Medication nonadherence in cardiometabolic syndrome negatively impacts patients' quality of life, health care systems, and economic stability. Despite extensive research, no universally recognized strategy has been established to improve adherence. SMS text messaging has emerged as a widely accessible and cost-effective intervention, particularly when the intervention is structured using behavioral theories.

This study aimed to review existing literature and identify key factors in the design of SMS text messaging interventions for improving medication adherence among patients with diabetes, hypertension, or hyperlipidemia.

We conducted a scoping review following the SPIDER (sample, phenomenon of interest, design, evaluation, research type) framework and guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Relevant literature on SMS text messaging interventions was searched in the PubMed and Scopus databases from inception to October 2024. The search terms included "diabetes," "hypertension," "hyperlipidemia," "message," "text," "text message," "app," "application," "digital," "device," "mobile," "medical adherence," and "medication adherence," combined using logical operators "OR" and "AND." Full-text articles were analyzed for study design, author, country, year of publication, disease focus, behavioral theory, and the constructs or domains of text messages.

A total of 52 studies investigating SMS text messaging interventions to enhance medication adherence were identified. The targeted conditions included diabetes (26/52, 50%), hypertension (16/52, 31%), and various other chronic diseases (10/52, 19%). More than half of the studies (33/52, 64%) incorporated behavioral theories or techniques in their intervention design, using 19 distinct behavioral models. The most frequently used frameworks were the behavior change technique taxonomy (16/52, 31%) and the capability, opportunity, motivation, and behavior model (6/52, 12%). In addition, 33 (64%) studies implemented tailored messaging strategies, with the most common approach being content customization based on individual patient information (21/52, 40%), followed by personalized timing and frequency of messages (14/52, 27%), to enhance interventions' adaptability and relevance to users' needs.

This review highlights critical factors influencing the design of SMS text messaging interventions for medication adherence in the management of diabetes, hypertension, and hyperlipidemia. The findings underscore the importance of integrating behavioral theories and tailoring strategies to optimize patient engagement and intervention effectiveness. Further research is needed to evaluate the impact of different tailoring approaches and translate these insights into practical interventions.

Scores and prediction models such as the mangled extremity severity score (MESS) for trauma and the Wound, Ischemia, and foot Infection (WIfI) classification for diabetic foot ulcers help in the decision-making process for amputation. However, these tools can be subjective as they depend on the experience of the medical staff applying them.

This study aimed to assess the impact of temperature measurement using infrared thermal imaging in extremity salvage in patients at risk of limb amputation.

We included 29 patients who sought a second opinion after an amputation recommendation. Infrared thermographic images were acquired to measure the temperature difference (ΔT) between the injured and uninjured limbs. For patients with salvaged limbs, we provided clinical follow-up for up to 12 weeks.

Of the 29 patients enrolled in the study, 27 limbs were salvaged. Thermographic imaging allowed the distinction into two groups: the first group of 18 patients with mean ΔT value of -3.6 °C (SD 1.99 °C) , and the second group of 9 patients with mean ΔT of 3.36 °C (SD 2.71 °C). None of the patients in either group showed progression in ΔT values within the first 5 days; at the twelfth week, ΔT values approached 0 °C at wound closure. Of the two patients who required amputation, one showed an initial ΔT of -4.3 °C, which worsened to -5 °C by the fifth day, and the other patient showed an initial ΔT of -4.5 °C, which worsened to -5.8 °C by the fifth day.

Digital infrared thermography is a tool that may help guide limb salvage in patients with uncertain clinical diagnoses. This imaging modality allows visualization of thermal differences and patterns derived from thermal changes in patients at risk of limb amputation.

Children's drawings are considered an important tool for detecting emotions and experiences that a child may be unable or unwilling to express verbally.

This study aimed to assess the emotional state, psychological development, and adjustment mechanisms of children with chronic diseases using projective drawing tests, and to compare their responses with those of healthy children.

A cross-sectional design was implemented in one region of Greece, involving 100 children aged 6-12 years. The sample included 50 children with chronic diseases (25 with type 1 diabetes and 25 with cystic fibrosis) and 50 healthy children serving as a control group, selected from pediatric clinics and schools. Data collection took place between January and June 2023. Participants completed three projective tests: the Kinetic Family Drawing Test (KFD), Tree Drawing Test, and House Drawing Test, which assessed emotional expression and psychological functioning.

Children with chronic diseases expressed emotions differently compared to healthy peers. In the KFD, they depicted fewer smiling faces, indicating higher emotional distress and a more negative perception of their family environment. In the tree drawings, symbolic elements such as birds-representing freedom or hope - were more common among children with chronic diseases, while healthy children more often drew roots, suggesting emotional stability. The House Drawing Test revealed no significant differences between the two groups.

Projective tests such as the KFD and Tree Drawing Test appear to be effective in identifying emotional issues in children with chronic illnesses, unlike the House Drawing Test. These findings support the integration of such tools into psychological assessments and therapeutic interventions for pediatric chronic disease populations.

Obesity and Type 2 diabetes mellitus (T2DM) are growing public health concerns in Southeast Asia, including Indonesia. Obesity promotes insulin resistance and metabolic irregularities, increasing the risk for T2DM. CTLA-4, an immune checkpoint receptor, plays a role in immune regulation, but its involvement in obesity, dyslipidemia, and T2DM remains unclear.

The aim of this study was to evaluate the association between CTLA-4 levels and obesity, dyslipidemia, and T2DM.

A cross-sectional study was conducted at Universitas Sumatera Utara Hospital and affiliated hospitals, including 100 adult participants from the endocrine clinic. Participants with coronary heart disease, kidney issues, heart problems, and cancers were excluded. Fasting blood glucose, A1C levels, LDL cholesterol, triglycerides, and CTLA-4 expression were measured. BMI was calculated from age, gender, height, and weight data. Statistical analysis was performed using SPSS 26.0, applying the Mann-Whitney U-test and Spearman correlation for variable relationships. Statistical significance was set at p < 0.05. Result: Among 100 participants, 36% were obese, 42% had dyslipidemia, and 31% had T2DM. The median CTLA-4 serum level was 93.3 pg/mL (range 36-264). CTLA-4 levels were significantly lower in obese individuals (67.2 pg/mL) compared to non-obese individuals (106.8 pg/mL, p = 0.019). No significant differences in CTLA-4 levels were found for dyslipidemia (p = 0.839) or T2DM (p = 0.351). A significant negative correlation was found between CTLA-4 levels and BMI (r = -0.329, p = 0.001).

CTLA-4 levels negatively correlate with BMI, indicating its potential involvement in obesity-related metabolic changes. No significant link was found with dyslipidemia or T2DM, warranting further research.

Introduction Candidemia is a significant cause of morbidity and mortality in patients with sepsis, particularly in tertiary care settings. Shifts in Candida species distribution and antifungal resistance underscore the need for localized epidemiological surveillance. Aim and objective This study aimed to evaluate the prevalence, species distribution, clinical risk factors, and antifungal susceptibility patterns of Candida isolates in sepsis patients admitted to a tertiary care hospital in Uttarakhand, India. Methods A retrospective observational study was conducted from February 2022 to January 2024. Blood culture records of 17,712 sepsis patients were reviewed, among which 312 cases of candidemia were identified. Blood cultures were processed using the BAC-T ALERT system, and isolates were identified to the species level using conventional microbiological methods and the Vitek-2 system. Antifungal susceptibility testing was performed as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Relevant demographic, clinical, and risk factor data were extracted and statistically analyzed using SPSS version 26.0. Associations between Candida species and clinical variables were evaluated, with p-values < 0.05 considered statistically significant. Results The prevalence of candidemia among sepsis patients was 1.76% (312/17,712), with a mean age of 37.7 years and a male-to-female ratio of 1.72:1. Non-albicans Candida species predominated, led by C. tropicalis 84 (26.9%), followed by C. albicans 68 (21.8%), C. parapsilosis 58 (18.6%), and C. pelliculosa 37 (11.8%). C. tropicalis was significantly associated with chronic kidney disease: 21 (25.0%) (p = 0.00018); C. parapsilosis with low-birth-weight neonates: 15 (25.9%) (p = 0.00024); and C. glabrata 12 (63.2%) with diabetes mellitus (p = 0.0067). C. pelliculosa was predominant in neonates: 31 (83.8%) (p < 0.001). Most isolates were susceptible to fluconazole 284 (91.0%), voriconazole 290 (93.0%), amphotericin B 296 (94.9%), and echinocandins 300 (96.1%). Fluconazole resistance was highest in C. krusei 2/3 (66.7%) and C. auris 8/8 (100%), while echinocandin resistance was noted in C. glabrata, caspofungin 7/19 (36.8%) and micafungin 3/19 (15.8%). Conclusion The study highlights an epidemiological shift toward non-albicans Candida species, particularly C. tropicalis and C. pelliculosa, in candidemia cases. Routine species-level identification and antifungal susceptibility testing are crucial for guiding effective therapeutic strategies and supporting institutional antifungal stewardship.

Background Type 2 diabetes mellitus (T2DM) significantly increases the risk of atherosclerotic cardiovascular disease (ASCVD), and optimal lipid control is essential for reducing major adverse cardiovascular events (MACE). However, despite the widespread use of statins, many high-risk diabetic patients fail to reach target low-density lipoprotein cholesterol (LDL-C) levels. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have emerged as effective adjunctive agents for lipid lowering. This study was conducted to evaluate the effect of PCSK9 inhibitors on lipid profile and cardiovascular outcomes in high-risk diabetic patients. Methods A prospective, observational study was conducted at Kakatiya Medical College/Mahatma Gandhi Memorial (MGM) Hospital Warangal over 18 months. A total of 100 patients with T2DM (age, 40-75 years), having established ASCVD or multiple cardiovascular risk factors and LDL-C >100 mg/dL despite maximal statin therapy, were included. All participants received proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors (alirocumab 75 mg or evolocumab 140 mg subcutaneously every two weeks) in addition to standard care. Lipid profile parameters were assessed at baseline, three months, and 12 months. MACE (non-fatal myocardial infarction, stroke, or cardiovascular death) was recorded and compared with a matched historical control group (n = 100) on statin therapy alone. Results At the end of 12 months, the PCSK9 inhibitor group (n = 100) showed a significant reduction in mean LDL-C from 138.5 ± 17.6 mg/dL to 64.3 ± 12.9 mg/dL (p < 0.001). An increase in high-density lipoprotein cholesterol (HDL-C) was observed from 40.8 ± 5.3 mg/dL to 45.1 ± 5.6 mg/dL (p = 0.04), and triglycerides reduced from 178.7 ± 25.2 mg/dL to 149.5 ± 19.8 mg/dL (p < 0.01). MACE occurred in seven out of 100 patients (7%) in the PCSK9 group, compared to 16 out of 100 patients (16%) in the control group (HR: 0.41; 95% CI: 0.17-0.98; p = 0.044). Specifically, non-fatal myocardial infarction occurred in three (3%) vs. seven (7%), stroke in two (2%) vs. five (5%), and cardiovascular death in two (2%) vs. four (4%) in the PCSK9 and control groups, respectively. No serious adverse drug reactions were reported among the PCSK9 users. Conclusion PCSK9 inhibitors significantly improve lipid parameters and reduce cardiovascular event rates in high-risk diabetic patients who are inadequately controlled with statins alone. These findings support their role as an effective and safe adjunctive therapy for secondary cardiovascular prevention in diabetes.

Autoimmune polyglandular syndrome type 2 (APS-2) is a rare complex autoimmune endocrinological entity and is reported even more rarely in children and adolescents. It consists of primary adrenal insufficiency (Addison's disease), autoimmune thyroiditis (AIT) and/or type 1 diabetes mellitus (T1DM). Treatment of the AIT component of the disease with levothyroxine as hormone replacement therapy has been reported rarely to cause adrenal crisis. This treatment adverse event is possibly explained due to the increase of basal metabolic rate and subsequently the increased demand and clearance of cortisol after levothyroxine therapy and should always be considered by physicians in order to avoid the development of adrenal crisis. We report the case of a 13-year-old adolescent girl with hypothyroidism due to Hashimoto's thyroiditis (HT) who developed signs of adrenal insufficiency after initial levothyroxine therapy. She was initially admitted with symptoms of hyperthyroidism, including weight loss, anxiety, and oligomenorrhea. A more thorough examination revealed pallor, signs of dehydration, tachycardia, and additionally serum electrolyte imbalance and extremely low cortisol levels in combination with very high adrenocorticotropic hormone (ACTH) levels. The patient received emergency treatment for adrenal insufficiency and recovered well. Due to positive adrenal autoantibodies, APS-2 was confirmed. This case report highlights the necessity of careful adrenal function screening in patients with hypothyroidism and HT before initiating thyroid therapy in order to avoid the rare occurrence of adrenal crisis.

 Diabetes mellitus is a recognized risk factor for impaired wound healing and greater postoperative complications. Thus, this study was conducted to assess the effect of diabetes on outcomes of hernia management in high-risk patients, including wound healing, recurrence, and postoperative infections.

This retrospective observational study was carried out between March and August 2024 and features 120 recruited patients who underwent elective hernia repair. The patients were stratified into two groups: group A (diabetics; n=60) and group B (non-diabetics; n=60). Age, BMI, comorbidities, and the American Society of Anesthesiologists (ASA) score were recorded as preoperative data. Operative time, wound healing duration, incidence of surgical site infections (SSIs), and recurrence over six months were analyzed during intraoperative and postoperative periods from surgical records. Statistical analysis was carried out with SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA), using the chi-square test and independent t-test with a p-value < 0.05 as statistically significant.

Diabetics had significantly longer operative times (p = 0.001). Patients in group A (with prolonged drainage time) had longer wound healing (17.2 ± 3.4 vs. 12.5 ± 2.7 days, p < 0.001), higher incidence of SSI (21.7% vs. 6.7%, p = 0.015), and longer drain retention (p < 0.001). Diabetics also had significantly longer hospital stays (6.3 vs. 4.5 days; p < 0.001). Diabetic recurrence was more than in non-diabetics at six months (11.7% vs. 3.3%), despite a p-value of 0.085. Diabetic patients also expressed trends towards increased formation of seroma and chronic pain.

Diabetic patients requiring hernia repair are at higher risk for delayed healing of wounds, surgical site infection, and longer hospitalization.

A localized pontine lesion affecting the abducens nucleus or paramedian pontine reticular formation (PPRF), the medial longitudinal fasciculus (MLF), and the facial nerve fascicle results in eight-and-a-half syndrome, a rare neurological condition. It manifests as ipsilateral peripheral facial nerve palsy, internuclear ophthalmoplegia (INO), and horizontal gaze palsy. This condition typically indicates a minor but well-placed infarct in the dorsal pons. We diagnosed eight-and-a-half syndrome in a patient who presented with dizziness and double vision, with a background history of hypertension and type 2 diabetes mellitus. A neurological examination showed right-sided lower motor neuron face paralysis, INO in the contralateral eye, and horizontal gaze palsy to the right, all of which are indicative of eight-and-a-half syndrome. An acute ischemic infarct was seen on magnetic resonance imaging (MRI) in the right posterior pons, which is next to the fourth ventricle. The patient started on a high-dose statin, dual antiplatelet therapy, and supportive care. His symptoms gradually improved over the next few weeks. The clinical significance of eight-and-a-half syndrome as a sign of localized pontine infarction is demonstrated by this instance. Neuroimaging and early detection are crucial for diagnosis and prompt stroke treatment.

Background Non-ST-elevation myocardial infarction (NSTEMI) represents a prevalent form of acute coronary syndrome associated with substantial early risk of adverse outcomes. Inflammatory and metabolic disturbances are increasingly recognized as key contributors to the disease. Hematologic indices such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune-inflammation value (PIV), along with the triglyceride-glucose index adjusted for BMI (TyG-BMI), have emerged as promising prognostic markers. However, their dynamic behavior in early NSTEMI remains insufficiently explored. Materials and methods This prospective study included 170 patients hospitalized for NSTEMI at the University Clinical Centre Tuzla between February 2022 and January 2023. Hematologic and metabolic indices were calculated at admission and repeated 24 hours later. Patients were followed for three months to document major adverse cardiovascular events (MACE), including cardiovascular death, reinfarction, and urgent revascularization. The median age was 67 years, and 60.6% of patients were male. Hypertension, hyperlipidemia, and diabetes mellitus were the most common comorbidities. Results Significant 24-hour reductions were observed in NLR, PLR, SII, SIRI, and PIV (all p < 0.01), while C-reactive protein (CRP) levels more than doubled (p < 0.001). Patients who developed MACE showed persistently elevated inflammatory indices and smaller declines in PIV and SIRI. Change in SIRI (ΔSIRI) demonstrated the strongest predictive value (AUC = 0.63), followed by SII and TyG-BMI. Notably, reduced resolution of PIV and persistently elevated TyG-BMI were significantly associated with adverse outcomes. Overall, MACE occurred in 51.2% of patients, including a 14.7% mortality rate. Conclusion Early changes in systemic inflammation and metabolic stress, particularly SIRI and TyG-BMI dynamics, offer valuable prognostic insight and may enhance early risk stratification in NSTEMI patients.