Search Results (691)

Diabetes complications may increase frailty rates among the elderly, leading to falls, immobility, dependency, hospitalizations, and death. The study aimed to assess any association between frailty status and glycaemic control among older adults with type 2 diabetes mellitus at Kenyatta National Hospital, Kenya. We conducted a cross-sectional study of 430 older individuals aged 60+ years with type 2 diabetes at a specialized diabetes clinic using a modified FRAIL scale. Mean age was 69.1 years; 65.7% were female and 76.2% completed primary school. Frailty prevalence was 3.8%, pre-frailty constituted 24.3%, and robust/non-frail comprised 71.9%. It was associated with age, social status, health knowledge, duration of DM, blood pressure, body mass index, high-density lipoprotein-C, and renal failure. Mean fasting plasma glucose (FPG) was 8.7 mmol/L, with 60% having FPG > 7 mmol/L; mean glycated haemoglobin (HbA1C) was 8.0%, with 41% having HbA1C > 8%. Glycaemic control was correlated with number of medications, blood pressure, and lipidaemia, but not age, sex, or social status. No correlation was found between frailty and glycaemic control: frailty versus FPG (r = 0.038, p = 0.459; χ² = 0.699, p = 0.705) and HbA1C (r = −0.009, p = 0.877; χ² = 0.046, p = 0.977). Low frailty prevalence was noted, with no association to glycaemic control. Our findings provide evidence for conducting frailty assessments in chronic disease care. Full article

The focus of modern livestock production is increasingly shifting toward improving animal health, welfare, and product quality through the use of natural feed ingredients. Pumpkin (Cucurbita spp.) and its seeds are of interest because they contain biologically active compounds, including tocopherols and phenolic antioxidants. This study evaluated the effects of pumpkin seed cake (PSC) in rabbit diets on blood parameters, oxidative status, and trace element distribution in tissues. Sixty Popielno White rabbits were initially assigned to three dietary groups: control (0% PSC), 5% PSC, and 10% PSC. At 90 days of age, samples from 30 rabbits (10 per group) were collected and analysed. PSC supplementation significantly increased red blood cell count, haemoglobin, haematocrit, and platelet indices (p ≤ 0.05), indicating affected haematological status. It also reduced (p ≤ 0.05) urea, triglycerides, total cholesterol, and LDL cholesterol. Antioxidant status significantly improved, as indicated by higher superoxide dismutase activity and ferric-reducing antioxidant power, together with lower malondialdehyde levels (p ≤ 0.05). Mineral analysis showed lower manganese concentrations in muscle and kidney tissues; cadmium remained low, and lead was below the detection limit in muscle and liver samples. Overall, PSC may be considered a promising feed ingredient that supports haematological status, antioxidant protection, and metabolic balance under the conditions of the present study. Full article

Background/Objectives: Type 2 Diabetes Mellitus (T2DM) is a prevalent metabolic disorder associated with major cardiovascular and metabolic complications. Regular physical activity is recommended for glycaemic management, but barriers such as obesity, joint pain, and impaired mobility may limit participation in land-based exercise. Aquatic exercise may provide a feasible alternative as water buoyancy reduces joint loading while allowing aerobic and resistance training. This systematic review and meta-analysis evaluated the effects of aquatic exercise interventions on glycaemic control in adults with T2DM. Methods: The review followed the PRISMA 2020 guidelines. MEDLINE, Cochrane CENTRAL, Scopus, Web of Science, and IEEE Xplore databases were searched. Randomised and non-randomised longitudinal studies involving adults aged ≥35 years with T2DM participating in structured aquatic exercise programmes were eligible. The primary outcome was glycated haemoglobin (HbA1c). Risk of bias was assessed using RoB 2 and RoBANS 2, and certainty of evidence was evaluated using GRADE. Random-effects meta-analysis calculated mean differences (MDs) with 95% confidence intervals. Results: Eleven randomised controlled trials involving 335 participants were included. Aquatic exercise significantly reduced HbA1c compared with passive control conditions (MD = −0.76%; 95% CI −1.21 to −0.32), although heterogeneity was high. No significant differences were observed between aquatic and land-based exercise interventions. Eight studies used wearable heart-rate monitors to regulate exercise intensity. Conclusions: Aquatic exercise may improve glycaemic control compared with sedentary conditions and yields effects comparable to those of land-based exercise in adults with T2DM. Further high-quality trials are needed to clarify optimal exercise dose–response and evaluate more advanced wearable technologies. Full article

Integrating sphere measurements are a well-established method for determining the optical properties of planar samples. In this study, the approach was expanded from slab geometry to cylindrical geometry illuminating the cylinder barrel, thereby demonstrating its applicability for determining the optical properties of human fingers. By adapting existing integrating sphere theory to cylindrical samples, the method was systematically validated using phantoms and subsequently applied to human fingers. It has been demonstrated that the absorption coefficient ${\mu }_{\mathrm{a}}$ and the reduced scattering coefficient ${\mu }_{\mathrm{s}}^{\prime }$ of cylindrical and 3D finger phantoms can be determined with a high degree of agreement to those of slab phantoms. Moreover, this approach facilitates the quantification of tissue components in human fingers, including fat, water and collagen content, total haemoglobin concentration and tissue oxygenation. Full article

Background/Objective: The primary aim of this study was to establish a clinically relevant cut-off for detecting postpartum anaemia using non-invasive haemoglobin measurement, and to compare the non-invasive method with laboratory haemoglobin testing. This study was conducted as a prospective observational study at a single centre. Pregnant women giving birth vaginally or by caesarean birth at a university hospital were included in this study. Methods: We measured haemoglobin by non-invasive and laboratory means at delivery room discharge and after childbirth in the operation room. We then calculated a clinically relevant cut-off for detecting postpartum anaemia using the non-invasive measurement method. The main outcomes were the invasively and non-invasively measurements of haemoglobin and the correlation between the two measurements. Results: In total, 466 complete measurement pairs from 323 women were included, and 179 (38.4%) laboratory measurements were found to be anaemic (haemoglobin value < 11 g dL⁻¹). Maximising specificity while maintaining a minimum sensitivity of 80%, we identified a cut-off of 13.75 g dL⁻¹, which achieved a sensitivity of 81.0% and a specificity of 54.7%. The NPV at this threshold was 82.2%, while the PPV was 52.7%. The mean difference between measurements was found to be +2.3 g dL⁻¹ (CI 95% 2.16 to 2.43). Conclusions: Non-invasive haemoglobin measurement did not sufficiently detect anaemia compared to laboratory measurement values in the setting of early postpartum women, even after adjusting for bias. However, the proposed cut-off could potentially aid healthcare providers in low-resource situations. Full article

Fin erosion is a common condition in aquaculture-reared salmonids used in river restocking programs and may influence multiple biomarkers applied in aquatic biomonitoring. The health status of Salmo trutta from a river with good ecological status was evaluated by analysing biometric traits, glucose concentration, haematological indices, erythrocyte morphometry, and erythrocytic nuclear abnormalities in relation to fin condition. Fish with eroded fins were larger and exhibited pelvic and dorsal fin erosion, suggesting a hatchery origin, but showed lower haemoglobin concentration, packed cell volume, and glucose levels, together with altered erythrocyte morphology and increased frequencies of cytotoxic nuclear abnormalities. In contrast, leukocyte profiles and overall erythropoietic activity did not differ between fin condition groups. These findings indicate that fin erosion can alter baseline biomarker responses independently of environmental contamination, highlighting the importance of considering fin integrity when interpreting biomonitoring data and evaluating the suitability of fish for restocking programs. Full article

Background: Frailty strongly influences outcomes after transcatheter aortic valve implantation (TAVI), but conventional risk models insufficiently capture functional and cognitive vulnerability. We compared conventional surgical risk scores with multidimensional frailty assessment and a biological score. Methods: This observational registry included 528 consecutive patients with severe symptomatic aortic stenosis undergoing TAVI between January 2019 and November 2024. Frailty was assessed using the Essential Frailty Toolset (EFT), Katz Index, and cognitive screening, alongside French Aortic National CoreValve and Edwards 2 (FRANCE-2) and Age, Creatinine, and Ejection Fraction (ACEF) scores. HALP was calculated as (haemoglobin × albumin × lymphocytes) ÷ platelets. Primary endpoints were 30-day, 6-month, and 1-year all-cause mortality. Secondary outcomes included non-fatal major adverse cardiovascular events (MACE), complications, and quality-of-life improvement. Results: One-year mortality was 12.7%. EFT and Katz Index showed the strongest discrimination for 1-year mortality (AUC 0.72 and 0.75), outperforming EuroSCORE II and STS-PROM (AUC 0.66 and 0.68). After adjustment, EFT (HR 1.91, 95% CI 1.47–2.48), Katz Index (HR 0.57, 95% CI 0.47–0.70, and cognitive impairment (HR 2.24, 95% CI 1.34–3.75) independently predicted 1-year mortality. HALP was not associated with outcomes. FRANCE-2 independently predicted 1-year MACE (HR 1.24, p = 0.019). Conclusions: Functional frailty and cognitive impairment add prognostic value beyond conventional comparator models, whereas HALP does not. Brief functional and cognitive screening may help Heart Teams identify patients who need closer peri-procedural optimisation, rehabilitation planning, and discharge support rather than relying on surgical risk scores alone. Full article

Background and Objectives: In real-world NSCLC management, prognostic assessment extends beyond tumour staging and molecular profiling, which represent a partial timeframe of disease biology. Routinely collected inflammatory and haematological markers may better reflect the dynamic host–tumour interactions during treatment. This study assessed the prognostic significance of baseline and longitudinal neutrophil-to-lymphocyte ratio (NLR) and haemoglobin levels on survival outcomes in a real-world NSCLC cohort. Materials and Methods: We conducted a retrospective observational cohort study of 615 patients with histologically confirmed NSCLC diagnosed between 1 May 2022 and 30 April 2024 at a tertiary referral centre in western Romania. Survival outcomes, including progression-free and overall survival, were analysed through Kaplan–Meier curves, complemented by 12-month restricted mean survival time estimates. High NLR was defined as ≥3 and low haemoglobin as <12 g/dL. Longitudinal changes were evaluated at 6 and 12 months, with 12-month analyses restricted to patients alive at that landmark. Results: The cohort had a median age of 66 years (IQR 60–72) and was predominantly male (66.3%). Most patients presented with advanced disease (60.3% stage IV, 23.6% stage III). At baseline, 57.1% (n = 351) exhibited high NLR and 39.8% (n = 245) had low haemoglobin. Median PFS was 9.0 months (IQR 4.5–15.5), and median OS was 16.5 months (IQR 8.5–27.0). Stage IV disease was associated with shorter PFS than stages I–II (7.0 vs. 20.8 months; log-rank p < 0.001). High-baseline NLR showed a borderline association with shorter PFS (adjusted HR 1.40; 95% CI 0.98–1.95). Among the 436 patients alive at 12 months, NLR increased in 56.7% of cases, and this increase showed a non-significant trend toward shorter PFS (HR 1.35; 95% CI 0.95–1.90; p = 0.09) in a 12-month landmark analysis. Conclusions: Baseline systemic inflammation and anaemia are highly prevalent in real-world NSCLC patients and cluster with advanced disease. Elevated NLR was associated with poorer survival outcomes, whereas low haemoglobin did not demonstrate a significant independent association in adjusted analyses. These haematological parameters are accessible tools for prognostic assessment in routine clinical practice. Full article

Background: Haemoglobinopathies are the most common monogenic disorders both in Greece and worldwide. The most effective strategies against them are carrier detection and prenatal testing following genetic risk assessment consultation for couples on the likelihood of their offspring being affected. Case Presentation: A novel alpha globin chain variant, named Hb Thessaloniki, was detected in Northern Greece. The underlying point variation HBA1:c.260T>C (ref. seq. NM_000558.5) was detected in the HBA1 gene, in heterozygosity, during a routinely performed population screening for haemoglobinopathies. The amino-acid residue Leu86 was replaced by a structure disrupting Pro residue, resulting in a hyperunstable product as shown by the isopropanol test and predicted by the Dynamut2 and Alphafold3 algorithms. The haematological phenotype, due to which genetic analysis was performed, presented with mild microcytosis and hypochromia and was also indicative of the presence of an unstable haemoglobin produced in small quantities (variant encoded by HBA1). Since the proband’s partner presented with a normal haematological phenotype, there is no risk of the couple giving birth to an affected offspring. Expanded analysis of the proband’s relatives identified biallelic variants (α^Parmaα/αα^{Τhessaloniki}) in the proband’s mother, who presented with no apparent clinical findings, expect for slightly reduced haematological indices. Conclusions: The novel Hb Thessaloniki identified, although theoretically hyperunstable, seems to have minor effects on erythrocyte function, as indicated by haematological findings on the proband and his close relatives. Future identification of co-inheritance with HBA pathogenic point variations or deletions may provide further information regarding genetic counselling. In parallel, the usage of structure–function relation-calculating algorithms may enhance our prediction capability for novel variants. Full article

Objectives: To determine whether four weeks of Rhodiola rosea (RHO) supplementation improves intermittent exercise performance, post-exercise blood lactate concentrations, and decision-making under fatigue in competitive football players. Methods: Twenty-four male competitive football players completed a randomised, double-blind, placebo-controlled 4-week intervention (RHO vs. placebo). Outcomes included Yo-Yo IR2, repeated-sprint ability (RSA), post-RSA blood lactate (0, 3, 5 min), football-specific technical tests (passing and shooting), a video-based decision-making task (reaction time and accuracy), GPS-derived match running metrics, countermovement jump (CMJ), foot tapping (TAP), and haematological markers. Results: Yo-Yo IR2 performance significantly improved in the RHO group (p = 0.012) and was superior to the placebo group (p = 0.046). For RSA, mean sprint time improved significantly from pre- to post-intervention in the RHO group (p = 0.017), whereas no significant change was observed in the placebo group. Post-intervention, mean sprint time was significantly better in RHO than placebo (p = 0.041), with no between-group difference observed at baseline. Best sprint time showed no between-group difference (p = 0.723). Post-exercise blood lactate concentrations were significantly lower in RHO than placebo at 0, 3, and 5 min (all p < 0.05). Under fatigue, the RHO group demonstrated faster reaction time (p = 0.042) and higher decision accuracy (p = 0.049) than placebo. Additionally, the RHO group showed significant pre- to post-intervention improvements in passing and shooting performance (p < 0.05), with between-group differences observed only for short-pass performance. Match total and high-speed running distances were higher in RHO, accompanied by increases in haemoglobin and haematocrit (p < 0.05). Conclusions: Four weeks of Rhodiola rosea supplementation enhanced high-intensity intermittent performance and decision-making under fatigue, with findings suggesting improved performance maintenance rather than increased peak sprint capacity. Full article

Background: Cryptococcal meningitis (CM) remains a leading cause of mortality among people with advanced HIV disease (AHD) in sub-Saharan Africa. Current guidelines recommend induction therapy with amphotericin B and flucytosine, typically administered in an inpatient setting due to concerns over severe clinical presentation and drug-related toxicities. This requirement poses a significant burden on resource-limited health systems. We evaluated the real-world outcomes of a fully outpatient model for CM therapy in Maputo, Mozambique. Methods: A longitudinal retrospective cohort study was conducted at the Centro de Referência de Alto-Maé (CRAM), a specialized AHD outpatient clinic. We included 83 PLWH with laboratory-confirmed CM treated between October 2020 and December 2024. The primary outcome was hospitalization-free survival (HFS) within the first 10 weeks of treatment. Secondary outcomes included the frequency and severity of adverse drug reactions (ADRs), analysed by tracking haemoglobin (Hgb), potassium (K+), and creatinine (Creat) levels on days 1, 3, and 7 of induction therapy, and retention in care (RIC) at 6, 12, and 24 months. Statistical analyses included Kaplan–Meier survival estimates and paired t-tests. Results: The median age was 37 years (IQR: 27–42), 63.9% were male, and the median CD4 count was 62 cells/µL (IQR: 27–105). Most patients (95.2%) were symptomatic at presentation, and 56.6% had concurrent tuberculosis. For the 52 patients who completed the full induction protocol at CRAM, the HFS rate at 10 weeks was 84.6% (44/52), with an overall survival of 90.4% (47/52). ADR analysis (n = 52) showed a predictable pattern of mild, manageable toxicity: a significant decline in Hgb (11.2 ± 1.8 to 10.6 ± 2.0 g/dL, p < 0.001) and K+ (4.27 ± 0.66 to 3.86 ± 0.78 mmol/L, p = 0.008), and a transient increase in Creat (0.83 ± 0.42 to 1.13 ± 0.64 mg/dL, p = 0.001) from day 1 to day 3, with stabilization or a trend toward recovery by day 7. No significant differences in ADRs were found between single-dose (47%) and multiple-dose (53%) L-AmB regimens. RIC for the entire cohort (n = 83) was high at 81.9% at 6 months, declining to 74.0% at 12 months and 70.4% at 24 months. Conclusions: An ambulatory model for CM therapy is feasible and effective in a resource-limited setting, demonstrating high hospitalization-free survival, manageable and reversible adverse drug reactions, and excellent medium-term retention in care. These findings suggest potential benefits and provide support for re-evaluating the standard of inpatient care. They indicate that integrating outpatient CM management into advanced HIV disease (AHD) care packages could help alleviate health system burdens and may contribute to improved patient outcomes. Full article

Background: Haemoglobinopathies such as beta-thalassemia (β-thal), alpha-thalassemia (α-thal) and sickle cell disease (SCD) are characterised by pathogenic gene variations (mutations) in the globin genes. Patients with haemoglobinopathies have the same disease-causing coding variations with very different disease phenotypes, from requiring blood transfusions to being non-symptomatic. The gap between the expected clinical outcomes based on primary coding mutations (the genotype) and the actual observed symptoms (the phenotype) often remains unexplained. We refer to the contribution of secondary genetic modifiers—specifically, non-coding variants of the genome that alter globin gene expression and pathophysiology—as the “missing heritability” of the clinical presentation [Primary Mutation + Missing Heritability (Non-Coding Variants) = Actual Clinical Phenotype]. Objectives: This systematic review aims to find evidence connecting genetic differences outside of the protein-coding region, as in promoters, enhancers or untranslated regions (UTRs), to the clinical severity (phenotype) of beta-thalassemia, alpha-thalassaemia and SCD. We summarise the molecular basis of phenotypic variation among haemoglobinopathy patients with identical variations to reveal their missing heritability and to enhance our understanding of prognostic strategies. Methods: This systematic review was performed in accordance with the PRISMA 2020 guidelines. We used search terms related to haemoglobinopathies, non-coding variation, SNP, promoters, enhancers and clinical severity to search major databases (PubMed and Google Scholar) as of October 2025. A total of 527 (out of 572) abstracts were fit for initial screening to identify the eligible reports. Due to heterogeneity in study designs and reported outcomes, findings were synthesised descriptively and grouped by variant mechanism (cis-acting and trans-acting). The final analysis included 89 articles that demonstrated a direct association between a non-coding genomic variant and a quantitative measure of clinical severity. Results: Two main groups of non-coding variants (NCVs) that modulate foetal haemoglobin (HbF) induction were identified. The first major group comprises cis-acting variants within globin gene clusters (HBG2 promoter XmnI polymorphism, HBB promoter mutations and α-globin enhancer variants), while the second major group comprises trans-acting quantitative trait loci (QTLs) (BCL11A and HBS1L-MYB loci). Non-globin NCVs in the UGT1A1 promoter were also found to influence the severity measures in β-thal and SCD. NCVs primarily alter the binding of transcription factors and the looping dynamics of chromatin, modulating the α/β chain balance ratio and γ-globin repression. The XmnI polymorphism is the most prominent cis-acting modifier associated with β-thal intermedia. The promoter polymorphisms in TNF-α and VCAM1 are associated with vascular complications in SCD. Conclusions: NCVs are fundamental when determining the clinical measures of haemoglobinopathies, in addition to coding variants. NCV screening should be integrated for clinical prognosis for the accurate prediction of haemoglobinopathy severity and associated high-risk complications. NCVs may represent promising targets for next-generation gene editing and therapeutic intervention strategies aimed at modifying the severity of β-thal, α-thal and SCD. Full article

Background/Objectives: Skin carotenoid measurements have been proposed as an indicator to reflect of fruit and vegetable intake, but evidence from occupational settings remains limited. The primary aim of this study was to assess the association between fruit and vegetable intake and skin carotenoid levels in the workplace. The secondary aim was to examine the association of skin carotenoid levels with blood glucose levels and blood pressure (BP). Methods: This cross-sectional study included Japanese workers aged ≥20 years between 2022 and 2023. Skin carotenoid levels were measured, dietary intake was assessed using self-administered questionnaires, and data from workplace health check-up records were collected. Multiple regression analysis was conducted to examine the association between skin carotenoid levels and fruit and vegetable intake in 210 participants. Associations between skin carotenoid levels and log-transformed glycated haemoglobin (HbA1c), fasting blood glucose (FBG), systolic BP, and diastolic BP levels were examined in 162, 158, and 183 participants, respectively. Results: Skin carotenoid levels were positively associated with the number of vegetable dishes consumed and the frequency of fruit intake. A slight positive association was observed with HbA1c levels (partial regression coefficient = 0.00012), whereas no associations were found with FBG or BP. Conclusions: Skin carotenoid levels reflect self-reported fruit and vegetable intake, supporting their potential use as a non-invasive dietary assessment tool in workplace nutrition education. However, the associations observed with HbA1c were very small and of limited clinical significance, and the results should be interpreted with caution. Full article

Background: Diabetes is a known risk factor of acute coronary syndrome (ACS). However, diabetes de novo and prediabetes are also common in ACS patients. This study explored the prevalence of prediabetes and diabetes de novo in ACS patients, glucose-mediating therapy at discharge, and compared the prevalence of 30-day major adverse cardiac and cerebrovascular events (MACCE) in patients with prediabetes and diabetes de novo with known diabetes. Methods: ACS patients with measured haemoglobin A1c (HbA1c) from the South-East Netherlands Heart Registry, a prospective, multicentre registry of patients undergoing percutaneous coronary intervention (PCI), were analysed. Patients were stratified into two groups: known diabetes, and prediabetes (HbA1c 39–47 mmol/mol) or diabetes de novo (HbA1c ≥ 48 mmol/mol). Outcomes were analysed at 30 days post-PCI. Results: HbA1c was available in 34.1% of ACS patients (n = 1836), of whom 526 (28.7%) had known diabetes, 619 (33.7%) prediabetes, and 180 (9.8%) diabetes de novo. Compared with patients with known diabetes, patients with prediabetes and diabetes de novo had a significantly higher risk of MACCE (HR = 1.81, 95% CI 1.12–2.93, p = 0.016) after multivariable adjustment. At discharge, 59% of patients with diabetes de novo received no insulin, metformin, nor sodium-glucose co-transporter-2 inhibitor, compared with 16% of patients with known diabetes (p < 0.001). Conclusions: Impaired glucose metabolism without known diabetes was observed in nearly 45% of ACS patients and they demonstrated a significantly higher risk of 30-day MACCE compared with patients with known diabetes. Despite clear guideline recommendations, routine screening for hyperglycaemia and the appropriate initiation of glucose-mediating therapy remain underutilised in clinical practice. Full article