Acute coronary syndrome (ACS) in young adults presents unique clinical and diagnostic challenges, with limited data from the Indian subcontinent.

This study aims to assess the clinical profile, risk factors, and diagnostic findings of ACS in adults aged ≤40 years.

This hospital-based, cross-sectional study included 60 patients aged 18-40 with confirmed ACS. Clinical symptoms, laboratory investigations, Electrocardiography (ECG), echocardiography, and coronary angiography were analyzed. Associations were tested using the Chi-square test, with P < 0.05 considered statistically significant.

The median age was 35.5 years; 96.7% were males. Breathlessness and palpitations were reported in all cases, while chest pain was present in 81.7%. Hypertension (40%), diabetes (31.7%), smoking (28.3%), and drug use (55%) were common risk factors. Single-vessel disease was the predominant angiographic finding (61.7%). Smoking correlated significantly with ECG abnormalities (P = 0.0382), and diabetes with severe coronary involvement (P = 0.0429).

ACS in young adults is more prevalent in males and often presents with nonclassical symptoms. Diabetes and smoking are significantly associated with diagnostic severity. Early risk identification and preventive strategies are essential in this population.

Transition to adult health care for young people and young adults (YP/YA) with type 1 diabetes mellitus (T1DM) starts around 11 years of age, but transition services may not meet their needs. A combination of self-management support digital health technologies exists, but no supportive chatbots with components to help YP/YA with T1DM were identified.

The aims of this study were to (1) evaluate the novel DigiBete Chatbot, the first user-led, developmentally appropriate, clinically approved transition chatbot for YP/YA with T1DM from four English diabetes services and (2) assess the feasibility of a future trial of the chatbot.

In a prospective, multimethod, nonrandomized feasibility and acceptability study in the UK National Health Service, YP/YA with T1DM from 4 hospital diabetes clinics (2 pretransition and 2 posttransition) were enrolled in a 6-week study to test the DigiBete Chatbot. During the study, YP/YA completed web-based, validated, and standardized questionnaires at baseline, 2 weeks, and 6 weeks to evaluate quality of life and anxiety and depression, along with chatbot usability and acceptability. Qualitative interviews involving YP/YA, parents, and health care professionals explored their views on the chatbot. Data were analyzed using descriptive statistics and framework analysis.

Eighteen YP/YA were enrolled. Qualitative interviews were conducted with 4 parents, 24 health care professionals, and 12 YP/YA. Questionnaire outputs and the emergent qualitative themes (living with T1DM, using the chatbot, and refining the chatbot) indicated that the measures are feasible to use and the chatbot is acceptable and functional. In addition, responses indicated that, with refinements that incorporate the feasibility results, the chatbot could beneficially support YP/YA during transition. Users scored the chatbot as "good" to "excellent" for being engaging, informative, and aesthetically pleasing, and they stated that they would use it again. The results suggest that, with some adaptations based on user feedback, the chatbot was feasible and acceptable among the YP/YA who enjoyed using it. Our reactive conversational agent offers content (messaging and additional multimedia resources) that is relevant for the target population and clinically approved. The DigiBete Chatbot addresses the identified lack of personalized and supported self-management tools available for 11-24 year olds with T1DM and other chronic conditions.

These results warrant chatbot refinement and further investigation in a full trial to augment it prior to its wider clinical use. Our research design and methodology could also be transferred to using chatbots for other long-term conditions. On the premise of this feasibility study, the plan is to rebuild the DigiBete Chatbot to meet identified user needs and preferences and progress to a national cohort study to assess the usability, feasibility, and acceptability of a modified chatbot, with a view to proceeding to rollout for national and international use on the established DigiBete platform.

Inflammatory bowel diseases (IBDs) are complex immune-mediated disorders characterised by an unpredictable direction and commonly associated metabolic comorbidities along with obesity and type 2 diabetes mellitus (T2DM). Recent evidence has highlighted the therapeutic capacity of glucagon-like peptide 1 receptor agonists (GLP-1 RAs), already employed in treating T2DM and obesity, in modulating systemic and intestinal inflammatory responses. This narrative review examines the general organic traits of GLP-1, with a specific awareness of its primary gastrointestinal actions and the efficacy of GLP-1 RAs in promoting weight loss and dealing with glycaemic control, mainly in sufferers with IBD. Furthermore, the effects of those agonists on the progression of IBD, their protection profile, their impact on bowel preparation for endoscopic procedures, and their therapeutic capacity, supported through preclinical and early clinical studies, are discussed. GLP-1 RAs appear to lessen the intestinal inflammatory burden by enhancing intestinal epithelial barrier features and modulating the gut microbiota. However, further clinical research will be necessary to verify whether GLP-1 RAs could play a position in IBD treatment.

RNA methylation plays a critical role in regulating all aspects of RNA function, which are implicated in the pathogenesis of various human diseases. Recent studies emphasize the role of 5-methylcytosine (m5C), an RNA modification, in key biological functions. Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as the leading chronic liver condition globally. However, the relationship between m5C methylation and MASLD remains unclear. This study aimed to investigate m5C modification in a mouse model of MASLD. In this research, using RNA transcriptome sequencing (RNA-Seq) and methylated RNA bisulfite sequencing (RNA-BS-Seq) in leptin receptor-deficient mice, we found that genes associated with hypermethylation were primarily linked to lipid metabolism. We identified 156 overlapping and differentially expressed genes (DEGs) that changed at both the mRNA expression level and the m5C modification level. Among them, 72 genes showed elevated expression and m5C modification. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses indicated that these genes were significantly associated with lipid metabolism-related signaling pathways. Our results demonstrate that m5C methylation modifications may play an important role in the development of MASLD.

Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) have emerged as a promising therapeutic option beyond their established role in managing type 2 diabetes mellitus (T2DM) and obesity. Recent research has highlighted their beneficial effects on liver, kidney, and cardiovascular health, mediated by both direct and indirect mechanisms. In the liver, GLP-1 RAs contribute to the improvement of metabolic dysfunction-associated steatotic liver disease (MASLD) by reducing hepatic fat accumulation, inflammation, and oxidative stress. Additionally, they enhance insulin sensitivity and lipid metabolism. Similarly, in diabetic kidney disease (DKD), GLP-1 RAs exhibit renoprotective properties by mitigating inflammation, oxidative stress, and glomerular hypertension. Furthermore, they promote natriuresis and stabilize renal function. Moreover, GLP-1 RAs present significant cardiovascular benefits, including improved myocardial function, reduced atherosclerosis progression, enhanced endothelial health, and decreased major adverse cardiovascular events (MACEs). Additionally, emerging evidence suggests GLP-1 RAs may exert substantial neuropsychiatric benefits, including reductions in depressive symptoms, anxiety, substance use behaviors, and lowering the risk of Alzheimer's disease, Parkinson's disease, and other dementias likely mediated by the modulation of neurotransmitter systems and neuroinflammation. Genetic polymorphisms in the GLP1R gene also impact the therapeutic response, highlighting the importance of personalized medicine in optimizing GLP-1 RA efficacy. This review synthesizes preclinical and clinical evidence supporting the multifaceted effects of GLP-1 RAs across multiple organ systems, highlighting their therapeutic potential beyond glycemic control. As research advances, further exploration of their mechanisms of action and long-term clinical outcomes, safety and effectiveness across diverse patient populations will be essential in optimizing their use in treating metabolic and neuropsychiatric conditions.

Dapagliflozin has demonstrated multiple benefits in clinical trials for heart failure with reduced ejection fraction (HFrEF), but older patients with multiple comorbidities were often excluded. This study aimed to evaluate the effectiveness and safety of dapagliflozin in a real-world population of HFrEF patients. This retrospective study included HFrEF patients from a tertiary hospital, who initiated dapagliflozin between January 202 and December 2022. The mean follow-up was 15.3 ± 8.3 months. Each patient served as their own control to compare left ventricular ejection fraction (LVEF), laboratory parameters, and time-dependent events, such as heart failure (HF) readmissions. A total of 155 HFrEF patients (mean age 68.5 ± 14.5 years; 75.5% male) were included. Of these, 47.1% had non-ischemic heart disease, 49.0% had type 2 diabetes mellitus, and most were on beta-blockers, loop diuretics and angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker, or angiotensin receptor neprilysin inhibitor. LVEF improved from 29.2% to 34.3% (P < .001), with significant reductions in body weight and heart rate (P < .001). HF-related emergency room visits decreased (0.68 ± 1.06 to 0.58 ± 0.96; P = .329). Renal function declined, with glomerular filtration rate decreasing from 67.6 ± 25.2 to 55.2 ± 30.8 mL/min/1.73 m² (P < .001), particularly in older patients (HR 1.033; 95% CI: 1.004-1.063) and those with higher baseline heart rate (HR 1.028; 95% CI: 1.011-1.045). Severe adverse drug reactions occurred in 3.9% of patients, with hypotension (12.9%) being the most common. In conclusion, dapagliflozin demonstrated a favorable safety profile and significant hemodynamic benefits, improving LVEF and stabilizing HF progression in a real-world HFrEF population.

Gestational diabetes mellitus (GDM) is a prevalent metabolic disorder that can occur during pregnancy, leading to various complications for both the mother and the fetus. Additionally, women with gestational diabetes are at a higher risk of experiencing mental health disorders. This study was conducted to investigate the impact of group counselling based on mindfulness on perceived stress in pregnant women with gestational diabetes, given the influence of cognitive-behavioral interventions such as mindfulness on stress and anxiety.

In this research, 80 pregnant women diagnosed with gestational diabetes were randomly divided into two groups: an intervention and a control. Before the intervention, participants completed a questionnaire that included demographic and obstetric information as well as the Cohen Perceived Stress Questionnaire. The intervention group participated in 8 sessions of mindfulness counselling, with each session lasting between 45 and 60 minutes. Mindfulness sessions focused on emotion regulation. The control group did not receive any intervention. Participants completed the questionnaires one month after the initial intervention in the control group and right after the counselling ended in the intervention group.

The mean score of perceived stress among pregnant women decreased significantly after the intervention (p ˂0.001). There was no difference in socio-demographic characteristics between the groups (p ˃0.05). After the intervention, the perceived stress levels of pregnant women significantly decreased compared to before (from 29.72 (5.33) to 26.10 (5.07)), and after the ANCOVA test, the difference was statistically significant (p ˂0.001).

Mindfulness-based counseling plays an important role in reducing the stress of pregnant women with gestational diabetes through increased awareness, and it can help them control disease conditions, reduce stress, and apply effective coping strategies for stress. Mindfulness- based counseling reduces the perceived stress of pregnant women and thus reduces adverse physical and psychological consequences during pregnancy.

A 44-year-old man with uncontrolled diabetes mellitus (A1C: 9.9%), a well-established risk factor for infection, presented with acute onset of complete vision loss in the right eye (OD) associated with periorbital swelling, pain, and proptosis. Visual acuity was no light perception OD with intraocular pressure of 45 mmHg. Clinical examination revealed significant right sided proptosis and orbital inflammation. Emergent canthotomy and cantholysis were performed. He was then taken to the operating room where biopsy revealed a rapidly progressive orbital necrotizing fasciitis (ONF) involving Prevotella baroniae. Due to clinical worsening despite broad spectrum antibiotics and surgical debridement, the patient ultimately required orbital exenteration. The identification of Prevotella baroniae in the orbit is rare. This case highlights the aggressive nature of ONF and its potential for progression to orbital compartment syndrome, emphasizing the need for high clinical suspicion of these conditions. Timely surgical and medical interventions are imperative for preserving visual function and preventing mortality.

Butyrylcholinesterase (BChE) has recently been associated with metabolic imbalance. A correlation between plasma activity and lipid and glucose metabolism has been reported in animal models and human patients. Here, we investigated plasma BChE activity in a rat model of comorbid hypertension and type 1 diabetes mellitus (DM) induced by a single injection of streptozotocin (STZ, 55 mg/kg) in male spontaneously hypertensive rats (SHR) (SHR+DM). The SHR+DM animals exhibit the main characteristics of the human comorbid pathology, including hypertension and hyperglycemia. Although STZ lowered blood pressure in SHR, the animals remained hypertensive as compared to the Wistar controls. Plasma levels of triacylglycerols, cholesterol and HDL were increased, while markers of liver damage such as ALT, AST, were increased and albumin was decreased. Plasma BChE activities were similar in Wistar and SHR. In SHR+DM, plasma BChE activity was increased by 43 %. Interestingly, liver BChE activity and relative mRNA expression were decreased by 60 % in SHR and SHR+DM. While plasma BChE activity is often used as a clinical marker of liver injury, our results suggest that it may not be a reliable indicator. Key words Butyrylcholinesterase " Streptozotocin " Spontaneously hypertensive rats " Diabetes mellitus " Liver damage.

Continuous glucose monitoring (CGM) has emerged as an important tool for managing gestational diabetes mellitus (GDM), offering real-time glucose data and the potential for improved glycemic control. Unlike traditional self-monitoring of blood glucose (SMBG), which provides intermittent readings, CGM captures continuous glucose fluctuations, including postprandial and nocturnal changes, which are critical in GDM management.

This systematic review aimed to assess the effectiveness of CGM compared with SMBG in managing glycemic control in women with GDM, focusing on key glycemic metrics such as time in range (TIR) and glycemic variability (GV), and exploring their associations with maternal and neonatal outcomes.

A comprehensive search of PubMed and Google Scholar was conducted, adhering to PRISMA guidelines. Studies included randomized controlled trials, observational studies, and prospective cohort studies comparing CGM and SMBG, with 35 studies ultimately reviewed.

Compared with SMBG, CGM demonstrated significant improvements in maintaining TIR and reducing GV, which correlated with favorable maternal and neonatal outcomes, including lower rates of large-for-gestational-age (LGA) infants, preterm birth, and NICU (neonatal intensive care unit) admissions. Furthermore, CGM detected more hyperglycemic and hypoglycemic events, particularly nocturnal fluctuations. However, the studies also highlighted the need for standardized metrics to optimize CGM use in GDM management.

Continuous glucose monitoring offers substantial advantages over SMBG for managing GDM by providing continuous, real-time glucose data, enabling timely treatment adjustments. These findings support the integration of CGM into clinical practice to improve maternal and neonatal outcomes in GDM. Further research is needed to establish standardized CGM metrics specific to GDM management.