Cardiac myxoma, the most common primary cardiac tumor, can present with symptoms that overlap with coronary artery disease (CAD), creating a diagnostic challenge, particularly in older patients with cardiovascular risk factors.

We report a case of a 67-year-old Arab woman with long-standing hypertension and type 2 diabetes mellitus, who presented with typical exertional angina. A transthoracic echocardiogram revealed a large left atrial mass consistent with a myxoma. Subsequent coronary angiography confirmed severe three-vessel CAD. Laboratory findings were notable for mild anemia and significantly elevated inflammatory markers, which had normalized by the time of surgery. The patient underwent a successful single-stage operation consisting of the complete surgical excision of the atrial myxoma and coronary artery bypass grafting. Histopathological analysis confirmed the diagnosis of a benign cardiac myxoma. Her postoperative recovery was uneventful, and she was discharged in good condition, with excellent clinical and echocardiographic results at follow-up.

This case highlights the importance of maintaining a high index of suspicion for coexisting CAD in elderly patients diagnosed with cardiac myxoma. Preoperative coronary angiography is essential in this demographic to facilitate accurate diagnosis and guide the surgical strategy, for which a combined, single-stage operation is widely considered the most appropriate approach.

To evaluate the associations between first-trimester inflammatory markers and gestational diabetes mellitus (GDM), including its subtypes and patterns, and to explore the role of these markers in the early identification of GDM risk.

This cohort study included pregnant women aged ≥ 18 years and < 16 weeks of gestation, based on their first antenatal registration date, at a tertiary hospital from March to December 2023 retrospectively and from December 2023 to August 2024 prospectively. Inflammatory markers, calculated from peripheral blood cell counts, included the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregated immune-inflammation index (AISI). Outcomes were GDM and its subtypes (isolated fasting hyperglycemia [IFH], isolated post-load hyperglycemia [IPH], and combined hyperglycemia [CH]), as well as patterns identified through latent class trajectory modeling based on blood glucose change during the OGTT.

Among 4,426 eligible women, 821 developed GDM. Elevated first-trimester NLR, SII, SIRI, and AISI were significantly associated with higher GDM risk. Compared with non-GDM pregnant women, these markers were positively associated with both IPH (ORs range: 1.16-1.22) and CH (ORs range: 1.28-1.54), but not IFH, and with two OGTT glucose trajectories (medium-speed increase-rapid decrease group [ORs range: 1.20-1.25] and rapid increase-slow decrease group [ORs range: 1.31-1.68]), while no significant associations were observed for the other two trajectories.

First-trimester inflammatory markers are associated with more severe GDM phenotypes and may serve as potential biomarkers to inform the early identification of higher-risk GDM phenotypes.

The hippocampus is a brain region critically involved in learning and memory and is particularly vulnerable to metabolic and inflammatory stresses. Diabetes mellitus, particularly type 2 diabetes mellitus (T2DM), is associated with cognitive decline and structural alterations in the hippocampus, a condition commonly referred to as diabetic encephalopathy (DE). Lipocalin-2 (LCN-2), an acute-phase glycoprotein involved in iron homeostasis and innate immunity, has emerged as an important mediator of neuroinflammation and glial reactivity in the central nervous system. Although LCN-2 has been implicated in several neurodegenerative disorders, its region-specific role in hippocampal dysfunction during T2DM remains incompletely understood. Unlike prior reviews that address DE broadly, the present review synthesizes current experimental and clinical evidence linking hippocampal LCN-2 to neuroinflammation, synaptic dysfunction, and cognitive impairment in T2DM, with particular emphasis on astrocyte-microglia crosstalk. We further discuss the potential therapeutic strategy of selectively modulating LCN-2 signaling as an alternative to broad anti-inflammatory approaches, along with its potential advantages and limitations.

To identify ethnic differences among women with gestational diabetes mellitus (GDM) in a multiethnic cohort.

This observational study included pregnant women with GDM (IADPSG criteria) attending a tertiary centre between January 2020-December 2023, classified according to their ethnic group as White, Black, Asian, or Other. Multivariable logistic and linear regression analyses were performed.

A total of 633 women (513 White, 64 Black, 32 Asian, and 24 Other/Middle Eastern) were considered eligible for inclusion. Asian women had higher HbA1c than White, Black, and Other (5.5% (37 mmol/mol) vs. 5.1% (32 mmol/mol), 5.2% (33 mmol/mol), and 5.1% (32 mmol/mol), respectively, p < 0.001). The mean birth weight was higher in Asian than White, Black, or Other groups (3429 g vs. 3102 g, 3279 g, and 3159 g, respectively, p = 0.05). Insulin therapy during pregnancy was more common in Asian and Other/Middle Eastern than White and Black women (71% and 79.2% vs. 54.5% and 52.4%, respectively, p = 0.03) and was independently associated with Middle Eastern ethnicity (aOR 6.73, 95% CI 1.31–34.46, p = 0.02).

This study confirmed the presence of ethnic differences in pregnancies complicated by GDM and the higher metabolic burden in Asian and Middle Eastern populations. Ethnicity-specific strategies for GDM prevention and early screening should be implemented.

Diabetes mellitus remains one of the most widespread and burdensome chronic diseases worldwide, yet invasive assays and high costs constrain early detection. Existing machine-learning studies often reduce diagnosis to a binary task and overlook the clinically important pre-diabetic stage; additionally, many deep models act as uninterpretable "black boxes". To address these gaps, we propose ProgMDD, an interpretable progressive residual network for multiclass diabetes diagnosis using routine clinical biomarkers. Employing a strict, leakage-free pipeline, LASSO-based feature selection and resampling were applied exclusively to the training set, yielding a compact, robust input panel. After comparing PCA, t-SNE, and UMAP, we selected UMAP for visualization because it optimally balances global and local structure to illustrate progressive class separation. ProgMDD integrates a progressive residual architecture with channel attention and multi-level regularization to enhance feature learning. Rigorously compared against multiple baselines, ProgMDD achieved 97.02% mean accuracy under 5-fold cross-validation, reinforced by a 97.59% accuracy on the purely original, imbalanced hold-out test set and supported by multiple ablation studies. The concordance between LASSO and SHAP rankings supports biological plausibility and model transparency. By uniting interpretable deep learning with low-cost clinical data, ProgMDD furnishes a feasible approach for early screening and risk stratification in primary care, providing a transferable methodological paradigm for other chronic-disease prediction tasks.

Vaccination against Streptococcus pneumoniae in high-risk patients is crucial and hospitalization is a valuable opportunity. Adult patients hospitalized (>48 hours) for various infectious conditions and eligible for 13-valent pneumococcal conjugate vaccination from April 2021 to 2023 were included. The primary endpoint was the vaccine response rate (VRR) at least one month after vaccination. Of the 725 potentially eligible patients, 143 were included in the study. The most common comorbidities were diabetes mellitus (47%) and chronic cardiovascular disease (42%). VRR was acceptable at 46%, with a lower geometric mean concentration (GMC) of IgG in non-responders than in responders (1.27 µg/mL vs. 9.49 µg/mL, p < 0.001). In the multivariate analysis, the strongest negative predictor of VRR was a Charlson score of >3 (OR: 0.23 [0.06-0.81], p = 0.022). Vaccination within 48 hours after apyrexia (OR: 6.25 [1.85-20], p = 0.004) and the presence of diabetes (OR: 2.70 [1.05-7.14], p = 0.039) were independently associated with a better VRR. Hospitalization for acute infection should not be viewed as a barrier to vaccination but as an opportunity for optimized pneumococcal prevention after a short delay of apyrexia and should not be routinely postponed.

Diabetic retinopathy (DR), an ocular disease resulting from retinal microvascular damage caused by diabetes, has circular RNAs playing a key regulatory role in its progression. We examine the involvement of hsa_circ_0000140 in DR progression and its molecular regulation. We evaluated hsa_circ_0000140 and miR-485-5p expression in DR clinical samples and retinal endothelial cells with RT-qPCR. Diagnostic utility was examined by ROC curve analysis. Dual luciferase assays validated the targeting interaction, while proliferation was characterized using CCK-8, migration by Transwell, and inflammatory cytokines by ELISA. Elevated levels of hsa_circ_0000140 in DR patient serum and high-glucose-treated hRMECs indicate its diagnostic potential. Functionally, this molecule enhances cell proliferation, migration, and inflammatory cytokine release. It directly targets miR-485-5p, showing an inverse correlation with this microRNA. Restoring miR-485-5p expression counteracted these pathological processes, whereas hsa_circ_0000140 overexpression suppressed miR-485-5p function. Furthermore, miR-485-5p directly bound OGT, a gene highly expressed in DR. Hsa_circ_0000140 shows promise as a DR diagnostic marker and contributes to disease progression through miR-485-5p targeting, influencing retinal vascular function and inflammatory responses.

Emphysematous pyelonephritis is a rare, life-threatening necrotizing infection that is typically characterized by classic urinary symptoms. However, it is exceptionally rare for emphysematous pyelonephritis to manifest with predominant gastrointestinal symptoms, a deceptive mimicry that often masks the underlying renal pathology and leads to significant diagnostic delays. We report the case of a woman in her 60s with type 2 diabetes whose initial presentation was limited to vomiting and diarrhea, suggesting acute gastroenteritis. In the absence of typical urological distress, her condition rapidly worsened, and she developed septic shock and altered mental status within 48 h. Computed tomography confirmed Huang-Tseng class 3B emphysematous pyelonephritis with extensive destruction of the right renal parenchyma. Recognizing the irreversible tissue necrosis and failure of medical therapy, a decisive transition to emergency nephrectomy was performed. This timely surgical intervention successfully arrested the fulminant progression, leading to hemodynamic stabilization and recovery. This case underscores that emphysematous pyelonephritis rarely masquerades as gastroenteritis; in diabetic patients, such atypical manifestations followed by rapid clinical deterioration necessitate immediate computed tomography evaluation. Furthermore, when imaging reveals extensive gas formation and clinical stability is lost, prompt and resolute surgical source control is a critical, life-saving measure for ensuring patient survival.

Diabetes self-management education and support (DSME/S) programmes must demonstrate effective engagement of family members to achieve diabetes self-management outcomes and well-being of the whole family. These are complex interventions and their effectiveness is context dependent. We present initial programme theories of DSME/S and aim to answer: In what contexts and through which mechanisms do DSME/S interventions involving family caregivers impact diabetes self-management outcomes?

The review will follow the Realist and Meta-narrative Evidence Syntheses: Evolving Standards and Pawson's five steps: define the scope, develop initial programme theories, search for evidence, appraise studies and extract and synthesise data. Literature searching will be combined with feedback from patient and public involvement stakeholders. PubMed, EMBASE, CINAHL, Scopus and PsycINFO will be searched to February 2026, with citation tracking and grey literature included. Data will be synthesised inductively to develop programme theories and context-mechanism-outcome configurations.

This study is a realist synthesis protocol and does not require ethics approval. The study will use published evidence and grey literature with contributions from patient and public involvement stakeholders. The study will produce transferrable programme theories that explain the contexts and mechanisms that influence DSME/S intervention impact and the considerations required to maximise family involvement in diabetes care. These programme theories will provide conceptual frameworks for consideration when designing DSME/S interventions for various contexts in order to maximise self-management capabilities of the persons with diabetes while promoting the health of the family as a whole. Findings will be published in peer-reviewed journals and presented at scientific conferences.

CRD420251179485.

Pharmacologic treatment is widely used for managing gestational diabetes mellitus (GDM). However, evidence remains limited on the comparative effectiveness and safety across different drug classes for GDM. This study aims to compare the efficacy and safety of pharmacologic treatments for GDM using network meta-analysis of randomised controlled trials (RCTs).

We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science up to May 16, 2025 to identify trials evaluating glucose levels and maternal or neonatal complications in GDM patients using any pharmacologic agents, e.g., insulin, biguanides, sulfonylureas, α-glycosidase inhibitors, sodium-glucose cotransporter-2(SGLT-2) inhibitors, dipeptidyl peptidase IV(DPP-IV) inhibitors or Glucagon-like peptide-1receptor (GLP-1 RAs) versus standard care. We used random-effects model for both pairwise meta-analyses and frequentist network meta-analyses and applied the Confidence in Network Meta-Analysis (CINeMA) framework to assess the certainty of evidence.

Seventy-three articles were eligible, comprising 71 trials in which 14 877 participants were enrolled and seven drug classes assessed. All subsequent effects refer to comparisons with standard care. Because of their moderate to high evidence of certainty, sulfonylureas were established as the most effective drugs used for lowering fasting glucose (mean difference [MD]: -0.33 mmol/L; 95% confidence interval [CI]: -0.55 to -0.1), followed by insulin (MD: -0.3 mmol/L; 95% CI: -0.4 to -0.21) and biguanides (MD: -0.2 mmol/L; 95% CI: -0.28 to -0.12). Biguanides were the most effective drugs used to control haemoglobin A1c (MD: -0.1%; 95% CI: -0.16 to -0.03), but their use was associated with increased adverse events leading to low birth weight among infants (OR: 2.04; 95% CI: 1.04-4.01). Insulin (OR: 0.51; 95% CI: 0.34-0.75), biguanides (OR: 0.39; 95% CI: 0.26-0.59), and sulfonylureas (OR: 0.5; 95% CI: 0.31-0.79) use could decrease the risk of macrosomia. Sulfonylureas were found to be more easily get premature delivery and neonatal hypoglycaemia than biguanides; evidence regarding their impact on low birth weight and long-term safety remains lacking.

Insulin use provides significant benefits in achieving glycaemic control and minimising maternal and foetal complications, and it has a favourable overall safety profile. Biguanide use may be associated with an increased risk of low birth weight, warranting careful consideration and thorough counselling for shared decision-making. Currently, insufficient evidence supporting the efficacy and safety of sulfonylureas, α-glycosidase, DPP-IV, and SGLT-2 inhibitors; and GLP-1 RAs in GDM management is available.