Educational Attainment and Diabetic Foot Ulceration: Outcomes From the Barbados Diabetic Foot Study

ABSTRACT

Diabetic foot ulceration (DFU) contributes significantly to diabetes-related morbidity and amputation. In Barbados, where amputation rates are among the highest globally, the influence of socioeconomic factors on ulceration outcomes remains underexplored. Educational attainment, a social determinant of health, may influence health behaviours, engagement with healthcare services, and ultimately clinical outcomes. This study examines whether educational attainment is associated with diabetic foot ulcer severity, as measured by the SINBAD scoring system, and six-week healing outcomes among inpatients with DFU. A prospective observational study was conducted over 6 months at Barbados' sole public hospital. A total of 176 participants admitted with a diagnosis of DFU were recruited. Baseline demographics, comorbidities, and ulcer characteristics were collected, and SINBAD scores were determined. Random forest modelling was employed to evaluate predictors of complete healing at 6 weeks and to assess ulcer severity stratified by educational attainment. Of the cohort, 17.5% reported primary education as their highest attainment level, compared with 2.9% of the general adult population. The mean SINBAD score was 2.45 among those with primary education and 2.51 among those with secondary education (p > 0.05). No statistically significant association was found between educational attainment and healing outcomes at 6 weeks. Educational attainment in this inpatient DFU cohort was lower than that of the general Barbadian population; however, it was not significantly associated with ulcer severity or six-week healing outcomes. In a universal healthcare setting, equitable access to care may attenuate the effect of educational attainment on clinical outcomes. These null findings highlight the need for future adequately powered studies incorporating health literacy assessment and key clinical confounders. Nonetheless, the observed disparity in educational attainment among DFU inpatients suggests that foot health education initiatives should be designed to be accessible to individuals across all educational levels.

Identification of non-cardiomyocytes marker genes in patients with diabetes and cardiomyopathy through single-cell analysis

by Wenze Yu, Hanglie Chen, Lihua Shi, Guofang Gao, Haihua Wang

Background

Diabetic cardiomyopathy (DCM) is a diabetes-related myocardial disorder causing fibrosis, hypertrophy, and progressive diastolic and systolic dysfunction. This study aims to explore how metabolic, inflammatory, and fibrotic mechanisms in non-cardiomyocytes drive DCM to reveal new therapeutic targets.

Methods

Single-cell RNA sequencing (scRNA-seq) was performed to investigate the role of non-cardiomyocytes in DCM, enabling the identification of cell types, gene expression dynamics, and intercellular communication networks in patients with type 2 diabetes. The scRNA-seq data were obtained from the GEO to investigate cell-type-specific contributions and heterogeneity across tissues. Metabolic pathway scores were calculated using scMetabolism. Moreover, cell trajectory analysis and cellular communication studies were performed to examine shared and disease-specific cell populations in diabetes and cardiomyopathy. CCK-8, colony formation, Transwell migration and invasion assays were preformed to explore the function of PTPRC in HUVECs.

Results

Using SingleR annotation, we identified eight distinct cell types, with NK cells and smooth muscle cells representing the shared cell populations across both diseases. Cell trajectory analysis revealed three distinct branches based on gene expression over pseudotime, and the top differentially expressed genes in each cell type clustering into six categories. Metabolic pathway analysis predicted that epithelial cells, macrophages, and neurons as the most metabolically active across multiple pathways, highlighting metabolic heterogeneity among patient samples. Additionally, four key signaling pathways associated with NK cells and smooth muscle cells were predicted to emphasize the divergence in gene expression across cell types. PTPRC is implicated in diabetes and cardiomyopathy and functions as a positive regulator of HUVEC viability, clonogenic growth, migration, and invasion.

Conclusion

This study demonstrates significant heterogeneity among non-cardiomyocytes in patients with diabetes and cardiomyopathy, highlighting the need for targeted therapeutic interventions to address these differences.

Mapping the landscape of psychological literature on threat from 1961 to 2023 through structural topic modeling

by Huixiang Ouyang, Ching Wan, Ronald Fischer

The past decades have generated a substantial volume of psychological literature on threat. However, the absence of systematic cross-field synthesis has resulted in limited understanding of major research domains and relationships between different lines of threat research. We analyzed 51,903 psychological publications on threat retrieved from APA PsycInfo, Scopus, and Web of Science Core Collection that were published between 1961 and 2023. We conducted structural topic modeling on publication titles and abstracts to identify key research topics, and network analysis on the resulting topics to map the thematic structure of the literature. 25 topics emerged, organized into four thematic areas through exploratory graph analysis: 1) threat processing mechanisms, 2) health and clinical threats, 3) social psychological threats, and 4) collective threats. Network analysis revealed differential connectivity patterns within and between thematic areas. Areas showed limited connectivity with each other and no area emerged as a central hub, suggesting gaps in cross-domain integration. Topic prevalence trends revealed diversification in research interest over time, together with responsiveness to broader developments within psychology and evolving societal concerns. Notably, mechanism-focused research declined over the past decade while event-driven research on specific threats increased, indicating reactive rather than theory-driven investigation. These findings provide insights into the landscape of psychological literature on threat and reveal critical gaps in current examinations alongside strategic opportunities to advance cross-field integration.

Changes in tobacco sales before, during, and after the COVID-19 pandemic in Japan: An interrupted time series analysis

by Kanae Kondo, Ichizo Morita, Shigemitsu Sakuma, Isao Ohsawa

Objectives

This study aimed to longitudinally examine nationwide changes in smoking behavior among the Japanese population in response to the COVID-19 pandemic.

Design and setting

A secondary analysis was conducted using cigarette sales data from the Tobacco Institute of Japan, monthly tobacco expenditures from the Family Income and Expenditure Survey conducted by the Ministry of Internal Affairs and Communications, and smoking prevalences from the National Database of Open Data Japan. An interrupted time-series segmented regression model adjusted for seasonality and autocorrelation was used to examine changes in cigarette sales and monthly tobacco expenditures before and after the first declaration of a state of emergency.

Participants

Depending on the data source, data from 2014 to 2022, from 2015 to 2025, or from 2015 to February 2026 were used.

Primary and secondary outcome measures

Changes in level and slope were evaluated before and after the first state of emergency and after COVID-19 was downgraded to a common infectious disease.

Results

Cigarette sales declined at a significantly slower rate after the first state of emergency than before. Price-adjusted monthly tobacco expenditures increased significantly by 132 JPY compared with the previous month, although the expenditure findings were less robust in the quadratic sensitivity analysis. The smoking prevalence among men declined slightly each year, from 34.2% in 2014 to 31.9% in 2022. In contrast, the smoking prevalence among women remained relatively stable, ranging between 9.4% and 9.9%.

Conclusions

Although cigarette sales declined more slowly and household tobacco expenditures increased during the first state of emergency in Japan, smoking prevalences did not change substantially. These findings suggest changes in tobacco purchasing patterns, including stockpiling, and possible changes in smoking intensity among continuing smokers, rather than a meaningful population-level decline in smoking behavior. There was no robust evidence of a clear reversal after May 2023.

Targeted Muscle Reinnervation (TMR) or Regenerative Peripheral Nerve Interface (RPNI) for pain prevention in patients with limb amputation: A protocol for a systematic review and meta-analysis

by Jesús del Moral Preciado, David Gurpegui, Montserrat Royo, Bernardo Hontanilla

Introduction

Regenerative Peripheral Nerve Interface (RPNI) and Targeted Muscle Reinnervation (TMR) have demonstrated superior outcomes compared to classical amputation in prophylactic prevention of pain, primarily by reducing the incidence of symptomatic neuromas, residual limb pain, and phantom limb pain. However, direct comparisons between these two techniques remain limited. Furthermore, their comparative effectiveness across diverse patient demographics (including age, sex, and comorbidities) and surgical variables (amputation level, etiology, and nerve handling) has not been systematically evaluated. Therefore, the objective of this systematic review and meta-analysis is to synthesize the available evidence to determine the comparative safety and efficacy of primary TMR or RPNI.

Methods and design

This review will be conducted following the methodological guidance of the Cochrane Handbook for Systematic Reviews of Interventions. A comprehensive electronic search will be performed in the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, PubMed, and MedRxiv, without language restrictions. We will include randomized controlled trials, quasi-randomized trials, and observational studies. Study selection and data extraction will be managed using Covidence. Two reviewers will independently screen titles and abstracts, assess full-text eligibility, evaluate risk of bias, and extract data.

Ethics and dissemination

As this systematic review relies on the analysis of secondary data from published studies, ethical approval is not required. Findings will be disseminated through publication in a peer-reviewed journal and presented at relevant conferences.

PROSPERO registration number

CRD42024617299

The application of large language models in bariatric surgery: A scoping review

by Ningjing Guo, Xuyan Li, Xiaoxue Li, Congmin Kang, Xiaoyan Gong, Xinyu Ji, Jie Zheng

Background

Exploratory applications of large language models within the specialized field of metabolic and bariatric surgery have begun to emerge. Nevertheless, existing research remains fragmented, lacking comprehensive integration.

Objective

To conduct a scoping review of studies on the application of large language models in the field of metabolic and bariatric surgery, aiming to provide a reference for clinical practice and future research.

Methods

This scoping review adhered to the Joanna Briggs Institute methodological framework and followed the preferred reporting items for systematic reviews and meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines.PubMed, Web of Science, The Cochrane Library, Embase, CINAHL, CNKI, Wanfang, and VIP databases were searched for relevant studies, with the search timeframe from database inception to November 2025. The included literature was summarized and analyzed.

Results

A total of 21 English-language studies were included. LLMs were primarily applied in scenarios such as patient education and information consultation, clinical decision support, and professional knowledge assessment. While LLMs performed well in information-provision tasks, they showed low consistency with expert opinions in complex clinical tasks such as individualized surgical recommendations. Performance varied across different models, with GPT-4 generally demonstrating superior performance, and domain-specific models showing professional potential. Current research still faces challenges regarding information accuracy, readability, and clinical applicability.

Conclusion

Large language models hold auxiliary potential in the field of metabolic and bariatric surgery, particularly for knowledge dissemination and patient education. However, their reliability in complex clinical decision-making remains limited. Future efforts should focus on conducting high-quality studies, advancing model specialization and standardized evaluation, and exploring safe and effective human-AI collaboration models.

Perspectives on preconception care in Ethiopia: Social, cultural, and structural determinants

by Yared Asmare Aynalem, Pauline Paul, Zohra S. Lassi, Salima Meherali

Background

Although Ethiopia introduced its first national preconception care (PCC) guideline in 2024, PCC remains rarely integrated into routine practice, and existing studies have largely focused on women’s knowledge and behaviors. Little is known about how adults navigate PCC within broader social, cultural, and structural contexts. This study provides an in-depth urban Ethiopian analysis of how adults experience and negotiate PCC within intersecting gender, moral, and institutional systems, offering insights beyond individual-level understanding.

Methods

An interpretive description design guided semi-structured interviews with 18 adults (10 women, 8 men; 19–45 years) recruited through maximum-variation sampling from two public hospitals in Addis Ababa. Interviews were conducted in Amharic, transcribed, translated, and analyzed inductively. Data analysis was guided by ID principles, complemented by thematic analysis techniques informed by grounded theory, including line-by-line coding, constant comparison, and analytic memoing. Field notes captured contextual and relational dynamics.

Results

Seven interrelated themes highlighted complex dynamics in PCC. Knowledge was fragmented and often recognized only after complications, shaped by marital gatekeeping, faith-based beliefs, and exclusion of unmarried women. PCC was valued as protective and morally significant, but stigma, poverty, staff shortages, and inconsistent services constrained practice. Men were largely financial supporters, though many expressed a desire to participate, limited by gender norms and women-centered services. Pharmacies and digital media provide informal but sometimes unsafe guidance. Emotional experiences, fear, guilt, secrecy, and hope were central to PCC engagement. Education, peer influence, schools, and community leaders emerged as catalysts for uptake, yet participants emphasized that sustainable PCC required visible institutional support, reliable services, and government recognition. Strategies to enhance practice included simplifying communication, creating accessible clinic entry points, and mobilizing community networks to normalize pre-pregnancy preparation.

Conclusions

This study reveals PCC in urban Ethiopia as a socially negotiated, morally contested, and structurally uneven practice, far more complex than knowledge deficits imply. These findings offer novel, actionable direction for implementing Ethiopia’s PCC guideline through visible, inclusive, relational, and community-anchored approaches that address the social conditions shaping PCC access.

Longitudinal employment patterns and parental health: A cross-country look

by Wen-Jui Han, Johanna Carrasco Saravia, Matthias Pollmann-Schult, Tinh Doan, Jianghong Li

Study aims

Using a cross-country lens, we investigate the links between longitudinal work trajectories and health among parents with children under age 18.

Background

Employment serves as a valuable resource, affording us a decent standard of living. The rising dominance of digital and technology, together with the service economy since the 1980s, has transformed the utility of employment from a resource to a vulnerability, subjecting more families to uncertain, unstable, and insecure work. Nonstandard work schedules or shiftwork, which often fall outside regular 9-to-5 daytime hours and can be unpredictable, carry potential health consequences.

Methods

Using the longitudinal data from Australia (HILDA), Germany (SOEP), the UK (UKHLS), and the US (NLSY79), we used sequence analysis to first chart parental work schedule patterns between three stages of the life course, 25–34, 35–44, and 45–54, to show the changes and transitions in work patterns. We then conducted multivariate regression analysis to examine how variations in parental work patterns may shape individual health (i.e., physical and mental health) at ages 35/40, 45/50, and 55/60 while controlling for a rich set of sociodemographic characteristics.

Results

Our sequence analyses uncovered roughly 4–6 work patterns during those three periods, revealing the heterogeneities of parental work trajectories that might correspond to childrearing demands and their sociodemographic backgrounds. We also found that mainly not-working pattern or volatile work arrangements (e.g., switching between daytime and non-daytime hours) were associated with significantly poorer physical and mental health; however, the persistence and magnitude of these associations varied by country.

Conclusions

This study advances our understanding of the critical role of employment in our health from a cross-country perspective and bears important implications for the intergenerational transmission of employment and health vulnerabilities.

Construction of a public health emergency information system framework: A case study of Zhuhai city, China

by Sicheng Huang, Xuebao Zhang, Long Chen, Xihe Ni, Ying Fan, Chaomin Zhao, Junfeng Xiao, Feng Ruan

Background

A public health emergency information system serves as a critical tool for collecting and analyzing data from sudden public health events, thereby providing a scientific basis for governmental decision-making. However, research on the systematic construction of such information system frameworks within China’s public health infrastructure is lacking.

Objective

Taking Zhuhai city as a case study, this study aims to construct a comprehensive public health emergency information system framework applicable to public health departments at the municipal, county, and street/township levels.

Methods

First, through a literature review and expert group discussion, the preliminary framework of system indicators is determined. Second, through two rounds of the Delphi method, 41 experts are invited to qualitatively select the system framework indicators, with the aim of obtaining consensus among experts. Finally, the system is improved through application, feedback, and redesign.

Results

After two rounds of consultation, the final system at the city and county levels consists of 5 first-level indicator modules and 21 second-level indicator modules, whereas the system at the city, county, and street/township levels consists of 4 first-level indicator modules and 17 second-level indicator modules. Most of the indicators in the “emergency preparedness” and “emergency response” modules are considered important and should be retained as they can play a role in collecting and analysing information on infectious disease outbreaks through practical applications.

Conclusion

The public health emergency information system constructed in this study can be applied to public health departments such as disease prevention and control centres. Promotion can improve the efficiency of handling infectious disease outbreaks and provide a scientific basis for decision-making analysis.

Why are some children under 24 months still undernourished in urban and peri-urban Vientiane? A mixed-methods study

by Kethmany Ratsavong, Dirk Essink, E. Pamela Wright, Somphou Sayasone, Sengchanh Kounnavong, Jacqueline E. W. Broerse

Child undernutrition remains a significant public health challenge in many low and middle-income countries (LMICs), including Lao PDR, where high levels persist even in urban areas with generally available and accessible food. This study aimed to explore factors underlying the persistently high rates of undernutrition among young children in urban (Saysetha) and peri-urban (Pakgneum) districts of the Vientiane Capital in Lao PDR. A cross-sectional survey employed a sequential explanatory mixed-methods approach, combining a structured questionnaire of 333 mother–child pairs for quantitative analysis with semi-structured interviews of 47 caregivers for qualitative insights. The prevalence of malnutrition among children under 24 months in Vientiane Capital was 27.3% for stunting, 4.2% for wasting, 14.4% for underweight, and 5.11% for overweight. Multiple logistic regression was applied to identify factors associated with malnutrition, while qualitative data were thematically analyzed. The principal findings revealed that, beyond food access, the quality of caregiving and, critically, caregivers’ capacity to translate nutrition knowledge into effective practices distinguished well-nourished from undernourished children. Caregivers of better-nourished children obtained health and nutrition information from diverse sources, whereas those of undernourished children relied mainly on health services. In conclusion, strengthening practical nutrition communication in various methods and channels, such as through videos and demonstrations, and enhancing caregivers’ ability to apply nutritional knowledge, are central to improving child nutritional outcomes in urban and peri-urban settings in Lao PDR.

Clinical characteristics and management strategies in adult foreign-body airway obstruction: A retrospective cohort study

by Hongzhen Yin, Tong Wang, Changshun Zhong, Yingya Cao, Xiaogan Jiang, Qiancheng Xu, Weihua Lu

Airway foreign-body aspiration in adults is uncommon but can be life-threatening.Flexible bronchoscopy is the standard first-line therapy,but critically ill patients may need extracorporeal life support.This study aims to characterize the diagnosis,management,and outcomes of adult airway foreign-body cases treated at a single center over nearly 12 years to inform a standardized clinical pathway.A single-center retrospective observational study of consecutive patients aged ≥14 years with confirmed airway foreign body who were treated at a tertiary hospital in China were conducted.Medical records of consecutive adolescent and adult patients diagnosed with airway foreign-body aspiration and admitted to the hospital from 01/01/ 2014–30/11/2025 were reviewed.Data included demographics,imaging,extraction method, respiratory support and so on.Descriptive statistics were reported as medians with interquartile ranges or counts and percentages.A total of 41 patients were included,with a median age of 59.5 years(interquartile ranges 51–72) and 65.85% male.Flexible bronchoscopy was attempted as the primary intervention in 38 patients(92.68%) and succeeded in 81.58%(31/38) to remove airway foreign body.Most patients(78.05%) required only nasal cannula oxygen,while nine patients(21.95%) needed advanced support including mechanical ventilation (14.63%),high-flow oxygen(4.88%),and extracorporeal life support (2.44%).At discharge,most survivors had a good neurological outcome,with 36 patients(87.80%) having a Cerebral Performance Categories score of 1.The 28-day survival rate was 92.68%.These findings show that flexible bronchoscopy is an effective first-line therapy,and rigid bronchoscopy or surgery is useful when flexible bronchoscopy fails.In unstable cases,timely extracorporeal life support can bridge to definitive removal.These results support a tiered,multidisciplinary approach incorporating early chest computed tomography,flexible bronchoscopy,and escalation to advanced airway or extracorporeal support.

Cumulative metabolic stress (microfilarial infection + moult) constrains the expression of carotenoid-based honest signals in breeding male village weavers (<i>Ploceus cucullatus</i>) of Amurum Forest Reserve, Nigeria

by Felix A. Andong, Olufemi Olasoji, Abdifatah Ahmed A. Afyare, Ezekiel S. Mayowa, Praise O. Nwanozie, Emmanuel E. Osayi, Ruth A. Agyo, Vincent C. Ejere

In wild birds, the breeding season involves a convergence of metabolically demanding life-history stages, including reproduction, moult, and immune defense. We investigated the relationships between microfilarial infection, moult, redox homeostasis, and plumage quality in breeding male village weavers (Ploceus cucullatus) at the Amurum Forest Reserve, Nigeria. We compared four groups (n = 148 total) sampled within 3 mins post-capture: infected-moulting (IM), infected-non-moulting (IN), non-infected-moulting (NM), and non-infected-non-moulting (NN). Physiological condition was assessed using the erythrocyte glutathione ratio (GSH:GSSG) and circulating glucose, while plumage reflectance traits were integrated into a composite quality axis (PC1). Microfilarial infections were present in 52.0% (n = 77) of individuals; mean parasite intensities were 6.13 ± 0.35 mf/µL (IN) and 6.45 ± 0.41 mf/µL (IM). Physiological indices varied strongly across groups. The GSH:GSSG ratio was reduced in infected birds, indicating altered redox balance (rs = −0.65). Circulating glucose was highest in the infected non-moulting group (IN) but substantially reduced in the infected moulting group (IM). Across physiological and ornamental traits, individuals experiencing both infection and moult (IM group) exhibited the strongest reductions relative to all other groups. However, this pattern reflects a statistically supported Infection × Moult interaction, rather than an untested synergistic or non-linear effect, as evidenced by significant IN vs. IM contrasts in glucose (Table 3; z = 33.43, P 

Genetic association and computational analysis of <i>CYP2R1</i> gene polymorphisms rs2060793 and rs12794714 with vitamin D deficiency and acute myocardial infarction in the Bangladeshi population: A case control study

by Sadia Akter, Md. Nazid Bin Ibrahim, Zimam Mahmud, Sonia Tamanna, Md. Shakhawat Hossain Shawon, Farzana Ansari, Md. Zakir Hossain Howlader

Acute myocardial infarction (AMI) remains a leading cause of cardiovascular morbidity and mortality worldwide. Emerging evidence highlights vitamin D as a critical determinant of cardiovascular health. The CYP2R1 gene encodes the key 25-hydroxylase enzyme responsible for converting vitamin D to its principal circulating metabolite, 25-hydroxyvitamin D. However, the influence of CYP2R1 polymorphisms on AMI susceptibility, particularly within South Asian populations, has not been well characterized. This study investigates the association of two CYP2R1 variants, rs2060793 and rs12794714, with AMI risk and their relationship with serum vitamin D levels in a Bangladeshi cohort. A total of 502 participants comprising 251 AMI patients and 251 age- and sex-matched controls were analyzed. Genomic DNA was extracted and genotyped using PCR-RFLP, while serum 25-hydroxyvitamin D₃ levels were quantified by HPLC. AMI patients exhibited markedly lower vitamin D concentrations (23.92 ± 0.94 ng/mL) than controls (30.3 ± 0.86 ng/mL; p p = 0.0064). The dominant model (TC + CC vs. TT) further confirmed this relationship (OR = 2.53, 95% CI: 1.39–4.61, p = 0.0016). In contrast, rs12794714 showed no significant association with AMI in this population. Stratified analysis indicated that rs2060793 was significantly linked to AMI in males but not females, while both variants were associated with increased risk in individuals aged ≤60 years, but not in those >60 years. Bioinformatic and molecular docking analyses (RegulomeDB, JASPAR, HADDOCK 2.4, DNAproDB) further demonstrated potential regulatory effects of these variants on CYP2R1 function. Collectively, our findings reveal a novel association between CYP2R1 rs2060793 and vitamin D deficiency with AMI risk in the Bangladeshi population, underscoring the interplay of genetic and metabolic determinants in the molecular pathogenesis of AMI.

Seasonal variation in species composition, deltamethrin susceptibility, and <i>kdr</i> mutations in anopheles mosquitoes in Northwest Ethiopia

by Ligabaw Worku, Amha Kebede, Ayalew Jejaw Zeleke, Saron Fekadu, Melat Abdo, Tigist Atele, Netsanet Worku, Mulugeta Aemero

Background

Anopheles mosquitoes are the main vectors of malaria. Effective vector control depends on understanding their species composition, behavior, distribution, and insecticide resistance. This study investigated Anopheles species composition, susceptibility to deltamethrin, and the frequency of knockdown resistance (kdr) mutations in Maksegnit and Gendawuha, Northwest Ethiopia.

Methods

Anopheles larvae and pupae were collected from breeding sites during the rainy and post-rainy seasons and reared to adults under field insectary conditions following WHO guidelines. In addition, adult mosquitoes were collected from houses near larval habitats. Only field-derived mosquito populations were used in this study. Adult females (3–5 days old) reared from field-collected larvae were tested for susceptibility to 0.05% deltamethrin using WHO bioassays. Based on bioassay outcomes, mosquitoes were classified as phenotypically susceptible (died after exposure) or resistant (survived exposure), while field-collected adults represented an unexposed group. A total of 480 mosquitoes (160 resistant, 160 susceptible, and 160 field-collected unexposed adults) were subjected to genomic DNA extraction. Species identification and detection of knockdown resistance (kdr) mutations (L1014F and L1014S) were performed using PCR.

Results

WHO bioassays conducted on 776 mosquitoes revealed confirmed resistance to deltamethrin, with mortality rates ranging from 48.5% to 72.5% (overall resistance: 37.5%). Resistance intensity exhibited significant variation, peaking after the rainy season and showing a higher prevalence in Maksegnit compared to Gendawuha (p Anopheles arabiensis was the predominant species (93%, 446/480), followed by An. pharoensis (6%, 29/480) and An. stephensi (1%, z/480), with the latter detected for the first time in Gendawuha. Regarding kdr mutation status, genotypic analysis showed that the L1014F mutation was the predominant allele, particularly among phenotypically resistant mosquitoes (67.8%), while lower frequencies were observed in susceptible (45.8%) and unexposed field-collected groups (61.4%). Conversely, the L1014S mutation was detected at low frequency (≤12.3%) and was restricted exclusively to the Maksegnit population.

Conclusion

Anopheles arabiensis predominated, with confirmed resistance to deltamethrin, particularly in the post-rainy season. The L1014F kdr mutation was prevalent, while L1014S kdr mutation was rare. Detection of Anopheles stephensi highlights emerging risks, underscoring the need for season-specific resistance monitoring and integrated control strategies.

Prevalence and determinants of metabolic syndrome among long-shift healthcare professionals in primary hospitals of Central Gondar Zone, Northwest Ethiopia

by Elias Chane, Yilkal Amlaku, Amare Mekuanint, Abebaw Worede, Habtamu Wondifraw Baynes, Getnet Fetene

Background

Metabolic syndrome (MetS) is a group of interrelated metabolic aberrations that significantly elevates the risk of poor cardiovascular outcomes and type 2 diabetes mellitus. Healthcare professionals, particularly those working long shifts, may have elevated risk due to the demanding nature of their work, irregular lifestyles, and associated stress. This study aimed to assess the prevalence and associated factors of MetS among healthcare professionals working long shifts in primary hospitals in the Central Gondar Zone, Northwest Ethiopia.

Methods

An institutional-based cross-sectional study was conducted among a total of 271 healthcare professionals working in three primary hospitals (from September to December 2023). Study data were collected using structured questionairs, anthropometric measurements, and biochemical assessments. Five mililiters of fasting blood sample was collected from each participant; and serum lipid profile and glucose analyzed on Beckman Coulter DXC 700 AU chemistry analyzer. MetS was defined using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Independent ttest and one-way ANOVA were used for intra and inter group comparison; and Logistic regression model was fitted to identify factors associated with MetS, and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported to determine the strength of associations.

Results

The prevalence of MetS among healthcare professionals was 11.44% (95% CI 8.14–15.83). Dyslipidemias were observed to be the most common forms of metabolic derangement with 145 (53.51%) of study subjects having at least one lipid profile abnormality; whereas, hyperglycemias was the least common 27 (9.96%) form of metabolic abnormalities. Age ≥ 35 years (AOR = 6.75; 95% CI: 2.34–19.46), a family history of diabetes among first-degree relatives (AOR = 7.78; 95% CI: 2.57–23.53), and short sleep duration ( Conclusion and recommondation

Metabolic syndrome is prevalent among healthcare professionals particularily those working long shifts; with age, family history of diabetes, and insufficient sleep identified as key risk factors. Hospital administrators and occupational health units should implement routine metabolic screening, optimized shift scheduling, and sleep hygiene support programs specifically for healthcare professionals working prolonged shifts, with particular attention to high-risk staff groups. Further workplace-based research is also needed to evaluate the effectiveness of these targeted interventions.

Clinical performance of the BioFire Blood Culture Identification 2 panel for microorganism species identification and resistance gene detection in blood culture-positive specimens

by Haruki Naruse, Noriyuki Watanabe, Sachie Koyama, Sachi Tanaka, Yoshitada Taji, Yasuhiro Ebihara

Introduction

Bloodstream infections are life-threatening, and the rapid identification of pathogens and resistance genes is essential for the administration of appropriate antimicrobial agents. The BioFire Blood Culture Identification 2 (BCID2) panel on the FilmArray multi-parameter genetic analyzer is a fully automated PCR test that rapidly identifies species and resistance genes. Here, we compared the performance of the Filmarray BCID2 panel (BCID2 method) with the conventional method.

Methods

Among the blood culture-positive specimens submitted between January 2023 and November 2024, this study analyzed 201 specimens that contained the target microorganisms of the BCID2 panel. In our laboratory, after subculturing the culture medium obtained from a positive blood-culture bottle, we perform species identification using mass spectrometry and drug susceptibility testing (the conventional method). We compared the results of the BCID2 method with those of the conventional method.

Results

Concordance between the BCID2 and conventional methods was found in 152 of the 161 monomicrobial specimens (94.4%) and in 31 of the 40 polymicrobial specimens (77.5%). The 18 specimens that were discordant were mostly matched at the genus level, but the BCID2 method also detected other microorganisms that were not identified by the conventional method. Resistance genes were identified in 57 of the 61 matched specimens (93.4%).

Conclusion

The BCID2 method exhibits excellent identification results and resistance gene detection rates, suggesting that it is a reliable and rapid diagnostic test system for bloodstream infections.

Long‐Term Clinical and Radiologic Evaluation of Micronized Acellular Dermal Matrix‐Assisted Reconstruction in Diabetes‐Related and Traumatic Foot Wounds With Bone Defects

ABSTRACT

To investigate whether micronized acellular dermal matrix (mADM) can be used to treat diabetes-related and traumatic foot wounds with bone defects after bone or joint resection. We retrospectively reviewed 52 patients who underwent bone or joint resection, followed by mADM-assisted reconstruction of diabetes-related or traumatic foot wounds between 2021 and 2024. mADM was applied using sheet-type, paste-type or combined formulations in one- or multi-stage procedures. Wound healing, contour preservation and radiological alignment were assessed. Among the 52 patients (43 with diabetes and 9 with trauma), complete epithelialization was achieved in 48 (mean follow-up: 14.8 months; mean time to wound closure: 5.6 weeks). Four cases showed recurrence or delayed healing and five developed mild early local infection; all were controlled with additional wound care or antibiotics, with no progressive osteomyelitis or graft loss. In 40 radiologically evaluable cases, the toe length and alignment were generally preserved (mean toe length ratio: 91.6% and no angular deformity > 10°). mADM-assisted reconstruction may be useful for treating diabetes-related and traumatic foot wounds with bone defects after bone or joint resection. Its role appears to lie in dead-space management, contour preservation and durable wound coverage, rather than bone replacement.

Haemodynamic‐Focused Bedside Ultrasound Enhances Early Detection of Sacral Pressure Injuries in Immobilised Polytrauma Patients

ABSTRACT

Early detection of sacral pressure injuries (PIs) in immobilised polytrauma patients remains challenging. This study evaluated ultrahigh-frequency (UHF) ultrasound combining structural and haemodynamic parameters for early PI diagnosis. In a prospective cohort of 73 polytrauma patients (Injury Severity Score 16–25), daily sacrococcygeal assessments were performed over 15 days using UHF ultrasound (Mindray Resona 11; L20-5 s probe). Parameters included 2D morphology, perfusion (colour power angiography [CPA]), flow metrics (peak systolic velocity [PSV]), Braden Scale and inflammatory markers. PI incidence was 27.4% (n = 20; all stage I/II). Haemodynamic markers outperformed 2D ultrasound: CPA grade ≥ 1 (AUC = 0.858, 80.0% sensitivity) and PSV > 5.55 cm/s (AUC = 0.841, 95.0% sensitivity). Combined CPA + PSV achieved superior accuracy (AUC = 0.922). Systemic inflammation showed no intergroup differences. UHF ultrasound detects early PIs by capturing ischaemia-reperfusion changes. The CPA + PSV protocol provides nurses with a rapid (< 5 min), sensitive bedside tool to guide proactive interventions.

Invisible Agency in the Search for Healing: Patient and Family Roles in the Care of Hard‐to‐Heal Wounds in Primary Healthcare

ABSTRACT

This study aimed to explore how persons living with a hard-to-heal wound and their family members experience care. The inclusion criteria for patients were wounds that had persisted for more than 6 weeks or hard-to-heal wounds that had recently healed. The study included 16 participants (13 patients and 3 family members) from primary healthcare services in Örebro County, Sweden. The interview data were transcribed and analysed using reflexive thematic analysis. One overarching theme was generated: Navigating an uncertain path towards healing, along with three subthemes: (1) Striving to be an active agent, (2) Being part of collaboration efforts and (3) Being a bystander in the search for the right treatment. Together, these themes illustrate how patients and family members engaged in an uncertain care process as they sought to understand the condition and manage care in everyday life. These everyday efforts reflected forms of invisible agency, as participants did not always recognise them as meaningful contributions to wound care. The findings highlight the importance of person-centred approaches that recognise and value patients' and family members' everyday contributions to wound care and support self-management through partnerships among patients, family members and HCPs.

Photobiomodulation and electro-stimulation for enhanced healing of hard-to-heal wounds: a literature review

Journal of Wound Care, Volume 35, Issue 6, Page 523-537, June 2026.