Okelue E. Okobi

Background Diabetes remains a significant public health concern in Canada, with rising prevalence rates observed over recent decades. Understanding geographic and demographic patterns is essential for informing targeted prevention and resource allocation strategies. This study aims to examine trends in crude diabetes prevalence across four Canadian health zones from 2000 to 2022, using aggregated, age- and sex-stratified surveillance data, and with a focus on regional and sociodemographic disparities. Methods Data were obtained from the Canadian Chronic Disease Surveillance System (CCDSS), comprising annual counts of diabetes cases and population estimates stratified by age group, sex, and health zone. Crude prevalence rates were calculated and analyzed over time. A Poisson regression model with a log link and population offset was used to quantify temporal trends and assess differences by region, sex, and age group. Interaction terms were included to explore variation in trends across zones. Results Between 2000 and 2022, crude diabetes prevalence rose steadily across all regions, although the pace of increase varied. Zone 3 (Eastern) consistently showed the highest prevalence, whereas Zone 4 (Central) recorded the lowest levels by 2022. The Poisson regression model confirmed a significant annual rise in prevalence (β = 0.016, p < 0.001). Males had a significantly higher prevalence than females (β = -0.225, p < 0.001), and advancing age was strongly associated with a greater diabetes burden. Interaction terms between year and health zone indicated that temporal trends were not uniform across regions. Conclusion Diabetes prevalence in Canada has increased markedly over the past two decades, with substantial disparities across regions, age groups, and sexes. These findings underscore the need for region-specific diabetes prevention and control strategies, especially in high-burden zones. Continued surveillance and disaggregated analyses will be vital for addressing the evolving epidemiology of diabetes across the country.

Background: Inappropriate antibiotic prescribing for children remains a major public health concern, contributing to antimicrobial resistance (AMR), adverse events, and excess healthcare costs. This study examined prescribing patterns in United States (US) pediatric outpatient visits between 2010 and 2015 using the National Ambulatory Medical Care Survey (NAMCS). Methods: We conducted a cross-sectional analysis of outpatient encounters for patients aged 0-17 years. Antibiotic prescribing was evaluated by diagnosis category, age group, and patient characteristics. Descriptive statistics and adjusted probabilities were generated. Missing data were assessed, with no imputation applied, as most key variables were complete. Results: Among 45,666 unweighted pediatric visits, representing 991,561,251 weighted visits, the strongest predictor of antibiotic use was the type of diagnosis. Bacterial infections, particularly otitis media and urinary tract infections, had the highest prescribing probabilities, while non-infectious diagnoses rarely received antibiotics. Respiratory illnesses accounted for substantial prescribing, consistent with prior reports of inappropriate use. Conclusion: Pediatric antibiotic prescribing during 2010-2015 was primarily diagnosis-driven, with persistent overuse for respiratory conditions. These results underscore the need for strengthened outpatient stewardship strategies to reduce inappropriate use and support guideline-concordant care.

Septic shock remains a major cause of illness and death worldwide despite improvements in critical care, and the optimal timing for starting norepinephrine continues to generate debate. This review assessed whether administering norepinephrine within the first hour of recognizing shock or upon ICU admission provides meaningful advantages compared with delayed initiation. A broad search of major databases from 2010 to May 2025 identified randomized trials and observational studies examining early versus later administration. Twenty-eight studies met the inclusion criteria, and nine were eligible for meta-analysis. The pooled results showed that early norepinephrine was associated with a modest but statistically non-significant reduction in mortality (RR 0.90; 95% CI 0.76-1.06; p = 0.18). Observational studies, however, demonstrated a clearer survival benefit, with early initiation linked to a significant decrease in deaths (RR 0.75; 95% CI 0.60-0.94). Moderate heterogeneity (I² = 65.6%) likely reflected variation in study design, patient severity, and differences in defining early treatment. Overall, the evidence suggests that early norepinephrine may help stabilize hemodynamics more quickly and could improve clinical outcomes, though current randomized data remain limited. Further high-quality research is needed to better define the magnitude of benefit and guide consistent practice.

Testosterone replacement therapy (TRT) is commonly used to treat men with hypogonadism in order to replace the physiological levels of testosterone, although the cardiovascular safety and metabolic advantages of this treatment are still controversial. This article is a systematic review of the existing literature on the cardiovascular impact of TRT on lipid levels, inflammatory parameters, as well as endothelial activity in hypogonadal men. This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search was conducted in PubMed, Scopus, Embase, Web of Science, and Google Scholar of peer-reviewed studies that were published between 2005 and 2025. The Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) tool was used to evaluate methodological quality, and the data were synthesized narratively due to substantial heterogeneity across study designs, including differences in TRT formulations, dosing regimens, treatment duration, and the clinical characteristics of hypogonadal populations. Quality ratings were considered when interpreting the evidence, with higher-quality studies providing stronger support for the cardiovascular effects of TRT. In this review, 25 studies were included as they met the inclusion criteria. The included studies comprised randomized controlled trials and observational research designs (systematic reviews, meta-analyses, and cohort studies). Overall, TRT was associated with reductions in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), while high-density lipoprotein cholesterol (HDL-C) showed modest increases or remained stable across studies. Anti-inflammatory effects of testosterone therapy were demonstrated by the decrease in pro-inflammatory cytokines (interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)) and the enhancement of endothelial-dependent vasodilation. In hypogonadal men, TRT shows some improvements in endothelial function and reduced systemic inflammation, with benefits most evident under physiological dosing, while its lipid effects may be generally neutral to mildly favorable (decrease in TC/LDL, HDL often somewhat decreased depending on formulation). Long-term cardiovascular safety appears generally reassuring with respect to major adverse cardiac events in appropriately selected patients, though some adverse events may warrant monitoring. High-quality, longer-duration trials remain needed to strengthen these conclusions.

Background The relationship between body mass index (BMI) and outcomes after percutaneous coronary intervention (PCI) remains complex. Although obesity is a major risk factor for coronary artery disease, several observational studies have reported comparable or improved outcomes among overweight or obese patients compared with normal-weight patients, a phenomenon described as the “obesity paradox.” Whether this paradox persists when patients are stratified across specific BMI categories, particularly among obesity classes, remains incompletely understood. This study evaluated in-hospital outcomes after PCI across BMI categories using a large national inpatient database. Methods The National Inpatient Sample (NIS) 2016-2020 was queried, and those who underwent PCI were identified using International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes. After excluding underweight patients, the study population was classified into Healthy Weight (HW), Overweight (OW), Obesity Class I (OB1), Obesity Class II (OB2), and Obesity Class III (OB3) based on their BMI: 19.9-24.9 kg/m², 25-29.9 kg/m², 30-34.9 kg/m², 35-39.9 kg/m², and ≥40 kg/m², respectively. The primary outcome was in-hospital mortality. Secondary outcomes were predictors of mortality, including stroke, acute kidney injury (AKI), hemorrhage, hematoma, cardiogenic shock, acute heart failure, and acute respiratory failure (ARF). Results There were 58,919 selected PCIs. Of these, 5.1% (3,029) were HW, 9.3% (5,449) were OW, 30.8% (19,895) were OB1, 25.3% (16,650) were OB2, and 30% (18,496) were OB3. While the HW group showed a higher mortality rate compared to the OB3 group, 2.4 (1.9-2.9, p<0.0001), mortality was less likely in the other subgroups (OW, OB1, and OB2). ARF 9.9 (8.3-11.9, p<0.0001), cardiogenic shock 7.9 (6.7-9.3, p<0.0001), AKI 2.2 (1.9-2.5, p<0.0001), and increasing age 2.4 (1.7-3.6, p = 0.001) were associated with mortality. Conclusion This study revealed that, despite the obesity paradox, among the population with a BMI > 30 kg/m², those with a lower BMI may have a lower mortality risk than their severely obese counterparts.

Background and aim Obesity is strongly linked to elevated blood pressure and increased cardiovascular risk. Glucagon-like peptide-1 (GLP-1) receptor agonists have gained attention for their role in weight management and potential cardiovascular benefits. Evidence in nondiabetic populations remains limited. The aim of this study was to descriptively evaluate the association between GLP-1 receptor agonist use and systolic and diastolic blood pressure levels among nondiabetic adults with obesity. Methods This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) 2017 to March 2020 prepandemic cycle, selected to ensure use of the most recent complete data prior to disruptions related to the COVID-19 pandemic. Adults aged 18 years or older with obesity were included, and individuals with self-reported diabetes were excluded. GLP-1 receptor agonist use was identified from prescription medication data, with a very small number of exposed participants in the analytic sample. Blood pressure was assessed using standardized examination measures. A complete-case approach was applied, whereby participants with missing data on any variables included in the analysis were excluded to ensure a consistent analytic sample. Analyses incorporated NHANES examination sample weights to produce nationally representative estimates and accounted for the complex survey design by including stratification and primary sampling units to ensure correct variance estimation. Descriptive statistics were used to compare characteristics by exposure. Results Lower systolic blood pressure was observed among GLP-1 users compared with nonusers (107.2 vs 122.1 mmHg), and diastolic blood pressure was also lower (74.4 vs 76.9 mmHg). The proportion of hypertension was lower among GLP-1 users, 5,814 (14.1%), compared with nonusers, 25,207,405 (36.5%). The extremely small number of exposed participants (n = 2) limited further statistical analysis and inference. Conclusions Lower blood pressure levels were observed among GLP-1 receptor agonist users compared with nonusers in this population. These findings are descriptive and reflect observed differences in blood pressure within the analytic sample, without implying a causal relationship. Further studies using datasets with greater representation of GLP-1 receptor agonist use in nondiabetic populations are needed to better characterize this relationship.

Labor induction is a commonly used intervention in obstetric care, yet uncertainty persists regarding the comparative effectiveness and safety of mechanical, pharmacological, and combined methods across different clinical settings. Variability in practice and patient characteristics continues to influence outcomes, and clear comparative evidence remains limited. This systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to evaluate maternal outcomes associated with different labor induction methods. Peer-reviewed studies published between 2010 and 2025 involving adult women with term singleton pregnancies were identified through structured database searches. Quantitative synthesis was performed using R version 4.5 (R Foundation for Statistical Computing, Vienna, Austria, https://www.R-project.org/). Risk ratios were pooled using a random-effects model to compare cesarean delivery, vaginal delivery within 24 hours, and uterine tachysystole across intervention groups. A total of 25 studies were included in the qualitative synthesis, and four studies with six comparisons were eligible for meta-analysis. The pooled analysis showed no significant difference in cesarean delivery rates between methods, while a higher likelihood of vaginal delivery within 24 hours was observed in selected interventions. A lower occurrence of uterine tachysystole was also identified in specific comparisons. These findings support individualized selection of induction methods based on clinical context and patient characteristics, with emphasis on balancing effectiveness and safety.

Postpartum depression (PPD) is a significant public health concern in the United States, affecting many women after childbirth and contributing to adverse maternal and infant outcomes. This study aimed to synthesize current evidence on the epidemiology, risk factors, and management of PPD, with particular attention to emerging therapeutic and digital care approaches. A systematic search of major databases identified 25 eligible studies published between 2010 and 2026. The findings indicate that PPD remains prevalent, with disparities strongly associated with race, socioeconomic status, and access to care. Risk factors are multifactorial and include prior mental illness, low social support, unintended pregnancy, and psychosocial stressors, with growing evidence also pointing to genetic contributions. Symptoms may emerge at different stages of the postpartum period, underscoring the importance of ongoing screening rather than a single assessment. While psychotherapy and antidepressant therapy remain the foundation of treatment, newer strategies such as telehealth, mobile health applications, and wearable technologies show promise in improving early detection and access to care. Overall, addressing PPD requires integrated, equitable, and patient-centered approaches to improve maternal and child health outcomes.