Search Results (25,011)

Global progress towards the 2030 Sustainable Development Goals (SDGs) remains critically off track, with current trends indicating that only 17% of targets will be met by the deadline. As sustainability transitions increasingly depend on regional and institutional capacity, understanding heterogeneous transition pathways and resilience across territorial contexts is essential. This study investigates whether observed divergence in SDG performance reflects temporary setbacks or persistent structural regimes characterised by distinct institutional and technological configurations. Using panel data from over 160 countries (2019–2024), we employ annual latent class analysis to identify hidden structures in SDG performance across 15 goals, introducing intertemporal volatility as a dimension of development dynamics. We complement this with ordered logistic regression to examine structural determinants of regime membership, including governance quality, digital infrastructure, health investment, and macroeconomic indicators. Our analysis identifies three temporally stable development regimes—lagging, transitional, and leading—with fewer than 15% of countries transitioning between classes over the observation period. ANOVA results reveal that internet access and government effectiveness exhibit the most substantial between-regime differences. Ordered logit models indicate that governance quality and digital connectivity are the strongest correlates of regime membership (government effectiveness: β = 0.943, p < 0.001; internet penetration: β = 0.049, p < 0.001), whereas short-term GDP growth exerts negligible influence (p > 0.10). These findings challenge assumptions of linear convergence in sustainable development and provide a data-driven framework for evaluating transition dynamics across diverse territorial contexts. The results suggest that achieving the SDGs requires that deep structural constraints be addressed—particularly digital divides and institutional quality—through regionally targeted policy design rather than relying solely on incremental adjustments or economic growth. The identified regimes provide a basis for place-based targeting by distinguishing contexts where governance and digital capacity constraints are binding. Full article

Background/Objectives: Early prognostication in critically ill patients with low burden of organ dysfunction (BOD) remains challenging. Progranulin (PGRN), a hypoxia inducible and anti-inflammatory protein, may offer prognostic value. We investigated whether PGRN levels predict mortality in ICU patients stratified by their BOD. Methods: In this secondary analysis of a prospectively recruited ICU cohort (n = 99), patients were categorized into low (Sequential Organ Failure Assessment Score (SOFA) ≤ 8) and high (SOFA > 8) BOD groups. Plasma PGRN concentrations were measured every 8 h for up to 5 days. Initial values and kinetic parameters (maximum, mean, and normalized area score (NAS)) were evaluated. Associations with in-hospital mortality were analyzed by univariate logistic regression and area under the receiver operating characteristic curve (AUROC) comparisons. Results: In patients with low BOD (n = 53), the PGRN kinetics were significantly associated with in-hospital mortality, with odds ratios of 1.086 (95% CI 1.027–1.148), 1.102 (95% CI 1.025–1.184), and 1.093 (95% CI 1.021–1.170) for maximum, mean, and NAS values, respectively. The respective AUROC values were 0.815 (p = 0.001), 0.753 (p = 0.010), and 0.738 (p = 0.016). By contrast, none of the PGRN metrics predicted mortality in patients with high BOD (n = 46; all AUROC values < 0.61, p > 0.25). The respective SOFA and CRP metrics were not predictive in low BOD patients. Maximum PGRN levels predicted death at least 32 h in advance. Conclusions: Serial PGRN measurements offer prognostic information, particularly in ICU patients with low BOD, a group whose deterioration is often difficult to anticipate and may be underestimated by conventional scoring systems such as SOFA. These findings support further investigation of PGRN as a tool for early risk stratification in critical illness. Full article

Respiratory support requirement among children hospitalized with pneumonia is a key marker of disease severity and resource needs, yet scalable risk stratification tools for routine hospital settings in Southern Vietnam remain limited. Background: This study aimed to develop and evaluate clinical and laboratory-based multivariable models to predict respiratory support requirement in children under five hospitalized with pneumonia, using a routine care dataset. Methods: We conducted a retrospective cohort study conducted at a tertiary pediatric hospital in Southern Vietnam (July 2024–November 2025), children aged 2–59 months hospitalized with pneumonia were included after predefined exclusions. The outcome was the maximum (worst) level of respiratory support required during hospitalization (oxygen therapy, CPAP, or invasive mechanical ventilation), analyzed as a binary endpoint (any support vs. none) for model development. Candidate predictors included bedside clinical variables (age < 12 months, malnutrition, recurrent pneumonia, cyanosis, tachypnea, chest indrawing) and complete blood count-derived inflammatory indices. Univariable logistic regression was used for crude associations. Two multivariable logistic regression models were built: Model 1 (clinical-only) and Model 2 (clinical + neutrophil-to-lymphocyte ratio [NLR]; primary). Discrimination was assessed using area under the ROC curve (AUC), and calibration was evaluated using the Hosmer–Lemeshow test and observed-to-expected (O:E) ratio. Results: A total of 1797 children were included; 154 (8.6%) required respiratory support. In the primary model, independent predictors were age < 12 months (aOR 2.57, 95% CI 1.69–3.92), malnutrition (aOR 4.33, 2.56–7.33), recurrent pneumonia (aOR 1.82, 1.18–2.81), cyanosis (aOR 24.02, 7.41–77.87), chest indrawing (aOR 4.19, 2.73–6.43), and higher NLR (per 1 unit: aOR 1.49, 1.38–1.60), while tachypnea was not independently associated after adjustment. Discrimination improved from Model 1 (AUC 0.754) to Model 2 (AUC 0.840; 95% CI 0.806–0.874). At the optimal probability cut-off (0.122), Model 2 achieved sensitivity 66.2%, specificity 86.2%, PPV 31.1%, NPV 96.5%, and accuracy 84.5%. Calibration was acceptable (Hosmer–Lemeshow p = 0.662; O:E = 1.00). Conclusions: A simple clinical model strengthened by NLR provided good discrimination and calibration for predicting respiratory support requirement among children under-five hospitalized with pneumonia in Southern Vietnam. This approach may support early triage, prioritization of monitoring intensity, and escalation readiness in resource-constrained settings, although external validation is warranted. Full article

Background/Objectives: Comprehensive epidemiological studies of bicycle crashes involving all ages in Japan are limited, particularly regarding multiple-rider incidents. This study investigated the epidemiology of single- and multiple-rider bicycle crashes in a Japanese core regional city. Methods: Ambulance transport data from Takatsuki City (1 January 2014 to 31 July 2024) were retrospectively analyzed, including demographics, crash characteristics, and severity of injury for bicycle crash patients. The primary outcome was examination of the epidemiology of bicycle crashes with moderate and severe severity or severe and fatal severity, encompassing both single- and multiple-rider incidents. Statistical tests and logistic regression analysis were used. Results: For 6683 transported patients, 6377 (95.4%) involved single-rider crashes and 306 (4.6%) involved multiple riders. Single-rider crash patients were older and more often male. Moderate or greater injuries occurred in 625 single-rider and 11 multiple-rider crash patients. No severe or fatal injuries occurred in multiple-rider crashes. General roadways and intersections were common crash locations. Male sex and older age predicted greater injury severity in single-rider crashes. Fifty single-rider bicycle crashes resulted in severe or greater severity injuries, and four fatal crashes were recorded. Conclusions: This study uniquely details multiple-rider bicycle crashes in Japan, revealing a lower severity of injuries compared to single-rider crashes. Full article

Background: Selective immunoglobulin A deficiency (sIgAD), the most common primary immunodeficiency, is associated with recurrent respiratory infections. Despite the established role of IgA in mucosal immunity, population-based data evaluating COVID-19 susceptibility and severity among individuals with sIgAD are scarce. Objectives: This study aimed to evaluate the association between selective IgA deficiency and the risk of SARS-CoV-2 infection, recurrent infection, COVID-19-related hospitalization, and vaccination uptake. Design and Setting: We conducted a retrospective population-based cohort study using the Clalit Health Services electronic health record database in Israel. Methods: Adults aged ≥18 years with documented serum IgA measurements between 2020 and 2022 were included. Selective IgA deficiency was defined as serum IgA < 7 mg/dL with normal IgG and IgM levels. Individuals with sIgAD were matched 1:4 with controls with normal IgA levels by age and sex. Outcomes included documented SARS-CoV-2 infection, recurrent infection (>2 episodes), COVID-19-related hospitalization, and vaccination status. Multivariable logistic regression models were adjusted for demographic characteristics, comorbidities, and vaccination status. Results: The matched cohort included 61,150 individuals (12,230 with sIgAD and 48,920 controls). The risk of primary SARS-CoV-2 infection did not differ significantly between groups (13.0% vs. 14.0%; adjusted OR 1.03, 95% CI 0.95–1.12). However, individuals with sIgAD had increased odds of recurrent infection (adjusted OR 1.15, 95% CI 1.09–1.22) and COVID-19-related hospitalization (adjusted OR 1.40, 95% CI 1.22–1.60). Booster vaccination uptake was slightly higher among individuals with sIgAD. Conclusions: Selective IgA deficiency was not associated with increased susceptibility to primary SARS-CoV-2 infection but was independently associated with recurrent infection and increased risk of hospitalization. These findings underscore the importance of mucosal immunity in post-infection viral control and suggest that individuals with sIgAD may benefit from closer monitoring after COVID-19 infection. Full article

Background and Aims: Autoimmune gastritis (AIG) is a chronic immune-mediated condition characterized by corpus-predominant atrophy, which can lead to vitamin B12 deficiency, achlorhydria, and an increased risk of gastric adenocarcinoma (GC) and neuroendocrine tumours. Diagnosis is often challenging due to a long asymptomatic phase and variable clinical presentation. This study aimed to assess the prevalence of gastric cancer and advanced premalignant lesions and to identify risk factors associated with a worse endoscopic outcome. Methods: This retrospective observational study involving AIG patients undergoing endoscopic surveillance (2006–2024) at the Hospital Clínic de Barcelona. Patients with AIG were identified based on the presence of anti-parietal cell antibodies and/or intrinsic factor antibodies and underwent endoscopic surveillance with histological assessment. Clinical, serological, endoscopic, and histological data were evaluated to estimate the prevalence of gastric lesions. Potential risk factors were evaluated using logistic regression. Results: A total of 70 patients met the inclusion criteria (median age 60 years; 60% female). Advanced premalignant findings (high- and low-grade dysplasia) were identified in 15.7% of the patients, while GC was found in 5.7%. Atrophy and intestinal metaplasia were present in 98.6% and 74.3% of patients, respectively. Female sex was independently associated with a lower risk of advanced neoplastic findings (OR = 0.24; 95% CI: 0.06–0.95; p = 0.044), whereas older age at diagnosis was associated with an increased risk (OR = 1.06; 95% CI: 1.00–1.11; p = 0.031). Conclusions: Given the high prevalence of premalignant lesions in AIG, endoscopic surveillance appears essential for early detection. The observed associations with female sex and older age, toward lower and higher probabilities of advanced neoplastic findings, respectively, may contribute to future risk stratification models. However, the limited identification of significant predictors underlines the complexity of AIG progression and supports the development of individualized follow-up protocols. Full article

Background: Recurrence remains a major challenge in the management of Clostridioides difficile infection (CDI), with reported rates of 20–30% after an index episode. Identification of factors associated with recurrence is essential for improved risk stratification. Methods: This retrospective cohort study included 100 adult patients diagnosed with CDI. Factors associated with recurrent CDI were evaluated using univariable analyses, receiver operating characteristic analysis and backward stepwise logistic regression. Results: Eighteen patients (18%) developed recurrent CDI. Baseline demographic characteristics, comorbidity burden, clinical presentation and admission laboratory parameters were not significantly associated with recurrence. Previous hospitalization within the preceding 12 months, longer duration of antibiotic therapy and poor or partial response to initial treatment were independently associated with recurrence. Duration of antibiotic treatment showed the strongest discriminatory performance (AUC 0.712). Predictive models combining treatment response, antibiotic duration and prior hospitalization demonstrated incremental improvement in discrimination, achieving an AUC of 0.775. Associations with specific antibiotic classes did not persist after adjustment for healthcare exposure and treatment duration. Conclusions: Recurrent CDI was associated primarily with healthcare exposure and post-diagnosis treatment characteristics rather than baseline clinical or laboratory features. These findings support the relevance of integrating antibiotic burden and early treatment response into recurrence risk assessment. However, the relatively small number of recurrent cases warrants cautious interpretation of these findings. Full article

Atrial fibrillation (AF) frequently coexists with chronic coronary syndrome (CCS), reflecting shared cardiovascular risk factors and structural remodeling pathways. Identifying CCS patients at increased likelihood of AF remains clinically relevant, particularly when arrhythmia is silent or paroxysmal. Background: We hypothesized that established clinical and angiographic risk scores used in CCS may capture cumulative cardiovascular burden and could therefore assist in AF risk stratification. The biomarker-based ABC-stroke score was incorporated as a biological reference framework reflecting myocardial stress and injury. Methods: This prospective, single-center proof-of-concept study included 131 consecutive patients undergoing invasive coronary angiography for suspected myocardial ischemia. Patients were classified according to rhythm status, irrespective of AF subtype. Coronary artery disease severity was quantified using the Gensini and SYNTAX (PCI and CABG) scores. Global cardiovascular risk was assessed using Framingham, ASCVD, SCORE2, and SCORE2-OP. Correlation analyses, ROC curves, and multivariable logistic regression were performed to evaluate associations between risk scores, coronary complexity, and AF. Results: Clinical and angiographic risk scores differed significantly according to rhythm status and AF phenotype. Patients with AF exhibited higher global cardiovascular risk and greater coronary anatomical complexity compared with those in sinus rhythm. SYNTAX PCI and SYNTAX CABG demonstrated moderate discriminative performance for AF detection (AUC 0.745 and 0.760, respectively), with SYNTAX CABG remaining independently associated with AF in multivariable analysis. Significant correlations were observed between traditional cardiovascular risk scores and SYNTAX-derived measures of coronary complexity, whereas correlations with the Gensini score were weaker. The ABC-stroke reference model showed a strong discriminative signal, consistent with its biological proximity to AF-related myocardial stress. Conclusions: Established clinical and angiographic risk scores used in CCS are associated with the presence and phenotype of AF. These findings suggest that routinely available coronary risk assessment tools may serve as practical instruments for identifying CCS patients at increased likelihood of AF, potentially facilitating targeted rhythm screening and earlier risk stratification. Full article

Promoting resilience, increasing productivity and sustainability, and profit maximization remain key challenges facing farmers globally. These are exacerbated by factors such as climate change, low to no access to technological advancement, financial constraints, poor technical and management skills, inadequate government support, and limited access to resources. However, there are diverse strategies that abound, including on-farm diversification, that farmers could leverage on to address these numerous and complex challenges. This study investigated the determinants of on-farm diversification strategies among smallholders in Mpumalanga Province. The study employed a quantitative approach using closed-ended survey questionnaires to elicit information from a total of 465 farmers who were randomly sampled from a total population of 14,411. The data gathered were analysed using descriptive statistics to determine the on-farm diversification strategies employed by farmers and the factors influencing the use of these strategies. A binary logistic regression model was employed to establish the relationship between on-farm diversification strategies and the determining factors. More than half of the farmers were female (51.8%), with only 48.2% male. The majority (59.1%) of the farmers were between the ages of 36 and 60, with only 20.2% youth participation in farming. Slightly more than half (50.8%) of the farmers practise mixed farming as their on-farm diversification strategy, while only 4.3% of the farmers practise mono-cropping. The study identified significant variables such as level of education (p = 0.001), secondary source of income (p = 0.057), farmland size (p = 0.022), number of farm assistants (p = 0.016), and on-farm diversification awareness as key determinants of on-farm diversification among smallholder farmers in Mpumalanga Province. Therefore, it is recommended that policies within the agricultural sector be revised to encourage on-farm diversification in order to motivate farmers to transition to agripreneurship for poverty alleviation, food security and rural economic development (RED). Full article

Background: High recurrence rates for non-muscle-invasive bladder cancer (NMIBC) remain a clinical challenge. Recommended post-operative treatments are underutilized, highlighting the need for alternative strategies. Given the variability in bladder cancer prognosis, personalized treatment approaches are highly relevant. In this study, we evaluated post-operative two-hour continuous sterile water bladder irrigation (CSWBI) regarding recurrence and safety, as a potential addition to the treatment arsenal for bladder cancer. Method: In 2018, two-hour CSWBI was implemented as routine treatment after all transurethral resection procedures of the bladder (TURB), at the urology department of Sundsvall Hospital. All patients who underwent TURBs four years prior (control group) and four years after the implementation of CSWBI (intervention group) were analyzed. Primary NMIBC were included, MIBC and CIS were excluded. Data were collected retrospectively from patient records, including baseline characteristics, adverse events, and recurrence rates within 12 months follow-up. Statistical analyses included Chi-squared test, Wilcoxon rank-sum test, univariate and multivariate logistic regression analyses, Kaplan–Meier curves and log-rank test. Results: A total of 168 patients were included (control group n = 90, irrigation group n = 78). Median age was 73 years, 23% were female, 77% were male, and 74% were active or previous smokers. The recurrence rate within twelve months for the intervention group vs. the control group was: 27% vs. 21% (p = 0.4) respectively. CSWBI had no statistically significant impact on recurrence (OR 1.25, 95% CI 0.58–2.68, p = 0.6). Adverse effects were limited and equal between groups. Conclusions: Post-operative two-hour CSWBI did not significantly reduce NMIBC recurrence within twelve months in this cohort. Full article

Introduction: Interpregnancy interval (IPI) plays a critical role in neonatal health, yet optimal spacing remains controversial. This study assessed neonatal outcomes across short and long IPI using three complementary classification approaches to identify consistent patterns of risk. Materials and Methods: In this retrospective cohort study, medical records of 1194 women with a prior live birth who delivered singleton pregnancies in 2024 at a tertiary referral center were analyzed. IPI was calculated as the delivery-to-conception interval (LMP + 14 days). Three IPI classification systems were applied: (1) classical cut-offs (<6, 6–11, 12–23, 24–59, and ≥60 months), (2) quartiles, and (3) tertiles. Primary outcomes included preterm birth, low birth weight (LBW), and NICU admission. Multivariable logistic regression models adjusted for maternal age, gravidity, and previous cesarean delivery. Results: Short IPI (6–11 months) demonstrated the highest NICU admission rates (29.4%). Very long IPI (≥60 months) showed the highest prevalence of LBW (16.6%). Multivariable regression analysis revealed that intervals ≥ 24 months were independently protective against preterm birth (24–59 months: aOR 0.48, p = 0.002; ≥60 months: aOR 0.58, p = 0.042), while maternal age increased preterm birth risk by 7% per year. Short IPI (6–11 months) and very long IPI (≥60 months) independently increased NICU admission risk (aOR 2.29, p = 0.002 and aOR 1.61, p = 0.036, respectively). Previous cesarean delivery was an independent predictor of NICU admission (aOR 1.35; p = 0.048). Conclusions: Short and very long IPIs are associated with increased neonatal morbidity, particularly NICU admission, while the apparent preterm risk in long intervals is largely mediated by maternal age. Once adjusted, IPIs exceeding 24 months demonstrate protective effects against preterm birth. However, the rising trend toward LBW and NICU admission in intervals beyond 5 years suggests that birth-spacing counseling targeting an optimal window of 18–24 months provides the best balance in minimizing competing neonatal risks. Full article

Background: Accurate evaluation of the Near Point of Convergence (NPC) is essential for diagnosing and managing convergence insufficiency (CI). Conventional assessment relies on the patient’s verbal feedback and the examiner’s visual observation, making it subjective and examiner-dependent. The AI-based MobileS platform, previously validated for both diagnosis and home-based therapy of CI, enables smartphone-based measurement and visualisation of NPC through eye tracking, without the need for verbal responses or additional equipment. This study, the third stage of our research programme, examined how ophthalmologists interpret NPC data when presented as videos versus AI-derived graphs. Methods: Twenty-two ophthalmologists completed an online questionnaire with 20 NPC test cases from the validated MobileS database, presented as both silent videos and AI-derived graphs. Accuracy was analysed using mixed-effects logistic regression, and continuous error was assessed using clustered bootstrap. Results: Graph-based interpretation showed higher odds of accurate NPC identification than video-based interpretation at the primary ±5 mm threshold (OR = 19.7, 95% CI: 13.50–28.74; p < 0.0001). Absolute error was lower for graphs than videos (Graphs − Videos: −22.73 mm; 95% CI: −26.88 to −18.59; p < 0.0001). “Uncertain” responses occurred in 28.2% of video-based assessments and 0% of graph-based assessments. Off-target errors decreased from 50.2% (videos) to 3.6% (graphs). Conclusions: AI-derived graphs of eye-movement data were associated with improved NPC estimation, suggesting a potential role in supporting clinical and tele-ophthalmology workflows. Full article

Background/Objectives: Histologic remission has emerged as a key treatment target in inflammatory bowel disease (IBD), but routine assessment requires repeated endoscopy and biopsies. Blood-based indices reflecting inflammation, nutritional status and atherogenic risk are inexpensive and widely available, yet their integrated contribution to histologic activity remains unclear. This study addresses this gap by simultaneously analyzing a broad panel of 44 variables—including nutritional status indicators, CBC-derived inflammation indices, and atherogenic lipid indices—in IBD patients. Methods: In this retrospective study, 100 patients with IBD (50 Crohn’s disease [CD], 50 ulcerative colitis [UC]) without additional comorbidities and with concomitant histologic assessment were analyzed. Histologic activity was coded as active vs. remission. At the time of biopsy, the complete blood count, biochemistry and lipid profile were used to calculate immuno-nutritional indices (CONUT score, prognostic nutritional index), inflammatory indices (neutrophil-to-platelet ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio [LMR], systemic immune-inflammation index, systemic immune-inflammation index, systemic inflammation response index [SIRI], aggregate index of systemic inflammation, C-reactive protein to albumin ratio) and atherogenic indices (atherogenic index of plasma [AIP], triglyceride-to-HDL cholesterol ratio). Variable selection was performed separately for CD and UC using least absolute shrinkage and selection operator (LASSO) regression and sparse partial least squares discriminant analysis (sPLS-DA). Independently associated predictors were then entered into multivariable logistic regression models, and their discriminative performance was evaluated using ROC analysis with bootstrap-derived 95% confidence intervals. Results: LASSO analysis identified a broadly similar systemic profile associated with histologic activity in CD and UC, dominated by the CONUT score, SIRI, AIP, LMR and red blood cell parameters, whereas demographic features and most routine biochemical markers were shrunk towards zero. Cross-validated AUCs for the LASSO models were 0.93 in CD and 0.87 in UC. sPLS-DA confirmed this pattern: CONUT, SIRI and AIP consistently showed the highest variable importance in projection scores and loadings on the first latent component. In multivariable regression, the CONUT score, SIRI and AIP remained independent predictors of histologic activity in CD, while hematocrit, CONUT score, SIRI and AIP were independently associated with histologic activity in UC. In ROC analysis, AUCs for CONUT, SIRI and AIP were 0.81, 0.89 and 0.87 in UC, and 0.72, 0.82 and 0.83 in CD, respectively. Conclusions: Histologic activity in IBD is characterized by a coupled systemic profile in which immuno-nutritional compromise (captured by CONUT) forms the core signal, supplemented by systemic inflammation (SIRI) and atherogenic dyslipidemia (AIP). These readily available blood-based indices may help to approximate histologic disease activity in clinical practice. However, considering that comorbid diseases may affect these indices, the strict exclusion criteria applied in this study may limit the generalizability of the findings among patients with IBD. Consequently, further validation in larger prospective cohorts is warranted. Full article

Prediabetes is a critical precursor to type 2 diabetes (T2DM) and cardiometabolic diseases, yet its burden in Oman remains understudied. Leveraging data from Oman’s 2023 National Screening Program, this study quantifies the prevalence of prediabetes and its risk profiles among adults in Muscat Governorate—providing urgent evidence to guide diabetes prevention strategies in the Gulf region. Objectives: To estimate the prevalence of prediabetes and identify associated risk factors among Omani adults screened at primary health centers in Muscat Governorate (2023), given its critical role in preventing type 2 diabetes mellitus (T2DM) progression. Methods: This cross-sectional study analyzed data from Oman’s national screening program. Socio-demographics, clinical parameters (blood pressure, body mass index [BMI]), and laboratory results (fasting glucose, lipids, renal function) were extracted from the Al-Shifa electronic health system and National Screening Register. Multivariable logistic regression was performed using SPSS 30.0 (IBM Corp., Armonk, NY, USA). Results: Among 4862 participants (mean age 43.2 ± 6.3 years; 61.7% female), prevalences were: prediabetes 29.0%, T2DM 5.5%, obesity (BMI 30–40 kg/m²) 35.7%, hypertension 42.0%, hypercholesterolemia 48.8%, and renal involvement 51.8%. Males had significantly higher prediabetes prevalence than females (35.4% vs. 24.7%; adjusted odds ratio [aOR] = 1.43; 95% confidence interval [CI]: 1.21–1.70). Independent risk factors included each 1-year age increase (aOR = 1.05; 95% CI: 1.03–1.08), each 1-unit BMI increase (aOR = 1.03; 95% CI: 1.01–1.05), and family history of diabetes (aOR = 1.28; 95% CI: 1.09–1.50). Conclusions: The high burden of prediabetes and comorbid non-communicable diseases in Oman necessitates urgent public health strategies, including enhanced screening, lifestyle interventions, and gender-specific approaches to curb the T2DM epidemic. Full article

Background/Objectives: We assessed the prevalence of impaired coronary flow velocity reserve (CFVR) and aimed to identify echocardiographic and clinical predictors of coronary microvascular dysfunction in adolescents after neonatal arterial switch operation (ASO). Methods: This single-center, cross-sectional study included patients that underwent neonatal ASO for simple D-transposition of the great arteries (D-TGA) during 1998–2013. All patients were evaluated by echocardiography with global left ventricular strain measurement (GLS) and cardiac catheterization, including coronary angiography. Coronary flow velocity reserve was assessed by transthoracic Doppler echocardiography in the left anterior descending artery (LAD) using adenosine induced hyperemia. Patients were stratified into two groups according to CFVR: group with impaired CFVR (<2.5) and group with normal CFVR (≥2.5). Spearman correlation was used to assess the relationship between CFVR and echocardiographic variables. Binary logistic regression was used to determine independent predictors of impaired CFVR. Results: Out of 48 patients included (median age 16 years, age range 13 to 23 years, 71% male), impaired CFVR was found in 21 patients (44%). These patients had decreased longitudinal tricuspid annular plane systolic excursion (TAPSE), greater Z scores for left ventricular end-systolic dimensions and higher mean pulmonary artery pressures (mPAP). CFVR showed modest but significant positive correlations with tricuspid annular plane systolic excursion (TAPSE). Left pulmonary artery branch stenosis, reduced TAPSE and mPAP ≥ 20 mmHg, were significantly associated with impaired CFVR, while decreased TAPSE remained independent predictor in multivariable analysis (odds ratio 5.6, 95% confidence interval 1.24–25.26, p = 0.025). Conclusions: Impaired CFVR appears to be frequently observed in adolescents after uncomplicated neonatal ASO for simple D-TGA. Importantly, impaired CFVR is associated with right ventricular dysfunction. Full article