The emerging concept of cardiovascular-kidney-metabolic syndrome (CKM) highlights the pathophysiological interconnection between cardiorenal and metabolic disorders. This study investigates the longitudinal association between the cardiometabolic index (CMI) and CKM stage progression.

This study utilized data from the China Health and Retirement Longitudinal Study. The baseline CMI was computed utilizing the triglycerides-to-high-density lipoprotein cholesterol ratio multiplied by the waist-to-height ratio. CKM is defined and categorized into five stages (0-4) based on metabolic, cardiovascular, and renal disorders. We evaluated the impact of CMI on the CKM stage progression from Wave 1(2011) to Wave 3(2015). Multivariable logistic regression and restricted cubic spline (RCS) models were constructed to illustrate the relationship between CMI and CKM stage progression. A total of 4080 patients were included. The rate of CKM progression to advanced stages significantly increased with higher CMI quartiles. When entered into the multivariable logistic regressions as a continuous variable, elevated CMI was a remarkable predictor for progression to CKM stages 2-4 among participants at baseline CKM stages 0-1 [OR(95%CI) 1.66 (1.32-2.11)], progression to CKM stages 3-4 among those at baseline CKM stages 0-2 [OR(95%CI) 1.14 (1.03-1.26)], and progression to CKM stage 4 among those at baseline CKM stages 0-3 [OR(95%CI) 1.13 (1.00-1.28)], after adjustment for potential confounders. This association persisted when CMI was modeled as a categorical variable. RCS analysis demonstrated significant positive associations between elevated CMI levels and an increased risk of progression to advanced CKM stages (all P < 0.05).

Elevated CMI is significantly associated with CKM stage progression over time. CMI could act as a simple, useful tool for the risk assessment of CKM.

This nationwide cohort study examined the effects of discontinuation versus continuation of renin-angiotensin system inhibitors (RASis) on major renal and cardiovascular outcomes after the estimated glomerular filtration rate (eGFR) decreased to below 45 mL/min/1.73 m² in patients with type 2 diabetes and treated with RASis.

Using linked Taiwanese databases with claims and clinical data, we identified patients with type 2 diabetes who used RASis during 2016-2020, and either discontinued or continued RASis within 180 days when their eGFR fell below 45 mL/min/1.73 m². The outcomes of interest included end-stage renal disease (ESRD), myocardial infarction, stroke, heart failure, and all-cause mortality. We estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) for RASi discontinuation versus RASi continuation using on-treatment and intention-to-treat analyses and inverse probability weighting to adjust for baseline and time-varying covariates.

We identified 251 853 eligible patients, of whom 37 108 (15%) discontinued RASis and 214 745 (85%) continued RASis. The on-treatment HR associated with RASi discontinuation was 2.52 (95% CI, 2.33-2.73) for ESRD, 1.18 (1.08-1.30) for myocardial infarction, 1.28 (1.19-1.37) for stroke, 1.18 (1.13-1.24) for heart failure, and 1.77 (1.70-1.84) for all-cause mortality. Results from the intention-to-treat analysis were similar, albeit more conservative. Findings remained consistent across eGFR strata (≥ 30 to < 45 and < 30 mL/min/1.73 m²), urine albumin-creatinine ratio categories (≥ 300 and < 300 mg/g), and patient subgroups with various baseline characteristics.

Our results support continuing RASi treatment even when the eGFR declines to below 45 mL/min/1.73 m² based on potential renal, cardiovascular, and survival benefits.

Advances in mesothelioma management have translated into longer patient survival and different treatment-related side effects including nephrotoxicity. The risk of developing adverse renal outcomes in patients with mesothelioma and associated risk factors remains undefined.

We analysed territory-wide data from electronic health records of patients with mesothelioma followed at public hospitals in Hong Kong between 1st January 2000 to 31st December 2022. Prevalence of acute kidney injury (AKI), renal progression (> 30 mL/min drop in eGFR), and upstaging of chronic kidney disease (CKD) and associated risk factors were evaluated.

222 patients were included. 18 (5.1%) patients developed acute kidney injury (AKI), and risk factors included diabetes mellitus (DM), use of bevacizumab and the presence of third space fluid (pleural effusion, pericardial effusion, ascites). 47 (21.2%) patients had upstage of CKD, and 31 (14.0%) patients showed renal progression. 18, 9, and 4 patients developed renal progression within 12 months from diagnosis, 12-24 months from diagnosis, and more than 24 months from diagnosis. Risk factors for upstage of CKD included the presence of third space fluid, platinum-based chemotherapy, use of immune check-point inhibitors, AKI during follow-up, more lines of cytotoxic chemotherapy received, and cycles of pemetrexed used. Predictors for renal progression included the presence of ascites and use of bevacizumab.

Short- and long-term adverse kidney outcomes are prevalent in patients with mesothelioma and show strong associations with treatments received. Careful patient selection and close monitoring of renal function may help avoid untoward acute and chronic nephrotoxicity.

To describe the clinical presentation of a patient with early-onset diabetes and to report a novel heterozygous WFS1 variant of uncertain significance (VUS) identified in this case. This report aims to contribute to the phenotypic and genotypic spectrum of WFS1-related disorders and to discuss the challenges of interpreting VUS in complex clinical scenarios.

Clinical data were collected from the proband and his family members. Whole-exome sequencing was performed on the proband. Sanger sequencing was subsequently utilized to validate the identified variant in the proband and his parents. A review of the relevant literature was also conducted.

A previously unreported heterozygous missense variant in the WFS1 gene, c.1550G>C (p.Arg517Pro), was identified in the proband. Segregation analysis confirmed that this variant was inherited from his father, a non-diabetic carrier; the mother did not carry the variant. The proband's clinical phenotype was primarily characterized by early-onset diabetes and its vascular complications. No discernible neurosensory features typical of classical Wolfram syndrome-such as optic atrophy, deafness, or diabetes insipidus-were observed. Following the American College of Medical Genetics and Genomics (ACMG) guidelines, this variant was classified as one of uncertain significance (VUS). The classification was based on the following supporting criteria: PM2_Supporting (due to its extremely low allele frequency of 0.000077 in population databases) and PP3_Moderate (based on in silico predictions from the REVEL tool, which suggested a deleterious effect).

This case report describes a novel WFS1 missense variant of uncertain significance (p.Arg517Pro) identified in a patient with early-onset diabetes. This finding contributes to the growing catalog of rare WFS1 variants and highlights the interpretive challenges they pose. It suggests that WFS1 could be considered in the genetic evaluation of selected cases of early-onset diabetes, even in the absence of full syndromic features. Prospective monitoring of asymptomatic carriers of similar variants may be warranted, pending further evidence to clarify their clinical significance.

Vitamin D deficiency has been implicated in metabolic dysregulation, including insulin resistance and inflammation, commonly observed in patients with type 2 diabetes mellitus (T2DM) and obesity. Evidence on the metabolic impact of vitamin D supplementation in this population remains inconsistent.

To evaluate the effects of high-dose vitamin D3 supplementation on anthropometric and selected metabolic parameters in ambulatory obese patients with T2DM treated with metformin monotherapy.

This 12-week prospective cohort study included 200 patients with T2DM, allocated to a supplementation group (n = 100; vitamin D3 - 4,000 IU/day) or a control group (n = 100; no supplementation). Primary outcome was change in serum 25-hydroxyvitamin D [25(OH)D] concentration. Secondary outcomes included fasting serum glucose (FSG), glycated hemoglobin (HbA1c), blood pressure (BP), serum calcium, and body mass index (BMI). Predictors of failure to achieve target HbA1c ≤ 6.5% were identified using logistic regression.

After 12 weeks, serum 25(OH)D significantly increased in the supplementation group compared with controls (Δ +23.7 vs +1.3 ng/mL; p < 0.001). FSG and HbA1c decreased significantly in the intervention group (Δ -0.4 mmol/L, p = 0.02; Δ -0.6%, p = 0.01, respectively), while no significant changes were observed in systolic or diastolic BP, serum calcium, or BMI. Logistic regression identified higher baseline FSG (OR 1.34, 95% CI 1.12-1.61), longer diabetes duration (OR 1.28, 95% CI 1.07-1.54), and higher BMI (OR 1.21, 95% CI 1.01-1.47) as independent predictors of suboptimal glycemic response.

High-dose vitamin D3 supplementation significantly improved vitamin D status and was associated with modest improvements in glycemic control in obese patients with T2DM, without affecting blood pressure, calcium, or body weight. These findings support vitamin D repletion as a potential adjunctive strategy in diabetes management, while not allowing causal inference, and warrant further confirmation in randomized controlled trials with longer follow-up.

Lower extremity ulcers are a major complication of diabetic disease, often leading to a source of infection for patients. Due to delayed wound healing, ulcers quickly develop into extensive lesions leading to infections that are polymicrobial in nature and highly likely to acquire antibiotic resistance. We present the case of a 44-year-old man with poorly controlled type 2 diabetes mellitus who developed an ulcer on the left lower extremity after an episode of mild pruritus. Failure of early patient presentation to the office resulted in the propagation of infection, including areas of depth and necrosis. The ulcer was initially treated with trimethoprim-sulfamethoxazole (SXT) until cultures revealed a polymicrobial infection of Bacteroides fragilis, group B Streptococcus, and Staphylococcus aureus, with resistance to SXT observed exclusively in S. aureus. Furthermore, the ulcer continued to show signs of infection. As a result, medications were adjusted to metronidazole and ciprofloxacin, combined with meticulous wound care, lifestyle modifications, and optimization of glycemic and lipid control. After treatment modifications, the ulcer showed full-thickness healing. This case highlights the evolving challenge of antimicrobial resistance in skin and soft tissue infections. While SXT is commonly used for infected diabetic ulcers, the increasing prevalence of resistant S. aureus strains emphasizes the importance of culture-guided therapy, careful empiric antibiotic selection, and close patient follow-up. With this holistic, patient-centered approach in managing diabetic ulcers, physicians can catch antibiotic resistance early, preventing serious adverse outcomes and improving quality of life.

Laryngeal tuberculosis (TB) is a rare extrapulmonary manifestation of TB. Patients often present with non-specific laryngeal complaints and may not have pulmonary TB, which was previously almost always associated with laryngeal TB. This case report describes a patient who initially presented with non-specific symptoms of chronic voice hoarseness and dry cough, who was initially diagnosed with pneumonia. Subsequent otorhinolaryngological evaluation was performed, which showed exudative laryngeal lesions with edema and narrowing of the supraglottis and glottis. The patient underwent urgent fiberoptic intubation to secure the airway, followed by a panendoscopy and biopsy of the laryngeal lesions. Microbiological testing and histopathological examination confirmed the diagnosis of laryngeal TB. The patient was also noted to have pulmonary TB involvement on chest radiographs. The patient was noted to have poorly controlled diabetes mellitus that was newly diagnosed, which is a significant risk factor for laryngeal TB. This case report highlights the ease of misdiagnosis and provides clinicians with a review of the epidemiology, clinical characteristics, diagnostic evaluation, and management of laryngeal TB. Additionally, it draws attention to the possibility of acute airway compromise in laryngeal TB, which is not widely reported in the literature. Laryngeal TB remains a relevant differential diagnosis for patients with chronic laryngeal symptoms, and clinicians should not exclude TB as a diagnosis even in developed or non-endemic regions.

Introduction The oral glucose tolerance test (OGTT), though valuable, is underutilized in outpatient settings for the diagnosis of type 2 diabetes mellitus (T2DM). Our study aimed to confirm prediabetes and assess the risk of developing T2DM in individuals with elevated risk, comparing the diagnostic utility of OGTT with fasting plasma glucose (FPG), post-prandial plasma glucose (PPPG), and HbA1C. Methods A hospital-based cross-sectional study was conducted in the Department of General Medicine of a tertiary care hospital in South India, including adults over 18 years with elevated random plasma glucose (RPG) (≥140 mg/dl), FPG (110-125 mg/dl), and HbA1C (5.7-6.4%). After an overnight fast, participants received 75 g of glucose, and venous blood samples were collected at fasting, one hour, and two hours to measure plasma glucose. Results Of the 113 participants, 55.8% (63) were males and 57.5% (65) were overweight or obese (BMI ≥ 23 kg/m²). FPG classified 44.3% (50) as prediabetic and 9.7% (11) as diabetic. While HbA1C categorized 63.7% (72) as prediabetic and 18.6% (21) as diabetic (cutoff >200 mg/dl), the one-hour OGTT categorized 32.7% (37) as prediabetic (cutoff: 155-199 mg/dl) and 44.2% (50) as diabetic. The one-hour OGTT showed greater sensitivity for detecting at-risk individuals. Conclusions The one-hour OGTT, compared to FPG, PPPG, and HbA1C, offers enhanced sensitivity in confirming prediabetes and unmasking T2DM in the prediabetic population. Incorporating the one-hour OGTT into routine screening may improve early diagnosis and intervention, especially in at-risk populations.

The growing burden of type 2 diabetes mellitus among young adults is a global public health problem. This study aimed to explore risk perception of type 2 diabetes mellitus among university students in Jordan and to identify predictors of perceived susceptibility.

A cross-sectional study that used proportional stratified sampling to recruit 496 third year university students in all fields of study at the University of Jordan. Participants answered online self-administered validated Arabic questionnaire that was designed based on the constructs of the health belief model. Data was analyzed using Statistical Package for Social Sciences (SPSS) software.

The participants in this study evidently underestimated their risk of developing T2DM. Only 25% of students believed that they have high potential of developing T2DM in the future. Perceived susceptibility was low to moderate; it scored lowest among all dimensions of risk perception (mean = 2.86 out of 5). Results of t-test and ANOVA showed that perceived susceptibility was higher among students in engineering and science (p = 0.001), males (p = 0.019), with higher income (p = 0.008), overweight (p = 0.026), and students with little knowledge of T2DM (p = 0.027). Results of logistic regression indicated that high income level was the only significant predictor of higher perceived susceptibility (OR = 2.7. 95%CI 1.35, 3.4). Likelihood of taking preventive action was high (mean = 4.15 out of 5).

Results of this study highlight the need for health system governance to commit to integrate national efforts to design culturally sensitive interventions to raise awareness about the risk of T2DM in Jordan, especially among young adult population.