Objective The purpose of this study was to better understand the impact of a preexisting diagnosis of rheumatoid arthritis (RA) on patient hospital outcomes in acute coronary syndrome (ACS) in comparison to traditional ACS risk factors. Methods This retrospective study protocol included 673 patients hospitalized with ACS in the HCA Healthcare West Florida Division from January 1, 2016, to December 31, 2023. Analysis via logistic regression and negative binomial regression compared associations between patients with ACS as primary diagnostic codes during their hospital admissions who also had RA, considering demographics like age, sex, and race. Patient encounters and diagnoses were identified using ICD-10 codes. Regression models were used for our analysis due to the straightforward computation, increased reproducibility, ability to use both categorical and continuous variables, and capability to convert diagnostic codes into binary variables. Traditional risk factors for ACS were also included in multivariate analyses. These included current tobacco use, former tobacco use, alcohol use disorder, elevated BMI, hyperlipidemia (HLD), and diabetes mellitus (DM). Pregnant patients, patients below 18 years of age, patients missing demographic information, and patients with other autoimmune conditions were excluded from the study. Results For RA, the odds of in-hospital mortality were not significantly 0.779 times as likely (p-value 0.2252, 95% CI (0.520, 1.167)), and 30-day readmission odds were not significantly 0.948 times as likely (p-value 0.5671, 95% CI (0.789, 1.139)). RA resulted in a 1.034-factor statistically insignificant increase in length of stay (LOS) (p-value 0.3369, 95% CI (0.965, 1.108)). For the traditional risk factors, odds of in-hospital mortality were 1.071 times as likely for every one-year increase in age (p-value <0.0001, 95% CI (1.065, 1.077)), 1.285 times as likely for current smokers (p-value 0.0020, 95% CI (1.096, 1.507)), 0.970 times as likely for every one-point increase in BMI (p-value <0.0001, 95% CI (0.961, 0.980)), 0.647 times as likely for patients with HLD (p-value <0.0001, 95% CI (0.576, 0.726)), and 1.349 times as likely for patients with DM (p-value <0.0001, 95% CI (1.212, 1.502)). Age, DM, and alcohol use disorder resulted in statistically significant increased 30-day readmission. Age, male sex, Black race, other non-Caucasian races, former tobacco use, current tobacco use, DM, and alcohol use disorder resulted in statistically significant increased LOS. Conclusions RA was surprisingly associated with decreased in-hospital mortality and 30-day readmission in the setting of ACS despite an associated increased LOS, which needs to be investigated further. In terms of statistical significance, there was no difference in these outcomes in patients with RA versus patients without RA. HLD was unexpectedly associated with a significant decrease in in-hospital mortality, which requires further investigation. Meanwhile, the traditional risk factors, except BMI and HLD, continued to show worse outcomes with statistical significance in the same patient population. Longitudinal follow-up and further clinical investigation of these patient encounters will likely shed more light on these associations. This knowledge may prevent over-utilization of time, equipment, and resources when addressing hospitalized patients with RA presenting with ACS, particularly in acute care settings.

Acute coronary syndrome represents a major global health issue. The aim of the study was to identify the risk factors related to acute coronary syndrome among patients admitted to cardiac care units in governmental hospitals in the Gaza Strip.

An analytical case-control study was conducted from February to September 2023, involving 300 participants (100 cases and 200 controls) selected by quota sampling from governmental hospitals in the Gaza Strip. The data were collected using structured interviews and questionnaires. Reliability testing by Cronbach's alpha coefficient (0.87) and statistical analysis was conducted using SPSS version 25.

Among the participants, 78 % were male while 22 % were female. 30 % fell into the age group of 56-60 years, and 34 % received treatment at Al Shifa Medical Complex. The logistic regression analysis revealed several significant risk factors associated with acute coronary syndrome. These included lower income (OR = 2.32, 95 % CI: 1.36-3.94, p = 0.002) and family history of acute coronary syndrome (OR = 5.46, 95 % CI: 3.24-9.19, p < 0.001). smoking (OR = 4.38, 95 % CI: 2.62-7.34, p < 0.001). A history of hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, and NSAID drug use is associated with acute coronary syndrome, overweight (OR = 2.86, 95 % CI: 1.58-5.19, p = 0.001), obesity (OR = 6.74, 95 % CI: 3.30-13.78, p < 0.001), higher waist-to-height ratio (OR = 3.75, 95 % CI: 1.62-8.66, p = 0.002), and waist-to-hip ratio (OR = 5.07, 95 % CI: 2.64-9.71, p < 0.001).

This study highlights lower income and familial predisposition as critical acute coronary syndrome predictors in Gaza, alongside traditional risks like obesity and smoking. Implementing strategies to control these risk factors and improve preventive measures is crucial for reducing the incidence of acute coronary syndrome.

Type 2 diabetes mellitus (T2DM) is associated with lower gray matter (GM) volumes. However, little is known about the impact of glycemic control on brain atrophy, especially in highly susceptible regions. Therefore, we aim to identify the effect of glycemic variability (GV) on long-term changes in brain volume among individuals with T2DM.

A longitudinal clinical, biochemical, and imaging assessment was conducted at a baseline visit on 170 individuals (85 with T2DM), from which 29 (15 with T2DM) were evaluated at a 7-year follow-up visit. Brain regional volumes were evaluated with 3 T MRI, using the FreeSurfer 7 longitudinal pipeline. GV metrics such as SD, M-value, MAG (mean absolute glucose change), MAGE (mean amplitude of glycemic excursion), and CoV (coefficient of variation) were calculated in both visits.

Statistically significant negative correlations between GV metrics and symmetrized percent change (SPC) of GM volumes were found in specific cortical and subcortical regions of individuals with T2DM. MAGE was correlated with regionally specific atrophy on the temporal lobe (r = -0.63, p = 0.021), insula (ρ = -0.62, p = 0.022), thalamus (r = -0.64; p = 0.024), hippocampus (r = -0.59; p = 0.034), and putamen (ρ = -0.65, p = 0.017). Concerning the hippocampal subregions, the presubiculum was significantly correlated with MAGE (r = -0.73; p = 0.005). Baseline GV was consistently associated with temporal lobe SPC. Linear regression analysis showed that, for each increase of 1 mmol/L in MAGE value, the SPC of the temporal lobe decreases on average by 1.2% (higher atrophy rate).

The relationship between longitudinal GM atrophy and GV has a regionally specific pattern, suggesting localized brain susceptibility to intra-daily glucose fluctuations. Negative correlations between GV metrics and SPC volume of regions involved in habit-learning, decision-making, and memory highlight GV as a mediator of the neural impact of T2DM on the reward prediction-error circuits.

This review examines the bidirectional relationship between periodontitis and systemic health conditions, offering an integrated perspective based on current evidence. It synthesizes epidemiological data, biological mechanisms, and clinical implications to support collaborative care strategies recognizing oral health as a key component of overall wellness. Periodontitis affects 7.4% to 11.2% of adults worldwide, and its prevalence increases with age. Beyond its local effects, including gingival inflammation, periodontal pocket formation, and alveolar bone loss, periodontitis is associated with various systemic conditions. Emerging evidence has established links with obesity, diabetes mellitus, cardiovascular disease, chronic kidney disease, inflammatory bowel disease, rheumatoid arthritis, respiratory diseases, adverse pregnancy outcomes, certain malignancies, neurodegenerative diseases, psychological disorders, and autoimmune conditions. These associations are mediated by 3 primary mechanisms: dysbiotic oral biofilms, chronic low-grade systemic inflammation, and the dissemination of periodontal pathogens throughout the body. The pathophysiology involves elevated levels of pro-inflammatory cytokines (including interleukin 6, tumor necrosis factor alpha, and C-reactive protein), impaired immune function, oxidative stress, and molecular mimicry. Periodontal pathogens, particularly Porphyromonas gingivalis, are crucial in initiating and sustaining systemic inflammatory responses. Treatment of periodontitis has demonstrated measurable improvements in numerous systemic conditions, emphasizing the clinical significance of these interconnections. Periodontitis should be understood as more than just a localized oral disease; it significantly contributes to the overall systemic inflammatory burden, with implications for general health. An integrated, multidisciplinary approach to prevention, early detection, and comprehensive treatment is vital for optimal patient outcomes. Healthcare providers should acknowledge oral health as an essential element of systemic well-being.

Diabetes mellitus (DM) has been linked to unfavorable outcomes in patients undergoing Mitral Transcatheter Edge-to-Edge Repair (TEER). Nevertheless, the literature contains conflicting data. This meta-analysis aimed to assess the impact of DM on outcomes following Mitral TEER.

We searched PubMed, Scopus, and Medline for studies reporting outcomes following mitral TEER in diabetic and non-diabetic patients. Using a random-effects model, we determined the pooled odds ratio (OR) for clinical outcomes in patients who underwent Mitral TEER, regardless of their diabetes status.

We included four studies with 2130 patients. DM was present in 31 % of the population, with a mean age of 73.9 (±8.2) years, 50.2 % of males, and 30 % of the population being obese. Patients with DM were more likely to be obese compared to patients without DM. In this meta-analysis, individuals with DM exhibited a higher 30-day MACCE (OR: 1.50, 95 % CI: 1.08-2.09, p = 0.02) and all-cause recurrent hospitalizations (OR: 1.36, 95 % CI: 1.07-1.72, p = 0.01) compared to those without diabetes. However, the difference in 30-day all-cause mortality (OR: 1.20, 95 % CI: 0.92-1.56, p = 0.19) and in-hospital all-cause mortality (OR: 0.92, 95 % CI: 0.51-1.67, p = 0.78) was not statistically significant between the two groups.

DM is associated with an increased risk of 30-day MACCE and recurrent hospitalizations following Mitral TEER. Consequently, DM should be regarded as a predictor of adverse outcomes. Future, well-designed prospective randomized trials are necessary to evaluate the mid-term impact of DM on MACCE.

Diabetic foot ulcers reduce patient's quality of life and increase treatment costs, evaluating this condition is promising. We report the clinical progression of an elderly patient who developed a diabetic foot ulcer following minor trauma. She was treated for over 2 months until her condition progressed to Grade 4 on the Wagner Classification of Diabetic Foot. A Serial infrared thermography was performed. The treatment plan included antibiotics and a polylactic acid membrane until complete ulcer remission. Thermographic imaging showed a quantitative reduction of the temperature differences between the affected and contralateral foot from an initial ΔT: -4.6°C ± 2.4, progressing to ΔT: -1.7°C ± 1.6 at 12 weeks, and a temperature reduction from the proximal third tibial area with ΔT: -1.7°C ± 0.6, with a change to ΔT 0.8°C ± 0.4 at 12 weeks near the metatarsal bone region. This article underscores the use of infrared thermography to give physicians feedback on ulcer healing progression phases and treatment effectiveness.

Pulmonary mucormycosis (PM) is an invasive and life-threatening fungal infection that predominantly affects immunocompromised individuals. This study thoroughly examined the disease through three case reports and a literature review. Case 1 involved a patient with type 1 diabetes mellitus diagnosed through bronchoscopic histopathology, who succumbed despite a combination of oral isavuconazole, nebulized amphotericin B, and intravenous amphotericin B cholesteryl sulfate complex. Case 2 involved a patient with follicular non-Hodgkin lymphoma who had a concurrent coronavirus disease 2019 (COVID-19) infection, which was confirmed through metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF). The patient experienced clinical improvement following sequential intravenous voriconazole, amphotericin B cholesteryl sulfate complex, and oral isavuconazole. Case 3 involved a patient diagnosed with mNGS in a lung cancer patient with chronic obstructive pulmonary disease, who showed poor therapeutic response to combined intravenous voriconazole, amphotericin B cholesteryl sulfate complex, and oral isavuconazole, resulting in fatal outcomes. Literature synthesis revealed mortality rates of 28.3% with antifungal monotherapy compared to 23.7% when antifungal monotherapy was combined with bronchoscopic intervention; the mortality rate for antifungal-surgical combination therapy was 9%. Notably, all 13 patients receiving multimodal treatment (antifungals, bronchoscopy, and surgery) survived. These findings underscore that combination therapy integrating pharmacotherapy, bronchoscopic intervention, and surgical resection demonstrated significantly superior survival outcomes compared to monotherapy.

Chronic hyperglycemia, a defining feature of type 2 diabetes (T2D) and related metabolic disorders, exacerbates insulin resistance and impairs muscle glucose utilization, contributing to systemic metabolic dysfunction. While skeletal muscle is the primary site for postprandial glucose uptake and plays a pivotal role in maintaining whole-body glucose homeostasis, the molecular mechanisms by which hyperglycemia induces maladaptive responses in muscle remain poorly understood. Here, PAXIP1-associated glutamate-rich protein 1 (PAGR1) is identified as a glucose-responsive regulator in skeletal muscle, whose expression is induced by high glucose levels and modulates systemic glucose homeostasis and hepatic metabolism. Using muscle-specific PAGR1-knockout mice, it is demonstrated that PAGR1 deficiency enhances insulin signaling, promotes glucose transporter 4 (GLUT4) translocation, and increases muscle glucose uptake and utilization. Mechanistically, PAGR1 directly activates the expression of TBC1 Domain Family Member 4 (TBC1D4), a RAB GTPase Activating Protein (RabGAP) known to negatively regulate GLUT4 translocation. Importantly, muscle-specific deletion of PAGR1 protects against high-fat-diet-induced insulin resistance and hepatic steatosis. These findings establish PAGR1 as a critical mediator of muscle glucose sensing and utilization, positioning it as a potential target for therapeutic strategies aimed at mitigating glucotoxicity and preventing metabolic diseases such as T2D.

Glycogen synthase kinase-3β (GSK-3β) is a proline-directed serine/threonine kinase identified over 40 years ago. It is the key enzyme involved in glycogen biosynthesis and is expressed in all human tissues. Overexpression of GSK-3β is linked to several diseases, including diabetes mellitus, neurodegenerative disorders such as Alzheimer's disease, and cancer. Owing to its critical role in the pathophysiology of these diseases, GSK-3β has emerged as a validated and potential target for therapeutic intervention. In recent years, significant progress has been made in developing novel GSK-3 inhibitors. Some of these new inhibitors have shown promising results in treating some of these diseases.

This review covers patent literature on various GSK-3β inhibitors published between 2019 and 2024. This review also discusses the recent clinical developmental status of some of the promising GSK-3 inhibitors.

Although many heterocyclic compounds from natural as well as synthetic origin have shown promising inhibitory effects against GSK-3β, most of them have not yet progressed to the development stage. However, a critical review of their structures and biological profiles reveals significant potential for further development.

This report details the case of a 64-year-old male with well-controlled type 2 diabetes mellitus and hypertension. The patient presented with a 20-day history of progressive dyspnea, cough, and intermittent fever, which worsened despite antibiotic treatment. The initial assessment revealed leukocytosis, neutrophilia, and abnormal chest computed tomography (CT) findings, which led to a provisional diagnosis of pulmonary infection. However, empirical antibacterial therapy was ineffective. Further investigations revealed a right perinephric abscess and empyema caused by an oral anaerobic bacterial infection. Although the sputum cultures were negative, targeted next-generation sequencing (tNGS) identified multiple oral anaerobes. The patient was treated with metronidazole and drainage. After 33 days, the symptoms and laboratory abnormalities gradually resolved. Follow-up over one year demonstrated complete resolution of symptoms, normalization of inflammatory markers and no recurrence of the infection. This case highlights the importance of considering occult anaerobic infections in refractory febrile patients with diabetes, while also raising awareness of the rare complication of perinephric abscess and highlighting the value of tNGS in pathogen identification.