-risk patients, clinical practice should formulate highly individualized anticoagulant treatment plans and further strengthen the monitoring of adverse reactions.

This case report describes a 29-year-old previously healthy male patient who presented to the emergency room with a painful purpuric vesicular rash. The lesions started on the bilateral lower extremities and rapidly spread to his abdomen and bilateral upper extremities. Otherwise, he remained stable without systemic symptoms. The laboratory studies showed hyperglycemia (344 mg/dL) and elevated hemoglobin A1C (10.3%), revealing previously undiagnosed diabetes mellitus. Treatment started with empiric antimicrobial therapy and supportive care, along with a diagnostic skin biopsy performed in the operating room. He was discharged three days later with outpatient follow-up and glycemic counseling. Our discussion explores the rare presentation of palisaded neutrophilic granulomatous dermatitis (PNGD) in a patient without a known autoimmune history. It highlights the role of a surgically obtained skin biopsy for a definitive diagnosis. In particular, this case links undiagnosed diabetes mellitus to the pathogenesis of PNGD. The report concludes that a systemic evaluation is key for granulomatous dermatoses, as managing underlying metabolic dysfunction can significantly improve the disease course and outcome.

Although elevated homocysteine has been consistently linked to cardiovascular disease development and progression, whether homocysteine-lowering therapy reduces diabetes risk and improves glycemic status in patients with coronary heart disease (CHD) remains unclear. This study investigated whether folic acid (FA) therapy and different treatment doses were associated with reduced new-onset diabetes risk and improved long-term glycemic control in CHD patients.

The multicenter study used a propensity score-matched design. Patients with CHD were categorized as FA users or non-users, followed by 1:4 propensity score matching to minimize baseline imbalance, ultimately yielding 2440 patients for analysis. During a median follow‑up of 3.35 years, 510 incident cases of diabetes were recorded. Multivariable Cox regression models evaluated the associations of FA use and daily dose with diabetes risk. Kaplan-Meier curves compared cumulative diabetes risk between groups. Repeated glycated hemoglobin (HbA1c) measurements were used to assess long-term glycemic trajectories, and restricted cubic spline analysis examined the dose-response relationship between cumulative FA dose and diabetes risk.

Multivariable Cox regression analyses showed that FA use was significantly associated with lower new-onset diabetes risk in CHD patients before and after matching (HR: 0.749; 95% CI:0.586-0.957; P=0.021). Dose-stratified analyses indicated that the 0.8 mg/day group had the greatest risk reduction and a more favorable long-term HbA1c trajectory (HR: 0.637; 95% CI:0.453-0.897; P=0.010). FA also showed a cumulative dosage effect, with risk-lowering benefits becoming more evident when cumulative dose exceeded 140 mg (HR: 0.478; 95% CI:0.351-0.650; P<0.001).

FA use was significantly associated with reduced new-onset diabetes risk and improved long-term glycemic status in CHD patients, particularly at 0.8 mg/day and cumulative dose >140 mg. These findings suggest that FA may have a potential role in diabetes prevention among CHD patients, although this should be interpreted cautiously given the observational study design.

Prediabetes (Pre-DM) confers an elevated risk of peripheral neuropathy and subsequent diabetic foot complications, yet there is a lack of sufficient research on the biomechanical alterations of plantar pressure distribution associated with glycemic abnormalities.

To investigate the relationship between blood glucose and plantar pressure distributions of 11 zones in Pre-DM patients.

Fifty-five Pre-DM patients were enrolled. Fasting blood glucose (FBG), glycated hemoglobin (HbA1c), and two-hour postprandial plasma glucose (2hPG) levels were measured. Pressure-time integral (PTI), peak force (PF), and mean plantar pressure (MPP) during walking were recorded using the FreeStep plantar pressure measurement system. Spearman's rank correlation analysis was used to assess the associations between three glycemic indicators and plantar pressure parameters. A hierarchical linear regression analysis was conducted to examine the association between blood glucose and the related plantar pressure.

Hierarchical linear regression analysis showed that in the first block, BMI was associated with on PF in left HL-L, MPP in left MH2, MPP in left HL-M/L (p < 0.01) and MPP in left MF-M (p< 0.05). Age was also associated with MPP in left MH2 (p< 0.01) and HL-M (p < 0.05). In the second block, 2hPG and HbA1c were independently associated with PTI and PF in left MH1, and 2hPG was associated with PF in left HL-L (p < 0.05); higher blood glucose levels were associated with increased plantar pressure. In contrast, 2hPG and HbA1c were associated with PF in left T2-5 and in both MH5 (p < 0.05); higher blood glucose levels were associated with decreased plantar pressure. FBG had no effect on plantar pressure (p>0.05).

Our exploratory study provides the first evidence that 2hPG and HbA1c are independently associated with dynamic plantar pressure in Pre-DM patients. Higher glucose levels are associated with increased loading on left MH1 and heel; conversely, with decreased loading on bilateral MH5 and left T2-5. BMI and age are also the independently associated with dynamic plantar pressure in the left foot.

Patients presenting with both type 2 diabetes (T2D) and lung function impairment (LFI) are exposed to an amplified risk of major adverse cardiovascular events (MACE). Although the SCORE2-Diabetes algorithm is widely endorsed for clinical risk assessment, its prognostic accuracy within this specific multimorbid phenotype remains inadequately explored. This study sought to evaluate the baseline utility of SCORE2-Diabetes and to investigate whether integrating a novel, machine learning-derived metabolomic signature could optimize 10-year MACE prediction in this highly vulnerable population.

We conducted a prospective analysis of UK Biobank participants with type 2 diabetes (T2D) and no cardiovascular disease at baseline. A reference cohort of 12,130 participants with preserved lung function was used to assess the base clinical model, and the primary cohort comprised 3,706 participants with lung function impairment (LFI). We profiled 249 plasma metabolites using nuclear magnetic resonance (NMR) spectroscopy. A machine-learning framework combining least absolute shrinkage and selection operator (LASSO) Cox regression, random forest survival analysis, and extreme gradient boosting (XGBoost) was used to derive a consensus signature. Internal validation used 1,000 bootstrap resamples; the complete modeling pipeline was repeated within each resample. Incremental performance beyond SCORE2-Diabetes was assessed using Harrell's concordance index (C-index), net reclassification improvement (NRI), calibration, and decision curve analysis (DCA).

During a median follow-up of 12 years, SCORE2-Diabetes showed lower discrimination in the LFI cohort than in the reference cohort (C-index, 0.670 vs. 0.707). Among the 3,706 participants with LFI, 845 developed major adverse cardiovascular events (MACE). Adding the 12-metabolite signature increased the C-index from 0.670 to 0.722 (absolute difference, 0.052; P < 0.001), representing a statistically significant but moderate improvement in discrimination. The five-metabolite model had a C-index of 0.708, while the two-metabolite sensitivity model yielded a C-index of 0.699 (95% CI, 0.683-0.716). Using the 2023 European Society of Cardiology SCORE2-Diabetes categories, the categorical NRI was 14.8% (95% CI, 10.8%-18.8%). Internal calibration and DCA suggested improved agreement and net benefit, but these results require external validation.

In participants with T2D and LFI, adding a metabolomic signature to SCORE2-Diabetes produced a statistically significant but moderate improvement in risk discrimination. These internally validated findings support further evaluation in independent cohorts and prospective impact studies; they do not establish immediate clinical usefulness.

The continuous evaluation of GFR among youth with T1D has traditionally been difficult during the transition to adult care given distinct pediatric & adult estimated GFR (eGFR) formulas recommended by clinical practice guidelines. We aimed to assess longitudinal trends in kidney function in type 1 diabetes from adolescence to early adulthood using updated eGFR formulae and to examine associations between eGFR and clinical as well as social factors over time in this population.

Clinical factors including age, sex, diabetes duration, insulin therapy, BMI and HbA1c in addition to social factors including ethnicity & material deprivation (MD) were collected alongside creatinine (Cr) and cystatin c (CysC) from Canadian participants in the AdDIT & CanSOLVE CKD-SPOR studies (2009-2023). Estimated glomerular filtration rates (eGFR) derived using updated Chronic Kidney Disease in Children under 25 (CKiD U25) Cr, CysC & combined Cr-CysC formulas were evaluated longitudinally using linear mixed effects regression, as were urine albumin-creatinine ratios (uACR).

Youth with type 1 diabetes ages 10 to <25 years were evaluated (N = 137) at a median 5 timepoints (IQR: 4-6) over 9.8 ± 1.3 years. As age increased, eGFR_Cr increased mildly (β:+1.0 ml/min/1.73m²/year; P<0.0001), whereas eGFR_CysC decreased until the age of 18 (β:-3.3 ml/min/1.73m²/year; P<0.0001) and stabilized thereafter (β: +0.1 ml/min/1.73m²/year; P = 0.433). These trends nullified one another across the age range using the combined eGFR_Cr-CysC, which remained stable (β:-0.1 ml/min/1.73m²/year) from ages 10-25 years (P = 0.452). Sex, BMI, insulin therapy, HbA1c and MD were associated with eGFR_Cr-CysC over time with a large difference of +6.5 ml/min/1.73m² seen in high relative to low MD groups (P = 0.0025). Log-transformed uACR was negatively associated with male sex (P = 0.017) and baseline diabetes duration (P = 0.049) yet positively associated with HbA1c (P = 0.021).

Different eGFR trends were observed using Cr- vs. CysC-derived estimates in youth with diabetes using updated eGFR formulae. Elevations in eGFR, alongside alterations in markers of albuminuria, were associated with increased glycemia and marginalization, providing insights into key clinical and social risk factors for kidney disease monitoring in this population. (NCT01581476).

Carbohydrate counting is central to dietary self-management in patients with type 1 diabetes mellitus (T1DM). However, objective assessments of carbohydrate counting knowledge and its relationship with psychosocial outcomes are scarce in Gulf populations. This study assessed carbohydrate counting knowledge, diabetes distress, and hypoglycaemia awareness in patients with T1DM attending a tertiary diabetes centre in the United Arab Emirates.

This was a cross-sectional study of 40 patients with T1DM (age ≥ 14 years, diabetes duration ≥ 12 months) attending the Tawam Hospital Diabetes Clinic, Al Ain, UAE. Carbohydrate counting knowledge was assessed using the Arabic version of the 43-item AdultCarbQuiz questionnaire. Diabetes distress was measured using the two-item Diabetes Distress Scale (DDS-2), and hypoglycaemia awareness was measured using the Gold score. Pearson's correlations, one-way analysis of variance (ANOVA) across knowledge quartiles, and partial correlations adjusted for HbA1c and Gold score were performed.

The mean AdultCarbQuiz score was 26.2 ± 4.0 out of 43 (60.9%). Domain analysis revealed strong carbohydrate food recognition (domain mean 80.1% correct) but poor quantification skills (20-27.5% correct for portion estimation) and meal-level counting (2.5-15% correct). Diabetes distress was present in 37.5% of the participants, and impaired hypoglycaemia awareness was present in 20.0% of the participants. Knowledge of carbohydrate counting showed a moderate inverse correlation with diabetes distress (r = -0.468, 95% CI -0.68 to -0.18, p = 0.002), which strengthened further after adjusting for HbA1c and Gold score (partial r = -0.579, 95% CI -0.77 to -0.30, p < 0.001). In exploratory analyses, younger age (r = -0.404, p = 0.010) and shorter diabetes duration (r = -0.344, p = 0.030) were associated with higher knowledge scores. No association was observed between the knowledge scores and HbA1c levels (r = 0.179, p = 0.295).

In this cross-sectional sample, carbohydrate counting knowledge was independently and inversely associated with diabetes distress, regardless of glycaemic control. Specific knowledge gaps in carbohydrate quantification and meal-level counting are actionable targets for educational intervention in this population. These findings highlight the value of addressing both nutritional knowledge and emotional well-being in T1DM management; whether improving carbohydrate-counting knowledge reduces distress requires longitudinal and interventional study.

This study aimed to observe and compare the visual and anatomical improvements over 24 months in patients with diabetic macular edema (DME) treated with intravitreal conbercept injection following five initial monthly doses, using either a Pro Re Nata (PRN) regimen or a Treat-and-Extend (T&E) regimen. The injection and visit frequency were also compared between the two groups.

This study retrospectively analyzed 119 patients with DME. Sixty patients received the 5+PRN regimen, while the other 59 patients were treated with the 5+T&E regimen. Baseline and post-treatment parameters, including best-corrected visual acuity (BCVA), central foveal thickness (CFT), microaneurysm count (MA count), retinal vein diameter, deep capillary plexus vessel density (DCP-VD), foveal avascular zone (FAZ) area, hard exudate (HE) area, and hemorrhage area, were recorded and compared between the two groups. The total number of intravitreal injections administered within 24 months was documented for both groups.

Significant improvements in BCVA, CFT, and MA count were observed as early as 6 months after treatment in both groups, and these improvements were sustained through 24 months. Significant improvements in retinal vein diameter and DCP-VD became evident at 18 months post-treatment. Both the HE area and hemorrhage area showed significant improvements at 24 months after treatment. No statistically significant change in FAZ area was detected during the follow-up period. There were no significant differences in all therapeutic outcomes between the two groups. The mean number of injections within the 24-month follow-up was 14.02 ± 2.05 in the 5+PRN group and 11.44 ± 1.74 in the 5+T&E group. Meanwhile, the average number of follow-up visits was 24.89 ± 1.67 in the 5+PRN group and 13.94 ± 2.60 in the 5+T&E group. Both the injection frequency and follow-up visits were significantly lower in the 5+T&E group than in the 5+PRN group.

Conbercept is safe and effective for the treatment of DME. Both the 5+PRN and 5+T&E regimens demonstrated significant improvements in visual acuity and retinal anatomical structure over the 24-month follow-up period. Over 24 months, the 5+T&E group had fewer mean injections and follow-up visits compared with the 5+PRN group, indicating that an individualized dosing strategy can reduce patient burden and healthcare costs while maintaining therapeutic efficacy.