Background: Body weight (BW) loss is an essential therapeutic goal in type 2 diabetes (T2D). Glucagon-like peptide-1 receptor agonists are effective in reducing BW, but their effect on body composition has not yet been fully explored. The study aim was to assess the impact of Semaglutide on body composition in patients with T2D. Methods: Forty patients with T2D were treated with subcutaneous Semaglutide and evaluated at the baseline (T0) and after three (T3) and six (T6) months. Body composition was assessed by a phase-sensitive bioimpedance analyzer. Visceral adipose tissue (VAT) thickness was also measured with an ultrasonographic method (US-VAT). Anthropometric variables, muscular strength, and laboratory tests were analyzed and compared. Results: A significant decrease in VAT, the fat mass index (FMI), and BW loss was observed at all observation times. US-VAT, the skeletal mass index (SMI), the fat-free mass index (FFMI), waist circumferences, and glycated hemoglobin had lessened after three months and remained stable at T6. No variations in muscle strength, the muscle quality index, and body water were found. Discussion: In a real-life setting, Semaglutide provided significant weight loss mainly due to a reduction in the FMI and VAT, with non-clinically relevant changes in the SMI, the FFMI, and muscle strength. Most importantly, the results were obtained after three months of treatment and persisted thereafter.

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) induce body weight loss, but their effect on skeletal muscle mass (SMM) and strength needs to be better elucidated. Objectives: This study aimed to evaluate the effects of SGLT2i on SMM in a real-life population setting of patients with type 2 diabetes (T2D). Secondary outcomes included changes in liver steatosis and in anthropometric and glucometabolic parameters. Methods: Seventy-one patients were treated with SGLT2is as an add-on to metformin for 52 consecutive weeks. Visits were scheduled at baseline (T0) and after 6 (T6) and 12 months of therapy (T12) and included the checking of laboratory tests, measurement of anthropometric parameters, bioimpedance analysis of body composition, and abdominal ultrasound (US). Results: Fat mass (FM) and visceral adipose tissue (VAT) progressively decreased compared to the baseline (FM: −2.9 ± 0.6 kg at T6; −2.8 ± 0.6 kg at T12; VAT: −0.3 ± 0.1 L at T6; −0.4 ± 0.1 L at T12; all p < 0.01). Changes in SMM were less pronounced (−0.4 ± 0.3 kg at T6, ns; −0.7 ± 0.4 kg at T12, p < 0.05), yielding a beneficial increase in the SMM/FM ratio (+0.3 ± 0.05 at T6 and +0.2 ± 0.05 at T12, all p < 0.01). No significant changes in sarcopenia, sarcopenic obesity, fat-free mass, muscle strength, and water compartments were observed at the end of the follow-up period. Anthropometric and glucometabolic parameters, insulin resistance, liver enzymes, and biometric indices and US grading of hepatic steatosis improved throughout this study. Conclusions: In a real-life setting, SGLT2i therapy is associated with weight loss attributable to FM rather than SMM loss without any relevant deterioration in muscle strength. In addition, SGLT2is proved to have beneficial effects on steatotic liver disease.

(1) Background: Glucagone-Like Peptide-1 Receptor Agonists (GLP-1 RAs) (GLP-1 RAs) are incretine-based medications recommended in the treatment of type 2 Diabetes Mellitus (DM2) with atherosclerotic cardiovascular disease (ASCVD) or high or very high cardiovascular (CV) risk. However, knowledge of the direct mechanism of GLP-1 RAs on cardiac function is modest and not yet fully elucidated. Left ventricular (LV) Global Longitudinal Strain (GLS) with Speckle Tracking Echocardiography (STE) represents an innovative technique for the evaluation of myocardial contractility. (2) Methods: an observational, perspective, monocentric study was conducted in a cohort of 22 consecutive patients with DM2 and ASCVD or high/very high CV risk, enrolled between December 2019 and March 2020 and treated with GLP-1 RAs dulaglutide or semaglutide. The echocardiographic parameters of diastolic and systolic function were recorded at baseline and after six months of treatment. (3) Results: the mean age of the sample was 65 ± 10 years with a prevalence of the male sex (64%). A significant improvement in the LV GLS (mean difference: −1.4 ± 1.1%; p value < 0.001) was observed after six months of treatment with GLP-1 RAs dulaglutide or semaglutide. No relevant changes were seen in the other echocardiographic parameters. (4) Conclusions: six months of treatment with GLP-1 RAs dulaglutide or semaglutide leads to an improvement in the LV GLS in subjects with DM2 with and high/very high risk for ASCVD or with ASCVD. Further studies on larger populations and with a longer follow-up are warranted to confirm these preliminary results.

Background/Objective: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends using the COPD Assessment Test (CAT) and the modified Medical Research Council (mMRC) scale for symptom assessment. However, discordant results between these tools are common and may affect clinical phenotyping and treatment decisions. This study aims to identify clinical, functional, and radiological characteristics associated with discordant CAT and mMRC scores in COPD and assess the stability of this classification over time. Methods: We retrospectively analyzed 222 COPD patients classified into GOLD A, B, E, or a newly defined discordant group (GOLD_D), characterized by CAT ≥ 10 with mMRC < 2 or CAT < 10 with mMRC ≥ 2. Clinical, functional, laboratory, and imaging data were collected. Logistic regression identified predictors of GOLD classification. GOLD group changes were assessed at follow-up. Results: At baseline, 12.8% of patients belonged to the GOLD_D group. Compared to GOLD A and B, these patients had lower occupational exposure and higher rates of chest HRCT findings such as consolidations and centrilobular nodules. Regression models confirmed these features and identified FEV1 and FVC as independent predictors. GOLD classification showed notable variability during follow-up. Conclusions: Patients with discordant CAT-mMRC scores display distinct clinical and radiologic traits not captured by standard GOLD categories. These results underscore the limitations of relying solely on symptom scores and support a more comprehensive, trait-based approach to COPD assessment and management.

Introduction Early prognostic stratification in patients hospitalized for acute infections is a major clinical challenge. Existing tools, such as the Sequential Organ Failure Assessment (SOFA) score and Charlson Comorbidity Index (CCI), were not specifically developed for this purpose. Objectives We aimed to design a novel multidimensional prognostic score, the Acute Severity Infection score (ASIs), to predict in-hospital mortality using routinely available clinical data. Methods This retrospective cohort study included 149 adults admitted with acute infections to an internal medicine unit between January 2023 and December 2024. In-hospital all-cause mortality was the primary outcome. Demographic, clinical and laboratory variables obtained within 12 h of admission were analyzed. Variables significantly associated with mortality in both univariate and multivariate regression were incorporated into the ASIs, which ranges from 0 to 7 points. Its performance was compared to SOFA and CCI using ROC curve and Cox regression models. Results In-hospital mortality occurred in 25.5% of patients. Five variables were independently associated with mortality: lactate ≥ 2.2 mmol/l, frailty composite (confined to bed status, long-term oxygen therapy or advanced malignancy), hemodynamic instability or need for non-invasive ventilation, age ≥ 79.5 years and symptom onset ≥ 3.5 days before admission. ASIs showed the highest discriminative ability (AUC = 0.883) compared to SOFA (AUC = 0.612) and CCI (AUC = 0.742). In multivariate models including all three scores, only ASIs retained independent prognostic significance. Conclusions The ASIs is a simple tool for early prognostic stratification of patients hospitalized with acute infections. It outperforms existing scores and may enhance clinical decision-making in real-world medical settings.

Background and Objectives: COPD is a heterogeneous disease in which conventional clinical classifications may not fully capture the complexity of patient profiles. This exploratory study aimed to examine whether multidimensional COPD phenotypes could be identified using unsupervised cluster analysis integrating clinical, functional, radiological and laboratory features. Materials and Methods: We enrolled 161 patients with confirmed COPD evaluated between January 2020 and January 2024. Demographic, clinical, functional, radiological and laboratory findings were collected. Mixed-type data were analyzed using Gower distance and Partitioning Around Medoids (PAM) clustering. The optimal solution was selected by average silhouette width; stability was assessed by 1000 bootstrap resamples and sensitivity analyses. Results: The two-cluster solution had the highest silhouette width (0.184), although separation was modest. Cluster 1 (n = 78) was characterized by greater symptom and exacerbation burden, worse lung function, greater static hyperinflation, shorter 6-min walking distance and more frequent emphysema than cluster 2 (n = 83). Bootstrap resampling indicated internal stability, although concordance with the primary partition varied across sensitivity analyses. After correction for multiple post hoc comparisons, only LAMA/LABA/ICS use differed between clusters, whereas demographic characteristics, comorbidity burden and blood eosinophil levels were comparable. Conclusions: These exploratory findings suggest multidimensional assessment may complement conventional classifications, but external and longitudinal validation is needed before clinical implementation.