Patients with established cardiovascular disease (CVD) may have a higher risk of recurrent stroke and a higher prevalence of antiplatelet resistance than those without CVD. This study investigated the efficacy and safety of dual antiplatelet therapy (DAPT) with clopidogrel plus aspirin in patients with established CVD. This is a secondary post hoc analysis of the Intensive Statin and Antiplatelet Therapy for Acute High-risk Intracranial or Extracranial Atherosclerosis (INSPIRES) trial. Patients with mild ischemic stroke (IS) or high-risk transient ischemic attack (TIA) of presumed atherosclerotic cause were randomized to receive either DAPT or aspirin alone within 72 h after symptom onset. Established CVD was defined as a prior diagnosis of IS, coronary artery disease, TIA, or peripheral arterial disease. The primary efficacy and safety outcomes were the occurrence of new stroke and moderate-to-severe bleeding within 90 days. This study included 6100 patients, with a mean age of 63.7 ± 9.6 years and 35.8% of female. DAPT was associated with a reduced risk of new stroke (hazard ratio [HR] = 0.67, 95%CI: 0.54-0.85, P < 0.001) in non-CVD patients but not in those with established CVD (HR = 0.97, 95%CI: 0.73-1.28, P = 0.82), compared with aspirin (P for interaction = 0.04). Moderate-to-severe bleeding did not differ by antiplatelet treatments across CVD subgroups (P for interaction = 0.32). In the INSPIRES trial, patients with established CVD may benefit less from clopidogrel-aspirin in reducing the risk of recurrent stroke within 90 days than those without CVD after mild IS or high-risk TIA. TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03635749.

Non-communicable diseases (NCDs) are the leading cause of premature mortality in Africa, with Burundi facing a growing double burden of malnutrition effects: undernutrition and rising obesity rates. Despite recent policy efforts, including national strategies and increased health spending, the country's health system remains under-resourced and vulnerable to nutrition-related health challenges.

This study aimed to assess the extent of implementation of public policies aimed at creating healthy food environments in Burundi using the Food Environment Policy Index (Food-EPI), and to identify policy gaps and priorities for addressing the double burden of malnutrition.

From December 2022 to February 2024, the Healthy Food Environment Policy Index (Food-EPI) tool was used to benchmark 56 policy and infrastructure indicators against Good Practice Statements. Documentation was reviewed, and evidence was validated by a panel of 24 experts from government, academia, and civil society through two workshops. Experts scored the level of policy implementation using a five-point Likert scale and prioritized future actions based on importance, achievability, and effectiveness.

Of the 56 indicators assessed, 27% were rated as "very little or no implementation" and 37% as "low implementation." Only 13% were rated as "high." Infrastructure support indicators generally scored higher than policy components. Thirteen indicators were not addressed in any existing policy documents. Experts identified 13 priority actions, seven of which aligned with WHO "double-duty actions." Inter-rater reliability was moderate (Gwet AC2 = 0.46).

Significant policy gaps remain in Burundi's approach to improving food environments. There is an urgent need for comprehensive, multisectoral strategies to strengthen public health nutrition and reduce the impact of diet-related NCDs.

Optimal glycaemic control is essential for preventing complications of type 2 diabetes mellitus (T2DM), yet a large proportion of patients fail to achieve recommended glycaemic targets even in tertiary care settings. Identifying independent behavioural and treatment-related determinants of glycaemic control is crucial for improving diabetes management.

A hospital-based analytical cross-sectional study was conducted among 416 adult patients with T2DM attending the diabetic outpatient department of a tertiary care hospital. Data were collected using a structured, pre-tested questionnaire covering sociodemographic profile, lifestyle practices, treatment adherence, and healthcare access. Glycaemic control was assessed using HbA1c values and categorized as optimal (< 7%) and poor (≥ 7%). Descriptive statistics, chi-square test, Spearman correlation, and multivariable logistic regression were applied using IBM SPSS Statistics for Mac (Version 31.0).

Optimal glycaemic control was observed in 239 (57.5%) participants, while 177 (42.5%) had poor control. Higher physical activity, adherence to a diabetic diet, and consistent medication adherence were significantly associated with optimal glycaemic control in bivariate analysis (p < 0.05). Spearman correlation showed a strong positive correlation between medication adherence and glycaemic control, followed by physical activity and regular follow-up. In multivariable regression analysis, medication adherence, physical activity, and regular follow-up emerged as significant independent predictors of optimal glycaemic control, whereas sociodemographic factors showed weaker adjusted effects.

Glycaemic control among patients with T2DM is predominantly influenced by modifiable behavioural and treatment-related factors. Strengthening medication adherence counselling, lifestyle modification, and structured follow-up within tertiary care diabetes clinics may substantially improve glycaemic outcomes and reduce the long-term burden of diabetes-related complications.

Not applicable.

Medication adherence remains a significant challenge among people with schizophrenia, particularly those having comorbidity with type 2 diabetes mellitus (T2DM) due to complex treatment regimens and long-term care demands. Family caregivers play a central role in medication management; however, evidence regarding how caregiver-related factors influence medication adherence is limited.

This study examined the factors predicting medication adherence among family caregivers of people with schizophrenia and T2DM.

A hospital-based cross-sectional study was conducted among 530 family caregivers of people with schizophrenia and T2DM receiving outpatient psychiatric services in seven provinces in Northeastern Thailand. Data were collected using validated questionnaires assessing sociodemographic characteristics, caregiver-related psychosocial factors, and medication adherence. Multivariable linear regression analysis was performed to identify factors predicting medication adherence, with a significance level of 0.05.

The final model explained 41.0% of the variance in medication adherence. Higher caregiver mental health literacy (MHL) and access to health information via the internet were positively associated with medication adherence, whereas higher family caregiver income and sense of coherence were negatively associated with medication adherence.

Medication adherence among people with schizophrenia and T2DM was associated with family caregiver-related psychosocial and socioeconomic factors. Family caregiver-centered interventions that enhanced MHL, promoted access to reliable health information, and considered family caregivers' socioeconomic contexts may improve medication adherence and long-term treatment outcomes in community mental health settings. Pharmacists are well positioned to conduct MHL screening during medication dispensing and to lead structured caregiver education programs as part of integrated community mental health services.

Timely identification of sepsis patients at elevated risk for in-hospital mortality or prolonged hospitalization remains a clinical imperative. This study aimed to assess the prognostic utility of two readily available hematological biomarkers, namely the neutrophil-to-lymphocyte count ratio (NLCR) and platelet-to-lymphocyte count ratio (PLCR), for their association with mortality and length of stay (LOS) among sepsis patients, including high-risk subgroups with acute kidney injury (AKI) or type 2 diabetes mellitus (T2DM).

This retrospective 1-year cohort study included 202 adult sepsis patients. NLCR and PLCR were derived from admission complete blood counts. Receiver operating characteristic (ROC) curve analysis was used to evaluate discriminative performance, with optimal thresholds determined using Youden's index. Kaplan-Meier and log-rank tests assessed survival differences, while LOS comparisons were analyzed using Mann-Whitney and Chi-square tests.

NLCR demonstrated limited overall prognostic value for mortality (AUC 0.560; sensitivity 53.68%; specificity 63.55%) but showed improved discrimination in patients with T2DM (AUC 0.603). PLCR was not associated with mortality in any subgroup (AUCs: 0.438-0.539). Diabetic patients with low NLCR had significantly higher survival (62.4% vs. 32.8%; p = 0.039). No significant survival differences were observed in the overall or AKI cohorts. Both NLCR and PLCR had poor association with LOS (AUC < 0.55). However, AKI patients with elevated NLCR had significantly prolonged hospitalization (11.5 ± 4.9 vs. 7.83 ± 4.5 days; p = 0.039). PLCR was not significantly associated with LOS.

NLCR may provide modest, preliminary prognostic value in specific sepsis subgroups, particularly those with T2DM or AKI, and may serve as a low-cost adjunct for early risk stratification.

Type 2 diabetes mellitus (T2D) is a metabolic disorder that confers increased risk of microbial infections, including those caused by the opportunistic pathogen group B Streptococcus (GBS). Asymptomatic GBS vaginal carriage is a notable reservoir for infection, but the impact of T2D on the vaginal mucosa and GBS colonization is not fully understood. We employed a diet-induced mouse model of T2D to investigate the impact of diabetes on glucose availability, vaginal microbiome composition, and vaginal cytokines at baseline and in response to GBS. We observed enhanced susceptibility of diabetic mice to GBS vaginal colonization and reproductive tract dissemination. Despite experiencing hyperglycemia, diabetic mice did not exhibit elevated glucose in the reproductive tract. Regarding the vaginal microbiota, diabetic mice had minimal compositional differences, with decreased Mammaliicoccus being the only significant taxonomic variance. Vaginal cytokine profiling revealed consistently depressed cytokines in diabetic mice, beginning with KC at baseline and expanding to eight pro-inflammatory cytokines post-GBS infection. Diabetic mice exhibited decreased proportions of uterine neutrophils and, following GBS exposure, also displayed an expanded vaginal γδ T cell compartment compared with controls. Pairing cytokine observations with GBS colonization revealed a correlation between delayed vaginal IL-1α induction and persistent vaginal GBS, suggesting that vaginal cytokine deficiency may contribute to diabetic GBS phenotypes. Intravaginal supplementation with rIL-1α resolved GBS burden differences between diabetic mice and controls, confirming that deficient vaginal cytokines contribute to diabetic GBS vaginal persistence. These findings advance our understanding of diabetic vaginal mucosal susceptibility to pathogens and support the potential for immunological intervention.IMPORTANCEPeople with T2D are more susceptible to microbial infections, but there is limited understanding of the mechanisms that drive this vulnerability. One possibility is that T2D enhances the colonization of opportunistic pathogens, like GBS, in mucosal reservoirs as a precursor to infection. In this study, we used a diabetic mouse model to test whether diabetes alters the vaginal mucosa to promote GBS colonization. We found that increased vaginal GBS colonization in diabetic mice was not linked to tissue glucose availability or changes in the vaginal microbiome but instead was associated with impaired vaginal immune responses. These findings provide a foundation for translational approaches to reduce GBS persistence and dissemination in at-risk individuals.

Gestational diabetes mellitus (GDM) is associated with metabolic and inflammatory alterations that may influence melatonin metabolism. This study evaluated associations between dietary intake of tryptophan-rich foods, urinary 6-sulfatoxymelatonin, and serum tumor necrosis factor-alpha (TNF-α) levels in pregnant women with GDM.

A cross-sectional study included 34 women with GDM and 18 with normal-risk pregnancies. Dietary habits were assessed using a validated food frequency questionnaire (FFQ). Serum TNF-α and first-morning urinary 6-sulfatoxymelatonin levels were measured by ELISA. Associations were evaluated using generalized linear models (GLMs), adjusting for maternal age, body mass index (BMI), gestational age, and sleep quality.

Women with GDM reported a significantly higher frequency of consumption of tryptophan-rich foods, particularly milk and dairy products (p < 0.01) and fruits (p < 0.05). The GDM group also exhibited higher urinary 6-sulfatoxymelatonin (p = 0.002) and serum TNF-α levels (p = 0.023). In multivariable models, GDM remained significantly associated with higher urinary 6-sulfatoxymelatonin levels, whereas TNF-α concentrations were primarily associated with maternal characteristics and interaction effects.

GDM was associated with higher urinary 6-sulfatoxymelatonin and TNF-α levels despite greater reported intake of tryptophan-rich foods. These findings highlight associations between dietary precursors, melatonin metabolism, and inflammatory markers in hyperglycemic pregnancy and underscore the need for longitudinal studies to clarify underlying mechanisms.

Diabetes mellitus is a metabolic disease that serves as an independent risk factor for the development of various pathologies, including mucormycosis.

A 47-year-old male, citizen of the Russian Federation, when seeking medical assistance, presented with the following complaints: pain, swelling, and numbness of the right side of the face; difficulty in nasal breathing through the right nasal passage, with purulent nasal discharge; reduced visual acuity in the right eye; a feeling of shortness of breath; dyspnea at rest; and general weakness. Diabetes mellitus and ketoacidosis were diagnosed for the first time. A comprehensive study was conducted, including radiological imaging, laboratory, and microbiological diagnostics. A clinical diagnosis was made: mucormycosis, rhino-orbito-cerebral form (Rhizopus oryzae). The components of the patient's treatment included surgical intervention with removal of nonviable tissues and etiotropic therapy. This clinical case ended in a fatal outcome.

Timely seeking of medical assistance, early diagnosis of the disease, prompt initiation of etiotropic therapy, and complete removal of affected tissues are key to the effectiveness of mucormycosis treatment.

Diabetic retinopathy (DR) and cognitive impairment are closely related complications of type 2 diabetes mellitus (T2DM). Although dietary patterns and gut microbiota have each been linked to these conditions, their combined associations with co-occurring DR and cognitive impairment remain unclear. This study examined dietary patterns and exploratory gut microbiota profiles in relation to co-occurring DR and cognitive impairment in patients with T2DM.

In this cross-sectional study, 306 patients with T2DM were classified into four groups: no DR with normal cognition (DMCN), no DR with cognitive impairment (DMCI), DR with normal cognition (DRCN), and DR with cognitive impairment (DRCI). Dietary patterns were derived using principal component analysis. Gut microbiota composition was assessed using 16 S rRNA sequencing in a subset of 108 participants. Multinomial logistic regression was used to examine associations between dietary patterns and group classification, and microbiome analyses included diversity, taxonomic composition, exploratory differential abundance, and diet-microbiota correlations.

Four dietary patterns were identified. In fully adjusted models, DP-I and DP-II were associated with higher odds of DMCI and DRCI, respectively, whereas DP-III was associated with lower odds of both DMCI and DRCN. DP-IV showed no significant association. Gut microbiota analyses showed modest but statistically significant group-related differences in community structure, with partial overlap across groups. Exploratory LEfSe analysis identified group-associated taxa, including higher relative abundances of Bifidobacterium, Streptococcus, and Dubosiella in DMCN and of Pseudomonas, Bilophila, and Sarcina in DRCI. However, these genus-level differences were not significant after covariate-adjusted MaAsLin2 analysis with false discovery rate (FDR) correction. Nominal diet-microbiota correlations were observed but were not statistically robust after FDR correction.

Dietary patterns were associated with clinical group classification based on DR and cognitive impairment in patients with T2DM. Gut microbiota analyses suggested modest, exploratory group-related differences, but diet-microbiota correlations were not statistically robust after FDR correction. These cross-sectional findings should be interpreted as hypothesis-generating and require validation in larger longitudinal studies.

To investigate the associations of the preoperative D-dimer-to-albumin ratio (DAR) and prognostic nutritional index (PNI) with aseptic wound complications (AWC) and periprosthetic joint infection (PJI) after primary total knee arthroplasty (TKA), and to evaluate their within-sample discrimination for distinct postoperative adverse outcomes.

This single-center retrospective cohort study included patients who underwent primary unilateral TKA at the Affiliated Hospital of Qingdao University between April 2019 and January 2024. Patients with both AWC and PJI were classified in the PJI group only. Deep venous thrombosis was excluded preoperatively using lower-extremity color Doppler ultrasonography. DAR and PNI were calculated from laboratory tests obtained within 48 h before surgery. AWC was assessed within 30 days after surgery, and PJI was assessed within 2 years according to the 2018 International Consensus Meeting criteria. Multivariable logistic regression, receiver operating characteristic (ROC) analysis with 95% confidence intervals (CIs), DeLong tests, bootstrap internal validation, calibration assessment, and sensitivity analyses were performed.

A total of 1,197 patients were included, including 45 isolated AWC events and 35 PJI events. After adjustment for age, sex, body mass index, diabetes mellitus, and Charlson Comorbidity Index, preoperative PNI was independently associated with isolated AWC (odds ratio [OR], 0.613; 95% CI, 0.543-0.693; P < 0.001), whereas preoperative DAR was not associated with isolated AWC (OR, 0.952; 95% CI, 0.852-1.064; P = 0.388). In contrast, DAR was independently associated with PJI (OR, 1.454; 95% CI, 1.328-1.592; P < 0.001), whereas PNI was not significantly associated with PJI (OR, 0.915; 95% CI, 0.825-1.015; P = 0.094). PNI showed an AUC of 0.873 (95% CI, 0.792-0.955) for isolated AWC, and DAR showed an AUC of 0.920 (95% CI, 0.865-0.975) for PJI. Bootstrap optimism-corrected AUCs were 0.862 for the adjusted PNI-AWC model and 0.900 for the adjusted DAR-PJI model.

In this exploratory single-center retrospective cohort, preoperative PNI was more strongly associated with isolated AWC, whereas preoperative DAR was more strongly associated with PJI. Although both markers showed good apparent discrimination and high negative predictive values, the low event numbers, limited positive predictive values, imperfect calibration, and absence of external validation require cautious interpretation. Larger multicenter prospective studies are needed before these cutoffs can be applied as clinical decision thresholds.