Dear Editor,
I read “Kidnapped But Not Kids: A Case Series of Three Octogenarian Hostages Held in Captivity by Hamas” by Clarfield and Levine1 with what I can only describe as a mix of disbelief and deep concern. It may well represent one of the starkest instances of elder abuse in recent years, if not modern memory. There’s something particularly troubling, even haunting, about the additional layers of trauma these elderly individuals endured, given both their age and medical vulnerability. The sense of disregard for even the most basic ethical standards is difficult to ignore.
Background: Sarcopenia and frailty are multi-factorial conditions, but few studies have examined their prevalence among older adults with diabetes in the Indian subcontinent. This study aimed to estimate prevalence of sarcopenia and frailty in ambulatory patients ≥65 years with type 2 diabetes mellitus (T2DM).
Methods: Sarcopenia was assessed utilizing the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Frailty was assessed using the Fried Frailty phenotype criteria. The study enrolled ambulatory participants aged 65 years and above with T2DM visiting the outpatient clinic. Patients with degenerative or inflammatory arthritis of the lower limbs, disabling cerebrovascular accidents, Alzheimer’s disease or other cognitive impairment, as well as those with chronic obstructive pulmonary disease, chronic liver disease, or chronic kidney disease were excluded from the study.
Results: Among the 100 outpatients meeting the inclusion criteria, sarcopenia was present in 30% (in-cluding 17% with severe sarcopenia). Frailty was present in 27%, pre-frailty in 59%, and 14% were classified as robust.
Conclusion: This study demonstrated a high prevalence of both sarcopenia and frailty among older adults with T2DM. Routine screening for these conditions may facilitate early identification and intervention in this high-risk population.
[Letter to the Editor] Home-based pulmonary rehabilitation (PR) represents a practical, patient-centered approach to managing chronic obstructive pulmonary disease (COPD), particularly in settings with limited access to conventional center-based programs. In their study, Kasim et al. demonstrated that a structured 12-week home-based PR program improved pulmonary function and disability outcomes, with particular gains in activities of daily living and social participation, as measured by the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). This letter highlights the significance of these findings, emphasizing the multidimensional benefits of PR beyond pharmacological therapy, including physiological, psychosocial, and functional improvements. We also discuss potential limitations, such as the lack of a control group, reliance on self-reported adherence, and the need for long-term and personalized interventions. The integration of tele-rehabilitation, cognitive and mobility-focused exercises, and family involvement may further enhance outcomes. Home-based PR has important implications for low- and middle-income countries, offering a cost-effective strategy to reduce disease burden, improve quality of life, and support sustainable, comprehensive COPD management.
Background: Cardiovascular disease is the leading global cause of death, with lifestyle and sociodemographic factors playing key roles in cardiovascular risk (CVR).
Objective: This two-phase study assessed the associations of alcohol intake, Mediterranean diet adherence, physical activity, and sociodemographic variables with CVR—as measured by the Registre Gironí del Cor (REGICOR) function and Systematic COronary Risk Evaluation 2 (SCORE2) algorithm—in a large cohort of Spanish workers (Phase 1). A secondary aim was to examine CVR trends from 2010 to 2020 (Phase 2).
Methods: A two-phase study was conducted: a cross-sectional analysis of 139,634 workers (Phase 1) and a longitudinal follow-up of 40,431 participants (Phase 2). Anthropometric, clinical, biochemical, and behavioral data were collected using standardized procedures. Multinomial logistic regression was used to evaluate associations.
Results: Phase 1 results showed a higher CVR associated with male sex, older age, lower education, manual labor, smoking, physical inactivity, low adherence to the Mediterranean diet, and alcohol consumption. In Phase 2, CVR increased over the decade, especially among smokers, sedentary individuals, and those with lower education.
Conclusions: Both modifiable behaviors and structural determinants significantly influence CVR. Preventive strategies should integrate lifestyle promotion with measures to reduce social inequalities, with targeted actions for vulnerable groups.
To the Editor,
We commend Cohen et al. for introducing a pragmatic composite—Padua score × D-dimer (PaDd)—designed to refine pulmonary embolism (PE) exclusion in adults aged ≥65 years, a population often characterized by multimorbidity, physiological het-erogeneity, and atypical presentations. Their single-center retrospective cohort (2021–2023) provides a compelling, hypothesis-generating signal: combining a validated venous thromboembolism risk score with D-dimer may enhance specificity without compromising safety.
To the Editor,
We commend Cohen et al. for introducing a prag-matic composite—Padua score × D-dimer (PaDd)—designed to refine pulmonary embolism (PE) exclusion in adults aged ≥65 years, a population often characterized by multimorbidity, physiological heterogeneity, and atypical presentations. Their single-center retrospective cohort (2021–2023) provides a compelling, hypothesis-generating signal: combining a validated venous thromboembolism risk score with D-dimer may enhance specificity without compromising safety.
As clinicians progress in their careers, they are often tasked with projects and responsibilities that require additional education, knowledge, and training in leadership and management. In the past, they were expected to pick up these skills along the way; current expectations, however, are different. Today, several avenues are available to clinicians to acquire and refine these competencies. This narrative review provides a structured overview of the education and training available—both with and without formal credentials—and outlines potential opportunities and pathways for developing leadership and management skills, particularly among critical care physicians.
Obesity is a complex, multifactorial disease that contributes to a broad range of cardiometabolic, reproductive, and psychological disorders. Representing a major global health challenge, obesity can be addressed by lifestyle modifications such as reduced calorie intake, physical activity, adequate sleep, and stress management to help achieve sustainable weight loss and improve metabolic health in the long term. Glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) are the two naturally produced incretin hormones in the gastrointestinal tract. Incretin analogues were initially approved for type 2 diabetes mellitus but were later found to exhibit weight-reducing properties. Liraglutide, semaglutide, and tirzepatide are the three incretin analogues approved for obesity in non-diabetic patients. This narrative review presents detailed comparisons of the three approved incretin analogues for obesity, their cost-effectiveness, and trends in the clinical setting.
Traditional coronary artery disease (CAD) risk scores offer limited precision, often failing to capture the complex, multifactorial nature of the disease. The proliferation of multimodal data from imaging, genomics, electronic health records (EHRs), and wearables offers a transformative opportunity for more individualized risk prediction. This narrative review systematically maps and critically evaluates the landscape of multimodal data fusion for CAD risk prediction. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we synthesized 39 empirical studies published from 2009 to 2025 to identify key methodological patterns, informatics challenges, and future directions. Our synthesis reveals consistent methodological patterns: (1) integrating imaging biomarkers (e.g. coronary computed tomography angiography, coronary artery calcium scoring) with clinical data robustly enhances risk discrimination and reclassification; (2) adding polygenic risk scores provides incremental value, typically via late-fusion models; and (3) leveraging longitudinal EHR data with machine learning captures dynamic risk trajectories, outperforming static scores. Advanced machine learning architectures, particularly deep and graph neural networks, are pivotal for enabling automated feature extraction and modeling complex cross-modal interactions. Despite these advances, significant informatics hurdles persist, including data heterogeneity, algorithmic bias, the need for robust external validation, and challenges in clinical workflow integration. Multimodal data fusion is a cornerstone of precision cardiology, but realizing its clinical potential requires a concerted focus on developing fair, interpretable, and scalable methodological frameworks to translate complex data into improved patient outcomes.
This paper presents a halakhic-ethical analysis of a 2025 case involving A.S., a brain-dead pregnant woman who was maintained on somatic support to enable fetal maturation and delivery. The case raises profound questions at the intersection of Jewish law and contemporary medical practice, particularly regarding the halakhic definition of death—brain versus cardiac cessation—and the moral status of the fetus. The paper explores divergent rabbinic opinions on whether sustaining a brain-dead body for fetal viability is halakhically permissible or obligatory. Key halakhic parameters examined include the principle of pikuach nefesh (saving life), the fetus as a potential nefesh, and the permissibility of delaying burial to perform a Cesarean section. We argue that Halakhah offers nuanced and compassionate responses to unprecedented bioethical dilemmas. Moreover, the paper affirms that Jewish law is ethically responsive, evolving through dialogue with changing human circumstances while remaining rooted in balancing reverence for life with the dignity of death. It underscores the importance of interdisciplinary collaboration between halakhic authorities and medical professionals to navigate ethically complex and medically novel scenarios with both compassion and rigor. This case illustrates that the moral courage of Halakhah’s heartbeat compels rabbinical scholars to navigate its boundaries with empathy, wisdom, and fidelity to tradition.
