All-cause mortality among people with HIV (PWH) in sub-Saharan Africa declined after antiretroviral therapy's introduction, but data in rural settings on evolving causes of death as this population age remain limited.

To compare all-cause and cause-specific mortality trends among PWH and people without HIV (PWOH) in western Kenya using a prospective cohort study.

Data from the Siaya Health and Demographic Surveillance System were used to estimate mortality rates from 2011 to 2018 among persons aged 15-64 years, with the study population (PWH/PWOH) determined through HIV testing. InterVA-4 was used to ascertain the cause of death.

45,581 individuals with an HIV test result contributed 209,078 person-years (py) of follow-up. The HIV prevalence was 14.5%. Median age among PWH increased from 37 to 42 years from 2011 to 2018. For PWOH, this was between 29 and 31 years. 1386 individuals died, 48.8% were PWH. HIV/AIDS/tuberculosis (319 deaths; 58.2%) was the leading mortality cause for PWH and non-communicable diseases (NCDs) (235; 40.9%) for PWOH. From 2011 to 2017, HIV/AIDS/tuberculosis mortality rates declined among PWH from 19.0 to 7.0 deaths/1,000py, and mortality due to NCDs increased from 3.7 in 2014 to 5.1/1,000py in 2017. For PWOH, cause-specific mortality trends were stable over time.

Among PWH, HIV/AIDS/tuberculosis mortality decreased from 2011 to 2017, while mortality rates due to NCDs rose over time as the population aged. Among PWOH, NCDs were the leading cause of death. Managing HIV and the increasing burden of NCDs in this community requires education on prevention, active screening, and delivery of treatment and palliative care services.

Type 2 diabetes (T2D) is a critical public health crisis in Pakistan, which currently holds the highest age-standardised prevalence globally. While semaglutide significantly improves glycemic control and weight, high costs limit access to the innovator molecule in low - and middle-income countries. Biosynthetic semaglutide provides an affordable local alternative, yet real-world evidence regarding its clinical performance and impact on quality of life (QoL) is currently lacking.

The BIOSURE study is a 30-week, multicenter, prospective, non-interventional, single-arm observational protocol evaluating biosynthetic semaglutide in 268 adults with T2D across Pakistan. The primary objective is to quantify the absolute change in glycated hemoglobine (HbA1c) from baseline to 30 weeks. Secondary objectives include assessing changes in body weight, waist circumference, blood pressure, lipid profiles, and safety. Patient-centered outcomes will be measured via the Diabetes Treatment Satisfaction Questionnaire, Morisky Medication Adherence Scale, and SF-36v2 health survey. Statistical analysis will utilise mixed-effects modelling and multiple imputation for missing data.

Ethical approval has been obtained from the USM Human Research Ethics Committee and local IRBs. The study is registered with the ANZCTR (ACTRN12625000610437). Findings will be disseminated through peer-reviewed journals and policy forums to provide a clinical and assistive framework for scalable diabetes care in resource-constrained settings.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12625000610437.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used for T2DM and obesity.

An electronic search was conducted in Scopus, PubMed/MEDLINE, and Google Scholar databases. Retatrutide (LY3437943) is a novel triple agonist targeting glucagon receptor (GCGR), glucose-dependent insulinotropic polypeptide receptor (GIPR), and glucagon-like peptide-1 receptor (GLP-1 R). In subjects with type 2 diabetes mellitus (T2DM), decreased glycated hemoglobin (HbA_1c) by up to 2.16% and decreased fasting glucose by up to 69.1 mg/dL have been seen. Weight loss up to 16.94% was observed in subjects with T2DM. Subjects with overweight or obesity experienced a greater weight loss by up to 26.56% (24.15 kg). Reductions in body-mass index and waist circumference were achieved. In subjects with T2DM and overweight or obesity, decreased systolic blood pressure was found. Finally, relative liver fat count in subjects with metabolic dysfunction-associated steatotic liver disease (MASLD) was reduced by up to 86%. Increased frequency of mild-to-moderate gastrointestinal adverse events (mainly nausea, vomiting, constipation and diarrhea) was reported in participants on the highest retatrutide doses, likely due to rapid dose escalation and higher starting dose.

These promising effects on glycemic control, weight loss and emerging pleiotropic actions merit further investigation.

Preventive strategies in endocrinology focus on five major fields (the big five): thyroid gland disorders, obesity and diabetes mellitus, dyslipidemia, arterial hypertension and osteoporosis. These highly prevalent conditions have a high morbidity and mortality. As many can be prevented by relatively simple nonpharmacological measures or effectively mitigated by low-threshold pharmacological interventions, they represent model diseases for prevention in internal medicine. This article outlines the current options and discusses them in the context of current prevention strategies. Endocrine and diabetic diseases are among the most common and consequential chronic disorders in industrialized countries and essentially contribute to the total morbidity and mortality. Principal preventive strategies include structural prevention (environmental prevention), such as promoting anti-adipogenic and anti-diabetogenic social structures and behavioral prevention. The emphasis of preventive strategies is on population-related measures, structured screening programs and evidence-based lifestyle interventions. Based on current epidemiological data and guidelines, practical approaches are presented, ranging from iodine prophylaxis, lipid and blood pressure screening to promotion of healthy bone and obesity preventive structures. The concepts discussed demonstrate that effective endocrine and diabetological prevention requires coordinated action across clinical medicine, public health and health policy to realize its full potential.

Introduction-Objective: Diabetes mellitus type 2 is a chronic and progressive metabolic disorder characterized by hyperglycemia and long-term inflammation. Vitamin D has anti-inflammatory properties that reduce the production of pro-inflammatory cytokines IL-6 and TNF-α. This study aimed to investigate the role of serum vitamin D, parathyroid hormone, and homeostatic model assessment for insulin resistance (HOMA-IR) on individuals with type 2 diabetes mellitus. Additionally, study the relationship between these factors and interleukin-6 (IL-6), tumour necrosis factorα (TNF-α), and C-reactive protein (CRP).

This case-control study included a total of 100 participants within the age range of 45 to 65 years. There were 50 participants diagnosed with type 2 diabetes mellitus (T2DM) and 50 healthy individuals (control).

The levels of serum IL-6 were significantly increased in the T2DM group compared to the control groups (p < 0.05). Additionally, the T2DM group were increased levels of HOMA-IR, TNF-α, and CRP compared to the control group (p < 0.05). The patient group showed a decreased in 25-OH vitamin D levels (P > 0.05). Although the mean serum PTH level increased, this increase was significantly greater in the T2DM group compared to the control group.

The study revealed a significant negative correlation between vitamin D, HBA1C, and HOMA-IR. There is also a strong positive correlation between HOMA-IR and HBA1c, TNF-α, IL-6, and CRP. This suggests that vitamin D and PTH play a role in glycemic control.

To evaluate the impact of clinical pharmacist interventions on HbA1c and adherence to diabetes preventative screenings among Spanish-speaking adults with uncontrolled type 2 diabetes.

This retrospective evaluation of a quality improvement initiative included Spanish-speaking adults with baseline HbA1c of 8% or greater who received at least 1 clinical pharmacist visit at a Federally Qualified Health Center. Outcomes included changes in glycemic control and timely preventive care screenings (diabetic eye exam, diabetic foot exam, urine albumin-to-creatinine ratio [UACR] test, and statin use), analyzed using logistical regression and McNemar's test.

Among 70 included patients, the mean age was 55.6 years, with 65.7% of patients identifying as female and 62.9% having Medicaid insurance. The baseline mean HbA1c was 11.0%. Within 12 months, 40 patients achieved HbA1c <8% (Cochran's Q₅ = 142.88, P < .0001). Gender and insurance status were significant predictors of success. The odds of a timely diabetic eye exams (odds ratio [OR]: 8.67, 95% confidence interval [CI]: 2.66-44.74, P < .0001), foot exams (P < .0001), and UACR tests (OR: 4.80, 95% CI: 1.80-16.11, P = .0008) increased.

Spanish-speaking patients exposed to clinical pharmacist care observed significant improvements in glycemic control and timely preventative care screening.

Stable coronary artery disease (SCAD) generally exhibits prolonged periods of stability. However, this condition can unpredictably progress into an unstable state, representing a complex pathological process involving multiple contributing factors. Thus, we aimed to utilize machine-learning techniques to identify predictive features from electronic health record (EHR) data for forecasting the long-term prognosis of patients with SCAD and intermediate coronary lesions.

Patients were divided into a training cohort (n = 403) and an external validation cohort (n = 247) according to their hospital of origin during the period from January 2018 to December 2020. Predictive features were determined using LASSO regression analysis and boruta algorithm, followed by multivariate Cox regression analysis for model construction.

The developed predictive model comprised four clinical variables: platelet-to-lymphocyte ratio, diabetes mellitus, lipoprotein(a), and mean platelet width. The area under the curve for predicting major adverse cardiovascular events (MACEs) within 2-, 3- and 4-year in the development cohort was 0.692 (95%CI:0.59-0.793), 0.709 (95%CI:0.625-0.792) and 0.743 (95%CI:0.672-0.813), respectively, while that in the external validation cohort was 0.658 (95%CI 0.542-0.773), 0.681 (95%CI:0.579-0.782) and 0.723 (95%CI: 0.635-0.811), respectively. Additionally, the developed predictive model was calibrated by analyzing the correlation between expected and observed MACEs in the development and external validation cohorts. Lastly, the clinical value of the developed predictive model was confirmed via decision curve analysis.

Our validated nomogram was based on inflammation biomarkers and EHR data, demonstrating moderate discriminative ability to detect individuals at high risk of poor outcome among patients with SCAD and angiographically intermediate coronary stenosis.

Intensive care units (ICUs) play a vital role in managing critically ill patients, but mortality rates remain high, especially in resource-limited settings like Nepal. This study aimed to describe the patterns and clinical characteristics of mortality cases in the ICU of a tertiary care hospital in western Nepal, with specific focus on sex-based differences and their associated comorbidities.

A retrospective study was conducted at Lumbini Medical College Teaching Hospital, Nepal, over a one-year period (January 1 to December 31, 2024). This record-based study included mortality data of all ICU patients who died during their hospital stay and had complete medical records. Data on demographics, clinical parameters, comorbidities, laboratory findings, and need for mechanical ventilation were extracted using a structured proforma.

A total of 82 (21.93%) ICU mortality cases were included out of 374 ICU admissions, consisting of 45 (54.88%) male and 37 (45.12%) female. Median age was 63 (IQR: 46-73) years in males and 70 (IQR: 58-78) years in females. There was clustering of mortality, with 13 (15.85%) deaths occuring in September and 11 (13.41%) in November. The median age of diabetic patients was 72 (IQR: 66-77) years, while the median age of non-diabetic patients was 57.50 (IQR: 44 -73.50) years. The mean systolic blood pressure in diabetic patients was 117.79±22.64 mmHg, and in non-diabetic patients was 102.35±30.20 mmHg.

The clustering of mortality was seen during a four-month period from August through November. Male patients constituted a majority of ICU deaths due to natural causes.

Vibrio vulnificus is a halophilic marine bacterium capable of causing rapidly progressive septic shock and necrotizing fasciitis, particularly in immunocompromised individuals. Mortality rates remain high due to the fulminant nature of the infection and diagnostic challenges.

A 70-year-old female with poorly controlled type 2 diabetes presented with fever and septic shock 48 hours after ingesting raw seafood. The clinical course was characterized by rapid deterioration, severe coagulopathy, and the development of extensive necrotizing fasciitis in the right upper limb. Vibrio vulnificus infection was confirmed via next-generation sequencing (NGS) on hospital day 6. Despite broad-spectrum antibiotic therapy and fluid resuscitation, surgical intervention was delayed until day 9 following multidisciplinary consultation. Intraoperative findings revealed extensive "dishwater" necrosis. The patient suffered from recurrent sepsis, graft failure, and deep vein thrombosis. Due to the rapid progression and delayed source control, the outcome was unfavorable, leading to discharge against medical advice.

This case underscores the high mortality risk associated with Vibrio vulnificus infection in immunocompromised individuals, particularly those with diabetes mellitus. Observations from this patient highlight that antibiotic therapy alone is often insufficient for necrotizing soft tissue infections. It is emphasized that in these high-risk populations, early recognition must trigger immediate, aggressive surgical debridement alongside antimicrobial therapy. Delays in surgical source control, even while awaiting molecular confirmation, can irreversibly compromise patient survival.