Emphysematous osteomyelitis is a rare condition caused by gas-producing bacteria in the bone and may be visualized by the presence of intraosseous gas on imaging. We report three cases of emphysematous osteomyelitis. The first case is an 80-year-old with acute myeloid leukemia with emphysematous osteomyelitis of the sacrum, right iliac bone, and multiple vertebrae and ribs. Blood cultures grew Enterococcus faecium and Clostridium spp. The second case is a 45-year-old man with diabetes mellitus with emphysematous osteomyelitis of the proximal left tibia with blood cultures positive for Proteus mirabilis and Clostridium perfringens. The final case is a 57-year-old male with diabetes mellitus who presents with emphysematous osteomyelitis of the left fifth metatarsal head. Wound cultures were positive for Klebsiella pneumoniae and Proteus mirabilis. Emphysematous osteomyelitis is associated with significant morbidity and mortality, and so an accurate and quick diagnosis is important for the radiologist to make.

Type 2 diabetes mellitus (T2DM) is associated with an increased risk of cardiometabolic complications, with attendant morbidity and mortality worldwide. Evidence suggests sex-linked disparities in cardiometabolic risks due to biological, social, behavioral, and socioeconomic determinants. However, sex-linked cardiometabolic risks among adults with T2DM in Kenya are poorly understood. This study examined sex differences in cardiometabolic risk factors among adults with T2DM attending Embu County Referral Hospital in Kenya.

This cross-sectional study included 136 adults with T2DM aged ≥18 years who were diagnosed at least six months earlier. Data were collected using a researcher-administered questionnaire. Physiological and anthropometric measurements, including body mass index (BMI), waist-hip ratio (WHR), blood pressure (BP), random blood glucose (RBG), and glycated haemoglobin (HbA1c), were measured. Data analysis involved descriptive and inferential statistics, including age-adjusted logistic regression analyses of cardiometabolic risks by sex. The p-value was set at ≤0.05.

Participants were predominantly female (69.9%), with a mean (±SD) age of 56.34 (±13.83) years. Females were more likely than males to have a prior hypertension diagnosis (73.33% vs. 26.67%; p < 0.001), be obese (88.9% vs. 11.1%; p = 0.003), have a higher waist circumference (93.6% vs. 6.4%; p < 0.001), and have a higher WHR (97.7% vs. 2.3%; p < 0.001). No significant sex differences were observed in RBG, HbA1c, or BP measurements. After age adjustment, sex was not independently associated with the cardiometabolic risks. Adults aged 50-65 years had significantly lower odds of high BMI compared with those aged <50 years (AOR = 0.35, 95% CI: 0.13-0.92; p = 0.033). Females showed a lower, but statistically nonsignificant, adjusted odds of poor glycemic control.

Notable sex differences in key sociodemographic characteristics and cardiometabolic markers were observed, though attenuated by age adjustment. These findings underscore the need for age- and sex-specific preventive and management strategies to improve cardiometabolic outcomes.

Latent autoimmune diabetes in adults (LADA) is an underrecognized form of autoimmune diabetes that is commonly misdiagnosed as type 2 diabetes mellitus (T2DM) because of its indolent progression and overlapping features with metabolic syndrome. We present a case of a 60-year-old woman with an initial diagnosis of T2DM who persistently had elevated hemoglobin A1c (HbA1c) despite optimal treatment and lifestyle modifications. After subsequent hospitalization and an episode of euglycemic diabetic ketoacidosis (DKA), further evaluation unmasked the diagnosis of LADA. This case emphasizes the need for a high index of suspicion for adults with poor glycemic control or unexplained DKA, as a timely diagnosis can significantly alter management and improve outcomes.

Diabetic patients receiving insulin therapy require frequent blood glucose monitoring. Recent advancements have enabled constant glucose monitoring using small sensors, such as continuous glucose monitoring (CGM) devices. Several studies have demonstrated improved HbA1c levels following CGM implementation. Glucose monitoring may influence dietary behaviors by providing real-time feedback and visualization of postprandial glucose excursions, which can enhance self-awareness and promote dietary modification. However, few studies have investigated its association with dietary behavioral changes. This study investigated the relationship between CGM implementation and changes in dietary behavior among insulin-using diabetic patients.

This study was a single-center prospective cohort study. Consecutive adult insulin-using diabetic participants were categorized into CGM and non-CGM groups based on participant intention. The primary outcome was changes in dietary behavior, defined as changes in the percentage of carbohydrates contributing to total caloric intake. Dietary intake was assessed twice at three-month intervals using the Brief-Type Self-Administered Diet History Questionnaire. A difference-in-differences analysis compared changes in carbohydrate intake percentages between the two groups.

A total of 42 participants were included. The mean age was 67 ± 13 years, and the median duration of diabetes was 11 (8.0-16.0) years. Thirty-one participants used CGM, whereas 11 did not. At baseline, the mean carbohydrate intake as a percentage of total calories was 51% in the CGM group and 52% in the non-CGM group. After three months, these values were 50% and 56%, respectively. However, difference-in-differences analysis revealed no significant difference between the groups (p = 0.295).  Conclusion: CGM implementation was not significantly associated with changes in dietary behavior among insulin-using patients with diabetes. These findings indicate that CGM alone is insufficient, necessitating complementary strategies to promote dietary behavioral modification in this population.

Fournier's gangrene (FG) is a rapidly progressive necrotizing infection involving the perineal and genital regions and is associated with significant morbidity and mortality. It is uncommon among adolescents and is typically linked to underlying comorbidities such as diabetes mellitus, immunosuppression, or trauma. We report a case of FG in a 19-year-old male with poorly controlled diabetes who required multiple surgical debridements. Wound cultures identified Actinomyces europaeus, an emerging but uncommon pathogen in necrotizing soft-tissue infections. Early initiation of broad-spectrum antimicrobial therapy combined with prompt surgical intervention was critical to disease control in this patient. This case underscores the need for heightened clinical suspicion in young patients with metabolic risk factors and highlights the importance of multidisciplinary management and strict glycemic control to improve clinical outcomes.

The expansion of the elderly population in China has been accompanied by an increase in the prevalence of diabetes among older adults. According to the National Bureau of Statistics, the total number of individuals aged 60 and over in China reached 310 million in 2024. Of these, approximately 78.9 million have been diagnosed with diabetes - with over 95% being classified as type 2 - while approximately 141 million have prediabetes. Approximately 90% of these patients present with multiple concurrent metabolic abnormalities, such as overweight/obesity, hypertension, dyslipidemia, and hyperuricemia, which increase the risk of cardiovascular and cerebrovascular disease and organ damage. Additionally, complications due to poor glycemic control are the main risk factors for healthy longevity. Diabetes prevention and treatment remain a priority within the Healthy China (2016-2030) initiative. In line with the main theme of the "Clinical Guidelines for the Prevention and Treatment of Type 2 Diabetes in the Elderly in China (2022 Edition)", we will continue to promote regular comprehensive patient assessments and the formulation/adjustment of personalized management goals to facilitate early diagnosis and intervention among the older population. These frameworks seek to refine diabetes education and self-management models, ensuring that patients can maintain quality of life, perform self-monitoring, adhere to pharmacological regimens, and seek medical treatment. Furthermore, prevention and treatment strategies advocate for the comprehensive management of comorbid metabolic abnormalities and the active and moderate treatment of complications, focusing on the patient's clinical baseline and balancing therapeutic targets to protect cardiac, cerebral, and renal functions, thereby optimizing outcomes. The updated 2026 Edition of the "Clinical Guidelines for the Prevention and Treatment of Type 2 Diabetes in the Elderly in China" incorporates supplemental guidelines and international and domestic research on geriatric diabetes generated over the past four years. This integration informs adjustments to hypoglycemic drug selection and promotes the implementation of standardized prevention, diagnosis, and clinical decision-making, aiming to continuously improve overall diabetes management in older adults.

Severe Acute Respiratory Syndrome - Coronavirus-2 (SARS-CoV-2) was initially known to affect the respiratory system and has been reported to also involve the cardiovascular system leading to myocardial damage. Remdesivir is one of the approved treatments for COVID-19, wherein viral replication is inhibited by terminating the RNA transcription prematurely. According to studies, the primary electrocardiographic effect of remdesivir in COVID-19 patients are sinus bradycardia and QT prolongation. The use of electrocardiogram (ECG) is an essential diagnostic tool in assessing the electrical conditions of the heart. The objective of this study is to describe the electrocardiographic profile of adult patients with COVID-19 who were given remdesivir and admitted in the University of the Philippines-Philippine General Hospital (UP-PGH). To this date, this is the only study done locally identifying the electrocardiographic profiles of adult patients with COVID-19 who were given remdesivir.

This was a retrospective descriptive study involving adult patients with COVID-19 who were given remdesivir and admitted in UP-PGH from June 2021 to June 2022. Demographic profiles and 12-lead ECG done during the hospital admission were gathered. Descriptive statistics was used to summarize the clinical characteristics and the electrocardiographic findings of the patients.

There were 412 confirmed COVID-19 patients who were given remdesivir (mean age 56 years old; female 52%) included in this study. The most common comorbidities were hypertension, diabetes mellitus, and stroke. Majority of the patients had severe (58%) to critical (22%) COVID-19 infection. Most of the patients had sinus rhythm (94%), normal rate (72%), and normal axis (93%). The most common baseline ECG findings were non-specific ST-T wave changes (42%). Some patients had atrioventricular blocks (3.4%), bundle branch blocks (3.6%), prolonged QT interval (1.9%). Among those with repeat 12-L ECG (136 patients) during admission, ECG changes observed were sinus bradycardia (6%), prolonged QT interval (4%), and both (1.5%).

Based on this retrospective review, which to our knowledge is the only study done locally investigating the effects of remdesivir on ECG of adult Filipino patients with COVID-19 infection, majority of the patients had sinus rhythm, normal rate, and axis. The most common ECG finding was non-specific ST-T wave changes. This study demonstrated a low incidence of adverse ECG changes that would preclude the administration of remdesivir when indicated. These include sinus bradycardia and QT interval prolongation which did not require further interventions. ECG remains to be useful, low-cost noninvasive tool that can help monitor electrophysiologic adverse events of remdesivir.

In Asia, younger individuals (below age 45) are diagnosed to have type 2 diabetes with increased rates of obesity defined by lower BMI yet with greater visceral adiposity (waist circumference and waisthip ratios). The prevalence data on type 1 diabetes is not well established, considered to be low, but is seen to be increasing as well. This changing phenotype therefore, presents a clinical dilemma in terms of correctly classifying diabetes and deciding on the consequent appropriate treatment. Distinguishing type 1 from type 2 diabetes has become more difficult with type 2 diabetes dramatically increasing in young adults and children. This study aims to define the characteristics of diabetes among young adults in the Philippines to provide a basis for appropriate management amidst changes in diabetes phenotypes seen globally.

In this cross-sectional analytic study, we characterized the demographic, metabolic, and autoimmune features of diabetes among young adult Filipinos aged 18 to 45 years old consulting at a tertiary referral center in Manila, Philippines. Baseline serum A1c, FBS, 75-g oral glucose tolerance test, insulin, serum C-peptide, insulin autoantibodies, leptin, adiponectin, lipid profile, and thyroid function tests were obtained from the participants and analyzed. The homeostasis model assessment (HOMA) was used to estimate the insulin sensitivity.

A total of 348 patients with diabetes were included, with females comprising two-thirds of the participants. The mean age at diagnosis of diabetes was 35.9±7.22 years. The mean BMI was 28.12 kg/m², with median waist to hip ratio (WHR) of 0·93. Metabolic syndrome was found in 60% of participants and 67.82% were obese by body mass index. The mean A1c was 9.07±2.52%. Good glucose control (A1c less than 7.0%) was seen in 23% of participants while nearly half (48%) had HbA1c which was >9.0%. The median levels of fasting insulin and C-peptide were 12.62 (range 1.33-90.42) mIU/L and 0.78 ng/mL (range 0-16.2), respectively.Included participants were diagnosed with diabetes within a year and as such, majority did not have any micro- or macrovascular complications. The most common diabetes complication was sensory neuropathy detected by monofilament testing, which was found in 28% of participants, followed by non-proliferative diabetic retinopathy in 13%. A history of previous diabetic ketoacidosis was found in 10 patients (2.87%). Glutamic acid decarboxylase (GAD) and insulin auto-antibodies were found in 3.2% and 19.3% of participants, respectively. Approximately half (51.73%) of the participants were insulin resistant by HOMA-IR.

In contrast with Caucasians and other Asians, diabetes among young Filipino adults is associated with lower BMI but with a similarly high visceral adiposity as shown by an elevated WHR. Metabolic syndrome with insulin resistance as defined by a variety of indices is predominant. Type 1 diabetes with autoantibodies occur in only a small fraction of this population. Data derived from this work can provide a framework for cluster analysis towards personalized management specific to this population.

Preeclampsia (PE), a multisystem and complex disorder diagnosed when maternal hypertension manifests after 20 weeks of gestation with proteinuria, is one of the direct causes of maternal morbidity and mortality, in addition to bleeding and infection. Despite its critical impact, effective preventive dietary interventions are scarce. Oxidative stress and microvascular damage are central to PE pathophysiology. Extra virgin olive oil (EVOO), particularly early harvested EVOO (EVOOEH), is rich in antioxidant compounds and may mitigate these issues.

This randomized, single-masked (investigator and data analysis) interventional pilot study protocol will enroll 156 high-risk pregnant women (8 to 16 weeks of gestation) at Barzilai University Medical Center. Participants will be allocated to two parallel arms: the EVOOEH arm (n=78), receiving 42 mL/day (three tablespoons) of EVOOEH in addition to general Ministry of Health (MOH) dietary recommendations for 4 weeks; and the Control arm (n=78), receiving MOH dietary recommendations only. Low-dose aspirin prophylaxis will be co-administered, if indicated. Adherence will be monitored via phone calls and assessment of maternal whole blood and plasma hydroxytyrosol (HT) at recruitment and approximately four weeks post-intervention initiation. Primary outcomes are incidence of gestational diabetes mellitus (GDM), PE, Cesarean section, preterm birth, and small for gestational age (SGA) newborns. Secondary outcomes include post-intervention maternal 1-hour glucose challenge test (GCT) and serum ratio of soluble fms-like tyrosine kinase 1 to placental growth factor (sFlt-1/PlGF), as well as maternal blood pressure, gestational age at delivery, and newborn percentile. Blood samples will be analyzed for serum 25-hydroxyvitamin D [25(OH)D], sFlt-1/PlGF ratio and HT. Statistical analysis will include use of JMP Pro software, with compared by chi-squared or Fisher's exact tests for categorical variables and Student's t-tests or Wilcoxon rank-sum tests for continuous variables when appropriate. Multivariate analyses will be performed for significant variables.

This pilot study will provide crucial insights into the potential of EVOOEH as a dietary intervention for reducing PE risk in high-risk pregnancies, addressing a significant gap in current preventive strategies. This protocol study findings can inform larger-scale trials and contribute to evidence-based nutritional recommendations for PE prevention.

This study was registered on ClinicalTrials.gov (NCT06759545).

Hypertension is a leading cause of cardiovascular morbidity and mortality globally, with particularly low control rates in India. Beyond controlling blood pressure (BP), effective management must address associated comorbidities such as cardiovascular disease (CVD), chronic kidney disease (CKD), and type 2 diabetes mellitus (T2DM). A multidisciplinary panel of experts, including cardiologists, nephrologists, and physicians, developed this consensus through six advisory board meetings. A comprehensive literature review of randomized controlled trials and systematic reviews published between 2019 and 2025 was conducted via PubMed and Google Scholar. Key topics included pharmacological and non-pharmacological management of hypertension, combination therapy, and comorbidity-focused treatment strategies. Early screening for hypertension-mediated organ damage and the use of combination therapy, specifically telmisartan and cilnidipine for their complementary benefits, were emphasized. Evidence showed improved BP control, reduced proteinuria, and organ protection in individuals with CVD, CKD, and T2DM. Non-pharmacological interventions such as dietary modification, physical activity, smoking cessation, stress management, and adherence to therapy through fixed-dose combinations were also endorsed. This expert consensus supports a comprehensive, patient-centered approach to hypertension management in India. Available evidence suggests that cilnidipine and telmisartan may offer potential benefits beyond BP reduction, largely based on pharmacologic properties and surrogate outcomes. Future large-scale, randomized, comparative outcome trials are needed to better define the relative clinical benefits of this combination.