María Guadalupe Ramos Zavala

Background: Periodontitis and type 2 diabetes (T2D) maintain a bidirectional pathophysiological relationship that impairs conventional periodontal treatment outcomes. Chitosan, a biopolymer derived from chitin, possesses well-documented antimicrobial, hemostatic, wound-healing, and osteo-inductive properties. Objective: We aimed to evaluate whether 1% chitosan gel delivered nightly via a custom occlusal guard, as an adjunct to full-mouth scaling and root planning (SRP), would improve periodontal clinical and radiographic outcomes in patients with T2DM and Stage I-II periodontitis compared to placebo. Methods: A double-blind, randomized, placebo-controlled, parallel-group clinical trial was conducted (n = 16; 8 per group) in adults aged 40-65 years with T2D and periodontitis. Following SRP, participants received either 1% chitosan gel or placebo nightly via a custom occlusal guard for 30 days. Primary outcomes included periodontal pocket depth (PPD), clinical attachment level (CAL), and radiographic bone level (RBL). Secondary outcomes were probing depth (PD), bleeding on probing (BOP), and Miller mobility grade. Statistical analysis employed the Wilcoxon signed-rank test (within-group) and Mann-Whitney U test (between-group); p < 0.05 was considered significant. Results: Groups were comparable at baseline. Within-group analysis at 30 days revealed significant reductions in PPD (4.2 +/- 1.1 to 3.4 +/- 1.1 mm; p = 0.019) and RBL (5.6 +/- 2.2 to 5.1 +/- 1.9 mm; p = 0.030) in the chitosan group, and a clinically meaningful trend in CAL (5.1 +/- 2.8 to 3.8 +/- 1.7 mm; p = 0.069). The placebo group showed significant BOP reduction (78.3 +/- 23.4 to 51.5 +/- 26.0%; p = 0.017), consistent with the known effect of mechanical debridement. No between-group differences reached significance in delta values. Conclusions: Adjunctive use of 1% chitosan gel via a custom occlusal guard as a delivery system produces clinically relevant improvements in PPD and RBL in T2D patients with periodontitis. The occlusal guard represents a novel, patient-administered, sustained-contact delivery platform for periodontal local therapy. Larger, long-term randomized trials with microbiological and glycemic endpoints are warranted.

Background: Cardiac arrhythmias are a frequent complication of acute SARS-CoV-2 infection. However, their long-term prevalence and clinical determinants among patients with post-COVID-19 syndrome, especially those previously hospitalized, remain poorly defined. Objectives: To assess the prevalence and types of arrhythmias in long COVID patients following hospitalization and to identify associated clinical risk factors. Methods: In this cross-sectional study, 53 patients previously hospitalized with confirmed COVID-19 were evaluated ≥3 months post-infection. All participants underwent a standardized clinical assessment, 12-lead electrocardiography, and 24 h Holter monitoring. Logistic and Cox regression analyses were performed to identify predictors of arrhythmia. Results: Arrhythmias were identified in 41.5% (n = 22) of patients. Atrial fibrillation (32%) was the most frequent arrhythmia, followed by sinus bradycardia (27%) and sinus tachycardia (18%). Age (OR 1.06, 95% CI 1.01–1.10, p = 0.01) and length of hospital stay (OR 1.1, 95% CI 1.01–1.2, p = 0.04) were independently associated with arrhythmia. Biguanide (metformin) therapy was inversely associated with the occurrence of arrhythmia (Exp(B) = 0.017, p = 0.008). Dyspnea (82.4%) and palpitations (41.5%) were the most commonly reported symptoms. Conclusions: Arrhythmias are common in patients with long COVID following severe disease. Advanced age and prolonged hospitalization are significant risk factors, while biguanide use may offer a protective effect. These findings underscore the need for targeted cardiac surveillance in this population.

(1) Background: Arterial stiffness, often measured by carotid–femoral pulse wave velocity (cf-PWV), is crucial in cardiovascular disease. Dapagliflozin has shown rapid effects on arterial stiffness, but there is limited evidence of empagliflozin’s acute effects, especially in type 2 diabetes (T2D) patients. This study evaluated the acute effects of empagliflozin and dapagliflozin on arterial stiffness and blood pressure (BP). (2) Methods: A one-week double-blind randomized trial involved 30 T2D patients on stable metformin therapy. Participants received empagliflozin (25 mg/day), dapagliflozin (10 mg/day), or a placebo. Arterial stiffness was assessed via cf-PWV, and BP was measured with an automated sphygmomanometer. (3) Results: Both SGLT2 inhibitors significantly reduced cf-PWV compared to the placebo after one week (p < 0.05), with dapagliflozin showing a more pronounced effect. No significant differences were observed in BP changes. (4) Conclusion: Short-term treatment with SGLT2 inhibitors acutely reduces arterial stiffness in T2D patients, with empagliflozin demonstrating a stronger effect, supporting the potential vascular benefits of SGLT2 inhibitors beyond glucose control.