Parkinson’s disease (PD) is a common neurodegenerative disorder caused by progressive loss of dopaminergic neurons in the substantia nigra and the presence of Lewy bodies. While PD is most recognized by its motor symptoms (resting tremor, rigidity, bradykinesia, and postural instability), cognitive decline (CD) may become apparent as PD progresses, leading to Parkinson’s disease dementia (PDD). Type 2 diabetes mellitus (T2DM) and insulin resistance (IR) are risk factors for dementia, especially Alzheimer’s disease; however, their influence on dementia in PD is underexplored. Therefore, we sought to determine the effect of T2DM and IR on dementia in PD. A systematic search of articles from 2005 to March 2025 was undertaken using Embase, PubMed, Scopus, Web of Science, and citation searching. Case–control, cross-sectional, longitudinal, and non-human population studies assessing cognitive outcomes in individuals with PD, with and without T2DM and IR, were included (PROSPERO registration number CRD420251013367). In total, 27 studies met the inclusion criteria, with clinical sample sizes ranging from 23 to 544,162 participants. Among the 23 clinical studies, 15 identified T2DM as a contributor to cognitive decline (CD) in PD, and 4 specifically examined insulin resistance (IR). Elevated HbA1c was consistently associated with poorer cognitive performance and increased risk of Parkinson’s disease dementia (PDD); HbA1c ≥ 7% independently predicted cognitive impairment (OR = 4.25, 95% CI: 1.59–11.34). Vascular and inflammatory markers, including elevated LDL-C, fibrinogen, and hs-CRP, further exacerbated CD. MoCA and MMSE scores were the most common cognitive measures, consistently showing worse outcomes in PD patients with T2DM. Preclinical studies supported these associations, showing that high-fat-diet-induced T2DM and IR aggravated dopaminergic neuronal loss by 38–45%, increased α-synuclein by 35%, and heightened microglial activation, providing mechanistic evidence for the observed clinical associations. This systematic review, the first to examine the impact of T2DM and IRs on the occurrence and advancement of CD in PD patients, demonstrates a possible association between the two. However, these results demonstrate the need for larger sample sizes and the inclusion of additional clinical variables, such as HbA1c levels and pharmacological interventions, providing further information about the link between metabolic dysfunction and CD in PD. To further strengthen this link, longitudinal studies with systematic follow-ups are essential to establish causal links and avoid misdiagnosis in clinical practice.

Objectives: Uterine fibroids are benign tumors that develop from the smooth muscle tissue of the uterus, typically during a woman's reproductive years. A substantial proportion of women with uterine fibroids exhibit symptoms, including menorrhagia that considerably compromise their quality of life. This study aims to characterize the fibroid subtype most commonly associated with the incidence of anemia. Methods: This retrospective multi-center cohort study investigated the incidence of anemia in premenopausal women who were diagnosed with uterine fibroids between January 2016 and December 2022. Fibroid position, size, location, and number were assessed by trans-abdominal/vaginal ultrasound and hysteroscopy and correlated to the pre-treatment hemoglobin level. Results: Three-quarters of patients (n=6) with submucosal fibroid presented with any form of anemia followed by 59.3% (n=115) of patients with intramural fibroid and only 36.8% (n=25) of patients with sub serousal fibroid. Interestingly, there was no difference between the groups with regard to the severity of anemia at presentation. Most red blood cells (RBCs) and hemoglobin (Hb) indices were comparable between the groups, except for mean corpuscle volume (MCV) as it was significantly lower in patients with intramural fibroids. Moreover, our investigations showed that the submucosal fibroids tend to present in a higher number as well as the biggest in size. The multivariable logistic regression showed that subserosal fibroids are associated with the lowest risk of developing anemia. Conclusion: In conclusion, our results suggest that the occurrence of anemia should always be considered in women with submucosal fibroids. However, after adjusting for other contributing factors such as menorrhagia, submucosal fibroid did not show an increase in the risk of anemia.

Since the World Health Organization (WHO) issued guidelines for developing a non-sputum test for active tuberculosis (TB) diagnosis that exhibits similar performance characteristics to sputum-based diagnosis, salivary diagnostic techniques have gained prominence as potential screening tools or adjuncts to existing diagnostics. We searched online databases for studies that looked at salivary diagnostic techniques. Afterwards, duplicates were removed, titles and abstracts were screened, and full-text studies were assessed for eligibility based on inclusion and exclusion criteria. The studies chosen for final analysis underwent a rigorous quality assessment following a QUADAS-2 template, and data were extracted. The primary outcome assessed the difference in mean levels of interleukins between TB+ patients and TB-controls (Hedges’ g). We then conducted two subgroup analyses: the first segregated the control group into healthy patients, and those with other respiratory diseases (ORD), and the second addressed three different interleukins separately (IL-6, IL-5, IL-17). The secondary outcome involved comparing salivary molecular diagnostic assays to WHO guidelines. This study is registered with PROSPERO, CRD42024536884. A total of 17 studies, out of an initial 1010, were chosen for the final analysis, but one was then excluded for being of poor quality. Our meta-analyses for the primary outcome revealed minimal diagnostic potential for interleukins. Our first subgroup analysis showed that interleukins were incapable of differentiating active TB patients from both healthy controls and ORD patients. Our second subgroup analysis showed that IL-17 was reduced in active TB patients. Assessment of the secondary outcome revealed that most studies relied on a GeneXpert MTB/RIF assay on saliva, but none fulfilled WHO guidelines for a non-sputum test. Individual biomarkers currently lack sufficient discriminatory power to definitively distinguish active tuberculosis from healthy individuals or those with other respiratory diseases (ORD), reinforcing the need for multi-biomarker panels. Interleukins may be alternatively used as markers for prognosis, severity, or treatment response. Our findings also suggest that assays are unable to meet WHO guidelines.

Background: Thyroid nodules are common, yet only a small proportion are malignant. The independent role of nodule size in malignancy risk remains debated, particularly after adjustment for clinical, biochemical, and sonographic features. Methods: A retrospective cohort study was conducted on adult patients with thyroid nodules evaluated between 2018 and 2025 at a tertiary care center. Clinical, laboratory, ultrasound, cytology, and histopathology data were extracted. Thyroid-stimulating hormone (TSH), free thyroxine (free T4), and sonographic characteristics were analyzed. Univariable and multivariable logistic regression were performed. Missing ultrasound data were addressed using multiple imputation (m = 20), with pooled estimates derived using Rubin’s rules. The final multivariable model included 446 patients. Results: A total of 446 patients were included, of whom 91 (20.4%) had thyroid malignancy. Malignant nodules were significantly larger than benign nodules (2.30 [1.80] cm vs. 1.80 [1.13] cm; p = 0.015). In univariable analysis, TSH, free T4, and multiple ultrasound features were associated with malignancy. In multivariable analysis, nodule size remained the strongest independent predictor of malignancy (adjusted odds ratio [aOR] 1.51; p < 0.001). Hypoechogenicity (aOR 2.07; p = 0.020) and microcalcifications (aOR 1.86; p = 0.047) also remained independently significant, whereas thyroid function parameters were not associated with malignancy after adjustment. Conclusions: Thyroid nodule size is the strongest independent predictor of malignancy, with select ultrasound features retaining additional predictive value. These findings support incorporating nodule size more prominently into thyroid cancer risk stratification while maintaining key sonographic features.

Objectives: This study aimed to evaluate the clinical characteristics, symptom presentation, and management outcomes of patients diagnosed with paroxysmal supraventricular tachycardia (PSVT) at King Hamad University Hospital (KHUH), a tertiary care center. It examined the influence of demographics, comorbidities, and sex on treatment responses to pharmacologic and non-pharmacologic interventions, including cardioversion. Methods: A retrospective observational study was conducted on 427 adult patients with PSVT (ICD-10: I47.1, confirmed by chart review) between January 2018 and early 2024. Data were extracted from the KHUH HOPE electronic medical records system. Descriptive statistics summarized baseline characteristics; chi-square tests examined categorical associations. Kaplan–Meier analyses for the cardioversion subgroup ( n = 18) are presented as exploratory and descriptive only. Results: Females comprised 56.9% of the cohort (mean age 52.8 ± 15.2 years). Palpitations were the most common symptom (94.4%). Of 219 patients who received adenosine, 177 (80.8%) achieved cardioversion with the first dose, 25 (11.4%) with the second, and 17 (7.8%) with the third. Vagal maneuvers showed reduced success in patients with structural heart disease and diabetes mellitus. Electrical cardioversion was required in 18 patients (4.2%). Pacemaker implantation was documented in 3 patients (0.7%) for co-existing conduction disease, not as a PSVT treatment. Comorbidities significantly influenced outcomes: hypertension was associated with favorable vagal maneuver response, while heart failure and ischemic heart disease correlated with poor response across all modalities. Conclusion: PSVT generally responds well to first-line treatments. However, individualized strategies are warranted for patients with structural heart disease or significant comorbidities. Observed sex-based and age-related response differences are descriptive and require multivariable validation.

Isolated posteromedial bundle (PMB) injuries of the posterior cruciate ligament (PCL) are rare, often subtle, and easily missed on standard clinical tests and imaging. This case report highlights a delayed diagnosis of PMB injury in a 24-year-old male athlete presenting with persistent knee instability eight months following anterior cruciate ligament (ACL) reconstruction. Despite resolution of anterior laxity, the patient exhibited increased hyperextension, a pseudo-Lachman sign, and a tibiofemoral posterior step-off at 10-20° flexion, while 90° posterior drawer testing and MRI were unremarkable. These findings raised suspicion for isolated PMB injury, which was confirmed via diagnostic arthroscopy. The patient underwent nonanatomic PMB augmentation using a semitendinosus autograft with internal bracing. A structured rehabilitation protocol was followed, incorporating PCL-specific bracing, protected range of motion exercises, delayed hamstring activation, and a staged return to activity. At six months, the patient demonstrated full resolution of symptoms, with return to competitive sports by nine months. Validated functional outcome scores confirmed clinical improvement, including an International Knee Documentation Committee subjective score of 92.0 and a Tegner activity scale improvement from 4 (preoperative) to 7 (postoperative), reflecting return to high-level athletic activity. This case emphasizes the importance of recognizing underappreciated clinical signs of isolated PMB injury, particularly following hyperextension trauma. It underscores the limited sensitivity of MRI in chronic or partial PMB tears and advocates for diagnostic arthroscopy when clinical suspicion remains high. Diagnostic arthroscopy should be considered when clinical findings suggest subtle posterior instability, despite normal imaging results. Targeted PMB augmentation can restore extension stability and deliver excellent functional outcomes, even in delayed presentations.