Cardiac arrest during pregnancy is a rare but potentially catastrophic event, often requiring rapid, coordinated, multidisciplinary intervention. Neuraxial anesthesia, while generally considered safe and commonly used in obstetric settings, may be associated with severe cardiovascular complications. Among the proposed mechanisms, the Bezold-Jarisch reflex has been implicated in cases of sudden bradycardia and asystole following spinal anesthesia. We report the case of a 39-week pregnant woman who was admitted for urgent cesarean delivery after failed induction of labor. The patient had a history of chronic hypertension, type 2 diabetes mellitus, and obesity, but was clinically stable at baseline. Spinal anesthesia was performed with co-loading of 500 mL of Ringer's lactate. Shortly after the block and repositioning to the supine position, she developed marked hypotension (mean arterial pressure (MAP) < 60 mmHg), severe bradycardia, and subsequent asystole. Cardiopulmonary resuscitation was initiated immediately, with return of spontaneous circulation (ROSC) after administration of 1 mg of intravenous (IV) epinephrine and four minutes of effective chest compressions. An emergent cesarean section was performed under general anesthesia, with delivery of a viable neonate. Postoperative evaluation revealed no underlying cardiac or obstetric pathology, and the patient was discharged with full neurological recovery. A comprehensive diagnostic approach was undertaken, including exclusion of maternal, medical, obstetric, and anesthetic-related causes of cardiac arrest. The temporal association between spinal anesthesia and cardiovascular collapse, in the absence of hemorrhage or underlying cardiac disease, supports the Bezold-Jarisch reflex as the most likely etiology. In this context, reduced preload - likely influenced by prolonged hospitalization and the relatively limited preloading volume of 500 mL - may have contributed to reflex activation in this patient. This case underscores the importance of early recognition of vagally mediated reflexes, such as the Bezold-Jarisch reflex, and highlights the need for prompt resuscitation and coordinated multidisciplinary management. Adequate fluid resuscitation and heightened vigilance are essential to prevent catastrophic outcomes in obstetric anesthesia.

Background and objective Fetal macrosomia, defined as a birth weight >4.0 kg, is associated with serious maternal and neonatal complications such as prolonged labor, cesarean delivery, postpartum hemorrhage, birth trauma, and long-term metabolic risks. Maternal factors, particularly gestational diabetes mellitus (GDM), excessive weight gain, and certain comorbidities, increase the risk of macrosomia. Early detection in high-risk pregnancies is crucial to guide clinical management and improve outcomes. Conventional sonographic estimated fetal weight (EFW) provides important information but may lack accuracy. Novel markers such as umbilical cord thickness (UCT), fetal fat layer (FFL), and shoulder pad thickness (SPT) have shown potential predictive value. This study aimed to evaluate the accuracy of these sonographic parameters in predicting fetal macrosomia among high-risk pregnancies in a tertiary care setting. Methodology This prospective hospital-based study was conducted at Sree Balaji Medical College and Hospital, Chennai, from July 2023 to June 2024. A total of 100 high-risk antenatal women at 35-36 weeks of gestation were recruited through purposive sampling. Inclusion criteria were pregnancies complicated by GDM, anemia, hypertensive disorders, bronchial asthma, epilepsy, or cardiac conditions. Women with multiple pregnancies, fetal anomalies, or unwillingness to participate were excluded. After informed consent, detailed histories and anthropometric data were recorded, followed by ultrasonographic measurements of UCT, FFL, SPT, and EFW. Outcomes were followed up till delivery. Results Out of the total 100 participants, the majority of women were aged 31-35 years (44%) and primigravida (59%). High-risk conditions included GDM (65%), anemia (16%), and hypertensive disorders (9%). Macrosomia occurred in 49% cases, predominantly among overweight women (37/49, 75.5%), upper socioeconomic class (45/49, 92.3%), and GDM mothers (49/65, 75.4%) (all p<0.001). Male infants were more affected (28/49, 57.1%, p=0.034). UCT >90th percentile, FFL >5 mm, and SPT >12 mm were exclusively associated with macrosomia (all p<0.001). EFW >4.0 kg predicted macrosomia with 100% accuracy. Macrosomia was most frequent in LSCS deliveries (19/20, 95%). Conclusion Umbilical cord thickness, fetal fat layer, and shoulder pad thickness are reliable predictors of fetal macrosomia in high-risk pregnancies. GDM emerged as the strongest maternal risk factor. Incorporating these sonographic markers into routine third-trimester screening may improve early detection, optimize delivery planning, and reduce maternal and neonatal complications.

Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous clinical syndrome with increasing prevalence and limited targeted therapeutic options. Oxysterols, i.e., oxidative derivatives of cholesterol, have been implicated in various cardiovascular pathologies through pro-apoptotic, pro-inflammatory, and cytotoxic mechanisms. However, their potential role in HFpEF pathophysiology remains unexplored.

This study aimed to investigate the relationship between serum oxysterol levels and HFpEF, and to evaluate their potential as novel biomarkers in this patient population.

In this prospective, single-center study, 101 participants were enrolled between September 27, 2022, and March 27, 2023. The study group consisted of 51 patients diagnosed with HFpEF, according to the current European Society of Cardiology (ESC) guidelines, while 50 age- and sex-matched individuals without HFpEF served as controls. Serum levels of 7-ketocholesterol, 25-hydroxycholesterol, and 7α,25-dihydroxycholesterol were measured using liquid chromatography-mass spectrometry (LC/MS). Clinical, biochemical, and echocardiographic parameters were recorded and compared between groups. Correlation analyses were performed to assess the relationship between oxysterol levels and other variables, including N-terminal pro-B-type natriuretic peptide (NT-proBNP) and echocardiographic measurements.

Median serum levels of 7-ketocholesterol, 25-hydroxycholesterol, and 7α,25-dihydroxycholesterol were significantly higher in the HFpEF group compared to controls (p < 0.001 for all). Strong positive correlations were found between oxysterol levels and NT-proBNP concentrations (r = 0.778, r = 0.733, and r = 0.630, respectively; p < 0.001). Additionally, oxysterol levels showed weak positive correlations with body mass index and left atrial diameter. No significant associations were observed between oxysterol levels and comorbidities such as hypertension, diabetes mellitus, hyperlipidemia, or coronary artery disease.

This is the first study to demonstrate significantly elevated serum oxysterol levels in HFpEF patients compared to healthy controls. The strong correlation with NT-proBNP suggests that oxysterols may serve as potential biomarkers for HFpEF, reflecting underlying pathophysiological mechanisms involving inflammation and myocardial remodeling. Larger, multicenter studies are warranted to confirm these findings and explore their prognostic value.

Introduction Gestational diabetes mellitus (GDM) is diabetes that is newly developed by women during pregnancy. There is an existing gap in the literature in the United States on the relationship between race and GDM; the results of this study will seek to address this gap by examining pregnant women of color in comparison to their White, non-Hispanic (NH) counterparts. Given the potential health risks posed by GDM and the overall impact of the social determinants of health, it is essential to address racial disparities in GDM. Methods A retrospective cohort study was conducted using data representative of the United States, which was acquired from the National Vital Statistics System (NVSS) from the National Center for Health Statistics (NCHS). The racial groups investigated included NH White, NH Black, NH American Indian or Alaskan Native/Native Hawaiian or Other Pacific Islander (AIAN/NHOPI), NH Asian, NH Mixed, and Hispanic women, while the outcome of interest was diagnosis of GDM. Initially, the sample's baseline characteristics were evaluated, followed by a bivariate analysis to ascertain any association between the exposure and outcome, as well as to pinpoint potential confounders. Ultimately, we conducted a multivariable analysis to control for confounders. Results A total of 3,367,601 women were included in our study. Most women included were NH White women (50.5%), followed by Hispanic women (26.5%), NH Black women (13.5%), and NH Asian women (6.1%). The adjusted odds of GDM were more than twice as high in NH Asian women when compared with NH White women (adjusted odds ratio (aOR) 2.79; 95% confidence interval (CI) 2.75-2.83), and were also increased in the NH AIAN/NHOPI women (aOR 1.61; 95% CI 1.55-1.67), NH Mixed women (aOR 1.08; 95% CI 1.05-1.11), and Hispanic women (aOR 1.16; 95% CI 1.15-1.17), but decreased in NH Black women (aOR 0.76; 95% CI 0.75-0.77). Conclusion Overall, our study found that GDM is associated with the race/ethnicity of mothers. NH Asian and NH AIAN/NHOPI women had the highest rates of GDM when compared with their NH White counterparts. Future research should examine subgroups within larger race categories to better understand the nuances of their experiences and other GDM risk factors, such as the psychosocial experiences of racism and discrimination.

Patients with diabetes mellitus face a significantly higher risk of severe influenza and its complications. The purpose of this study was to investigate the immunogenicity of the trivalent immunoadjuvanted subunit influenza vaccine in children with type 1 diabetes (T1D) over two consecutive seasons.

A prospective non-randomized study during 2 epidemic seasons included 146 children with T1D at the age of 12.0 (9.0-14.0) years; the main group consisted of 81 patients vaccinated against influenza, the control group included 65 unvaccinated children. Antibody (Ab) levels to influenza viruses were evaluated using the hemagglutination inhibition assay before vaccination, one month and 12 months after vaccination.

Over two seasons, vaccinated children with T1D demonstrated a significant increase in Ab against all three vaccine strains 1 month post-vaccination, irrespective of their initial specific Ab levels. Differences in the persistence of antibodies 12 months post-vaccination were observed between children initially seronegative for A/H1N1 and A/H3N2 strains, who exhibited lower antibodies levels and fold increases, and those initially seropositive. Vaccinated seropositive children experienced significant post-vaccination Ab increases, surpassing levels in initially seronegative patients. Regardless of the epidemiological season, vaccination significantly increased the chance of achieving a seroprotective Ab level within one month for the A/H1N1 strain by 4.7 [2.9-9.7] (χ²M-H = 16.4, p < 0.001), for the A/H3N2 strain by 15.8 [5.9-41.4] (χ²M-H = 44.0, p < 0.001), and for strain B by 14.8 [6.5-33.6] (χ²M-H = 46.2, p < 0.001). Twelve months post-vaccination, Ab persistence was highest for the B strain, with levels 7.2 [3.2-16] times higher than in unvaccinated children, regardless of the season. Persistence of antibodies to the A/H1N1 strain was season-dependent (lower in the 2015-2016 season) and 2.5 [1.3-5] times higher than in unvaccinated children (χ²M-H = 6.5, p = 0.01). Antibodies persistence to the A/H3N2 strain did not differ significantly between vaccinated and unvaccinated groups (1.0 [0.5-2.3], χ²M-H = 0.02, p = 0.89).

Administration of the trivalent immunoadjuvanted subunit influenza vaccine in children with T1D resulted in the formation of postvaccination Ab, meeting the Committee for Proprietary Medicinal Products (CPMP) immunogenicity criteria regardless of vaccination history.

Macrosomia is associated with overweight and obesity across the life course. Most research to date has been based on cross-sectional analyses, and longitudinal investigations between macrosomia and developmental trajectories of growth throughout the first decade of life are lacking. This research aimed to examine associations between macrosomia and postnatal growth trajectories from birth to 10 years of age.

Children (n = 337) from the ROLO longitudinal birth cohort, who were born to mothers with previous macrosomic delivery.

Birthweight was recorded at delivery and dichotomised using the cut-off criteria for macrosomia (birthweight ≥ 4 kg and < 4 kg). Child weight, length/height, body mass index (BMI) and waist circumference were measured at birth, 6 months, 2, 5 and 10 years of age. Postnatal growth trajectories were developed using these longitudinal measurements from birth up to 10 years of age. Linear spline multilevel models were used to examine associations between macrosomia and postnatal trajectories with adjustment for confounders (maternal ethnicity, socioeconomic status, maternal age at delivery, maternal smoking in pregnancy, paternal BMI, adherence to gestational weight gain guidelines in pregnancy, sex of the child, original study group allocation, adherence to a special diet in pregnancy, maternal physical activity levels, metabolic complications in pregnancy and breastfeeding).

In this cohort, 53.7% (n = 181) had a birthweight ≥ 4 kg. The median (IQR) early pregnancy BMI was 25.4 (23.1, 28.6) kg/m², and mothers were 33.1 (30.6, 35.3) years old at delivery. We found no strong evidence of associations between macrosomia and trajectories of childhood growth from birth to 10 years of age. Significant findings in crude and adjusted models were close to the null and provide limited evidence for a meaningful association.

Macrosomia was associated with early, but not later, childhood growth trajectories. Associations were weak and varied according to definition and growth measurement. The lack of strong results indicates uncertain clinical relevance and warrant additional future research in a larger cohort.

Methicillin-resistant Staphylococcus aureus (MRSA) presents serious clinical and public health complications, and Staphylococcus aureus is still a major cause of morbidity and mortality globally. The objective of this study was to assess the temporal dynamics, microbiological traits, and epidemiological trends of methicillin-susceptible S. aureus (MSSA) and MRSA isolates over a twelve-year period in a tertiary care facility.

This retrospective cohort study analyzed the data of all confirmed S. aureus isolates collected between January 2013 and June 2024. Identification and antimicrobial susceptibility testing were performed using automated methods according to CLSI guidelines. MRSA was confirmed by detection of the mecA gene in all isolates using the GeneXpert MRSA assay. Additionally, 100 randomly selected MRSA isolates were further tested with the same platform for the presence of the SCCmec gene; all of which were positive. Demographic, clinical, and microbiological data were evaluated, and Generalized Linear Models were applied to assess temporal trends in oxacillin resistance.

The total of confirmed S. aureus isolates was 4,267. MRSA accounted for 52.7% (2,250) of all S. aureus isolates. It was significantly more prevalent in patients with COVID-19 (62.5%), diabetes mellitus (56.4%), and end-stage renal disease (52.7%) (p = 0.041). MRSA rates were higher in inpatient settings, particularly in surgical (56.0%), ICU/IMCU (53.4%), and medical wards (52.7%) (p < 0.001). While culture sources did not differ significantly between MRSA and MSSA (p = 0.212), MRSA was more commonly found in blood, skin, and abscess samples. Over time, MRSA prevalence increased across all wards, with the surgical ward showing the most significant rise (OR = 1.115; 95% CI: 1.080-1.152; p < 0.001).

This study demonstrates a rising burden of MRSA over the past decade, especially among vulnerable populations. The findings underscore the need for strengthened infection control, targeted antimicrobial stewardship, and ongoing surveillance to combat MRSA in Saudi Arabia and similar high-risk settings.

Acute movement disorder is a rare complication of diabetes mellitus. Uncontrolled diabetes mellitus can present with various movement disorders, of which chorea and ballism are the most common. Various nomenclatures have been used in the past for this condition. However, diabetic striatopathy is the most common and comprehensive terminology. It refers to a condition of hyperglycaemia and an acute-onset movement disorder with or without characteristic radiological findings on CT or MRI scan. It is commonly associated with non-ketotic hyperglycaemia in the background of type 2 diabetes mellitus. Previous studies have mostly reported it in the Asian population in the sixth to seventh decades of life with a female predominance. We present an 84-year-old British woman with type 2 diabetes mellitus, atrial fibrillation and suspected primary pancreatic malignancy, who presented after a fall and head injury with a one-week history of choreoathetoid movement of the right forearm and hand. Blood sugars and ketones were raised on presentation. CT and MRI brain demonstrated hyperdensity and T1 hyperintensity in the left basal ganglia, respectively. The patient was treated with variable-rate insulin for a prolonged period, followed by pre-mix insulin. Tetrabenazine was also started. Within one week, there was a dramatic improvement in the choreoathetoid movement. Although increasingly recognised, diabetic striatopathy remains underreported, largely due to limited physician awareness. This case is notable for the unusual association with ketotic hyperglycaemia, advanced age and significant comorbidities. Despite these factors, the patient achieved full recovery, underscoring the importance of early recognition and symptomatic treatment in addition to metabolic correction. Therefore, it should be considered in the list of differential diagnoses in any diabetic patient presenting with a movement disorder, even outside the typical Asian demographic and non-ketotic setting. Prompt diagnosis prevents misclassification as an intra-cerebral haemorrhage and facilitates timely management with an excellent prognosis.

Factors impacting on the conversion of prediabetes to diabetes or normoglycemia remain unclear. This study aimed to investigate the role of subclinical inflammation, assessed by high-sensitivity C-reactive protein (hsCRP), in the progression to diabetes from prediabetes, assessed by impaired fasting glucose (IFG).

Time-to-event survival analyses were conducted among 82 475 participants without diabetes from Kailuan Study (a real-life prospective cohort in China) to access the isolated and joint effect of hsCRP and IFG on diabetes risk, and quantify their relative contribution to incident diabetes.

Over a median 11-year follow-up, 14 215 diabetes cases were recorded. IFG and hsCRP independently and jointly increased diabetes risk. Diabetes incidence was higher in those with elevated inflammation (hsCRP≥2 mg/L: 90.45 vs. 66.76 per 1000 person-years). The joint effect risk (hazard ratios (HR) = 4.96; 95% confidence interval (CI) = 4.66-5.28) exceeded the sum of individual risks (HR = 4.29; 95% CI = 4.09-4.49 for IFG and HR = 1.11; 95% CI = 1.06-1.16 for elevated inflammation), with a relative excess risk due to interaction of 0.56 (95% CI = 0.23-0.89). Attributable proportions were 83.08% for IFG, 2.78% for hsCRP, and 14.14% for their interaction. The joint risks and the additive interaction were significant in both men and women, and were more pronounced among individuals aged <60 years than those aged ≥60 years.

Elevated inflammation synergistically amplifies diabetes risk in prediabetes among Chinese adults, particularly in those <60 years.

Periodontitis has become one of the most widespread chronic inflammatory diseases worldwide, affecting roughly 11% of the adult population. In China, periodontal health is notably poor, with less than 10% of individuals over the age of 35 maintaining periodontal health, while the prevalence of periodontitis in middle-aged and elderly populations reaches as high as 82.6%. From a public health perspective, periodontitis not only seriously compromises oral health but is also closely linked to multiple chronic systemic diseases, including cardiovascular disease, diabetes mellitus, and cognitive impairment. A substantial body of cohort studies and meta-analyses consistently demonstrate that patients with periodontitis are at a significantly increased risk of cardiovascular events. Moreover, periodontitis tends to progress more rapidly in individuals with diabetes, highlighting a bidirectional causal relationship between these two conditions. Our research team has maintained a long-term focus on elucidating the relationship between periodontitis and systemic diseases within Chinese community populations. In this review, we comprehensively summarize epidemiological findings on the associations between periodontitis and cardiovascular disease, metabolic syndrome, and cognitive decline, specifically drawing on data from Chinese cohorts. Complementing these observations, animal experiments provide evidence that experimental periodontitis can induce glucose intolerance and accelerate the development of atherosclerotic lesions. At the mechanistic level, we preliminarily validate that mitochondrial DNA efflux and the hematogenous spread of periodontal pathogens may act as biological conduits bridging local periodontal inflammation with systemic pathologies. We also address current challenges in the field, including difficulties in disentangling causal relationships due to confounding comorbidities like diabetes and cardiovascular diseases, which often coexist and influence each other. To advance understanding, there is an urgent need for well-designed longitudinal and interventional studies employing advanced causal inference methods. Ultimately, this work aims to deepen the current knowledge of periodontitis ' systemic effects and to support the development of evidence-based public health strategies for integrating oral health into chronic disease prevention efforts in China.