Foot infections are the most common cause of hospitalization in patients with diabetes. They may be superficial, involving only the skin, or deep, involving the soft tissues or bone. Superficial infections are generally caused by aerobic gram-positive cocci, whereas deep infections, including osteomyelitis, tend to be polymicrobial in origin. Clinical manifestations of skin and soft tissue infections include local evidence of inflammation, but peripheral neuropathy and peripheral artery disease may mask these findings. Management is determined by the extent of infection and often includes oral or parenteral antibiotic therapy in combination with surgical debridement. In 2023, the International Working Group on the Diabetic Foot and the Infectious Diseases Society of America updated their guideline on the diagnosis and management of diabetic foot infection. The guideline includes specific recommendations regarding the use of inflammatory markers, tissue and bone culture, and imaging studies in the diagnosis of diabetic foot infection, as well as the indications for surgical debridement and hospitalization. Here, 2 experts in this field, an infectious diseases physician and a podiatrist, debate how to manage the case of a diabetic patient with foot infection. They discuss diagnostic and treatment challenges in the care of this population.

The OperA (Optimising Colorectal Cancer Prevention through Personalized Treatment with Artificial Intelligence) project aims to transform colorectal cancer care through artificial intelligence (AI) innovations. Recognizing that legal and ethical challenges remain key obstacles to clinical integration, this Delphi study sought to identify and prioritize such concerns in the context of gastrointestinal (GI) endoscopy. Fourteen international experts participated in a 2-round Delphi process. In round 1, the steering committee, with feedback from participants, proposed legal and ethical issues pertaining to AI in endoscopy. Round 2 involved iterative rating and refinement of these issues to achieve consensus on their importance. Consensus was reached on 10 key statements spanning 3 thematic domains: data governance, medicolegal implications, and equity and bias. Experts emphasized the need for robust data protection, transparent algorithmic development, and institutional clarity on data ownership. Liability concerns related to AI-assisted diagnosis and automated reporting were highlighted, alongside calls for guidance from legal and professional bodies. Finally, participants underscored the importance of demographic diversity in training data sets and transparent reporting practices to mitigate bias and ensure equitable AI deployment. As AI tools become increasingly integrated into the clinical practice of gastroenterology, addressing legal, ethical, and equity-related challenges is essential. This expert consensus provides a foundation for developing guidelines and regulatory frameworks to support responsible AI adoption in GI endoscopy.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are used for type 2 diabetes mellitus (T2DM) and overweight or obesity, but their association with cancer is unclear.

Hyponatremia is the most common electrolyte disorder in hospitalized patients. Hospital-associated hyponatremia includes community-acquired (e.g., hyponatremia on admission) and hospital-acquired hyponatremia. Acute-onset hyponatremia requires rapid treatment with hypertonic saline to decrease cerebral edema. In cases of chronic hyponatremia (>48 hours), the brain has time to normalize cell volume by losing solutes. However, even mild chronic cases can have adverse outcomes, such as decreased cognition, osteoporosis, increased risk for falls, and fractures. Hyponatremia is associated with increased hospital length of stay, readmissions, morbidity, and mortality. Prompt recognition and appropriate treatment are therefore necessary to improve outcomes.

Opioid use disorder (OUD) drives high morbidity and mortality, but access to opioid agonist therapy (OAT) is limited in low- and middle-income countries. Integrating OAT into primary care may expand access and improve comorbidity management, although provider discomfort remains a barrier.

Mpox virus (MPXV) clade Ib, first detected in the Democratic Republic of the Congo (DRC) in September 2023, spread internationally within months, prompting an emergency declaration from the World Health Organization. Data on its incubation period, which both shapes outbreak dynamics and informs epidemic response strategies, remain limited.

The last 5 years in the United States have witnessed a flurry of policies attempting to limit access to gender-affirming care (GAC), with state and federal authorities instituting restrictions on care for transgender and gender-diverse (TGD) adolescents and attempting to limit funding for treatment costs. Although many have decried these policies as an unprecedented assault on GAC, there is actually a long history of attempts to limit access to GAC in the United States through the creation of restrictive policies directed at patients, clinicians, and payers. Even amid such restrictions, TGD people have demonstrated a remarkable ability to access GAC, often finding new ways to obtain this care. These have included shifts in tactics deployed by advocates of GAC as hostile policymakers attempted to limit the expansion of access. The current landscape of restrictive policies represents the culmination of a longstanding regulatory evolution, integrating various legislative approaches that have been used over almost a century. This article discusses how TGD communities have navigated several iterations of hostile legislative environments to access such care.

The benefit-risk profile of systemic corticosteroids in non-COVID-19 pneumonia and acute respiratory distress syndrome (ARDS) remains debated.

GIM/FP/GP: [Formula: see text] Geriatrics: [Formula: see text].

Emergency Med: [Formula: see text] GIM/FP/GP: [Formula: see text] Neurology: [Formula: see text].

GIM/FP/GP: [Formula: see text] Cardiology: [Formula: see text].

The digitization of academic publications and newspapers from the 1800s has permitted identification of several authoritative sources that credit Dr. Joseph W. Gleitsmann with establishing the first successful tuberculosis sanitarium in the United States in Asheville, North Carolina, in 1875, antedating by 9 years the Trudeau Sanatorium in Saranac Lake, New York. The facility used German climatological methods and a defined medical treatment program. Gleitsmann's Mountain Sanitarium for Pulmonary Diseases had a 30-bed occupancy and published outcomes data from 5 years of clinical experience by 1880. By 1910, Asheville had become a tuberculosis care "colony," with 25 private tuberculosis sanitaria with a national referral base. Asheville was a key driver of the development of climatotherapy in the treatment of tuberculosis and other respiratory ailments in the preantibiotic era. From 1870 to 1930, medical, mental health, and wellness tourism largely drove the population growth (1500 to 50 000) of Asheville, a previously remote Appalachian town. The stigmatization of tuberculosis sufferers is illustrated by restrictive municipal regulations that led to the demolition of almost all tuberculosis sanitaria within Asheville city limits by the 1920s. The Von Ruck Research Laboratory for Tuberculosis produced more than 50 papers from 1890 to 1930, published mostly in the Journal of the American Medical Association and the Journal of Immunology. These included pioneering immunotherapy studies with tuberculin variants and the first robust description of the antigenic profile of Mycobacterium tuberculosis. Tuberculosis was both incurable and a leading cause of death, and thus perseverance with fractionated tubercle bacillus products and subunits by so many is understandable in the context of the times. By analogy, public health now seems more ready to accept disease-specific immunotherapy agents and vaccines that save lives even if they are substantially less than 100% effective.

GIM/FP/GP: [Formula: see text] Neurology: [Formula: see text].