Search Results (14,445)

Strenuous exercise is a well-established physiological stimulus that enhances muscular strength and hypertrophy but can also increase reactive oxygen species production, leading to oxidative stress (OS). Numerous studies have investigated whether dietary supplements can attenuate exercise-induced OS, yet findings remain inconsistent, and methodological quality varies. This systematic review aimed to synthesize current clinical evidence on dietary supplementation for OS management in young adults undergoing intensive exercise and to evaluate study methodology critically. The review was conducted in accordance with PRISMA 2021 guidelines and the Cochrane Risk of Bias (RoB 2.0) framework and was prospectively registered in PROSPERO. A comprehensive search of MEDLINE (PubMed), Scopus, Cochrane Central, ClinicalTrials.gov, OpenGrey, and ISRCTN identified interventional and observational human studies assessing supplementation and OS biomarkers. Forty-six studies met the inclusion criteria. The analysis revealed substantial heterogeneity in study design and reporting quality. Frequent methodological limitations included incomplete reporting of allocation concealment, participant and investigator blinding, examiner involvement, and deviations from intended interventions. Despite these limitations, several studies reported favorable effects of specific supplements on OS modulation and post-exercise recovery. Overall, the findings highlight widespread methodological shortcomings and emphasize the need for standardized trial designs, consistent biomarker selection, and transparent reporting. Well-designed, long-term randomized controlled trials are required to establish robust, evidence-based guidelines for dietary supplement use in managing exercise-induced OS in young adults. Full article

Background/Objectives: Pulmonary hypertension (PH) is an increasingly recognized complication in patients with end-stage renal disease (ESRD) undergoing hemodialysis, particularly those utilizing arteriovenous fistulas (AVF) or grafts (AVG) for vascular access. The prevalence and clinical impact of PH in this population remain unclear due to methodological heterogeneity and variable diagnostic criteria. This systematic review and meta-analysis aimed to quantify the association between AVF/AVG use and PH prevalence in ESRD patients and to explore sources of heterogeneity. Methods: A systematic search of PubMed, Embase, Scopus, and Web of Science was conducted for studies published through 31 December 2024, without language or date restrictions. Eligible studies included adults (≥18 years) with ESRD on dialysis, comparing those with AVF/AVG access to non-AVF/AVG controls (e.g., tunneled dialysis catheters or peritoneal dialysis), and reporting PH prevalence or mean pulmonary artery pressures. Study quality was assessed using the Newcastle–Ottawa Scale, and risk of bias was evaluated. A random-effects meta-analysis calculated pooled odds ratios (OR) for PH prevalence, with heterogeneity assessed by I² and Cochran’s Q. Sensitivity analyses and tests for publication bias (Egger’s and Begg’s) were performed. Secondary analysis compared pooled mean pulmonary artery pressures between groups. Results: Eleven observational studies (1299 dialysis patients) met the inclusion criteria; ten studies (1224 patients) contributed to the quantitative meta-analysis after exclusion of one study with a zero-event control arm. Most studies were small, predominantly cross-sectional, and of moderate methodological quality. The pooled analysis showed a statistically significant association between AVF/AVG use and PH (OR 2.06, 95% CI: 1.69–2.52), with low statistical heterogeneity (I² = 0%). This estimate was sensitive to individual studies: in leave-one-out analysis the association lost statistical significance when the single most influential study was removed indicating that the pooled result is driven in part by a small number of studies rather than being uniformly robust. No statistical evidence of publication bias was detected. Five studies reported continuous pulmonary artery pressures, which were directionally higher in AVF/AVG patients but were not pooled because of extreme heterogeneity (I² = 99.4%). Conclusions: In this synthesis of observational data, AVF/AVG use was associated with higher odds of pulmonary hypertension than non-AVF/AVG access. Because all included studies were observational and the pooled estimate is sensitive to individual influential studies, these findings indicate a possible association rather than a causal effect and should be interpreted with caution. They support the rationale for prospective hemodynamic studies and for evaluating—rather than presuming the benefit of—PH monitoring and individualized access strategies in higher-risk dialysis patients. Full article

Background: Postural problems such as head forward posture, thoracic hyperkyphosis, and lumbar hyperlordosis, when seen together, further complicate postural control, increasing the importance of comprehensive approaches in treatment. This study aims to examine the effect of 6 weeks of telerehabilitation with web-based exercises and compare the home-based exercises in individuals with postural problems. Trial Design: A Randomized Controlled Study. Methods: A total of 34 volunteers with postural deformity among young adults were randomly divided into telerehabilitation (n = 17) and control (n = 17) groups. Craniovertebral, thoracic kyphosis, and lumbar lordosis angles of all individuals were evaluated with a smartphone application (Clinometer+ Bubble), hamstring and pectoral muscle shortness with a goniometer, and trunk muscle endurance with endurance tests created by McGill and Sorenson. Whilst the tele-rehabilitation group was provided with a video-based exercise program, the control group was advised to follow the same exercise program at home. Exercises were performed 3 days a week for 6 weeks, as 1-h sessions. Participants in the telerehabilitation group were followed up with a synchronized video conference. Results: A significant difference was observed in the telerehabilitation group in muscle shortness and the endurance tests (p < 0.05). Only a significant difference in left (p = 0.03) and right (p = 0.04) muscle shortness was observed in the home exercise group. Significant differences were observed in Craniovertebral and lumbar lordosis angles between groups (p < 0.05), with the telerehabilitation group showing better outcomes. The kyphosis angle, muscle shortness, and endurance test results between groups were found to be similar (p > 0.05). Conclusions: Six weeks of telerehabilitation can improve muscle shortness and trunk endurance in young adults with postural deformities. Both the exercise program using telerehabilitation and the home exercise program were beneficial for individuals with postural problems, with more favorable effects observed in the telerehabilitation group. Full article

Background: Immune checkpoint inhibitors (ICIs) have transformed cancer treatment but are associated with immune-related adverse events (irAEs) and variable clinical outcomes. Clinical predictors of organ-specific irAEs remain indeterminate, particularly in real-world populations. Methods: We conducted a retrospective single-center cohort study including 751 adult patients with solid tumors treated with ICIs between 2018 and 2025. Clinical, demographic, and treatment-related variables were analyzed. Multivariable logistic regression identified predictors of irAEs, while associations with objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) were assessed using logistic and Cox regression models. Results: The most frequent irAEs were endocrine (9.9%), dermatologic (9.1%), gastrointestinal (7.6%), and pulmonary (4.7%). Female sex independently predicted endocrine (aOR 1.98, p = 0.007) and rheumatologic irAEs (aOR 4.06, p = 0.007). Combination immunotherapy was associated with increased dermatologic (aOR 2.66, p = 0.013) and gastrointestinal irAEs (aOR 2.65, p = 0.016), while concurrent radiotherapy predicted gastrointestinal toxicity (aOR 1.82, p = 0.044). Atezolizumab was associated with higher pulmonary irAE risk (aOR 2.97, p = 0.048). Endocrine, dermatologic, gastrointestinal, and pulmonary irAEs were independently associated with improved ORR (OR range: 2.53–4.30, all p < 0.01). Conclusions: Organ-specific irAEs exhibit distinct clinical predictors and differential prognostic implications in patients receiving ICIs. Select irAEs are associated with improved treatment response and disease control, yet our results should be regarded as hypothesis-generating requiring further investigation. Full article

Candida auris has emerged as a multidrug-resistant, healthcare-associated pathogen worldwide; however, outcome data on C. auris candidaemia in East Asia remain limited. We conducted a retrospective cohort study of adult patients with candidaemia who received antifungal therapy at a tertiary hospital in Seoul, Republic of Korea, from January 2023 to December 2024, comparing C. auris with other Candida species. Confounding was addressed by inverse probability of treatment weighting (IPTW) using a five-covariate propensity score (age, Charlson Comorbidity Index, septic shock, ICU admission at antifungal initiation, and concomitant Gram-negative infection). Among 423 patients, C. auris accounted for 6.9% of cases and was uniformly fluconazole non-susceptible, with frequent high-level caspofungin resistance but preserved micafungin and anidulafungin susceptibility. Patients with C. auris were older, with greater comorbidity and more frequent ICU admission at antifungal initiation. After IPTW adjustment, C. auris was not associated with higher 30-day mortality, the primary outcome (adjusted hazard ratio 0.59, 95% CI 0.26–1.32); the wide confidence interval indicates limited precision rather than equivalence, and results were directionally consistent for 90-day and in-hospital mortality and across sensitivity analyses that varied both the comparison cohort and the analytic method. Residual confounding by unmeasured illness severity and limited precision preclude concluding equivalence. Continued surveillance, molecular characterisation, and infection control remain essential. Full article

Background: The financial burden of diagnostic testing for obstructive sleep apnea (OSA) represents a substantial barrier to treatment initiation, with cost-related access disparities disproportionately affecting the low-income and underinsured population. Home sleep testing (HST) offers a cost-effective diagnostic alternative, yet economic patterns across provider types remain unclear. This study assessed whether board-certified sleep medicine provider (BCSMP) status is associated with differences in provider-billed HST charges and evaluated how organizational and payment contexts influence these charges. Methods: A retrospective cross-sectional analysis was conducted using 2019 data from Optum’s de-identified Clinformatics^® Data Mart Database (N = 61,531 adult HST claims). The main exposure was provider status (BCSMP vs. non-BCSMP). The outcome was total provider-requested charge per HST procedure. Generalized Linear Models with a gamma distribution estimated adjusted charge differences, controlling for organizational context, place of service, and payer type. Results: BCSMP encounters had significantly lower adjusted mean HST charges than non-BCSMPs (mean difference: −$78.04; 95% CI: −$89.06 to −$67.02; p < 0.001). Individual practitioners charged $168.48 less than hospital-affiliated providers, while group practices and other facilities charged more (all p < 0.001). Fee-for-service arrangements were associated with lower charges than commercial and Medicare Advantage plans (p < 0.001). Conclusions: Board-certified sleep medicine providers and individual practice settings were associated with lower billed charges for home sleep testing; however, these findings do not necessarily reflect actual cost reduction. To translate these baseline charge differences into equitable clinical protocols and healthcare policies, future research must analyze negotiated reimbursement rates, billing structures, and practice environments to determine how these cost parameters impact the overall cost of an OSA diagnosis. Full article

Background: Bone tissue is a dynamic structure capable of continuous remodeling; however, its regenerative capacity is limited in critical-size defects, often requiring the use of bone grafting procedures. Available grafting materials present inherent limitations, highlighting the need for strategies that can enhance regenerative outcomes. Hyaluronic acid (HA) has been proposed as a promising adjunctive agent because of its biological properties, including anti-inflammatory and pro-angiogenic effects. Objective: To systematically evaluate the available clinical evidence regarding the effects of HA as an adjunct in bone regeneration procedures, including alveolar ridge preservation, ridge augmentation, and maxillary sinus elevation. Materials and Methods: A systematic search was conducted in the PubMed, ScienceDirect, Google Scholar, and Wiley Online Library databases for studies published within the last 10 years. Clinical studies involving adult patients were included if they evaluated the local application of HA, regardless of formulation, and reported quantitative clinical, radiographic, histological, or histomorphometric outcomes related to bone regeneration. Results: Of the 728 records initially identified, 10 studies met the eligibility criteria and were included in the qualitative synthesis. Discussion: Overall, the available evidence suggests that HA may positively influence bone regeneration outcomes. The most consistent benefits were observed in alveolar ridge preservation and ridge augmentation procedures, including increased new bone formation, improved bone density, enhanced bone maturation, and reduced dimensional bone loss. In contrast, findings regarding maxillary sinus augmentation were less consistent. Conclusions: HA appears to be a promising adjunct in bone regeneration procedures. However, the current evidence remains limited and is primarily based on clinical outcomes, providing insufficient mechanistic data to fully elucidate its biological effects. Further well-designed randomized controlled trials with standardized protocols are required before definitive clinical recommendations can be established. Full article

Background/Objectives: Pregnant women with obesity may experience a substantial burden of sleep disruption and obstetric risk, but prospective data integrating non-respiratory sleep symptoms, prescribed nutritional supplement exposure, and routinely collected hematological measures are limited. This single-center prospective pilot study aimed to describe longitudinal changes in anthropometry, non-respiratory sleep symptoms, prescribed nutritional supplement exposure, routine hematological and blood-count-derived inflammatory indices, and obstetric and neonatal outcomes, and to document study-accrual and data completeness metrics for a future controlled cohort. Methods: Seventeen adult women with singleton pregnancies and first-trimester body mass index (BMI) ≥ 30 kg/m² reached the sleep unit, and all consented to participate. Protocol-based assessments were performed in the first and third trimesters, whereas routine laboratory and treatment data were extracted from medical records. Nutritional exposure was defined solely by prescription status in routine records; doses, formulations, adherence, dietary intake, and serum micronutrient markers were unavailable. Analyses were endpoint-specific complete-case analyses. Results: Study accrual at the sleep unit occurred from 27 July 2023 to 14 March 2024 (17 participants over 7.6 months; approximately 2.2 participants/month). The number informed in Obstetrics and the number not reaching the sleep unit were not recorded. Paired anthropometry was available for 15/17 participants, paired Epworth and Insomnia Severity Index scores for 14/17, paired restless-legs scores for 13/17, and delivery outcomes for 16/17. Median paired changes were 6.0 kg (IQR 1.4–7.9) for weight and 2.3 kg/m² (IQR 0.5–3.1) for BMI. Hemoglobin decreased, and selected blood-count-derived indices varied across routine trimester measurements. Sleep scores showed no clear longitudinal change, although nocturnal awakenings and subclinical insomnia were frequent. Type III polygraphy was attempted in all 17 participants at T1 and was valid in 16; one participant declined a repeat study after a technically invalid recording. Polygraphy was valid in 15 participants at T3; a respiratory event index (REI) ≥5 events/h was observed in 6/16 (37.5%) and 8/15 (53.3%), respectively. Conclusions: This pilot provides feasibility, data completeness, and variability estimates for a larger controlled cohort. The small uncontrolled sample, non-standardized laboratory timing, treatment heterogeneity, and missing upstream referral logs prevent obesity-specific, mechanistic, or clinically actionable conclusions. Full article

Background: Despite evidence-based guidelines for cardiovascular risk management, many patients fail to achieve therapeutic targets. The relative contribution of medication non-adherence versus suboptimal treatment optimization to poor cardiovascular outcomes remains unclear in real-world primary care settings. The aim of this study was to describe changes in cardiovascular risk factor control following protocolized adherence reinforcement combined with physician-driven treatment optimization in high-risk patients. Methods: This multicenter, real-world longitudinal study included 789 participants with high or very high cardiovascular risk enrolled from primary care settings across 9 Spanish regions between 2023 and 2025. All participants received a protocolized intervention combining adherence reinforcement and physician-driven treatment optimization. This was a single-arm, pre–post study without a concurrent control group; observed changes therefore cannot be attributed to the intervention alone. Of 789 participants screened, all completed the baseline assessment, and 628 (79.6%) completed the 90-day follow-up. A total of 161 participants (20.4%) were lost to follow-up. Primary outcomes included changes in systolic and diastolic blood pressure, lipid parameters (total cholesterol [TC], low-density lipoprotein cholesterol [LDL-c], high-density lipoprotein cholesterol [HDL-c], triglycerides [TG]), glucose, glycated hemoglobin (HbA1c), and body mass index (BMI) from baseline to 90-day follow-up. Changes were assessed using linear mixed models. Results: Among participants with complete paired data (n = 453–615 depending on the outcome), significant improvements were observed in most cardiovascular risk factors (HDL-c and HbA1c did not change significantly). Mean changes (95% confidence interval [CI]) were: systolic blood pressure, −9.24 mmHg (−10.41 to −8.06; p < 0.001); diastolic blood pressure, −4.75 mmHg (−5.49 to −4.01; p < 0.001); LDL-c, −22.29 mg/dL (−25.59 to −19.00; p < 0.001); TC, −23.24 mg/dL (−26.73 to −19.74; p < 0.001); TG, −16.75 mg/dL (−23.03 to −10.46; p < 0.001); fasting plasma glucose, −10.03 mg/dL (−12.61 to −7.46; p < 0.001); and BMI, −0.46 kg/m² (−0.58 to −0.35; p < 0.001). Linear mixed models including all available data (n = 628 at 90-day follow-up) confirmed these findings. No significant interactions were observed between assessment timepoint and sex, age, or overweight/obesity status for most outcomes, except for age-related differences in lipid responses. Conclusions: Protocolized adherence reinforcement combined with physician-driven treatment optimization was associated with clinically meaningful improvements in multiple cardiovascular risk factors in high-risk primary care patients. Given the single-arm pre–post design, the observed improvements are associative and cannot establish causality. Residual uncontrolled risk, particularly in lipid management and among older adults, persisted despite active treatment optimization (treatment was modified in 82.0% of participants), consistent with residual suboptimal treatment intensification even after adherence had been reinforced. These findings suggest that achieving optimal cardiovascular risk factor control requires addressing both medication adherence and treatment intensification, particularly in patients with multimorbidity. Full article

Vitamin K is a well-established cofactor for γ-glutamyl carboxylase in vertebrates, yet its physiological functions in insects remain poorly understood. Warfarin, a vitamin K antagonist, inhibits vitamin K epoxide reductase, thereby blocking the vitamin K cycle. We have previously demonstrated that, in Drosophila melanogaster, vitamin K3 (menadione sodium bisulfite, MSB) is converted into endogenous vitamin K2, and that warfarin interferes with this cycle, leading to reduced oxidative stress. In the present study, we investigated the effects of chronic exposure to MSB (3.5 mM) and/or warfarin (1 mM and 10 mM) during larval development on adult survival, lifespan, mitochondrial ATP hydrolysis rate, and the transcriptional expression of target genes. Warfarin at 1 mM did not affect development or egg laying, whereas 10 mM caused significant postembryonic lethality. Transcriptional analysis revealed marked sex-specific effects. In females, warfarin downregulated the levy gene (encoding a complex IV subunit) and the ATPsynB gene (encoding an ATP synthase subunit B), while MSB suppressed cell cycle genes (cmet, sti, mcm2). In contrast, males exhibited upregulation of COQ7 (encoding a key enzyme in ubiquinone biosynthesis) in response to warfarin and increased sti expression in response to MSB, suggesting a more robust compensatory response. Notably, the combined application of MSB and warfarin increased mitochondrial ATP hydrolysis, thereby offsetting the negative physiological effects despite persistent transcriptional suppression. In females, either MSB or warfarin alone significantly reduced median lifespan; however, when applied together, female lifespan was restored to control levels. In males, the effects were considerably weaker. Thus, this study reveals a novel, sex-specific interaction between vitamin K and its antagonist in D. melanogaster, providing new insights into mitochondrial adaptation and sexual dimorphism in metabolic stress responses. Full article

Background/Objectives: Overweight and obesity have consistently increased in prevalence. Early exposure to foods high in fats and sugar through maternal conditions may increase vulnerability to developing metabolic diseases and cognitive impairments in adulthood. In this regard, we aim to evaluate the effects that perinatal exposure to cafeteria diet (CAF) and physical activity (PA) has on anxiety-like, depressive-like behavior, memory and diet preference in male and female offspring. Methods: Seventy female and male offspring rats were divided into five groups according to maternal conditions: (1) CONTROL, fed only standard diet (SD) with no voluntary PA, (2) SED+SD, fed only SD with no voluntary PA, (3) SED+CAF, fed SD and CAF with no voluntary PA, (4) PA+SD, fed only SD with voluntary PA, and (5) PA+CAF, fed SD and CAF with voluntary PA. Starting on PND 24, offspring rats were exposed to SD and CAF (except for rats from the CON maternal group) and evaluated for seven weeks for diet preference, and at week seven for anxiety-like, depressive-like behavior and memory. Results: After seven weeks of exposure to CAF, maternal conditions showed significantly different effects on adult male and female offspring for diet preference and memory impairments. Furthermore, maternal PA significantly reduced anxiety-like and depressive-like behaviors in the offspring. Conclusions: Our results suggest that maternal conditions and postweaning CAF exposure have a joint influence on diet preference, anxiety-like and depressive-like behavior. Additionally, perinatal CAF exposure impairs memory in male and female offspring, regardless of maternal PA conditions. However, maternal PA was associated with reduced affective behaviors induced by lifelong CAF, presenting as a promising non-pharmacological intervention to promote favorable long-term behavioral outcomes in offspring. Full article

Background: Oxidative stress and chronic inflammation contribute to the pathogenesis of obesity and type 2 diabetes (T2D), yet the effects of dietary interventions on endogenous antioxidant defences remain poorly defined. This is a non-randomized study evaluates the effects of very-low-energy ketogenic therapy (VLEKT), compared with a Mediterranean diet (MedD) and a control group, on antioxidants, metabolic, and inflammatory markers. Materials and Methods: Thirty adults with obesity and T2D were assigned to VLEKT (n = 10), MedD (n = 10), or control (n = 10) for 90 days. Metabolic parameters, inflammatory cytokines, superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities were assessed. Longitudinal changes were analyzed using linear mixed models. Results: VLEKT exhibited significant reductions in body weight, fat mass, HbA1c, and HOMA-IR. SOD activity increased in the VLEKT group, whereas no significant changes were observed in MedD. Changes in SOD were inversely associated with changes in HOMA-IR. GPx showed a less consistent response pattern, while inflammatory markers did not differ between groups. Conclusions: VLEKT was associated with substantial metabolic improvement accompanied by a selective modulation of antioxidant enzyme activity. The increase in SOD activity and its association with HOMA-IR suggest a link between metabolic and redox adaptations in subjects with obesity and T2D. Full article

Since its first detection in 2010, Aedes albopictus has spread across northern Algeria, where vector control relies on the use of chemical insecticides. This study aimed to evaluate the susceptibility of Ae. albopictus populations from Algiers to commonly used larvicides and adulticides, as well as to characterize the underlying resistance mechanisms. Eggs were collected from three sites in Algiers. The susceptibility of larvae to temephos and Bacillus thuringiensis israelensis (Bti), as well as that of adults to permethrin, deltamethrin, malathion, and bendiocarb was evaluated using WHO bioassays. Genotyping of knockdown resistance (kdr) mutations was performed via PCR and sequencing. Metabolic resistance mechanisms were investigated using CDC bottle bioassays. The larvae were found to be susceptible to temephos and Bti. Bioassays on adults demonstrated susceptibility to deltamethrin, suspected resistance to permethrin, and resistance to malathion and bendiocarb. Genotyping revealed low frequencies of heterozygous kdr mutations (V1016G, I1532T, F1534C/S). Synergist assays highlighted the key role of esterases in malathion resistance, a minimal involvement of glutathione S-transferases and an unexpected antagonistic effect of cytochrome P450 monooxygenases. Although larvicides remain effective, resistance to organophosphates, carbamates, as well as suspected resistance to permethrin, has been detected. Esterase-mediated metabolic resistance and kdr mutations may contribute to this profile. These findings highlight the need for resistance monitoring and integrated vector control to ensure sustainable control of Ae. albopictus. Full article

Background/Objectives: Dietary habits are important modifiable factors influencing survival among cancer patients. The dietary quality among cancer survivors may differ from those of the general population and may vary according to age at cancer diagnosis. This study aimed to compare dietary quality between cancer survivors and the general population and to examine whether age at diagnosis is associated with dietary quality. Methods: This retrospective cross-sectional study used data from 8706 adults aged ≥ 30 years (641 cancer survivors and 8065 controls) from the 2019–2021 Korea National Health and Nutrition Examination Survey. Dietary quality was assessed using the Diet Quality Index-International (DQI-I; range 0–100). Survey-weighted multiple linear regression models were used to compare DQI-I scores between cancer survivors and controls. Subgroup analyses were stratified by age at diagnosis, and quadratic age terms were included to assess nonlinear associations. All analyses accounted for the complex survey design. Results: Cancer survivors had significantly higher mean DQI-I scores than controls (69.1 ± 0.4 vs. 66.1 ± 0.2; p < 0.001). Among survivors diagnosed before age 50, dietary quality was significantly higher in those currently under 65 years than in controls (mean difference +3.02, 95% CI 1.44–4.60), but notably lower in those aged ≥ 65 years (−3.18, 95% CI −6.16 to −0.20). In contrast, survivors diagnosed at age ≥ 50 consistently showed higher dietary quality than controls across all age groups (+3.76, 95% CI 2.83–4.68). Conclusions: While cancer survivors generally exhibit better dietary quality than the general population, this positive trend was not observed among younger-onset survivors in older age groups. These findings suggest that age at cancer diagnosis may be associated with dietary quality and highlight the need for sustained, age-specific nutritional support strategies in cancer survivorship. Full article

Background/Objectives: Acromegaly is a chronic endocrine disorder caused mainly by GH-secreting pituitary adenomas, leading to excess GH and elevated IGF-1. Although surgery is first-line therapy, many patients require medical treatment, and remission is often not achieved with first-generation somatostatin receptor ligands (SRLs). Pasireotide, a second-generation SRL, offers superior biochemical and tumor control but is associated with hyperglycemia. This study aimed to evaluate real-world outcomes associated with pasireotide treatment in patients with acromegaly inadequately controlled on first-generation SRLs, with IGF-1 normalization as the primary endpoint. Secondary outcomes included GH control, tumor response, and glycemic safety. Methods: We conducted a historical cohort study of adults with acromegaly treated at Clínica Imbanaco (Cali, Colombia) between 2017 and 2024. Eligible patients had residual tumors and persistently elevated GH and/or IGF-1 levels above the age-adjusted upper limit of normal despite treatment with clinically adequate doses of first-generation SRLs, as well as 12 months of continuous pasireotide treatment and follow-up after pasireotide initiation. Demographic, biochemical, imaging, and glycemic data were collected. Statistical analysis included paired and independent Student’s t-tests, Wilcoxon signed-rank tests, McNemar’s test, and Fisher’s exact test, with significance set at p < 0.05. Results: Fourteen patients (50% female; mean age 52.1 ± 14.5 years) were included. After 12 months, mean IGF-1 decreased from 2.73 ± 0.73 to 0.99 ± 0.56 × ULN, and 50% achieved IGF-1 normalization. Additionally, 35.7% achieved GH <1 ng/mL, and 14.3% achieved combined control. Mean tumor diameter decreased by −3.26 mm (95% CI −4.56 to −1.95; p < 0.001). HbA1c increased from 5.56% to 6.05%, while type 2 diabetes mellitus prevalence rose from 14.3% to 35.7%. No patient discontinued pasireotide due to metabolic adverse events. Conclusions: Pasireotide was associated with favorable biochemical and tumor responses in patients with acromegaly inadequately controlled on first-generation SRLs under real-world conditions. Although treatment was associated with higher HbA1c and increased diabetes incidence, proactive monitoring and early management of hyperglycemia may have supported treatment persistence. Full article