Acute mental stress-induced alpha or beta-adrenergic reactivity patterns linked to unique cardiometabolic risk profiles

Cardiometabolic risk may differ based on a stress-induced alpha(α)-adrenergic response versus a predominant beta(β)-adrenergic response. Whether these responses might serve as significant markers of distinct cardiometabolic risk profiles based on hemodynamic reactivity remain unknown. We (1) characterized predominant α-and β-adrenergic hemodynamic response patterns to acute mental stress; and (2) determined the cardiometabolic risk profile within predominant α-or β-adrenergic responders, irrespective of age, sex, or ethnicity. We included 117 South African teachers (aged 20-65 years) and administered an acute mental stress task (Color-Word-Conflict test) for one-minute. Participants' hemodynamic response profiles were characterized as predominant α-adrenergic (decreases in cardiac output (CO) and Windkessel arterial compliance (Cwk) (lowest quartile)) (n = 48) and β-adrenergic (increases in CO, Cwk (highest quartile)) responses (n = 69) via Finometer beat-to-beat hemodynamic monitoring. Ambulatory-BP was measured and the number of 24 H-ischemic events determined by ECG. Cardiometabolic markers were analyzed using fasting blood samples, and abnormal glucose tolerance (Abnl-GT), combining prediabetes and diabetes, was defined as glycated hemoglobin (HbA1c) ≥ 5.7% and/or fasting glucose > 100 mg/dL and/or diabetes medication usage. Predominant α-adrenergic responders presented with an overall poorer cardiometabolic profile, with higher levels of HbA1c, insulin, greater insulin resistance and higher total cholesterol and lower HDL-cholesterol. Adjusted analyses indicated that a predominant α-adrenergic profile had higher odds of central obesity (P = 0.031), low HDL-cholesterol (P = 0.042), 24-H-hypertension (P < 0.001), cardiac stress (P = 0.025), ischemic events (P = 0.048) and medium-to-high 10-year stroke probability (P < 0.001), compared to β-adrenergic responders. In the β-adrenergic responders, higher odds for ischemic events, stroke probability and Abnl-GT were found (all P ≤ 0.022), compared to α-adrenergic responders. Independent of age, sex or ethnicity, the risk profile identified in predominant α-adrenergic responders mainly involved the effects of a high-pressure system, cardiac stress, and ischemia. Whereas in predominant β-adrenergic responders, the risk profile pointed to a more metabolic and hyperperfusion injury-related cardiometabolic risk.

Achievement of guideline targets among people with type 2 diabetes with eASCVD and high risk of ASCVD in the UAE: Results of the PACT-MEA-UAE cohort

AIM

The Prevalence of Atherosclerotic Cardiovascular Disease in Patients with Type 2 Diabetes across the Middle East and Africa (PACT-MEA) study compared cardiovascular disease (CVD) risk and 2021 ESC guidelines adherence between UAE and broader MEA region participants for enhanced type 2 diabetes mellitus (T2D) and atherosclerotic cardiovascular disease (ASCVD).

METHODS

A survey of 385 physicians explored clinical decision-making factors. Chart reviews of 3726 participants classified ASCVD risk as per 2021 ESC guidelines and compared T2D target achievement in primary and secondary care centers.

RESULTS

The survey highlighted factors influencing T2D management decisions, with most adhering to international guidelines. Among 542 UAE participants, 62.7 % were at high and 37.1 % at very high risk for ASCVD. Target HbA1c was achieved 45 % UAE vs. 37 % in regionally, BP by 41 % vs. 30 %, LDL by 36 % vs. 30 %, BMI <25 kg/m2 by 20 % vs. 15 %, SGLT2is use by 63 % vs. 37 % and GLP-1RAs use by 22 % vs. 13 %, respectively. No participants met all ESC-recommended targets for T2D.

CONCLUSION

Physicians followed international guidelines, considering patient history, drug efficacy, and HbA1c levels for diabetes and ASCVD risks. In UAE, <50 % of at-risk individuals with T2D met ESC targets. Cardioprotective medication use was higher in UAE.

Association of GGT and hs-CRP with hypertension across different glycemic states in Saudi adults: A cross-sectional study

Introduction

Atherosclerosis, hypertension, and diabetes (DM) is preceded by inflammation and endothelial dysfunction. Early detection of these risk factors is expected to improve prognosis. We aimed to examine the association between gamma-glutamyl transferase (GGT) and highly sensitive C-reactive protein (hs-CRP) with hypertension (HTN) in the presence and absence of dysglycaemia among Saudi adults not previously diagnosed with DM.Methods: adults were recruited randomly from public healthcare centres in Jeddah. Demographic information, blood pressure, and anthropometric measurements were taken. Fasting blood samples were drawn to measure glucose, glycated haemoglobin, lipid profile, hs-CRP, and GGT. Blood was drawn again following a 1-h oral glucose tolerance test, and plasma glucose was measured.

Results

Mean GGT and hs-CRP were higher in people with HTN and dysglycaemia than those without both (P < 0.001). In people with HTN, those with intermediate hyperglycaemia (pre-DM) had significantly higher means of GGT and hs-CRP compared with those without (P < 0.001 and 0.013, respectively). In people with pre-DM, those with HTN had significantly higher means of GGT than those without (P = 0.008), but the increase in mean hs-CRP was not statistically significant. Mean GGT was higher in people with DM compared to means of those with pre-DM and HTN (P = 0.04).

Conclusion

An association between higher serum levels of hs-CRP and GGT and dysglycaemia exists, especially in hypertensive people. Monitoring both biomarkers in dysglycaemic people, especially if they have elevated blood pressure, is recommended to initiate therapeutic interventions.

Skin temperature and nitric oxide in premenopausal and postmenopausal women with fibromyalgia

OBJECTIVE

This study aimed to investigate skin temperature, indicative of peripheral vascular blood flow, core body temperature and nitric oxide (NO) levels in premenopausal and postmenopausal women with fibromyalgia (FM) and controls.

METHOD

A case-control study was carried out in 32 healthy premenopausal and 52 healthy postmenopausal women and in 17 premenopausal and 53 postmenopausal women with FM. Hand skin temperature was measured using infrared thermography, tympanic and axillary temperature with an infrared thermometer, and serum NO levels using an ozone chemiluminescence-based method.

RESULTS

Tympanic temperature was higher in postmenopausal women with FM than in postmenopausal controls. Significant differences were found in all of the temperatures recorded in both hands between healthy premenopausal women and premenopausal women with FM and between postmenopausal controls and postmenopausal women with FM. No differences were found in hand temperature, axillary or tympanic temperature, or NO levels between healthy premenopausal and postmenopausal women or between premenopausal and postmenopausal women with FM.

CONCLUSION

The association between menopause and FM could be responsible for the higher tympanic temperature observed in women with FM. FM, but not menopause, may increase hand skin temperature, which could be indicative of excessive peripheral vasodilation. Menopause may not alter body temperature or NO levels in either patients with FM or healthy women.

Mechanistic study of α-mangostin derivatives as potent α-glucosidase inhibitors

α-Glucosidase inhibitors (AGIs) are pharmacological agents commonly used to manage postprandial hyperglycemia associated with type 2 diabetes mellitus (T2DM). Developing novel, potent AGIs remains a significant area of research. In this study, we investigated a series of derivatives of the natural product from α-mangostin as potential AGIs. A combined experimental and computational approach was employed to characterize promising compounds with potent α-glucosidase inhibitory activity. We found that α-mangostin (AM) and its derivatives (AM1 - 3) exhibited micromolar range α-glucosidase inhibition (IC50 ranging from 15.14 to 67.81 µM), surpassing the known drug acarbose (IC50 of 197.09 µM). Among the derivatives, AM1 exhibited the most promising α-glucosidase inhibition, displaying competitive inhibition kinetics with a Ki value of 47.04 µM. Molecular docking and molecular dynamics (MD) simulations provided mechanistic insights into the binding interactions between AM1 and the α-glucosidase active site. AM1 was observed to form hydrogen bonds and hydrophobic interactions with key amino acid residues within the enzyme's active site. The introduction of amine groups in compound AM1 enhanced activity compared to AM, the parent compound. This study highlights the potential of α-mangostin derivatives as potent AGIs. The identified lead compound, AM1, warrants further investigation to assess its efficacy and safety in managing T2DM.

Examining shift duration and sociodemographic influences on the well-being of healthcare professionals in the United Arab Emirates: a cross-sectional study

Objective

Providing quality healthcare is an essential part of the healthcare system. The high workload and night work associated with healthcare providing may result in work-life imbalance among healthcare professionals (HCPs) and in degradation in the quality of care.

Methods

This cross-sectional study aimed to assess the effects of sociodemographic characteristics and shift work on HCPs' well-being in four large hospitals in the United Arab Emirates using a validated questionnaire.

Results

Responses from 526 participants indicated that 79.2% of them were under the age of 40, 70.2% were females and 50.2% were single or divorced. Responses indicated that many HCPs reported engaging in unhealthy behaviors such as consuming energy drinks (37.3%), smoking (14.2%) and taking stimulant pills (5.7%) with males being more susceptible to these practices compared to females. Results also showed that participants perceived their overall health rate, on the average, to be moderate with one third of participants indicating to be overweight. Moreover, results showed that many participants reported having blood pressure issues (16%), diabetes (8.6%) and/or heart diseases (2.7%), with females more prone to these diseases than males. Another important finding was that most respondents reported sleeping significantly less than the recommended duration and taking too long time to fall asleep. Finally, results revealed that HCPs on 12-h shifts indicated having greater satisfaction but tend to experience more exhaustion levels and worsened health indicators than those on 8-h shifts.

Conclusion

HCPs work has adverse effects on their well-being especially when combined with working at night. Healthcare implications of the results as well as recommendations to improve the well-being of HCPs based on the findings are given at the end.

Improving nursing care protocols for diabetic patients through a systematic review and meta-analysis of recent years

BACKGROUND

Diabetes mellitus has become one of the major pandemics of the 21st century. In this scenario, nursing interventions are essential for improving self-care and quality of life in patients with type 2 diabetes mellitus. Nursing interventions are crucial for managing the disease and preventing complications.

AIM

To analyse nursing interventions in recent years through a systematic review and meta-analysis and to propose improvements in care plans.

METHODS

This study conducted a systematic review and meta-analysis of the impact of nursing interventions on quantitative glycaemic variables, such as glycated haemoglobin and fasting plasma glucose.

RESULTS

After confirming that the combined effect of all studies from the past 5 years positively impacts quantitative variables, a descriptive analysis of the studies with the most significant changes was conducted. Based on this, an improvement in diabetic patient care protocols has been proposed through follow-up plans tailored to the patient's technological skills.

CONCLUSION

The combined results obtained and the proposal for improvement developed in this manuscript could help to improve the quality of life of many people around the world.

Perioperative Management and Outcome of Catecholamine-Induced Takotsubo and Dilated Cardiomyopathy in Pheochromocytoma and Paraganglioma

OBJECTIVES

To outline and compare the clinical features, preoperative preparation, perioperative management, and outcome of Takotsubo cardiomyopathy (TCM) and dilated cardiomyopathy (DCM) associated with pheochromocytomas and paragangliomas (PPGLs).

DESIGN

A retrospective cohort study.

SETTING

A single tertiary hospital.

PARTICIPANTS

All patients scheduled for elective surgery of PPGL resection with TCM and DCM between March 2005 and June 2023 were enrolled.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

This study enrolled 29 patients: 20 patients were in the TCM group and 9 patients were in the DCM group. The tumor size of the DCM group was bigger and the level of 24-hour urine norepinephrine was higher than those in the TCM group. After the preoperative medication preparation (111 median days) and anti-heart failure treatment (if necessary), the mean preoperative ejection fraction in the TCM group was significantly higher than that in the DCM group (66.8% ± 4.4% v 48.8% ± 7.8%, p<0.001), both elevated compared to ejection fraction at presentation (p<0.001). The intraoperative hemodynamic instability score was rather high in PPGL-TCM and PPGL-DCM patients (84.6 points), as well as in the hemodynamic variables section (13.7 points). Patients with DCM were more prone to present hemodynamic disturbances and to require a lower volume of fluids but a higher infusion of vasoactive agents than patients with TCM. The incidence of complications was 6.9% and there was no perioperative mortality.

CONCLUSIONS

Following the preoperative medication preparation and anti-heart failure treatment, patients with TCM had better left ventricular recovery before surgery and fewer cardiovascular risks compared to patients with DCM. Optimal perioperative management and individualized anesthetic strategies are essential for this unique patient population.

Mid-term outcomes of valve replacement surgery with or without coronary artery bypass grafting in patients with overweight and obesity: A cohort study

Current data evaluating outcomes of valve replacement surgery in patients with overweight/obesity is contradictory. There is a scarce study comparing outcomes of valve surgery considering the type of valve involved in the procedure. We followed outcomes in patients with overweight and obesity after valve replacement surgery with or without coronary artery bypass graft (CABG) and also patients with aortic valve replacement (AVR) and mitral valve replacement (MVR), separately to compare their mid-term prognosis in each group. Consecutive patients who had undergone cardiac valve surgery with or without CABG in Tehran Heart Center were enrolled. We enrolled 3158 patients. Median survival was 125.71 ± 82.20 weeks in patients with overweight/obesity. We found a significantly higher LVDd, LVDs and RVDd in patients with CABG (51.85 ± 7.31, 36.80 ± 8.81 and 30.04 ± 3.58, respectively) compared to the valve group (50.10 ± 6.35 mm, 35.08 ± 7.29 mm and 29.76 ± 4.07 mm, respectively). All-cause mortality is significantly higher in patients with AVR (5.7%) than those with MVR (3.3%). Patients with CABG are at higher risk of myocardial infarction (MI) compared to the ones without CABG (0.8% vs. 0.1%). No significant interaction was observed between the type of valve surgery (AVR/MVR) or valve surgery combinations (valve/valve + CABG) (p-values = .81 vs. .97, respectively). Post-operative outcomes in patients with overweight/obesity depend on several factors such as type of valve involved and presence of CABG. Risk management can lower the rate of mortality and morbidity in these patients.

The Possible effect of Bosentan on the methotrexate-induced salivary gland changes in male rats: histological and Immunohistochemical study

Methotrexate (MTX) is an antimetabolite drug utilized for managing a variety of cancers and autoinflammatory conditions. MTX may trigger detrimental effects in mout, h tissues, including salivary gland impairment. Bosentan (BOS), a drug that blocks endothelin receptors, has strengthened antioxidant, anti-inflammatory, and anti-apoptotic properties. The study aimed to estimate the protective effect of BOS on MTX-exacerbated salivary changes in Wistar Albino rats. Thirty male rats were arbitrarily sorted into three groups of ten animals each. The control group received a normal saline for 18 days. The MTX (induction) group received MTX (25 mg/kg) intraperitoneally on the 7th day of the experiment once daily for 6 consecutive days. The MTX + BOS group received BOS (50 mg/kg) orally once a day for 18 days: 6 days before induction, 6 days 2-h after induction, and 6 days post-induction. Animals were euthanized on day 19, and salivary gland tissues were dissected for biochemical, histopathological, and immunohistochemical analyses. BOS dramatically improved MTX-aggravated biochemical and histopathological abnormalities, as evidenced by diminished Bax, caspase 3, TNF-α, IL-1β, MDA, and MPO levels, increased SOD, GSH, and GPX levels, and reduced degenerative changes in the granular convolute tubule, mucous acini, and striate duct. BOS further substantially upregulated MTX-induced decline of the Ki-67 and Bcl-2, as indicated by immunohistochemistry scoring methods. The anti-oxidative, ant-inflammatory, and antiapoptotic properties of BOS are a promising strategy for ameliorating the toxic effect of MTX on submandibular glandular tissues.

Exploring Cardiovascular Health: The Role of Dyslipidemia and Inflammation

BACKGROUND

Cardiovascular diseases (CVDs) are a major global health concern, with their prevalence rising significantly in developing regions like South India. This increase is driven by unique dietary patterns, lifestyle habits, and genetic predispositions contributing to the region's distinct cardiovascular risk profile. However, gaps remain in understanding the biochemical risk factors specific to this population. This study addresses these gaps by focusing on key markers, namely, low-density lipoprotein (LDL), high-density lipoprotein (HDL), high-sensitivity C-reactive protein (hs-CRP), and homocysteine, which are critical in dyslipidemia, inflammation, and endothelial dysfunction. Identifying these markers' prevalence and their role in CVD is essential for developing effective, region-specific preventive strategies.

METHODS

This study employed a cross-sectional design and included 1,200 participants aged between 30 and 70 years from both urban and rural areas in South India, selected through a multistage stratified random sampling approach to ensure demographic representation across socioeconomic groups, gender, and residential settings. Data on demographics, lifestyle choices, and medical histories were collected using structured questionnaires, which were validated through a pilot study involving 50 participants to ensure clarity, cultural relevance, and content validity. Biochemical assessments included lipid profiles, fasting glucose, hs-CRP, and serum homocysteine levels, which were conducted following standardized laboratory protocols. Quality control measures, such as duplicate testing of 10% of samples, ensured reliability. Statistical analyses included logistic regression to identify independent predictors of CVDs and ANOVA to compare mean biochemical parameter values between groups.  Results: The study reported that 274 participants (22.83%) were affected by CVDs, with a higher prevalence in urban areas (75 participants (27.37%)) compared to rural regions (48 participants (17.51%)). This disparity is likely attributed to urban-specific risk factors, including sedentary lifestyles, dietary patterns, and environmental stressors. Biochemical analysis revealed significant predictors of CVD, such as elevated LDL cholesterol (498 participants (41.5%), odds ratio (OR) = 2.1, 95% CI: 1.7-2.6), reduced HDL cholesterol (428 participants (35.7%), OR = 1.8, 95% CI: 1.4-2.3), and increased hs-CRP levels (353 participants (29.4%), OR = 1.9, 95% CI: 1.5-2.4), emphasizing the central roles of dyslipidemia and systemic inflammation in CVD pathogenesis.

CONCLUSION

The findings of this study highlight critical implications for public health policies and healthcare systems in South India. The higher prevalence of CVDs in urban areas necessitates targeted interventions such as community-based physical activity programs, dietary counseling, and stress management initiatives. Biochemical management strategies, including early screening and control of dyslipidemia through lipid-lowering agents and addressing elevated hs-CRP levels with anti-inflammatory measures, are essential. Supplementation with folate and vitamin B12 to manage hyperhomocysteinemia should also be considered. However, the cross-sectional nature of the study and its single-center design limit causal inference and generalizability, emphasizing the need for multicenter, longitudinal research to validate these findings and guide comprehensive CVD prevention strategies.

Achillea millefolium capsule improved liver enzymes and lipid profile compared to placebo in patients with type 2 diabetes: a double-blind randomized clinical trial

BACKGROUND

The therapeutic properties of Achillea Millefolium (AM) in regulating blood lipids and liver enzymes have been proven in studies. Considering the abnormal lipid levels and elevated liver enzymes in diabetic patients, this study was conducted to investigate the effect of AM on the lipid profile and serum level of liver enzymes in type 2 diabetic (T2D) patients.

METHODS

In this 90-day double-blind clinical trial study, 60 eligible diabetic patients were enrolled and divided into intervention and control (each 30 patients) groups. The intervention group received AM capsules (dose of 500 mg/day) for 3 months, and the control group received placebo capsules during the same period. Blood was taken from patients on day 0 and day 90. The serum levels of liver enzymes and lipid profiles of patients were measured at baseline and on day 90. The obtained values were analyzed and compared between two control and treatment groups and within each group.

RESULTS

AM oral supplementation caused a significant decrease in alanine aminotransferases (ALT; from 28.79 ± 10.99 to 24.41 ± 6.84, p = 0.017) and aspartate aminotransferases (AST; from 24.28 ± 7.91 to 18.76 ± 6.77, p = 0.007). A significant reduction in the levels of serum lipids such as triglyceride (TG; from 161.7 ± 77.18 to 147.3 ± 66.79, p = 0.045), low-density lipoprotein (LDL; from 98.90 ± 35.67 to 80.86 ± 32.10, p = 0.001), and total cholesterol (TC; from 168.3 ± 47.46 to 150.1 ± 38.77, p = 0.006) was noted in AM group. According to these results, after the intervention, the mean of all variables (except HDL) in the two groups had a significant difference (P < 0.05).

CONCLUSION

The study showed that the 3-month treatment of T2D patients with 500 mg/day AM capsules led to the reduction of liver enzymes and the regulation of blood lipids in them.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials IRCT20230612058459N1 Registered on 2023-06-24.

Unhealthy behaviours associated with uncontrolled hypertension among adults in India- Insights from a national survey

BACKGROUND

Non-communicable diseases (NCDs) are governed by a cluster of unhealthy behaviours and their determinants, like tobacco and alcohol, unhealthy diet, lack of physical activity, overweight and obesity, pollution (air, water, and soil), and stress. Regulation of these unhealthy behaviours plays a crucial role in blood pressure control among individuals on hypertensive treatment, especially those suffering from uncontrolled hypertension. Hence, the present study aims at identifying the unhealthy behaviours associated with uncontrolled hypertension.

MATERIALS AND METHODS

We did a secondary data analysis of the National Family Health Survey (NFHS) -5 data (2019-2021). Among those taking prescribed medication to lower blood pressure levels, SBP ≥140 mm Hg or DBP ≥90 mm Hg were considered uncontrolled hypertension. The other socio-demographic variables and unhealthy behaviours were used as independent variables for analysis.

RESULTS

The proportion of uncontrolled hypertension was 49·5% (95% CI: 45·5-53·4) and 36·8% (95% CI: 35.8-37.8) among males and females, respectively. Alcohol consumption, clean fuel usage, and high BMI (≥30kg/m2) were the behavioural characteristics significantly associated with uncontrolled hypertension among males. In contrast, tobacco usage, alcohol consumption, coverage by Health insurance, presence of Diabetes, heart disease, usage of clean fuel, and high BMI (≥30kg/m2) were the behavioural characteristics significantly associated with uncontrolled hypertension among females. Regression results portrayed that higher age groups (45 and above) have found higher odds for men (OR: 7.6, CI: 4.6-12.3) and women (OR: 6.08, CI: 4.0-6.0) compared with 30 years and below age groups. Similarly, higher odds were found among the wealthiest wealth quintile than the poorest wealth quintile among men and women.

CONCLUSION

The current study reported a high proportion of uncontrolled hypertension. Providing opportunistic health education during blood pressure monitoring, regular screening, and targeted interventions will not only help to reduce its prevalence but also reduce the risk of developing related health implications.

Immunometabolic alterations in type 2 diabetes mellitus revealed by single-cell RNA sequencing: insights into subtypes and therapeutic targets

Background

Type 2 Diabetes Mellitus (T2DM) represents a major global health challenge, marked by chronic hyperglycemia, insulin resistance, and immune system dysfunction. Immune cells, including T cells and monocytes, play a pivotal role in driving systemic inflammation in T2DM; however, the underlying single-cell mechanisms remain inadequately defined.

Methods

Single-cell RNA sequencing of peripheral blood mononuclear cells (PBMCs) from 37 patients with T2DM and 11 healthy controls (HC) was conducted. Immune cell types were identified through clustering analysis, followed by differential expression and pathway analysis. Metabolic heterogeneity within T cell subpopulations was evaluated using Gene Set Variation Analysis (GSVA). Machine learning models were constructed to classify T2DM subtypes based on metabolic signatures, and T-cell-monocyte interactions were explored to assess immune crosstalk. Transcription factor (TF) activity was analyzed, and drug enrichment analysis was performed to identify potential therapeutic targets.

Results

In patients with T2DM, a marked increase in monocytes and a decrease in CD4+ T cells were observed, indicating immune dysregulation. Significant metabolic diversity within T cell subpopulations led to the classification of patients with T2DM into three distinct subtypes (A-C), with HC grouped as D. Enhanced intercellular communication, particularly through the MHC-I pathway, was evident in T2DM subtypes. Machine learning models effectively classified T2DM subtypes based on metabolic signatures, achieving an AUC > 0.84. Analysis of TF activity identified pivotal regulators, including NF-kB, STAT3, and FOXO1, associated with immune and metabolic disturbances in T2DM. Drug enrichment analysis highlighted potential therapeutic agents targeting these TFs and related pathways, including Suloctidil, Chlorpropamide, and other compounds modulating inflammatory and metabolic pathways.

Conclusion

This study underscores significant immunometabolic dysfunction in T2DM, characterized by alterations in immune cell composition, metabolic pathways, and intercellular communication. The identification of critical TFs and the development of drug enrichment profiles highlight the potential for personalized therapeutic strategies, emphasizing the need for integrated immunological and metabolic approaches in T2DM management.

Cardiometabolic Aspects of Congenital Adrenal Hyperplasia

Treatment of classic congenital adrenal hyperplasia (CAH) is directed at replacing deficient hormones and reducing androgen excess. However, even in the era of early diagnosis and lifelong hormonal substitution, the presence of CAH is still associated with numerous complications and also with increased mortality. The aim of this article was to create an authoritative and balanced review concerning cardiometabolic risk in patients with CAH. The authors searched all major databases and scanned reference lists of all potentially eligible articles to find relevant articles. The risk was compared with that in other forms of adrenal insufficiency. The reviewed articles, most of which were published recently, provided conflicting results, which can be partially explained by differences in the inclusion criteria and treatment, small sample sizes, and gene-environment interactions. However, many studies showed that the presence of CAH is associated with an increased risk of weight gain, worsening of insulin sensitivity, high blood pressure, endothelial dysfunction, early atherosclerotic changes in the vascular wall, and left ventricular diastolic dysfunction. These complications were more consistently reported in patients with classic than nonclassic CAH and were in part related to hormonal and functional abnormalities associated with this disorder and/or to the impact of overtreatment and undertreatment. An analysis of available studies suggests that individuals with classic CAH are at increased cardiometabolic risk. Excess cardiovascular and metabolic morbidity is likely multifactorial, related to glucocorticoid overtreatment, imperfect adrenal hormone replacement therapy, androgen excess, and adrenomedullary failure. Cardiometabolic effects of new therapeutic approaches require future targeted studies.

Ameliorating role of co-administration of granulocyte colony stimulating factor and sodium bicarbonate on the skeletal muscle of a rat model of chronic kidney disease (A histological and immunohistochemical study)

Over half million individuals suffer from chronic kidney disease (CKD) worldwide. In addition to raising the possibility of cardiovascular diseases, skeletal myopathy remains a challenging complication that is highly correlated with mortality and a lower quality of life. Granulocyte-colony stimulating factor (G-CSF) is an active cytokine for mobilization of immunological and hematopoietic stem cells that can replace exogenous stem cell infusions. So, it is seen as a less expensive and noninvasive tool for regenerative medicine. Sixty three rats were divided into 4 groups: I control, II CKD induced, IIIa, IIIb treated and IV recovery groups. After induction of CKD in all rats, group II were sacrificed after 4 weeks. Rats of group IIIa received NaHCO3. Group IIIb rats were injected subcutaneously by G-CSF as 100 µg/kg/day for 5 successive days in addition to NaHCO3 as group IIIa. Group IV rats were housed for 4 weeks without treatment. Serum urea, creatinine, tissue MDA& TNF-α were assessed. Renal and gastrocnemius muscle sections were evaluated for histological structure, CD34 and myogenin immune expression, morphometric and statistical analyses. The CKD group revealed a significant increase in MDA and TNF-α. Furthermore, features of renal injury, muscle degenerative changes, increased collagen and decreased CD34 and myogenin expression were observed. Alterations were partially attenuated by NaHCO3, while GCSF remarkably improved most parameters. The current results indicated that co-administration of GCSF and NaHCO3 could ameliorate CKD myopathy via attenuating oxidative stress, immunomodulation, pro-angiogenic ability, myocyte regeneration. In addition to the reduction of mitochondrial stress and maintenance of cellular homeostasis.

Biochemical liver damage during gender affirming therapy in trans adults assigned female at birth: a meta-analysis

PURPOSE

To assess the effects of testosterone (T)-based gender affirming hormone therapy (GAHT) on liver blood tests (LBTs) in assigned female at birth adults, using a meta-analytic approach.

METHODS

Prospective and retrospective studies were selected that reported the prevalence of biochemical liver damage (BLD) and LBTs changes during T therapy. Data collected included pre-and-during therapy alanine-aminotransferase (ALT), aspartate-aminotransferase (AST), gamma-glutamyl-transferase (GGT), and alkaline phosphatase (ALP) mean concentration values.

RESULTS

The prevalence of BLD in 14 studies on 1698 subjects was 1% (95% CI 0.00-3.00; I2 = 14.1%; p = 0.82). In 17 studies on 2758 subjects, GAHT was associated with a statistically (but not clinically) significant increase in AST, GGT and ALP at 12 months and ALT at 3-7 (MD: 1.19 IU/l; 95% CI 0.31, 2.08; I2: 0%), at 12 (MD: 2.31 IU/l; 95% CI 1.41, 3.21; I2: 29%), but with no more significant increase at 24 months (MD: 1.71 IU/l; 95% CI -0.02, 3.44; I2: 0%).

CONCLUSIONS

Analysis of aggregate estimates confirms a low risk of BLD and abnormalities in LBTs, transient in most cases, during T-based GAHT, thus suggesting a limited need for careful liver monitoring in AFAB people.

The Effects of Testosterone Replacement Therapy in Adult Men With Metabolic Dysfunction-Associated Steatotic Liver Disease: A Systematic Review and Meta-analysis

INTRODUCTION

Sex steroids modulate metabolic dysfunction-associated steatotic liver disease (MASLD) pathobiology. We hypothesized that testosterone treatment (TT) modulates progression of MASLD and performed a systematic review to evaluate the efficacy of TT on liver steatosis and fibrosis.

METHODS

We searched PubMed and Embase from inception until November 2023. We screened 1,489 studies and identified 9 eligible studies. We assessed risk of bias for randomized trials using RoB-2 "Cochrane risk of bias tool for randomized trials," nonrandomized studies using ROBINS-I tool "Risk of Bias In Nonrandomized Studies-of Interventions," and Murad's tool for single-arm studies. We pooled estimates using RevMan 5.

RESULTS

Three randomized controlled trials|, 4 nonrandomized studies, and 2 single-arm studies were identified. The population of interest comprised men with MASLD. TT was administered at varying doses, routes, and frequencies, with follow-up ranging from 12 weeks to 8 years. Liver fibrosis and steatosis were assessed using liver biopsy in 3 studies, CT/MRI in 5, and serum scores in 2. All studies provided evidence of reduction in liver steatosis with TT compared with no TT. In addition, the LiFT (randomized controlled trials) trial demonstrated a resolution of MASLD/ metabolic dysfunction-associated steatohepatitis and a regression in liver fibrosis. TT led to decrease in liver enzymes. Studies were heterogenous in terms of population characteristics, treatment modalities, endpoints, and follow-up. Adverse events were comparable between the 2 groups.

DISCUSSION

TT is a promising treatment option for men with MASLD and low testosterone. It may improve liver steatosis and reduce liver fibrosis. Large, double-blinded randomized placebo-controlled trials are needed.

Menopause-induced 17β-estradiol and progesterone loss increases senescence markers, matrix disassembly and degeneration in mouse cartilage

Female individuals who are post-menopausal present with higher incidence of knee osteoarthritis (KOA) than male counterparts; however, the mechanisms underlying this disparity are unknown. The most commonly used preclinical models lack human-relevant menopausal phenotypes, which may contribute to our incomplete understanding of sex-specific differences in KOA pathogenesis. Here we chemically induced menopause in middle-aged (14-16 months) C57/BL6N female mice. When we mapped the trajectory of KOA over time, we found that menopause aggravated cartilage degeneration relative to non-menopause controls. Network medicine analyses revealed that loss of 17β-estradiol and progesterone with menopause enhanced susceptibility to senescence and extracellular matrix disassembly. In vivo, restoration of 17β-estradiol and progesterone in menopausal mice protected against cartilage degeneration compared to untreated menopausal controls. Accordingly, post-menopausal human chondrocytes displayed decreased markers of senescence and increased markers of chondrogenicity when cultured with 17β-estradiol and progesterone. These findings implicate menopause-associated senescence and extracellular matrix disassembly in the sex-specific pathogenesis of KOA.

Protective Role of Methanol Leaf Extract of Catharanthus Roseus in Lipid Profile Modulation in Diabetic Wistar Rats

Background Diabetes mellitus (DM) is a long-term metabolic condition frequently linked to lipid imbalances, which may elevate the risk of cardiovascular complications. Abnormalities in lipid profiles, such as increased cholesterol and triglycerides and decreased high-density lipoproteins (HDL), are commonly observed in diabetic individuals. Natural plant extracts, including Catharanthus roseus, have long been recognized for their medicinal properties, although their potential impact on lipid profiles requires further investigation. Objective To evaluate the effects of methanol leaf extract of Catharanthus roseus on the lipid profile of streptozotocin (STZ)-induced diabetic Wistar rats. Methods The study involved 30 male Wistar albino rats, divided into five groups: Normal Control (NC), Diabetic Control (DC), Positive Control (PC), Low Dose (LD-200 mg/kg) Catharanthus roseus (LD-200 mg/kg), and High Dose (HD-400 mg/kg) Catharanthus roseus. Diabetes was induced with a single intraperitoneal dose of streptozotocin (55 mg/kg). Animals with fasting blood glucose levels above 180 mg/dL were included. Treatments were administered for 30 days, with lipid profiles like total cholesterol, triglycerides, HDL, low-density lipoproteins (LDL), and very low-density lipoproteins (VLDL) assessed on the 15th and 30th days. Results Diabetic rats exhibited increased total cholesterol, triglycerides, LDL, and VLDL levels, and decreased HDL levels. Treatment with Catharanthus roseus extract significantly improved lipid profiles in a dose-dependent manner, with the HD-400 mg/kg showing the most notable changes, including increased HDL levels. Conclusion The study highlights the potential of Catharanthus roseus methanol leaf extract in improving lipid profiles in diabetic rats, suggesting its utility as a complementary therapy for managing dyslipidemia in diabetes.

Assessing intention to use mobile phone-based self-management support among adults with type 2 diabetes in Saudi Arabia: A cross-sectional study

Introduction

The use of mobile phone technology for chronic illness self-management is growing, and it may help people with type 2 diabetes mellitus (T2DM). Innovative methods are needed to improve patient involvement and disease management in the Kingdom of Saudi Arabia due to the high incidence of T2DM.

Objective

The purpose of this study was to explore how the T2DM patients in KSA utilizes their mobile phones for self-management.

Methods

A cross-sectional study was conducted between April and June 2025 among T2DM patients who were attending endocrinologists for their diabetes management in the Northern Border region (Rafha and Arar) and the Central region (Riyadh) in KSA using a validated questionnaire.

Results

This study included a total of 267 participants with T2DM. Nearly all participants (99.3%) possess a cellphone, with 94.8% having daily internet access. The majority of the patients reported to have an intention to use mobile phones and the internet for managing diabetes, with 78.3% for dietary planning, 79.4% for physical activity planning, and 78.7% for text messages as reminders. Factors such as female (p = 0.008), younger age (p = 0.001), and duration of diabetes (p = <0.001) were significantly associated with the intention to use mobile apps for managing their diabetes.

Conclusions

This study demonstrates a significantly higher inclination of participants toward mobile phone technology for diabetes self-management vs. face-to-face consultations. These findings highlight the promising role of mobile phone technology for enhancing diabetes self-management among T2DM patients, thus highlighting the need for targeted interventions.

The association of HDL-cholesterol levels with incident major adverse cardiovascular events and mortality in 0.6 million individuals with type 2 diabetes: a population-based retrospective cohort study

BACKGROUND

High levels of high-density lipoprotein cholesterol (HDL-C) are previously considered protective against cardiovascular diseases (CVD), but recent studies suggest an increased risk of adverse events at very high HDL-C levels in the general population. It remains to be elucidated such a relationship in diabetes, a condition with high cardiovascular risks. We examined the association of HDL-C levels with the risk of major adverse cardiovascular events (MACE) and mortality in type 2 diabetes.

METHODS

This retrospective cohort study identified individuals with type 2 diabetes who had HDL-C records (2008-2020) from the electronic health record database of the Hong Kong Hospital Authority. They were classified into three groups based on their first-recorded HDL-C levels following diabetes diagnosis: low (≤ 40 mg/dL), medium (> 40 and ≤ 80 mg/dL) and high HDL-C (> 80 mg/dL) groups. The primary outcome was incident MACE (composite of myocardial infarction, stroke, heart failure, and cardiovascular mortality). Cox regression model and restricted cubic spline analysis were employed to assess the relationship between HDL-C and adverse outcomes.

RESULTS

Among 596,943 individuals with type 2 diabetes included, 168,931 (28.30%), 412,863 (69.16%), and 15,149 (2.54%) were classified as low HDL-C, medium HDL-C, and high HDL-C groups, respectively. Over a median follow-up of 79.5 months, both low and high HDL-C groups had higher risk of incident MACE compared to the medium HDL-C group (HR 1.24, 95% CI 1.23-1.26, P < 0.001; HR 1.09, 95% CI 1.04-1.13, P < 0.001). The spline curves revealed a U-shaped association between HDL-C levels and incident MACE (non-linear p < 0.001). Similar U-shaped relationship was observed for all-cause and non-cardiovascular mortality.

CONCLUSIONS

Our study demonstrated a U-shaped association between HDL-C levels and incident MACEs and all-cause and non-cardiovascular mortality in individuals with type 2 diabetes, highlighting the need for mechanistic studies on the adverse outcomes seen at high HDL-C levels in type 2 diabetes.

The prevention opportunities of retinopathy in diabetic patients - position paper endorsed by the Polish Lipid Association

Cardiovascular diseases (CVD) prevention does not only mean effective fight against the existing and well-recognized cardiovascular risk factors, but also against their complications, including micro- and macrovascular complications. Only then we might comprehensively reduce CVD burden and cardiovascular and cause-specific morbidity and mortality. In relation to obesity, prediabetes and especially diabetes, we recognize a number of potential dangerous non-cardiovascular complications, such as neuropathy, nephropathy and retinopathy. The latter's prevalence is even 30-40% and may appear in as many as 15% of patients with prediabetes. If not treated well it might result in the need for eye surgery or even vision loss. Fenofibrate has had a long history of evidence suggesting its preventive role in primary and especially secondary prevention of retinopathy, what has been investigated since the FIELD trial 19 years ago. Thus, given the obesity (the prevalence of 30% in Poland) and diabetes (10% which is predicted to be doubled in next 25 years) epidemic, we should look for the effective methods not only to optimize fasting blood glucose and haemoglobin A1C, but also atherogenic dyslipidaemia and their complications, including retinopathy. In this Position Paper by the Polish Lipid Association (PoLA) we have reviewed the current stage of knowledge on possible mechanisms by which fenofibrate may contribute to retinopathy prevention, available data on safety and efficacy, to finally recommend administering fenofibrate in prevention of this dangerous diabetic complication, which significantly affects quality of life and disability-adjusted life-years (DALY). This intervention - well-recognized and already in common use in diabetic patients - may significantly improve population health in Poland and worldwide.

Age-dependent effects of lockdown and post-lockdown periods on HbA1c during the COVID-19 pandemic: A 3-year longitudinal cohort study

The impact of COVID-19 lockdown on glycemic control in patients with diabetes mellitus (DM) remains unclear. This study aimed to investigate the effects of lockdown measures on the metabolic parameters of patients with DM, with particular emphasis on geriatric populations. In this retrospective, longitudinal cohort study, 1224 patients were analyzed. Three periods were identified to examine the effects of the lockdown: pre-lockdown, lockdown, and post-lockdown. Each period spanned 1-year. Within each 1-year period, at least 2 measurements were taken at least 3 months apart, and their arithmetic mean was calculated. Only patients who presented to the hospital for DM management during all 3 periods were included in the study. While HbA1c levels significantly increased in patients over 65 years old during the lockdown period (P = .017), we observed a significant decrease in HbA1c levels in patients under 65 years old (P = .014). Upon further stratification of patients over 65 by age groups, HbA1c levels increased the most among those aged 75 to 85 years, with a significant rise also observed in those aged 65 to 75 years during the lockdown. However, there was no change in HbA1c levels for patients over 85 years old during the lockdown. These findings highlight the need for careful monitoring of elderly patients with DM during lockdown periods, facilitated via home care or telehealth services. Structured diet and exercise programs should also be provided for at home adherence.

Association of obesity and overweight with the risk of preeclampsia in pregnant women: an observational cohort study

BACKGROUND

According to the World Health Organization, obesity is considered a pervasive global epidemic with significant medical and social implications. In antenatal mothers, the prevalence varies from 40% in Western countries to 12% in India which leads to life-threatening complications-preeclampsia and eclampsia.

AIM

This study delves into the association between body mass index (BMI) and preeclampsia, among primi antenatal mothers with pregnancy-induced hypertension (PIH).

METHODS

An observational cohort (prospective) study was conducted among 150 primi antenatal mothers with pregnancy-induced hypertension in Government Headquarters Hospital, Tamil Nadu, India. Demographic data, body mass index, and pregnancy outcomes were assessed. Statistical analysis was performed using the SPSS 28.0 version.

RESULTS

Among 150 pregnant women, 63 (42%) were overweight, and 13 (8.7%) were obese. Higher BMI was significantly associated with maternal complications, especially preeclampsia (P < 0.001). Moreover, other complications such as abruptio placenta, pulmonary edema, eclampsia, and postpartum hemorrhage were not significantly associated with BMI.

CONCLUSION

The study calls attention to the persistent link between BMI and preeclampsia, emphasizing the need for comprehensive strategies aligned with the Sustainable Development Goal. Despite ongoing efforts, the study suggests a lack of substantial change in the prevalence of preeclampsia associated with increased BMI, prompting the exploration of innovative interventions to address weight-related factors during pregnancy for improved maternal and neonatal well-being.

Investigating the cause of cardiovascular dysfunction in chronic kidney disease: capillary rarefaction and inflammation may contribute to detrimental cardiovascular outcomes

Myocardial ischemia-reperfusion (IR) injury is a major cause of morbidity and mortality in patients with chronic kidney disease (CKD). The most frequently used and representative experimental model is the rat dietary adenine-induced CKD, which leads to CKD-associated CVD. However, the continued intake of adenine is a potential confounding factor. This study investigated cardiovascular dysfunction following brief adenine exposure, CKD development and return to a normal diet. Male Wistar rats received a 0.3% adenine diet for 10 weeks and normal chow for an additional 8 weeks. Kidney function was assessed by urinalysis and histology. Heart function was assessed by echocardiography. Sensitivity to myocardial IR injury was assessed using the isolated perfused rat heart (Langendorff) model. The inflammation profile of rats with CKD was assessed via cytokine ELISA, tissue histology and RNA sequencing. Induction of CKD was confirmed by a significant increase in plasma creatinine and albuminuria. Histology revealed extensive glomerular and tubular damage. Diastolic dysfunction, measured by the reduction of the E/A ratio, was apparent in rats with CKD even following a normal diet. Hearts from rats with CKD had significantly larger infarcts after IR injury. The CKD rats also had statistically higher levels of markers of inflammation including myeloperoxidase, KIM-1 and interleukin-33. RNA sequencing revealed several changes including an increase in inflammatory signaling pathways. In addition, we noted that CKD induced significant cardiac capillary rarefaction. We have established a modified model of adenine-induced CKD, which leads to cardiovascular dysfunction in the absence of adenine. Our observations of capillary rarefaction and inflammation suggest that these may contribute to detrimental cardiovascular outcomes.

Synergies between diabetes and hyperhomocysteinaemia: New insights to predict and prevent adverse cardiovascular effects

AIM

To explore the association of hyperhomocysteinaemia (HHcy) and diabetes synergies with cardiovascular events in the adult population of northern China.

METHODS

Data were collected from the Asymptomatic Polyvascular Abnomalities Community study for 2010 to 2019. Serum homocysteine (Hcy) levels were determined by enzyme-linked immunosorbent assay. The participants were categorized into four groups based on their Hcy levels and diabetes status: non-diabetes/non-HHcy, non-diabetes/HHcy, diabetes/non-HHcy and diabetes/HHcy. The composite endpoint consisted of the occurrence of first-ever stroke, myocardial infraction (MI) or all-cause mortality. Cox regression analyses were performed to evaluate the associations of diabetes and HHcy with cardiovascular disease (CVD) events.

RESULTS

In total, 5278 participants were eligible (average age 55.1 years, 60% male). Over a follow-up of 9.1 years, 618 events were identified, 202 stroke, 52 MI and 406 all-cause deaths. Compared with the non-diabetes/non-HHcy group, hazard ratios with 95% confidence intervals in the diabetes/HHcy group for stroke, MI, major adverse cardiovascular event (MACE), all-cause death and composite endpoint were 1.85 (1.12-3.04), 1.33 (0.42-4.23), 1.78 (1.13-2.80), 2.24 (1.56-3.23) and 1.97 (1.47-2.65), respectively. Significant interactions between HHcy and diabetes status were found for stroke, MI and MACE (P for interaction = .002, .027 and .044, respectively). In addition, the association of diabetes/HHcy with stroke was modified by age (< 60 and ≥ 60 years; P for interaction = .016).

CONCLUSIONS

The findings highlight the synergistic impact of diabetes and HHcy on CVD. Joint assessments of diabetes and Hcy levels should be emphasized for risk stratification and primary prevention of CVD.

Diabetes Mellitus and Cardiovascular Disease: Exploring Epidemiology, Pathophysiology, and Treatment Strategies

Diabetes mellitus (DM) affects 537 million people as of 2021, and is projected to rise to 783 million by 2045. This positions DM as the ninth leading cause of death globally. Among DM patients, cardiovascular disease (CVD) is the primary cause of morbidity and mortality. Notably, the prevalence rates of CVD is alarmingly high among diabetic individuals, particularly in North America and the Caribbean (46.0%), and Southeast Asia (42.5%). The predominant form of CVD among diabetic patients is coronary artery disease (CAD), accounting for 29.4% of cases. The pathophysiology of DM is complex, involving insulin resistance, β-cell dysfunction, and associated cardiovascular complications including diabetic cardiomyopathy (DCM) and cardiovascular autonomic neuropathy (CAN). These conditions exacerbate CVD risks underscoring the importance of managing key risk factors including hypertension, dyslipidemia, obesity, and genetic predisposition. Understanding the genetic networks and molecular processes that link diabetes and cardiovascular disease can lead to new diagnostics and therapeutic interventions. Imeglimin, a novel mitochondrial bioenergetic enhancer, represents a promising medication for diabetes with the potential to address both insulin resistance and secretion difficulties. Effective diabetes management through oral hypoglycemic agents (OHAs) can protect the cardiovascular system. Additionally, certain antihypertensive medications can significantly reduce the risk of diabetes-related CVD. Additionally, lifestyle changes, including diet and exercise are vital in managing diabesity and reducing CVD risks. These interventions, along with emerging therapeutic agents and ongoing clinical trials, offer hope for improved patient outcomes and long-term DM remission. This study highlights the urgent need for management strategies to address the overlapping epidemics of DM and CVD. By elucidating the underlying mechanisms and risk factors, this study aims to guide future perspectives and enhance understanding of the pathogenesis of CVD complications in patients with DM, thereby guiding more effective treatment strategies.

Exploring the effects of estrogen deficiency and aging on organismal homeostasis during menopause

Sex hormone signaling declines during aging, from early midlife through menopause, as a consequence of reduced circulating estrogens and decreased receptiveness to these hormones in target tissues. Estrogens preserve energy homeostasis and promote metabolic health via coordinated and simultaneous effects throughout the brain and body. Age-associated loss of estrogen production during menopause has been implicated in a higher risk for metabolic diseases and increased mortality. However, it remains unclear whether age-associated changes in homeostasis are dependent on reduced estrogen signaling during menopause. Although menopausal hormone therapies containing estrogens can alleviate symptoms, concerns about the risks involved have contributed to a broad decline in the use of these approaches. Non-hormonal therapies have emerged that target tissues or pathways with varying levels of selectivity, reducing risk. We summarize here the broad effects of estrogen loss on homeostasis during menopause, current and emerging therapies and opportunities for understanding homeostatic disruptions associated with menopause.

Atherogenic Index of Plasma (AIP): The Most Accurate Indicator of Overweight and Obesity Among Lipid Indices in Type 2 Diabetes-Findings From a Cross-Sectional Study

BACKGROUND

This study aimed to evaluate the relationships of conventional and calculated lipid indices with obesity or overweight in patients with type 2 diabetes (T2D).

METHODS

In this cross-sectional study, all participants were categorised into three groups: normal weight (18 ≤ BMI < 25), overweight (25 ≤ BMI < 30) and obese (BMI ≥ 30). Conventional lipid indices, including triglyceride (TG), total cholesterol, LDL-C and HDL-C, were measured. Lipid indices, including the atherogenic index of plasma (AIP), non-HDL-C, TC/HDL-C, LDL-C/HDL-C, non-HLD-C/HDL-C (atherogenic index, AI) and lipoprotein combine index (LCI), were calculated. The associations of these lipid indices with obesity and overweight status were evaluated using univariate and multivariate multinomial logistic regression analyses.

RESULTS

In this study, 2661 patients with T2D, including 651 patients with normal weight, 1144 with overweight, and 866 with obesity, were recruited. According to a multinomial logistic regression analysis after adjustment for multiple confounders, the odds ratio (OR) was greater for the AIP than for other conventional and calculated lipid indices in overweight and obese patients with T2D. The AIP had a significant relationship with overweight, with an OR of 4.79 (95% CI: 1.65-13.85), and it had a significant relationship with obesity, with an OR of 13.64 (95% CI: 3.96-47.04). According to the ROC curve, with a cut-off value of 0.68, AIP could predict obesity with 82% sensitivity and 55% specificity (AUC = 0.770, 95% CI: 0.729-0.812, p < 0.001).

CONCLUSION

Compared with other conventional and calculated lipid markers, the AIP is most strongly associated with obesity and overweight in patients with T2D.

Association Between Low Sex Hormone-Binding Globulin and Increased Risk of Type 2 Diabetes Is Mediated by Increased Visceral and Liver Fat: Results From Observational and Mendelian Randomization Analyses

The aim of this study was to investigate the associations among sex hormone-binding globulin (SHBG), visceral adipose tissue (VAT), liver fat content, and risk of type 2 diabetes (T2D). In the Netherlands Epidemiology of Obesity study, 5,690 women (53%) and men (47%) without preexisting diabetes were included and followed for incident T2D. SHBG concentrations were measured in all participants, VAT was measured using MRI, and liver fat content was measured using proton magnetic resonance spectroscopy in a random subset of 1,822 participants. We examined associations between SHBG and liver fat using linear regression and bidirectional Mendelian randomization analyses and between SHBG and T2D using Cox regression adjusted for confounding and additionally for VAT and liver fat to examine mediation. Mean age was 56 (SD 6) years, mean BMI was 30 (SD 4) kg/m2, median SHBG was 47 (interquartile range [IQR] 34-65) nmol/L in women and 34 (26-43) nmol/L in men, and median liver fat was 3.4% (IQR 1.6-8.2%) in women and 6.0% (2.9-13.5%) in men. Compared with the highest SHBG quartile, liver fat was 2.9-fold (95% CI 2.4, 3.4) increased in women and 1.6-fold (95% CI 1.3, 1.8) increased in men, and the hazard ratio of T2D was 4.9 (95% CI 2.4, 9.9) in women and 1.8 (1.1, 2.9) in men. Genetically predicted SHBG was associated with liver fat content (women: SD -0.45 [95% CI -0.55, -0.35]; men: natural logarithm, -0.25 [95% CI -0.34, -0.16]). VAT and liver fat together mediated 43% (women) and 60% (men) of the SHBG-T2D association. To conclude, in a middle-aged population with overweight, the association between low SHBG and increased risk of T2D was, for a large part, mediated by increased VAT and liver fat.

ARTICLE HIGHLIGHTS

Individuation of a cut-off value of triglyceride-glucose index for incident diabetes mellitus in patients with essential hypertension

The prevalence of obesity and diabetes, risk factors for atherosclerotic vascular diseases, is increasing worldwide; therefore, it is desirable to early identify them to reduce cardiovascular events. Thus, we investigated whether the triglyceride-glucose index (TyG index), a new marker of insulin resistance, is associated with incident diabetes in patients with newly diagnosed arterial hypertension. We selected 585 patients with newly diagnosed arterial hypertension referred to our tertiary Clinic of Catanzaro University Hospital for the evaluation of their cardiometabolic risk profile. None of the patients had diabetes mellitus at enrollment and took any drug known to affect glucose metabolism. Patients underwent medical history collection, clinical examination and laboratory tests. The TyG index was calculated as the ln [fasting TG (mg/dl) × FPG (mg/dl)/2], as previously suggested. During the follow-up [mean 8.5 years (range 3.1-10.7)], there were 78 new cases of incident diabetes (1.57% patient-year). Patients who developed diabetes mellitus were older and had a higher body mass index (BMI), baseline blood pressure, fasting glucose, insulin, homeostatis model sssessment (HOMA) index, triglyceride, creatinine and hs-CRP mean values, while estimated glomerular filtration rate values were lower. At the Cox regression analysis, covariates significantly associated with incident diabetes were: BMI (HR = 2.842, 95%CI = 2.299-3.514), TyG index (HR = 2.392, 95%CI = 1.745-3.192), age (HR = 1.944, 95%CI = 1.527-2.474), hs-CRP (HR = 1.409, 95%CI = 1.153-1.722), and HOMA (HR = 1.325, 95%CI = 1,079-1.756). The best estimated cut-off value of TyG index in predicting diabetes was 4.71. In addition, we documented a significant relationship between TyG index and HOMA (r = 0.575; p < 0.0001). Present data demonstrate that TyG index, a simple and cost-effective marker of insulin resistance, is useful in predicting incident diabetes in patients with arterial hypertension.

Cardiovascular Disease and Diabetes Are Among the Main Underlying Causes of Death in Twenty Healthcare Facilities Across Two Cities in the Democratic Republic of Congo

INTRODUCTION

The mortality rates associated with cardiovascular disease (CVD) and diabetes exhibit disparities by region, with Central Africa ranking fourth globally in terms of mortality rate. The Democratic Republic of Congo (DRC) does not possess mortality data pertaining to these specific underlying causes of death. This study aimed to determine the death rate attributable to CVD and diabetes in two cities in the DRC.

METHODOLOGY

The data on CVD and diabetes utilized in this study were obtained from a pilot project and were registered in the National Health Information System (NHIS). Data quality was initially evaluated using an automated Digital Open Rule Integrated Selection (DORIS), followed by an assessment conducted manually by three assessors. Descriptive and comparative analyses were carried out to determine the proportion of mortality related to CVD and diabetes.

RESULTS

CVD accounted for 20.4% (95%CI: 17.7-23.4%) of deaths in the two cities (Kinshasa and Matadi), whereas diabetes accounted for 5.4% (95%CI: 3.9-7.2%). After adjusting for age and city, the proportional mortality from CVD and diabetes was higher for women than men and increased with age. This study recorded 4.4% of deaths among men and 7.0% among women as the proportional mortality from diabetes.

CONCLUSIONS

Non-communicable diseases (NCDs) continue to be a major cause of death, and CVD and diabetes are among the leading causes of early mortality in adults in urban areas. The proportional mortality related to CVD and diabetes appears to be higher in women than in men. Special emphasis should be placed on women, particularly during adulthood, to ensure the prompt detection of diabetes and cardiovascular conditions.

Genetic Associations of Plasminogen Activator Inhibitor-1-Related miRNA Variants with Coronary Artery Disease

Coronary artery disease (CAD) is one of the most common types of cardiovascular disease and can lead to a heart attack as plaque gradually builds up inside the coronary arteries, blocking blood flow. Previous studies have shown that polymorphisms in the PAI-1 gene are associated with CAD; however, studies of the PAI-1 3'-untranslated region, containing a miRNA binding site, and the miRNAs that interact with it, are insufficient. To investigate the association between miRNA polymorphisms and CAD in the Korean population based on post-transcriptional regulation, we genotyped five polymorphisms in four miRNAs targeting the 3'-untranslated region of PAI-1 using real-time PCR and TaqMan assays. We found that the mutant genotype of miR-30c rs928508 A > G was strongly associated with increased CAD susceptibility. In a genotype combination analysis, the combination of the homozygous mutant genotype (GG) of miR-30c rs928508 with the wild-type genotype (GG) of miR-143 rs41291957 resulted in increased risk for CAD. Also, in an allele combination analysis, the combination of the mutant allele (G) of miR-30c rs928508 and the wild-type allele (G) of miR-143 rs41291957 resulted in increased risk for CAD. Furthermore, metabolic syndrome and diabetes mellitus showed synergistic effects on CAD risk when combined with miR-30c rs928508. These results can be applied to identify CAD prognostic biomarkers among miRNA polymorphisms and various clinical factors.

Menstrual Cycle Variations in Wearable-Detected Finger Temperature and Heart Rate, But Not in Sleep Metrics, in Young and Midlife Individuals

Most studies about the menstrual cycle are laboratory-based, in small samples, with infrequent sampling, and limited to young individuals. Here, we use wearable and diary-based data to investigate menstrual phase and age effects on finger temperature, sleep, heart rate (HR), physical activity, physical symptoms, and mood. A total of 116 healthy females, without menstrual disorders, were enrolled: 67 young (18-35 years, reproductive stage) and 53 midlife (42-55 years, late reproductive to menopause transition). Over one menstrual cycle, participants wore Oura ring Gen2 to detect finger temperature, HR, heart rate variability (root mean square of successive differences between normal heartbeats [RMSSD]), steps, and sleep. They used luteinizing hormone (LH) kits and daily rated sleep, mood, and physical symptoms. A cosinor rhythm analysis was applied to detect menstrual oscillations in temperature. The effect of menstrual cycle phase and group on all other variables was assessed using hierarchical linear models. Finger temperature followed an oscillatory trend indicative of ovulatory cycles in 96 participants. In the midlife group, the temperature rhythm's mesor was higher, but period, amplitude, and number of days between menses and acrophase were similar in both groups. In those with oscillatory temperatures, HR was lowest during menses in both groups. In the young group only, RMSSD was lower in the late-luteal phase than during menses. Overall, RMSSD was lower, and number of daily steps was higher, in the midlife group. No significant menstrual cycle changes were detected in wearable-derived or self-reported measures of sleep efficiency, duration, wake-after-sleep onset, sleep onset latency, or sleep quality. Mood positivity was higher around ovulation, and physical symptoms manifested during menses. Temperature and HR changed across the menstrual cycle; however, sleep measures remained stable in these healthy young and midlife individuals. Further work should investigate over longer periods whether individual- or cluster-specific sleep changes exist, and if a buffering mechanism protects sleep from physiological changes across the menstrual cycle.

Hypogonadism and nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD), recently proposed to be renamed to metabolic dysfunction-associated steatotic liver disease (MASLD), is a major global public health concern, affecting approximately 25-30% of the adult population and possibly leading to cirrhosis, hepatocellular carcinoma, and liver transplantation. The liver is involved in the actions of sex steroids via their hepatic metabolism and production of the sex hormone-binding globulin (SHBG). Liver disease, including NAFLD, is associated with reproductive dysfunction in men and women, and the prevalence of NAFLD in patients with hypogonadism is considerable. A wide spectrum of possible pathophysiological mechanisms linking NAFLD and male/female hypogonadism has been investigated. As therapies targeting NAFLD may impact hypogonadism in men and women, and vice versa, treatments of the latter may affect NAFLD, and an insight into their pathophysiological pathways is imperative. This paper aims to elucidate the complex association between NAFLD and hypogonadism in men and women and discuss the therapeutic options and their impact on both conditions.

Impact of Interventions on Medication Adherence in Patients With Coexisting Diabetes and Hypertension

BACKGROUND

The coexistence of diabetes and hypertension is prevalent due to shared risk factors. Pharmacological treatment has been reported to be effective in managing both conditions. However, treatment effectiveness depends on the extent to which a patient adheres to their treatment. Poor adherence to long-term treatment for chronic diseases is a growing global problem of significant magnitude. Several interventions have been developed to help improve medication adherence in patients with coexisting diabetes and hypertension. This review aimed to determine the characteristics of these interventions and their impact on medication adherence.

METHODS

A systematic review of the literature was conducted using the PRISMA guidelines and registered in the PROSPERO International Registry of Systematic Reviews. Studies were searched in the databases CINAHL, Embase and Medline to identify relevant articles published during 2012-2023. The search concepts included 'medication adherence', 'hypertension', 'diabetes' and 'intervention'. Studies were included if they were in English and evaluated the impact of an intervention aimed at promoting adherence to medications for both diabetes and hypertension.

RESULTS

Seven studies met the inclusion criteria, with five demonstrating a statistically significant improvement in medication adherence. Of the five studies that improved medication adherence, four were multifaceted and one was a single-component intervention. All successful interventions addressed at least two factors influencing non-adherence. Patient education was the foundation of most of the successful interventions, supported by other strategies, such as follow-ups and reminders.

CONCLUSION

Multifaceted interventions that also included patient education had a positive impact on medication adherence in patients with coexisting diabetes and hypertension. Improving adherence in patients with coexisting diabetes and hypertension requires a multipronged approach that considers the range of factors impacting medication-taking.

PATIENT OR PUBLIC CONTRIBUTION

This systematic review provides comprehensive insights into the benefits of patient-centred approaches in intervention development and strengthening. Such patient involvement ensures that medication adherence interventions are more relevant, acceptable and effective, ultimately leading to better health outcomes and more meaningful patient engagement in healthcare research.

Assessing Cardiovascular Target Attainment in Type 2 Diabetes Mellitus Patients in Tertiary Diabetes Center in Romania

INTRODUCTION

Type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) share a bidirectional link, and the innovative antidiabetic molecules GLP-1 Ras and SGLT-2is have proven cardiac and renal benefits, respectively. This study aimed to evaluate CV risk categories, along with lipid-lowering and antidiabetic treatments, in patients with T2DM from a real-life setting in Romania.

MATERIAL AND METHODS

A cross-sectional evaluation was conducted on 405 consecutively admitted patients with T2DM in an ambulatory setting, assessing them according to the 2019 ESC/EAS guidelines for moderate, high, and very high CV risk categories.

RESULTS

The average age of the group was 58 ± 9.96 years, with 38.5% being female. The mean HbA1C level was 7.2 ± 1.7%. Comorbidities included HBP in 88.1% of patients, with a mean SBP and DBP of 133.2 ± 13.7 mm Hg and 79.9 ± 9 mm Hg, respectively, and obesity in 66.41%, with a mean BMI of 33 ± 6.33 kg/m2. The mean LDL-C levels varied by CV risk category: 90.1 ± 34.22 mg/dL in very high risk, 98.63 ± 33.26 mg/dL in high risk, and 105 ± 37.1 mg/dL in moderate risk. Prescribed treatments included metformin (100%), statins (77.5%), GLP-1 Ras (29.4%), and SGLT-2is (29.4%).

CONCLUSIONS

In Romania, patients with T2DM often achieve glycemic control targets but fail to meet composite targets that include glycemic, BP, and lipid control. Additionally, few patients benefit from innovative glucose-lowering therapies with proven cardio-renal benefits or from statins.

Influence of metabolic syndrome on plaque features and clinical outcomes in patients with acute coronary syndrome

BACKGROUND AND AIMS

Currently, the influence of metabolic syndrome (Mets) on the plaque characteristics and prognosis of patients with acute coronary syndrome (ACS) is poorly understood. Thus, the study aimed to characterize the pancoronay plaques of ACS patients with Mets using optical coherence tomography (OCT) and to evaluate the cohort's prognosis.

METHODS

Between February 2015 and September 2020, 745 ACS patients who underwent OCT imaging of the three coronary arteries were included, divided into Mets (n = 252) and non-Mets (n = 493) groups. The major adverse cardiovascular event (MACE) was a composite of cardiac death, non-fatal myocardial infarction (MI), and revascularization.

RESULTS

Compared to the non-Mets group, the Mets group exhibited a higher proportion of females and cases of multivessel disease. In the Mets group, culprit lesions were found to have a greater degree of stenosis, thinner fibrous cap thickness and more thin-cap fibroatheroma (TCFA). Additionally, nonculprit lesions were more likely to exhibit plaque rupture, high-risk plaque characteristics, TCFA, macrophage infiltration, cholesterol crystals, and layered plaque. After a median follow-up of 2 years, 8.3% of patients experienced MACE, a rate that was higher in the Mets group, primarily attributed to non-fatal myocardial infarction and cardiac death. Multivariate analysis showed that Mets (aHR 1.73, p = 0.037), high-risk plaque (aHR 2.63, p < 0.001), age (aHR 1.03, p = 0.020), and left ventricular ejection fraction (aHR 0.96, p = 0.002) were independent predictors of MACE.

CONCLUSIONS

The presence of Mets increased the vulnerability of the entire coronary tree and worsened the prognosis for patients with ACS.

Role of Triglyceride-Glucose Index in Type 2 Diabetes Mellitus and Its Complications

Insulin resistance (IR) is the major mechanism in the pathogenesis of type 2 diabetes mellitus (T2DM). Early identification of IR is of great significance for preventing the onset of T2DM and delaying the progression of the disease. Previous studies have shown that triglyceride-glucose (TyG) index can be used as an effective surrogate marker for IR. There is a significant correlation between TyG index and T2DM and its common complications. In addition, the predictive efficacy of TyG index is better than that of other IR surrogate indicators. TyG index may not only become an important marker to identify people at high risk of T2DM and its complications, but is also expected to become a strong predictor of the prognosis of these diseases. However, there are still some challenges in the widespread application of TyG index in clinical practice. In the future, more high-quality studies are needed to clarify the assessment methods of TyG index for the prognosis of T2DM and its complications. Further investigations of the relationship between TyG index and T2DM and its complications will be expected to provide new ideas and methods for the prevention and treatment of T2DM and its complications.

Effect of melatonin as a therapeutic strategy against intrauterine growth restriction: a mini-review of current state

Intrauterine growth restriction (IUGR) or intrauterine growth retardation is a condition that the fetus does not grow as expected. And the biometric profile does not match with the age of fetus. This condition is associated with increased mortality and morbidity of the neonates along with increased risk of cardiovascular, lung, and central nervous system damage. Despite close monitoring of high-risk mothers and the development of new therapeutic approaches, the optimal outcome has not been achieved yet that it indicates the importance of investigations on new therapeutic approaches. Melatonin (MLT) is a neurohormone mainly produced by the pineal gland and has a wide range of effects on different organs due to the broad dispersion of its receptors. Moreover, melatonin is produced by the placenta and also its receptors have been found on the surface of this organ. Not only studies showed the importance of this neurohormone on growth and development of fetus but also they proved its highly anti-oxidant properties. As in IUGR the oxidative stress and inflammation increased melatonin could counteract these changes and improved organ's function. In this study, we found that use of MLT could be a good clinical approach for the treatment of IUGR as its high anti-oxidant activity and vasodilation could dampen the mechanisms lead to the IUGR development.

Genito Urinary Infection and Urinary Tract Infection in Patients with Type 2 Diabetes Mellitus Receiving SGLT2 Inhibitors: Evidence from a Systematic Literature Review of Landmark Randomized Clinical Trial

BACKGROUND AND PURPOSE

SGLT2 inhibitors are class of drugs that are used in adults with type 2 diabetes through a novel mechanism of action by reducing renal tubular glucose reabsorption, leading to a reduction in blood glucose without stimulating insulin release. In this systematic review, we report the effects of treatment with SGLT2 inhibitors on urinary tract infection (UTI) and genitourinary infection (GUI).

METHOD

The study integrated data from landmark trials of SGLT2 inhibitors (CANVAS, CREDENCE, DECLARE-TIMI 58, and EMPA-REG) to interpret the association of SGLT2 inhibitors with genital infection (GI) and UTI. We reported the review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The primary outcome was a composite of participants reporting UTI and GUI prescribed on SGLT2 inhibitors.

RESULTS

The analysis of four studies involving 38,723 participants revealed incidences of both UTIs and GUI. In the SGLT2 inhibitor group, comprising 21,266 participants, 222 (1.04%) experienced UTIs, and 477 (2.24%) reported GUI. In contrast, among the placebo group consisting of 17,457 participants, 201 (1.15%) reported UTIs, and 70 (0.40%) reported genital infections. These findings underscore the elevated risk associated with SGLT2 inhibitor use, particularly regarding GUI, necessitating careful consideration in clinical practice and patient management strategies.

CONCLUSION

The incidence of UTIs and particularly more pronounced GUI associated with SGLT2 inhibitors highlights the importance of careful risk assessment and monitoring in clinical decision-making, underscoring the need for patient management strategies.

Diabetes is not a negative prognostic factor for 30-days mortality after surgery for acute type A aortic dissection

Background

The correlation between diabetes and aortic dissection is not fully understood yet, although in literature many studies have suggested that there may be an association between the two conditions. The purpose of this study is to evaluate whether diabetes represents a short- and long-term risk factor for mortality from type A acute aortic dissection.

Materials and methods

A total of 340 patients with the diagnosis of type A acute aortic dissection underwent aortic surgery between January 2002 and March 2023. The sample was divided into 2 cohorts according to the presence of diabetes (n = 34) or not (n = 306).

Results

The mean age was 66 (±12.4) years and 60.9% were male. The primary endpoint was 30-day mortality. Hospital mortality was 12 (35.3%) for the diabetes group and 70 (22.9%) for nondiabetes group (P = 0.098). Overall survival at 10 years was 48.3% [95% confidence interval (CI): 41.6-54.7%], while the 10-year survival for people with diabetes was 29.5% (95% CI: 13.2-47.9%) and for nondiabetes group 50.6% (95% CI: 43.4-57.3%) (Log-rank, P = 0.024).

Conclusion

Diabetes was not found to be a risk factor associated with 30-day mortality in patients undergoing surgery for type A acute aortic dissection. It was a risk factor for long-term survival, but this may be related to diabetes complications.

Comparative Efficacy and Safety of Weekly GLP-1/GIP Agonists vs. Weekly Insulin in Type 2 Diabetes: A Network Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Diabetes mellitus (DM) significantly impacts global health due to its complications and the economic burden it places on healthcare systems. The rise of novel once-weekly diabetes medications with different mechanisms of action necessitates an evaluation of their relative efficacy and safety.

OBJECTIVES

This study compares the efficacy and tolerability of once-weekly insulin analogs (icodec and BIF) with once-weekly GLP-1/GIP agonists (semaglutide, exenatide, tirzepatide, dulaglutide) in managing type 2 diabetes mellitus (T2DM).

METHODS

We conducted a network meta-analysis (NMA) using data from randomized controlled trials (RCTs) that compared these treatments with a baseline of daily basal insulin. Primary outcomes included changes in HbA1c, body weight, and tolerability.

RESULTS

The analysis integrated data from 25 RCTs, involving 18,257 patients. Tirzepatide significantly outperformed other treatments in reducing HbA1c and promoting weight loss. Weekly insulins, compared to GLP-1/GIP agonists, showed a more tolerable profile and were beneficial for certain patient demographics emphasizing weight stability.

CONCLUSION

Our findings suggest that while once-weekly GLP-1/GIP agonists provide superior glycemic control and weight management, weekly insulins offer viable options for patients prioritizing fewer side effects and weight stability. This comprehensive comparison aids in refining personalized treatment strategies for T2DM management.

Role of the type 3 cytokines IL-17 and IL-22 in modulating metabolic dysfunction-associated steatotic liver disease

Metabolic dysfunction-associated steatotic liver disease (MASLD) comprises a spectrum of liver diseases that span simple steatosis, metabolic dysfunction-associated steatohepatitis (MASH) and fibrosis and may progress to cirrhosis and cancer. The pathogenesis of MASLD is multifactorial and is driven by environmental, genetic, metabolic and immune factors. This review will focus on the role of the type 3 cytokines IL-17 and IL-22 in MASLD pathogenesis and progression. IL-17 and IL-22 are produced by similar adaptive and innate immune cells such as Th17 and innate lymphoid cells, respectively. IL-17-related signaling is upregulated during MASLD resulting in increased chemokines and proinflammatory cytokines in the liver microenvironment, enhanced recruitment of myeloid cells and T cells leading to exacerbation of inflammation and liver disease progression. IL-17 may also act directly by activating hepatic stellate cells resulting in increased fibrosis. In contrast, IL-22 is a pleiotropic cytokine with a dominantly protective signature in MASLD and is currently being tested as a therapeutic strategy. IL-22 also exhibits beneficial metabolic effects and abrogates MASH-related inflammation and fibrosis development via inducing the production of anti-oxidants and anti-apoptotic factors. A sex-dependent effect has been attributed to both cytokines, most importantly to IL-22 in MASLD or related conditions. Altogether, IL-17 and IL-22 are key effectors in MASLD pathogenesis and progression. We will review the role of these two cytokines and cells that produce them in the development of MASLD, their interaction with host factors driving MASLD including sexual dimorphism, and their potential therapeutic benefits.

Identification of Antioxidant Methyl Derivatives of Ortho-Carbonyl Hydroquinones That Reduce Caco-2 Cell Energetic Metabolism and Alpha-Glucosidase Activity

α-glucosidase, a pharmacological target for type 2 diabetes mellitus (T2DM), is present in the intestinal brush border membrane and catalyzes the hydrolysis of sugar linkages during carbohydrate digestion. Since α-glucosidase inhibitors (AGIs) modulate intestinal metabolism, they may influence oxidative stress and glycolysis inhibition, potentially addressing intestinal dysfunction associated with T2DM. Herein, we report on a study of an ortho-carbonyl substituted hydroquinone series, whose members differ only in the number and position of methyl groups on a common scaffold, on radical-scavenging activities (ORAC assay) and correlate them with some parameters obtained by density functional theory (DFT) analysis. These compounds' effect on enzymatic activity, their molecular modeling on α-glucosidase, and their impact on the mitochondrial respiration and glycolysis of the intestinal Caco-2 cell line were evaluated. Three groups of compounds, according their effects on the Caco-2 cells metabolism, were characterized: group A (compounds 2, 3, 5, 8, 9, and 10) reduces the glycolysis, group B (compounds 1 and 6) reduces the basal mitochondrial oxygen consumption rate (OCR) and increases the extracellular acidification rate (ECAR), suggesting that it induces a metabolic remodeling toward glycolysis, and group C (compounds 4 and 7) increases the glycolysis lacking effect on OCR. Compounds 5 and 10 were more potent as α-glucosidase inhibitors (AGIs) than acarbose, a well-known AGI with clinical use. Moreover, compound 5 was an OCR/ECAR inhibitor, and compound 10 was a dual agent, increasing the proton leak-driven OCR and inhibiting the maximal electron transport flux. Additionally, menadione-induced ROS production was prevented by compound 5 in Caco-2 cells. These results reveal that slight structural variations in a hydroquinone scaffold led to diverse antioxidant capability, α-glucosidase inhibition, and the regulation of mitochondrial bioenergetics in Caco-2 cells, which may be useful in the design of new drugs for T2DM and metabolic syndrome.

Comparison of the effects of single injection and continuous infusion popliteal nerve block on pain and hemodynamics in diabetic foot surgery; prospective randomized clinical trial

Objectives

In patients undergoing surgery due to diabetic foot complications from uncontrolled diabetes may lead to neuraxial or general anesthesia-related issues. Regional anesthesia techniques can be preferred to prevent these complications. This study aimed to compare the hemodynamic effects and outcomes in terms of pain of continuous infusion and single injection methods of popliteal nerve block in patients undergoing surgery due to diabetic foot.

Materials and methods

Sixty-three patients in ASA II-IV risk group scheduled for diabetic foot surgery were randomized into two groups for popliteal nerve block as the anesthesia method. Group 1 (n:32), 30 mL of local anesthetic was administered around the popliteal nerve under ultrasound guidance and nerve stimulator. Group 2 (n:31) had a catheter placed beyond the needle tip by 4-5 cm. An elastomeric pump was prepared for the infusion of 2 mL/h of 0.25 % bupivacaine through the catheter. Hemodynamic parameters before and after the block, onset, block duration times, postoperative pain scores, time to analgesic requirement, patient satisfaction, and discharge time were recorded.

Results

Pain scores were higher in Group 1 after 12 h postoperatively and in Group 2 after 60 h postoperatively (p = 0.006, p < 0.01, respectively). The time to the first analgesic requirement was not statistically different between Group 1 (mean 804.64 ± 1020.8 min) and Group 2 (mean 2012.78 ± 1424 min) (p = 0.072). There was no significant difference in systolic, diastolic, mean arterial blood pressure, and heart rate between groups before and after successful blockade (p > 0.05).

Conclusions

Continuous infusion method of popliteal nerve block provides a longer pain-free period. Both methods showed similar hemodynamic data and low pain scores. Although continuous infusion method provides better analgesia, its procedural cost, technical difficulties, and adverse effects on patient comfort should also be considered.

Inter-relation between diabetes mellitus and hypertension in terms of incidence and prediction in Saudi Arabia: a retrospective cohort study

BACKGROUND

Hypertension (HTN) and type 2 diabetes mellitus (T2DM) are interconnected metabolic disorders with escalating global incidence and prevalence. However, no longitudinal studies have specifically examined the incidence of HTN and T2DM in the same study population. This study aimed to elucidate the association between HTN and T2DM and ascertain their respective roles in the development of each other.

METHODS

This retrospective cohort study encompassed 809 Saudi patients from primary healthcare centers in Al Madinah Al Munawarah, Saudi Arabia. The sample was stratified into three cohorts: 226 patients with HTN but without T2DM, 274 patients with T2DM but without HTN, and 309 patients devoid of both T2DM and HTN. Over a retrospective follow-up period of approximately 5 years, incidence density rates (IDR) were computed for HTN in the T2DM cohort, T2DM in the HTN cohort, and both HTN and T2DM in the control cohort. Multiple logistic regression analysis was employed to identify predictors of HTN and T2DM.

RESULTS

The IDR of T2DM among patients with HTN stood at 73.9 (95% confidence interval [CI] 56, 92) per 1000 person-years, in contrast to 33.9 (95% CI 24, 44) per 1000 person-years in the control cohort (adjusted odds ratio [OR] = 7.1, 95%CI 3.55, 14.13). Conversely, the IDR of HTN among patients with type-2 T2DM was 55.9 (95% CI 42, 70) per 1000 person-years, while in the control cohort, it was 20.8 (95% CI 13, 28) per 1000 person-years (adjusted OR = 5.8, 95% CI 3.11, 11.09). Significant predictors of HTN in the logistic regression model encompassed age, smoking status, family history of HTN, T2DM status, and body mass index (BMI). Similarly, significant predictors of T2DM in the logistic regression model included age, sex, family history of T2DM, HTN, and BMI.

CONCLUSION

This study unveils HTN and T2DM as mutually significant risk factors. The IDR of each condition in the presence of the other significantly exceeded that among individuals devoid of HTN or T2DM.

Long-term safety and effectiveness of lurasidone in adolescents and young adults with schizophrenia: pooled post hoc analyses of two 12-month extension studies

BACKGROUND AND OBJECTIVES

The aim of this analysis was to evaluate the long-term safety and effectiveness of lurasidone in the treatment of schizophrenia in adolescents and young adults (13-25).

METHODS

The 2 pooled studies used similar designs and outcome measures. Patients (13-25) with schizophrenia completed an initial double-blind 6-week trial of lurasidone (40 and 80 mg/day) in the adolescent trial and (80 and 160 mg/day) in the young adult trial. In open-label long-term trials, adolescent patients were treated with 20-80 mg/day lurasidone, and adults were treated with 40-160 mg/day lurasidone. Efficacy was evaluated based on the Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression-Severity Scale (CGI-S).

RESULTS

The safety population consisted of 306 patients (mean age, 16.2 years; 208 patients (68.0%) who completed 12 months of treatment; 8.2% who discontinued treatment by 12 months due to an adverse event). The mean (SD) changes in the PANSS total score from the extension baseline to months 6 and 12 were - 11.8 (13.9) and - 15.3 (15.0), respectively (OC), and the mean (SD) changes in the CGI-S score were - 0.8 (1.0) and - 1.0 (1.1), respectively (OC). The most frequent adverse events were headache (17.6%), anxiety (11.4%), schizophrenia (9.8%), and nausea (9.8%). No clinically meaningful changes were observed in weight, metabolic parameters, or prolactin.

CONCLUSIONS

In adolescents and young adults with schizophrenia, treatment with lurasidone was generally well tolerated and effective. Long-term treatment was associated with a continued reduction in symptoms of schizophrenia. Long-term treatment was associated with minimal effects on weight, metabolic parameters, and prolactin.

CLINICALTRIALS

gov identifiers D1050234, D1050302.

Grape Seed Proanthocyanidin Extract Attenuates Cafeteria-Diet-Induced Liver Metabolic Disturbances in Rats: Influence of Photoperiod

This study investigated the influence of photoperiod (day length) on the efficacy of grape seed proanthocyanidin extract (GSPE) in mitigating metabolic disorders in obese rats fed a cafeteria diet. Rats were exposed to standard (L12), long (L18), or short (L6) photoperiods and treated with GSPE or vehicle. In the standard photoperiod, GSPE reduced body weight gain (50.5%), total cholesterol (37%), and triglycerides (34.8%), while increasing the expression of hepatic metabolic genes. In the long photoperiod, GSPE tended to decrease body weight gain, increased testosterone levels (68.3%), decreased liver weight (12.4%), and decreased reverse serum amino acids. In the short photoperiod, GSPE reduced glycemia (~10%) and lowered triglyceride levels (38.5%), with effects modified by diet. The standard photoperiod showed the greatest efficacy against metabolic syndrome-associated diseases. The study showed how day length affects GSPE's benefits and underscores considering biological rhythms in metabolic disease therapies.