Youth Who Control HIV on Antiretroviral Therapy Display Unique Plasma Biomarkers and Cellular Transcriptome Profiles Including DNA Repair and RNA Processing

Combination antiretroviral therapy (ART) suppresses detectible HIV-1 replication, but latent reservoirs and persistent immune activation contribute to residual viral-associated morbidities and potential viral reactivation. youth with HIV (YWH) virally suppressed on ART early in infection before CD4 T cell decline with fewer comorbidities compared to adults represent a critical population for identifying markers associated with viral control and predictors of viral breakthrough. This study employed a multi-omics approach to evaluate plasma biomarkers and cellular gene expression profiles in 52 participants, including 27 YWH on ART for 144 weeks and 25 youth with no infection (NI) (ages 18-24). Among the 27 YWH, 19 were virally suppressed (VS; <50 RNA copies/mL), while eight were non-suppressed (VNS; >50 RNA copies/mL). VS YWH displayed unique bioprofiles distinct from either VNS or NI. Early viral suppression mitigates inflammatory pathways and normalizes key biomarkers associated with HIV-related comorbidities. Genes upregulated in pathways linked to cellular homeostasis such as DNA repair, RNA processing, and transcription regulation may diminish viral breakthrough and maintain sustained HIV control on ART. Candidate markers and putative molecular mechanisms were identified, offering potential therapeutic targets to limit viral persistence, enhance HIV treatment strategies, and pave the way for improved clinical outcomes.

Vitamin D Deficiency Meets Hill's Criteria for Causation in SARS-CoV-2 Susceptibility, Complications, and Mortality: A Systematic Review

Clinical trials consistently demonstrate an inverse correlation between serum 25-hydroxyvitamin D [25(OH)D; calcifediol] levels and the risk of symptomatic SARS-CoV-2 disease, complications, and mortality. This systematic review (SR), guided by Bradford Hill's causality criteria, analyzed 294 peer-reviewed manuscripts published between December 2019 and November 2024, focusing on plausibility, consistency, and biological gradient. Evidence confirms that cholecalciferol (D3) and calcifediol significantly reduce symptomatic disease, complications, hospitalizations, and mortality, with optimal effects above 50 ng/mL. While vitamin D requires 3-4 days to act, calcifediol shows effects within 24 h. Among 329 trials, only 11 (3%) showed no benefit due to flawed designs. At USD 2/patient, D3 supplementation is far cheaper than hospitalization costs and more effective than standard interventions. This SR establishes a strong inverse relationship between 25(OH)D levels and SARS-CoV-2 vulnerability, meeting Hill's criteria. Vitamin D3 and calcifediol reduce infections, complications, hospitalizations, and deaths by ~50%, outperforming all patented, FDA-approved COVID-19 therapies. With over 300 trials confirming these findings, waiting for further studies is unnecessary before incorporating them into clinical protocols. Health agencies and scientific societies must recognize the significance of these results and incorporate D3 and calcifediol for prophylaxis and early treatment protocols of SARS-CoV-2 and similar viral infections. Promoting safe sun exposure and adequate vitamin D3 supplementation within communities to maintain 25(OH)D levels above 40 ng/mL (therapeutic range: 40-80 ng/mL) strengthens immune systems, reduces hospitalizations and deaths, and significantly lowers healthcare costs. When serum 25(OH)D levels exceed 70 ng/mL, taking vitamin K2 (100 µg/day or 800 µg/week) alongside vitamin D helps direct any excess calcium to bones. The recommended vitamin D dosage (approximately 70 IU/kg of body weight for a non-obese adult) to maintain 25(OH)D levels between 50-100 ng/mL is safe and cost-effective for disease prevention, ensuring optimal health outcomes.

Role of CD4+ T cell-derived cytokines in the pathogenesis of uveitis

Uveitis refers to a diverse group of inflammatory diseases that affecting the uveal tract, comprising the iris, ciliary body, and choroid, with potential repercussions ranging from visual impairment to blindness. The role of autoimmunity in uveitis etiology is complex and still under investigation. CD4+ T cells intricately regulate immune responses in uveitis through their diverse subtypes: Th1, Th2, Th17, Treg (T regulatory), and Tfh (follicular T helper) cells. Each T cell subtype secretes specific cytokines with either pathogenic or protective implications in uveitis. Th1 cells, characterized by IFN-γ secretion and T-bet expression, drive type 1 immune responses against intracellular pathogens. Conversely, Th2 cells, which produce interleukin (IL)-4, IL-5, and IL-13 and express the transcription factor GATA3, mediate type 2 immune responses to larger extracellular threats like helminths. Th17 cells, generating IL-17 and IL-22 and controlled by RORγt, engage in type 3 immune responses against select pathogens. Tfh cells, releasing IL-21 and governed by Bcl6, aid B cell antibody production. Conversely, Tregs, identified by Foxp3, exert regulatory functions in immune homeostasis. This review delves into the roles of CD4+ T cell-derived cytokines in uveitis, emphasizing their intricate involvement in disease progression and resolution. Insight into these mechanisms might guide therapeutic approaches targeting CD4+ T cell responses in uveitis management.

An Attomolar-Level Optical Device for Monitoring Receptor-Analyte Interactions Without Functionalization Steps: A Case Study of Cytokine Detection

A plastic optical fiber (POF)-based device for biosensing strategies has been developed to monitor several protein-protein interactions at ultra-low concentrations without functionalization processes, exploiting plasmonic phenomena. In this work, novel tests were applied to different kinds of analyte-receptor interactions, such as interleukins, where the bioreceptor's (protein antibody) molecular weight is roughly ten times that of the analyte (protein interleukin), while intracellular bioreceptors and small molecules at low molecular weight interactions have already been demonstrated via the same point-of-care test (POCT). The POCT was implemented by a white light source and a spectrometer connected via two POF-based chips connected in series: an innovative microcuvette chip and a D-shaped POF surface plasmon resonance (SPR) probe. In particular, the POF microcuvette chip was achieved by drilling three micro holes in the core of a modified POF. Instead of performing a functionalization step, the micro holes were filled with a specific receptor solution for the analyte (one microliter at the femtomolar level), which selectively captured the target (e.g., cytokine) when the samples were dropped over the filled micro holes (twenty microliters at the attomolar level). Three interleukins, IL-1β, IL-17A, and IL-18, were detected in the attomolar concentrations range by monitoring the resonance wavelength shift over time due to the cytokine/antibody (protein-protein) interaction. The POF-based device was proven to be effective for detecting several interleukins at the attomolar level in a few minutes and without functionalization processes.

Direct immunofluorescence on plucked hair outer root sheath can predict relapse in pemphigus vulgaris

BACKGROUND

Prospective research is lacking on the utility of plucked hair outer root sheath direct immunofluorescence (ORS DIF) in the prediction of relapse in pemphigus vulgaris (PV) and the correlation of ORS DIF positivity with serum desmoglein antibody titers.

METHODS

We performed a prospective cohort study enrolling 80 PV patients in complete clinical remission at a tertiary care center in North India. Study participants underwent ORS DIF at baseline, which was repeated every 3 months. Skin biopsy DIF was done at study inclusion, repeated at 3 months, and upon clinical relapse. An antidesmoglein antibody titer was assessed concurrently with ORS DIF in a subset of patients. Patients on adjuvant therapy had their adjuvant therapy withdrawn either at the initial visit, at 3 months, or at a 6-month follow-up. Our objectives were to determine the association between positive ORS DIF and clinical relapse, the correlation between positive ORS DIF and skin biopsy DIF, and between positive ORS DIF and positive antidesmoglein antibody titers (when concurrently done).

RESULTS

Twenty-two patients (27.5%) had a clinical relapse. Baseline immunological markers significantly associated with relapse are ORS DIF positivity with IgG (16/36 [45.44%] P = 0.005) and C3 (12/29 [41.37%] P = 0.047) and greater intensity of baseline IgG and C3 positivity in ORS DIF (IgG, P = 0.002; C3, P = 0.033). Notably, a significant correlation was observed between baseline positive ORS DIF and skin biopsy DIF (IgG, ρ = 0.695; C3, ρ = 0.498). Positive ORS DIF strongly correlated with positive anti-Dsg3 antibody titers (φs = 0.815; P < 0.01). Early withdrawal of adjuvant immunosuppressant (within 3 months) (P = 0.007) and positive ORS DIF were also associated with relapse (P = 0.017).

CONCLUSION AND RELEVANCE

ORS DIF is a reliable predictor of PV clinical relapse and demonstrated robust correlations with skin biopsy DIF and antidesmoglein antibody titers. Periodic assessment of ORS DIF aids in determining new-onset positivity that heralds clinical relapse.

The role of lncRNAs in the interplay of signaling pathways and epigenetic mechanisms in glioma

Gliomas, highly aggressive tumors of the central nervous system, present overwhelming challenges due to their heterogeneity and therapeutic resistance. Glioblastoma multiforme (GBM), the most malignant form, underscores this clinical urgency due to dismal prognosis despite aggressive treatment regimens. Recent advances in cancer research revealed signaling pathways and epigenetic mechanisms that intricately govern glioma progression, offering multifaceted targets for therapeutic intervention. This review explores the dynamic interplay between signaling events and epigenetic regulation in the context of glioma, with a particular focus on the crucial roles played by non-coding RNAs (ncRNAs). Through direct and indirect epigenetic targeting, ncRNAs emerge as key regulators shaping the molecular landscape of glioblastoma across its various stages. By dissecting these intricate regulatory networks, novel and patient-tailored therapeutic strategies could be devised to improve patient outcomes with this devastating disease.

Prevention of Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage-Summary of Existing Clinical Evidence

The 2023 International Subarachnoid Hemorrhage Conference identified a need to provide an up-to-date review on prevention methods for delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage and highlight areas for future research. A PubMed search was conducted for key factors contributing to development of delayed cerebral ischemia: anesthetics, antithrombotics, cerebrospinal fluid (CSF) diversion, hemodynamic, endovascular, and medical management. It was found that there is still a need for prospective studies analyzing the best methods for anesthetics and antithrombotics, though inhaled anesthetics and antiplatelets were found to have some advantages. Lumbar drains should increasingly be considered the first line of CSF diversion when applicable. Finally, maintaining euvolemia before and during vasospasm is recommended as there is no evidence supporting prophylactic spasmolysis or angioplasty. There is accumulating observational evidence, however, that intra-arterial spasmolysis with refractory DCI might be beneficial in patients not responding to induced hypertension. Nimodipine remains the medical therapy with the most support for prevention.

Effect of Moderately High-Dose Vitamin D3 Supplementation on Mortality in Patients Hospitalized for COVID-19 Infection

BACKGROUND

Despite a large number of published studies, the effect of vitamin D3 supplementation on mortality in hospitalized patients, as well as the recommended dose and duration of therapy, is unclear. In our retrospective study, we aimed to investigate the impact of vitamin D deficiency and moderately high-dose vitamin D3 supplementation on mortality and disease outcomes in patients with COVID-19 infection.

METHODS

We analyzed data from 148 COVID-19-infected hospitalized patients in two different departments, Internal Medicine and Oncology, at Semmelweis University. The severity of COVID-19 and the treatment used were the same except at one of the departments, where patients received circa 90,000 IU of vitamin D3. We compared in-hospital mortality rates between the groups. In a subgroup analysis, we evaluated the efficacy and safety of vitamin D3 supplementation by assessing 25(OH)D and 1,25(OH)2D concentrations on days 0, 4, and 8.

RESULTS

As a result of the supplementation, the deficiency was resolved in 4 days in deficient patients, and none of the 25(OH)D or 1,25(OH)2D concentrations exceeded the normal range. Mortality was significantly lower and decreased 67% in the group receiving vitamin D3 supplementation, regardless of baseline 25(OH)D concentrations.

CONCLUSIONS

The supplemental dosage, 3 × 30,000 IU of vitamin D3, is effective and safe and may reduce mortality in COVID-19 infection.

Impact of Vitamin D on Skin Aging, and Age-Related Dermatological Conditions

Human skin is a physical and biochemical barrier that protects the internal body from the external environment. Throughout a person's life, the skin undergoes both intrinsic and extrinsic aging, leading to microscopic and macroscopic changes in its morphology. In addition, the repair processes slow with aging, making the older population more susceptible to skin diseases. Intrinsic factors associated with advanced age gradually degrade the dermal collagen matrix, resulting in fine wrinkles and reduced elasticity; this is accelerated in post-menopausal women due to estrogen deficiency. In contrast, extrinsic factors associated with advanced age, primarily caused by exposure to ultraviolet (UV) radiation, lead to coarse wrinkles, solar elastosis, hyperkeratosis, irregular pigmentation, and skin cancers. UVB radiation, while contributing to skin photo-aging, also induces the cutaneous synthesis of vitamin D. Vitamin D, in turn, protects the skin from oxidative stress, inflammation, and DNA damage, thereby delaying both chronological and photo-aging. Moreover, research has demonstrated an association between lower vitamin D levels and a higher prevalence of certain cutaneous diseases. This review explores and summarizes the critical role of vitamin D in skin aging and age-related skin diseases. The data presented highlight the importance of maintaining vitamin D adequacy throughout life.

Pre-Type 1 Diabetes in Adolescents and Teens: Screening, Nutritional Interventions, Beta-Cell Preservation, and Psychosocial Impacts

Type 1 Diabetes (T1D) is a progressive autoimmune disease often identified in childhood or adolescence, with early stages detectable through pre-diabetic markers such as autoantibodies and subclinical beta-cell dysfunction. The identification of the pre-T1D stage is critical for preventing complications, such as diabetic ketoacidosis, and for enabling timely interventions that may alter disease progression. This review examines the multifaceted approach to managing T1D risk in adolescents and teens, emphasizing early detection, nutritional interventions, beta-cell preservation strategies, and psychosocial support. Screening for T1D-associated autoantibodies offers predictive insight into disease risk, particularly when combined with education and family resources that promote lifestyle adjustments. Although nutritional interventions alone are not capable of preventing T1D, certain lifestyle interventions, such as weight management and specific nutritional choices, have shown the potential to preserve insulin sensitivity, reduce inflammation, and mitigate metabolic strain. Pharmacological strategies, including immune-modulating drugs like teplizumab, alongside emerging regenerative and cell-based therapies, offer the potential to delay disease onset by protecting beta-cell function. The social and psychological impacts of a T1D risk diagnosis are also significant, affecting adolescents' quality of life, family dynamics, and mental health. Supportive interventions, including counseling, cognitive-behavioral therapy (CBT), and group support, are recommended for managing the emotional burden of pre-diabetes. Future directions call for integrating universal or targeted screening programs within schools or primary care, advancing research into nutrition and psychosocial support, and promoting policies that enhance access to preventive resources. Advocacy for the insurance coverage of screening, nutritional counseling, and mental health services is also crucial to support families in managing T1D risk. By addressing these areas, healthcare systems can promote early intervention, improve beta-cell preservation, and support the overall well-being of adolescents at risk of T1D.

A narrative review focusing on randomized clinical trials of vitamin D supplementation for COVID-19 disease

Current evidence is inconsistent on whether vitamin D supplementation can prevent COVID-19 infection or improve its clinical outcomes. To better understand and look into the issue, we went through the background knowledge of COVID-19 and vitamin D, searched in Pubmed [by using key words in the title containing "randomized clinical trial", "COVID-19", and "vitamin D (25-hydroxyvitamin D, or cholecalciferol, or calcidiol, or calcifediol) supplementation"] for publications of studies on vitamin D/supplementation in COVID-19 patients, especially those about the randomized clinical trials (RCTs). After reviewing these papers, we did a short background review of vitamin D and the pathophysiology of COVID-19, summarized the key features of the 25 RCTs in text and tabulated in a table of some of the features, commented, compared and discussed the differences between RCTs (for example, change the serum 25-hydroxyvitamin D concentration from nmol/L to ng/mL, making the comparison easier). The take-home question of the review is that serum 25-hydroxyvitamin D concentration is an important indicator of the supplementation effect of vitamin D correction but may not be reliable in predicting the supplementation effect on the clinical outcomes of COVID-19.

Machine learning applications in healthcare clinical practice and research

Machine learning (ML) is a type of artificial intelligence that assists computers in the acquisition of knowledge through data analysis, thus creating machines that can complete tasks otherwise requiring human intelligence. Among its various applications, it has proven groundbreaking in healthcare as well, both in clinical practice and research. In this editorial, we succinctly introduce ML applications and present a study, featured in the latest issue of the World Journal of Clinical Cases. The authors of this study conducted an analysis using both multiple linear regression (MLR) and ML methods to investigate the significant factors that may impact the estimated glomerular filtration rate in healthy women with and without non-alcoholic fatty liver disease (NAFLD). Their results implicated age as the most important determining factor in both groups, followed by lactic dehydrogenase, uric acid, forced expiratory volume in one second, and albumin. In addition, for the NAFLD- group, the 5th and 6th most important impact factors were thyroid-stimulating hormone and systolic blood pressure, as compared to plasma calcium and body fat for the NAFLD+ group. However, the study's distinctive contribution lies in its adoption of ML methodologies, showcasing their superiority over traditional statistical approaches (herein MLR), thereby highlighting the potential of ML to represent an invaluable advanced adjunct tool in clinical practice and research.

The Impact of Vitamin D Deficiency on Coronary Artery Disease Severity Based on Myocardial Perfusion Imaging: A Cross-Sectional Study

Background

The impact of low levels of vitamin D (Vit D) on the severity of cardiovascular diseases has become a significant challenge. This study aimed to assess this impact.

Methods

This pilot cross-sectional study enrolled two hundred patients referred to Namazi Hospital, Shiraz, Iran for myocardial perfusion imaging in 2019. The assessment included myocardial perfusion imaging and Vit D level evaluation. Quantitative ischemia analysis utilized Estimated Summed Stress Scores (SSS), Summed Rest Scores (SRS), and Summed Difference Scores (SDS). Myocardial Perfusion Imaging (MPI) results were categorized into normal, mild ischemia, moderate ischemia, and severe ischemia based on estimated SSS. Ischemia severity was aligned with established criteria, designating severe quantitative ischemia as SSS>13. Vit D was categorized using cutoffs at 10, 20, and 30 ng/mL. Mann-Whitney U-test was used for quantitative variables and Chi Square test for qualitative variables.

Results

Chi Square test revealed a significant association between categorized Vit D levels below 10 ng/mL and severe ischemia (SSS>13) (P<0.001). Total Vit D level and also categorized Vit D with cut-offs of 10, 20, and 30 ng/mL showed no association with abnormal MPI. SSS was notably higher in patients with Vit D levels below 10 ng/mL (P=0.026).

Conclusion

The findings of this study emphasize an association between Vit D level below 10 ng/mL and severe myocardial ischemia, as indicated by SSS.

Primary Hyperparathyroidism: Clinical, Biochemical, and Radio-Pathological Profiles of 804 Patients - A Retrospective Study from South India

Introduction

Primary hyperparathyroidism (PHPT) is a common endocrine disorder with variable clinical presentation. We intend to describe the clinical, biochemical, and radio-pathological profiles of PHPT patients managed over 13 years from South India.

Methods

We analysed all patients who underwent evaluation and surgery for PHPT from July 2011 to April 2024.

Results

A total of 862 PHPT patients underwent parathyroidectomy, with female preponderance (61.2%). Analysis was done on 804 patients (>20 years of age) excluding adolescent and paediatric age groups. The mean age was 43.8 years. The presentation in decreasing order of frequency was weakness and fatigue (84.2%); bone pain (35%); renal disease (20.8%) in the form of nephrolithiasis, nephrocalcinosis, or renal dysfunction; and neuropsychiatric manifestations (23.8%). Pathological fractures were observed in 4.5%, hypercalcaemic crisis in 2.6% of patients, and 1% had MEN I (Multiple Endocrine Neoplasia) syndrome. The mean albumin adjusted serum calcium level was 12.3 ± 1.01 mg/dl, and the median serum PTH level was 338 (80-3864) pg/ml. The sensitivity of the ultrasound neck and 99mTc Sestamibi scan was 97.5% and 98.3%, respectively, with a concordance of 93.4%. 25% underwent bilateral neck exploration and parathyroidectomy. Lesions were ectopic in 20 (2.4%) patients. The mean parathyroid gland weight was 1.45 ± 0.75 g. Histopathology revealed parathyroid adenoma (93.5%), parathyroid hyperplasia (1.6%), and parathyroid carcinoma (2.2%). The cure rate was 99.3%, while three patients had persistent disease. Hungry bone syndrome was observed in 12.1%.

Conclusion

There is a changing trend in the clinical and biochemical profiles of PHPT patients in India to a milder form of the disease. The incidence of parathyroid carcinoma was slightly higher compared to a few other centres in India.

The Spectrum of Presumed Tubercular Uveitis in a Referral Eye Clinic in Qatar

PURPOSE

To analyze the clinical spectrum of patients with presumed tubercular uveitis in a referral eye clinic in Qatar.

METHODS

We retrospectively reviewed the clinical records of 50 patients (80 eyes) diagnosed with presumed ocular tuberculosis who presented to the uveitis clinic, department of Ophthalmology Hamad Medical Corporation, Qatar, from January 2014 till December 2019.

RESULTS

Mean age at presentation was 34.5 ± 9.3 years. Forty one patients were males (82%) and 30 patients had bilateral involvement (60%). Forty eyes (50%) had posterior uveitis, 21 eyes (26.3%) intermediate uveitis, 11 eyes (13.7%) panuveitis, and 8 eyes (10%) anterior uveitis. Ocular findings included vitritis in 82.5% of eyes, retinal vasculitis in 46.3% (92% of which were occlusive in nature), multifocal choroiditis in 18.8%, serpiginous-like choroiditis in 11.3%, Most common complications at presentation or during follow-up included macular edema in 32 eyes (40%), preretinal or optic disc neovascularization in 29 eyes (36.3%) and vitreous hemorrhage in 17 eyes (21.3%). Anti-tubercular treatment was provided to 46 patients (92%). Systemic corticosteroids and corticosteroid sparing agents were associated, respectively, in 39 patients (78%) and 14 patients (28%). After 1 year of follow up, inflammation was controlled, with a significant improvement in visual acuity (p < 0.0001).

CONCLUSIONS

In Qatar, tubercular uveitis has a broad spectrum of ocular features, with posterior and intermediate uveitis being the most common anatomic forms. Vitritis, multifocal choroiditis without or with a serpiginous-like pattern, and occlusive retinal vasculitis are the most common ocular findings. Main sight-threatening ocular complications are macular edema, posterior segment neovascularization, and vitreous hemorrhage.

Consensus Based Indian Guidelines for the Management of Pemphigus Vulgaris and Pemphigus Foliaceous

Pemphigus is an autoimmune blistering disorder characterized by the presence of intraepidermal blisters and erosions, primarily affecting the mucosa and/or skin. There are no established Indian guidelines for the management of pemphigus, and Western guidelines cannot be directly applied due to differences in clinicodemographic profiles, comorbidities, and resource limitations. These guidelines aim to provide Indian dermatologists with evidence-based and consensus-driven recommendations for the management of pemphigus vulgaris (PV) and pemphigus foliaceous (PF), taking into account the unique challenges posed by the Indian healthcare setting. The guidelines focus on the comprehensive management of PV and PF, addressing diagnosis, treatment, monitoring, and follow-up. It is intended for dermatologists working in both outpatient and inpatient settings across India. The first draft of the guidelines was prepared by the writing group and then reviewed by 19 national experts in pemphigus management, including inputs from allied specialties. Areas with limited evidence or anticipated variation in recommendations were subjected to rounds of voting, with responses categorized as "strongly agree," "agree," "neutral," "disagree," or "strongly disagree." Suggestions were incorporated, and statements were revised until a mean agreement score of 4 or higher was reached across 16 key areas after four voting rounds. These guidelines offer a structured approach to managing pemphigus in India, addressing the need for region-specific recommendations that account for unique challenges such as resource constraints and specific comorbidities in Indian patients. They serve as a valuable resource for dermatologists treating pemphigus in a range of clinical settings.

Gut microbiota as a modulator of type 1 diabetes: A molecular perspective

Type 1 diabetes (T1D) is defined as an autoimmune metabolic disorder, characterized by destruction of pancreatic β-cells and high blood sugar levels. If left untreated, T1D results in severe health complications, including cardiovascular and kidney disease, as well as nerve damage, with ultimately grave consequences. Besides the role of genetic and certain environmental factors in T1D development, in the last decade, one new player emerged to affect T1D pathology as well, and that is a gut microbiota. Dysbiosis of gut bacteria can contribute to T1D by gut barrier disruption and the activation of autoimmune response, leading to the destruction of insulin producing cells, causing the development and aggravation of T1D symptoms. The relationship between gut microbiota and diabetes is complex and varies between individuals and additional research is needed to fully understand the effects of gut microbiome alternations in T1D pathogenesis. Therefore, the goal of this review is to understand the current knowledge in underlying molecular mechanism of gut microbiota effects, which leads to the new approaches for further studies in the prevention and treatment of T1D.

Small Intestinal Bacterial Overgrowth and Childhood Malnutrition: A Comprehensive Review of Available Evidence

The gut microbiome is essential for children's normal growth and development, with its formation aligning closely with key stages of growth. Factors like birth method, feeding practices, and antibiotic exposure significantly shape the composition and functionality of the infant gut microbiome. Small intestinal bacterial overgrowth (SIBO) involves an abnormal increase in bacteria within the small intestine. This overgrowth can interfere with digestion, impair nutrient absorption, and lead to both local and systemic inflammation, potentially contributing to malnutrition. In this review, we provide a comprehensive overview of the current understanding of the relationship between SIBO and malnutrition, with a particular focus on the pediatric population. SIBO seems to play an important role in nutrient malabsorption through the gut microbiome imbalance, local inflammation, and disruption of the mucosal intestinal barrier. Additionally, SIBO is more prevalent in digestive disorders linked to malabsorption and malnutrition. Different therapeutic strategies for addressing malnutrition-related SIBO have been proposed. While antibiotics are the primary treatment for SIBO, their effectiveness in promoting weight gain among malnourished children remains uncertain. Hence, future research directed at the impact of microbiome imbalance on nutrient intake and absorption could bring to light new strategies for the effective prevention and treatment of malnutrition.

No causal association between serum vitamin D levels and bronchiectasis: A Mendelian randomization analysis

Observational studies have reported an association between Vitamin D deficiency and an increased risk of bronchiectasis. This study aims to investigate the causal relationship between Vitamin D levels and bronchiectasis using a 2-sample Mendelian randomization (MR) analysis. Data from 2 genome-wide association studies (GWAS) based on European ancestry were analyzed: serum vitamin D levels (sample size = 441,291 [UK Biobank]) and bronchiectasis (sample size = 187,830 [cases = 1107, controls = 186,723; FinnGen]). Inverse-variance weighted (IVW) analysis was primarily used to assess the causal effect of 25(OH)D levels on bronchiectasis, supplemented by Mendelian randomization Egger regression (MR-Egger), weighted median, simple mode, and weighted mode analyses. Additionally, MR-Egger intercept test and MR-Pleiotropy Residual Sum and Outlier methods were implemented to determine pleiotropy, and Cochran's Q test was conducted for heterogeneity testing. Leave-one-out analysis and Bayesian weighted Mendelian randomization was also used to assess the robustness of the results. The MR analysis suggested no significant causal effects of serum 25(OH)D levels on bronchiectasis using the IVW method (odds ratio = 1.550; 95% confidence interval [CI]: 0.908-2.315; P = .120). These results were consistent across MR-Egger regression, weighted median, simple mode, and weighted mode analyses. No significant heterogeneity, pleiotropy, or bias was detected in instrumental variables. Additionally, no evidence supported the causal effects of bronchiectasis on serum vitamin D levels (β = -0.002, 95% CI: -0.007 to 0.003; P = .463). Our study found no significant causal association between serum 25(OH)D levels and bronchiectasis, in either direction. A larger sample-sized randomized controlled trial (RCT) is needed to further investigate this potential causal relationship.

Research Trends of Ocular Tuberculosis: A Bibliometric Analysis

PURPOSE

Ocular tuberculosis (OTB), an extrapulmonary manifestation of tuberculosis (TB), significantly impacts vision acuity and presents challenges in diagnosis and treatment. With ongoing research efforts, new insights into its pathogenesis and treatment have emerged. This study employed bibliometric methods to investigate key research areas and emerging trends, aiming to provide a comprehensive overview of the field.

METHODS

The documents about OTB from January 1, 2003 to December 31, 2023, were retrieved from the Web of Science Core Collection (WoSCC). VOSviewer, CiteSpace, R package bibliometrix, and GraphPad were utilized to analyze the data and visualize the network of the country, organization, author, journal, and keyword related to the field of OTB.

RESULTS

300 articles in the past 21 years were included in this research. The overall number of annual publications exhibits an upward trend. The most productive country, institution, author, and journal were India, Post Graduate Institute of Medical Education & Research (PGIMER), Gupta Vishali, and Ocular Immunology and Inflammation. The main keywords focused on ocular tuberculosis, intraocular tuberculosis, and uveitis. The time trend of keyword occurrences indicated that "T cells" and "aqueous humor" have become new hotspots. Burst detection analysis of keywords shows that "pattern" and "standardization" have emerged as new focal points.

CONCLUSIONS

This study represents the first bibliometric analysis on OTB, offering insights into hot topics and emerging trends within this field. T cells and aqueous humor are identified as novel directions for ongoing research endeavors. The latest research focus is on the standardization of OTB in diagnosis, treatment, and other aspects.

Vitamin D: A key player in COVID-19 immunity and lessons from the pandemic to combat immune-evasive variants

As of the 7th of July 2024, 775,754,322 confirmed cases of COVID-19, including 7,053,902 deaths worldwide, had been reported to the WHO (World Health Organization). Nevertheless, untill the 15th of July 2024, a total of 13,578,710,228 vaccine doses had been administered, with almost no country spared from COVID-19 attacks. The pathophysiology of this virus is complicated, and several symptoms require a deep understanding of the actual mechanisms. It is unclear why some patients develop severe symptoms while others do not, although literature suggests a role for vitamin D. Vitamin D plays a crucial role in the infection or in ameliorating the severity of symptoms. The mechanism of action of vitamin D and vitamin D deficiency (VDD) is well understood. VDD is associated with increased hospitalization of severely ill patients and increased levels of COVID-19-caused mortality. Recent studies suggest that vitamin D levels and genetic variations in the vitamin D receptor (VDR) gene significantly impact the severity and outcomes of COVID-19, especially in the infections caused by Delta and Omicron variants. Furthermore, VDD causes immune system dysregulation upon infection with SARS-CoV-2, indicating that vitamin D sufficiency is crucial in fighting against COVID-19 infection. The therapeutic effect of vitamin D raises interest in its potential role as a prophylactic and treatment adjunct. We evaluate the immunomodulatory effects of vitamin D and its ability to enhance the efficacy of new antiviral drugs like molnupiravir and paxlovid against SARS-CoV-2. This review discusses the role of vitamin D sufficiency and VDD in COVID-19 initiation and progression, emphasizing the molecular mechanisms by which vitamin D exerts its actions as a proactive step for the next pandemic. However, there is still no clear evidence of vitamin D's impact on prevention and treatment, leading to contradictory findings. Therefore, large-scale randomized trials are required to reach a definitive conclusion. A bibliometric analysis of publications related to vitamin D, immunity, and COVID-19 revealed a significant increase in research activity in this area, particularly in 2020-2024, underscoring the growing recognition of vitamin D's potential role in the context of the pandemic.

The adjuvant treatment role of ω-3 fatty acids by regulating gut microbiota positively in the acne vulgaris

Objectives:We aimed to explore the potential role of omega-3 (ω-3) fatty acids on acne vulgaris by modulating gut microbiota.Materials and Methods:We randomly divided the untreated acne patients into two groups with or without ω-3 fatty acids intervention for 12 weeks. The Sprague Dawley (SD) rats with acne model were given isotretinoin, ω-3 fatty acids or their combination respectively. Then the colonic contents samples of the drug intervention SD rats were transferred to the pseudo sterile rats with acne model. The severity of the disease was assessed by the Global Acne Grading System (GAGS) score of the patients, and the swelling rate of auricle and the pathological section of the rat with acne model. The 16S rDNA gene sequencing was performed to detect the alteration of the gut microbiota.Results:ω-3 fatty acids could increase the diversity of the gut microbiota and regulate the flora structure positively both in the patients and rats, increase the abundance of butyric acid producing bacteria and GAGS score in the patients, and alleviate the inflammation and comedones of rats.Conclusion:Supplementation of ω-3 fatty acids could alleviate the inflammation of acne vulgaris by increasing the abundance of butyric acid producing bacteria.

Pemphigus relapse: Mechanisms, risk factors, and agents associated with disease recurrence

Pemphigus represents a spectrum of potentially life-threatening autoimmune-mediated skin blistering conditions caused by antibody production against desmoglein 1 and 3 (anti-DSG 1 and 3) in keratinocytes. Greater than 50% of pemphigus patients experience relapse, which complicates long-term medical management, including risks associated with re-treatment and complications such as infection and dehydration. This review aims to elucidate mechanisms, risk factors, and medications associated with pemphigus relapse. Mechanisms of relapse include the persistence of auto-reactive B-cell populations post-treatment and CD20- B-cell populations that reactivate after B-cell depletion therapy. Risk factors for relapse include high body surface area (BSA) of pemphigus involvement, high body mass index, high severity according to the Pemphigus Disease Area Index (PDAI) at onset, treatment delay, and high anti-DSG1 and DSG3 titers post-treatment. Targeted B-cell localization is associated with better clinical outcomes, including less frequent relapses. Rituximab is currently the gold standard of treatment for moderate-severe pemphigus and has relapse rates of 11%-44% in selected studies, with a mean time to relapse of 5.8 months to 36 months following treatment. Relapse rates across lymphoma dosing (375 mg/m2) versus rheumatoid arthritis dosing (1 g dosing weekly) was inconsistent; however, more frequent dosing, earlier treatment, and higher cumulative dosing were associated with lower relapse rates. Alternative agents that have clinical efficacy include corticosteroid monotherapy, mycophenolate mofetil, azathioprine, and intravenous immunoglobulin. Future studies should include head-to-head comparators over long follow-up periods to identify the best treatment agents associated with the least relapse risk.

The efficacy and safety of low-dose rituximab in the treatment of pemphigus vulgaris: a cohort study

BACKGROUND

Rituximab (RTX) is considered the first-line treatment for pemphigus vulgaris (PV), which is a B-cell-mediated acquired autoimmune disease. However, no consensus on the optimum dosage has been achieved.

OBJECTIVES

To investigate the efficacy and safety of low-dose RTX (a single infusion of 500 mg) for the treatment of PV, a cohort study was conducted for patients with PV, along with a 12-month follow-up following the administration of RTX.

METHODS

Patients with moderate or severe PV were divided into group A (low-dose RTX combined with corticosteroids) and group B (corticosteroids alone). Data on complete remission (CR) rates, doses of corticosteroids, cumulative doses of corticosteroids at the third, sixth, and twelfth months, pemphigus disease area index and adverse effects (AEs) were collected.

RESULTS

Forty-four patients with moderate or severe PV were enrolled in this study (19 in group A and 25 in group B). Patients treated with low-dose RTX had higher CR rates, lower doses of corticosteroids at the third, sixth, and twelfth months, lower cumulative doses of corticosteroids at the sixth and twelfth months, and fewer AEs than those who received corticosteroids alone.

CONCLUSIONS

This study indicated that low-dose RTX may be a beneficial and secure therapy option for patients with moderate to severe PV.

Revisiting Vitamin D Guidelines: A Critical Appraisal of the Literature

BACKGROUND/OBJECTIVE

The goal of this review is to compare the 2024 and 2011 Endocrine Society's Clinical Practice Guidelines on vitamin D2 or vitamin D3 (vitamin D). The 2024 Guideline made recommendations for the general healthy population for skeletal and extra skeletal health benefits of vitamin D. This contrasts with the 2011 Guidelines which provided clinicians with guidance on how to evaluate and treat patients with vitamin D deficiency and prevent recurrence.

DISCUSSION

The 2024 Guideline focused on randomized controlled trials and ignored association studies and other studies that have supported the skeletal and extra skeletal health benefits of vitamin D. The 2024 Guideline recommended empiric vitamin D in children and adolescents aged 1 to 18 years to reduce risk of upper respiratory tract infections, pregnant women to improve pregnancy-related outcomes, prediabetic patients to reduce risk of diabetes, and to improve mortality in those over 75 years.

CONCLUSION

These guidelines do not apply to individuals with abnormalities in calcium, phosphate, vitamin D, and bone metabolism which were provided in the 2011 Guidelines. For nonpregnant adults up to the age of 75, they recommend the Dietary Reference Intakes of 600 IUs (international units; 1 IU = 25 ng of vitamin D), and 800 IUs as recommended by The Institute of Medicine. Association studies have suggested that to obtain maximum extraskeletal benefits from vitamin D including reducing risk of upper respiratory tract infection for children and adults, autoimmune disorders, pre-eclampsia, low birth weight, neonatal dental caries, and deadly cancers circulating concentrations of 25-hydroxyvitamin D should be at least 30 ng/mL with a preferred range of 40-60 ng/mL as recommended by the 2011 Guidelines.

Vitamin D supplementations and mortality among patients with moderate/severe COVID-19: A meta-analysis of randomized controlled trials

BACKGROUND

Vitamin D deficiency is associated with severe COVID 19 and poor outcomes. However, the role of Vitamin D supplementation on mortality is controversial. The current meta analysis aimed to investigate the same among patients with COVID 19.

MATERIALS AND METHODS

We searched six databases from inception up to July 2023. The keywords used were COVID 19, SARS COV 2, mortality, Vitamin D, calcitriol, cholecalciferol, Calcifediol, survival, death, small dose, and high dose. Eight hundred and sixteen studies were retrieved, 103 full texts were screened, and 14 randomized controlled trials were included in the meta analysis. A structured checklist was used to gather the author's name, country, year of publication, Vitamin D dose, age, sex, number of patients, mortality, and comorbidities. The Cochrane system for meta analysis (RevMan, version 5.4) was used for the data analysis.

RESULTS

No association was found between Vitamin D supplementation and mortality among patients with COVID 19, odd ratio, 1.16, 95% confidence interval (CI), 0.84-1.59, and P = 0.36. No difference between high and low dose Vitamin D supplementation, odd ratio, 0.65, 95% CI, 0.37-1.57, and P = 0.13. In a sub analysis, no significant statistical difference was found between low dose Vitamin D supplementation versus placebo, and when considering patients who were Vitamin D deficient, odd ratio, 1.10, 95% CI, 0.74-1.63. The P = 0.64 and, odd ratio, 0.99, 95% CI, 0.71-1.40, and P = 0.97 respectively.

CONCLUSION

No association was evident between Vitamin D supplementation and mortality among patients with COVID 19 irrespective of doses and Vitamin D status. Further studies are needed to address the timing and frequency of Vitamin D supplementations.

History of Breast Cancer in Patients with Oral Lichen Planus: A Case-Control Study

Objectives: The purpose of this study was to determine the association between oral lichen planus (OLP) and the history of cancer outside of oral cavity and the predominance of its location. Methods: This case-control study included 600 OLP patients and 600 control subjects evaluated in the same section, matched for age and sex to the OLP patients. OLP patients were diagnosed clinically and histologically. Initially, the prevalence of the most frequent types of cancers was described. A Pearson chi-squared test model was used to determine the association of cancer history and OLP. It was considered statistically significant whether p value was ≤0.05. The final multivariate regression model was built after applying a backward selection method to the complete multivariate model considering the odds ratio (OR) with a 95% confidence interval (CI). Results: The history of cancer was significantly associated with OLP regardless of age, sex, tobacco and or alcohol use in both univariate [OR = 2.26 (95%CI: 1.26-4.24); p = 0.008] and multivariate analyses [OR = 2.21 (95%CI: 1.21-4.19); p = 0.012]. According to the location of cancer, there was an association between OLP and history of breast cancer [OR = 3.71 (95%CI = 1.03-13.38); p = 0.032]. Conclusions: This case-control study suggests a higher frequency of cancer, particularly breast cancer, among patients with OLP compared to the control group. Due to the study's design and sample limitations, these findings should be interpreted cautiously. Future longitudinal, multi-institutional studies with rigorous control for cancer history and other confounding factors are essential to further explore the association between OLP and cancer, particularly breast cancer.

Targeted Transcriptome Analysis of Beef Cattle Persistently Infected with Bovine Viral Diarrhea Virus

BACKGROUND

Bovine viral diarrhea virus (BVDV) is an endemic virus of North American cattle populations with significant economic and animal health impacts. While BVDV infection has a myriad of clinical manifestations, a unique and problematic outcome is the establishment of a persistently infected (PI) animal following in utero viral infection. While it is well established that PI animals serve as a constant reservoir of BVDV, the mechanism for the maintained infection remains unknown despite multiple theories.

OBJECTIVE

The purpose of this study was to use transcriptome analysis to investigate the long-term immune status of adult PI cattle and offer insight into the potential mechanistic establishment of persistent BVDV infection.

METHODS

Peripheral blood mononuclear cells were collected from PI beef cattle (N = 6) and controls (N = 6) for targeted RNAseq analysis using 54 immune-related genes followed by pathway enrichment analysis.

RESULTS

Analysis revealed 29 differentially expressed genes (FDR < 0.05, fold change ≥ 2), representing 14 significant KEGG pathways between groups (FDR < 0.05). Transcriptome changes indicated chronic upregulation of interferon-gamma (IFNG) with an unexpected expression of related genes.

CONCLUSIONS

These results provide novel insight into understanding the adult PI immune system and indicate maintained stimulation resulting from virus-mediated dysregulation.

Late Bone Marrow Mononuclear Cell Transplantation in Rats with Sciatic Nerve Crush: Analysis of a Potential Therapeutic Time Window

After peripheral nerve injury, axon and myelin regeneration are key events for optimal clinical improvements. We have previously shown that early bone marrow mononuclear cell (BMMC) transplantation exerts beneficial effects on myelin regeneration. In the present study, we analyze whether there is a temporal window in which BMMCs migrate more efficiently to damaged nerves while still retaining their positive effects. Adult Wistar rats of both sexes, with sciatic nerve crush, were systemically transplanted with BMMC at different days post injury. Vehicle-treated, naïve, and sham rats were also included. Morphological, functional, and behavioral analyses were performed in nerves from each experimental group at different survival times. BMMC transplantation between 0 and 7 days after injury resulted in the largest number of nested cells within the injured sciatic nerve, which supports the therapeutic value of BMMC administration within the first week after injury. Most importantly, later BMMC administration 7 days after sciatic nerve crush was associated with neuropathic pain reversion, improved morphological appearance of the damaged nerves, and a tendency toward faster recovery in the sciatic functional index and electrophysiological parameters. Our results thus support the notion that even delayed BMMC treatment may represent a promising therapeutic strategy for peripheral nerve injuries.

Protection of beta cells against cytokine-induced apoptosis by the gut microbial metabolite butyrate

Type 1 diabetes (T1D) is characterized by immune cell infiltration in the islets of Langerhans, leading to the destruction of insulin-producing beta cells. This destruction is driven by secreted cytokines and cytotoxic T cells inducing apoptosis in beta cells. Butyrate, a metabolite produced by the gut microbiota, has been shown to have various health benefits, including anti-inflammatory and anti-diabetic effects. In this study, we investigated the potential protective effects of butyrate on cytokine-induced apoptosis in beta cells and explored the underlying mechanisms. Insulin-secreting INS-1E cells and isolated mouse islets were treated with interleukin-1beta (IL-1β) or a combination of IL-1β and interferon-gamma (IFN-γ) in the presence or absence of butyrate. We analyzed apoptosis, nitric oxide (NO) levels, expression of stress-related genes, and immune cell migration. Our results demonstrated that butyrate significantly attenuated cytokine-induced apoptosis in both INS-1E cells and mouse islets, accompanied by a reduction in NO levels. Butyrate also decreased the expression of endoplasmic reticulum (ER) stress markers such as Chop, phosphorylated eIF2α and Atf4, as well as some pro-apoptotic genes including Dp5 and Puma. Butyrate reduced the cytokine-induced expression of the chemokine genes Cxcl1 and Cxcl10 in mouse islets, as well as the chemotactic activity of THP-1 monocytes toward conditioned media from IL-1β-exposed islets. In conclusion, these findings indicate that butyrate protects beta cells from cytokine-induced apoptosis and ER stress, suggesting its potential as a therapeutic agent to prevent beta cell destruction in T1D.

Using the follicular unit extraction technique in treatment of male androgenetic alopecia

BACKGROUND

The incidence of androgenetic alopecia in males is on the rise annually, with hair transplantation using follicular unit extraction (FUE) gaining increasing acceptance as an appropriate treatment for these individuals.

METHODS

A retrospective study was undertaken, involving 158 male patients diagnosed with androgenetic alopecia, who underwent treatment between January 2016 and December 2020 at the Medical Cosmetology Department of the First Affiliated Hospital of Xi'an Medical University. Demographic data and treatment characteristics were documented and analyzed. Clinical efficacy, operation-related complications, patient satisfaction rates, and quality of life scores were assessed and analyzed.

RESULTS

Following FUE hair transplantation, over 90% of the hair follicles survived in 158 patients, with more than 85% of patients achieving a hair follicle survival rate exceeding 95% at 12 months post-operation. Patient satisfaction rates exceeded 98%, while the complication rate was below 6%.

CONCLUSION

Our findings demonstrate that FUE is a minimally invasive hair transplant technique associated with a high hair follicle survival rate and optimal hair density. This approach proves effective in treating male androgenetic alopecia and merits further clinical application.

Management Practices for Hemodynamic Impairment in Neonates Born Prematurely: A Quality Improvement Project

Background: No consensus exists on the management of hemodynamic impairment in very premature neonates. At level 3 NICU, the protocol involves an initial infusion of crystalloids, followed by a cardiac ultrasound if the infusion fails to restore appropriate hemodynamics. Based on the ultrasound findings, a decision is then made regarding a second infusion or the prescription of vasopressor amines. The aim of the present study was to assess the effect of and compliance with this management practice in neonates born prematurely between 26 and 31 completed weeks of gestation following a plan-do-study-act design. Methods: Data were collected retrospectively from patient records for all neonates who were managed for hemodynamic impairment within the first 24 h of life. Results: Of 604 neonates born during the study period, 68 were included in this study, but only eight cases followed the protocol. Reasons for non-compliance were the absence of cardiac ultrasound and variations in the duration and dosage of fluid administration. There was a significant relationship between blood pressure and positive inspiratory pressure levels at the time of management and compliance with the protocol. Conclusions: A revision of the protocol will emphasize the importance of echocardiography assessment, as all neonates responded to the ultrasound-guided therapy. As a quality improvement measure, attending neonatologists will be trained to thoroughly adhere to the protocol before the next evaluation.

COVID-19 in Children and Vitamin D

In December 2019, the so-called "coronavirus disease 2019" (COVID-19) began. This disease is characterized by heterogeneous clinical manifestations, ranging from an asymptomatic process to life-threatening conditions associated with a "cytokine storm". This article (narrative review) summarizes the epidemiologic characteristics and clinical manifestations of COVID-19 and multi-system inflammatory syndrome in children (MIS-C). The effect of the pandemic confinement on vitamin D status and the hypotheses proposed to explain the age-related difference in the severity of COVID-19 are discussed. The role of vitamin D as a critical regulator of both innate and adaptive immune responses and the COVID-19 cytokine storm is analyzed. Vitamin D and its links to both COVID-19 (low levels of vitamin D appear to worsen COVID-19 outcomes) and the cytokine storm (anti-inflammatory activity) are detailed. Finally, the efficacy of vitamin D supplementation in COVID-19 is evaluated, but the evidence supporting vitamin D supplementation as an adjuvant treatment for COVID-19 remains uncertain.

Evaluation the level of vitamin D and its relationship with clinical symptoms in patients with COVID-19 referred to the medical center in Bam city

Background

Vitamin D is a steroid hormone that protects against viral infections by influencing innate and adaptive immune responses. The effectiveness of vitamin D3 supplementation in COVID-19 is unknown. The study's goal was to elucidate the relationship between blood vitamin D levels and COVID-19 clinical outcomes by examining the effect of a single high dose of vitamin D3 on the length of hospital stay in COVID-19 patients.

Methods

The descriptive, retrospective study was performed from March to May 2021 at a referral center for patients with COVID-19, in Bam, Iran. A checklist consisting of demographic variables was used to gather data, and laboratory assessments of serum 25(OH) D were evaluated and documented. The connection between serum vitamin D and patient clinical outcomes was investigated after patients were given a single oral dose of 200,000 IU of vitamin D3.

Results

71 COVID-19 patients were treated. Radiological results did not change substantially amongst individuals with various levels of 25(OH)D. After a single dosage of vitamin D3, mean blood levels of 25-hydroxyvitamin D increased considerably and the need for intubation and SpO2 decreased, and as did the respiratory rate in patients requiring hospitalization due to COVID-19.

Conclusion

A single administration of 200,000 IU of vitamin D3 significantly reduced the severity of COVID-19.

Establishing a Female Animal Model of Prediabetes Using a High-Carbohydrate, High-Fat Diet

Prediabetes is a condition that often precedes the onset of type 2 diabetes and is characterized by moderate levels of insulin resistance. This condition is well established in male animal models for diabetes; however, few female models exist. There is accumulating evidence that sex variations affect the pathogenesis, treatment, and consequences of numerous diseases, such as type 2 diabetes. Therefore, we sought to develop a diet-induced prediabetic female animal model to better understand prediabetes development and its effects in females. Female Sprague Dawley rats were randomly allocated to one of two groups: the standard diet (SD) group fed a standard diet with normal drinking water, and the high-carbohydrate, high-fat (HCHF) group fed a high-carbohydrate and high-fat diet with drinking water supplemented with fructose. During induction, we measured food intake, body weight, body mass index (BMI), and oral glucose tolerance response (OGT). After the induction period, biochemical analyses were conducted to assess the levels of plasma leptin, ghrelin, insulin, and glycated hemoglobin (HbA1c). Glycogen concentrations were quantified in the liver and skeletal muscles. The HCHF diet-fed group presented higher body weight gain, food intake, and BMI levels, which were accompanied by elevated plasma insulin, ghrelin, and liver and skeletal muscle glycogen levels compared to the SD-fed group. In the HCHF diet-fed group, the HOMA-IR was above 1.9, suggesting the presence of moderate levels of insulin resistance. The OGT response was significantly higher in the HCHF-fed group versus the SD-fed group, suggesting impaired glucose tolerance, thus displaying the signs and symptoms of prediabetes. The HCHF diet with fructose led to the induction of prediabetes in female Sprague Dawley rats. This model could be used to investigate and outline the pathophysiological complications associated with prediabetes in females as a result of the prolonged ingestion of a high carbohydrate, high-fat diet with fructose. The development of this model could also serve as an effort to further bridge the gap regarding the inclusion of females in biomedical research, thus providing advancements in deriving better, specified treatment strategies for women.

Deletion of both anaerobic regulator genes fnr and narL compromises the colonization of Salmonella Typhimurium in mice model

Salmonella Typhimurium (STM), a zoonotic pathogen, can adjust its metabolic pathway according to the variations in the partial pressure of atmospheric oxygen and nitrate via fumarate nitrate reductase regulator (Fnr) and NarL, the response regulator for nitrate reductase. Both Fnr and NarL have been individually reported to be the contributors of virulent phenotypes of STM. Hypoxia along with nitrate-rich environment are prevalent in macrophages and the Salmonella-induced inflammatory lumen of the host's large intestine activates both fnr and narL genes. In this study, the double (fnr and narL) knockout STM showed a synergistic reduction in the swimming (62%), swarming (84%) and biofilm density (86%) phenotypes anaerobically in association with its significant aerobic attenuation. The intracellular replication of the double mutant was reduced by 2.3 logs in chicken monocyte-derived macrophages. Furthermore, the competitive index of the double mutant in liver and spleen was found to be 0.3 and 0.44 respectively at 120 h post-infection (PI) in mice. Surprisingly, no double mutant could be recovered from the infected mouse liver 3 days PI. Histopathological findings showed moderate infiltration of mononuclear cells in the large intestine of mice infected with double mutant, but severe infiltration was seen with the wild-type strain.

Performance of Vasopressin Stimulated Bilateral Inferior Petrosal Sinus Sampling in Corticotropin Dependent Cushing's Syndrome with Negative or Equivocal 3 Tesla Contrast Enhanced Magnetic Resonance Imaging of Pituitary

Introduction

Corticotropin releasing hormone (CRH)-stimulated bilateral inferior petrosal sinus sampling (BIPSS) is the most accurate procedure in the differential diagnosis of adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome (CS) with a sensitivity of 88-100% and a specificity of 67-100%. However, CRH is not available globally currently. We undertook this study of BIPSS using lysine vasopressin (LVP) as an agent to stimulate the release of ACTH from corticotrophs. Our objective was to assess the accuracy of LVP-stimulated BIPSS in differentiating Cushing's disease (CD) from ectopic ACTH syndrome (EAS) with negative or equivocal 3T contrast-enhanced MRI (CEMRI).

Methods

Seventeen patients with clinically and biochemically confirmed ACTH-dependent CS with equivocal or negative CEMRI pituitary underwent BIPSS using LVP as a stimulating agent.

Results

Of seventeen patients who underwent BIPSS, nine patients had a raised central-to-peripheral ACTH ratio and were classified as having CD that was confirmed on histopathology following transsphenoidal sinus surgery. Remaining eight patients, who did not show a raised central-to-peripheral ACTH ratio, were classified to have EAS. All patients with EAS underwent contrast-enhanced computerised tomography of the neck, chest, and abdomen and/or Gallium 68 DOTANOC positron emission tomography/computerised tomography. Seven out of eight patients demonstrated solitary pulmonary nodule in the lung (bronchial carcinoid), and one patient had a mass in the thymus (thymic carcinoid).

Conclusion

BIPSS using LVP confirmed the source of ACTH excess correctly in all the patients with ACTH-dependent CS without the loss of specificity.

European flow cytometry quality assurance guidelines for the diagnosis of primary immune deficiencies and assessment of immune reconstitution following B cell depletion therapies and transplantation

Over the last 15 years activity of diagnostic flow cytometry services have evolved from monitoring of CD4 T cell subsets in HIV-1 infection to screening for primary and secondary immune deficiencies syndromes and assessment of immune constitution following B cell depleting therapy and transplantation. Changes in laboratory activity in high income countries have been driven by initiation of anti-retroviral therapy (ART) in HIV-1 regardless of CD4 T cell counts, increasing recognition of primary immune deficiency syndromes and the wider application of B cell depleting therapy and transplantation in clinical practice. Laboratories should use their experience in standardization and quality assurance of CD4 T cell counting in HIV-1 infection to provide immune monitoring services to patients with primary and secondary immune deficiencies. Assessment of immune reconstitution post B cell depleting agents and transplantation can also draw on the expertise acquired by flow cytometry laboratories for detection of CD34 stem cell and assessment of MRD in hematological malignancies. This guideline provides recommendations for clinical laboratories on providing flow cytometry services in screening for immune deficiencies and its emerging role immune reconstitution after B cell targeting therapies and transplantation.

Stem cell therapy approaches for non-malignant diseases & non-haematological diseases in India: A systematic review

Background & objectives Our study aims to provide the diversity of stem cell use for non-malignant, non-haematological diseases in India through the lens of clinical trials. Methods A PRISMA approach was used to evaluate the safety and efficacy of stem cell use for the period 2001-2021 in India. The outcomes were measured using each disease category, types of stem cells, the origin of stem cells, safety, and efficacy. Results Of the 9206 studies screened, 61 studies that were relevant to stem cell use for non-malignant diseases were included for analysis. Autologous stem cells (75%) were used predominantly compared to allogenic stem cells (18.33%), followed by mixed type (6.67%). Use of bone marrow-derived stem cells (51%) was dominant, followed by melanocytes (19%), adipose (7%), haematopoietic (12%), and (11%) other types of stem cells. The study revealed 37 randomized clinical trial studies conducted in the government research hospital compared to the non-government. Interpretation & conclusions Maintaining the gold standard for stem cell therapy requires randomized clinical trials with large sample sizes, control groups, failures, adverse effects, etc. It is important to have a monitoring and regulation system in stem cell clinical research activities with enough preclinical data and repeated exchanges between the bench and the bedside.

Advancement in perioperative management of pituitary adenomas-Current concepts and best practices

Pituitary adenomas are very common representing 18.1% of all brain tumors and are the second most common brain pathology. Transsphenoidal surgery is the mainstay of treatment for all pituitary adenomas except for prolactinomas which are primarily treated medically with dopamine agonists. A thorough endocrine evaluation of pituitary adenoma preoperatively is crucial to identify hormonal compromise caused by the large sellar mass, identifying prolactin-producing tumors and comorbidities associated with Cushing and acromegaly to improve patient care and outcome. Transsphenoidal surgery is relatively safe in the hands of experienced surgeons, but still carries a substantial risk of causing hypopituitarism that required close follow-up in the immediate postoperative period to decrease mortality. A multidisciplinary team approach with endocrinologists, ophthalmologists, and neurosurgeons is the cornerstone in the perioperative management of pituitary adenomas.

Melasma: A Clinical and Epidemiological Single-Group Observational Study in the Greek Population

INTRODUCTION

Melasma is a common acquired disorder of melanogenesis that predominately affects women and presents as hyperpigmented skin lesions mainly located on the face. The study aims to investigate the epidemiologic characteristics and hormonal profiles in melasma patients.

METHODS

One hundred fifty patients were enrolled in this study in a tertiary care hospital. Clinical patterns, pigment depth, disease severity, underlying conditions, and heredity were recorded. Endocrinologic profile and vitamin D levels were assessed.

RESULTS

On clinical examination, the condition indicated a centrofacial localization in 74% of the patients. Extra facial melasma was noticed in 10 patients who had centrofacial melasma to begin with. Wood's lamp examination showed the dermal type as the most common. A family history of melasma was noted in 38% of the patients. Melasma Area and Severity Index (MASI) score ranged from 0.3 to 10.8, with a mean score of 4.12 ± 2.06. Pregnancy-induced melasma was reported in 36.1% of the patients. In 17.4% of women, melasma was related to using oral contraceptives. In 22% of patients, mild vitamin D deficiency was detected, while 21% had thyroid disorders.

CONCLUSION

There is a strong correlation between family history and prevalence of melasma. Sun exposure is a major precipitating factor and should be carefully addressed in Mediterranean countries like Greece. However, other factors such as concomitant medication, multiple pregnancies, use of oral contraceptives, thyroid disorders and vitamin D deficiency might precipitate melasma.

The investigation of the relationship between vitamin D level and severity of diabetic ketoacidosis in new cases of type 1 diabetes in children referred to Hazrat-E- Ali-Asghar Hospital in 2021

Background and Purpose

According to the role of 25-hydroxyvitamin D (25OHD) in glucose homeostasis and immune modulation, vitamin D deficiency may be associated with type 1 diabetes and diabetic ketoacidosis (DKA). Therefore, this study was conducted with the aim of investigation of the relationship between the vitamin D level and severity of diabetic ketoacidosis in new cases of type 1 diabetes in children referred to Hazrat-E-Ali-Asghar Hospital in 2021.

Methods

The present study is based on a cross-sectional study. The population studied in this research includes new cases of children with type 1 diabetes referred to Ali Asghar Children's Hospital in Tehran in 2021. The data analysis was performed using SPSS version 23 software and a significance level of less than 0.05 was considered.

Results

In total, 112 people were included in the study. The difference between the three groups of severity of ketoacidosis in blood pH and bicarbonate level was significant (P < 0.001). The comparison of serum vitamin D levels in different severity of ketoacidosis showed a significant difference between the three groups (P = 0.013), which seems to be caused by the significant difference between the severe and mild ketoacidosis groups. There was observed no significant difference between the gender subgroups and different serum vitamin D levels and also different severity of ketoacidosis (P = 0.801) and (P = 0.25).

Conclusion

Based on the findings of our study, there is a significant relationship between vitamin D and the severity of diabetic ketoacidosis in children with type 2 diabetes. We suggest that routine evaluation of vitamin D levels in diabetic patients and prescribing vitamin D supplements to patients with vitamin D deficiency to prevent the risk of diabetic ketoacidosis.

IL-10: A Key Regulator and potential therapeutic target in uveitis

Uveitis is a prevalent inflammatory eye disease that primarily affects working-age individuals and can lead to blindness if untreated. Interleukin-10 (IL-10) is a multifunctional cytokine with broad immunosuppressive properties and plays a significant role in various pathological and physiological processes. However, its specific role and underlying mechanisms in uveitis remain incompletely understood. This review aims to shed light on the biological characteristics of IL-10, its involvement in the uveitis pathophysiology, and its potential as a novel therapeutic target. By examining existing literature, the review analyzes IL-10 expression levels and regulatory mechanisms in different types of uveitis, discussing its role in immune regulation. Despite IL-10 being expressed variably across various forms of autoimmune uveitis, studies consistently highlight its protective role, prompting research into ways to enhance its bioavailability in the eye. IL-10 is often upregulated in infectious uveitis, contributing to pathogen immune evasion. Furthermore, primary intraocular lymphoma (PIOL), which shares clinical similarities with uveitis, also shows upregulated IL-10 levels, whereas IL-6 is more commonly elevated in uveitis. This differential expression suggests that IL-6 and IL-10 could be diagnostic markers to distinguish between PIOL and uveitis. Future research should continue to focus on elucidating the molecular mechanisms of IL-10 in uveitis, exploring its potential therapeutic applications, and developing targeted treatments that leverage the immunomodulatory effects of IL-10 to prevent and manage this sight-threatening condition.

Homocysteine in androgenetic alopecia: A case control study and observational experiments on mice

OBJECTIVE

To investigate the relationship between homocysteine (HCY) and androgenetic alopecia (AGA).

METHODS

A case control study and two observational experiments on mice were conducted. In the first part, a total of 528 Chinese AGA patients and 500 age-matched healthy controls were included. Serum HCY levels of AGA and controls were compared. In the second part, eight mice were divided into two groups. Both groups of mice had their hair removed. AGA group received a DHT injection, and the other as control group. HCY levels in hair follicles (HFs) were detected by ELISA and compared. In the third part, twelve mice were divided into three groups and fed with different concentrations of methionine. After 4 weeks, serum HCY levels, parameters related to hair growth through observation and HE staining, and expression of immunohistochemistry (IHC) hair-growth-related markers Ki67, VEGF, IGF-1, Krt27, FGF9, and TGF-β1 were compared among the three groups.

RESULTS

In the first part, HCY levels were higher in AGA than the controls of both genders. However, there was no difference in HCY levels between groups with varying severity. Rates of hyperhomocysteinemia was higher in AGA patients than the controls. Logistic regression analysis showed serum HCY levels was positively correlated with the incidence of AGA. In the second part, HCY of the HFs in the AGA group was significantly higher than that in the control group. The third part showed that the increase in serum HCY levels inhibited the growth of mice hair, with the less expressed stimulative markers Ki67, VEGF, IGF-1, Krt27, and FGF9, while there was no difference in the expression of inhibitory markers TGF-β1.

CONCLUSION

There is a potential relationship between HCY and AGA. HCY had an inhibitory effect on hair growth. Further studies are necessary to explore the specific mechanism.

An 8-Week Vitamin D3-Fortified Fruit Drink Supplementation Increases Serum Ferritin Concentration: A Randomized Controlled Trial in Malaysian Women With Low Iron Stores

BACKGROUND

There is limited randomized controlled trial evidence to support the association between vitamin D deficiency and anemia risk, highlighting the necessity for further investigations into the role of vitamin D in influencing iron status.

OBJECTIVE

The aim of this study was to determine the effect of vitamin D3-fortified fruit drink consumption (4,000 IU) on vitamin D and iron status biomarkers among iron-deficient women (serum ferritin of <20 μg/L [to convert μg/L ferritin to ng/mL, multiply by 1]).

DESIGN

An 8-week double-blind randomized controlled trial was conducted.

SUBJECTS/SETTING

A total of 45 healthy, nonpregnant, nonlactating subjects aged 18 through 40 years (mean [SD] 25.3 [4.6] years) were included in the study, excluding those who donated blood 6 months prior, regularly consumed nutritional supplements, or had gastrointestinal or iron metabolic disorders.

INTERVENTION

Subjects were randomly assigned to receive either vitamin D3-fortified fruit drink or a placebo.

MAIN OUTCOME MEASURES

Measurements of 25-hydroxyvitamin D (25[OH]D), serum ferritin, high-sensitivity C-reactive protein, and full blood count concentrations were obtained at baseline, interim, and post intervention.

STATISTICAL ANALYSES

A mixed model, repeated measures analysis of variance was used to analyze the intervention effect.

RESULTS

Attrition rate for the study was 13%, with 6 dropouts, and 39 subjects completed the study. Daily consumption of vitamin D3-fortified fruit drink in the intervention group resulted in significant increases in 25(OH)D and serum ferritin concentrations compared with the placebo group. The intervention group showed significantly higher mean (SD) changes (Δ) in both 25(OH)D (Δ 76.4 [30.2] nmol/L [to convert nmol/L 25(OH)D to ng/mL, multiply by .4] vs Δ -1.3 [10.7] nmol/L; P = .001) and serum ferritin concentrations (Δ 2.2 [4.2] μg/L vs Δ -0.3 [3.4] μg/L; P = .048) between baseline and post intervention. The other iron status biomarkers were not affected by the intervention.

CONCLUSIONS

Our study found that daily vitamin D3-fortified fruit drink supplementation for 8 weeks effectively improved 25(OH)D and iron stores, indicated by increased serum ferritin concentrations, in iron-deficient women. Further research is needed to evaluate its safety, efficacy, feasibility, and optimal food fortification in diverse populations.

Filling the Gaps: Vitamin D Status in Diffuse Hair Fall Among Pakistanis

INTRODUCTION

Hair loss can happen for various reasons, including emotional stress, physical strain, certain medical issues, and nutritional gaps. When it comes to nutrition, a lack of vitamin D3 could be linked to diffuse hair loss.

OBJECTIVES

The aim was to look for the frequency of vitamin D3 deficiency with diffuse hair fall, especially in the Pakistani population.

METHODS

A total of 120 patients of both sexes and all ages presenting to the Dermatology Clinic with complaints of non-scarring alopecia and loss of over 100 strands of hair within a 24-hour period (counted by patient) of any duration and positive hair pull test were advised to take serum vitamin D3. Tests and results were then analyzed by SPSS statistical software package (version 19.0 for Windows).

RESULTS

The mean age of participants enrolled in the study was 28.56 ± 11.62 years. The majority of the patients, i.e., 77 (63.64%), were ≤30 years of age. Among the 120 patients, 17 were males and 103 were females. Mean serum vitamin D3 levels were 17.33 ± 5.43 ng/ml. 95 (79.17%) patients were found to be vitamin D3 deficient, with 37 patients having female pattern hair loss, seven patients with male pattern hair loss, seven patients with diffuse alopecia areata, and 44 patients with telogen effluvium.

CONCLUSIONS

This study concluded that there is considerable frequency of vitamin D3 deficiency in individuals with diffuse hair fall. Therefore, we recommend that there should be early recognition and treatment of this condition in these particular patients in order to reduce hair fall.

Human mesenchymal stem/stromal cell based-therapy in diabetes mellitus: experimental and clinical perspectives

Diabetes mellitus (DM), a chronic metabolic disease, poses a significant global health challenge, with current treatments often fail to prevent the long-term disease complications. Mesenchymal stem/stromal cells (MSCs) are, adult progenitors, able to repair injured tissues, exhibiting regenerative effects and immunoregulatory and anti-inflammatory responses, so they have been emerged as a promising therapeutic approach in many immune-related and inflammatory diseases. This review summarizes the therapeutic mechanisms and outcomes of MSCs, derived from different human tissue sources (hMSCs), in the context of DM type 1 and type 2. Animal model studies and clinical trials indicate that hMSCs can facilitate pleiotropic actions in the diabetic milieu for improved metabolic indices. In addition to modulating abnormally active immune system, hMSCs can ameliorate peripheral insulin resistance, halt beta-cell destruction, preserve residual beta-cell mass, promote beta-cell regeneration and insulin production, support islet grafts, and correct lipid metabolism. Moreover, hMSC-free derivatives, importantly extracellular vesicles, have shown potent experimental anti-diabetic efficacy. Moreover, the review discusses the diverse priming strategies that are introduced to enhance the preclinical anti-diabetic actions of hMSCs. Such strategies are recommended to restore the characteristics and functions of MSCs isolated from patients with DM for autologous implications. Finally, limitations and merits for the wide spread clinical applications of MSCs in DM such as the challenge of autologous versus allogeneic MSCs, the optimal MSC tissue source and administration route, the necessity of larger clinical trials for longer evaluation duration to assess safety concerns, are briefly presented.

Age-dependent immune profile in healthy individuals: an original study, systematic review and meta-analysis

BACKGROUND

The circulatory peripheral immune system is the most convenient approach for determining an individual's immune status. Due to various reasons, while previous studies have addressed the critical impact of age, most individual studies did not analyze immunosenescence in a systemic manner, which complicates the possibility of building a reference range for age-dependent immune profiles for effective immune monitoring. To address this gap, this study analyzed a group of healthy individuals to establish age-specific reference ranges of the healthy circulatory immune profile, and a systematic review and meta-analysis were conducted to validate the findings and create generalizable immune cell reference ranges.

RESULTS

Our study recruited a total of 363 healthy Taiwanese adults (median age 42 years [IQR 30, 62], age range 21 to 87 years, 43.3% male), including 158 under 40 years old, 127 between 40-64 years old, and 78 over 64 years old. Significant age-related alterations were observed in both adaptive and innate immune cell subsets. CD8 + T cells decreased and CD4/CD8 ratio increased, with notable increases in NK cells. CD4 + T cells were less impacted by aging, while CD8 + T cells significantly lost CD28 and increased CD31 expression with age. A clear reverse trend in naïve and memory subsets of CD4 + and CD8 + T cells was observed. Detailed reference ranges for immune cell subsets in healthy Taiwanese adults were established. A systematic review included 7,425 adults and a meta-analysis of 12 eligible studies confirmed our findings in Taiwan, enhancing generalizability.

CONCLUSIONS

Combined with previous studies and original data through a systematic review and meta-analysis, we highlighted and quantified significant immune profile differences between older and younger individuals. The sex and age-specific reference ranges for peripheral immune cell subsets can serve as a basis for effective immune monitoring of various aging-related illnesses.