Leukocyte chemotactic factor 2 (LECT2) amyloidosis (ALECT2) is a form of renal amyloid deposition that can present with features resembling diabetic kidney disease. We report the case of a woman with long-standing type 2 diabetes mellitus and hypertension who developed progressive renal dysfunction over three years, with her estimated glomerular filtration rate declining from approximately 28 to 10 mL/min/1.73 m² despite stable glycemic control and no identifiable nephrotoxic exposures. Laboratory evaluation revealed minimal albuminuria and unremarkable monoclonal studies, including serum protein electrophoresis, urine protein electrophoresis, and serum free light chain testing. Given the discordance between the degree of proteinuria and the severity of renal function decline, a computed tomography-guided renal biopsy was performed. Histopathologic examination demonstrated Congo red-positive deposits with apple-green birefringence, and immunohistochemical staining confirmed ALECT2. No evidence of systemic amyloid involvement was identified. The patient's kidney function continued to decline, ultimately progressing to stage 5 chronic kidney disease, and she elected to pursue conservative management. This case illustrates the importance of tissue diagnosis in patients with atypical patterns of chronic kidney disease.

Skull base osteomyelitis (SBO) is a rare and potentially fatal deep-space infection most commonly arising from malignant external otitis in immunocompromised or diabetic patients. Vascular complications, including septic thrombosis of the internal carotid artery (ICA) and dural venous sinuses, are among the most severe and life-threatening sequelae, yet remain underreported in the radiological literature. We present the case of a 59-year-old male with type 2 diabetes mellitus who initially presented with severe, refractory left-sided otalgia, purulent otorrhea, and progressive lower cranial nerve palsies. He was diagnosed with left-sided SBO on MRI, characterised by extensive infiltration of the carotid, lateral pharyngeal, and perivertebral spaces, with osseous involvement of the clivus, left occipital condyle, the anterior arch of C1, and the left mastoid. Critically, MRI demonstrated encasement and non-opacification of the cervical segment of the left internal carotid artery, thrombosis of the left internal jugular vein with extension to the left sigmoid sinus, and ipsilateral otomastoiditis. This case illustrates the pivotal diagnostic value of multiparametric MRI, combining fluid-attenuated inversion recovery, diffusion-weighted, and post-gadolinium sequences, in characterising the full extent of SBO and its neurovascular complications, findings that are critical for guiding urgent multidisciplinary management.

 Hypertension is a major noncommunicable disease in Pakistan, and suboptimal blood pressure (BP) control remains a significant public health challenge, largely influenced by poor adherence to antihypertensive medications.

This study aimed to assess the prevalence of antihypertensive medication adherence and its association with BP control among hypertensive patients attending outpatient clinics in Khyber Pakhtunkhwa, Pakistan.

This analytical cross-sectional study included 436 hypertensive patients selected through consecutive sampling from tertiary care hospitals. Data were collected using a structured questionnaire and the validated Brief Medication Questionnaire. BP was measured using standardized procedures with a Medico Aneroid Sphygmomanometer AND-85 and the Omron M3 Comfort device (Omron Healthcare, Kyoto, Japan). BP control was defined as <140/90 mmHg. Data were analyzed using Statistical Package for the Social Sciences version 25 (IBM Corp., Armonk, NY). The chi-square test and multivariable binary logistic regression were used to assess associations and adjust for confounders.

Of 436 participants, 196 (44.95%) were adherent and 240 (55.05%) were nonadherent. BP was controlled in 178 (40.83%) patients and uncontrolled in 258 (59.17%). Controlled BP was significantly higher among adherent patients (67.35%) compared with nonadherent patients (19.17%) (P < 0.001). Nonadherence was independently associated with uncontrolled hypertension (adjusted odds ratio = 3.82; 95% confidence interval: 2.45-5.97; P < 0.001). Other significant predictors included age ≥60 years, diabetes mellitus, and longer duration of hypertension.

Medication nonadherence is a major independent and modifiable determinant of poor BP control among hypertensive patients in Khyber Pakhtunkhwa. Targeted adherence-enhancing interventions are urgently needed in outpatient clinical settings.

Cerebral amyloid angiopathy (CAA) is a small vessel disease marked by β-amyloid deposition within cortical and leptomeningeal vessels. It is associated with a range of hemorrhagic manifestations, including lobar intracerebral hemorrhage (ICH), cortical superficial siderosis, and convexity subarachnoid hemorrhage (cSAH). In addition to hemorrhagic complications, cerebral ischemic events may occur due to impaired vascular reactivity and reduced cerebral perfusion. The coexistence of ischemic and hemorrhagic strokes in patients with biopsy-confirmed CAA poses significant diagnostic and therapeutic challenges, particularly in relation to antithrombotic use. A 74-year-old woman with type 2 diabetes mellitus and dyslipidemia initially presented with transient focal neurological deficits and subsequently developed left parietal cSAH along with multiple acute infarcts involving the left parietal, temporal, and centrum semiovale regions, for which aspirin and rivaroxaban were initiated. Over the following years, she developed progressive cognitive decline. Three years after her ischemic event, she experienced a lobar ICH in the right frontotemporoparietal region and later suffered another ischemic stroke, prompting treatment with cilostazol. This case illustrates the coexistence of ischemic and hemorrhagic pathology in CAA. Recurrent lobar ICH is a characteristic feature of CAA; however, ischemic events may also occur during its course and can adversely affect prognosis. The lack of clear guidance regarding antithrombotic therapy further complicates management. In this context, cilostazol was selected due to its favorable safety profile in patients at high risk of hemorrhage. This approach underscores the importance of individualized treatment strategies in CAA.

Periodontal remodeling is a continuous, adaptive process essential for maintaining the structural and functional integrity of periodontal tissues. While external factors such as bacterial biofilm, excessive forces, and poor oral hygiene are recognized triggers of periodontal pathologies, they do not fully explain their persistent prevalence.

This opinion paper emphasizes the impact of systemic diseases on periodontal homeostasis and considers periodontal disease as a manifestation of systemic dysfunction rather than solely a bacterial local disease.

This paper is conceptually designed as a narrative review and synthesizes the molecular and cellular mechanisms through which systemic diseases converge to disrupt periodontal remodeling.

Emerging evidence underscores the critical role of systemic diseases, including chronic kidney disease, cardiovascular disease, liver dysfunction, and hematologic malignancies, in addition to studied uncontrolled diabetes mellitus, in destabilizing periodontal homeostasis. These systemic conditions are all associated with excess systemic inflammation that impairs regenerative capacity, mineralization, vascularity, and immune responses, fostering a subclinical environment prone to periodontal tissue pathologies with clinical impact. This opinion paper is conceptually designed as a narrative review and synthesizes the molecular and cellular mechanisms through which systemic diseases converge to disrupt periodontal remodeling, including periodontal pathologies as a consequence of systemic dysfunction rather than a purely bacterially induced local disease.

Clinically, this understanding demands intensified dental surveillance to uncover modifiers of susceptibility and interdisciplinary care for systemically compromised patients. Future research should identify early biomarkers of systemic impact and inform strategies that integrate oral and systemic health to reduce the periodontal disease burden.

To characterize duration-dependent topographic macular neurovascular unit (NVU) alterations in type 2 diabetes (T2DM) without diabetic retinopathy (DR) using 26×21 mm ultra-widefield swept-source OCT angiography (UWF-SS-OCTA) and evaluate its diagnostic utility for long-duration eyes.

This cross-sectional study included 295 eyes (69 controls; 226 T2DM without DR stratified by duration: <5, 5-10, ≥10 years). The superficial vascular density (SVD), deep vascular density (DVD), superficial macular vascular density (SMVD), and nerve-fibre-layer microvascular density (NFMVD) were quantified in the fovea (1 mm), inner (1-12 mm) and outer (12-21 mm) rings and their quadrants. Ganglion cell-inner plexiform layer (GCIPL) thickness was derived from the 26 × 21 mm OCTA scan. ANCOVA adjusted for age, sex, BMI, hypertension, IOP with false discovery rate correction, multivariable regression, and ROC/decision curve analyses were used.

Longer duration was associated with progressive GCIPL thinning and deep-predominant DVD reduction across nearly all macular zones (q<0.05); the DVD deficit was most pronounced in the outer ring. SVD showed nasal-temporal asymmetry; selective nasal inner loss in ≥10-year group. GCIPL-DVD coupling, present in controls, attenuated in ≥10-year group, indicating NVU decoupling. Duration independently predicted GCIPL (β=-0.21) and DVD (β=-0.27) after adjustment (P<0.01). DVD alone discriminated ≥10-year eyes from controls (AUC 0.723, 95% CI 0.63-0.81); addition of GCIPL did not improve AUC (0.724, P>0.05). Decision curve analysis confirmed net clinical benefit.

Preclinical NVU decoupling-predominantly in the deep capillary plexus and nasally asymmetric-already occurs in T2DM without fundoscopic DR and progresses with disease duration. Deep-layer UWF-SS-OCTA metrics may strengthen risk stratification before clinical retinopathy.

Preterm birth is a leading cause of infant mortality and morbidity, with very preterm infants (VPI) being particularly vulnerable to poor physical growth and developmental challenges. This study aimed to investigate the trends and factors influencing physical growth in VPI within the first 12 months of corrected age (CA).

A cohort study was conducted on 223 VPI admitted between November 2020 and July 2022 at a tertiary maternity and neonatal hospital in Shanghai, China. Multiple linear regression and logistic regression models were used to identify risk factors for weight, length, and head circumference growth outcomes within 12 months CA.

The results showed that maternal postnatal depression (p < 0.05), the presence of clinical hypothyroidism, gestational diabetes mellitus (GDM), preeclampsia in mothers and VPI with congenital heart diseases were risk factors for physical growth. Girls with greater gestational age and birth weight, a higher 1-minute Apgar score, and exclusive breastfeeding have better physical growth outcomes.

Targeted interventions addressing maternal mental health, pregnancy complications, and infant-specific risk factors are warranted to promote physical growth in VPI.

Treatment guidelines can improve population health; however, their implementation within electronic health records (EHRs) can be challenging. We aimed to create an implementable framework using the American Diabetes Association (ADA) Standards of Care (SOC) for people with type 2 diabetes and cardiovascular or renal disease as an example.

A multidisciplinary team used agile methods to translate the text-based ADA SOC into structured elements within the EHR, including logic-driven algorithms and ontology groupers for diagnoses, laboratory values, and medications, leveraging standard terminologies such as SNOMED CT, LOINC, and RxNorm.

The structured elements were used to implement 3 tools in the EHR: a real-time patient registry and 2 clinical decision support (CDS) instruments. The real-time registry enables dynamic, ongoing identification of patients eligible for guideline-directed medical therapy, supports more advanced analytics, and can be filtered to evaluate treatment gaps at the population and individual provider levels. The CDS tools allow clinicians to address these gaps directly within their EHR workflows.

Transforming clinical guidelines into executable constructs within the EHR is feasible but remains complex and labor-intensive. Broader and more consistent implementation could be achieved if guideline organizations provided technical frameworks, regular updates (through addenda or shared interfaces), and collaborated with EHR vendors to support the distribution and maintenance of implementable algorithms.

The integration of executable logic into clinical guidelines, using deterministic frameworks such as Unified Modeling Language and standardized ontologies, would simplify guideline implementation across EHR platforms.

Uterine leiomyomas are a common benign neoplasm of the female reproductive tract. They are often asymptomatic and can be present during pregnancy without complication. When leiomyomas outgrow their blood supply, the tissue undergoes degeneration. This process is most often seen in pregnancy. A rare complication of this process is spontaneous rupture, which is a surgical emergency often resulting in intra-abdominal leakage, bleeding, and peritonitis. This report describes the case of a 36-year-old White woman (G1P0) at 35 weeks of gestation with a known enlarging anterior fundal leiomyoma with degeneration who presented with worsening abdominal pain and contractions in the setting of gestational diabetes mellitus. Imaging and clinical findings were concerning for rupture of a degenerating fibroid with intra-abdominal fluid leakage. This event resulted in threatened preterm labor. She underwent low transverse cesarean section, resulting in delivery of a viable neonate. Intraoperative findings included a broad-based fundal leiomyoma with a 1.5 cm defect and drainage of degenerative contents. Six months postpartum, the patient had persistent fibroid degeneration requiring robotic-assisted laparoscopic myomectomy. This case highlights the rare but serious complications of leiomyoma rupture in pregnancy and underscores the importance of close monitoring and appropriate surgical intervention for patients with degenerating leiomyomas.

Uric acid metabolism is associated with the development of type 2 diabetes mellitus (T2DM), cardiometabolic, and cardiovascular diseases. Additionally, T2DM patients often exhibit mild cognitive impairment (MCI). However, the underlying mechanisms remain unclear. This study aims to identify and validate biomarkers associated with uric acid metabolism in T2DM and MCI, with the goal of discovering potential diagnostic and therapeutic targets to improve the quality of life for T2DM patients. Transcriptomic data for T2DM, MCI and uric acid metabolism-related genes were sourced from public databases. Biomarkers were screened using machine learning and validated for expression. Subsequent analyses included functional enrichment, immune infiltration, subcellular localization, and drug prediction. Three biomarkers-HP, ITGB3, and SELP-were identified. All showed significantly elevated expression in the T2DM group (p < 0.05). HP and ITGB3 were primarily enriched in ribosome-related pathways, primary immunodeficiency, and adherens junction processes. Immune infiltration analysis revealed that immature B cells and plasmacytoid dendritic cells were significantly enriched in T2DM. HP showed the strongest positive correlation with plasmacytoid dendritic cells (cor = 0.65, FDR <0.05), while ITGB3 exhibited the strongest positive correlation with immature B cells (cor = 0.76, FDR <0.05). Several potential therapeutic drugs were predicted, including calcifediol (score = -99.93) and meclofenamic acid (score = -99.89). This study identified three candidate biomarkers co-dysregulated across T2DM and MCI transcriptomes and associated with uric acid metabolism. Given the exploratory sample sizes, these findings are considered hypothesis-generating and require validation in larger independent cohorts.