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De Luca M, Shikora S, Eisenberg D, Angrisani L, Parmar C, Alqahtani A, Aminian A, Aarts E, Brown W, Cohen RV, Di Lorenzo N, Faria SL, Goodpaster KPS, Haddad A, Herrera M, Rosenthal R, Himpens J, Iossa A, Kermansaravi M, Kow L, Kurian M, Chiappetta S, LaMasters T, Mahawar K, Merola G, Nimeri A, O'Kane M, Papasavas P, Piatto G, Ponce J, Prager G, Pratt JSA, Rogers AM, Salminen P, Steele KE, Suter M, Tolone S, Vitiello A, Zappa M, Kothari SN. Scientific Evidence for the Updated Guidelines on Indications for Metabolic and Bariatric Surgery (IFSO/ASMBS). Obes Surg 2024:10.1007/s11695-024-07370-7. [PMID: 39320627 DOI: 10.1007/s11695-024-07370-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 05/21/2024] [Indexed: 09/26/2024]
Abstract
The 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) updated the indications for Metabolic and Bariatric Surgery (MBS), replacing the previous guidelines established by the NIH over 30 years ago. The evidence supporting these updated guidelines has been strengthened to assist metabolic and bariatric surgeons, nutritionists, and other members of multidisciplinary teams, as well as patients. This study aims to assess the level of evidence and the strength of recommendations compared to the previously published criteria.
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Affiliation(s)
| | - Scott Shikora
- Department of Surgery, Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital , and Harvard Medical School, Boston, MA, USA
| | - Dan Eisenberg
- Department of Surgery, Stanford School of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue , GS 112, Palo Alto, CA, 94304, USA
| | - Luigi Angrisani
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | | | - Aayed Alqahtani
- New You Medical Center, King Saud University, Riyadh, Saudi Arabia
| | - Ali Aminian
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Edo Aarts
- Weight Works Clinics and Allurion Clinics, Amersfoort, The Netherlands
| | - Wendy Brown
- Department of Surgery, Central Clinical School, Alfred Health, Monash University, Melbourne, Victoria, Australia
| | - Ricardo V Cohen
- Center for the Treatment of Obesity and Diabetes, Hospital Alemão Oswaldo Cruz, São Paolo, Brazil
| | - Nicola Di Lorenzo
- Department of Surgical Sciences, University of Rome "Tor Vergata", Rome, Italy
| | - Silvia L Faria
- Gastrocirurgia de Brasilia, University of Brasilia, Brasilia, Brazil
| | | | - Ashraf Haddad
- Gastrointestinal Bariatric and Metabolic Center (GBMC), Jordan Hospital, Amman, Jordan
| | - Miguel Herrera
- Endocrine and Bariatric Surgery, UNAM at INCMNSZ, Mexico City, Mexico
| | - Raul Rosenthal
- Cleveland Clinic Florida, The Bariatric Institute, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Jacques Himpens
- Bariatric Surgery Unit, Delta Chirec Hospital, Brussels, Belgium
| | - Angelo Iossa
- Department of Medico Surgical Sciences and Biotechnologies Sapienza Polo Pontino, ICOT Hospital Latina, Latina, Italy
| | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat-e Fatemeh Hospital, Iran University of Medical Sciences, Tehran,, Iran
| | - Lilian Kow
- Adelaide Bariatric Centre, Flinders University of South Australia, Adelaide, Australia
| | - Marina Kurian
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Sonja Chiappetta
- Department of General and Laparoscopic Surgery, Obesity and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
| | | | - Kamal Mahawar
- South Tyneside and Sunderland Foundation NHS Trust, Sunderland, UK
| | - Giovanni Merola
- General and Laparoscopic Surgery, San Giovanni di Dio Hospital - Frattamaggiore, Naples, Italy
| | - Abdelrahman Nimeri
- Department of Surgery, Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital , and Harvard Medical School, Boston, MA, USA
| | - Mary O'Kane
- Department of Nutrition and Dietetics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Pavlos Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, CT, USA
| | - Giacomo Piatto
- UOC Chirurgia Generale e d'Urgenza, Ospedale di Montebelluna, Montebelluna, Italy
| | - Jaime Ponce
- Bariatric Surgery Program, CHI Memorial Hospital, Chattanooga, TN, USA
| | | | - Janey S A Pratt
- Department of Surgery, Stanford School of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue , GS 112, Palo Alto, CA, 94304, USA
| | - Ann M Rogers
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Paulina Salminen
- Division of Digestive Surgery and Urology, Department of Digestive Surgery, Turku University Hospital, Turku, Finland
| | - Kimberley E Steele
- NIDDK Metabolic and Obesity Research Unit, National Institutes of Health, Bethesda, MD, USA
| | - Michel Suter
- Department of Visceral Surgery, University Hospital, Lausanne, Switzerland
| | | | - Antonio Vitiello
- Department of Advanced Biomedical Sciences, Università Degli Studi Di Napoli "Federico II", Naples, Italy
| | - Marco Zappa
- General Surgery Unit, Asst Fatebenefratelli-Sacco Milan, Milan, Italy
| | - Shanu N Kothari
- Department of Surgery, Prisma Health, University of South Carolina School of Medicine, Greenville, SC, USA
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202
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Xu X, Xu S, Gao Y, He S, He J, Chen X, Guo J, Zhang X. Remote ischemic conditioning slows blood-retinal barrier damage in type 1 diabetic rats. Brain Res 2024:149253. [PMID: 39332618 DOI: 10.1016/j.brainres.2024.149253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 09/03/2024] [Accepted: 09/24/2024] [Indexed: 09/29/2024]
Abstract
Diabetic retinopathy (DR) is one of the major complications of diabetes and can cause severe visual impairment. Blood-retina barrier (BRB) destruction resulted from chronic hyperglycemia underlines its major pathological process. However, current treatments have limited efficacy and may even cause serious complications. Remote ischemic conditioning (RIC), through repeated transient mechanical occlusion of limb blood vessels, has been confirmed to promote blood-brain barrier integrity after stroke, but its role in BRB disruption has not been elucidated. This study aimed to investigate the protective effects of RIC on the BRB in diabetic rats and its potential mechanisms. 48 Sprague-Dawley rats were randomly assigned to the Sham group, Sham + RIC group, diabetes mellitus (DM) group and DM+RIC group. The diabetic model was successfully induced by intraperitoneal injection of streptozotocin (STZ). RIC treatment was administered daily and lasted for 9 weeks. In functional analysis, RIC improved the retinal function based on electroretinogram data and reduced the leakage of BRB in diabetic rats. In proteomic analysis, tight junction pathway was enriched after RIC treatment, in which Patj gene was significantly increased. We also found that RIC increased mRNA levels of Patj, claudin-1 and zonula occludens (ZO)-1, protein expression of claudin-1 when compared with diabetic models. In conclusion, RIC slowed BRB damage in diabetic rats which may be related to the preservation of tight junction proteins. RIC may be a promising protective strategy for the treatment of DR.
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Affiliation(s)
- Xiaohan Xu
- Department of Ophthalmology, Xuanwu Hospital of Capital Medical University, Beijing, China.
| | - Shuaili Xu
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.
| | - Yuan Gao
- Department of Ophthalmology, Xuanwu Hospital of Capital Medical University, Beijing, China.
| | - Shan He
- Department of Ophthalmology, Xuanwu Hospital of Capital Medical University, Beijing, China.
| | - Jiachen He
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.
| | - Xi Chen
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.
| | - Jiaqi Guo
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.
| | - Xuxiang Zhang
- Department of Ophthalmology, Xuanwu Hospital of Capital Medical University, Beijing, China.
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203
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Rosen RC, Miner M, Burnett AL, Blaha MJ, Ganz P, Goldstein I, Kim N, Kohler T, Lue T, McVary K, Mulhall J, Parish SJ, Sadeghi-Nejad H, Sadovsky R, Sharlip I, Kloner RA. Proceedings of PRINCETON IV: PDE5 inhibitors and cardiac health symposium. Sex Med Rev 2024; 12:681-709. [PMID: 38936840 DOI: 10.1093/sxmrev/qeae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 05/16/2024] [Accepted: 05/27/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Prior consensus meetings have addressed the relationship between phosphodiesterase type 5 (PDE5) inhibition and cardiac health. Given significant accumulation of new data in the past decade, a fourth consensus conference on this topic was convened in Pasadena, California, on March 10 and 11, 2023. OBJECTIVES Our meeting aimed to update existing knowledge, assess current guidelines, and make recommendations for future research and practice in this area. METHODS An expert panel reviewed existing research and clinical practice guidelines. RESULTS Key findings and clinical recommendations are the following: First, erectile dysfunction (ED) is a risk marker and enhancer for cardiovascular (CV) disease. For men with ED and intermediate levels of CV risk, coronary artery calcium (CAC) computed tomography should be considered in addition to previous management algorithms. Second, sexual activity is generally safe for men with ED, although stress testing should still be considered for men with reduced exercise tolerance or ischemia. Third, the safety of PDE5 inhibitor use with concomitant medications was reviewed in depth, particularly concomitant use with nitrates or alpha-blockers. With rare exceptions, PDE5 inhibitors can be safely used in men being treated for hypertension, lower urinary tract symptoms and other common male disorders. Fourth, for men unresponsive to oral therapy or with absolute contraindications for PDE5 inhibitor administration, multiple treatment options can be selected. These were reviewed in depth with clinical recommendations. Fifth, evidence from retrospective studies points strongly toward cardioprotective effects of chronic PDE5-inhibitor use in men. Decreased rates of adverse cardiac outcomes in men taking PDE-5 inhibitors has been consistently reported from multiple studies. Sixth, recommendations were made regarding over-the-counter access and potential risks of dietary supplement adulteration. Seventh, although limited data exist in women, PDE5 inhibitors are generally safe and are being tested for use in multiple new indications. CONCLUSION Studies support the overall cardiovascular safety of the PDE5 inhibitors. New indications and applications were reviewed in depth.
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Affiliation(s)
- Raymond C Rosen
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States
| | - Martin Miner
- Men's Health Center, Miriam Hospital, 180 Corliss St. 2nd Floor, Providence, RI 02904, United States
| | - Arthur L Burnett
- Department of Urology, Ciccarone Center for Clinical Research, Johns Hopkins University, 600 N Wolfe St # B110, Baltimore, MD 21287, United States
| | - Michael J Blaha
- Department of Cardiology, Johns Hopkins Health Care & Surgery Center, Green Spring Station, Lutherville, 10755 Falls Road, Lutherville, MD 21093, United States
| | - Peter Ganz
- Department of Cardiology and Vascular Research, University of California, San Francisco, 1001 Potrero Ave # 107, San Francisco, CA 94110, United States
| | - Irwin Goldstein
- Institute for Sexual Medicine, 5555 Reservoir Dr # 300, San Diego, CA 92120, United States
| | - Noel Kim
- Institute for Sexual Medicine, 5555 Reservoir Drive, Suite 300, San Diego, CA 92120, United States
| | - Tobias Kohler
- Dept of Urology, Mayo Clinic, 200 First St. S.W., Rochester, Minnesota 55905, US, United States
| | - Tom Lue
- Department of Urology, University of California, San Francisco, School of Medicine, 400 Parnassus Ave #610, San Francisco, CA 94143, United States
| | - Kevin McVary
- Center for Male Health, Stritch School of Medicine, Loyola University, 6800 N Frontage Rd, Burr Ridge, IL 60527, United States
| | - John Mulhall
- Memorial Sloan Kettering Cancer Center, Sloan Kettering Hospital, 205 E 64th St, New York, NY 10065, United States
| | - Sharon J Parish
- Weill Cornell Medical College, 21 Bloomingdale Rd, White Plains, NY 10605, United States
| | - Hossein Sadeghi-Nejad
- Professor of Urology and Ob-Gyn, Department of Urology, Langone Grossman School of Medicine, New York University, 222 East 41st Street, 12th Floor, New York, NY 10017, United States
| | - Richard Sadovsky
- Dept of Family Medicine, Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, United States
| | - Ira Sharlip
- Department of Urology, University of California, San Francisco, School of Medicine, 400 Parnassus Ave #610, San Francisco, CA 94143, United States
| | - Robert A Kloner
- Chief Scientist and Director, Cardiovascular Research Institute, Huntington Medical Research Institutes, 686 S. Fair Oaks Ave., Pasadena, CA. 91105, United States
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204
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Peluso MJ, Deeks SG. Mechanisms of long COVID and the path toward therapeutics. Cell 2024:S0092-8674(24)00886-9. [PMID: 39326415 DOI: 10.1016/j.cell.2024.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 07/30/2024] [Accepted: 07/30/2024] [Indexed: 09/28/2024]
Abstract
Long COVID, a type of post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PASC) defined by medically unexplained symptoms following infection with SARS-CoV-2, is a newly recognized infection-associated chronic condition that causes disability in some people. Substantial progress has been made in defining its epidemiology, biology, and pathophysiology. However, there is no cure for the tens of millions of people believed to be experiencing long COVID, and industry engagement in developing therapeutics has been limited. Here, we review the current state of knowledge regarding the biology and pathophysiology of long COVID, focusing on how the proposed mechanisms explain the physiology of the syndrome and how they provide a rationale for the implementation of a broad experimental medicine and clinical trials agenda. Progress toward preventing and curing long COVID and other infection-associated chronic conditions will require deep and sustained investment by funders and industry.
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Affiliation(s)
- Michael J Peluso
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Steven G Deeks
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA.
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205
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Tienstra M, de Boer JW, van Doesum JA, Keijzer K, Morsink LM, Hazenberg CLE, Ammatuna E, Huls GA, Choudhary P, Gans ROB, Wiersma VR, van Meerten T, van Dijk PR. High frequency of severe hyperglycemia observed during intensive hematological care: a prospective study using continuous glucose monitoring. Endocr Pract 2024:S1530-891X(24)00679-7. [PMID: 39332497 DOI: 10.1016/j.eprac.2024.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 09/11/2024] [Accepted: 09/19/2024] [Indexed: 09/29/2024]
Abstract
OBJECTIVES During intensive hematological care, patients are exposed to high-dose chemotherapy, corticosteroids, immunosuppressants and total parenteral nutrition. Combined with physiological stress and increased release of cytokines and hormones, this can lead to dysglycemia, which is associated with adverse clinical outcomes. This prospective study aims to investigate continuous glucose monitoring (CGM) to identify dysglycemia during intensive hematological care. METHODS Patients receiving chimeric antigen receptor (CAR) T-cell therapy, allogeneic or autologous stem cell transplantation (SCT) were eligible. Throughout the study, glucose levels were concurrently monitored using CGM and point-of-care (POC) glucose measurements in sixty patients (71% male, median age of 64 (IQR [58-68]) years and 10% with diabetes). RESULTS Hyperglycemia (glucose >10mmol/L) was prevalent in 93% of patients, of which 90% had no history of diabetes. Severe hyperglycemia (glucose >13.1mmol/L) was present in 38%. Additionally, hyperglycemia was associated with prolonged hospitalization in patients undergoing CAR T-cell treatment (β=0.19, 95% CI=0.04-0.35) and autologous SCT (β=0.16, 95% CI=0.01-0.32). CGM outperformed POC in detecting hyperglycemia (>10 mmol/L: 1060 vs. 124, detected 2.8 hours (IQR [0.7-4.0]) earlier). Mean absolute relative difference between CGM and POC was 21.5% with 99.8% of measurements in the clinical acceptable zones A+B of the Clarke Error Grid. CONCLUSION These findings emphasize the potential and importance of glucose monitoring with CGM for improved and earlier detection of hyperglycemia, in this patient population, which seems feasible. Our results suggest a need for further studies into CGM as method to optimize glucose levels, which could improve outcomes in patients receiving intensive hematological care.
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Affiliation(s)
- Marieke Tienstra
- University of Groningen, University Medical Center, Department of Hematology, Groningen, The Netherlands
| | - Janneke W de Boer
- University of Groningen, University Medical Center, Department of Hematology, Groningen, The Netherlands
| | - Jaap A van Doesum
- University of Groningen, University Medical Center, Department of Hematology, Groningen, The Netherlands
| | - Kylie Keijzer
- University of Groningen, University Medical Center, Department of Hematology, Groningen, The Netherlands
| | - Linde M Morsink
- University of Groningen, University Medical Center, Department of Hematology, Groningen, The Netherlands
| | - Carin L E Hazenberg
- University of Groningen, University Medical Center, Department of Hematology, Groningen, The Netherlands
| | - Emanuele Ammatuna
- University of Groningen, University Medical Center, Department of Hematology, Groningen, The Netherlands
| | - Gerwin A Huls
- University of Groningen, University Medical Center, Department of Hematology, Groningen, The Netherlands
| | - Pratik Choudhary
- University of Leicester, Diabetes Research Center, Leicester, UK
| | - Rijk O B Gans
- University of Groningen, University Medical Center, Department of Internal Medicine, Groningen, The Netherlands
| | - Valerie R Wiersma
- University of Groningen, University Medical Center, Department of Hematology, Groningen, The Netherlands
| | - Tom van Meerten
- University of Groningen, University Medical Center, Department of Hematology, Groningen, The Netherlands.
| | - Peter R van Dijk
- University of Groningen, University Medical Center, Department of Endocrinology, Groningen, The Netherlands.
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206
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Propper-Lewinsohn T, Shalitin S, Gillon-Keren M, Yackobovitch-Gavan M, Liberman A, Phillip M, Elran-Barak R. Glycemic Variability and Disordered Eating Among Adolescents and Young Adults with Type 1 Diabetes: The Role of Disinhibited Eating. Diabetes Technol Ther 2024. [PMID: 39284171 DOI: 10.1089/dia.2024.0267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
Background and Aims: Disordered eating behaviors (DEB) are common among individuals with type 1 diabetes (T1D). Glycemic variability, potentially harmful in T1D, may reveal distinct characteristics between those with higher versus lower variability, particularly concerning DEB. Our aim was to evaluate the prevalence of DEB and associated risk factors among adolescents and young adults with T1D and to investigate unique factors associated with DEB across different levels of glycemic variability. Methods: An observational, cross-sectional study was conducted with 147 individuals with T1D, aged 13-21 years. Data were collected from medical charts, personal technological devices for assessing glycemic variability, and self-reported questionnaires, including assessments of DEB. Results: DEB were found in 62 (42.1%) individuals, and 41.5% achieved the glycemic variability (% coefficient of variation) target ≤36%. Among individuals with low glycemic variability, DEB were positively associated with diabetes distress (odds ratio [OR]: 1.14 [95% confidence interval or CI: 1.05-1.22], P < 0.001), longer diabetes duration (OR: 1.34 [95% CI: 1.05-1.70], P = 0.016) and lower socioeconomic-status (OR: 0.53 [95% CI: 0.31-0.90], P = 0.019). Among those with high glycemic variability, body mass index Z score (OR: 3.82 [95% CI: 1.48-9.85], P = 0.005), HbA1c (OR: 4.12 [95% CI: 1.33-12.80], P = 0.014), disinhibited eating (OR: 1.57 [95% CI: 1.14-2.15], P = 0.005), and tendency to lower socioeconomic status (OR: 0.75 [95% CI: 0.56-1.01], P = 0.065). Discussion: DEB are prevalent among adolescents and young adults with T1D and are associated with various risk factors. Factors associated with DEB vary across different levels of glycemic variability. Both low and high glycemic variability are associated with specific risk factors for DEB. One notable risk factor is diabetes-specific disinhibited eating among individuals with high glycemic variability, in contrast to those with low glycemic variability. Given these different risk factors, it may be prudent to adjust intervention programs to reduce DEB among T1D adolescents according to their glycemic variability levels.
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Affiliation(s)
- Tamar Propper-Lewinsohn
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- School of Public Health, University of Haifa, Haifa, Israel
| | - Shlomit Shalitin
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Gillon-Keren
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Faculty of Sciences, Kibbutzim College of Education Technology and the Arts, Tel Aviv, Israel
| | - Michal Yackobovitch-Gavan
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Liberman
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Moshe Phillip
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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207
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Parua S, Das A, Hazra A, Chaudhuri P, Bhattacharya K, Dutta S, Sengupta P. Assessing body composition through anthropometry: Implications for diagnosing and managing polycystic ovary syndrome (PCOS). Clin Physiol Funct Imaging 2024. [PMID: 39320052 DOI: 10.1111/cpf.12905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 08/28/2024] [Accepted: 09/10/2024] [Indexed: 09/26/2024]
Abstract
Polycystic ovary syndrome (PCOS) is a multifaceted endocrine disorder with profound implications for the reproductive and metabolic health of women. The utilization of anthropometric measures in the diagnosis and management of PCOS has gained increasing attention due to their practicality and predictive capacity for associated conditions such as obesity and insulin resistance. This review rigorously explores the application of various anthropometric indices, including body mass index, waist-to-hip ratio, and advanced metrics such as the body shape index and body roundness index, wrist circumference, neck circumference. These indices offer critical insights into body fat distribution and its association with the metabolic and hormonal perturbations characteristic of PCOS. The review underscores the necessity of addressing obesity, a prevalent comorbidity in PCOS, through lifestyle modifications and personalized therapeutic approaches. By incorporating anthropometric evaluations into routine clinical practice, healthcare professionals can enhance diagnostic precision, optimize treatment strategies, and ultimately improve patient outcomes. This integrative approach not only facilitates the management of the metabolic challenges inherent in PCOS but also contributes to the development of more individualized therapeutic interventions, thereby enhancing the overall quality of life for women affected by PCOS.
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Affiliation(s)
- Suparna Parua
- School of Paramedics and Allied Health Sciences, Centurion University of Technology and Management, Jatni, Odisha, India
| | - Arnab Das
- Department of Sports Science & Yoga, Ramakrishna Mission Vivekananda Educational & Research Institute, Howrah, West Bengal, India
| | - Anukona Hazra
- School of Paramedics and Allied Health Sciences, Centurion University of Technology and Management, Jatni, Odisha, India
| | - Prasenjit Chaudhuri
- Department of Physiology, Government General Degree College, Vidyasagar University, Mohanpur, West Bengal, India
- Department of Physiology, Hooghly Mohsin College, University of Burdwan, Hooghly, West Bengal, India
| | - Koushik Bhattacharya
- School of Paramedics and Allied Health Sciences, Centurion University of Technology and Management, Jatni, Odisha, India
| | - Sulagna Dutta
- Basic Medical Sciences Department, College of Medicine, Ajman University, Ajman, UAE
| | - Pallav Sengupta
- Department of Biomedical Sciences, College of Medicine, Gulf Medical University, Ajman, UAE
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208
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Kong YW, Morrison D, Lu JC, Lee MH, Jenkins AJ, O'Neal DN. Continuous ketone monitoring: Exciting implications for clinical practice. Diabetes Obes Metab 2024. [PMID: 39314201 DOI: 10.1111/dom.15921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 08/09/2024] [Accepted: 08/20/2024] [Indexed: 09/25/2024]
Abstract
Diabetic ketoacidosis (DKA) is a life-threatening complication usually affecting people with type 1 diabetes (T1D) and, less commonly, people with type 2 diabetes. Early identification of ketosis is a cornerstone in DKA prevention and management. Current methods for ketone measurement by people with diabetes include capillary blood or urine testing. These approaches have limitations, including the need to carry testing strips that have a limited shelf life and a requirement for the user to initiate a test. Recent studies have shown the feasibility of continuous ketone monitoring (CKM) via interstitial fluid with a sensor inserted subcutaneously employing an enzymatic electrochemical reaction. Ketone readings can be updated every 5 minutes. In the future, one would expect that commercialized devices will incorporate alarms linked with standardized thresholds and trend arrows. Ideally, to minimize the burden on users, CKM functionality should be integrated with other devices used to implement glucose management, including continuous glucose monitors and insulin pumps. We suggest CKM provision to all at risk of DKA and recommend that the devices should be worn continuously. Those who may particularly benefit are individuals who have T1D, are pregnant, on medications such as sodium-glucose linked transporter (SGLT) inhibitors that increase DKA, people with recurrent DKA, those with T1D undertaking high intensity exercise, are socially or geographically isolated, or those on low carbohydrate diets. The provision of ketone profiles will provide important clinical insights that have previously been unavailable to people living with diabetes and their healthcare professionals.
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Affiliation(s)
- Yee Wen Kong
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Dale Morrison
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Jean C Lu
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Diabetes and Endocrinology, St. Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Melissa H Lee
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Diabetes and Endocrinology, St. Vincent's Hospital, Fitzroy, Victoria, Australia
- Werribee Mercy Hospital, Werribee, Victoria, Australia
| | - Alicia J Jenkins
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Diabetes and Endocrinology, St. Vincent's Hospital, Fitzroy, Victoria, Australia
- Australian Centre for Accelerating Diabetes Innovations, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - David N O'Neal
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Diabetes and Endocrinology, St. Vincent's Hospital, Fitzroy, Victoria, Australia
- Werribee Mercy Hospital, Werribee, Victoria, Australia
- Australian Centre for Accelerating Diabetes Innovations, Melbourne, Victoria, Australia
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Roy M, Parveen R, Khan P, Majid H, Pathak M, Saxena R, Nidhi. A systematic review on effect of sodium-glucose cotransporter-2 inhibitors on the metabolic and endocrinological profile of patients with polycystic ovarian syndrome. Expert Opin Pharmacother 2024:1-8. [PMID: 39312193 DOI: 10.1080/14656566.2024.2407513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 09/18/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Polycystic ovarian syndrome (PCOS) has been a common metabolic and endocrinal disorder, prevalent amongst women belonging to the reproductive age group. The aim of this systematic review was to assess the safety and efficacy profile of sodium-glucose cotransporter 2 (SGLT2) inhibitors (Canagliflozin, Dapagliflozin, Empagliflozin, and Licogliflozin) for the treatment of women suffering from PCOS. METHODS A literature search in PubMed, Science Direct, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov was conducted for randomized clinical trials of SGLT-2 inhibitors in PCOS patients by applying predetermined inclusion and exclusion criteria. The articles in English language were included. RESULTS Four randomized controlled trials including 146 subjects were included in the review. The clinical studies indicated a significant decrease in the levels of total testosterone, free androgen index, total body fat, homeostasis model assessment-estimated insulin resistance (HOMA-IR), body mass index (BMI), dehydroepiandrosterone sulfate (DHEAS) and fasting plasma glucose (FPG). However, no significant difference was reported in levels of sex hormone-binding globulin (SHBG). Overall, there was improvement in metabolic and endocrine profiles, suggesting a potentially beneficial impact of SGLT2 inhibitors in the management of PCOS. CONCLUSION There is a requirement for large extensive clinical trials to demonstrate the efficacy of SGLT-2 inhibitors in PCOS patients.
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Affiliation(s)
- Madhura Roy
- Department of Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Rizwana Parveen
- Department of Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Parvej Khan
- Department of Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Haya Majid
- Department of Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Mani Pathak
- Department of Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Rajesh Saxena
- Department of Clinical Research, Max Super Specialty Hospital, New Delhi, India
| | - Nidhi
- Department of Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
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210
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Uchida A, Mihata T, Hasegawa A, Noguchi Y, Neo M. Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears yields Good Clinical Outcomes for Patients With and Without Diabetes Mellitus. Arthroscopy 2024:S0749-8063(24)00740-0. [PMID: 39326570 DOI: 10.1016/j.arthro.2024.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 08/09/2024] [Accepted: 09/02/2024] [Indexed: 09/28/2024]
Abstract
PURPOSE To compare the clinical outcomes after superior capsule reconstruction (SCR) for irreparable rotator cuff tears (RCTs) in patients with and without diabetes mellitus (DM). METHOD Patients who underwent SCR using fascia lata autograft for irreparable RCTs between 2012 and 2020 with a minimum 2-year follow-up were divided into non-DM and DM groups. Propensity score matching was used to select controls matched for patients' characteristics. Only patients with HbA1c <8% were eligible. The Visual Analog Scale (VAS) for shoulder pain, American Shoulder and Elbow Surgeons (ASES) and Japanese Orthopaedic Association scores, and acromiohumeral distance were evaluated preoperatively and at 2 years postoperatively. Shoulder active range of motion (ROM) was evaluated preoperatively, at 6 months, 1 year, and 2 years postoperatively. Graft integrity and postoperative complications required additional surgery were evaluated. The Wilcoxon signed-rank test and Mann-Whitney U test were used to compare continuous variables. Pearson's chi-squared test and Fisher's exact test were used for categorical variables. The interaction between the postoperative period and ROM were analyzed by Friedman test and Wilcoxon rank sum test with Holm-Sidak post-hoc test. RESULTS We studied 154 patients (non-DM, 130; DM, 24) who underwent SCR. After matching, 21 patients were selected in each group. All clinical outcomes significantly improved at 2 years (all P<0.05) in both groups. We found no significant differences in clinical outcomes and rates of patients who achieved minimal clinically important differences of VAS and ASES scores between the groups (P=0.10-1.0). The rates of graft tear (both 9.5%) and complications (non-DM, 4.8%; DM, 0%) were not significantly different (both P=1.0). CONCLUSION SCR using fascia lata autograft for irreparable RCTs yields good clinical outcomes, including ROM, in patients with and without DM. No significant differences in postoperative outcomes were observed between the two groups. LEVEL OF EVIDENCE Retrospective cohort study, Level III.
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Affiliation(s)
- Akihiro Uchida
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan; Department of Orthopedic Surgery, First Towakai Hospital, Takatsuki, Japan
| | - Akihiko Hasegawa
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yusuke Noguchi
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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211
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Hagström A, Sabazade S, Gill V, Stålhammar G. Association of female sex with cataract surgery in the general population but not in plaque brachytherapy-treated uveal melanoma patients. Sci Rep 2024; 14:22016. [PMID: 39317717 PMCID: PMC11422500 DOI: 10.1038/s41598-024-73346-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 09/17/2024] [Indexed: 09/26/2024] Open
Abstract
Cataract is a leading cause of blindness worldwide, necessitating a deeper understanding of its risk factors. We analyzed two cohorts: 1000 individuals from the general Swedish population and 933 patients who received plaque brachytherapy for uveal melanoma. Using Kaplan-Meier and cumulative incidence analyses, as well as Cox and competing risk regressions, we assessed whether there is a relationship between sex and cataract surgery. In the general population, female sex was a significant risk factor for cataract surgery, with a 10-year incidence of 16% compared to 10% for males (subdistribution hazard ratio adjusted for age, 1.35, P < 0.001). In the brachytherapy cohort, female sex was not associated with an increased incidence of cataract surgery, with a 10-year incidence of 25% versus 23% for males (HR 1.08, P = 0.61). Visual acuity at the time of cataract surgery did not significantly differ between sexes in either cohort, suggesting that differences in surgery rates are not due to health-seeking behavior or surgery assessment thresholds. These findings indicate that female sex is associated with a higher risk of cataract surgery in the general population, but not among those treated with plaque brachytherapy for uveal melanoma.
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Affiliation(s)
- Anna Hagström
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Eugeniavägen 12, 17164, Stockholm, Sweden
| | - Shiva Sabazade
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Eugeniavägen 12, 17164, Stockholm, Sweden
- Ocular Oncology Service, St. Erik Eye Hospital, Stockholm, Sweden
| | - Viktor Gill
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Eugeniavägen 12, 17164, Stockholm, Sweden
- Department of Pathology, Västmanland Hospital Västerås, Västerås, Sweden
| | - Gustav Stålhammar
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Eugeniavägen 12, 17164, Stockholm, Sweden.
- Ocular Oncology Service, St. Erik Eye Hospital, Stockholm, Sweden.
- St. Erik Ophthalmic Pathology Laboratory, St. Erik Eye Hospital, Stockholm, Sweden.
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212
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Fang CY, Rao A, Handorf EA, Deng M, Cheung P, Tseng M. Increases in Psychological Stress Are Associated With Higher Fasting Glucose in US Chinese Immigrants. Ann Behav Med 2024:kaae056. [PMID: 39316655 DOI: 10.1093/abm/kaae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND The majority of Chinese Americans is foreign-born, and it is well-documented that immigration to the United States (US) leads to increased risk for chronic diseases including type 2 diabetes. Increased disease risk has been attributed to changes in lifestyle behaviors following immigration, but few studies have considered the psychosocial impact of immigration upon biomarkers of disease risk. PURPOSE To examine associations of psychological stress and social isolation with markers of type 2 diabetes risk over time among US Chinese immigrants. METHODS In this longitudinal study of 614 Chinese immigrants, participants completed assessments of perceived stress, acculturative stress, negative life events, and social isolation annually at three time points. Fasting blood samples were obtained at each time point to measure blood glucose, glycated hemoglobin, and insulin resistance. Mean duration between baseline and follow-up assessments was approximately 2 years. RESULTS Increases in migration-related stress, perceived stress and social isolation were associated with significant increases in fasting glucose at follow-up independent of age, body mass index, length of US residence, and other potential covariates. Moreover, increases in glucose varied depending on perceived stress levels at baseline, such that those with higher baseline stress had a steeper increase in glucose over time. CONCLUSIONS Psychological stress and social isolation are associated with increases in fasting glucose in a sample of US Chinese immigrants. Findings suggest that the unique experiences of immigration may be involved in the risk of developing type 2 diabetes, a condition that is prevalent among US Chinese despite relatively low rates of obesity.
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Affiliation(s)
- Carolyn Y Fang
- Cancer Prevention & Control Program, Fox Chase Cancer Center, USA
| | - Ajay Rao
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lewis Katz School of Medicine, Temple University, USA
- Center for Metabolic Disease Research, Department of Medicine, Lewis Katz School of Medicine, Temple University, USA
| | | | - Mengying Deng
- Department of Biostatistics & Bioinformatics, Fox Chase Cancer Center, USA
| | - Peter Cheung
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lewis Katz School of Medicine, Temple University, USA
| | - Marilyn Tseng
- Department of Kinesiology and Public Health, California Polytechnic State University, USA
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213
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Naik AR, Save SN, Sahoo SS, Yadav SS, Kumar A, Chugh J, Sharma S. Metabolic perturbations associated with hIAPP-induced insulin resistance in skeletal muscles: Implications to the development of type 2 diabetes. Int J Biochem Cell Biol 2024; 176:106665. [PMID: 39322038 DOI: 10.1016/j.biocel.2024.106665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 09/16/2024] [Accepted: 09/18/2024] [Indexed: 09/27/2024]
Abstract
The human islet amyloid polypeptide (hIAPP) tends to misfold and self-assemble to form amyloid fibrils, which has been associated with the loss of function and viability of pancreatic β-cells in type 2 diabetes mellitus (T2DM). The role of hIAPP in the development of insulin resistance (a hallmark of T2DM) in skeletal muscles - the major sites for glucose utilization - needs further investigation. Even though, insulin-resistant conditions have been known to stimulate hIAPP aggregation, the events that lead to the development of insulin resistance due to hIAPP aggregation in skeletal muscles remain unidentified. Here, we have attempted to identify metabolic perturbations in L6 myotubes that were exposed to increasing concentrations of recombinant hIAPP for different time durations. It was observed that hIAPP exposure was associated with increased mitochondrial and cellular ROS levels, loss in mitochondrial membrane potential and viability of the myotubes. Metabolomic investigations of hIAPP-treated myotubes revealed significant perturbations in o-phosphocholine, sn-glycero-3-phosphocholine and dimethylamine levels (p < 0.05). Therefore, we anticipate that defects in glycerophospholipid metabolism and the associated oxidative stress and membrane damage may play key roles in the development of insulin resistance due to protein misfolding in skeletal muscles. In summary, the perturbed metabolites and their pathways have not only the potential to be used as early biomarkers to predict the onset of insulin resistance and T2DM but also as therapeutic targets for the effective management of the same.
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Affiliation(s)
- Arya R Naik
- Department of Biotechnology, Savitribai Phule Pune University, Ganeshkhind Road, Pune 411007, India
| | - Shreyada N Save
- Department of Biotechnology, Savitribai Phule Pune University, Ganeshkhind Road, Pune 411007, India
| | - Soumya S Sahoo
- Department of Chemistry, Indian Institute of Science Education and Research (IISER), Dr. Homi Bhabha Road, Pashan, Pune 411008, India
| | - Saurabh S Yadav
- Department of Biotechnology, Savitribai Phule Pune University, Ganeshkhind Road, Pune 411007, India
| | - Ashutosh Kumar
- Department of Biosciences and Bioengineering, Indian institute of technology Bombay, Powai, Mumbai, Maharashtra 400076, India
| | - Jeetender Chugh
- Department of Chemistry, Indian Institute of Science Education and Research (IISER), Dr. Homi Bhabha Road, Pashan, Pune 411008, India
| | - Shilpy Sharma
- Department of Biotechnology, Savitribai Phule Pune University, Ganeshkhind Road, Pune 411007, India.
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Amin SM, Ali AS, Khedr MA, Hendy A, Atta MHR. The Mediating Role of Spirituality in Delineating the Interconnection Between Self-Efficacy and Resilience Among the Parents of Children With Newly Diagnosed Diabetes: A Community Nursing-Led Cross-Sectional Study. J Adv Nurs 2024. [PMID: 39315724 DOI: 10.1111/jan.16467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 08/19/2024] [Accepted: 09/01/2024] [Indexed: 09/25/2024]
Abstract
AIM This study examined the interplay among spirituality, self-efficacy and resilience in this context. DESIGN A cross-sectional study. METHOD A total of 178 parents of children newly diagnosed with diabetes mellitus; the instruments used for data collection were the Parental Self-Efficacy Scale for Diabetes Management, The Arabic version of The Walsh Family Resilience Questionnaire and the Spiritual Perspective Scale. RESULTS Self-efficacy had a significant positive direct effect on family resilience. Spirituality also had a significant positive direct effect on family resilience. Additionally, self-efficacy had a significant positive indirect effect on family resilience through its effect on spirituality. CONCLUSION The findings underscore the impact of spirituality and self-efficacy on a family resilience. IMPLICATIONS FOR THE PROFESSION Nurses should prioritise self-care and personal reflection to enhance their spiritual well-being. This can help them better understand and empathise with their patients' spiritual needs, allowing for more effective and compassionate care. IMPACT Upon the initial diagnosis of diabetes in a child, parents undergo a profound emotional and psychological upheaval. They are faced with the daunting task of managing their child's condition while also coping with their feelings of distress, uncertainty and fear. Amidst these challenges, factors such as self-efficacy and resilience play pivotal roles in determining how parents adapt to and navigate this new reality. Nurses can use spiritual care to give parents a sense of meaning, purpose and hope, bolstering their self-efficacy and resilience. REPORTING METHOD The relevant reporting method has been adhered to, that is, STROBE. PATIENT OR PUBLIC CONTRIBUTION In our research, data collection is assisted by nurses working in community-based settings.
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Affiliation(s)
- Shaimaa Mohamed Amin
- Lecturer of Community Health Nursing, Faculty of Nursing, Damanhour University, Damanhour, Egypt
| | - Ahmed Salah Ali
- Pediatric nursing, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Mahmoud Abdelwahab Khedr
- Department of Nursing, College of Applied Medical Sciences, Hafr Albatin University, Hafr Albatin, Saudi Arabia
- Lecturer of Psychiatric and Mental Health Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Abdelaziz Hendy
- Pediatric Nursing, Faculty of Nursing, Ain Shams University, Cairo, Egypt
| | - Mohamed Hussein Ramadan Atta
- Lecturer of Psychiatric and Mental Health Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
- Nursing Department, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Wadi Addawasir City, Saudi Arabia
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215
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Chau GC, Lim JE, Moon K, Kim IS, Um SH. The stimulatory effect of HI 129, a novel indole derivative, on glucose-induced insulin secretion. Biochem Pharmacol 2024:116558. [PMID: 39326678 DOI: 10.1016/j.bcp.2024.116558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 08/29/2024] [Accepted: 09/24/2024] [Indexed: 09/28/2024]
Abstract
Indole derivatives exhibit a broad spectrum of beneficial effects, encompassing anti-inflammatory, antiviral, antimalarial, anti-diabetic, antioxidant, anti-hepatitis, and antidepressant properties. Here, we describe the potentiation of insulin secretion in pancreatic islets and INS-1 cells through methyl 2-(2-ethoxy-1-hydroxy-2-oxoethyl)-1-(pyrimidine-2-yl)-1H-indole-3-carboxylate (HI 129), a novel indole derivative. Treatment with HI 129 led to notably decreased ADP/ATP ratios in pancreatic islets and INS-1 cells compared with those in the vehicle-treated controls, indicating a shift in cellular ATP production. Moreover, the augmentation of insulin secretion by HI 129 was closely correlated with its ability to enhance the mitochondrial membrane potential and respiration, partly by reducing the phosphorylation levels of AMP-activated protein kinase (AMPK). Mechanistically, HI 129 enhanced the association between AMPK and β-arrestin-1, critical molecules for glucose-induced insulin secretion. Furthermore, β-arrestin-1 depletion attenuated the effect of HI 129 on glucose-induced insulin secretion, suggesting that HI 129 potentiates insulin secretion via β-arrestin-1/AMPK signaling. These results collectively underscore the potential of HI 129 in enhancing insulin secretion as a novel candidate for improving glucose homeostasis in type 2 diabetes.
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Affiliation(s)
- Gia Cac Chau
- Department of Molecular Cell Biology, School of Medicine, Sungkyunkwan University, Suwon, Gyeonggi-do 16419, Korea
| | - Ji Eun Lim
- Department of Molecular Cell Biology, School of Medicine, Sungkyunkwan University, Suwon, Gyeonggi-do 16419, Korea
| | - Kyeongwon Moon
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do 16419, Korea
| | - In Su Kim
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do 16419, Korea.
| | - Sung Hee Um
- Department of Molecular Cell Biology, School of Medicine, Sungkyunkwan University, Suwon, Gyeonggi-do 16419, Korea; Biomedical Institute Convergence at Sungkyunkwan University, School of Medicine, Sungkyunkwan University, Suwon, Gyeonggi-do 16419, Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Samsung Medical Center, Sungkyunkwan University, Seoul, 06351, Korea.
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216
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Chen Q, Qiu FS, Xie W, Yu WY, Su ZA, Qin GM, Kang YK, Jiang SL, Yu CH. Gypenoside A-loaded mPEG-PLGA nanoparticles ameliorate high-glucose-induced retinal microvasculopathy by inhibiting ferroptosis. Int J Pharm 2024; 666:124758. [PMID: 39326476 DOI: 10.1016/j.ijpharm.2024.124758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 08/30/2024] [Accepted: 09/24/2024] [Indexed: 09/28/2024]
Abstract
Diabetic retinopathy (DR) is one of the chronic microvascular complications of type 2 diabetes mellitus (T2DM), which will cause retinal detachment and blindness without ideal therapies. Gypenoside A (GPA) are the main bioactive compound from Gynostemma pentaphyllum, and have various pharmacological effects. However, it suffered from poor bioavailability and potential cardiotoxicity in the clinical application. To overcome those limitations, in this study, nearly spherical nanoparticles (GPA-NP) with a mean particle size of 140.6 ± 22.4 nm were prepared by encapsulating GPA into mPEG-PLGA. This encapsulation efficiency was 84.4 ± 6.9 %, and the drug load was 4.02 %±0.35 %. The results showed that GPA-NP displayed more prolonged GPA release and higher bioavailability in vitro than GPA. GPA-NP obviously reduced the levels of oxidative stress markers and inflammatory cytokines in both retinal tissues of DR mice and high glucose-exposed HRMEC better than GPA alone. Mechanismly, GPA blocked the Nrf2-Keap1 interaction by binding with Kelch domain of Keap1 via alkyl and hydrogen bonds. Therefore, GPA-NP exerted more potent protectivity effects against high glucose-induced retinal microvascular endothelial ferroptosis in vitro and in vivo by activating Nrf2/HO-1/GPX4 pathway. It could be a promising therapeutic agent for preventing DR.
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Affiliation(s)
- Qin Chen
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou 310003, China
| | - Fen-Sheng Qiu
- Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou 310018, China; Key Laboratory of Experimental Animal and Safety Evaluation, Hangzhou Medical College, Hangzhou 310013, China
| | - Wei Xie
- Key Laboratory of Experimental Animal and Safety Evaluation, Hangzhou Medical College, Hangzhou 310013, China
| | - Wen-Ying Yu
- Key Laboratory of Experimental Animal and Safety Evaluation, Hangzhou Medical College, Hangzhou 310013, China
| | - Zhao-An Su
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou 310003, China
| | - Guang-Ming Qin
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou 310003, China.
| | - You-Kun Kang
- Key Laboratory of Experimental Animal and Safety Evaluation, Hangzhou Medical College, Hangzhou 310013, China
| | - Song-Lin Jiang
- Key Laboratory of Experimental Animal and Safety Evaluation, Hangzhou Medical College, Hangzhou 310013, China
| | - Chen-Huan Yu
- Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou 310018, China.
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217
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Dragonieri S, Portacci A, Quaranta VN, Carratu P, Lazar Z, Carpagnano GE, Bikov A. Therapeutic Potential of Glucagon-like Peptide-1 Receptor Agonists in Obstructive Sleep Apnea Syndrome Management: A Narrative Review. Diseases 2024; 12:224. [PMID: 39329893 PMCID: PMC11431450 DOI: 10.3390/diseases12090224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 09/20/2024] [Accepted: 09/20/2024] [Indexed: 09/28/2024] Open
Abstract
Background: Obstructive Sleep Apnea (OSA) is a prevalent disorder characterized by repetitive upper airway obstructions during sleep, leading to intermittent hypoxia and sleep fragmentation. Current treatments, particularly Continuous Positive Airway Pressure (CPAP), face adherence challenges, necessitating novel therapeutic approaches. Methods: This review explores the potential of Glucagon-like Peptide-1 receptor agonists (GLP-1RA), commonly used for type 2 diabetes and obesity, in managing OSA. GLP-1RA promotes weight loss, enhances insulin sensitivity, and exhibits anti-inflammatory and neuroprotective properties, potentially addressing key pathophysiological aspects of OSA. Results: Emerging evidence suggests that these agents may reduce OSA severity by decreasing upper airway fat deposition and improving respiratory control. Clinical trials have demonstrated significant reductions in the Apnea-Hypopnea Index (AHI) and improvements in sleep quality with GLP-1 therapy. Conclusions: Future research should focus on elucidating the mechanisms underlying GLP-1 effects on OSAS, optimizing combination therapies, and identifying patient subgroups that may benefit the most. Integrating GLP-1RA into OSAS management could revolutionize treatment by addressing both the metabolic and respiratory components of the disorder, ultimately enhancing patient outcomes.
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Affiliation(s)
- Silvano Dragonieri
- Respiratory Medicine, Dipartimento di Biomedicina Traslazionale e Neuroscienze, University of Bari, 70121 Bari, Italy; (A.P.); (V.N.Q.); (G.E.C.)
| | - Andrea Portacci
- Respiratory Medicine, Dipartimento di Biomedicina Traslazionale e Neuroscienze, University of Bari, 70121 Bari, Italy; (A.P.); (V.N.Q.); (G.E.C.)
| | - Vitaliano Nicola Quaranta
- Respiratory Medicine, Dipartimento di Biomedicina Traslazionale e Neuroscienze, University of Bari, 70121 Bari, Italy; (A.P.); (V.N.Q.); (G.E.C.)
| | - Pierluigi Carratu
- Internal Medicine “A. Murri”, Department DIMEPREJ, University of Bari, 70121 Bari, Italy;
| | - Zsofia Lazar
- Department of Pulmonology, Semmelweis University, 1085 Budapest, Hungary;
| | - Giovanna Elisiana Carpagnano
- Respiratory Medicine, Dipartimento di Biomedicina Traslazionale e Neuroscienze, University of Bari, 70121 Bari, Italy; (A.P.); (V.N.Q.); (G.E.C.)
| | - Andras Bikov
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK;
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218
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Ianoș RD, Cozma A, Lucaciu RL, Hangan AC, Negrean V, Mercea DC, Ciulei G, Pop C, Procopciuc LM. Role of Circulating Biomarkers in Diabetic Cardiomyopathy. Biomedicines 2024; 12:2153. [PMID: 39335666 PMCID: PMC11428922 DOI: 10.3390/biomedicines12092153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Revised: 09/18/2024] [Accepted: 09/21/2024] [Indexed: 09/30/2024] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a metabolic disorder that has alarmingly increased in incidence in recent decades. One of the most serious complications of T2DM is diabetic cardiomyopathy (DCM), an often underrecognized yet severe condition that is a leading cause of mortality among diabetic patients. In the early stages of DCM, patients typically show no symptoms and maintain normal systolic and diastolic left ventricle function, making early detection challenging. Currently available clinical markers are often not specific enough to detect the early stage of DCM. Conventional biomarkers of cardiac mechanical stress and injury, such as natriuretic peptides (NPs) and cardiac troponin I (cTnI), have shown limited predictive value for patients with T2DM. NPs have proven efficacy in detecting diastolic dysfunction in diabetic patients when used alongside 2D echocardiography, but their utility as biomarkers is limited to symptomatic individuals. While cTnI is a reliable indicator of general cardiac damage, it is not specific to cardiac injury caused by high glucose levels or T2DM. This underscores the need for research into biomarkers that can enable early diagnosis and management of DCM to reduce mortality rates. Promising novel biomarkers that showed good performance in detecting diastolic dysfunction or heart failure in diabetic patients include galectin-3, ST2, FGF-21, IGFBP-7, GDF-15, and TGF-β. This review summarizes the current understanding of DCM biomarkers, aiming to generate new ideas for the early recognition and treatment of DCM by exploring related pathophysiological mechanisms.
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Affiliation(s)
- Raluca Diana Ianoș
- Department of Cardiology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400001 Cluj-Napoca, Romania;
| | - Angela Cozma
- 4th Department of Internal Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania; (V.N.); (G.C.)
| | - Roxana Liana Lucaciu
- Department of Pharmaceutical Biochemistry and Clinical Laboratory, Faculty of Pharmacy, “Iuliu-Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Adriana Corina Hangan
- Department of Inorganic Chemistry, Faculty of Pharmacy, “Iuliu-Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Vasile Negrean
- 4th Department of Internal Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania; (V.N.); (G.C.)
| | - Delia Corina Mercea
- Department of Cardiology, Emergency County Hospital, 430031 Baia Mare, Romania; (D.C.M.); (C.P.)
| | - George Ciulei
- 4th Department of Internal Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania; (V.N.); (G.C.)
| | - Călin Pop
- Department of Cardiology, Emergency County Hospital, 430031 Baia Mare, Romania; (D.C.M.); (C.P.)
- Faculty of Medicine Arad, “Vasile Goldis” Western University, 310045 Arad, Romania
| | - Lucia Maria Procopciuc
- Department of Medical Biochemistry, University of Medicine and Pharmacy “Iuliu Hațieganu”, 400349 Cluj-Napoca, Romania;
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Anbar HS, Shehab NG, Yasin A, Shaar LM, Ashraf R, Rahi Z, Alamir R, Alsabbagh D, Thabet A, Altaas I, Lozon YA, El Rouby NMM, Shahiwala A. The wound healing and hypoglycemic activates of date palm (Phoenix dactylifera) leaf extract and saponins in diabetic and normal rats. PLoS One 2024; 19:e0308879. [PMID: 39312526 PMCID: PMC11419346 DOI: 10.1371/journal.pone.0308879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/28/2024] [Indexed: 09/25/2024] Open
Abstract
INTRODUCTION Indigenous plants have historically been crucial in treating human diseases across various cultures worldwide. Research continues to uncover new therapeutic uses for indigenous plants, from treating infectious diseases to managing chronic conditions such as diabetes and wound care. This study aimed to examine the effect of palm tree leaves "Phoenix dactylifera L" extract and its topical film formulation on wound healing and blood glucose levels. METHODS Palm leaves were collected, authenticated, powdered, and extracted with ethanol by cold maceration. Saponins were isolated. The dried extract was analyzed using reverse-phase high-pressure liquid chromatography to identify the phytochemicals present. Diabetes mellitus was induced by a single intraperitoneal injection of Streptozotocin (40mg/kg). Rats with blood glucose levels ≥ 200 mg/dl were used to determine the reduction in blood glucose with or without the oral extract. Incision and excision wounds were induced in both diabetic and normal rats. Topical films containing extract or saponin and inert films were applied to the wounds every other day, and wound sizes were recorded until the wound was completely healed. RESULTS The presence of six flavonoids, Naringin, Rutin, Quercetin, Kaempferol, Apigenin, and Catechin, and five phenolic acids, Syringic acid, p Coumaric acid, Caffeic acid, Ferulic acid, Ellagic acid were detected in the dried extract. A significant reduction in blood sugar in diabetic rats and wound diameter in the treated group compared to the control group in both diabetic and normal rats was observed, confirming the promising role of palm leaf extract on diabetes and wound care. Macroscopic, morphometric, and histological data suggested that the cutaneous wound healing in rats treated with the leaf extract was better and faster than the control or inert groups. CONCLUSIONS Our research findings highlight the marked effect of Phoenix dactylifera extract as a supportive or alternative treatment for both hyperglycemia and incision or excision wounds. Further research and clinical trials are warranted to validate these findings and explore the underlying mechanisms of action.
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Affiliation(s)
- Hanan S. Anbar
- Department of Pharmaceutical Sciences, Dubai Pharmacy College for Girls, Dubai, United Arab Emirates
| | - Naglaa Gamil Shehab
- Department of Pharmaceutical Sciences, Dubai Pharmacy College for Girls, Dubai, United Arab Emirates
- Pharmacognosy Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Ayah Yasin
- Undergraduate Student, Dubai Pharmacy College for Girls, Dubai, United Arab Emirates
| | - Lana Mazen Shaar
- Undergraduate Student, Dubai Pharmacy College for Girls, Dubai, United Arab Emirates
| | - Ruba Ashraf
- Undergraduate Student, Dubai Pharmacy College for Girls, Dubai, United Arab Emirates
| | - Zahraa Rahi
- Undergraduate Student, Dubai Pharmacy College for Girls, Dubai, United Arab Emirates
| | - Raneem Alamir
- Undergraduate Student, Dubai Pharmacy College for Girls, Dubai, United Arab Emirates
| | - Deema Alsabbagh
- Undergraduate Student, Dubai Pharmacy College for Girls, Dubai, United Arab Emirates
| | - Aya Thabet
- Undergraduate Student, Dubai Pharmacy College for Girls, Dubai, United Arab Emirates
| | - Israa Altaas
- Undergraduate Student, Dubai Pharmacy College for Girls, Dubai, United Arab Emirates
| | - Yosra A. Lozon
- Department of Pharmaceutical Sciences, Dubai Pharmacy College for Girls, Dubai, United Arab Emirates
| | - Nadia M. M. El Rouby
- Department of Biomedical Sciences, Dubai Medical College for Girls, Dubai, United Arab Emirates
| | - Aliasgar Shahiwala
- Department of Pharmaceutical Sciences, Dubai Pharmacy College for Girls, Dubai, United Arab Emirates
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Siquan L, Weilin C, Xiuwen C, Meiyan Z, Weihong G, Xiaoli F. Evaluating the safety and efficiency of nanomaterials: A focus on mitochondrial health. Biomed Pharmacother 2024; 180:117484. [PMID: 39316969 DOI: 10.1016/j.biopha.2024.117484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 09/09/2024] [Accepted: 09/20/2024] [Indexed: 09/26/2024] Open
Abstract
Nanomaterials (NMs) have extensive application potential in drug delivery, tissue engineering, and various other domains, attributable to their exceptional physical and chemical properties. Nevertheless, an increasing body of literature underscores the diverse safety risks are associated with NMs upon interaction with the human body, including oxidative stress and programmed cell death. Mitochondria, serving as cellular energy factories, play a pivotal role in energy metabolism and the regulation of cell fate. Organs with substantial energy demands, including the heart and brain, are highly sensitive to mitochondrial integrity, with mitochondrial impairment potentially resulting in significant dysfunction and pathologies such as as heart failure and neurodegenerative disease. This review elucidates the pathways by which NMs translocate into mitochondria, their intracellular dynamics, and their impact on mitochondrial morphology, respiratory chain activity, and metabolic processes. We further investigate associated molecular mechanisms, including mitochondrial dynamic imbalance, calcium overload, and oxidative stress, and elucidate the pivotal roles of mitochondria in different forms of programmed cell death such as apoptosis and autophagy. Finally, we offer recommendations regarding the safety and efficacy of NMs for medical applications. By systematically analyzing the interactions and molecular mechanisms between NMs and mitochondria, this paper aims to enhance the toxicological evaluation framework of NMs and provide a foundational reference and theoretical basis for their clinical utilization.
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Affiliation(s)
- Liu Siquan
- Stomatology Hospital, School of Stomatology, Southern Medical University, Guangzhou 510515, China
| | - Cheng Weilin
- Stomatology Hospital, School of Stomatology, Southern Medical University, Guangzhou 510515, China
| | - Chen Xiuwen
- Stomatology Hospital, School of Stomatology, Southern Medical University, Guangzhou 510515, China
| | - Zou Meiyan
- Stomatology Hospital, School of Stomatology, Southern Medical University, Guangzhou 510515, China
| | - Guo Weihong
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China.
| | - Feng Xiaoli
- Stomatology Hospital, School of Stomatology, Southern Medical University, Guangzhou 510515, China.
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Cristescu L, Tilea I, Iancu DG, Stoica F, Moldovan DA, Capriglione V, Varga A. Insights into the Neutrophil-to-Lymphocyte Ratio and the Platelet-to-Lymphocyte Ratio as Predictors for the Length of Stay and Readmission in Chronic Heart Failure Patients. Diagnostics (Basel) 2024; 14:2102. [PMID: 39335781 PMCID: PMC11431337 DOI: 10.3390/diagnostics14182102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 09/19/2024] [Accepted: 09/22/2024] [Indexed: 09/30/2024] Open
Abstract
Background/Objectives: Chronic heart failure (CHF) is characterized by complex pathophysiology, leading to increased hospitalizations and mortality. Inflammatory biomarkers such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) provide valuable diagnostic insights. METHODS This study evaluates the prognostic relationship between NLR, PLR, and, in a specific subcohort, N-terminal pro B-type natriuretic peptide (NT-proBNP), alongside length of stay (LOS) and 90-day readmission rates in CHF patients, irrespective of heart failure phenotype. A retrospective analysis of 427 CHF admissions (males = 57.84%) was conducted. RESULTS The mean age of the entire population was 68.48 ± 11.53 years. The average LOS was 8.33 ± 5.26 days, with a readmission rate of 73 visits (17.09%) for 56 patients. The NLR (3.79 ± 3.32) showed a low but positive correlation with the LOS (r = 0.222, p < 0.001). Conversely, the PLR (144.84 ± 83.08) did not demonstrate a significant association with the LOS. The NLR presented a low negative correlation for days until the next admission (r = -0.023, p = 0.048). In a prespecified subanalysis of 323 admissions, the NT-proBNP exhibited a low positive Pearson correlation with the NLR (r = 0.241, p < 0.001) and PLR (r = 0.151, p = 0.006). CONCLUSIONS The impact of the NLR across heart failure phenotypes may suggest the role of systemic inflammation in understanding and managing CHF.
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Affiliation(s)
- Liviu Cristescu
- Faculty of Medicine in English, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania; (L.C.); (D.-A.M.); (V.C.); (A.V.)
- Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania; (D.-G.I.); (F.S.)
- Department of Internal Medicine II-Cardiology, Emergency Clinical County Hospital, 540042 Targu Mures, Romania
| | - Ioan Tilea
- Department of Internal Medicine II-Cardiology, Emergency Clinical County Hospital, 540042 Targu Mures, Romania
- Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Dragos-Gabriel Iancu
- Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania; (D.-G.I.); (F.S.)
- Department of Internal Medicine II-Cardiology, Emergency Clinical County Hospital, 540042 Targu Mures, Romania
- Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Florin Stoica
- Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania; (D.-G.I.); (F.S.)
- Department of Internal Medicine II-Cardiology, Emergency Clinical County Hospital, 540042 Targu Mures, Romania
| | - Diana-Andreea Moldovan
- Faculty of Medicine in English, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania; (L.C.); (D.-A.M.); (V.C.); (A.V.)
- Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania; (D.-G.I.); (F.S.)
- Department of Cardiology I, The Emergency Institute for Cardiovascular Diseases and Transplantation, 540136 Targu Mures, Romania
| | - Vincenzo Capriglione
- Faculty of Medicine in English, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania; (L.C.); (D.-A.M.); (V.C.); (A.V.)
| | - Andreea Varga
- Faculty of Medicine in English, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania; (L.C.); (D.-A.M.); (V.C.); (A.V.)
- Department of Internal Medicine II-Cardiology, Emergency Clinical County Hospital, 540042 Targu Mures, Romania
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Cortés Malagón EM, López Ornelas A, Olvera Gómez I, Bonilla Delgado J. The Kynurenine Pathway, Aryl Hydrocarbon Receptor, and Alzheimer's Disease. Brain Sci 2024; 14:950. [PMID: 39335444 PMCID: PMC11429728 DOI: 10.3390/brainsci14090950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 09/12/2024] [Accepted: 09/21/2024] [Indexed: 09/30/2024] Open
Abstract
Alzheimer's disease (AD) is the leading cause of dementia, mainly affecting elderly individuals. AD is characterized by β-amyloid plaques, abnormal tau tangles, neuronal loss, and metabolic disruptions. Recent studies have revealed the involvement of the kynurenine (KP) pathway and the aryl hydrocarbon receptor (AhR) in AD development. The KP pathway metabolizes tryptophan to produce neuroactive substances like kynurenine, kynurenic acid, and quinolinic acid. In AD, high levels of kynurenine and the neurotoxic quinolinic acid are associated with increased neuroinflammation and excitotoxicity; conversely, reduced levels of kynurenic acid, which acts as a glutamate receptor antagonist, compromise neuroprotection. Research has indicated elevated KP metabolites and enzymes in the hippocampus of AD patients and other tissues such as blood, cerebrospinal fluid, and urine. However, the finding that KP metabolites are AD biomarkers in blood, cerebrospinal fluid, and urine has been controversial. This controversy, stemming from the lack of consideration of the specific stage of AD, details of the patient's treatment, cognitive deficits, and psychiatric comorbidities, underscores the need for more comprehensive research. AhR, a ligand-activated transcription factor, regulates immune response, oxidative stress, and xenobiotic metabolism. Various ligands, including tryptophan metabolites, can activate it. Some studies suggest that AhR activation contributes to AD, while others propose that it provides neuroprotection. This discrepancy may be explained by the specific ligands that activate AhR, highlighting the complex relationship between the KP pathway, AhR activation, and AD, where the same pathway can produce both neuroprotective and harmful effects.
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Affiliation(s)
- Enoc Mariano Cortés Malagón
- Research Division, Hospital Juárez de México, Mexico City 07760, Mexico; (E.M.C.M.); (A.L.O.); (I.O.G.)
- Genetics Laboratory, Hospital Nacional Homeopático, Mexico City 06800, Mexico
| | - Adolfo López Ornelas
- Research Division, Hospital Juárez de México, Mexico City 07760, Mexico; (E.M.C.M.); (A.L.O.); (I.O.G.)
- Genetics Laboratory, Hospital Nacional Homeopático, Mexico City 06800, Mexico
| | - Irlanda Olvera Gómez
- Research Division, Hospital Juárez de México, Mexico City 07760, Mexico; (E.M.C.M.); (A.L.O.); (I.O.G.)
- Facultad Ciencias de la Salud, Universidad Anáhuac Norte, Estado de México 52786, Mexico
| | - José Bonilla Delgado
- Research Unit, Hospital Regional de Alta Especialidad de Ixtapaluca, IMSS-BINESTAR, Ixtapaluca 56530, Mexico
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Ullah A, Chen Y, Singla RK, Cao D, Shen B. Exploring cytokines dynamics: Uncovering therapeutic concepts for metabolic disorders in postmenopausal women- diabetes, metabolic bone diseases, and non-alcohol fatty liver disease. Ageing Res Rev 2024; 101:102505. [PMID: 39307315 DOI: 10.1016/j.arr.2024.102505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/18/2024] [Accepted: 09/12/2024] [Indexed: 09/26/2024]
Abstract
Menopause is an age-related change that persists for around one-third of a woman's life. Menopause increases the risk of metabolic illnesses such as diabetes, osteoporosis (OP), and nonalcoholic fatty liver disease (NAFLD). Immune mediators (pro-inflammatory cytokines), such as interleukin-1 (IL-1), IL-6, IL-17, transforming growth factor (TGF), and tumor necrosis factor (TNF), exacerbate the challenges of a woman undergoing menopause by causing inflammation and contributing to the development of these metabolic diseases in postmenopausal women. Furthermore, studies have shown that anti-inflammatory cytokines such as interleukin-1 receptor antagonists (IL-1Ra), IL-2, and IL-10 have a double-edged effect on diabetes and OP. Likewise, several interferon (IFN) members are double-edged swords in the OP. Therefore, addressing these immune mediators precisely may be an approach to improving the health of postmenopausal women. Hence, considering the significant changes in these cytokines, the present review focuses on the latest findings concerning the molecular mechanisms by which pro- and anti-inflammatory cytokines (interleukins) impact postmenopausal women with diabetes, OP, and NAFLD. Furthermore, we comprehensively discuss the therapeutic approaches that identify cytokines as therapeutic targets, such as hormonal therapy, physical activities, natural inhibitors (drugs), and others. Finally, this review aims to provide valuable insights into the role of cytokines in postmenopausal women's diabetes, OP, and NAFLD. Deeply investigating the mechanisms and therapeutic interventions involved will address the characteristics of immune mediators (cytokines) and improve the management of these illnesses, thereby enhancing the general quality of life and health of the corresponding populations of women.
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Affiliation(s)
- Amin Ullah
- Department of Abdominal Oncology, Cancer Center of West China Hospital and Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yongxiu Chen
- Gynecology Department, Guangdong Women and Children Hospital, No. 521, Xingnan Road, Panyu District, Guangzhou 511442, China
| | - Rajeev K Singla
- Department of Abdominal Oncology, Cancer Center of West China Hospital and Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China; School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Dan Cao
- Department of Abdominal Oncology, Cancer Center of West China Hospital and Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Bairong Shen
- Department of Abdominal Oncology, Cancer Center of West China Hospital and Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
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Sun Y, Lu B, Hu Y, Lv Y, Zhong S. Glycemic Variability in Pancreatogenic Diabetes Mellitus: characteristics, Risks, Potential Mechanisms, and Treatment Possibilities. Int J Gen Med 2024; 17:4297-4309. [PMID: 39324147 PMCID: PMC11423834 DOI: 10.2147/ijgm.s477497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 09/03/2024] [Indexed: 09/27/2024] Open
Abstract
In recent years, pancreatogenic diabetes mellitus has garnered significant attention due to its high incidence, complications, and mortality rates. Glycemic variability (GV) can increase the risk of pancreatogenic diabetes mellitus and its associated complications; however, the precise mechanism remains unclear. The effective control of GV is crucial for preventing the onset of pancreatic diabetes mellitus and improving prognosis. Both diet and antidiabetic medications have substantial effects on GV. However, many patients are prescribed suboptimal or even harmful drugs. Therefore, to provide a comprehensive treatment basis for clinicians to prevent and treat pancreatogenic diabetes mellitus, this study aimed to elucidate the relationship between GV and pancreatogenic diabetes mellitus; investigate the potential mechanisms (such as oxidative stress, inflammatory response, insulin resistance, and lipid metabolism disorders); provide lifestyle guidance; and recommend drug selections to reduce the GV in patients with pancreatogenic diabetes mellitus.
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Affiliation(s)
- Yuyan Sun
- Department of Endocrinology, Gusu School, Nanjing Medical University, The First People’s Hospital of Kunshan, Kunshan, 215300, People’s Republic of China
| | - Bing Lu
- Department of Endocrinology, Gusu School, Nanjing Medical University, The First People’s Hospital of Kunshan, Kunshan, 215300, People’s Republic of China
| | - Yuanwen Hu
- Department of Gastroenterology, The First People’s Hospital of Kunshan, Kunshan, 215300, People’s Republic of China
| | - Yingqi Lv
- Division of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People’s Republic of China
| | - Shao Zhong
- Department of Endocrinology, Gusu School, Nanjing Medical University, The First People’s Hospital of Kunshan, Kunshan, 215300, People’s Republic of China
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Bertran L, Rusu EC, Guirro M, Aguilar C, Auguet T, Richart C. Circulating proteomic profiles in women with morbid obesity compared to normal-weight women. J Proteomics 2024; 310:105317. [PMID: 39307454 DOI: 10.1016/j.jprot.2024.105317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 09/04/2024] [Accepted: 09/05/2024] [Indexed: 09/27/2024]
Abstract
In this study, we aimed to evaluate circulating proteomic levels in women with morbid obesity (MO) compared to normal-weight (NW) women. Moreover, we have compared the proteomic profile between women with metabolically healthy (MH) MO and those with type 2 diabetes mellitus (T2DM). The study included 66 normal-weight (NW) women and 129 women with MO (54 MH and 75 with T2DM). Blood samples were processed for proteomics, involving protein extraction, quantification, digestion with peptide labelling and Nano (liquid chromatography (LC)-(Orbitrap) coupled to mass/mass spectrometry (MS/MS) analysis. Statistical analyses were performed. We identified 257 proteins. Women with MO showed significantly increased levels of 35 proteins and decreased levels of 45 proteins compared to NW women. Enrichment analysis of metabolic pathways revealed significant findings. Women with MO have an altered proteomic profile compared to normal-weight women, involving proteins significantly related to chylomicron assembly, complement cascade, clotting pathways and the insulin growth factor system. Regarding women with MO and T2DM compared to MHMO women, the proteomic profile shows alterations in mostly the same pathways associated with obesity. These findings confirmed in previous reports can help us better understand the pathophysiology of obesity and associated diseases. SIGNIFICANCE: Women with morbid obesity (MO) exhibit substantial proteomic alterations compared to normal-weight (NW) women, involving 80 proteins. These alterations are linked to significant metabolic pathways, including chylomicron assembly, complement cascade, clotting pathways and the insulin growth factor system. Additionally, women with MO and type 2 diabetes mellitus (T2DM) compared to metabolically healthy MO women share similar proteomic changes than the first comparison. These findings enhance our understanding of the pathophysiology of obesity and associated diseases, offering potential targets for therapeutic intervention.
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Affiliation(s)
- Laia Bertran
- Departament de Medicina i Cirurgia, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili (URV), 43201 Reus, Spain.
| | - Elena Cristina Rusu
- GEMMAIR Research Group, Institut d'Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain.
| | - Maria Guirro
- Centre for Omic Sciences (COS), Joint Unit URV-EURECAT, Unique Scientific and Technical Infrastructures (ICTS), Eurecat, Centre Tecnològic de Catalunya, 43204 Reus, Spain.
| | - Carmen Aguilar
- Departament de Medicina i Cirurgia, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili (URV), 43201 Reus, Spain; GEMMAIR Research Group, Institut d'Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain.
| | - Teresa Auguet
- Departament de Medicina i Cirurgia, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili (URV), 43201 Reus, Spain; GEMMAIR Research Group, Institut d'Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain.
| | - Cristóbal Richart
- Departament de Medicina i Cirurgia, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili (URV), 43201 Reus, Spain.
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Velagapudi S, Karsai G, Karsai M, Mohammed SA, Montecucco F, Liberale L, Lee H, Carbone F, Adami GF, Yang K, Crucet M, Stein S, Paneni F, Lapikova-Bryhinska T, Jang HD, Kraler S, Vdovenko D, Züllig RA, Camici GG, Kim HS, Laaksonen R, Gerber PA, Hornemann T, Akhmedov A, Lüscher TF. Inhibition of de novo ceramide synthesis by sirtuin-1 improves beta-cell function and glucose metabolism in type 2 diabetes. Cardiovasc Res 2024; 120:1265-1278. [PMID: 38739545 DOI: 10.1093/cvr/cvae100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 03/03/2024] [Accepted: 03/26/2024] [Indexed: 05/16/2024] Open
Abstract
AIMS Obesity and type 2 diabetes (T2D) are major risk factors for cardiovascular (CV) diseases. Dysregulated pro-apoptotic ceramide synthesis reduces β-cell insulin secretion, thereby promoting hyperglycaemic states that may manifest as T2D. Pro-apoptotic ceramides modulate insulin sensitivity and glucose tolerance while being linked to poor CV outcomes. Sirtuin-1 (SIRT1) is a NAD + -dependent deacetylase that protects against pancreatic β-cell dysfunction; however, systemic levels are decreased in obese-T2D mice and may promote pro-apoptotic ceramide synthesis and hyperglycaemia. Herein, we aimed to assess the effects of restoring circulating SIRT1 levels to prevent metabolic imbalance in obese and diabetic mice. METHODS AND RESULTS Circulating SIRT1 levels were reduced in obese-diabetic mice (db/db) as compared to age-matched non-diabetic db/+ controls. Restoration of SIRT1 plasma levels with recombinant murine SIRT1 for 4 weeks prevented body weight gain and improved glucose tolerance, insulin sensitivity, and vascular function in mice models of obesity and T2D. Untargeted lipidomics revealed that SIRT1 restored insulin secretory function of β-cells by reducing synthesis and accumulation of pro-apoptotic ceramides. Molecular mechanisms involved direct binding to and deacetylation of Toll-like receptor 4 (TLR4) by SIRT1 in β-cells, thereby decreasing the rate-limiting enzymes of sphingolipid synthesis SPTLC1/2 via AKT/NF-κB. Among patients with T2D, those with high baseline plasma levels of SIRT1 prior to metabolic surgery displayed restored β-cell function (HOMA2-β) and were more likely to have T2D remission during follow-up. CONCLUSION Acetylation of TLR4 promotes β-cell dysfunction via ceramide synthesis in T2D, which is blunted by systemic SIRT1 replenishment. Hence, restoration of systemic SIRT1 may provide a novel therapeutic strategy to counteract toxic ceramide synthesis and mitigate CV complications of T2D.
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Affiliation(s)
- Srividya Velagapudi
- Center for Molecular Cardiology, University of Zürich, Schlieren, Switzerland
| | - Gergely Karsai
- Institute of Clinical Chemistry, University Hospital Zürich, Zürich, Switzerland
| | - Maria Karsai
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zürich and University of Zürich, Zürich, Switzerland
| | - Shafeeq A Mohammed
- Department of Cardiology, Center for Translational and Experimental Cardiology (CTEC), Zurich University Hospital and University of Zürich, Zürich, Switzerland
| | - Fabrizio Montecucco
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa School of Medicine, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Genoa, Italy
| | - Luca Liberale
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa School of Medicine, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Genoa, Italy
| | - Hwan Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Federico Carbone
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa School of Medicine, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Genoa, Italy
| | - Giovanni Francesco Adami
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa School of Medicine, Genoa, Italy
| | - Kangmin Yang
- Center for Molecular Cardiology, University of Zürich, Schlieren, Switzerland
| | - Margot Crucet
- Center for Molecular Cardiology, University of Zürich, Schlieren, Switzerland
| | - Sokrates Stein
- Center for Molecular Cardiology, University of Zürich, Schlieren, Switzerland
| | - Franceso Paneni
- Department of Cardiology, Center for Translational and Experimental Cardiology (CTEC), Zurich University Hospital and University of Zürich, Zürich, Switzerland
| | | | - Hyun-Duk Jang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Simon Kraler
- Center for Molecular Cardiology, University of Zürich, Schlieren, Switzerland
| | - Daria Vdovenko
- Center for Molecular Cardiology, University of Zürich, Schlieren, Switzerland
| | - Richard Arnold Züllig
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zürich and University of Zürich, Zürich, Switzerland
| | - Giovanni G Camici
- Center for Molecular Cardiology, University of Zürich, Schlieren, Switzerland
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Reijo Laaksonen
- Zora Biosciences and Finnish Cardiovascular Research Center, Finland Medical School, Tampere University, Tampere, Finland
| | - Philipp A Gerber
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zürich and University of Zürich, Zürich, Switzerland
| | - Thorsten Hornemann
- Institute of Clinical Chemistry, University Hospital Zürich, Zürich, Switzerland
| | - Alexander Akhmedov
- Center for Molecular Cardiology, University of Zürich, Schlieren, Switzerland
| | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zürich, Schlieren, Switzerland
- Royal Brompton and Harefield Hospitals, Imperial College and King's College, London, United Kingdom
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Kc P, Madsen IEH, Rugulies R, Xu T, Westerlund H, Nyberg A, Kivimäki M, Hanson LLM. Exposure to workplace sexual harassment and risk of cardiometabolic disease: a prospective cohort study of 88 904 Swedish men and women. Eur J Prev Cardiol 2024; 31:1633-1642. [PMID: 38875457 DOI: 10.1093/eurjpc/zwae178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 03/11/2024] [Accepted: 05/02/2024] [Indexed: 06/16/2024]
Abstract
AIMS Exposure to work-related sexual harassment may increase the risk for certain adverse behavioural and emotional outcomes but less is known about its association with somatic diseases such as cardiovascular disease (CVD) and type 2 diabetes. This study investigated the prospective association of work-related sexual harassment and risk of cardiometabolic diseases. METHODS AND RESULTS This cohort study included 88 904 Swedish men and women in paid work who responded to questions on workplace sexual harassment in the Swedish Work Environment Survey (1995-2015) and were free from cardiometabolic diseases at baseline. Cardiometabolic diseases (CVD and type 2 diabetes) were identified from the National Patient Register and Causes of Death Register through linkage. Cox proportional hazard regression was used, adjusting for socio-demographic, work-related psychosocial, and physical exposure at baseline. Overall, 4.8% of the participants (n = 4300) reported exposure to workplace sexual harassment during the previous 12 months. After adjustment for sex, birth country, family situation, education, income, and work-related factors, workplace sexual harassment was associated with increased incidence of CVD [hazard ratio (HR) 1.25, 95% confidence interval 1.03-1.51] and type 2 diabetes (1.45, 1.21-1.73). The HR for CVD (1.57, 1.15-2.15) and type 2 diabetes (1.85, 1.39-2.46) was increased for sexual harassment from superior or fellow workers, and sexual harassment from others was associated with type 2 diabetes (1.39, 1.13-1.70). The HR for both CVD (1.31, 0.95-1.81) and type 2 diabetes (1.72, 1.30-2.28) was increased for frequent exposure. CONCLUSION The results of this study support the hypothesis that workplace sexual harassment is prospectively associated with cardiometabolic diseases. Future research is warranted to understand causality and mechanisms behind these associations.
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Affiliation(s)
- Prakash Kc
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Gerontology Research Center, Tampere University, Tampere, Finland
- Stress Research Institute, Department of Psychology, Stockholm University, Albanovägen 12, 114 19 Stockholm, Sweden
| | - Ida E H Madsen
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark
- The National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Reiner Rugulies
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark
- Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Tianwei Xu
- Stress Research Institute, Department of Psychology, Stockholm University, Albanovägen 12, 114 19 Stockholm, Sweden
| | - Hugo Westerlund
- Stress Research Institute, Department of Psychology, Stockholm University, Albanovägen 12, 114 19 Stockholm, Sweden
| | - Anna Nyberg
- Stress Research Institute, Department of Psychology, Stockholm University, Albanovägen 12, 114 19 Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Mika Kivimäki
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- UCL Brain Sciences, University College London, London, UK
| | - Linda L Magnusson Hanson
- Stress Research Institute, Department of Psychology, Stockholm University, Albanovägen 12, 114 19 Stockholm, Sweden
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Mohamed AH, Darraj M, Yassin A, Somaili M, Sayed A, Oraibi O, Mohrag M, Madkhali MA, Alqassimi S, Madkhali MA. Prevalence and short-term clinical impacts of new-onset diabetes mellitus among patients with COVID-19 in jazan region, Saudi Arabia. BMC Endocr Disord 2024; 24:197. [PMID: 39304825 DOI: 10.1186/s12902-024-01724-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 09/05/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Diabetes Mellitus is a major predictor for severity and mortality that is increased by 50% in COVID-19 infection. The aim of this study is to estimate the prevalence of new-onset DM among patients with COVID-19 and examined the short clinical outcomes of the disease. METHOD This is a retrospective study of revising electronic medical records to assess the prevalence of new-onset DM in COVID-19 patients and its impact on the severity of the disease. Adult patients with confirmed COVID-19 during the period from June 2020 to December 2021 were enrolled. RESULTS 725 patients were included. 53.8% of them were males and 46.2 were females, the mean age was 43.35 ± 16.76. 13.2% were diabetics; 2.2% with preexisting DM and 11.0% had new-onset DM. 6.34% had coexisting medical conditions. DKA at presentation was observed in 6 patients (0.8%) of newly diagnosed DM. There is a significant correlation between age and family history (FH), and BMI and new-onset DM (P < 0.05). The overall mortality rate was 2.2%, and it was significantly higher in diabetics in comparison to non-diabetics (P < 0.001). 8.6% had persistent hyperglycemia after 4 months of follow-up. CONCLUSION The prevalence of COVID-19 related new-onset DM was correlated significantly with disease severity and mortality rate. Age, FH, and BMI, were the major predictors. We recommend that frequent monitoring of blood glucose for patients with COVID-19 infections to detect DM, therefore, prompt treatment can be initiated.
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Affiliation(s)
- Amal H Mohamed
- Internal Medicine Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia.
| | - Majid Darraj
- Internal Medicine Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Abuobaida Yassin
- Internal Medicine Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Mohammed Somaili
- Internal Medicine Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Ahmed Sayed
- Internal Medicine Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Omar Oraibi
- Internal Medicine Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Mostafa Mohrag
- Internal Medicine Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Mohammed Ali Madkhali
- Internal Medicine Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Sameer Alqassimi
- Internal Medicine Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Mohammed A Madkhali
- Internal Medicine Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
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Gana N, Huluta I, Gica N. Hypoglycaemia in screening oral glucose tolerance test in pregnancy with low birth weight fetus. World J Exp Med 2024; 14:96720. [PMID: 39312706 PMCID: PMC11372735 DOI: 10.5493/wjem.v14.i3.96720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/30/2024] [Accepted: 07/17/2024] [Indexed: 08/29/2024] Open
Abstract
Maternal hypoglycemia, a condition characterized by lower than normal blood glucose levels in pregnant women, has been increasingly associated with adverse pregnancy outcomes, including low birth weight (LBW) in neonates. LBW, defined as a birth weight of less than 2500 g, can result from various factors, including maternal nutrition, health status, and metabolic conditions like hypoglycemia. Maternal hypoglycemia may affect fetal growth by altering the supply of essential nutrients and oxygen to the fetus, leading to restricted fetal development and growth. This condition poses significant risks not only during pregnancy but also for the long-term health of the child, increasing the likelihood of developmental delays, health issues, and chronic conditions later in life. Research in this area has focused on understanding the mechanisms through which maternal hypoglycemia influences fetal development, with studies suggesting that alterations in placental blood flow and nutrient transport, as well as direct effects on fetal insulin levels and metabolism, may play a role. Given the potential impact of maternal hypoglycemia on neonatal health outcomes, early detection and management are crucial to minimize risks for LBW and its associated complications. Further investigations are needed to fully elucidate the complex interactions between maternal glucose levels and fetal growth, as well as to develop targeted interventions to support the health of both mother and child. Understanding these relationships is vital for improving prenatal care and outcomes for pregnancies complicated by hypoglycemia.
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Affiliation(s)
- Nicoleta Gana
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital Bucharest, Bucharest 099098, Romania
| | - Iulia Huluta
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital Bucharest, Bucharest 099098, Romania
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest 098909, Romania
| | - Nicolae Gica
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest 098909, Romania
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Arora E, Regan R, Surendra VU, Arumugam A. Prevalence of peripheral arterial disease among individuals with type 2 diabetes mellitus in India - A systematic review and meta-analysis. Diabetes Metab Syndr 2024; 18:103124. [PMID: 39326343 DOI: 10.1016/j.dsx.2024.103124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 09/18/2024] [Accepted: 09/19/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND Peripheral arterial disease (PAD) is a prevalent complication of type 2 diabetes mellitus (T2DM). As India ranks second in the population afflicted by T2DM, and the objective of this systematic review was to estimate the pooled prevalence of PAD in individuals living with T2DM in India. METHODS Five databases (Cochrane (CENTRAL), MEDLINE (via PubMed), CINAHL (via EBSCO), PEDro, and Scopus) were searched using database-specific search terms from inception to August 2023. Inclusion criteria included studies reporting the prevalence of PAD in Indian adults diagnosed with T2DM of either or both sexes, employing ankle brachial index measurements with a Doppler test or sphygmomanometer. The risk of bias was evaluated using the JBI checklist, and the certainty of evidence was determined via the GRADE approach. RESULTS Twenty-three articles met the inclusion criteria which comprised of 196,883 individuals with T2DM aged between 30 and 70 years from nine states and one union territory. Utilizing a random effects model, the meta-analysis revealed that the pooled prevalence of PAD among individuals with T2DM in India was 18 % (95 % confidence interval: 10-28 %), with statistically significant heterogeneity observed between studies (I2 = 100 %, P < 0.001). Overall certainty in the evidence was low. CONCLUSION The combined prevalence of PAD among individuals with T2DM in India is 18 %, indicating a significant portion of the Indian population has been affected. Epidemiological studies utilizing precise assessment tools can enhance the early detection and prevention of PAD in T2DM and improve the certainty of findings.
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Affiliation(s)
- Esha Arora
- School of Physiotherapy, Faculty of Allied Health Professions, AIMST University, Kedah, 08100, Malaysia.
| | - Raja Regan
- School of Physiotherapy, Faculty of Allied Health Professions, AIMST University, Kedah, 08100, Malaysia.
| | - Vyshak Uddur Surendra
- Department of Respiratory Medicine, Yenepoya Medical College, Yenepoya Deemed to be University, Mangalore, Karnataka, India.
| | - Ashokan Arumugam
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, P.O. Box: 27272, Sharjah, United Arab Emirates; Neuromusculoskeletal Rehabilitation Research Group, RIMHS-Research Institute of Medical and Health Sciences, University of Sharjah, P.O. Box: 27272, Sharjah, United Arab Emirates; Sustainable Engineering Asset Management Research Group, RISE-Research Institute of Sciences and Engineering, University of Sharjah, P.O. Box: 27272, Sharjah, United Arab Emirates; Adjunct Faculty, Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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231
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Luo Y, Hou Y, Zhao W, Yang B. Recent progress in gene therapy for familial hypercholesterolemia treatment. iScience 2024; 27:110641. [PMID: 39262805 PMCID: PMC11387600 DOI: 10.1016/j.isci.2024.110641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024] Open
Abstract
Familial hypercholesterolemia (FH) is a genetic disorder that affects 1 in 300 people, leading to high cholesterol levels and significantly increased cardiovascular risk. The limitations of existing FH treatments underscore the need for innovative therapeutics, and gene therapy offers a promising alternative to address FH more effectively. In this review, we survey approved gene therapy drugs first and then delve into the landscape of gene addition, gene inactivation, and gene editing therapies for hypercholesterolemia, highlighting both approved interventions and those in various stages of development. We also discussed recent advancements in gene editing tools that are essential for their application in gene therapy. Safety considerations inherent to gene therapy are also discussed, emphasizing the importance of mitigating potential risks associated with such treatments. Overall, this review highlights the progress and prospects of gene therapies for FH treatments, underscoring their potential to revolutionize the management of this prevalent and challenging condition.
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Affiliation(s)
- Yaxin Luo
- Shanghai Institute for Advanced Immunochemical Studies, ShanghaiTech University, Shanghai 201210, China
- Gene Editing Center, School of Life Science and Technology, ShanghaiTech University, Shanghai 201210, China
| | - Yaofeng Hou
- Shanghai Institute for Advanced Immunochemical Studies, ShanghaiTech University, Shanghai 201210, China
- Gene Editing Center, School of Life Science and Technology, ShanghaiTech University, Shanghai 201210, China
| | - Wenwen Zhao
- Shanghai Institute for Advanced Immunochemical Studies, ShanghaiTech University, Shanghai 201210, China
- Gene Editing Center, School of Life Science and Technology, ShanghaiTech University, Shanghai 201210, China
| | - Bei Yang
- Shanghai Institute for Advanced Immunochemical Studies, ShanghaiTech University, Shanghai 201210, China
- Gene Editing Center, School of Life Science and Technology, ShanghaiTech University, Shanghai 201210, China
- Shanghai Clinical Research and Trial Center, Shanghai 201210, China
- Shanghai Frontiers Science Center for Biomacromolecules and Precision Medicine, ShanghaiTech University, Shanghai 200031, China
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232
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Tian K, Ang LC, Choudhary P, Choo JCJ, Bee YM, Goh SY, Teh MM. High incidence of low interstitial fluid glucose among type 2 diabetes patients with chronic kidney disease (CKD) despite adhering to appropriate glycated haemoglobin targets-has time come for robust integration of interstitial fluid glucose targets into glycaemic guidelines? Diabet Med 2024:e15438. [PMID: 39301988 DOI: 10.1111/dme.15438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/29/2024] [Accepted: 08/31/2024] [Indexed: 09/22/2024]
Abstract
AIM We aim to compare the burden of Level 1 (<4 mmol/L) and Level 2 (<3 mmol/L) hypoglycaemia between type 2 diabetes (T2D) patients with and without chronic kidney disease (CKD). METHODS T2D subjects with and without CKD (eGFR<60 mL/min/1.73 m2) were recruited from a tertiary-care hospital. Subjects wore the Freestyle Libre-Pro sensor for 2 weeks. The number of hypoglycaemic events and intra-day difference in Level 1 and 2 hypoglycaemias were compared between the cohorts. RESULTS We recruited 134 subjects: 74 with CKD (44 M:30F) and 60 without CKD (36 M:24F), with no difference in HbA1c between the two cohorts (66 ± 20 vs 64 ± 16 mmol/mol, p = 0.529). The CKD cohort had increased level 1 (OR 1.73, p = 0.011), level 2 hypoglycaemias (OR 2.16, p = 0.002), and glycaemic variability than the non-CKD cohort (35.3 ± 9.5 vs 32.3 ± 6.8%). The CKD cohort had more level 2 hypoglycaemia events nocturnally compared to day at 1.9 ± 3.1 vs. 1.4 ± 2.5 events/person within the two week sensor wearing period (p = 0.022), whereas there was no significant intra-day difference in the number of such events within the non-CKD cohort. CONCLUSIONS The CKD cohort has a greater burden of hypoglycaemia despite being treated to similar HbA1c targets. The greater number of nocturnal events warrants safety concern. Interstitial fluid glucose targets should be incorporated into the glycaemic guidelines for T2D patients with CKD.
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Affiliation(s)
- Kristy Tian
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Li Chang Ang
- Medicine Academic Clinical Programme, Singapore General Hospital, Singapore
| | - Pratik Choudhary
- Leicester Diabetes Center, University of Leicester, Leicester, United Kingdom
| | | | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Su-Yen Goh
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Ming Ming Teh
- Department of Endocrinology, Singapore General Hospital, Singapore
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233
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Alkhalifah M, Afsar H, Shams A, Blaibel D, Chandrabalan V, Pappachan JM. Semaglutide for the management of diabesity: The real-world experience. World J Methodol 2024; 14:91832. [PMID: 39310241 PMCID: PMC11230069 DOI: 10.5662/wjm.v14.i3.91832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 01/29/2024] [Accepted: 03/01/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Diabesity (diabetes as a consequence of obesity) has emerged as a huge healthcare challenge across the globe due to the obesity pandemic. Judicious use of antidiabetic medications including semaglutide is important for optimal management of diabesity as proven by multiple randomized controlled trials. However, more real-world data is needed to further improve the clinical practice. AIM To study the real-world benefits and side effects of using semaglutide to manage patients with diabesity. METHODS We evaluated the efficacy and safety of semaglutide use in managing patients with diabesity in a large academic hospital in the United States. Several parameters were analyzed including demographic information, the data on improvement of glycated hemoglobin (HbA1c), body weight reduction and insulin dose adjustments at 6 and 12 months, as well as at the latest follow up period. The data was obtained from the electronic patient records between January 2019 to May 2023. RESULTS 106 patients (56 males) with type 2 diabetes mellitus (T2DM), mean age 60.8 ± 11.2 years, mean durations of T2DM 12.4 ± 7.2 years and mean semaglutide treatment for 2.6 ± 1.1 years were included. Semaglutide treatment was associated with significant improvement in diabesity outcomes such as mean weight reductions from baseline 110.4 ± 24.6 kg to 99.9 ± 24.9 kg at 12 months and 96.8 ± 22.9 kg at latest follow up and HbA1c improvement from baseline of 82 ± 21 mmol/mol to 67 ± 20 at 12 months and 71 ± 23 mmol/mol at the latest follow up. An insulin dose reduction from mean baseline of 95 ± 74 units to 76.5 ± 56.2 units was also observed at the latest follow up. Side effects were mild and mainly gastrointestinal like bloating and nausea improving with prolonged use of semaglutide. CONCLUSION Semaglutide treatment is associated with significant improvement in diabesity outcomes such as reduction in body weight, HbA1c and insulin doses without major adverse effects. Reviews of largescale real-world data are expected to inform better clinical practice decision making to improve the care of patients with diabesity.
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Affiliation(s)
- Mohammed Alkhalifah
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
- Department of Family Medicine, King Faisal Specialist Hospital, Riyadh 11211, Saudi Arabia
| | - Hafsa Afsar
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
| | - Anindya Shams
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
| | - Dania Blaibel
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
| | - Vishnu Chandrabalan
- Department of Data Science, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
| | - Joseph M Pappachan
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
- Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9PL, United Kingdom
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234
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Zahra S, Saleem MK, Ejaz KF, Akbar A, Jadoon SK, Hussain S, Ali AI, Ifty M, Jannati SZ, Armin F, Sarker D, Islam DZ, Khandker SS, Khan MS, Alvi S. Prevalence of nephropathy among diabetic patients in North American region: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e39759. [PMID: 39312314 PMCID: PMC11419527 DOI: 10.1097/md.0000000000039759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 08/29/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND Nephropathy is one of the most common microvascular impediments of diabetes mellitus. In this study, we aimed to estimate the prevalence of nephropathy in diabetic patients across the North American region. METHODS Eligible studies were screened out from 3 electronic databases, for example, PubMed, Google Scholar, and ScienceDirect using specific search keywords based on the eligibility criteria. Extracting the data from the included studies publication bias, quality assessment, outlier investigation, and meta-analysis was done followed by the subgroup analysis. A total of 11 studies met the study inclusion criteria. Meta-analysis was performed with the extracted data. RESULTS Pooled prevalence of 28.2% (95% confidence interval [CI]: 19.7-36.7) with a high rate of heterogeneity (I2 = 100%) was identified. The pooled prevalence of nephropathy among diabetic patients in the United States of America, Canada, and Mexico was 24.2% (95% CI: 13.8-34.5), 31.2% (95% CI: 25.8-36.5), and 31.1% (95% CI: 20.8-41.5), respectively. CONCLUSION The prevalence of nephropathy among diabetic patients was found lower in the United States of America as compared to Canada and Mexico. Besides, the pooled prevalence of the North American region was found to be lower as compared to the African, European, and Asian regions. Minimizing the pathogenic factors, sufficient diagnostic, healthcare facilities, and awareness are recommended to improve the situation.
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Affiliation(s)
- Sabahat Zahra
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Muhammad Khurram Saleem
- General Internal Medicine, University Hospital, Bristol and Weston NHS Foundation Trust, Royal College of Physicians and Surgeons of Glasgow, Glasgow, United Kingdom
| | | | - Amna Akbar
- District Headquarter Hospital Jhelum Valley, Muzaffarabad, AJK, Pakistan
| | | | - Shoukat Hussain
- Medicine (AJKMC), Fellow Endocrinology Capital Hospital Islamabad, Islamabad, Pakistan
| | - Amir Iqbal Ali
- Consultant Surgeon, Combined Military Hospital/SKBZ, Muzaffarabad, AJK, Pakistan
| | | | | | - Fariza Armin
- School of Pharmacy, Brac University, Dhaka, Bangladesh
| | | | | | - Shahad Saif Khandker
- Department of Microbiology, Gonoshasthaya Samaj Vittik Medical College, Dhaka, Bangladesh
| | | | - Sarosh Alvi
- Teaching Faculty, University of Khartoum, Khartoum, Sudan
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235
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Yang Y, Rivera L, Fang S, Cavalier M, Suris A, Zhou Y, Huang Y. Maternal high-fat diet alters Tet-mediated epigenetic regulation during heart development. iScience 2024; 27:110631. [PMID: 39262804 PMCID: PMC11388159 DOI: 10.1016/j.isci.2024.110631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/24/2024] [Accepted: 07/29/2024] [Indexed: 09/13/2024] Open
Abstract
Imbalanced dietary intake, such as a high-fat diet (HFD) during pregnancy, has been associated with adverse offspring outcomes. Metabolic stress from imbalanced food intake alters the function of epigenetic regulators, resulting in abnormal transcriptional outputs in embryos to cause congenital disorders. We report herein that maternal HFD exposure causes metabolic changes in pregnant mice and non-compaction cardiomyopathy (NCC) in E15.5 embryos, accompanied by decreased 5-hydroxymethylcytosine (5hmC) levels and altered chromatin accessibility in embryonic heart tissues. Remarkably, maternal vitamin C supplementation mitigates these detrimental effects, likely by restoring iron, a cofactor for Tet enzymes, in a reduced state. Using a genetic approach, we further demonstrated that the cardioprotective benefits of vitamin C under HFD conditions are attributable to enhanced Tet activity. Our results highlight an interaction between maternal diet, specifically HFD or vitamin C, and epigenetic modifications during early heart development, emphasizing the importance of balanced maternal nutrition for healthy embryonic development.
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Affiliation(s)
- Yuhan Yang
- Center for Epigenetics and Disease Prevention, Institute of Biosciences and Technology, Texas A&M University, Houston, TX 77030, USA
| | - Logan Rivera
- Center for Epigenetics and Disease Prevention, Institute of Biosciences and Technology, Texas A&M University, Houston, TX 77030, USA
| | - Shaohai Fang
- Center for Epigenetics and Disease Prevention, Institute of Biosciences and Technology, Texas A&M University, Houston, TX 77030, USA
| | - Maryn Cavalier
- Center for Epigenetics and Disease Prevention, Institute of Biosciences and Technology, Texas A&M University, Houston, TX 77030, USA
| | - Ashley Suris
- Center for Epigenetics and Disease Prevention, Institute of Biosciences and Technology, Texas A&M University, Houston, TX 77030, USA
| | - Yubin Zhou
- Center for Translational Cancer Research, Institute of Biosciences and Technology, Texas A&M University, Houston, TX 77030, USA
- Department of Translational Medical Sciences, School of Medicine, Texas A&M University, Houston, TX 77030, USA
| | - Yun Huang
- Center for Epigenetics and Disease Prevention, Institute of Biosciences and Technology, Texas A&M University, Houston, TX 77030, USA
- Department of Translational Medical Sciences, School of Medicine, Texas A&M University, Houston, TX 77030, USA
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Park W, Park HY, Kim SW. Effects of 12 Weeks of Combined Exercise Training in Normobaric Hypoxia on Arterial Stiffness, Inflammatory Biomarkers, and Red Blood Cell Hemorheological Function in Obese Older Women. Healthcare (Basel) 2024; 12:1887. [PMID: 39337228 PMCID: PMC11431341 DOI: 10.3390/healthcare12181887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 09/07/2024] [Accepted: 09/20/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND/OBJECTIVES The present study examined the effect of 12-week combined exercise training in normobaric hypoxia on arterial stiffness, inflammatory biomarkers, and red blood cell (RBC) hemorheological function in 24 obese older women (mean age: 67.96 ± 0.96 years). METHODS Subjects were randomly divided into two groups (normoxia (NMX; n = 12) and hypoxia (HPX; n = 12)). Both groups performed aerobic and resistance exercise training programs three times per week for 12 weeks, and the HPX group performed exercise programs in hypoxic environment chambers during the intervention period. Body composition was estimated using bioelectrical impedance analysis equipment. Arterial stiffness was measured using an automatic waveform analyzer. Biomarkers of inflammation and oxygen transport (tumor necrosis factor alpha, interleukin 6 (IL-6), erythropoietin (EPO), and vascular endothelial growth factor (VEGF)), and RBC hemorheological parameters (RBC deformability and aggregation) were analyzed. RESULTS All variables showed significantly more beneficial changes in the HPX group than in the NMX group during the intervention. The combined exercise training in normobaric hypoxia significantly reduced blood pressure (systolic blood pressure: p < 0.001, diastolic blood pressure: p < 0.001, mean arterial pressure: p < 0.001, pulse pressure: p < 0.05) and brachial-ankle pulse wave velocity (p < 0.001). IL-6 was significantly lower in the HPX group than in the NMX group post-test (p < 0.001). Also, EPO (p < 0.01) and VEGF (p < 0.01) were significantly higher in the HPX group than in the NMX group post-test. Both groups showed significantly improved RBC deformability (RBC EI_3Pa) (p < 0.001) and aggregation (RBC AI_3Pa) (p < 0.001). CONCLUSIONS The present study suggests that combined exercise training in normobaric hypoxia can improve inflammatory biomarkers and RBC hemorheological parameters in obese older women and may help prevent cardiovascular diseases.
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Affiliation(s)
- Wonil Park
- Department of Sports Science, Korea Institute of Sports Science, 424 Olympic-ro, Songpa-gu, Seoul 05540, Republic of Korea;
| | - Hun-Young Park
- Department of Sports Medicine and Science, Graduate School, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea;
- Physical Activity and Performance Institute, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
| | - Sung-Woo Kim
- Department of Sports Medicine and Science, Graduate School, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea;
- Physical Activity and Performance Institute, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
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Pierzynowska K, Wychowański P, Zaworski K, Woliński J, Donaldson J, Szkopek D, Roszkowicz-Ostrowska K, Kondej A, Pierzynowski SG. Amylase intrapancreatic infusion delays insulin release during an intravenous glucose tolerance test, proof of acini-islet-acinar interactions. World J Exp Med 2024; 14:92589. [PMID: 39312707 PMCID: PMC11372737 DOI: 10.5493/wjem.v14.i3.92589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 06/19/2024] [Accepted: 07/10/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND The possible existence of an acini-islet-acinar (AIA) reflex, involving mutual amylase and insulin interactions, was investigated in the current acute experiment on pigs. AIM To confirm the existence of an AIA reflex and justify the placement of the exocrine and endocrine pancreatic components within the same organ. METHODS The study was performed on six pigs under general anesthesia. An intravenous glucose tolerance test was performed, with a bolus infusion of 50% glucose to the jugular vein, while amylase (5000 U/kg) or vehicle intrapancreatic infusions were administered via the pancreaticoduodenalis cranialis artery during 30 min with a 1 mL/min flow rate. RESULTS The amylase infusion to pancreatic arterial circulation inhibited and delayed the insulin release peak which is usually associated with the highest value of blood glucose and is typically observed at 15 min after glucose infusion, for > 1 h. The intrapancreatic infusion of the vehicle (saline) did not have any effect on the time frame of insulin release. Infusion of 1% bovine serum albumin changed the insulin release curve dramatically and prolonged the high range of insulin secretion, far beyond the glucose peak. CONCLUSION Intrapancreatic arterial infusion of amylase interrupted the integrated glucose-insulin interactions. This confirms an AIA reflex and justifies placement of the exocrine and endocrine pancreatic components within the same organ.
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Affiliation(s)
- Kateryna Pierzynowska
- Department of Biology, Lund University, Lund 22362, Sweden
- Department of Animal Physiology, The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, Jabłonna 05110, Poland
- Anara AB, Trelleborg 23132, Sweden
| | - Piotr Wychowański
- Department of Head and Neck and Sensory Organs, Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Gemelli Foundation for the University Policlinic, Catholic University of the “Sacred Heart”, Rome 00168, Italy
- Department of Oral Surgery, Medical University of Gdańsk, Gdańsk 80211, Poland
| | - Kamil Zaworski
- Department of Animal Physiology, The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, Jabłonna 05110, Poland
| | - Jarosław Woliński
- Laboratory of Large Animal Models, The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, Jabłonna 05110, Poland
| | - Janine Donaldson
- Anara AB, Trelleborg 23132, Sweden
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand (WITS), Johannesburg 2050, South Africa
| | - Dominika Szkopek
- Laboratory of Large Animal Models, The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, Jabłonna 05110, Poland
| | - Katarzyna Roszkowicz-Ostrowska
- Department of Animal Physiology, The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, Jabłonna 05110, Poland
| | - Agata Kondej
- Laboratory of Large Animal Models, The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, Jabłonna 05110, Poland
| | - Stefan G Pierzynowski
- Department of Biology, Lund University, Lund 22362, Sweden
- Anara AB, Trelleborg 23132, Sweden
- Department of Medical Biology, Institute of Rural Health, Lublin 20090, Poland
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Taheri S, Sohrabi Z, Bahari H, Mirmohammadali SN, Hashempur MH, Golafrouz H, Haghighat N, Asbaghi O. ٍEffects of Sumac Consumption on Blood Pressure, Glycemic Indices, and Body Composition in Adults: A GRADE-assessed Systematic Review and Dose-response Meta-analysis. Diabetes Metab Syndr 2024; 18:103122. [PMID: 39316955 DOI: 10.1016/j.dsx.2024.103122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/16/2024] [Accepted: 09/17/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Owing to the rich phytochemical content of Rhus coriaria L. (Anacardiaceae), known as Sumac, it may affect blood pressure, glycemic, and anthropometric indices. We, therefore, aimed to examine evidence on effect of Sumac on these factors by conducting a meta-analysis of RCTs. METHODS A systematic literature search up to January 2024 was completed in PubMed/Medline, Scopus, and Web of Science. Heterogeneity tests of the selected trials were performed using the I2 statistic. Random effects models were assessed based on the heterogeneity tests, and pooled data were determined as weighted mean differences (WMD) with a 95 % confidence interval (CI). RESULTS Fifteen RCTs were included in this meta-analysis. Our findings showed that Sumac consumption significantly reduced diastolic blood pressure (DBP) (WMD = -2.88 mmHg; 95 %CI, -4.22 to -1.54; P = 0.001), fasting blood glucose (FBG) (WMD = -5.15 mg/dL; 95 %CI, -8.73 to -1.57; P = 0.005), insulin (WMD = -1.95 uIU/ml; 95 %CI, 3.11 to -0.79; P = 0.001), Hemoglobin A1c (WMD = -0.48 %; 95 %CI -0.84 to -0.12; P = 0.001), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (WMD = -0.71; 95 %CI, -1.14 to -0.27; P = 0.001), and waist to hip ratio (WHR) (WMD = -0.01; 95 %CI, -0.02 to -0.00; P = 0.017). Sumac consumption had no significant effects on weight, body mass index, and waist circumference. CONCLUSION We found that Sumac consumption could improve DBP, glycemic indices, and WHR. Also, supplementation of this herb in higher doses or longer durations had more promising effects on FBG, HOMA-IR, and WHR.
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Affiliation(s)
- Shaghayegh Taheri
- Department of Clinical Biochemistry, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Zahra Sohrabi
- Community Nutrition Department, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Bahari
- Transplant Research Center, Clinical Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
| | | | - Mohammad Hashem Hashempur
- Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Haniyeh Golafrouz
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Haghighat
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Omid Asbaghi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Grosskopf A, Rahn J, Kim A, Szabó G, Rujescu D, Klawonn F, Frolov A, Simm A. Peptide-Bound Glycative, AGE and Oxidative Modifications as Biomarkers for the Diagnosis of Alzheimer's Disease-A Feasibility Study. Biomedicines 2024; 12:2127. [PMID: 39335639 PMCID: PMC11428617 DOI: 10.3390/biomedicines12092127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 09/14/2024] [Accepted: 09/17/2024] [Indexed: 09/30/2024] Open
Abstract
Background: The diagnosis of Alzheimer's disease (AD) relies on core cerebrospinal fluid (CSF) biomarkers, amyloid beta (Aβ) and tau. As the brain is then already damaged, researchers still strive to discover earlier biomarkers of disease onset and the progression of AD. Glycation, advanced glycation end products (AGEs) and oxidative modifications on proteins in CSF mirror the underlying biological mechanisms that contribute to early AD pathology. However, analyzing free AGEs in the body fluids of AD patients has led to controversial results. Thus, this pilot study aimed to test the feasibility of detecting, identifying and quantifying differentially glycated, AGE or oxidatively modified peptides in CSF proteins of AD patients (n = 5) compared to a control group (n = 5). Methods: To this end, we utilized a data-dependent (DDA) nano liquid chromatography (LC) linear ion trap-Orbitrap tandem mass spectrometry (MS/MS) ) approach and database search that included over 30 glycative and oxidative modifications in four search nodes to analyze endogenous modifications on individual peptides. Furthermore, we quantified candidate peptide abundance using LC Quan. Results: We identified 299 sites of early and advanced glycation and 53 sites of oxidatively modified tryptophan. From those, we identified 17 promising candidates as putative biomarkers (receiver operating curve-area under the curve (ROC-AUC) > 0.8), albeit without statistical significance. Conclusions: The potential candidates with higher discrimination power showed correlations with established diagnostic markers, thus hinting toward the potential of those peptides as biomarkers.
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Affiliation(s)
- Anne Grosskopf
- Clinic for Cardiac Surgery, University Medicine Halle, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Jette Rahn
- Clinic for Cardiac Surgery, University Medicine Halle, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Ahyoung Kim
- Department of Bioorganic Chemistry, Leibniz Institute of Plant Biochemistry, 06120 Halle (Saale), Germany
| | - Gábor Szabó
- Clinic for Cardiac Surgery, University Medicine Halle, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Dan Rujescu
- Department of Psychiatry, Psychotherapy, Psychosomatic Medicine, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Frank Klawonn
- Biostatistics Group, Helmholtz Centre for Infection Research, 38124 Braunschweig, Germany
| | - Andrej Frolov
- Department of Bioorganic Chemistry, Leibniz Institute of Plant Biochemistry, 06120 Halle (Saale), Germany
- Laboratory of Analytical Biochemistry and Biotechnology, Timiryazev Institute of Plant Physiology, 127276 Moscow, Russia
| | - Andreas Simm
- Clinic for Cardiac Surgery, University Medicine Halle, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
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Nassar M, Nassar O, Abosheaishaa H, Misra A. Decreased risk of recurrent acute pancreatitis with semaglutide and tirzepatide in people with type 2 diabetes or obesity with a history of acute pancreatitis: A propensity matched global federated TriNetX database-based retrospective cohort study. Diabetes Metab Syndr 2024; 18:103116. [PMID: 39332263 DOI: 10.1016/j.dsx.2024.103116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 09/02/2024] [Accepted: 09/04/2024] [Indexed: 09/29/2024]
Abstract
BACKGROUND Acute pancreatitis (AP) is a significant health concern with potential for recurrent episodes and serious complications. The risk of recurrence in type 2 diabetes (T2D) or obesity can be influenced by various factors and treatments, including GLP-1 receptor agonists (GLP-1RAs). This study evaluates the risk of recurrent AP among patients with a history of the condition, focusing on the effects of different GLP-1RA treatments. OBJECTIVES Our objective is to compare the recurrence risks of AP between patients treated with different GLP-1RAs. METHODS We conducted a retrospective cohort study using the TriNetX platform, encompassing 258,238 individuals with T2D or obesity who have a history of AP. We assessed the recurrence of AP over a five-year period, analyzing data on treatment regimens, with a focus on the use of Semaglutide, Tirzepatide, and other GLP-1RAs. RESULTS GLP-1RA users experienced significantly lower recurrence rates of AP, with those without risk factors showing GLP-1RA users had a recurrence rate of 13.8 % compared to 40.9 % for non-users. Semaglutide and Tirzepatide showed the most favorable outcomes; Semaglutide users had lower recurrence rates than Exenatide (10.1 % vs. 27 %) and slightly lower than Dulaglutide (13.6 % vs. 15.4 %), though not statistically significant with Dulaglutide. Tirzepatide users displayed the lowest recurrence risk at 6.2 %, significantly lower than those on Semaglutide (11.7 %). CONCLUSIONS GLP-1RAs, particularly Semaglutide and Tirzepatide, are associated with a reduced risk of recurrent AP in people with T2D or obesity. The differential risk profile between these drugs highlights the need for further studies and personalized treatment plans.
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Affiliation(s)
- Mahmoud Nassar
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; American Society for Inclusion, Diversity, and Equity in Healthcare (ASIDE), Delaware, USA.
| | - Omar Nassar
- Williamsville East High School, Buffalo, NY, USA.
| | - Hazem Abosheaishaa
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, NY, New York, USA.
| | - Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, National Diabetes, Obesity and Cholesterol Foundation (N-DOC), Diabetes Foundation (India) (DFI) India, India.
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Kalogeropoulou MS, Couch H, Thankamony A, Beardsall K. Neonatal hyperinsulinism: a retrospective study of presentation and management in a tertiary neonatal intensive care unit in the UK. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-327322. [PMID: 39304222 DOI: 10.1136/archdischild-2024-327322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 09/05/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVE Reports of hyperinsulinism typically focus on infants managed by highly specialised services. However, neonates with hyperinsulinism are initially managed by neonatologists and often not referred to specialists. This study aimed to characterise the diversity in presentation and management of these infants. SETTING Level 3 neonatal intensive care. PATIENTS Neonates with hyperinsulinism, defined as blood glucose <2.8 mmol/mL and insulin level >6 pmol/L. DESIGN 7-year retrospective study (January 2015-December 2021). RESULTS 99 cases were identified: severe-treated with diazoxide (20%), moderate-clinically concerning hyperinsulinism not treated with diazoxide (30%), mild-biochemical hyperinsulinism (50%). Birth weight z-score was -1.02±2.30 (mean±SD), 42% were preterm, but neither variable correlated with clinical severity. The severe group received a higher concentration of intravenous glucose (27±12%) compared with the moderate (15±7%) and mild (16±10%) groups (p<0.001). At diagnosis, the intravenous glucose intake was similar in the severe (7.43±5.95 mg/kg/min) and moderate (5.09±3.86 mg/kg/min) groups, but higher compared with the mild group (3.05+/2.21 mg/kg/min) (p<0.001). In the severe group, term infants started diazoxide earlier (9.9±4.3 days) compared with preterm (37±26 days) (p=0.002). The national congenital hyperinsulinism service was consulted for 23% of infants, and 3% were transferred. CONCLUSIONS This study highlights the diversity in clinical presentation, severity and prognosis of neonatal hyperinsulinism, irrespective of birth weight and gestational age. More infants were small rather than large for gestational age, and the majority had transient hyperinsulinism and were not referred to the national centre, or treated with diazoxide. Further research is required to understand the breadth of neonatal hyperinsulinism and optimal management.
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Affiliation(s)
| | - Helen Couch
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ajay Thankamony
- Paediatric Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kathy Beardsall
- Neonatal Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Academic Department of Paediatrics, University of Cambridge, Cambridge, UK
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Guo M, He F, Zhang C. Molecular Therapeutics for Diabetic Kidney Disease: An Update. Int J Mol Sci 2024; 25:10051. [PMID: 39337537 PMCID: PMC11431964 DOI: 10.3390/ijms251810051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 09/13/2024] [Accepted: 09/15/2024] [Indexed: 09/30/2024] Open
Abstract
Diabetic kidney disease (DKD) is a common microvascular complication of diabetes mellitus (DM). With the increasing prevalence of DM worldwide, the incidence of DKD remains high. If DKD is not well controlled, it can develop into chronic kidney disease or end-stage renal disease (ESRD), which places considerable economic pressure on society. Traditional therapies, including glycemic control, blood pressure control, blood lipid control, the use of renin-angiotensin system blockers and novel drugs, such as sodium-glucose cotransporter 2 inhibitors, mineralocorticoid receptor inhibitors and glucagon-like peptide-1 receptor agonists, have been used in DKD patients. Although the above treatment strategies can delay the progression of DKD, most DKD patients still ultimately progress to ESRD. Therefore, new and multimodal treatment methods need to be explored. In recent years, researchers have continuously developed new treatment methods and targets to delay the progression of DKD, including miRNA therapy, stem cell therapy, gene therapy, gut microbiota-targeted therapy and lifestyle intervention. These new molecular therapy methods constitute opportunities to better understand and treat DKD. In this review, we summarize the progress of molecular therapeutics for DKD, leading to new treatment strategies.
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Affiliation(s)
| | - Fangfang He
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Chun Zhang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Hennies N, Görgens SW, Killer J, Otto T, Richter LM, Müller-Wieland D, Häckl D. Prevalence of obesity and cardiovascular disease in adults with type 2 diabetes and use of diabetes medication in Germany: A claims data study. Diabetes Obes Metab 2024. [PMID: 39300717 DOI: 10.1111/dom.15931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 08/21/2024] [Accepted: 08/23/2024] [Indexed: 09/22/2024]
Abstract
AIMS To identify the prevalence of cardiovascular disease (CVD) and obesity in patients with type 2 diabetes (T2D) in Germany and to evaluate if antidiabetic treatment patterns varied by comorbidity status. MATERIALS AND METHODS Patients with T2D (aged ≥18 years) were identified during the study period (2014-2020) from medical claims of 4.5 million publicly insured German residents and divided into different cohorts based on CVD and/or obesity diagnosis. Annual prevalence and incidence were estimated for each study year, while characteristics and treatments were assessed in 2020. Data were extrapolated to the German population by age and sex. RESULTS The prevalence of T2D in 2020 was 11.4%. Among patients with T2D, 53.0% had CVD, 39.3% had obesity, and 20.9% had CVD and obesity. Since 2014, CVD increased by 1.4%, obesity by 4.5%, and CVD with obesity by 2.7% in patients with T2D. The incidence of T2D in 2020 was 1.0% (42.9% had CVD, 37.9% had obesity, and 15.8% had CVD and obesity). Among the prevalent T2D population in 2020, 4.9% received glucagon-like peptide-1 receptor agonists (GLP-1RAs), 9.7% received sodium-glucose cotransporter-2 (SGLT2) inhibitors, and 13.0% received GLP-1 RAs and/or SGLT2 inhibitors. Of those with CVD, 12.9% received GLP-1 RAs and/or SGLT2 inhibitors (without CVD, 13.2%). Of those with obesity, 19.4% received GLP-1RAs and/or SGLT2 inhibitors (without obesity, 9.0%). CONCLUSIONS In this retrospective claims database study, more than two thirds of patients with T2D also had CVD, obesity, or both CVD and obesity. GLP-1 RA and SGLT2 inhibitor use remained low.
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Affiliation(s)
- Nora Hennies
- Lilly Deutschland GmbH, Werner-Reimers-Straße 2, Bad Homburg vor de Höhe, Germany
| | - Sven W Görgens
- Lilly Deutschland GmbH, Werner-Reimers-Straße 2, Bad Homburg vor de Höhe, Germany
| | - Jonas Killer
- Lilly Deutschland GmbH, Werner-Reimers-Straße 2, Bad Homburg vor de Höhe, Germany
| | - Thorsten Otto
- Lilly Deutschland GmbH, Werner-Reimers-Straße 2, Bad Homburg vor de Höhe, Germany
| | - Lena M Richter
- Scientific Institute for Health Economics and Health System Research (WIG2 GmbH) Markt 8, Leipzig, Germany
| | | | - Dennis Häckl
- Scientific Institute for Health Economics and Health System Research (WIG2 GmbH) Markt 8, Leipzig, Germany
- Faculty of Economics and Management, Leipzig University, Universitätsstr. 1, Leipzig, Germany
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Raasveld FV, Weigel DT, Liu WC, Mayrhofer-Schmid M, Gomez-Eslava B, Tereshenko V, Hwang CD, Wainger BJ, Renthal W, Fleming M, Valerio IL, Eberlin KR. Neuroma morphology: A macroscopic classification system. Muscle Nerve 2024. [PMID: 39295574 DOI: 10.1002/mus.28261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 09/05/2024] [Accepted: 09/07/2024] [Indexed: 09/21/2024]
Abstract
INTRODUCTION/AIMS Neuromas come in different shapes and sizes; yet the correlation between neuroma morphology and symptomatology is unknown. Therefore, we aim to investigate macroscopic traits of excised human neuromas and assess the validity of a morphological classification system and its potential clinical implications. METHODS End-neuroma specimens were collected from prospectively enrolled patients undergoing symptomatic neuroma surgery. Protocolized images of the specimens were obtained intraoperatively. Pain data (Numeric rating scale, 0-10) were prospectively collected during preoperative interview, patient demographic and comorbidity factors were collected from chart review. A morphological classification is proposed, and the inter-rater reliability (IRR) was assessed. Distribution of neuroma morphology with patient factors, was described. RESULTS Forty-five terminal neuroma specimens from 27 patients were included. Residual limb patients comprised 93% of the population, of which 2 were upper (8.0%) and 23 (92.0%) were lower extremity residual limb patients. The proposed morphological classification, consisting of three groups (bulbous, fusiform, atypical), demonstrated a strong IRR (Cohen's kappa = 0.8). Atypical neuromas demonstrated higher preoperative pain, compared with bulbous and fusiform. Atypical morphology was more prevalent in patients with diabetes and peripheral vascular disease. DISCUSSION A validated morphological classification of neuroma is introduced. These findings may assist surgeons and researchers with better understanding of symptomatic neuroma development and their clinical implications. The potential relationship of neuroma morphology with the vascular and metabolic microenvironment requires further investigation.
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Affiliation(s)
- Floris V Raasveld
- Hand and Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands
- Division of Plastic and Reconstructive Surgery, Department of General Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Daniel T Weigel
- Hand and Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Wen-Chih Liu
- Hand and Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Maximilian Mayrhofer-Schmid
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | - Barbara Gomez-Eslava
- F.M. Kirby Neurobiology Center, Boston Children's Hospital and Department of Neurobiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Vlad Tereshenko
- Division of Plastic and Reconstructive Surgery, Department of General Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Charles D Hwang
- Division of Plastic and Reconstructive Surgery, Department of General Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Brian J Wainger
- Departments of Anesthesia, Critical Care & Pain Medicine and Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - William Renthal
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Mark Fleming
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ian L Valerio
- Division of Plastic and Reconstructive Surgery, Department of General Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Kyle R Eberlin
- Division of Plastic and Reconstructive Surgery, Department of General Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
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Warner JD, Blake GM, Garrett JW, Lee MH, Nelson LW, Summers RM, Pickhardt PJ. Correlation of HbA1c levels with CT-based body composition biomarkers in diabetes mellitus and metabolic syndrome. Sci Rep 2024; 14:21875. [PMID: 39300115 DOI: 10.1038/s41598-024-72702-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024] Open
Abstract
Diabetes mellitus and metabolic syndrome are closely linked with visceral body composition, but clinical assessment is limited to external measurements and laboratory values including hemoglobin A1c (HbA1c). Modern deep learning and AI algorithms allow automated extraction of biomarkers for organ size, density, and body composition from routine computed tomography (CT) exams. Comparing visceral CT biomarkers across groups with differing glycemic control revealed significant, progressive CT biomarker changes with increasing HbA1c. For example, in the unenhanced female cohort, mean changes between normal and poorly-controlled diabetes showed: 53% increase in visceral adipose tissue area, 22% increase in kidney volume, 24% increase in liver volume, 6% decrease in liver density (hepatic steatosis), 16% increase in skeletal muscle area, and 21% decrease in skeletal muscle density (myosteatosis) (all p < 0.001). The multisystem changes of metabolic syndrome can be objectively and retrospectively measured using automated CT biomarkers, with implications for diabetes, metabolic syndrome, and GLP-1 agonists.
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Affiliation(s)
- Joshua D Warner
- The Departments of Radiology and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Glen M Blake
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - John W Garrett
- The Departments of Radiology and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Matthew H Lee
- The Departments of Radiology and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Leslie W Nelson
- The Departments of Radiology and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ronald M Summers
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Perry J Pickhardt
- The Departments of Radiology and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI, 53792-3252, USA.
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246
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Guraka A, Duff R, Waldron J, Tripathi G, Kermanizadeh A. Co-Culture of Gut Bacteria and Metabolite Extraction Using Fast Vacuum Filtration and Centrifugation. Methods Protoc 2024; 7:74. [PMID: 39311375 PMCID: PMC11417889 DOI: 10.3390/mps7050074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 09/13/2024] [Accepted: 09/16/2024] [Indexed: 09/26/2024] Open
Abstract
This protocol describes a robust method for the extraction of intra and extracellular metabolites of gut bacterial mono and co-cultures. In recent years, the co-culture techniques employed in the field of microbiology have demonstrated significant importance in regard to understanding cell-cell interactions, cross-feeding, and the metabolic interactions between different bacteria, fungi, and microbial consortia which enable the mimicking of complex co-habitant conditions. This protocol highlights a robust reproducible physiologically relevant culture and extraction protocol for the co-culture of gut bacterium. The novel extraction steps are conducted without using quenching and cell disruption through bead-cell methods, freeze-thaw cycles, and sonication, which tend to affect the physical and biochemical properties of intracellular metabolites and secretome. The extraction procedure of inoculated bacterial co-cultures and monocultures use fast vacuum filtration and centrifugation. The extraction methodology is fast, effective, and robust, requiring 4 h to complete.
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Affiliation(s)
- Asha Guraka
- College of Science and Engineering, University of Derby, Derby DE22 1GB, UK
| | - Richard Duff
- College of Science and Engineering, University of Derby, Derby DE22 1GB, UK
| | - Joe Waldron
- College of Science and Engineering, University of Derby, Derby DE22 1GB, UK
| | - Gyanendra Tripathi
- School of Science and Technology, Nottingham Trent University, Nottingham NG1 4BU, UK;
| | - Ali Kermanizadeh
- College of Science and Engineering, University of Derby, Derby DE22 1GB, UK
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247
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Gutiérrez-Domingo T, Farhane-Medina NZ, Villaécija J, Vivas S, Tabernero C, Castillo-Mayén R, Luque B. Effectiveness of Mindfulness-Based Interventions with Respect to Psychological and Biomedical Outcomes in Young People with Type 1 Diabetes: A Systematic Review. Healthcare (Basel) 2024; 12:1876. [PMID: 39337217 PMCID: PMC11430895 DOI: 10.3390/healthcare12181876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/28/2024] [Accepted: 09/01/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Type 1 diabetes is a chronic disease especially affecting young people. Mindfulness-based psychological interventions might reduce emotional symptoms post-diagnosis, but the evidence is limited. OBJECTIVES This systematic review aimed to evaluate the effectiveness of mindfulness interventions on psychological well-being and biomedical variables in young people with type 1 diabetes. METHODS A systematic review of trials was conducted that involved a bibliographic search in electronic databases (Web of Science, MEDLINE, SciELO, Scopus, PsycINFO, and Cochrane Library) considering studies published between 2013 and 2024. RESULTS A total of 434 records were identified, of which 252 underwent selection according to title and abstract, leaving 32 that were evaluated for eligibility and 7 included in this review. From Google Scholar, six more studies were identified and evaluated, and two were selected. Finally, nine studies were subjected to full reading and a detailed analysis of the inclusion criteria. A total of 66.6% of the studies were evaluated as having a methodological quality of moderate or optimal, but the samples analysed tended to be small, and only two articles carried out short-term follow-up evaluations. CONCLUSIONS Mindfulness-based interventions, upon reviewing the preliminary results, may be posited as a viable strategy to enhance psychological (anxiety, diabetes distress, perceived stress, depression, self-efficacy, psychological well-being, and quality of life) and biomedical outcomes (glycaemic control, blood glucose levels, and diastolic blood pressure) for type 1 diabetes in young people. Although promising, further research is required to improve the quality, methodology, and design of studies.
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Affiliation(s)
- Tamara Gutiérrez-Domingo
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14071 Córdoba, Spain; (N.Z.F.-M.); (J.V.); (S.V.); (C.T.); (R.C.-M.); (B.L.)
- Department of Psychology, University of Cordoba, 14071 Córdoba, Spain
- Reina Sofia University Hospital, 14071 Córdoba, Spain
| | - Naima Z. Farhane-Medina
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14071 Córdoba, Spain; (N.Z.F.-M.); (J.V.); (S.V.); (C.T.); (R.C.-M.); (B.L.)
- Department of Psychology, University of Cordoba, 14071 Córdoba, Spain
- Reina Sofia University Hospital, 14071 Córdoba, Spain
| | - Joaquín Villaécija
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14071 Córdoba, Spain; (N.Z.F.-M.); (J.V.); (S.V.); (C.T.); (R.C.-M.); (B.L.)
- Department of Psychology, University of Cordoba, 14071 Córdoba, Spain
- Reina Sofia University Hospital, 14071 Córdoba, Spain
| | - Sebastián Vivas
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14071 Córdoba, Spain; (N.Z.F.-M.); (J.V.); (S.V.); (C.T.); (R.C.-M.); (B.L.)
- Department of Psychology, University of Cordoba, 14071 Córdoba, Spain
- Reina Sofia University Hospital, 14071 Córdoba, Spain
| | - Carmen Tabernero
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14071 Córdoba, Spain; (N.Z.F.-M.); (J.V.); (S.V.); (C.T.); (R.C.-M.); (B.L.)
- Reina Sofia University Hospital, 14071 Córdoba, Spain
- Department of Psychology, University of Salamanca, 37007 Salamanca, Spain
- Institute of Neurosciences of Castilla y León (INCYL), University of Salamanca, 37007 Salamanca, Spain
| | - Rosario Castillo-Mayén
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14071 Córdoba, Spain; (N.Z.F.-M.); (J.V.); (S.V.); (C.T.); (R.C.-M.); (B.L.)
- Department of Psychology, University of Cordoba, 14071 Córdoba, Spain
- Reina Sofia University Hospital, 14071 Córdoba, Spain
| | - Bárbara Luque
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14071 Córdoba, Spain; (N.Z.F.-M.); (J.V.); (S.V.); (C.T.); (R.C.-M.); (B.L.)
- Department of Psychology, University of Cordoba, 14071 Córdoba, Spain
- Reina Sofia University Hospital, 14071 Córdoba, Spain
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248
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Dar MI, Gulya A, Abass S, Dev K, Parveen R, Ahmad S, Qureshi MI. Hallmarks of diabetes mellitus and insights into the therapeutic potential of synergy-based combinations of phytochemicals in reducing oxidative stress-induced diabetic complications. Nat Prod Res 2024:1-15. [PMID: 39290074 DOI: 10.1080/14786419.2024.2402461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 08/03/2024] [Accepted: 09/05/2024] [Indexed: 09/19/2024]
Abstract
Diabetes mellitus (DM) is a serious health issue and is still one of the major causes of mortality around the globe. Natural products have progressively integrated into modern, advanced medical practices. Phytoconstituents from some medicinal plants have demonstrated therapeutic activity in treating different metabolic disorders and have been used to treat DM and its severe complications. The present review provides details of the major anti-diabetic targets identified in the literature and also provides comprehensive information regarding the therapeutic role of a synergy-based combination of phytoconstituents that functions by controlling specific molecular pathways synchronously by inhibiting certain key regulators involved in the development and progression of DM. The review also implicated the role of oxidative stress in diabetic complications and presented scientific validations of phytochemicals and their synergy-based combination using in vitro and or in vivo approaches.
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Affiliation(s)
- Mohammad Irfan Dar
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
- School of Pharmaceutical Education and Research, Centre of Excellence in Unani Medicine (Pharmacognosy & Pharmacology), and Bioactive Natural Product Laboratory, New Delhi, India
| | - Anu Gulya
- All India Institute of Medical Science, New Delhi, India
| | - Sageer Abass
- School of Pharmaceutical Education and Research, Centre of Excellence in Unani Medicine (Pharmacognosy & Pharmacology), and Bioactive Natural Product Laboratory, New Delhi, India
- School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Kapil Dev
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Rabea Parveen
- School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Sayeed Ahmad
- School of Pharmaceutical Education and Research, Centre of Excellence in Unani Medicine (Pharmacognosy & Pharmacology), and Bioactive Natural Product Laboratory, New Delhi, India
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249
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Kang KT, Chang RE, Lin MT, Chen YC. Pay-for-performance in Taiwan: A systematic review and meta-analysis of the empirical literature. Public Health 2024; 236:328-337. [PMID: 39299087 DOI: 10.1016/j.puhe.2024.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 06/27/2024] [Accepted: 09/04/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVES This study aimed to assess the impact of pay-for-performance (P4P) programmes on healthcare in Taiwan. STUDY DESIGN This was a systematic review and meta-analysis. METHODS A systematic literature search was performed using the PubMed, Medline, Embase, Cochrane review, Scopus, Web of Science and PsycINFO databases up to July 2023. Meta-analysis of the available outcomes was conducted using a random-effects model. RESULTS The search yielded 85 studies, of which 58 investigated the programme for diabetes mellitus (DM), eight looked at the programme for chronic kidney disease (CKD), and the remaining studies examined programmes for breast cancer, tuberculosis, schizophrenia and chronic obstructive pulmonary disease. The DM P4P programme was a cost-effective strategy associated with reduced hospitalisation and subsequent complications. The CKD P4P was associated with a lower risk of dialysis initiation. The P4P programme also improved outcomes in breast cancer, cure rates in tuberculosis, reduced admissions for schizophrenia and reduced acute exacerbation in chronic obstructive pulmonary disease. The meta-analysis revealed that the P4P programme for DM (odds ratio [OR] = 0.59; 95% confidence interval [CI] = 0.48-0.73) and CKD (OR = 0.73; 95% CI = 0.67-0.81) significantly reduced mortality risk. However, participation rate in the DM P4P programme was only 19% in 2014. CONCLUSIONS P4P programmes in Taiwan improve quality of care. However, participation was voluntary and the participation rate was very low, raising the concern of selective enrolment of participants (i.e. 'cherry-picking' behaviour) by physicians. Future programme reforms should focus on well-designed features with the aim of reducing healthcare disparities.
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Affiliation(s)
- Kun-Tai Kang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ray-E Chang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taiwan; Department of Information Systems and Operations Management, College of Business Administration, University of Texas at, Arlington, USA.
| | - Ming-Tzer Lin
- Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei City, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Yin-Cheng Chen
- Division of Nephrology, Department of Internal Medicine, Changhua Hospital, Ministry of Health and Welfare, Changhua, Taiwan
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250
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Sheikh RK, Toseef A, Omer A, Aftab A, Haider Khan MM, Ayaz SB, Althomli O, Razzaq A, Khokhar S, Jabbar N, Awan WA. Effects of moderate physical activity on diabetic adhesive capsulitis: a randomized clinical trial. PeerJ 2024; 12:e18030. [PMID: 39308811 PMCID: PMC11416079 DOI: 10.7717/peerj.18030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/12/2024] [Indexed: 09/25/2024] Open
Abstract
Background Moderate physical activity (MPA) has proven advantages for glycemic control, cardiovascular health, and functional independence. However, physical activity is not part of routine conventional physical therapy (CPT) in managing diabetic adhesive capsulitis patients. Objective To determine the effects of moderate MPA on diabetic adhesive capsulitis (AC). Methodology A randomized control trial was conducted at the Combined Military Hospital (CMH), Muzaffarabad, Pakistan from March 2022 to October 2022. A total of n = 44 patients with diabetic AC, aged 40 to 65 years, HbA1c > 6.5% were enrolled. Group A received MPA and CPT, while Group B only received CPT for six weeks. The upper extremity function, pain, and range of motion were assessed at baseline, third week, and sixth week through the disability of arm, shoulder, and hand (DASH) questionnaire, numeric pain rating scale (NPRSS), and goniometer respectively. Results The NPRS score and ROMs showed significant improvement (p < 0.05) in group A compared to group B with a large effect size. When comparing the mean difference of the DASH score (73 + 7.21 vs. 57.9 + 12.64, p < 0.001, Cohen's d = 1.46) was significantly improved with large effect size in group A as compared to group B. Conclusion MPA along with CPT has positive effects on patient pain, range of motion, and disability in patients with diabetic adhesive capsulitis.
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Affiliation(s)
- Raheela Kanwal Sheikh
- Department of Physiotherapy, College of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia
| | - Amna Toseef
- Physical Medicine & Rehabilitation, Sheikh Khalifa Bin Zayed Al Nahyan Hospital CMH, Muzaffarabad, Azad Kashmir, Pakistan
- Faculty of Rehaibilitation & Allied Health Sciences, Riphah International University, Islamabad, islamabad, Pakistan
| | - Aadil Omer
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Islamabad College of Physical Therapy, Margalla Institute of Health Sciences, Islamabad, Pakistan
| | - Anam Aftab
- M. Islam Institute of Rehabilitation Sciences, Gujranwala, Pakistan
| | | | - Saeed Bin Ayaz
- Physical Medicine & Rehabilitation, Sheikh Khalifa Bin Zayed Al Nahyan Hospital CMH, Muzaffarabad, Azad Kashmir, Pakistan
| | - Omar Althomli
- Department of Physiotherapy, College of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia
| | - Aisha Razzaq
- Faculty of Rehaibilitation & Allied Health Sciences, Riphah International University, Islamabad, islamabad, Pakistan
| | - Samra Khokhar
- Nawabshah Institute of Medical and Health Sciences, College of Physical Therapy and Rehabilitation Sciences (NIMHS), Shaheed Benazirabad, Pakistan
| | - Nazia Jabbar
- Royal Institute of Physiotherapy and Rehabilitation Sciences, Hidayat Campus, Sukkur, Pakistan
| | - Waqar Ahmed Awan
- Faculty of Rehaibilitation & Allied Health Sciences, Riphah International University, Islamabad, islamabad, Pakistan
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