Steroidal mineralocorticoid receptor antagonists (MRAs) reduce morbidity in heart failure (HF) but frequently cause hyperkalemia, limiting long-term use. Non-steroidal MRAs such as finerenone offer improved receptor selectivity, but real-world comparative data remain scarce.

 We used the TriNetX Global Collaborative Network to identify adults with type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), and HF initiated on a non-steroidal (finerenone) or steroidal MRA (spironolactone, eplerenone) between January 2020 and December 2024. Propensity score matching (1:1) yielded 780 patients per cohort. Outcomes included hyperkalemia, arrhythmia, stroke, myocardial infarction (MI), and all-cause mortality.

 Non-steroidal MRAs were associated with significantly lower risks of hyperkalemia >5.5 mmol/L (16.0% vs 21.8%; HR 0.683, 95% CI 0.542-0.861; p=0.001) and severe hyperkalemia >6.0 mmol/L (7.6% vs 10.4%; HR 0.690, 95% CI 0.493-0.965; p=0.029). They were also linked to a lower arrhythmia incidence (31.2% vs 44.7%; HR 0.596, 95% CI 0.506-0.703; p<0.001), stroke (6.2% vs 9.9%; HR 0.606, 95% CI 0.422-0.869; p=0.006), and all-cause mortality (6.3% vs 16.5%; HR 0.359, 95% CI 0.258-0.499; p<0.001). MI was numerically lower (10.9% vs 13.5%; HR 0.762, 95% CI 0.572-1.014; p=0.061) but not statistically significant.

 In patients with T2DM, CKD, and HF, non-steroidal MRAs were associated with improved safety and cardiovascular outcomes compared with steroidal MRAs. However, the observational study design and, hence, the limitation in data that can be collected warrant cautious interpretation. Prospective randomized head-to-head trials are warranted before adaptation in clinical practice.

A 42-year-old man with poorly controlled diabetes mellitus, hypertension, chronic kidney disease, and a diabetic foot received treatment with panretinal laser photocoagulation in his right eye and intravitreal injection of Bevacizumab in both eyes to manage proliferative diabetic retinopathy accompanied by diabetic macular edema in the right eye and complicated by vitreous hemorrhage in the left eye. He then presented on the same day with right eye pain, eyelid swelling, ecchymosis, and subconjunctival hemorrhage. Additionally, he showed right-sided signs suggestive of facial palsy. Laboratory tests revealed a significantly low platelet count. Orbital and brain imaging ruled out retrobulbar hemorrhage and ischemic insults. A referral was made to a tertiary hospital for further evaluation and treatment of suspected disseminated intravascular coagulation (DIC) by a multidisciplinary team. To the best of our knowledge, the development of DIC after ocular procedures has not been previously reported. We recommend careful management of patients with poorly controlled diabetes and kidney disease to prevent further systemic complications.

Pityriasis versicolor (PV) is a common superficial fungal infection caused by Malassezia species, typically confined to seborrheic areas. Disseminated forms are uncommon and may reflect underlying host or environmental factors. We describe a 40-year-old male construction worker from a tropical region presenting with widespread hypopigmented macules and acanthosis nigricans. Direct microscopy confirmed Malassezia infection, and laboratory evaluation revealed previously unrecognized type 2 diabetes mellitus (T2DM) (acylated hemoglobin (HbA1c) 8%, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) 5.2; insulin resistance threshold > 2.5). Baseline liver function tests were normal. The patient achieved complete resolution after two weeks of oral itraconazole (100 mg twice daily) with concurrent initiation of metformin and dietary management. This single, hypothesis-generating case suggests that metabolic dysregulation may serve as a contextual rather than causal factor in PV dissemination, acting together with environmental conditions such as heat and humidity that favor fungal proliferation. We propose a speculative "partial-containment" model in which Malassezia overgrows within lipid-rich, low-inflammation environments, producing azelaic acid that suppresses melanogenesis and results in hypopigmentation. While causality cannot be determined from a single case, multidisciplinary care and metabolic screening may benefit patients with atypical or extensive PV, and prospective studies are warranted to validate these mechanisms.

Metabolic syndrome (MetS) is a cluster of conditions that increases the risk of cardiovascular disease and diabetes. It has become a major global health concern, significantly affecting adults worldwide. Dental caries is also one of the most prevalent diseases globally, sharing common risk factors with MetS. Despite emerging evidence suggesting a link between the two conditions, findings remain inconsistent, and no study has explored this association in a nationally representative US sample. Our study aimed to assess the association between dental caries and MetS, as well as to evaluate the effect of the five components of MetS, both separately and collectively, on dental caries.

In this cross-sectional study, data from the National Health and Nutrition Examination Survey (NHANES 2015-2018) were used to draw a sample of adults aged 30 years and older who had completed laboratory and clinical examinations for both MetS and dental caries. Dental caries outcomes were assessed using untreated caries and the decayed, missing, and filled teeth (DMFT) index, analyzed both as discrete and categorical (very low, low, moderate, and high) variables. MetS was defined using the National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATP III) criteria, requiring at least three of the five MetS components. Covariates included demographics, socioeconomic status, smoking, sugar intake, and dental visit history. Weighted descriptive statistics were calculated to include prevalence, chi-square, and p-value. Also, logistic regression was used to estimate crude odds ratios (cOR), adjusted odds ratios (aOR), and 95% confidence intervals (CI) for associations between untreated caries and MetS prevalence, number of MetS components, and individual components. Negative binomial regression was used to estimate crude mean ratios (cMR), adjusted mean ratios (aMR), and 95% CIs for associations with DMFT.

There were 3,291 participants who met our inclusion criteria. Approximately 1,342 participants (41%) had MetS, where the most affected groups were age 70 and above (267 participants, 45.13%), Hispanic race (442 participants, 44.47%), untreated dental caries (408 participants, 46.31%), and high DMFT score (588 participants, 44.80%) (p-value < 0.05). The odds of having untreated caries and a high DMFT score among the MetS group compared to no MetS increased by 34% (95% CI: 1.03-1.75) and 10% (95% CI: 1.11-1.23), respectively. Having all five MetS components increased the chance of having a higher DMFT score by 17% compared to having no MetS, but there was no statistically significant association between the number of MetS components and untreated caries. When one of the MetS components was insulin resistance, abdominal obesity, or low high-density lipoprotein (HDL), the odds of having untreated caries were significantly higher by 40% (95% CI: 1.06-1.86), 40% (95% CI: 1.08-1.83), and 45% (95% CI: 1.04-2.04), respectively.

Our study suggests that individuals with MetS are more likely to have dental caries. These findings highlight the importance of developing targeted prevention and management guidelines for dental caries in patients with MetS. The results can guide health providers in educating patients about MetS components to improve control and lower dental caries risk. Future cohort studies are needed to establish temporality and clarify the causal relationship between MetS and dental caries.

Vitamin D deficiency and gestational diabetes mellitus (GDM) are two overlapping public health concerns that are increasingly prevalent among pregnant women. This study was designed to assess whether serum vitamin D deficiency in the first trimester is associated with the development of GDM in an Indian antenatal population. This study aimed to evaluate the association between first-trimester serum 25-hydroxyvitamin D [25(OH)D] levels and subsequent development of GDM.

This prospective observational study was conducted over 18 months in a tertiary care center in South India. Eighty-seven singleton pregnant women in their first trimester (<13 weeks of gestation) were recruited. Exclusion criteria included pre-gestational diabetes and a previous history of GDM. Serum 25(OH)D was measured using chemiluminescence immunoassay (CLIA). The oral glucose challenge test was utilized for GDM screening at 24-28 weeks and again at 32-34 weeks. Statistical analyses included logistic regression and an ROC curve to identify predictive thresholds.

Vitamin D deficiency (<20 ng/mL) was detected in 60.9% of participants. GDM occurred in 30 women, with a significant association noted between vitamin D deficiency and GDM (p = 0.001). Logistic regression revealed that vitamin D deficiency conferred a fivefold increased risk of GDM (aOR: 5.03; 95% CI: 2.12-11.94). ROC analysis demonstrated high predictive accuracy (AUC = 0.94), with <19.5 ng/mL identified as the optimal threshold (sensitivity: 88.2%, specificity: 91.3%).

First-trimester vitamin D deficiency was significantly associated with increased risk of developing GDM later in pregnancy. These findings support routine early pregnancy screening for vitamin D and suggest potential benefits of timely nutritional interventions in high-risk populations.

This study aimed to assess the impact of knowledge, attitudes, and practices (KAP) related to oral health on oral health-related quality of life (OHRQoL) among patients with type 2 diabetes mellitus (T2DM).

A cross-sectional study was conducted from July 2023 to July 2024 in primary healthcare centers in the West Bank, using cluster sampling to select participants from three geographic regions A convenience sample was drawn from participants aged 40 years and older who were diagnosed with (T2DM). A structured validated Arabic questionnaire was employed to collect data on socio-demographic characteristics, oral health knowledge, attitudes, practices, and OHRQoL, using validated scales such as the OHIP-14.

The results showed that the mean OHRQoL score was 17.84 ± 11.65 (range 0-50), the primary domains negatively impacting participants' oral health-related quality of life were psychological discomfort, social disability, and handicap. Key oral health problems reported included dry mouth (62.2%), tooth loss (48.6%), and caries (46.1%). Knowledge scores averaged 6.53 ± 2.07 (range 1-10) attitudes scores were 4.88 ± 1.65 (range 0-6), and practices scores were 1.99 ± 1.02 (range 0-6). Spearman's correlation analysis revealed significant positive correlations between practice and knowledge (ρ = 0.160, P = 0.000), practice and attitude (ρ = 0.171, P = 0.000), and Knowledge and attitude (ρ = 0.238, P = 0.000). In the final model, predicting factors to improve OHRQoL were full-time employment, better income, and positive attitude, while poorer OHRQoL was predicted by pain reason to visit dentist, discussion with a dentist about diabetes and oral complications, poor general health status, poor oral health status, lower educational level, no history of diabetes and long duration of to do HbA1c test.

This study highlights that positive attitudes significantly improve OHRQoL in diabetic patients, while poor outcomes relate to socioeconomic and health system barriers. Despite good knowledge, practices remain inadequate. Integrating oral health into diabetes care, improving access, and addressing social determinants are essential for enhancing overall quality of life in this population.

The biomarkers associated with gestational diabetes mellitus (GDM) remain incompletely understood. This article is aimed at investigating whether inflammatory factors may contribute as risk factors for GDM.

The study included 160 adult patients with GDM, who were enrolled as the experimental group. Additionally, 280 healthy individuals from the same time period were selected as the control group. Cytokine expression levels were measured using a flow cytometer with fluorescence, while gene polymorphisms were analyzed through the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. The cytokines examined included interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α), and interferon-gamma (IFN-γ).

Significantly higher expression levels of IL-1, IL-6, IL-10, and TNF-α were detected in GDM patients (p < 0.05). Additionally, the study identified specific polymorphisms-IL-1β -511 C/T, IL-10 -1082 G/A, IL-6 -174 G/C, and TNF-α -308 G/A-that were significantly associated with an increased risk of GDM (p < 0.05). IL-6, TNF-α, and IL-1β levels significantly differed among genotypes of IL-6 -174 G/C, TNFA -308 G/A, and IL-1B -511 C/T, respectively (p < 0.01), with risk-associated alleles linked to higher cytokine expression. No significant differences were observed for IL-10 -1082 G/A or IFN-γ +874 A/T. These results suggest that select polymorphisms may regulate cytokine levels relevant to GDM inflammation.

Elevated plasma levels of IL-1, IL-6, IL-10, and TNF-α have been observed in patients with GDM. Furthermore, polymorphisms such as IL-1β -511 C/T, IL-6 -174 G/C, IL-10 -1082 G/A, IFN-γ +874 A/T, and TNF-α -308 G/A show a strong correlation with an increased risk of GDM in the Han women from northern China (specifically, Hebei Province). Pregnant women with ACC haplotypes of IL-10 have a lower risk of GDM. Cytokine gene polymorphisms in IL-6, TNF-α, and IL-1B are associated with altered inflammatory profiles in GDM, suggesting a genetic contribution to disease-related immune dysregulation. Our study suggests that these factors hold potential as biomarkers for the diagnosis and clinical prognosis of GDM in Han women from northern China (Hebei Province).

The aim was to investigate the potential therapeutic targets for ischemic stroke (IS) and vascular dementia (VD).

We assessed the causal effects of 2943 plasma proteins on IS and VD using a two-sample Mendelian randomization (MR) framework. Results were validated via summary data-based MR (SMR) analysis. A two-step mediation MR analysis was conducted to elucidate potential causal mechanisms by which plasma proteins influence IS and VD through risk factors. We performed a phenome-wide association study (PheWAS) MR analysis to explore side effects and additional indications for IS and VD-associated plasma proteins. We established middle cerebral artery occlusion and reperfusion (MCAO/R) and VD rat models to verify potential therapeutic targets for IS and VD.

Genetically predicted plasma levels of six proteins demonstrated causal relationships with both IS and VD. SMR analysis validated four of these proteins (CD40, F11, F2, and Furin). Atrial fibrillation (AF), type 2 diabetes (T2D), low-density lipoprotein (LDL), and diastolic blood pressure (DBP) were causally associated with the risk of IS and VD, indicating common risk factors. CD40 and Furin associations with IS and VD appeared to be mediated by AF or DBP. The mechanisms of action of IS- and VD-related proteins primarily involve the complement and coagulation cascade. In vivo experiments confirmed that CD40, Furin, F11, and integrin alpha-V (ITGAV) were causally associated with IS and VD.

Our findings illuminate causal pathways and potential therapeutic targets for IS and VD. We identified six plasma proteins with causal relationships to IS, VD, and their risk factors, providing insights into using these proteins as therapeutic targets for IS and VD.

Acute kidney injury (AKI) is a common and serious condition often associated with hypoalbuminemia, which can influence the pharmacokinetics and efficacy of diuretics like furosemide. In critically ill patients, sepsis is the major cause of AKI, accounting for nearly 50% of cases.

To evaluate whether AKI patients with hypoalbuminemia can respond to FST without albumin supplementation.

This is a prospective quasi-experimental study. Patients were obtained from the intensive care unit of Cairo University Hospital with AKI stages 1 and 2 with hypoalbuminemia. A bolus of furosemide was administered at a dose calculated to be 1-1.5 mg/kg in a single dose to patients without a prior diagnosis of kidney disease and clinical signs of hypovolemia.

A total of 41 critically ill patients with AKI were enrolled, aged between 18 and 80 years, of whom 56.10% had diabetes mellitus, 53.70% were on at least one nephrotoxic medication, and 56.10% had sepsis as the cause of AKI. The median (IQR) albumin level was 1.9 g/dL (1.4-2.7). Among 41 hypoalbuminemic AKI patients included, 80.50% responded to FST without prior albumin infusion. Non-responders had significantly lower baseline serum albumin levels, median (IQR) 1(1-2) vs. 2 (1-3) g/dL, p < 0.002).

AKI patients with mild-to-moderate hypoalbuminemia may still respond to FST without albumin infusion, although response rates decline with the increasing severity of hypoalbuminemia. The FST remains a valuable predictive tool in hypoalbuminemic AKI patients but warrants further investigation to optimize its utility in this population.

Not applicable.

Gestational diabetes mellitus (GDM) may adversely affect the long-term health of mother and child, as the condition puts both at risk for developing type 2 diabetes (T2D). Maintaining healthy behaviors/habits and undergoing a postpartum oral glucose tolerance test (OGTT) are validated strategies to prevent T2D as well as other long-term health issues among women with previous GDM. There is a need for more knowledge about how women with previous GDM perceive their health risks and practice self-care in the postpartum period, particularly in low- and middle-income settings.

This ethnographic study investigates how women with GDM in Vietnam perceive their diagnosis and practice self-care in the postpartum period, focusing on examining the interplay between postpartum maternal responsibilities, family support, and healthcare system engagement.

In-depth ethnographic interviews were carried out with 20 mothers who were three to six months postpartum after experiencing GDM in their most recent pregnancy. The interviews were held in the participants’ homes, using a phenomenological approach to explore their experiences and analyze the data.

Three themes emerged from the analysis as particularly pertinent to women’s self-care after GDM: (1) Lack of routine postnatal care and T2D screening in the healthcare system; (2) The mother’s attention and priorities in the postpartum period; (3) and Family expectations and cultural norms shape women’s postpartum health behaviors. The mothers and their family members showed a low-risk perception of GDM’s long-term risks, influenced by traditional customs and insufficient information from the healthcare system. As a result, many women viewed their T2D screening postpartum as insignificant. Prioritizing their own health and practicing postpartum GDM self-care were highlighted as challenging, as the child’s development became the whole family’s primary concern.

This study provides insights into mothers’ postpartum experiences following pregnancies with GDM, highlighting the barriers to GDM-compliant postpartum self-care. Addressing GDM self-care information gaps within the health care system, coordinating health care follow-ups for mother and child, and engaging family members in communication programs can support women in continuous postpartum care practices.

NCT05744856. (Registration Date: 2023-02-15 and Last Update Posted: 2024-04-30)

The online version contains supplementary material available at 10.1186/s12884-025-08399-x.