Background: Late diagnosis of type 2 diabetes mellitus causes preventable complications and higher morbidity. Obesity, inactivity, poor diet, and smoking increase the risk of diabetes; however, their relationship with undiagnosed diseases in middle-aged adults requires further clarification. Methods: Between January and June 2024, we enrolled 200 adults aged 35–45 years from outpatient clinics. The staff measured the height, weight, and body mass index of each participant. Participants completed the International Physical Activity Questionnaire and Mediterranean Diet Adherence Screener and reported their smoking histories. After overnight fasting, we measured the fasting blood glucose and HbA1c levels. Undiagnosed diabetes was defined according to the 2024 American Diabetes Association criteria (FBG ≥ 126 mg/dL or HbA1c ≥ 6.5%) in patients without a prior diagnosis. Statistical analyses included independent t -tests, chi-square tests, and multivariable logistic regression. Results: Undiagnosed diabetes was found in 29 participants (14.5, 95% CI 9.8–19.2). Those with undiagnosed diabetes had a higher body mass index (30.6 ± 2.6 vs. 27.6 ± 3.4 kg/m ² , p < 0.001), lower physical activity prevalence (10.3% vs. 21.6%, p < 0.018), and higher smoking rates (48.3% vs. 26.3%, p < 0.024). After adjusting for physical activity, smoking, and diet quality, body mass index remained independently associated with undiagnosed diabetes (OR 1.36 per kg/m ² , 95% CI 1.16–1.70, p < 0.001). Physical activity level (OR 1.54 per category decrease, 95% CI 1.30–1.92, p < 0.024) and smoking (OR 1.33, 95% CI 1.13–1.66, p < 0.005) were also independently associated with undiagnosed status. Model discrimination was good (area under the curve 0.74, 95% CI 0.67–0.81), with a 93.3% negative predictive value. Conclusion: Approximately one in seven middle-aged adults in outpatient settings has undiagnosed type 2 diabetes. A higher body mass index, lower physical activity, and smoking were independently associated with an undiagnosed status. These readily assessable socio-behavioral factors should inform screening strategies and risk assessments in primary care.

The Aconitum genus is a leading source of a wide range of structurally diverse metabolites with significant pharmacological implications. The present study investigated metabolite profiling, pharmacological investigation, anticancer potential, and molecular docking analysis of the stem part of Aconitum heterophyllum (AHS). The metabolite profiling of the AHS extract was experimentally examined using LC-MS/MS-orbitrap in both modes (ESI+/ESI–) and GC-MS in EI mode. The in vitro MTT model was used to study the anticancer potential, while the in vivo animal model was used to study the anti-inflammatory and antinociceptive activities. The MOE software was used for the molecular docking study. A total of 118 novel and previously known metabolites, among 44 metabolites (26 in ESI+ positive mode and 18 in ESI– negative mode) in the MeOH extract, while 74 metabolites (46 in ESI+ and 28 in ESI– mode) were identified in the n-hexane extract via LCMS/MS. The identified metabolites include 24 phenolic compounds, 18 alkaloids, 10 flavonoids, 24 terpenoids, 2 coumarins, 2 lignans, and 38 other fatty acids and organic compounds. The major bioactive metabolites identified were hordenine, hernagine, formononetin, chrysin, N-methylhernagine, guineesine, shogaol, kauralexin, colneleate, zerumbone, medicarpin, boldine, miraxinthin-v, and lariciresinol-4-O-glucoside. Furthermore, the GC-MS study helped in the identification of volatile and nonvolatile chemical constituents based on the mass spectrum and retention indices. The methanol extract significantly inhibited tumor progression in H9c2 and MDCK cancer cells with IC50 values of 186.39 and 199.63 μg/mL. In comparison, the positive control aconitine exhibited potent IC50 values (132.32 and 141.58 μg/mL) against H9c2 and MDCK cell lines. The anti-inflammatory (carrageenan-induced hind paw edema) and antinociceptive (acetic acid-induced writhing) effects were significantly dose-dependent, (p < 0.001) and (p < 0.05), respectively. In addition, a molecular docking study was conducted on identified ligands against the anti-inflammatory enzyme (COX-2) (PDB ID: 5JVZ) and the cancer enzyme ADAM10 (PDB ID: 6BDZ) which confirmed the anti-inflammatory and anticancer effects in an in silico model. Among all ligands, L2, L3, and L7 exhibit the most potent potential for inhibiting COX-2 inflammation with binding energies of −7.3424, −7.0427, and −8.3562 kcal/mol. Conversely, against ADAM10 cancer protein, ligands L1, L4, L6, and L7, with binding energies of −8.0650, −7.7276, −7.0454, and −7.2080 kcal/mol, demonstrated notable effectiveness. Overall, the identified metabolites revealed in this AHS research study hold promise for discovering novel possibilities in the disciplines of chemotaxonomy and pharmacology.

Background: Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are major drivers of inappropriate antimicrobial use and resistance in hospitals. Clinical pharmacist-led antimicrobial stewardship programs (ASPs) are promising interventions for optimizing antimicrobial prescriptions and combating antimicrobial resistance. Methods: This prospective randomized controlled trial was conducted over 18 months (from April 2023 to October 2024) at a tertiary care hospital. Adult patients with HAP or VAP were randomized to receive either pharmacist-led ASP interventions ( n = 366) or standard care ( n = 334) in a clinical trial setting. The intervention comprised daily medication reviews, culture-guided optimization, therapeutic drug monitoring, duration optimization, adverse event monitoring, and multidisciplinary communication training. The primary outcome was an appropriate antimicrobial prescription on day three. Results: The intervention group demonstrated significantly higher rates of appropriate antimicrobial prescriptions (77.6% vs. 60.8%; odds ratio [OR] = 2.26, 95% confidence interval [CI]: 1.65–3.09; p < 0.001). Clinical cure rates were higher in the intervention group (84.4% vs. 74.3%; OR = 1.86, 95% CI: 1.27–2.72; p = 0.001). The mean hospital length of stay was reduced by 2.83 days (14.64 ± 5.48 vs. 17.47 ± 7.22 days; p < 0.001). Total antimicrobial treatment duration decreased by 10.9% (11.98 ± 5.80 vs. 13.45 ± 6.12 days; p < 0.001). Antimicrobial-related adverse events occurred less frequently in the intervention group (8.7% vs. 14.1%; p = 0.04). Conclusion: Clinical pharmacist-led antimicrobial stewardship programs (ASPs) significantly reduced antimicrobial exposure and healthcare utilization, improving the appropriateness of antimicrobial prescriptions and clinical outcomes. These findings highlight the importance of ASPs as an evidence-based strategy to address antimicrobial resistance and optimize patient care in HAP.

Atrial fibrillation (AF) affects about 1 to 2% of the general population and increases the risk of ischaemic stroke by 5-fold. Non-valvular atrial fibrillation (NVAF), the most common form of AF, i...