Primary Health Care

Background: Prediabetes is a critical intermediate stage in the development of type 2 diabetes mellitus and is increasingly prevalent in the Eastern Mediterranean Region. In Qatar, high levels of metabolic and lifestyle-related risk factors underscore the need for scalable, non-invasive risk stratification tools within primary care. The Prediabetes Risk Score in Qatar (PRISQ) was developed as a population-specific screening tool; however, its distribution and associated risk patterns within national primary care settings remain insufficiently characterized. This study aimed to assess the population-level distribution of PRISQ scores among adults attending primary care in Qatar and to identify key sociodemographic and clinical correlates of elevated prediabetes risk. Methods: A cross-sectional analysis was conducted among adults (≥18 years) registered with the Primary Health Care Corporation (PHCC), using data derived from the HEALTHSIGHT study. PRISQ scores were calculated based on five non-invasive clinical parameters: age, sex, body mass index, waist circumference, and blood pressure. Participants were categorized into low, moderate, and high-risk groups using established PRISQ cut-offs. Descriptive analyses summarized risk distributions, and multivariable linear regression was used to identify independent predictors of PRISQ scores. Results: Among 1,116 participants included in the final analysis, the mean PRISQ score was 26.5 ± 11.0. Nearly half of the study population (47.7%) was classified as high risk for prediabetes, while 34.4% and 17.9% were categorized as moderate and low risk, respectively. Increasing age was the strongest contributor to higher PRISQ scores, followed by body mass index, waist circumference, and blood pressure (all p < 0.001). High-risk individuals were more frequently male, older, overweight or obese, and long-term residents of Qatar, with variation across nationality groups. Conclusions: A substantial proportion of adults attending primary care in Qatar are at high predicted risk for prediabetes. These findings support the utility of PRISQ as a risk stratification and engagement tool in primary care to guide early lifestyle counselling and targeted preventive interventions. Longitudinal studies are needed to assess progression to dysglycemia and to further refine risk-based screening strategies.

Abstract Background and Objective The pituitary gland is a small gland found in the pituitary fossa. Significant variations exist in pituitary gland's size and shape among healthy individuals. This variability can create uncertainty making it challenging radiologists to determine whether a certain size falls within a normal range. The objective of the study is to perform a radiologic and morphometric analysis of pituitary gland, focusing on age and sex-related changes in its size and morphology. Materials and Methods This was a retrospective observational study conducted in the department of radiology at Punjab Institute of Neurosciences after obtaining clearance from the institutional review board. The sample size was 503 and ran from January 1, 2022, to December 31, 2024. Normative measurements of pituitary gland among healthy individuals were observed using MRI brain T1 weighted mid sagittal and T2 weighted coronal images. Results The pituitary gland dimensions showed a linear increase with age during childhood and adolescence, peaking in early adulthood and declining in older age groups except length dimension which exhibited peak in fifth decade. Females exhibited higher pituitary mean height and volume compare to males. Mean pituitary height was 5.48 ± 1.49 mm and 5.32 ± 1.43 mm in females and males respectively. Most common shape of the superior surface of pituitary gland was flat. Conclusion This study established normative measurements of the pituitary gland encompassing subjects of all age groups within the Pakistani population. The data provided reference values for the pituitary dimensions and morphology, which serve as diagnostic parameters for evaluating pituitary pathologies.

Background Information about a treatment's benefits and harms available to a patient often relies on text. However, for many medical conditions, patients must trade off benefits and harms across multiple competing treatments. It remains unknown how to appropriately communicate information on benefits and harms to patients.Aims We compared three communication tools using textual information (Cochrane summary of findings table) or increasing combinations of textual and graphical information (Kilim and Vitruvian plots, respectively) to convey the available evidence.Method Communication of Benefit-Risk Information, an online randomised controlled trial, is a three-group, parallel, open-label, automated, randomised controlled trial (no. NCT05917639). We recruited participants aged between 18 and 65 years from the general population. Participants were randomly allocated (1:1:1) to one of the three communication tools providing information on competing fictional treatments for social anxiety, and were asked to choose one based on externally provided preferences. The primary outcome was the perceived level of decisional conflict when selecting a treatment (decisional conflict scale (DCS): 0 = best, 100 = worst). Because this was an all-or-nothing, single-visit trial, only those participants providing data contributed to the primary analyses (modified intention to treat).Results We recruited 2178 adults between 1 June and 27 November 2023. Vitruvian and Kilim plots outperformed the Cochrane summary of findings table on the primary outcome (adjusted mean difference -10.9, 95% CI -13.5 to -8.2, P < 0.0001 and -9.7, 95% CI -12.4 to -7.1, P < 0.0001), respectively). Results varied by participants' literacy and numeracy skills, lived experience of the condition of interest, ethnic group, gender assigned at birth and age.Conclusions Combining graphical and textual information, as opposed to text only, improved communication and reduced decisional conflict when choosing across multiple competing medical interventions. Organisations involved in disseminating scientific evidence should consider endorsing a combined graphical and textual approach and adopting more intuitive and accessible communication methods. We identified several prognostic factors that should inform the development of future patient decision aids and communication of scientific findings.Trial Registration Number NCT05917639.

Ischemic stroke (IS) remains a leading cause of death and disability worldwide. Stroke–heart syndrome, triggered by acute cerebral ischemia, causes autonomic dysfunction that can result in myocardial injury, arrhythmias, and sudden cardiac death, even in the absence of preexisting cardiac disease. The Electrical Risk Score (ERS), derived from standard electrocardiographic (ECG) parameters, has prognostic value in cardiac conditions, but its utility in IS populations remains unclear. This study aimed to evaluate the discriminative performance of ERS between confirmed acute IS patients and matched healthy controls, and to assess its prognostic value for 30-day all-cause mortality among patients with IS. This prospective observational study enrolled 200 patients with acute IS and 101 age- and sex-matched healthy controls at a tertiary emergency department. ERS (range: 0–6) was calculated using six predefined ECG parameters: heart rate, QTc interval, Tp-e interval, frontal QRS-T angle, QRS transition zone, and left ventricular hypertrophy. ERS was significantly higher in IS patients compared to controls (p < 0.001). ERS independently predicted 30-day mortality (adjusted OR 1.66, 95% CI 1.14–2.42; p = 0.008). Receiver operating characteristic (ROC) analysis showed that ERS ≥ 3 discriminated confirmed IS cases from matched controls with 61% sensitivity and 77% specificity (AUC: 0.725; 95% CI: 0.669–0.781; PPV: 0.841; NPV: 0.500; p < 0.001). ERS ≥ 4 predicted 30-day mortality with 55% sensitivity and 74% specificity (AUC: 0.681; 95% CI: 0.585–0.778; PPV: 0.267; NPV: 0.907; p = 0.002). Higher ERS values showed a significant positive correlation with stroke severity based on Glasgow Coma Scale (GCS) scores (p = 0.005). ERS is a simple bedside ECG-based tool with moderate accuracy for predicting acute IS and short-term mortality. It may support early risk stratification in settings with limited stroke-specific resources. Further multicenter studies are needed for validation.

ABSTRACTMetabolic dysfunction‐Associated Steatotic Liver Disease (MASLD) is a growing clinical challenge, necessitating effective diagnostic strategies to identify advanced liver fibrosis while minimising unnecessary referrals of mild cases. Current clinical guidelines recommend care pathways utilising non‐invasive tests (NITs) to stratify patients, but the optimal diagnostic algorithm across care settings remains unclear. This state‐of‐the‐art review systematically examines studies describing clinical care pathways for detecting advanced fibrotic MASLD and stratifying patients at risk. A comprehensive literature search of MEDLINE, Embase, Cochrane Library, and Scopus, finalised in January 2026, identified nine relevant studies that met predefined criteria including structured care plans and applicability beyond diagnosis alone. Pathway populations included patients at risk for MASLD (type 2 diabetes (n = 4) or broad range cardiometabolic risk factors (n = 1)) or confirmed MASLD (n = 4). The most frequently employed NITs were FIB‐4 and vibration‐controlled transient elastography (VCTE). Numbers needed to screen (NNS) for hepatology referral and advanced fibrosis detection varied considerably across pathways and populations, reflecting heterogeneity in design and fibrosis assessment methods. All studies reported improved patient risk stratification; attendance rates declined at each pathway step. Findings suggest that NIT‐based clinical care pathways can effectively align patient management and optimise transmural care for MASLD. Nonetheless, heterogeneity in pathway design and fibrosis determination highlights the need for standardised protocols and validation in larger, at‐risk cohorts to strengthen evidence supporting widespread adoption. This review contributes to advancing MASLD management within evolving clinical frameworks.

Objectives To determine whether mupirocin-based decolonization, compared with placebo, no treatment, or alternative agents, reduces S. aureus-related surgical site infection (SA-SSI), nasal S. aureus colonization and overall SSIs incidence in elective surgery.Methods We searched EMBASE, Medline (Ovid), PubMed, CENTRAL, and Google Scholar to 15 May 2024 for randomized controlled trials. Risk ratios (RRs) were pooled using a random-effects model with the restricted maximum likelihood (REML) estimator with the Hartung-Knapp (HK) adjustment. Prespecified subgroup analyses evaluated application strategy, surgical type, and chlorhexidine gluconate (CHG) co-administration.Results Seventeen RCTs (15,533 participants) were included. In trials with no-treatment or placebo controls, mupirocin-based decolonization reduced S. aureus-related SSI (SA-SSI) (RR 0.67, 95% CI 0.49-0.91) and nasal colonization (RR 0.22, 95% CI 0.18-0.26). Effects were larger with targeted use in confirmed carriers and when combined with CHG. No reduction was observed for overall SSIs, except in orthopedic surgery (RR 0.80, 95% CI 0.65-0.99). Head-to-head data versus active alternatives were sparse and did not show a consistent advantage for mupirocin.Conclusions Targeted preoperative mupirocin, especially when combined with CHG, reduces SA-SSI in elective surgery. The lack of significant impact on overall SSIs is interpreted as a reflection of polymicrobial etiologies in surgical infections. Given the emerging risk of mupirocin resistance, further adequately powered head-to-head trials with standardized outcomes and integrated resistance surveillance are warranted.

To explore associations of clinic and 24-hour ambulatory blood pressure (BP) monitoring (ABPM) with cardiovascular death (CVD), parameters were modeled for age and sex in this large cohort in primary care. In the Spanish ABPM Registry, 59.124 patients had complete data on mortality, age, sex, and all ABPM. Office, mean, 24-hour, daytime, and nighttime systolic BP (SBP), diastolic BP, and pulse pressure (PP) were related to CVD according to age and sex and were modelled with restricted cubic splines to get trajectories. During a median of 9.7 years, 2361 patients had CVD (1229 males, 1132 females). Nonlinear relationships for office, 24-hour mean, daytime, and nighttime SBP, diastolic BP, and PP (P<0.0001 for all) for both sexes were observed. Until 75 years, SBP was higher in males than females, but differences were minimized after ≈60 to 70 years (P for interaction <0.0001). High SBP and PP are associated with CVD without heterogeneity between sexes and across aging. The increase of SBP and PP was higher at a higher age for females than males (P for interaction <0.0001). CVD was age-dependent, and ABPM, in particular nighttime BP did more closely associated with risk than office BP in younger than in older individuals. Twenty-four-hour mean, nighttime BP, and PP were closely associated with risk being higher in elderly females than males after 75 years, corresponding to a rise in BP in older females. Guidelines should continue to mandate the evaluation of 24-hour ABPM data for risk prediction.

To identify gaps and inconsistencies in the coding and testing of chronic kidney disease (CKD) among people with type 2 diabetes mellitus in UK primary care by evaluating clinical inertia in those with reduced estimated glomerular filtration rate (eGFR) and/or elevated urine albumin-creatinine ratio (uACR) levels. We conducted a retrospective cross-sectional analysis using SystmOne and the PARM Diabetes tool. A cohort from two primary care settings was screened to identify type 2 diabetes mellitus patients with eGFR <60 mL/min/1.73 m2 on two occasions. A retrospective analysis evaluated CKD coding accuracy per NICE guidelines, identifying gaps in coding and testing. Significant variation was observed in CKD monitoring and diagnosis between the two settings. Overall, 77.3% had eGFR testing, and 37.6% had uACR testing within the past 12 months, with significantly higher testing rates in primary care setting one (urban) compared to primary care setting two (rural). Only 35% of patients received both tests within the past 12 months, with the lowest uptake among patients under 60 years (28%) and those with advanced CKD stages. Among patients with ≥2 eGFR readings <60 mL/min/1.73 m2, 61% remained uncoded for CKD if they had exactly two readings, compared to 15% uncoded among those with more than two. Coding rates increased with age but did not differ significantly between settings. The study emphasises the need for increased uACR testing and CKD coding in type 2 diabetes mellitus patients to ensure accurate monitoring and management. Fluctuating eGFR/ACR levels and process issues may contribute to clinical inertia. These findings specifically highlight gaps in CKD monitoring and diagnosis, particularly in younger patients and rural settings. We recommend healthcare professionals review coding practices and follow CKD guidelines to improve patient outcomes.