Islet transplantation is a valuable therapy for selected type 1 diabetes mellitus (T1DM) patients, especially those with recurrent severe hypoglycemia, glycemic variability, or impaired hypoglycemia awareness. It improves glycemic control and protects against hypoglycemic episodes. Beyond glucose regulation, islet transplantation may mitigate diabetes-related microvascular and macrovascular complications. We conducted a systematic review to assess its impact on vascular outcomes in T1DM, focusing on islet transplantation alone (ITA) and islet-after-kidney transplantation (IAK). We included studies that quantitatively assessed vascular complications after ITA or IAK in adults with T1DM. Eligible studies compared pre-and post-transplant outcomes or posttransplant outcomes with control groups receiving standard treatment. Twenty-five studies (1,373 patients) evaluated microvascular and macrovascular outcomes using eGFR, ophthalmic e xams, and nerve conduction studies. Islet transplantation was associated with stabilization or improvement in most microvascular complications and longterm renal function preservation. While macrovascular data were less frequent, improvements in vascular health markers such as reduced procoagulant states and atherosclerosis progression were reported, suggesting possible reductions in cardiovascular events and mortality, though data remain limited. Islet transplantation shows clear benefits for microvascular complications and potential advantages for macrovascular outcomes, alongside its established role in improving glycemic stability and quality of life. Systematic Review Registration: PROSPERO Identifier CRD420251036400.

Post-acute care (PAC) plays a key role in recovery following hip fractures. The aim of the study is to examine the factors affecting the achievement of the minimal important change (MIC) in older patients with hip fractures.

This retrospective cohort study included 228 patients who underwent surgical interventions for hip fractures and received subsequent PAC between 2020 and 2021. Data on demographics, medical history, and lifestyle habits were collected. Outcomes were measured using the Barthel Index, Numeric Rating Scale (NRS), and Harris Hip Score (HHS). Univariate and multivariate regression analyses were conducted to identify predictors of achieving the MIC.

After treatment, significant improvements were observed in the Barthel Index (from 41.45 to 65.15, P < 0.001), NRS (from 5.03 to 2.52, P < 0.001), and HHS (from 29.35 to 63.68, P < 0.005). The MIC for the Barthel Index, NRS, and HHS were determined to be 6.20, 0.92, and 6.69, respectively. Dementia (odds ratio [OR] = 3.77, 95% confidence interval [CI] = 1.51-9.44, P = 0.005), age above 80 years (OR = 2.80, 95% CI = 1.15-6.84, P = 0.024), and heart failure (OR = 4.21, 95% CI = 1.34-13.23, P = 0.014) served as significant predictors of failure to achieve the MIC with the Barthel Index. For HHS, Diabetes mellitus was the only significant predictor of failure to achieve the MIC (OR = 4.32, 95% CI = 1.00-18.62, P = 0.050).

This study highlights major improvements in the Barthel Index, NRS, and HHS among older patients receiving PAC after hip fractures, along with a quantifiable MIC. Dementia is a robust predictor of failure to achieve the MIC with the Barthel Index, and advanced age, heart failure, and diabetes mellitus are key factors for optimizing recovery.

Diabetic retinopathy (DR) is a preventable cause of vision loss; with screening, there is the capability to recognise and treat the condition early. However, screening compliance remains sub-optimal, and the COVID-19 pandemic caused widespread disruptions to the screening programme. This review aims to update prior systematic reviews to identify barriers that remain, as well as identify new barriers that may have occurred due to the pandemic. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines, we searched seven databases (January 2020-July 2025) for English language primary studies on DR screening non-attendance, yielding 16 relevant studies across diverse regions. Key barriers fell into patient-related, health system, and environmental categories. Although there was evidence to suggest the same barriers remained, there is evidence to suggest the pandemic exacerbated prior barriers and introduced new barriers. These findings suggest the need for context-specific interventions to improve DR screening in the post-pandemic era.

Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance and progressive β-cell dysfunction, leading to long-term complications that negatively affect patients' quality of life (QoL). Various demographic, psychological, and clinical factors influence QoL. However, limited research has explored these associations within the sociocultural context of a rural regency in Indonesia, where variations in healthcare access, education, and economic conditions may uniquely affect QoL.

This study aimed to examine the relationships between clinical and demographic factors and QoL among patients with T2DM.

A cross-sectional study was conducted from June 2024 to February 2025 with 1,030 adult T2DM patients recruited via purposive sampling. QoL was assessed using the Diabetes Quality of Life Scale (DQOL), and anxiety was measured using the State-Trait Anxiety Inventory (STAI). Additional data on employment status, disease duration, age, and therapy type were collected via structured questionnaires. Data were analyzed using SPSS 27 with univariate, bivariate (chi-square), and multivariate logistic regression analyses. Statistical significance was set at p < 0.05.

Descriptively, most participants were female (90.8%), aged 51-60 years (59.7%), and had completed senior high school (84%). Overall, 61.2% reported good QoL. Anxiety was mild in 73.3% and moderate in 26.7% of participants. Multivariate logistic regression indicated that moderate anxiety (OR = 2.78; 95% CI [1.48-5.25], p = 0.041), disease duration ≥5 years (OR = 10.24; 95% CI [2.13-12.40], p = 0.027), older age (≥50 years) (OR = 8.94; 95% CI [2.15-14.73], p = 0.032), unemployment (OR = 3.66; 95% CI [1.03-13.07], p = 0.030), and insulin therapy (OR = 11.3; 95% CI [2.80-12.60], p = 0.019) were significantly associated with poor QoL. The model showed good fit (Hosmer-Lemeshow χ² = 5.32, p = 0.72) and moderate explanatory power (Nagelkerke R² = 0.24).

Longer disease duration, older age (≥50 years), unemployment, moderate anxiety, and insulin therapy were significantly associated with lower QoL among T2DM patients. These findings emphasize the need for integrated care strategies combining educational, psychosocial, and socioeconomic interventions. Nursing practice should prioritize holistic, patient-centered approaches incorporating psychological support, individualized education, and social empowerment.

This study aims to investigate the relationship between the neutrophil-to-lymphocyte (NLR) and the risk of sudden cardiac death (SCD) in the patients with diabetic foot ulcer (DFU).

A retrospective study enrolled 688 patients with DFU who were admitted to Air Force Medical Center between January 2010 and December 2023. To control for potential confounding effects, a 1:1 propensity score matching (PSM) method was applied. The relationship between NLR and SCD risk was analyzed using the Kaplan-Meier (K-M) survival curve analysis, multivariate Cox proportional hazard regression model, Restricted cubic spline (RCS) model analysis and subgroup analyses.

Over a median follow-up period of 61 months, 38 cases of SCD were documented. Based on median NLR, participants were stratified into higher (<4.22) and lower (≥4.22) NLR groups. Cox proportional hazard model revealed that individuals with higher NLR was independently associated with the increased risk of SCD (HR: 3.64, 95% CI: 1.21 ~ 10.91, P=0.021). RCS model showed that SCD risk was non-linearly correlated with gradual increases in NLR levels. Subgroup analyses confirmed the stability of the results.

Elevated NLR independently confers an increased risk for SCD in individuals with DFU.

Objective This study aimed to explore how individuals with different educational levels in urban Pakistan experience barriers to type 2 diabetes mellitus (T2DM) self-care across key self-care dimensions. Methods A qualitative phenomenological study was conducted at the Diabetes Clinic of the Pakistan Institute of Medical Sciences, Islamabad. Forty-three adults diagnosed with T2DM were recruited and stratified by educational level (≥ high school, n = 17; < high school, n = 26). Semi-structured interviews were conducted, and transcripts were thematically analyzed to examine how educational level shapes barriers to T2DM self-care within Pakistan's sociocultural context. Coding was performed iteratively until thematic saturation was reached, ensuring comprehensive representation of participant perspectives. Results Participants with higher education reported barriers such as time constraints due to demanding workloads and restrictive sociocultural expectations that limit engagement in public physical activity (e.g., walking) and structured meal planning. Many also reported receiving insufficient dietary guidance from healthcare providers tailored to their schedules and lifestyles. Predominant misconceptions among participants with lower education included equating household chores with adequate exercise and failing to recognize hypoglycemic symptoms. They also demonstrated limited understanding of dietary principles, such as believing that fruit juice is beneficial for individuals with T2DM. Notably, participants across both educational strata found it difficult to adhere to dietary restrictions in social settings, particularly during weddings and communal meals, where refusing food is culturally discouraged. Conclusions Barriers to T2DM self-care in urban Pakistan differ markedly by educational level. Improving T2DM self-care requires education-sensitive, community-based interventions tailored to the local sociocultural context. Higher educational attainment alone does not ensure adequate self-care, as cultural norms exert a strong influence that education alone cannot overcome. For individuals with lower education, self-care programs should prioritize tailored foundational dietary education to address fundamental knowledge gaps. For those with higher education, interventions should emphasize practical implementation strategies, including structured guidance on integrating self-care practices into demanding work routines and community-based initiatives that promote physical activity and challenge restrictive cultural norms. Such context-specific, stratified approaches may enhance T2DM self-care, improve glycemic control, and lead to better health outcomes.

Corporoplasty is typically accompanied by circumcision to prevent complications such as phimosis, foreskin edema, and necrosis, yet supporting evidence is limited. We reassessed the need for concomitant circumcision by quantifying postoperative phimosis and exploring associated comorbidities.

In this single-centre retrospective cohort study, 69 of 191 men who underwent corporoplasty between 2010 and 2023 met predefined criteria. Patients with incomplete records, refusal to participate, or loss to follow-up were excluded. Data collection involved the administration of a questionnaire to patients, supplemented by data retrieved from medical databases. The median age was 55 years (range 17-70 years).

48 of 69 patients did not undergo circumcision either before or during the corporoplasty. Only 3 out of the 48 patients (6.25%) developed post-surgical phimosis. No post-surgical foreskin necrosis were reported. A relevant finding was type2 diabetes mellitus as a significant risk factor for post-surgical phimosis (p < 0.0038). Additionally, the negative impact of the degree of curvature on post-surgical glans penis sensitivity was identified (p = 0.027).

Our findings advocate against the obligatory practice of circumcision performing corporoplasty. Nonetheless, our results emphasize the importance of counseling patients with type2 diabetes mellitus due to their heightened susceptibility to post-surgical phimosis development.

Carbuncles are deep infections of the subcutaneous tissue not originating from skin, and often require surgical intervention. The traditional approach, which includes aggressive debridement via saucerization and prolonged antibiotic therapy, presents several limitations, such as delayed wound healing, extended hospital stays, increased dressing requirements, and heightened risks of antibiotic resistance. This case series evaluates a new skin-sparing saucerization technique followed by delayed primary closure, which has demonstrated improved outcomes in wound healing and overall patient recovery.

A case series of ten patients who underwent skin-sparing saucerization is presented. The patients, aged 44-62 years and of Chinese and Malay ethnicity, had wound sizes ranging from 4 to 8 cm, located on various anatomical regions, including the back, anterior abdomen, axilla, and gluteal area. Some patients had underlying conditions such as diabetes mellitus, hypertension, and hypercholesterolemia, which could complicate wound healing. Unlike the conventional approach, which leaves wounds open to heal by secondary intention, this technique preserves surrounding healthy skin by delaying primary closure, allowing for better granulation and minimizing the risk of infection. Postoperative outcomes showed significant improvement in healing time, with wound closure achieved within 2-5 weeks compared with the prolonged healing durations commonly associated with conventional techniques. Hospital stays were notably shortened to 1-3 days, enabling earlier discharge and reducing the burden of prolonged inpatient care. Most patients experienced uneventful recovery, with only one case of mild surgical site infection and one patient requiring additional wound monitoring due to delayed granulation.

The skin-sparing saucerization technique followed by delayed primary closure offers a promising alternative to conventional methods, particularly for patients with underlying health conditions. This approach reduces hospital stays, enhances wound healing, minimizes dressing changes, and allows for an earlier return to daily activities, ultimately improving patient quality of life. Further studies with larger sample sizes are necessary to establish standardized protocols and confirm the broader efficacy of this method.

Severe chronic limb-threatening ischemia has significant challenges, leading to poor outcomes, including amputation and death. By guiding angiosome blood flow to the ulcerated foot, a therapeutic combination of endovascular revascularization and mesenchymal stem cells can achieve a good outcome.

To describe the efficacy and safety of combination endovascular treatment and umbilical cord mesenchymal stem cell (UCMSC) treatment for chronic limb threatening ischemia.

The design of the study was a longitudinal study, serial case report and prospectively observed pilot study. All patients received intramuscular UCMSC with a dosage of 1-2 million cells per kilogram of body weight then followed by endovascular intervention based on angiosome guided. We monitored the patients efficacy and safety for 12, 18, and 24 months.

This study involved six patients. All patients have an ankle brachial index below 0.4, and 83.3% of patients have diabetes mellitus, high creatinine level with an average of 1.64 mg/dl, and severe pain scores based on the Visual Analog Scale (VAS) of more than 7. 6th month was the time where the creatinine median was reduced, the ABI median was increased, the wound improvement started to happen. While the pain median score was reaching zero in 12 months of observation. 24 months revealed significant improvements in patient outcomes across pain scores, creatinine levels, and ankle-brachial index (ABI) with p < 0.05.

The new technique, unique and innovative research, for using combination treatment of intramuscular UCMSC and modern endovascular procedures based on angiosome concept showed fast and safe wound healing, reduce rest leg pain, and increase ABI.

To determine the relationship between serum Ism-1 levels and the progression of renal function decline in patients with T2DM.

This prospective longitudinal study included 223 patients with T2DM. Patients were divided into quartiles according to serum Ism-1 levels. A Cox proportional hazards ratio model was applied to analyze the relationship between CKD progression and serum Ism-1 levels.

A total of 197 patients were finally analyzed, and the mean length of follow-up was 40.86 months. The serum Ism-1 levels were associated with eGFR decline and an increased risk of composite renal outcomes after adjusting for age, gender, body mass index, diabetes duration, history of hypertension, fasting blood glucose, fasting C-peptide, total cholesterol, triglycerides, drinking, smoking and follow-up period (all p < 0.05). However, the predictive ability of Ism-1 for composite renal outcomes disappeared after adjusting for baseline eGFR in Cox regression analysis and receiver operating characteristic (ROC) curve analysis.

High serum Ism-1 may be a biomarker for the progression of renal function decline in patients with T2DM.

Not applicable.