Medicine and Pharmacology

Abstract: Background: Sarcopenia is highly prevalent among older adults with chronic kidney disease (CKD) and is associated with adverse clinical outcomes. The finger-ring (Yubi-wakka) test is a simple anthropometric screening tool based on calf circumference; however, its performance in older adults with CKD remains unclear. This study aimed to investigate the association of the finger-ring test with low muscle mass, sarcopenia, and comprehensive geriatric assessment parameters and to evaluate its diagnostic performance for identifying low muscle mass in older adults with CKD. Methods: This cross-sectional study included 115 patients aged ≥65 years with CKD who were evaluated in geriatric and nephrology inpatient services. After excluding two participants with missing finger-ring measurements, 113 individuals were analyzed. Muscle mass was assessed using bioelectrical impedance analysis and low muscle mass was defined according to EWGSOP2-based Turkish cut-off values. Demographic characteristics, anthropometric measurements, laboratory findings, and comprehensive geriatric assessment parameters were recorded. Correlation analyses, logistic regression models, receiver operating characteristic (ROC) analyses, and likelihood-ratio tests were performed. Results: Among 113 participants, 62 were classified as finger-ring positive (FR=0) and 51 as finger-ring negative (FR=1). Low muscle mass was significantly more frequent in the FR=0 group than in the FR=1 group (51.6% vs. 24.0%, p=0.005). Finger-ring test results showed strong correlations with calf circumference (rho=0.689, p< 0.001) and body mass index (BMI) (rho=0.631, p< 0.001), whereas the correlation with muscle mass was modest (rho=0.250, p=0.008). For detecting low muscle mass, the finger-ring test demonstrated an area under the curve (AUC) of 0.643 (95% CI 0.554–0.732), sensitivity of 72.7%, specificity of 55.9%, positive predictive value of 51.6%, and negative predictive value of 76.0%. In multivariable analyses, BMI remained the strongest independent determinant of finger-ring test results, whereas the association with muscle mass lost statistical significance after BMI adjustment. Adding age and sex significantly improved discrimination, while the contribution of nutritional status was limited. Conclusions: The finger-ring test is associated with low muscle mass in older adults with CKD; however, its diagnostic performance is modest and appears to be substantially influenced by body size and calf circumference. Therefore, the finger-ring test should be considered a simple adjunctive screening tool rather than a stand-alone method for identifying low muscle mass in this population.

Abstract: Background: The widespread success of antiretroviral therapy (ART) has transformed HIV into a chronic condition, shifting clinical attention toward aging-associated comorbidities, including autoimmune and rheumatologic diseases. However, the epidemiology, clinical spectrum, and treatment outcomes of these conditions in older people living with HIV (PLH) remain incompletely characterized. Objective: This scoping review aimed to map contemporary evidence on autoimmune and rheumatologic diseases in aging PLH in the ART era, with emphasis on epidemiology, clinical phenotypes, diagnostic challenges, and therapeutic outcomes. Methods: A systematic search of PubMed, Embase, and Scopus was conducted for studies published from January 1, 2021, onward. Eligible studies included adult PLH with autoimmune or rheumatologic conditions and were screened according to PRISMA-ScR methodology. Case reports, non-human studies, and studies published before 2021 were excluded. Data were extracted narratively from included studies. Results: The search yielded 438 records, of which 134 duplicates were removed. After title, abstract, and full-text screening, 8 studies were included. The evidence identified a heterogeneous spectrum of autoimmune and rheumatologic manifestations in PLH, including systemic lupus erythematosus, reactive arthritis, psoriatic arthritis, rheumatic heart disease, immune thrombocytopenia, renal immune-mediated pathology, and myasthenia gravis. Contemporary data suggest that biologic and targeted small-molecule therapies are generally effective and well tolerated in selected PLH, although opportunistic infections and transient viral load increases have been reported with some agents. Conclusion: Autoimmune and rheumatologic diseases in aging PLH represent an emerging ART-era challenge. Prospective studies and multidisciplinary guidelines are needed to optimize diagnosis and treatment.

Abstract: Autoimmune rheumatic diseases are still treated predominantly through broad or targeted suppression of inflammatory pathways, yet durable restoration of self-tolerance remains a central unmet therapeutic goal. This narrative review examines restoration of immune tolerance as an emerging translational framework in rheumatology, integrating checkpoint agonism, antigen-specific immunotherapy, regulatory cell-based strategies, and immune-reset approaches within a unified therapeutic perspective. Rather than treating these strategies as isolated innovations, the review evaluates how each attempts to restore, reinforce, or reconfigure immune restraint at distinct biological levels, spanning inhibitory receptor signaling, antigen-selective non-responsiveness, dominant regulatory control, and deeper reconfiguration of pathogenic immune architecture. Their relevance is considered across rheumatoid arthritis, systemic lupus erythematosus, Sjögren’s disease, and systemic sclerosis, with emphasis on mechanistic rationale, translational maturity, disease-specific therapeutic fit, biomarkers, therapeutic timing, and major barriers to clinical implementation. Collectively, these approaches suggest a shift in rheumatology from repeated control of inflammatory consequences toward more selective and potentially durable recalibration of autoreactive immunity. Although the field remains biologically and clinically immature, restoration of immune tolerance is emerging as an important organizing principle for the development of more precise and potentially disease-modifying therapies in autoimmune rheumatic disease.

Abstract: Objectives: Streptococcus pneumoniae is a major respiratory pathogen. Reports during the COVID-19 era suggest decreased pneumococcal activity. This study aimed to assess the frequency of S. pneumoniae in adult sputum cultures and its antimicrobial susceptibility in a tertiary care hospital. Materials and Methods: This retrospective laboratory-based study was conducted in a tertiary care hospital in Turkey. Sputum cultures from adult patients between October 1, 2021, and October 1, 2023, were analyzed. Demographic, clinical, and antimicrobial susceptibility data of culture-confirmed cases were obtained from medical records. Results: Among 3,433 sputum cultures, only three (0.087%; 95% CI: 0.018%–0.255%) yielded S. pneumoniae. All patients were male with comorbidities such as cardiovascular disease, COPD, or diabetes. Pneumonia developed during hospitalization for non-infectious conditions. All isolates were susceptible to fluoroquinolones, rifampicin, tetracycline, and ceftriaxone; one showed resistance to macrolides and clindamycin. No multidrug resistance was detected. Conclusion: An extremely low pneumococcal isolation rate was observed during the COVID-19 and post-pandemic period. These findings align with global reports of reduced pneumococcal activity. Continued surveillance is essential to monitor epidemiological trends and resistance patterns.

Abstract: Background/Objectives: Acute pulmonary embolism (PE) is a major cause of cardio-vascular mortality, with prognosis influenced by hemodynamic status, comorbidities, and biomarker profiles. Although several laboratory markers have demonstrated prog-nostic relevance in PE, it remains unclear whether their predictive performance differs in patients with active malignancy. This study aimed to identify laboratory predictors of in-hospital mortality in acute PE and to evaluate the modifying effect of malignancy on biomarker-based prognostic stratification. Methods: This retrospective multicenter cohort study included 2803 consecutive patients with computed tomography-confirmed acute PE enrolled in the Regional Pulmonary Embolism Registry (REPER) between January 2015 and April 2026. Univariate and multivariable logistic regression analyses were performed to identify predictors of in-hospital mortality in the overall cohort and in subgroups stratified by malignancy status. Interaction analyses were used to assess effect modification by malignancy. Results: Active malignancy was present in 14.02% of patients, while overall in-hospital mortality was 14.93%. In the overall cohort, multivariable analysis identified malignancy (OR 1.698, 95% CI 1.128–2.555, p = 0.011), C-reactive protein (CRP), glucose, creatinine clearance (CrCl), platelet count, and white blood cell count as independent predictors of in-hospital mortality (BNP was excluded from multivariable models due to missing data). Mortality was significantly higher in patients with ma-lignancy compared with those without (20.9% vs. 13.2%, p < 0.001). In patients with malignancy, CRP and glucose remained independent predictors, whereas in non-malignant patients, CRP, glucose, and CrCl were independently associated with mortality. Significant interaction effects were observed for CrCl, age, glucose, and white blood cell count. Conclusions: Malignancy is an important predictor of in-hospital mortality in acute PE and may partially influence the prognostic performance of certain conventional biomarkers. These findings suggest that while standard risk markers remain broadly reliable, specific parameters might benefit from a cautious, malignancy-aware interpretation.

Abstract: Aim: Severe aortic stenosis (AS) with cardiogenic shock (CS) presents a complex clinical challenge. For these patients, the optimal management strategy- either direct transcatheter aortic valve replacement (TAVR) or a staged approach with balloon aortic valvuloplasty (BAV) as a bridge to TAVR (BAV-TAVR) is uncertain. We aimed to compare the outcomes of these two strategies. Methods: We conducted a retrospective cohort study using TriNetX database. In this study, we identified patients with CS undergoing TAVR or BAV-TAVR. After matching propensity scores, 198 patients were analyzed in each group (total 396). The primary outcome was major adverse cardiovascular events (MACE) at 30 days, 1 year, and 3 years. Results: The analysis included 396 matched patients (198 in each cohort). There was no significant difference in the primary endpoint of MACE at 30 days between the staged BAV and direct TAVR groups (HR 1.14; 95% CI 0.79–1.64; p=0.91), and this finding was consistent at 1 and 3 years with HR 1.20 and 1.17 respectively. Similarly, no differences were observed in secondary outcomes including all-cause mortality, stroke, and new permanent pacemaker implantation, at 30 days, 1, and 3 years. Conclusion: For patients with severe AS complicated by CS, a staged strategy of using BAV-TAVR resulted in comparable short and long-term outcomes to direct TAVR. These findings suggest that BAV is a viable and safe bridging option in high-risk patients whose immediate candidacy for definitive therapy is uncertain.

Abstract: The rapid expansion of biologic therapies for immune-mediated inflammatory diseases has raised significant clinical concerns regarding malignancy risk, particularly for patients with a history of cancer. This narrative review explores the safety of targeted therapies across dermatology, rheumatology, respiratory medicine, and gastroenterology to guide clinicians in these therapeutic dilemmas. We conducted a non-systematic review of the literature, prioritizing longitudinal registry and real-world cohort data over clinical trials to better capture malignancy outcomes with long latency periods. Results indicate that tumor necrosis factor (TNF) inhibitors, which have the most extensive evidence base, do not consistently demonstrate an increased risk of overall malignancy or recurrence across specialties. Newer agents, including interleukin (IL)-17 and IL-23 inhibitors, show particularly reassuring safety profiles in both trial and registry data, with some evidence suggesting a potential reduction in certain cancer incidences. While dupilumab is associated with the potential unmasking of cutaneous T-cell lymphoma, overall cancer rates remain stable among users. Most clinical guidelines support an individualized, multidisciplinary approach involving oncology consultation. We conclude that current biologic therapies generally pose a lower malignancy risk compared to older systemic treatments. Future management requires validated decision frameworks and mandatory participation in real-world registries to refine long-term safety assessments.

Abstract: Background: Peripheral intravenous catheters (PIVCs) are the most frequently inserted intravascular devices globally (~2 billion per year), yet their infectious complications—and particularly hematogenous distant infections—remain systematically underestimated and excluded from mainstream catheter-associated bloodstream infection (CABSI) surveillance. We present the first systematic review and meta-analysis specifically focused on hematogenous distant complications as the primary outcome. Methods: A systematic search of PubMed, EMBASE, CINAHL, and the Cochrane Library (no date restriction through April 2025) was conducted following PRISMA 2020 guidelines. Random-effects meta-analysis with Freeman–Tukey double-arcsine transformation was used for proportion outcomes; pooled incidence rates per catheter and per 1000 catheter-days were computed. Primary outcomes were infective endocarditis (IE), osteomyelitis, septic arthritis, epidural abscess, and septic emboli attributable to PIVC-related bacteremia. Results: Sixty-seven studies (n = 1,247,430 PIVCs; 2,547,841 catheter-days) met inclusion criteria. Pooled PIVC-BSI incidence was 0.028% per catheter (95% CI 0.009–0.081; I² = 96.8%) in high-income settings and 2.41/1000 catheter-days (95% CI 1.97–2.89) in low-/middle-income country ICUs. Among PIVC-related Staphylococcus aureus bacteremia (PIVC-SAB) episodes, the pooled metastatic complication rate was 37.2% (95% CI 24.1–51.6%; I² = 71.4%). IE developed in 6–23% of PIVC-SAB cases. Thirty-day all-cause mortality ranged from 12.9% to 25.0% overall; for S. aureus-specific cohorts it reached 18.3–26.5%. Dwell time &gt; 96 h (OR 3.16, 95% CI 1.73–5.77), antecubital fossa insertion (OR 8.20, 95% CI 3.10–21.70), and large-bore gauge ≤16G (HR 4.65, 95% CI 1.19–18.20) were independently associated with PIVC-BSI in PIVC-specific multivariate analyses. Conclusions: PIVCs cause clinically severe hematogenous distant infections in approximately one-third of bacteremia episodes, with 30-day mortality equivalent to central venous catheter bloodstream infections. Current national surveillance systems that exclude PIVCs produce a critical undercount of catheter-attributable infections and deaths. Mandatory bundle-based PIVC care, inclusion of PIVCs in national BSI surveillance, and dedicated prospective studies quantifying the burden of hematogenous complications are urgently warranted.

Abstract: Background/Objectives: Coexistence of systemic sclerosis and sarcoidosis is very ra-re. Both are systemic autoimmune diseases with lung involvement but with different pathogenesis. In contrast to findings of mid- to upper-lobe interstitial lung disease (ILD) or/with hilar lymphadenopathy in sarcoidosis, the most common lung manifes-tation of systemic sclerosis is lower-lobe ILD, which is typically characterized by a nonspecific interstitial pneumonia pattern. Distinction between lung involvement re-lated to each disease is crucial due to different therapeutic approach Methods We present herein a serie of three overlap cases: two with sarcoidosis onset before the diagnosis of systemic sclerosis and the other with systemic sclerosis onset before sarcoidos. Results: A review of cases of concomitant sarcoidosis and systemic sclerosis is dis-cussed, including the pathophysiology of each disease with shared pathways leading to the development of both conditions in one patient Conclusions: The systemic sclerosis-sarcoidosis overlap is a high-risk phenotype. Early recognition and a personalized, aggressive therapeutic approach are essential to alter the natural history of these two converging fibrotic and granulomatous processes.

Abstract: Background: Cardiovascular (CV) risk is increased in psoriatic arthritis (PsA), yet vascular assessment has largely focused on carotid arteries, potentially underestimat-ing systemic atherosclerosis. Objective: To characterize the distribution and concord-ance of atherosclerotic plaques across carotid, femoral, and aortic territories in PsA and evaluate their incremental value over SCORE2. Methods: In this cross-sectional study, 250 unselected patients with PsA underwent carotid and femoral ultrasound and ab-dominal X-ray. Plaque prevalence and multiterritorial involvement (≥2 vascular beds) were assessed. Agreement between territories was evaluated using Cohen’s κ. In pa-tients aged 50–69 years, the incremental value of vascular territories over SCORE2 was evaluated using ROC curves, bootstrap-corrected decision curve analysis (DCA), and reclassification metrics (IDI and continuous NRI). Results: Plaques were detected in carotid (36.0%), femoral (62.8%), and aortic (31.6%) territories, with multiterritorial involvement in 43.2%. Agreement between vascular beds was moderate (κ ≈ 0.35). Notably, 48.1% of patients without carotid plaques had femoral involvement. SCORE2 categories showed a strong gradient with plaque prevalence (p < 0.0001). In patients aged 50–69 years, adding vascular imaging improved discrimination for multiterrito-rial disease (AUC 0.73 vs 0.86–0.90). Reclassification analyses showed greater im-provement for carotid and aortic plaque (IDI 0.28; NRI 1.24–1.33) than femoral plaque (IDI 0.21; NRI 1.11). Bootstrap-corrected DCA confirmed improved net benefit. Con-clusions: The incremental value of vascular imaging over SCORE2 is pheno-type-dependent, with femoral plaque enhancing detection of subclinical disease and carotid/aortic plaque better identifying multiterritorial burden. These findings support a tailored, multiterritorial approach to CV risk assessment in PsA.

Abstract: This study investigated the molecular epidemiological characteristics of Cryptococcus neoformans (C. neoformans) isolates from AIDS patients with cryptococcal meningitis (CM) in southern China and examined their associations with clinical features and outcomes. A total of 100 clinical isolates were identified by MALDI-TOF MS and genotyped by multilocus sequence typing (MLST). Antifungal susceptibility to five agents was assessed using the FUNGUS 3 system. Baseline demographic, clinical manifestations, radiological, and laboratory data were collected from the corresponding 100 patients, and outcomes were evaluated at weeks 4, 12, 24, and 48. Seven sequence types (STs) were identified: ST5 (83/100, 83.0%), ST4 (5/100, 5.0%), ST31 (3/100, 3.0%), ST43 (1/100, 1.0%), ST93 (4/100, 4.0%), ST395 (1/100, 1.0%), and a presumptive novel ST685 (3/100, 3.0%). Most patients were male (80.0%), and headache was the most common symptom (85.0%). Susceptibility rates for 5-flucytosine, amphotericin B, fluconazole, itraconazole, and voriconazole were 98.9% (94/95), 71.9% (69/96), 82.3% (79/96), 59.4% (41/69), and 86.8% (59/68), respectively. Cumulative mortality reached 16%, 33%, 37%, and 39% at weeks 4, 12, 24, and 48. No significant differences were observed between 83 patients infected with ST5 and 17 patients with non-ST5 in clinical presentations or antifungal susceptibility. However, patients infected with ST5 exhibited consistently better survival rates across all time points, whereas those infected with ST93 showed the highest 12-week mortality. Accordingly, ST5 is the dominant sequence type of C. neoformans in HIV-associated CM in southern China; meanwhile, non-ST5 types could have worse prognosis, indicating ST sequence typing may act as a prognostic biomarker in AIDS patients with CM.

Abstract: Introduction: A major health issue in individuals living at high altitude regions is an increase in the number of red blood cells (RBCs). This condition generates a series of physiological alterations, including the nervous system, where damage can occur due to increased blood viscosity. This increased viscosity, in turn, could compromise oxygen uptake, potentially leading to a degree of cognitive impairment. Objective: To determine the association between exposure to chronic hypoxia and sleep quality with the degree of cognitive impairment (IQ) in a young adult population residing at different altitude levels. Methodology: Two hundred apparently healthy subjects of both sexes, aged 21 to 26 years, permanently residing in four cities at different altitudes—Lima, Arequipa, Puno, and La Rinconada (50 participants per location)—were evaluated. Physiological variables such as oxygen saturation (SpO2), blood pressure (BP), heart rate (HR), and hemoglobin (Hb) and hematocrit (Hct) levels were measured. Cognitive impairment was assessed using the Montreal Cognitive Assessment (MoCA), and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). ANOVA, chi-square, and linear regression models were used to analyze correlations. Results: Hemoglobin (Hb) levels increased gradually with altitude, reaching a maximum of 19.47 ± 3.01 g/dL in La Rinconada, while SpO2 decreased to 81.64% at the same site. Moderate to severe cognitive impairment was a finding exclusive to the La Rinconada population (5100 m), where only 10% of subjects remained unaffected. Regression analysis showed that for each unit increase in Hb, the MoCA score decreased by 0.59 points, indicating that elevated Hb levels were associated with varying degrees of cognitive impairment. No association was found between sleep quality and the degree of cognitive impairment. Conclusions: Chronic exposure to severe hypoxia (>5000 m) is associated with a greater presence of cognitive impairment, while sleep quality is not associated with any degree of cognitive impairment.

Abstract: Background: Mean arterial pressure (MAP) is widely used to guide hemodynamic management, yet it provides limited insight into the underlying physiological determinants of circulation. Identical MAP values may reflect markedly different states of cardiac output and vascular tone. The arterial pressure waveform contains rich physiological information beyond static pressure values, but this information is rarely quantified in a simple, continuous, and interpretable manner. Objective: To evaluate the relationship between a novel arterial waveform–derived metric, the Pulse Energy Ratio (PER), and reference cardiac output in a large intraoperative dataset. Methods: We performed a retrospective observational analysis using the VitalDB database, including 248 patients with concurrent high-resolution arterial pressure waveforms and cardiac output measurements obtained from an EV1000 volumetric monitoring system. PER was calculated as the area of the arterial waveform above the diastolic baseline normalized to the diastolic pressure–time integral for each cardiac cycle. Beat-level and rolling 10-beat averaged PER values (PERC) were analyzed. Correlations with cardiac output were assessed using aggregated time-segment data to account for repeated measures, with additional sensitivity analyses including first-differenced signals and mixed-effects modeling. Results: PER demonstrated strong positive correlation with cardiac output across a wide range of intraoperative conditions. Beat-level PER correlated with cardiac output at r = 0.781, while PERC showed r = 0.797. Rolling 10-beat averaging further strengthened these relationships (PER r = 0.834; PERC r = 0.822; all p < 0.001). These associations remained consistent across multiple analytic approaches designed to account for temporal dependence and within-subject clustering. Conclusions: The Pulse Energy Ratio is a physiologically grounded, waveform-derived metric that correlates strongly with cardiac output without requiring calibration or additional hardware. By quantifying the pulsatile component of the arterial waveform, PER may provide continuous insight into the interaction between forward flow and vascular tone. This approach has the potential to enhance interpretation of arterial pressure and support more physiologically informed hemodynamic monitoring, warranting prospective validation.

Abstract: Background and Objectives: Human immunodeficiency virus (HIV) infection is associated with immune dysregulation, which may influence the development of autoimmune diseases. However, population-based evidence on the prevalence of autoimmune diseases in individuals living with HIV remains limited, particularly in Asian populations. This study aimed to evaluate the prevalence of autoimmune diseases in individuals living with HIV in Korea using nationwide population-based data. Materials and Methods: We conducted a cross-sectional analysis using the Health Insurance Review and Assessment Service National Patient Samples from 2012 to 2015, including 4,851,064 individuals aged ≥15 years. HIV infection and autoimmune diseases were identified using ICD-10 codes. The prevalence of autoimmune diseases in individuals with HIV infection was compared with that in the general population. Antiretroviral therapy (ART) status was determined based on prescription records. Results: A total of 1,023 individuals were identified with HIV infection, all of whom were receiving antiretroviral therapy. The overall prevalence of autoimmune diseases was 4.37% in males and 2.38% in females with HIV, without significant differences compared to controls. However, the prevalence of Behçet’s disease, ulcerative colitis, and primary biliary cholangitis was significantly higher in males with HIV (P &lt; 0.05), while dermatomyositis was significantly more prevalent in females with HIV (P &lt; 0.001). Conclusions: Although the overall prevalence of autoimmune diseases was not significantly increased in individuals living with HIV, specific autoimmune diseases showed higher prevalence in this population. These findings suggest that clinicians should consider autoimmune dis-eases in the differential diagnosis of patients with HIV and highlight the need for further research on underlying immunological mechanisms.

Abstract: This study aims to present a series of cases reports of- knee arthritis occurring following COVID-19 RNA vaccination and to examine the potential role of these Spike protein-based RNA vaccines in the development of this arthritis. Although musculoskeletal disorders have been reported in connection with COVID-19 vaccines, post-vaccination arthritis is not yet listed. Given the different and specific mechanisms of Spike protein-based RNA vaccines and viral vector-based DNA vaccines, we report 7 cases that question the role of COVID-19 vaccines in the onset of early or late-onset knee arthritis observed following one or more injections. All patients (5 early onset and 2 late-onset cases) were examined in the same department and underwent a comprehensive assessment to investigate the usual causes of unilateral or bilateral oligoarthritis; none of them had a previous predisposition to rheumatic disease. No inflammatory rheumatic disease was detected, nor did any develop after a follow-up period of at least 24 months. A double-check of medical histories (both prior to and following diagnosis) was carried out by consulting the general medical database for all patients described. Post-vaccination serological monitoring of blood and synovial fluid to detect the presence of anti-spike antibodies has been requested for all patients and a synovial biopsy was performed in four of them. All patients showed improvement following low-dose prednisolone treatment within two months, but in some patients the symptoms persist. Anti-Spike antibody levels were found to be elevated in blood and synovial fluid samples from all patients. Synovial biopsies reveal chronic histiocytic (CD68+) and plasmocytic infiltration (CD3+) accompanied by neovascularisation. The similar timeline, progression and clinical manifestations of this knee arthritis might suggest a pathogenic role for the spike protein and/or an overproduction of anti-spike antibodies following mRNA vaccination.

Abstract: The COVID-19 pandemic has disrupted the lives of the world's population, resulting in over 7 million deaths. It was immediately noted that obese and/or diabetic subjects and frail elderly individuals with multiple comorbidities were more likely to have a more severe disease course. The cause of the increased morbidity and mortality in obese and/or diabetic subjects was found to be related to the presence of insulin resistance in these individuals. Furthermore, it was also discovered that COVID-19, particularly in its more severe forms, was capable of causing de novo type 1 and type 2 diabetes as well as worsening the disease course, if already present. This review aims to highlight the most accredited possible mechanisms by which subjects with insulin resistance may have a more severe disease course and those by which SARS-CoV-2 infection may cause new onset of diabetes or worsening of existing diabetes. To write this manuscript, the authors independently reviewed and compared the results of peer-reviewed and impacted journal publications, written in English, selected from the most well-known search platforms such as PubMed, Scopus, Science Direct, Google Scholar, and ResearchGate, using the following keywords: SARS-CoV-2, COVID-19, Insulin resistance, Glucose metabolism, Obesity, Diabetes, Hospitalization, Mortality.

Abstract: Background: Respiratory syncytial virus (RSV) is a serious disease in older adults with comorbidities; however, comparative data across epidemic waves, both clinically and in terms of inflammatory profiles and their diagnostic and prognostic utility, remain limited. Methods: We conducted a retrospective study of adults hospitalized with RSV infection across two epidemic waves (2022–2023 and 2024–2025). Clinical characteristics, comorbidities, severity scores, and outcomes were collected. Serum interleukin-6 (IL-6), C-reactive protein (CRP), and hematological parameters were analyzed and compared with healthy controls. Results: A total of 152 patients were included (81 in wave 1 and 71 in wave 2). Patients in wave 2 were older and had a higher burden of comorbidities, although ICU admission and in-hospital mortality were similar across waves. RSV induced a consistent systemic inflammatory response in both waves, characterized by elevated IL-6 and CRP levels, neutrophilia, lymphopenia, and increased neutrophil-to-lymphocyte ratio, without relevant inter-wave differences. All biomarkers demonstrated good diagnostic performance. The neutrophil-to-lymphocyte ratio, showed the highest accuracy, while IL-6 exhibited excellent rule-in capacity due to perfect specificity. However, none of the evaluated biomarkers were associated with disease severity (McCabe index) or in-hospital mortality. Conclusion: RSV infection in older adults is associated with a stable inflammatory signature across epidemic waves. Although biomarkers showed strong diagnostic utility, they lacked clinical prognostic value. We suggest that disease severity is mainly driven by host-related factors, particularly comorbidities, rather than differences in inflammatory response, highlighting the need for improved preventive and risk stratification strategies in this population.

Abstract:

Background: Overlapping endemic infections often present with non-specific systemic features, which could initially lead to delayed recognition and inappropriate treatment. Strongyloides stercoralis and Coccidioides spp. are rarely encountered together, yet both may cause pulmonary disease, constitutional symptoms, and eosinophilia, complicating diagnosis. Corticosteroid exposure in particular can unmask severe strongyloidiasis, highlighting the importance of early detection. Case Presentation: We present the case of a 30-year-old man from the Dominican Republic with recent travel to Brazil and Mexico, who presented with a 3-week history of fever, cough, myalgias, rash, and 13-pound weight loss. Initial treatment for presumed asthma exacerbation and bacterial pneumonia with corticosteroids and multiple antibiotics failed to relieve symptoms. Laboratory evaluation revealed marked eosinophilia (absolute eosinophil count 3,400/µL) and elevated inflammatory markers. Chest CT demonstrated diffuse bilateral tree-in-bud and micronodular opacities. Bronchoalveolar lavage contained 44% eosinophils. Serologic testing was positive for Strongyloides IgG, Coccidioides IgM/IgG, and β-D-glucan. The patient improved with ivermectin and fluconazole but experienced a relapse of coccidioidomycosis after antifungal discontinuation, requiring reinitiation of long-term azole therapy. Discussion: Coinfection with Strongyloides stercoralis and Coccidioides spp. poses a difficult diagnosis due to overlapping respiratory and systemic manifestations that could mimic common bacterial, fungal or allergic processes. Corticosteroid exposure can precipitate Strongyloides hyperinfection while promoting fungal proliferation, worsening disease severity. Recognition of eosinophilia in patients with a compatible travel history should prompt evaluation for parasitic and fungal etiologies. This case emphasizes the need for early serologic testing and targeted therapy while providing close follow-up to prevent relapses and complications in overlapping endemic infections. Conclusion: This case shows the difficulty of diagnosing overlapping infections like Strongyloides stercoralis and Coccidioides, which can easily be mistaken for bacterial pneumonia. It highlights the risk of giving corticosteroids before ruling out parasitic diseases and stresses the value of screening those at risk. The patient’s relapse after stopping treatment reflects the chronic nature of coccidioidomycosis and the need for close follow-up. Clinicians should keep an open, exposure-based approach when evaluating unexplained pulmonary symptoms, especially in people from endemic areas. This case underscores the importance of broad differentials, timely diagnosis, and long-term monitoring in patients with complex overlapping infections.

Abstract: Glycemic variability has become a critical predictor of diabetes progression and complications, surpassing traditional single-point measures such as fasting plasma glucose or glycated hemoglobin in capturing dynamic glucose level patterns. Continuous glucose monitoring (CGM) enables a detailed assessment of glycemic variability, which may reveal early dysregulation that is invisible to conventional tests. This study applies functional data analysis to evaluate the effects of a culturally tailored dietary intervention on CGM data from a prediabetic older adult. Over two consecutive weeks, CGM captured baseline glucose dynamics and post-intervention changes. The results indicated significant reductions in both mean glucose levels and variability throughout the intervention, highlighting meaningful changes in glycemic control attributable to culturally tailored dietary interventions. Furthermore, these results underscore the potential of combining CGM with advanced statistical methodologies to improve early detection and guide personalized interventions in the management of prediabetes.

Abstract: Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is now the leading cause of chronic liver disease globally, mirroring the in-creasing prevalence of obesity, insulin resistance, and type 2 diabetes. Early detection of hepatic steatosis is vital for cardiometabolic risk assessment; however, conventional imaging is costly and impractical for population screening. This study aimed to devel-op interpretable machine-learning models to predict ultrasound-detected hepatic ste-atosis within the MASLD spectrum using routinely available clinical and biochemical data. Methods: We analyzed data from 644 adults, 50% of whom had ultra-sound-detected hepatic steatosis. Preprocessing, imputation, and feature selection were implemented within a single scikit-learn pipeline to avoid information leakage. An Elastic Net–regularized logistic regression identified the top 20 predictors, which were subsequently used across nine supervised machine learning (ML) classifiers. Model performance was evaluated via repeated stratified 5-fold cross-validation (25 resamples) using accuracy, F1 score, sensitivity, specificity, Youden’s J, balanced accu-racy, and Area Under the Receiver Operating Characteristic Curve (AUROC). Inter-pretability was assessed using SHapley Additive exPlanations (SHAP). Results: Par-ticipants with ultrasound-detected hepatic steatosis exhibited greater adiposity, insu-lin resistance, and dyslipidemia compared with controls [p < 0.05 for body mass index (BMI), waist circumference, glucose, glycated hemoglobin (HbA1c), triglycerides]. Elastic Net selection highlighted Weight, Ponderal Index, Fibrosis-4 Index (FIB-4), blood urea nitrogen (BUN)/Creatinine ratio, Aspartate Aminotransferase to Platelet Ratio Index (APRI), and Visceral Adiposity Index as the strongest predictors. Logistic Regression and Gradient Boosting achieved the best performance (accuracy = 0.65 ± 0.03; AUROC = 0.71 ± 0.04; balanced accuracy = 0.66 ± 0.06), outperforming rule-based indices such as Fatty Liver Index (FLI) and Hepatic Steatosis Index (HSI) reported in the literature. SHAP analysis confirmed clinically coherent feature effects, with higher anthropometric and hepatic injury indices increasing the predicted probability of ul-trasound-detected hepatic steatosis. Conclusions: Routinely available clinical and bi-ochemical parameters can predict hepatic steatosis with moderate accuracy using transparent, interpretable ML models. Logistic Regression and Gradient Boosting pro-vided best discrimination and robust internal performance, offering a pragmatic, low-cost approach for early identification of ultrasound-detected hepatic steatosis within the MASLD spectrum in primary and metabolic care settings.