Integrated care for individuals with type 2 diabetes (T2D) and arterial hypertension (AH) should be accessible, continuous, and person-centred. However, formal healthcare systems often struggle to sustain long-term self-management support. Community-based peer support, provided by individuals with lived experience, may enhance continuity and quality of care by offering emotional, social, and practical assistance.To explore the role and contribution of trained peer supporters in strengthening integrated primary care for people with T2D and AH in XXX.A prospective interventional mixed-methods study was conducted between May 2021 and December 2023 at two primary healthcare centres: the urban Community Health Centre XXX and the rural Community Health Centre XXX. A purposive sample of 36 individuals with T2D and AH, completed a two-month structured educational programme to become trained peer supporters for other patients (n=226). Participants attended monthly peer support meetings over three months. Quantitative data were collected from medical records, clinical measurements, and questionnaires, while qualitative insights were gathered through interviews and focus groups. Statistical analyses included paired t-tests and multivariate linear regression.Thirty-one participants (retention 86.1%) completed the training (mean age 63.9±8.9 years; 67.7% women). The intervention was feasible, acceptable, and effective. Training significantly improved knowledge of T2D (p<0.001) and AH (p=0.024), and BMI decreased from 30.4 to 29.8 after six months (p=0.020). Three peer support meetings were attended by 200 patients (retention 88.5%; mean age 68.3±10.5 years; 51% male), resulting in a significant increase in empowerment (p<0.001). Higher empowerment was associated with younger age (p=0.009), rural residence (p<0.001), and not receiving antihyperglycaemics (p=0.015). Qualitative findings highlighted the value of accessibility, empathy, and informality in fostering trust, reducing stigma, and promoting open communication.Adequately trained peer supporters can complement healthcare professionals by enhancing patient engagement and continuity of care. The success of such programmes depends on clear role definition, ongoing training, and sustained motivation.Peer support is a compassionate and sustainable complement to primary healthcare for people with T2D and AH. By fostering trust, self-efficacy, and social connectedness, it strengthens integrated care and warrants policy support and further research on long-term impact and scalability.

Superior mesenteric artery syndrome (SMAS), or Wilkie’s syndrome, is a rare cause of duodenal obstruction resulting from reduced aortomesenteric distance. Its symptoms overlap with common gastrointestinal complaints frequently seen in primary care, which often leads to diagnostic delays. This case highlights the relevance of continuity of care and multidisciplinary coordination in identifying severe malnutrition secondary to SMAS.A 38-year-old woman was referred from internal medicine to primary care for nutritional assessment due to significant weight loss. She had experienced progressive reduction in oral intake and postprandial abdominal pain over one year, reporting a 6.4 kg loss from her habitual weight of 54 kg. She denied nausea or vomiting and had occasional constipation and diarrhea. Examination revealed BMI 16.8 kg/m², reduced muscle mass, and minimal physical activity. An abdominal CT scan showed gastric dilation with a markedly reduced aortomesenteric angle of 12°, decreased aortomesenteric distance (4 mm), and compression of the third duodenal portion, supporting the diagnosis of SMAS. Additional findings included left ovarian vein dilation and periuterine venous varicosities consistent with pelvic congestion syndrome. Liver, pancreas, and kidneys were normal. Duodenal biopsies showed preserved villous architecture, excluding celiac disease. Given the severity of malnutrition, the patient was started on high-calorie oral supplements and instructed to take frequent small meals.Vascular surgery evaluated the possibility of endovascular intervention, including superior mesenteric artery stenting or alternative approaches, given the persistence of symptoms.This case illustrates an uncommon etiology of chronic abdominal pain and severe weight loss, demonstrating the diagnostic complexity of SMAS and its overlap with functional or nutritional disorders.Early recognition of red flags—progressive weight loss, early satiety, and postprandial pain—is essential in primary care. SMAS should be considered in low-BMI patients with persistent upper abdominal symptoms.Timely imaging and multidisciplinary management can prevent complications.Family medicine plays a central role in longitudinal monitoring of nutritional status, evaluating persistent gastrointestinal symptoms, and coordinating referrals.This case emphasizes how primary care continuity supports the identification of rare conditions and optimizes patient outcomes.Severe malnutrition secondary to SMAS requires high clinical suspicion, prompt imaging, and coordinated care.Early intervention can improve nutrition and quality of life.

Previous studies have reported significant associations between cortisol, dehydroepiandrosterone sulfate (DHEA-S), and heart rate variability (HRV) indices, suggesting dynamic interactions between the hypothalamic–pituitary–adrenal axis and the autonomic nervous system.The objective of this study was to apply an unsupervised machine-learning clustering approach based on adrenal hormones and HRV indices to identify stress response phenotypes in healthy adults, and to examine their dynamic interactions and associated clinical and metabolic risks.This retrospective cross-sectional study included 1,200 healthy adults. Morning fasting assessments covered demographics, anthropometrics, questionnaires on stress, fatigue, and sleep, routine labs, adrenal hormones (cortisol, DHEA-S, cortisol/DHEA-S ratio), HRV indices (SDNN, RMSSD, TP, LF, HF, LF/HF), and urinary metabolites. Non-normal variables were log-transformed, with normality confirmed via Shapiro–Wilk tests. Spearman correlations explored hormone-HRV associations. K-means clustering (k=3) classified participants using DHEA-S, cortisol/DHEA-S ratio, RMSSD, TP, and HF. Cluster differences were evaluated by Kruskal–Wallis, Wilcoxon rank-sum, and chi-square tests, with all analyses performed in R 4.5.1.Significant positive correlations were observed between DHEA-S and LF, TP, SDNN, HF, and LF/HF, with a negative correlation between cortisol/DHEA-S ratio and these HRV metrics. Clustering revealed three distinct phenotypes. Cluster 1 had low HRV, high LF/HF, and strong positive DHEA-S–HRV correlations. Cluster 2 showed intermediate HRV but low DHEA-S and high cortisol/DHEA-S ratio, with disrupted hormone-HRV correlations. Cluster 3 exhibited high HRV and favorable hormone profiles with inverse correlation patterns to Cluster 1. Metabolic profiling showed Cluster 1 had elevated insulin resistance and inflammation with high fatigue and stress, Cluster 2 showed oxidative stress and aging markers, while Cluster 3 had protective parasympathetic and metabolic profiles.Distinct physiological stress phenotypes relate to heterogeneous metabolic, inflammatory, and oxidative profiles and varying subjective stress fatigue, reflecting complex HPA–autonomic system interactions. Limitations include cross-sectional design, requiring prospective studies for causal inference and disease outcome evaluation.Adrenal hormone and HRV-based clustering identify heterogeneous stress response phenotypes with distinct clinical and metabolic risks in healthy adults, presenting a framework for personalized risk assessment in precision medicine. Future longitudinal validation is warranted.

Syphilis is a re-emerging sexually transmitted infection with a broad clinical spectrum. Secondary syphilis typically presents with a maculopapular rash. Otosyphilis and ocular syphilis are uncommon manifestations that may occur at any stage and mimic frequent benign conditions. These atypical presentations often lead to diagnostic delay and increase the risk of irreversible sequelae.We report the case of a 37-year-old male with no relevant medical history who presented to primary care with bilateral otalgia, mild fever, and progressive right-sided hearing loss, and was treated for presumed otitis. In the following weeks, he developed a generalized non-pruritic maculopapular rash and later bilateral ocular hyperemia with reduced visual acuity. Reassessments in primary care and the emergency department attributed ocular signs to conjunctivitis, and no serology testing was performed. One month after symptom onset, persistent visual symptoms prompted ophthalmologic assessment, revealing bilateral anterior uveitis. Given the systemic presentation, syphilis serology was requested and returned positive for VDRL and TPHA, confirming secondary syphilis with otologic and ocular involvement. HIV testing was negative. The patient was treated with intravenous penicillin G for 14 days following neurosyphilis guidelines. At one month follow-up, auditory symptoms had improved only partially.Concomitant otosyphilis and ocular syphilis during the secondary stage are uncommon. This case differs from most reports which typically involve a single organ system, highlighting a less-recognized presentation.Primary care clinicians should maintain a low threshold for syphilis suspicion when evaluating unexplained sensorineural hearing loss, persistent ocular inflammation or systemic rash. Early investigation may reduce diagnostic delay and improve auditory outcomes, emphasizing the need for continuous training on atypical syphilis presentations.This case illustrates how common differential diagnosis may mask a multisystem infectious etiology. Delayed recognition of ocular syphilis and otosyphilis is associated with poorer recovery, reinforcing the importance of prompt diagnosis and multidisciplinary collaboration.Increasing awareness of atypical secondary syphilis presentations and improving diagnostic pathways in primary care is crucial to ensure early detection, to prevent irreversible complications and to limit transmission.

Headache is one of the most common complaints in primary care. While most cases are primary headaches, changes in headache pattern, inadequate response to treatment and increased analgesic use are red-flag indicators suggesting secondary causes.A 45-year-old woman presented to a primary care clinic with a one-year history of progressively worsening headaches, increasing from 1–2 times/month to 4–5 times/week, sometimes waking her from sleep. The pain was throbbing, radiating to the neck, and associated with photophobia, phonophobia and nausea, resulting in significant functional limitation. She had recently been evaluated by neurology, where migraine prophylaxis was adjusted, yet no improvement was achieved, and daily analgesic use increased. Vital signs and neurological examination were normal. Due to the presence of red-flag features, the family physician referred the patient to ENT for neck–carotid imaging. CT angiography revealed a 56×25 mm hypervascular mass, interpreted as a glomus tumor (vagal paraganglioma). Preoperative embolization and surgical excision were performed. The patient recovered well and continued follow-up in primary care.The only presenting symptom was headache, without neurological deficit or classic otologic complaints. The diagnosis of a rare glomus tumor was achieved solely through primary care clinical reasoning and red-flag assessment, not through typical tumor manifestations.Change in headache characteristics requires reassessment. Lack of improvement after specialist evaluation and increased analgesic use should alert clinicians to search for secondary causes. Early referral in primary care can prevent diagnostic delay and improve patient outcomes.Glomus tumors are rare and often present with nonspecific symptoms, leading to potential diagnostic delay. This case highlights the educational importance of recognizing red-flag features in common symptoms such as headache and demonstrates the critical role of family physicians in patient safety, decision-making and coordination of multidisciplinary care.Early identification of red-flag symptoms and timely referral enabled the diagnosis of a rare glomus tumor, reinforcing the pivotal role of primary care in early detection of serious disease behind common presentations.

Obstructive sleep apnea (OSA) is frequent but remains underdiagnosed in primary care. Screening strategies mainly rely on questionnaires and anthropometric measurements, while clinical observation is often underused. General practitioners routinely observe patients’ posture during consultation. Clinical experience suggests that patients with suspected OSA frequently present common postural characteristics, such as forward head posture (FHP) and shoulder curl, which may reflect chronic upper airway constraints and altered autonomic regulation. These postural features are easily observable and reproducible, and could represent an additional clinical approach to improve early identification of patients at risk for OSA in routine primary care practice.A retrospective study included 523 patients referred for suspected sleep disorders. Postural parameters (FHP assessed by inion–vertical distance, shoulder curl, shoulder antepulsion) were measured in standing position and correlated with polysomnographic and autonomic parameters using regression analysis and ANOVA.This study explores postural assessment as a novel, equipment-free clinical screening approach tailored for primary care. While posture is routinely observed by clinicians, it has rarely been formally evaluated in relation to sleep apnea severity. The originality lies in the use of simple, standardized postural measurements and their correlation with both respiratory and autonomic markers in a large clinical cohort.Simple postural assessment can provide additional clinical clues in patients with suspected obstructive sleep apnea in primary care. FHP and shoulder curl appear to be relevant markers, while not all postural parameters are clinically useful. Integrating postural observation into routine consultation may help improve early identification, guide referral for sleep investigations, and support non-CPAP management strategies, including postural and rehabilitative approaches. Future research should focus on prospective validation and on integrating postural assessment into simplified clinical screening tools for general practice.FHP and shoulder curl are associated with OSA severity (p < 0.01) and autonomic parameters, suggesting that posture reflects a clinically relevant respiratory phenotype. Not all postural measures are informative, underlining the importance of targeted clinical observation.Simple postural assessment, especially forward head posture and shoulder curl, may support earlier identification of obstructive sleep apnea in primary care and encourage integrated, clinically grounded management strategies for patients.