Search Results (230)

Background/Objectives: Acute coronary syndrome (ACS) in old people is a growing global health problem, with high incidence and mortality. The aim of this study was to assess the cardiovascular risk factors in older patients with ACS, with particular emphasis on sex differences. Methods: We retrospectively analyzed 1482 patients with ACS (1184 old patients; men ≥ 55 years and women ≥ 65 years) and 298 young ACS patients (men ≤ 55 years and women ≤ 65 years) from University Clinical Centre of Kosovo. Data on cardiovascular risk factors, echocardiographic, electrocardiographic, angiographic indices and medications were collected from medical records. Results: Old ACS patients had higher prevalence of diabetes (50.1 vs. 34.6%; p < 0.001), hypertension (79.8 vs. 42.8; p < 0.001), multivessel coronary artery disease (88.6 vs. 22.1%; p < 0.001) but less prevalent hypercholesterolemia (31.5 vs. 48.2; p < 0.001), smoking, family history of coronary artery disease and other noncardiac risk factors compared with young ACS patients (p < 0.05, for all). Older women smoked less (26.3 vs. 41.1; p < 0.001) and drank less alcohol (0.8 vs. 6.8%; p < 0.001) but had higher prevalence of uncontrolled diabetes, arterial hypertension and hypercholesterolemia (p < 0.05 for all) compared with older males. Family history for coronary artery disease (CAD) was not significant between groups. Multivariate analysis revealed uncontrolled diabetes (OR = 2.26; 95% CI: 1.104–3.989; p < 0.001) and having three or more cardiac risk factors (OR = 3.141; 95% CI: 2.166–4.406; p < 0.001) as the strongest independent predictors of ACS in old patients. These associations remained significant when stratified by gender, with even stronger impact in female (uncontrolled diabetes OR = 2.942, 95% CI: 1.644–4.890; p < 0.001; ≥3 risk factors OR = 2.821; 95% CI: 1.782–4.436; p < 0.001) and in males who smoked (OR: 2.381, 95% CI: 1.109–2.981; p < 0.001). Conclusions: Uncontrolled diabetes and multiple cardiovascular risk factors are key contributors to ACS in older adults. Early identification and management of these risk factors are essential in reducing the burden of CAD older patients. Full article

Background: Diabetes Mellitus (DM) represents a significant public health challenge in Pakistan, with a high prevalence exacerbated by various socio-demographic, clinical, and environmental factors. Community pharmacies offer an accessible setting for managing chronic diseases, yet the combined influence of these factors on diabetes control within Pakistani community settings remains underexplored. Objective: This study aimed to assess the impact of socio-demographic, environmental, and clinical factors on diabetes control among patients attending community pharmacies in Lahore, Pakistan. Methods: A cross-sectional study was conducted involving 321 patients with type 2 diabetes recruited from community pharmacies across three regions of Lahore. A structured questionnaire, developed based on international guidelines, was used to collect data on socio-demographic characteristics, clinical history, lifestyle behaviors, and environmental factors. Diabetes control was categorized as controlled, partially controlled, or uncontrolled. Data were analyzed using descriptive statistics, chi-square tests, and multiple logistic regression in SPSS version 26.0. Results: Key socio-demographic predictors of better diabetes control included higher education levels (AOR = 1.317–2.338, p ≤ 0.006) and non-obese status (AOR = 1.057, p = 0.006). Significant clinical and lifestyle predictors were treatment adherence (AOR = 1.287, p < 0.001), regular physical activity (AOR = 1.387, p < 0.001), healthy dietary patterns (AOR = 1.317, p < 0.001), and longer duration of diabetes (>5 years, AOR = 1.277, p = 0.008). Conversely, a family history of diabetes (AOR = 1.967, p < 0.001) and the presence of comorbidities were associated with poorer control. Rural residence showed lower odds of good diabetes control (AOR = 0.857, p = 0.001). Smoking status was also influential, with ex-smokers demonstrating better control than current smokers. Conclusions: Diabetes control is multifactorial, strongly influenced by education, residence, obesity, lifestyle behaviors, and treatment adherence. Interventions targeting modifiable risk factors through patient education, lifestyle counseling, and personalized care are essential to improve diabetes outcomes in community settings. These findings underscore the critical role of community pharmacists in providing holistic diabetes management. Full article

Mucormycosis (MCM) is an opportunistic fungal infection in immunocompromised hosts, most commonly associated with poorly controlled diabetes mellitus (DM). We conducted a retrospective review of 45 MCM cases diagnosed between 2010 and 2023 at a referral center in Central California, a region with high DM prevalence and significant healthcare disparities. Clinical features, histopathology, microbiology, treatment, and outcomes were analyzed. Ninety-six percent of patients had DM, and 69% had no other predisposing condition. Glycemic control was markedly poor: 36% had HbA1c > 10%, and 61% had HbA1c > 8%. Diabetic ketoacidosis (DKA) was present in 19% of patients and associated with 100% mortality. Rhino-orbito-cerebral mucormycosis (ROCM) accounted for 60% of cases and carried a 70% mortality rate. Angioinvasion, confirmed in 62% of biopsied cases, significantly increased mortality (69% vs. 28%, p = 0.015). In-hospital mortality remained high at 58%, consistent with outcomes reported in other high-burden settings. Over 60% of patients identified as Hispanic. ZIP code–based analyses revealed that 75% of individuals lived in neighborhoods with Healthy Places Index (HPI) scores below the 25th percentile, and 64% resided in areas with a Social Deprivation Index (SDI) of 85 or higher, indicating entrenched structural disadvantage. Our findings highlight that MCM in Central California disproportionately affects individuals with uncontrolled DM living in socially deprived areas. These data underscore the need for early diagnosis, targeted antifungal therapy, and upstream public health interventions addressing diabetes management and healthcare access. Full article

Type 2 diabetes mellitus (T2D) is a chronic metabolic disorder in which inflammation plays a central role in its onset, progression, and complications. Identifying reliable biomarkers is essential to improve risk prediction, disease monitoring, and early intervention. A total of 169 Ecuadorian participants were stratified into four clinical groups: non-diabetic controls (NDC), controlled T2D (C-T2D), uncontrolled T2D (NC-T2D), and diabetic kidney disease (DKD). Circulating levels of cytokines (IL-6, IL-8, TNF-α), adipokines (leptin, adiponectin), and PBMC-derived microRNAs (miR-146a, miR-155) were quantified. Associations with disease stage were evaluated using ROC curve analysis and logistic regression. Leptin showed the strongest association with T2D (OR = 13.76, 95% CI: 6.47–29.26), followed by IL-8 (OR = 6.73, 95% CI: 3.30–13.70) and IL-6 (OR = 4.43, 95% CI: 2.26–8.97). Adiponectin distinguished NC-T2D from DKD (OR = 4.15, 95% CI: 1.77–9.71), underscoring its potential as an indicator of renal complications. Interestingly, TNF-α levels declined across disease stages, possibly reflecting subclinical inflammation in Ecuadorian NDC with high rates of obesity and dyslipidemia. PBMC-derived miR-146a was upregulated in T2D patients, contrasting with prior serum-based studies and emphasizing the importance of compartment-specific analysis. miR-155 was elevated in C-T2D, suggesting a compensatory immune-regulatory mechanism that diminishes with poor glycemic control and advanced disease. Inflammatory cytokines, adipokines, and microRNAs act in distinct yet complementary ways in T2D. Leptin, IL-6, and IL-8 emerge as strong predictors of disease, while miR-146a and miR-155 provide additional insight into immune-inflammatory regulation. Integrated biomarker panels may enhance patient stratification and support personalized monitoring of T2D progression. Full article

Background and Objectives: Dyslipidemia and hyperuricemia frequently co-exist in uncontrolled type 2 diabetes mellitus (T2DM), amplifying renal and cardiovascular risk. This study aimed to develop and evaluate an optimized Renal–Metabolic Risk Score (RMRS) integrating renal and lipid parameters to identify patients with both conditions. Materials and Methods: We conducted a retrospective observational study including 304 patients with uncontrolled T2DM hospitalized at the Emergency County Hospital Oradea, Romania (2022–2023). Hyperuricemia was defined as uric acid > 6 mg/dL in females and >7 mg/dL in males; dyslipidemia was diagnosed according to standard lipid thresholds. RMRS was calculated from standardized values of urea, TG/HDL ratio, and eGFR, with variable weights derived from logistic regression coefficients. The score was normalized to a 0–100 scale. Receiver operating characteristic (ROC) analysis assessed discriminative performance; quartile analysis explored stratification ability. Results: The prevalence of dyslipidemia and hyperuricemia co-occurrence was 81.6%. RMRS was significantly higher in the co-occurrence group compared to others (median 16.9 vs. 10.0; p < 0.001). ROC analysis showed an AUC of 0.78, indicating good discrimination. Quartile analysis demonstrated a monotonic gradient in co-occurrence prevalence from 64.5% in Q1 to 96.1% in Q4. Conclusions: The Renal–metabolic Risk Score (RMRS) demonstrated moderate discriminative performance in identifying patients with uncontrolled T2DM at risk for combined hyperuricemia and dyslipidemia. Because it relies on inexpensive, routine laboratory parameters, RMRS may be particularly useful in resource-limited settings to support early risk stratification, dietary counseling, and timely referral. Further validation in larger and more diverse cohorts is required before its clinical adoption. Full article

Diabetes mellitus (DM) is a major global health concern, associated with both microvascular and macrovascular complications. Early identification of individuals at risk of hyperglycemia and diabetes progression is crucial for preventing long-term complications and improving patient outcomes. We investigated the association between neck circumference (NC) and hyperglycemia in non-diabetic individuals and in patients with uncontrolled DM, using data from the nationally representative Korea National Health and Nutrition Examination Survey (KNHANES) 2019–2021. Uncontrolled DM was defined as hemoglobin A1c (HbA1c) ≥ 7.0%, while hyperglycemia in non-diabetic individuals was defined as fasting blood glucose ≥ 126 mg/dL or HbA1c ≥ 6.5%. Logistic regression analyses were conducted to evaluate the association between NC and glycemic outcomes. NC was independently associated with hyperglycemia in non-diabetic individuals (Model 1: odds ratio (OR): 1.09; 95% confidence interval (CI): 1.05–1.13; Model 2: OR: 1.09; 95% CI: 1.05–1.13) and patients with uncontrolled DM (Model 1: OR: 1.10; 95% CI: 1.03–1.17; Model 2: OR: 1.11; 95% CI: 1.04–1.18) after adjusting for potential confounders. This study demonstrates that NC is a significant risk factor for hyperglycemia in the general population and for individuals with uncontrolled DM. NC may serve as a simple, non-invasive anthropometric marker to help identify individuals at elevated risk for poor glycemic control. Full article

Background. Although melatonin is widely used in Sleep Medicine for its chronobiological action, its potent antioxidant and mitochondrial regulatory effects, as well as its immunomodulatory and anti-inflammatory functions, make it of interest as a cytoprotective agent in several chronic pathologies. These actions are evident at doses higher than those used for sleep disorders. Even at high doses, melatonin’s adverse effects are few, mild, and self-limited or resolve quickly after discontinuation of treatment. Based on its safety profile, we treated melatonin for sleep disorders in the presence of comorbidities with doses ≥ 40 mg daily. Methods. This was a retrospective mixed observational analytical design comprising a retrospective uncontrolled cohort analysis and a cross-sectional study. Eighty-one patients (57 female) with sleep disorders ranging in age from 55 to 98 years (mean 74.4 years) were treated with melatonin 40 to 200 mg daily (mean 72.7 mg) were examined. Fifty-six percent of patients received treatment for more than 4 years. The control group for the cross-sectional analysis included 81 patients over 52 years of age, matched by age and sex and not receiving melatonin but having sleep disorders within the same period. Results. A significant decrease was observed in arterial hypertension, ischemic heart disease and diabetes mellitus after melatonin administration. Analysis of clinical laboratory variables indicated no changes in the treated group versus the untreated group, except for a lower alkaline phosphatase concentration in patients who received melatonin. Conclusions. These findings suggest a beneficial effect of cytoprotective doses of melatonin on the cardiovascular and metabolic profile in an aged population. Full article

With the rise in physiological data sampled from wearable devices, efficient methods must be developed to encode temporal information for the comparison of time series arising from uncontrolled monitoring. We present a fast, nonparametric method called Multiscale Average Absolute Difference (MSAAD) to extract multiscale temporal features from wearable device data for purposes ranging from statistical analysis to machine learning inference. MSAAD outperforms comparable algorithms like multiscale sample entropy (MSSE) and multiscale Katz Fractal Dimension (MS-KFD) in terms of calculation stability on short realizations and faster runtime. MSAAD outperforms MSSE and MS-KFD by being able to separate diabetic and non-diabetic cohorts with moderate and large effect sizes in both sexes. Furthermore, it is capable of capturing “critical slowing down” in the temperature dynamics of aging populations, a phenomenon that has been previously observed in controlled settings. We propose that MSAAD is a scalable, interpretable time series feature that is capable of identifying meaningful differences in physiological time series data without making assumptions regarding underlying process models. MSAAD could improve the ability to derive insight from time series data mining for health applications. Full article

Background: Oral candidiasis is a prevalent opportunistic infection, predominantly caused by Candida albicans (CA), though non-albicans Candida (NAC) species are increasing worldwide. This study aimed to characterize the prevalence of Candida species, evaluate antifungal susceptibility, and identify predisposing risk factors in patients with oral mucosal candidiasis. Methods: A retrospective review of 1286 electronic patient medical records (788 women, 498 men) from 2018 to 2022 was conducted at the Department of Periodontal and Oral Mucosa Diseases, Medical University of Silesia. Swabs from the oral cavity were processed to identify Candida strains by mass spectrometry, followed by drug susceptibility testing for amphotericin B, nystatin, flucytosine, econazole, ketoconazole, miconazole, and fluconazole. Relevant local and systemic predisposing factors were recorded and analyzed statistically. Results: Among 958 patients with positive fungal cultures, CA accounted for 66.79% of isolates, while NAC constituted 33.21%. Multi-strain infections were detected in 8.46% of patients. CA showed lower resistance (<10%) to amphotericin B, nystatin, and flucytosine, but up to 30% resistance to azoles. NAC strains demonstrated elevated resistance rates (>40% for most azoles), with C. krusei exhibiting the highest resistance to the previously mentioned antifungal agents. Key risk factors included wearing removable dentures (p = 0.042) and uncontrolled diabetes mellitus (p = 0.0431). Additional factors, including poor oral hygiene, reduced salivary flow, and immunosuppressive conditions, further increased infection risk. Patients presenting with multiple risk factors were more likely to have multi-strain infections and more severe disease courses. Conclusions: This retrospective analysis highlights the growing prevalence of NAC, rising antifungal resistance (particularly to azoles), and the importance of identifying risk factors, especially denture use and poor glycemic control. Enhanced preventive strategies, robust diagnostic approaches, and optimized antifungal regimens are essential to address this evolving clinical challenge. Full article

Background: The global increase in type 2 diabetes mellitus (T2DM) cases necessitates the need for early detection of metabolic changes. This study investigated variations in liver enzymes, renal markers, electrolytes, and lipid profiles among T2DM patients stratified by hemoglobin A1c (HbA1c) categories to support early identification and better management of diabetes-related complications. Methods: A retrospective observational study at King Khalid University Hospital (KKUH), Riyadh, included 621 adult patients diagnosed with T2DM categorized into four HbA1c groups: normal (<5.7%), prediabetes (5.7–6.4%), controlled diabetes (6.5–7.9%), and uncontrolled diabetes (≥8.0%). Biochemical parameters included the liver profile: alkaline phosphatase (ALP) and bilirubin, renal profile: creatinine, blood urea nitrogen (BUN), glucose, sodium, and chloride, and lipid profile: cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides. Regression models identified predictors of ALP, cholesterol, and LDL. Results: ALP was higher in uncontrolled diabetes (89.0 U/L, Q1–Q3: 106.3–72.0) than in the prediabetes group (75.0 U/L, Q1–Q3: 96.8–62.3). Sodium and chloride were lower in uncontrolled diabetes (Na: 138.3 mmol/L, Q1–Q3: 140.3–136.4; Cl: 101.1 mmol/L, Q1–Q3: 102.9–99.4) compared to the normal group (Na: 139.5 mmol/L, Q1–Q3: 142.4–136.9; Cl: 103.5 mmol/L, Q1–Q3: 106.1–101.7). LDL was lower in uncontrolled diabetes (2.1 mmol/L, Q1–Q3: 2.8–1.7) than in the normal group (2.8 mmol/L, Q1–Q3: 3.7–2.2), while triglycerides were higher in patients with uncontrolled diabetes compared to the normal group (1.45 mmol/L, Q1–Q3: 2.02–1.11 vs. 1.26 mmol/L, Q1–Q3: 1.44–0.94). Regression models showed low explanatory power (R² = 2.1–7.3%), with weight, age, and sex as significant predictors of select biochemical markers. Conclusions: The study observed biochemical variations across HbA1c categories in T2DM patients, likely reflecting insulin resistance. Monitoring these markers in conjunction with HbA1c can enhance early detection and improve the management of complications. Full article

Periodontal disease is a common and serious oral disease among older adults. As the global older population increases, preventing periodontal disease is vital for healthy ageing. Poor oral hygiene, uncontrolled diabetes, and smoking are key risk factors of periodontal disease. Improving oral hygiene, diabetes management, and quitting smoking are essential health behavioural change interventions to manage periodontal disease. The objective of this study is to review the prevention of periodontal disease among older adults through health behavioural change interventions. Effective strategies to improve oral hygiene include personalised education on proper brushing and interdental cleaning. Educating caregivers is equally important as they supervise care-dependent older adults to maintain oral health. For those with diabetes, physical activity improves glycated haemoglobin levels and clinical periodontal parameters by reducing reactive oxygen species and systemic inflammation. Smoking cessation could be achieved through a multi-faceted approach. Effective smoking cessation combines brief interventions with intensive behavioural/pharmacological support for long-term success, especially in highly dependent individuals. Tailored strategies for older adults, integrated care, and expanded research improve outcomes and health equity in ageing populations. In conclusion, health behavioural change interventions are non-invasive preventive measures that include oral hygiene reinforcement, diabetic management, and smoking cessation. Prioritising these interventions empowers older adults to maintain oral health, reducing disease burden and enhancing overall well-being for healthy ageing. Full article

Background: Cytomegalovirus (CMV) colitis is commonly seen in patients who are immunodeficient or have inflammatory bowel disease. Among the gastrointestinal sites affected by CMV, the colon is the most frequently affected, though rectal involvement is relatively rare. Reactivated CMV proctitis primarily occurs in elderly patients with comorbidities and is quite uncommon in immunocompetent individuals. Patients with reactivated CMV typically present with symptoms such as diarrhea, hematochezia, or tenesmus. Case presentation: We report a case of a female patient with uncontrolled diabetes who presented to the clinic complaining of perianal pain. She had no history of diarrhea or rectal bleeding. Lower GI endoscopy reported a small, localized, approximately 0.5 cm swelling in the proximal anal canal in addition to sigmoid diverticulosis. The biopsy revealed a small ulcer at the anorectal junction caused by CMV and confirmed by immunohistochemistry. Unfortunately, the patient was lost to follow-up before antiviral therapy could be initiated. Conclusions: This case highlights an uncommon presentation of reactivated CMV proctitis in an older diabetic patient presenting solely with perianal pain. Clinicians should maintain a high index of suspicion for CMV infection in elderly patients with comorbidities, even when classical colitis symptoms are absent, to avoid delayed diagnosis and management. Full article

Background: Acute respiratory distress syndrome (ARDS) secondary to tuberculosis (TB) is rare and associated with high mortality. Management is further complicated by comorbidities and ICU-related complications. Methods: We report a 43-year-old woman with post-polio sequelae and uncontrolled diabetes who developed ARDS due to pulmonary TB, complicated by recurrent nosocomial infections and gastrointestinal bleeding. Early bronchoscopy and GeneXpert MTB/RIF PCR were performed on ICU Day 2, enabling anti-TB therapy initiation by ICU Day 3. The patient received lung-protective ventilation, prone positioning, tailored antibiotics, and multidisciplinary care. Results: The patient’s clinical course was complicated by two episodes of ventilator-associated pneumonia and gastrointestinal bleeding, but with individualized management, she achieved ventilator weaning and functional recovery. Conclusions: Early TB recognition in ARDS is crucial. Multidisciplinary ICU management, including prudent steroid use, improves outcomes. Full article

Background: Type 2 diabetes mellitus (T2DM) is common among patients with chronic obstructive pulmonary disease (COPD). We examined the association between glycemic control and clinical outcomes in patients with COPD exacerbation and T2DM. Methods: A retrospective study of patients with T2DM and COPD exacerbation comparing controlled (HbA1c < 7.5%) to uncontrolled (HbA1c ≥ 7.5%) glycemia prior to admission. The primary endpoint is defined as a composite of 6-month rehospitalization/mortality. Secondary endpoints included 6-month mortality and 6-month readmission. Results: Of 426 admissions, 179 (42%) had uncontrolled glycemia. The risk of rehospitalization/mortality was significantly increased in the uncontrolled group in univariate (HR1.6, 95%CI 1.11–2.3, p = 0.01) and multivariate (HR 1.82, 95%CI 1.24–2.67, p = 0.002) analyses. The risk of 6-month rehospitalization was increased in the uncontrolled group in both univariate (HR1.94, 95%CI 1.16–3.23, p = 0.011) and multivariate (HR1.98, 95%CI 1.19–3.27, p = 0.008) analyses. No difference was found between 6-month mortality risks. Conclusions: Optimal glycemic control may improve COPD management and reduce adverse outcomes. Full article

A 71-year-old Caucasian woman presented with lesions on both elbows. A physical examination revealed arcuate plaques with raised erythematous edges and central clearing. Comedones and cysts were evident on the border of the lesions. The dermatoscopic view showed the presence of pores, in addition to granuloma annulare changes. The biopsies showed changes according to granuloma annulare, but the granulomas were closely related to comedones and cysts. Furthermore, the presence of elastophagocytosis via multinucleated Langhans-type giant cells was evident. Verhoeff–van Gieson staining highlighted the transepithelial elimination of elastic fibers in the bottom of some cysts. The presence of comedones or cysts is exceptional in granuloma annulare. Only four similar cases have been reported. Although all previous cases showed lesions in sun-exposed areas over photodamaged skin, only our case showed transepithelial elimination of elastic fibers. Diabetes mellitus (DM) could play a role in the pathogenesis of this variant of actinic granuloma annulare, because most cases are associated with uncontrolled DM and the lesions improve after DM is controlled. Full article