Background Cardiac arrhythmias are a leading cause of morbidity and mortality among patients with chronic kidney disease (CKD) undergoing maintenance hemodialysis. Objective The objective of the study is to determine the prevalence and patterns of cardiac arrhythmias in CKD patients receiving maintenance hemodialysis and to identify clinical and dialysis-related factors associated with arrhythmia occurrence. Methods This retrospective cross-sectional study was conducted at Sir Ganga Ram Hospital, Lahore, Pakistan, from March 2022 to March 2025. A total of 155 patients undergoing maintenance hemodialysis were included using non-probability consecutive sampling. Data were extracted from hospital records, dialysis charts, and electrocardiographic (ECG) reports routinely recorded before, during, and after dialysis sessions, as well as 24-hour Holter monitoring reports when clinically indicated. Arrhythmias were categorized as atrial, ventricular, or bradyarrhythmic according to standard ECG criteria, and their timing relative to dialysis sessions (pre-, intra-, and post-dialysis) was documented. Only patients with complete clinical, dialysis, and ECG/Holter data were included. Results The mean age of participants was 52.6 ± 12.8 years, with 101 men (65.2%). Hypertension (72.3%), diabetes mellitus (57.4%), and ischemic heart disease (29.7%) were the most common comorbidities. Cardiac arrhythmias were identified in 97 patients (62.6%). Atrial fibrillation was the most frequent sustained arrhythmia (24.5%), followed by ventricular arrhythmias (20.0%) and bradyarrhythmias (10.3%). Arrhythmias were most commonly observed during dialysis (45.4%) and in the post-dialysis period (33.0%). On multivariate logistic regression analysis, arrhythmia occurrence was independently associated with age > 55 years (odds ratio (OR) = 1.9, 95% confidence interval (CI): 1.1-3.4; p = 0.02), hypertension (OR = 2.1, 95% CI: 1.1-4.0; p = 0.01), diabetes mellitus (OR = 1.8, 95% CI: 1.0-3.3; p = 0.04), ischemic heart disease (OR = 2.4, 95% CI: 1.2-4.9; p = 0.01), dialysis vintage > 5 years (OR = 2.2, 95% CI: 1.2-4.2; p = 0.02), and low-potassium dialysate use (OR = 2.6, 95% CI: 1.3-5.3; p = 0.005). Conclusion Cardiac arrhythmias are highly prevalent among patients receiving maintenance hemodialysis, with atrial fibrillation being the most common sustained type. Several patient-related and dialysis-related factors were associated with arrhythmia occurrence; however, these associations should be interpreted in the context of the retrospective, single-center design and clinically indicated rhythm monitoring. Prospective studies with systematic cardiac monitoring are warranted to further clarify causal relationships and preventive strategies.

The relationship between optic nerve sheath diameter (ONSD) and mortality outcomes in critically ill intensive care unit (ICU) patients is an area of increasing interest. This study aimed to explore whether ONSD can serve as a reliable predictor of mortality in ICU patients, potentially offering a non-invasive tool to guide clinical decision-making and patient management.

This prospective cohort study included critically ill ICU patients aged 14 years and above, excluding those with pre-existing optic nerve disorders, traumatic brain injury (TBI), or intracerebral hemorrhage (ICH). Demographic and clinical data, including age, sex, comorbidities, injury severity score, Glasgow Coma Scale (GCS), and laboratory data, such as liver function tests (LFTs), hemoglobin (Hb) level, and procalcitonin (PCT) level, were collected. ONSD was measured on Day 1 and Day 10 using transorbital ultrasonography. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 21 (released 2012; IBM Corp., Armonk, New York, United States) to determine the association between ICU mortality and other outcomes.

The patients in this study had a mean age of 58.29 years, with the majority presenting with comorbidities such as diabetes mellitus (DM) and hypertension (HTN). Clinical outcomes showed significant reductions in C-reactive protein (CRP) over ten days, with a notable prevalence of sepsis (91.2%) and a survival rate of 66.2%, while the ONSD values on ICU admission day were significantly higher in non-survivors (mean right/left ONSD = 4.02/3.97 mm) versus survivors (mean right/left ONSD = 3.68/3.67 mm), with p-values of 0.001 indicating statistical significance.

ONSD measurement is a valuable prognostic tool in ICU patients, correlating with mortality outcomes, especially in septic patients, and can help guide timely interventions for better outcomes.

Exposure to iodinated contrast media (ICM), particularly at higher doses, carries significant risks of acute hypersensitivity and organ toxicity, especially involving the kidneys and cardiovascular system. Documenting these reactions is vital for patient safety, risk management, and medico-legal considerations. This study aimed to determine the incidence of ICM-induced adverse reactions and to identify associated risk factors among patients undergoing radiologic imaging in tertiary hospitals in Tanzania.

This prospective cohort study enrolled 283 patients undergoing contrast-based radiologic procedures between March and May 2024 at two tertiary hospitals in the Ilala district, Tanzania. Data on demographics, drug history, comorbidities, and prior contrast exposure were collected through structured questionnaires and patient files. Blood pressure and BMI were measured, with hypertension defined as BP ≥140/90 mmHg or a history of treatment. Reactions were assessed at baseline and post-procedure at 24, 72, and 168 hours. Data analysis was performed using SPSS version 27 (IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp.), applying univariate and multivariate analysis, with p-values <0.05 considered statistically significant.

The incidence of any ICM-induced reaction was 39.2% (111/283). Acute reactions predominated, including gastrointestinal (27.9%), neurological (18.0%), and dermatological (13.5%) symptoms, while delayed events were mainly contrast-associated acute kidney injury (6.3%) and delayed cutaneous reactions (4/111, 3.6%). Significant risk factors included normal BMI (adjusted risk ratio (ARR) = 1.445), overweight (ARR = 1.305), neurological conditions (ARR = 1.496), cardiopulmonary disease (ARR = 1.335), oncologic indications (ARR = 1.350), anemia (ARR = 1.490), and stage 2 renal failure (ARR = 2.143). Interestingly, diabetes mellitus was associated with a lower risk (ARR = 0.540).

These findings highlight that acute reactions are more common than delayed ones, emphasizing the need for careful risk assessment and targeted preventive strategies during contrast procedures.

Autoimmune hepatitis triggered by Herpes Zoster infection is a relatively rare condition and a diagnosis of exclusion, as there are other more common causes of autoimmune hepatitis. While evaluating a patient with suspected autoimmune hepatitis, common causes such as viral hepatitis, Epstein-Barr virus, and medications like amoxicillin-clavulanic acid, statins, nitrofurantoin and methyldopa must be ruled out. Furthermore, autoimmune processes like thyroiditis, type 1 diabetes mellitus, rheumatoid arthritis, and ulcerative colitis should be considered. Herpes Zoster virus is known to cause diseases such as post-herpetic neuralgia, meningitis, meningoencephalitis, myelitis, cranial neuropathies, keratitis, uveitis, scleritis, and vision loss. Rarely, it can also trigger an autoimmune process in the body, causing hepatitis. A major dilemma that can be encountered while evaluating a patient with suspected autoimmune hepatitis precipitated by Herpes Zoster infection is drug-induced liver injury, especially if the patient had been managed with a medication known to cause liver injury. Both drug-induced liver injury and Herpes Zoster hepatitis have overlapping clinical, laboratory and histological pictures that can pose a significant diagnostic challenge. We report a case of autoimmune hepatitis in an elderly female precipitated by Herpes Zoster infection. She was observed with findings typical of cholestatic liver disease, and an extensive workup, including imaging and liver biopsy, was done to determine the cause of liver injury. Her clinical presentation, laboratory and Imaging findings favored Herpes Zoster virus as the likely culprit for autoimmune hepatitis.

Type 2 Diabetes Mellitus (T2DM) and depression are major public health challenges, with Mexico ranking among the countries with the highest prevalence of both. Research into the bidirectional relationship between the two conditions in Mexico is scarse. This study aims to investigate the prevalence of T2DM and depression, the co-occurrence of these conditions, the strength of their association, and socio-demographic, and geographical factors contributing to their prevalence in Mexico.

We used data from the 2022 National Health and Nutrition Survey. T2DM was self-report. Depression was assessed using the Center for Epidemiological Studies Depression Scale. Descriptive statistics and multivariate logistic regression models were used to explore the bidirectional relationship and associated factors.

A high prevalence of depressive symptoms (16.7%) and Type 2 Diabetes Mellitus (T2DM, 10.9%) was found in a representative sample for the Mexican population (n =11 913). Participants with T2DM had higher odds of depressive symptoms (OR:1.78, 95 95% CI: 1.48-2.14), and those with depressive symptoms were also more likely to have T2DM (OR:1.97, 95% CI:1.52-2.54) for ages 20-59, and for ages 60+ (OR: 1.63, 95% CI: 1.27-2.09). Women were more likely to report depression than men (OR:2.14, 95% CI:1.83-2.51), and older adults (60+) had over three times higher odds of depression compared to younger adults (OR:3.53, 95% CI:3.00-4.15). Higher education was protective against both conditions, with individuals having high school or higher education showing lower odds of depression (OR:0.41, 95% CI: 0.31-0.53) and T2DM (OR: 0.52, 95% CI: 0.37-0.74).

Integrated strategies to address the co-occurrence of T2DM and depression are needed, particularly among vulnerable and older populations.

Post-stroke patients need support from their caregivers to adapt to changing lifestyles. Difficulty meeting their existing needs increases the care burden and reduces the quality of care and life.

To examine the care preparedness and needs of caregivers of patients diagnosed with stroke.

A cross-sectional study design was employed. Study data were collected in the neurology units of a university hospital between January 1 and May 31, 2024 with the participation of 139 caregivers. Data were analysed using independent samples t-test, One-Way ANOVA, and multiple linear regression analyses.

The mean age of patients diagnosed with stroke was 62.87 ± 14.31 years, 64.7% were male, and 69.1% were diagnosed recently. The mean age of the caregivers was 48.40 ± 15.82 years, 61.2% were female, and the preparedness for caregiving scale means were 21.44 ± 7.22. It was found that care preparedness was associated with patient characteristics, such as age that was ≥ 65, comorbid diseases, diabetes mellitus and caregiver characteristics such as female gender and having care experience. The study showed that the presence of comorbid diseases in the patient and having difficulty in caregiving explained 13.2% of the variance in the level of caregivers' care preparedness (p = 0.001). The most common needs of caregivers during the care process were preventing falls (64.0%), patient mobility (57.6%), having information on monitoring secondary stroke symptoms (51.1%), receiving physiotherapy support (45.3%), coping with stress (40.3%), and resting (33.1%). In addition, the needs that caregivers had the most difficulty meeting were positioning, monitoring secondary stroke symptoms, understanding medical terms, management of swallowing difficulties, psychotherapy, and receiving voluntary/paid caregiver support.

The study emphasises the need for comprehensive evaluation of the care needs of post-stroke caregivers and targeted interventions specific to these needs.

A limited number of physical activity programmes exist for Chinese people with young-onset (18-40 years) type 2 diabetes amid its rising global prevalence. This study aims to develop a multimodal intervention for improving physical activity levels for individuals with young-onset type 2 diabetes using co-design.

The development process included three stages. Stage 1 involved synthesising the findings of a review of existing physical activity interventions and a qualitative study of exercise experiences of young adults with type 2 diabetes. This generated a list of candidate intervention elements and behaviour change techniques to inform the co-design process. Stage 2 involved the development of animated trigger films, using findings from stage 1, to present the physical activity experiences of people with young-onset type 2 diabetes. In stage 3, a series of co-design workshops engaging relevant stakeholders were conducted, utilising the outputs from the previous two stages and aligning with the Design Thinking theory.

Twenty-five participants (12 young adults with type 2 diabetes, 12 healthcare professionals, and one family member) attended co-design workshops to develop the intervention. The co-design process resulted in a logic model for a tailored programme-IPAYD (Improving Physical Activity in people with Young-onset type 2 Diabetes). This programme integrates behaviour change techniques across four elements: individualised goal setting and planning, exercise monitoring, a peer support forum, and educational resources. An eHealth platform was preferred to deliver the programme, incorporating one-to-one consultations and optional group sessions to enhance social support and social interaction.

Through stakeholder engagement in a co-design process, this study makes a novel and much-needed contribution to developing a physical activity intervention for Chinese people with young-onset type 2 diabetes.

An advisory group of six Chinese young people with type 2 diabetes met online and communicated through a project-focused WeChat group. They contributed to the animated film scripts, the topic guide of the workshops, the design of the intervention materials, and how to conduct the workshops to align with Chinese culture.

This study aimed to compare blood pressure and vascular responses during isometric handgrip exercise and muscle metaboreflex activation in the offspring of parents with type 2 diabetes and individuals without a family history of diabetes.

The sample consisted of a family history of type 2 diabetes parents (n = 12; 30.92 ± 4.87 years) and those without a family history of diabetes (n = 12; 28.42 ± 5.43 years). Blood pressure (Dixtal®), heart rate (ECG-Dixtal®) and muscle blood flow (Hokanson®) were recorded for 3 min at baseline and 3 min during isometric handgrip exercise (Saehan®). Immediately after the exercise, circulatory occlusion was performed for 2 min to assess muscle metaboreflex activation. Additionally, the vascular conductance was calculated. A two-factor repeated measures analysis of variance was conducted to test for possible differences between the groups for all variables under baseline conditions and during isometric handgrip exercise and to analyse the muscle metaboreflex activation. A significance level of p < 0.05 was adopted.

Blood pressure, heart rate, muscle blood flow and vascular conductance showed similar baseline values in both groups, with significant and similar increases during the isometric handgrip exercise. Furthermore, for muscle metaboreflex activation, the systolic, diastolic and mean blood pressure values were significantly and similarly increased compared with baseline in both groups.

The blood pressure and vascular responses during isometric handgrip exercise, as well as the muscle metaboreflex activation of blood pressure, are preserved in the offspring of parents with type 2 diabetes compared to those without a family history of diabetes.

Diabetic nephropathy (DN) is a primary contributor to end-stage renal disease, and non-coding RNAs (ncRNAs) extracted from urinary extracellular vesicles (uEVs) are being investigated as prospective biomarkers. This study reviewed the expression patterns, clinical associations, and diagnostic efficacy of them in DN cases. Following the PRISMA 2020 guidelines, PubMed, Embase, and Web of Science were systematically searched up to March 15, 2025 (PROSPERO: CRD420251039771). Eligible studies included primary human observational studies comparing uEV-derived ncRNAs in DN patients with non-DN diabetic subjects and healthy controls. Information on ncRNA expression, how it relates to clinical factors, and its performance as a diagnostic test was included. Bias assessment was done using the ROBINS-I tool. Twenty-four studies met the inclusion criteria. A total of 197 uEV-derived miRNAs were identified, while only one study evaluated other ncRNA species (four lncRNAs and two circRNAs). These miRNAs exhibited significant relationships with renal function markers, such as uACR, eGFR, serum creatinine, and BUN. Different miRNA signatures, such as miR-30a, miR-24-3p, and miR-27b-3p, were associated with stages of albuminuria. There were also associations between some miRNAs and glycemic indices, blood pressure, and lipid profiles. Individual miRNAs showed strong diagnostic efficacy, with miR-636, miR-34a, and miR-15b achieving AUCs of over 0.88. Combination biomarker panels significantly improved the ability to distinguish between DN stages. These results validate uEV-derived ncRNAs as sensitive indicators of DN development and prospective noninvasive biomarkers. However, standardized analytical procedures are necessary to make results more reproducible.

Obesity-induced insulin resistance is an escalating global health challenge that substantially contributes to the development of metabolic disorders, including type 2 diabetes mellitus and cardiovascular disease. This narrative review critically examines the molecular and cellular mechanisms linking excess adiposity to impaired insulin action, with a particular focus on adipose tissue dysfunction, chronic low-grade inflammation, and oxidative stress. A comprehensive literature search was conducted using PubMed, ScienceDirect, and Google Scholar, covering preclinical and clinical studies published primarily over the past two decades. Evidence indicates that adipocyte hypertrophy and hypoxia promote excessive free fatty acid release, ectopic lipid accumulation, and lipotoxicity, thereby disrupting insulin signalling pathways. Numerous clinical studies report that obesity triggers chronic, low-grade inflammation in the liver and pancreas, activating pathways such as NF-κB and SOCS proteins, thereby disrupting insulin signalling. Concurrently, obesity-associated inflammation drives immune cell infiltration and macrophage polarization toward a pro-inflammatory phenotype, further exacerbating insulin resistance and metabolic dysregulation. This review also synthesizes current therapeutic strategies targeting these mechanisms, including insulin-sensitizing agents, anti-inflammatory therapies, glucagon-like peptide-1 receptor agonists, and sodium-glucose cotransporter 2 inhibitors, as well as emerging approaches. Future perspectives highlight the growing relevance of personalized medicine, pharmacogenomics, digital health tools, and gene-based interventions in improving therapeutic precision. A deeper understanding of these interconnected pathways is essential for developing effective strategies to mitigate obesity-related insulin resistance and its global metabolic consequences.