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Žnidarič M, Škrinjar D, Kapel A. Electrodermal activity and heart rate variability for detection of peripheral abnormalities in type 2 diabetes: A review. Biomol Biomed 2023; 23:740-751. [PMID: 36803545 PMCID: PMC10494848 DOI: 10.17305/bb.2022.8561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/12/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
Modern medicine exhibits an upward trend towards non-invasive methods for early detection of disease and long-term monitoring of patients' health. Diabetes mellitus and its complications are a promising area for implementation of new medical diagnostic devices. One of the most serious complications of diabetes is diabetic foot ulcer. The main causes responsible for diabetic foot ulcer are ischemia caused by peripheral artery disease and diabetic neuropathy caused by polyol pathway-induced oxidative stress. Autonomic neuropathy impairs function of sweat glands, which can be measured by electrodermal activity. On the other hand, autonomic neuropathy leads to changes in heart rate variability, which is used to assess autonomic regulation of the sinoatrial node. Both methods are enough sensitive to detect pathological changes caused by autonomic neuropathy and are promising screening methods for early diagnosis of diabetic neuropathy, which could prevent the onset of diabetic ulcer.
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Affiliation(s)
- Matej Žnidarič
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | | | - Alen Kapel
- Faculty of Health and Social Sciences, Slovenj Gradec, Slovenia
- Alma Mater Europaea, Maribor, Slovenia
- Modus Medical, Maribor, Slovenia
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Patel P, Adusumilli A, Hari Narayanan D, Patel D, Patel S, Gutlapalli SD, Patel S, Patel KG, Kheyson B, Bibawy S, Otterbeck P. Evaluation of Efficacy of Bromocriptine as a Therapeutic Modality in the Treatment of Diabetes Mellitus: A Systematic Review. Cureus 2023; 15:e41931. [PMID: 37588318 PMCID: PMC10425704 DOI: 10.7759/cureus.41931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/15/2023] [Indexed: 08/18/2023] Open
Abstract
Diabetes mellitus (DM), one of the oldest diseases known to mankind has always been difficult to treat even with the availability of a variety of medications. In such a scenario, the Food and Drug Administration (FDA) has approved a novel therapeutic, bromocriptine, with a different mechanism of action than the traditional medications since 2009 but has not been used as either first-line therapy or add-on therapy. In this systematic review, we searched databases like PubMed, Medline, PubMed Central, Cochrane Library, Clinicaltrials.gov, and Wiley Online Library. The selected articles were screened using inclusion and exclusion criteria and quality appraised; finally, 11 studies including eight clinical trials and three narrative reviews were included. It was found that an increase in dopamine and serotonin levels were hypothesized to convert the insulin-resistant (IR) state to an insulin-sensitive (IS) state. Hence in DM, as there is an IR state, the administration of dopamine was hypothesized to increase insulin sensitivity. In our study based on included studies, it was found that bromocriptine was superior as an add-on therapy to metformin compared to metformin alone, also it was found beneficial in people failing treatment with any one oral hypoglycemic agent. On the contrary, bromocriptine was found inferior to teneligliptin in treating DM. Still, more studies are required to make an accurate and reliable assessment of the efficacy of bromocriptine in treating DM.
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Affiliation(s)
- Priyansh Patel
- Department of Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Department of Internal Medicine, Medical College Baroda, Vadodara, IND
| | - Amulya Adusumilli
- Department of Internal Medicine, Mahadevappa Rampure Medical College, Kalaburagi, IND
| | | | - Diya Patel
- Department of Internal Medicine, Gujarat Medical Education and Research Society, Sola, Ahmedabad, IND
| | - Sunny Patel
- Department of Internal Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Sai Dheeraj Gutlapalli
- Department of Internal Medicine, Richmond University Medical Center, New York, USA
- Department of Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sunil Patel
- Department of Internal Medicine, Richmond University Medical Center, New York, USA
| | - Kavan G Patel
- Department of Internal Medicine, Richmond University Medical Center, New York, USA
| | - Borislav Kheyson
- Department of Internal Medicine, Richmond University Medical Center, New York, USA
| | - Suzy Bibawy
- Department of Internal Medicine, Richmond University Medical Center, New York, USA
| | - Philip Otterbeck
- Department of Internal Medicine, Richmond University Medical Center, New York, USA
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Khalil SK, Saeed L, Fadul A, Elawad MF, Ferih K. DVT as the Initial Presentation of Multiple Myeloma: A Rare Case Report and Literature Review. Cureus 2023; 15:e42600. [PMID: 37644932 PMCID: PMC10461026 DOI: 10.7759/cureus.42600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 08/31/2023] Open
Abstract
Multiple myeloma patients are recognized to have a higher risk of venous thrombosis. The cause of this could be attributed to several risk factors, such as circulating prothrombotic microparticles, disease-specific variables, and alterations in coagulation and fibrinolysis factors. Recent research has revealed that these individuals also experience greater arterial thrombosis, including acute myocardial infarction and stroke. In this case report, we present the clinical profile and management of a 42-year-old patient who presented with signs and symptoms of deep venous thrombosis (DVT) and was diagnosed with multiple myeloma. The aim of this case report is to highlight a rare clinical presentation and diagnostic workup in a patient with multiple myeloma. Additionally, we discuss the possible factors provoking the development of DVT as a first presentation before treatment initiation and their possible mechanisms.
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Affiliation(s)
- Sondos K Khalil
- Internal Medicine Department, Hamad Medical Corporation, Doha, QAT
| | - Leena Saeed
- Internal Medicine Department, Hamad Medical Corporation, Doha, QAT
| | - Abdalla Fadul
- Internal Medicine Department, Hamad Medical Corporation, Doha, QAT
| | | | - Khaled Ferih
- Medicine, College of Medicine Qatar University, Doha, QAT
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Patel P, Patel D, Gutlapalli SD, Okorie IJ, Onana AE, Ugwendum D, Arrey Agbor DB, Munoh Kenne F, Otterbeck P, Nfonoyim J. The Associations of Auto-Brewery Syndrome and Diabetes Mellitus: A Literature Review and Clinical Perspective. Cureus 2023; 15:e41924. [PMID: 37588335 PMCID: PMC10425700 DOI: 10.7759/cureus.41924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/15/2023] [Indexed: 08/18/2023] Open
Abstract
Endogenous production of alcohol without the external intake of alcohol is called auto-brewery syndrome (ABS), and to get its levels to rise to a level that it has physical symptoms of alcohol intake is rare. The most common cause of ABS is the metabolism of ingested carbohydrates by intestinal microflora. This occurrence does not happen in all normal individuals but only in some high-risk individuals. Patients with diabetes mellitus (DM) have been hypothesized to be at high risk for ABS. We searched databases, such as PubMed, Medline, and PubMed Central, to search for existing literature with relevant keywords. In the finalized review, we have included 30 relevant articles. Alcohol formed in the gut gets absorbed in the bloodstream and immediately gets metabolized, so usually it does not achieve a level in blood high enough to cause symptoms. In high-risk patients, there is an increase in the level of bloodstream alcohol above a certain level, so it shows symptoms. Because there is higher blood glucose in DM, the patients have been shown to be at increased risk for developing ABS. Similarly, obesity is also a risk factor for DM, making it a high-risk condition for ABS. The most involved pathogens are Candida and Saccharomyces.
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Affiliation(s)
- Priyansh Patel
- Department of Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Department of Internal Medicine, Baroda Medical College, Vadodara, IND
| | - Diya Patel
- Department of Internal Medicine, Gujarat Medical Education & Research Society, Sola, Ahmedabad, IND
| | - Sai Dheeraj Gutlapalli
- Department of Internal Medicine, Richmond University Medical Center, New York, USA
- Department of Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ikpechukwu J Okorie
- Department of Internal Medicine, Richmond University Medical Center, New York, USA
| | - Arnold E Onana
- Department of Internal Medicine, Richmond University Medical Center, New York, USA
| | - Derek Ugwendum
- Department of Internal Medicine, Richmond University Medical Center, New York, USA
| | | | - Foma Munoh Kenne
- Department of Internal Medicine, Richmond University Medical Center, New York, USA
| | - Philip Otterbeck
- Department of Internal Medicine, Richmond University Medical Center, New York, USA
| | - Jay Nfonoyim
- Department of Pulmonary and Critical Care Medicine, Richmond University Medical Center, New York, USA
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Bhattacharya P, Talukdar K, Barman B, Jamil M, Phukan P, Mobing H, War G, Nonglait PL, Murti S, Prithviraj K, Sangma B. Clinical Spectrum and Medical Comorbidities in Tuberculosis: A Hospital-Based Study in Northeast India. Cureus 2020; 12:e10580. [PMID: 33110716 PMCID: PMC7580495 DOI: 10.7759/cureus.10580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Tuberculosis (TB) is one of the most common infectious diseases and is commonly associated with comorbidities. However, data regarding TB and comorbidities are lacking from northeast India. The aim of the study is to see the clinical spectrum of TB and the frequency of comorbidities. Methods This was a prospective observational study of all hospitalized TB patients between January 2016 and June 2017 who were selected by consecutive sampling. Data were analyzed using SPSS v. 17.0 (IBM Corp., Armonk, NY), and a p-value of <0.05 was considered significant. Results Of the 173 patients selected, the mean age was 41.05±17.04 years with a male:female ratio of 4.27:1. Pulmonary TB (PTB) was found in 43.94%, extra-pulmonary TB (EPTB) in 52.02%, and disseminated TB in 4.04%. Fever (61.27%) was the most common presentation, followed by cough (54.33%) and breathlessness (32.94%). Of the 76 patients with PTB and seven with disseminated TB, making a total of 83 patients, 56 (67.4%) were sputum positive. Out of 90 patients suffering from EPTB, pleural effusion (53.33%) was the commonest type of EPTB, followed by central nervous system (CNS) tuberculosis (26.66%) and abdominal tuberculosis (8.88%). Comorbidities were present in 53.17% of the patients, of which diabetes mellitus (DM) (26.58%) and hypertension (17.34%) were the most common. Comorbid conditions were significantly higher in PTB than EPTB (51 of 83 vs. 41 of 90, p<0.05). Mean glycated hemoglobin (HbA1c) was significantly higher in PTB as compared to EPTB (8.74±2.04 vs. 7.58±0.29, p<0.05). Conclusion Comorbidities, particularly DM, were present in half of the patients, mostly in PTB than EPTB, with glycemic control being significantly poorer in PTB patients.
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Affiliation(s)
- Prasanta Bhattacharya
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Kishore Talukdar
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Bhupen Barman
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Md Jamil
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Pranjal Phukan
- Department of Radiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Habung Mobing
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Gwenette War
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Phibakordor L Nonglait
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Subrahmanya Murti
- Department of Cardiology, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College (NHLMMC), Ahmedabad, IND
| | - Konthoujam Prithviraj
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Bandi Sangma
- Department of Chest & Tuberculosis, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
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Abstract
Objective Methods Results Conclusions
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Zhang Y, Wang T, Yang J, Li R, Chen Z, Wang S, Liu J, Ye Z. AB157. Treatment of diabetic erectile dysfunction by using endothelial progenitor cells genetically modified by human telomerase reverse transcriptase. Transl Androl Urol 2015. [PMCID: PMC4708846 DOI: 10.3978/j.issn.2223-4683.2015.s157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Erectile dysfunction (ED) is one of the most common complications of diabetes mellitus (DM). Under the background that effectivity of treatments for diabetic ED are quite poor, stem cell therapy is emerging a useful method. The aim of this study is to evaluate the possibility and mechanism of treatment of diabetic ED with endothelial progenitor cells (EPCs) genetically modified by human telomerase reverse transcriptase (hTERT). Methods Rat EPCs were isolated and transfected with hTERT (EPCs-hTERT). The paracrine characters and resistance to oxidative stress of EPCs-hTERT was determined in vitro. Thirty SD male rats were divided into five groups: diabetic ED rats, diabetic ED rats treated with EPCs, diabetic ED rats treated with EPCs-control, diabetic ED rats treated with EPCs-hTERT, normal control rats. Diabetes was induced by intraperitoneal injection of streptozotocin. After 8 weeks, diabetic ED rats were selected by apomorphine (APO) test. After injection of EPCs for 2 weeks, intracavernosal pressure (ICP) was measured by means of electrical stimulation for each group. Concentration of growth factors, the amount of EPCs and endothelium/smooth muscle content were evaluated in vivo. Results EPCs-hTERT showed stable expression of hTERT at the level of, mRNA and protein for more than 40 passages. EPCs-hTERT could paracrine more VEGF, HGF and bFGF. EPCs’ ability of resistance to oxidative stress was dramatically improved by tranfection of hTERT. ICP/mean arterial pressure (MAP) ratio induced by electrical stimulation in diabetic ED treated with EPCs-hTERT was markably higher than diabetic ED rats treated with EPCs or EPCs-control. Immunofluorescence demonstrated that more cells survived in penile tissues after implantation of EPC-hTERT. More growth factors were detected, and the endothelium/smooth muscle content was increase in penile tissues. Conclusions The paracrine effect and resistance to oxidative stress of EPCs-hTERT contributed to the improvement of erection of diabetic ED rats.
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Abstract
Objective Erectile dysfunction (ED) worsens in patients with diabetes mellitus (DM) despite good control of blood glucose level with insulin. Recent studies imply that diabetic vascular stresses (e.g., oxidative stress) persist in spite of glucose normalization, which is defined as metabolic memory. Studies suggest that the interaction between advanced glycation end products (AGEs) and their receptor (RAGE) mediates the development of metabolic memory. To investigate the effects of the antioxidant icariside II plus insulin on erectile function in streptozotocin (STZ) -induced type 1 diabetic rats. Methods Fifty 8-week-old Sprague-Dawley rats were randomly distributed into five groups: normal control, diabetic, insulin-treated diabetic, icariside II-treated diabetic, and insulin plus icariside II-treated diabetic. Diabetes was induced by a single intraperitoneal injection of STZ. Eight weeks after induction of diabetes, icariside II was administered by gastric lavage once a day (5 mg/kg) for 6 weeks; and 2-6 units of intermediate-acting insulin were given to maintain normal glycemia for 6 weeks. The main outcome measures were the ratio of intracavernous pressure (ICP) to mean arterial pressure (MAP); histology of penile endothelial cells and smooth muscle cells; neural nitric oxide synthase, AGEs and RAGE expression; malondialdehyde concentration; superoxide dismutase activity; and apoptosis index. Results Diabetic rats demonstrated a significantly lower ICP/MAP ratio, reduced penile endothelial cells, reduced smooth muscle cells, increased AGEs and RAGE, and increased apoptosis. Insulin and icariside II monotherapy partially restored erectile function and histological changes. However, the combination therapy group showed significantly better erectile parameters, cytological components and biochemistry, similar to those in the normal control group. Conclusions These results suggest that, although insulin can effectively control glycemic levels, it does not completely alter the pathological changes in erectile tissues. Better efficacy could be expected with tight glycemic control plus the antioxidant icariside II. The proposed combination therapy might have the potential to eliminate metabolic memory by down-regulating the AGEs-RAGE oxidative stress axis.
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Abstract
Objective Materials and methods Results Conclusions
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Abstract
Streptozotocin (STZ) induced diabetic model has been widely used to study the effects of diabetes mellitus (DM) on male infertility, but it remains unclear whether the responses in this model are due to hyperglycemia or STZ per se. This study was designed to investigate the mechanism of STZ on testicular dysfunction. In the present study, sperm characteristics, serum testosterone, steroidogenic enzymes (StAR and 3β-HSD), and the vimentin apical extension of sertoli cells decreased significantly in the STZ group compared with those in the normal controls (P<0.05), while Johnsen’s score, testicular lipid peroxidation, spermatogenic cell apoptosis, and the expressions of NF-κB and Wnt4 significantly increased (P<0.05). Insulin replacement mainly restored the decreased serum testosterone and steroidogenic enzymes, but not other parameters. The results indicated that spermatogenic dysfunction in the early stage of STZ-induced diabetic rats was due to direct STZ cytotoxity to sertoli cells, which could be regulated by Wnt4 and NF-κB, while steroidogenic dysfunction might be a direct or indirect consequence of insulin deficiency. The results suggested that STZ-induced diabetic model, at least in the early stage, is not suitable to study the diabetes-related spermatogenic dysfunction.
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Zheng Z, Wu J, Wang R, Zeng Y. Diabetes mellitus may induce cardiovascular disease by decreasing neuroplasticity. Funct Neurol 2014; 29:7-13. [PMID: 25014044 PMCID: PMC4172250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Neuroplasticity has been defined "the ability of the nervous system to respond to intrinsic or extrinsic stimuli by reorganizing its structure, function and connections". The nervous system monitors and coordinates internal organ function. Thus neuroplasticity may be associated with the pathogenesis of other diseases besides neuropsychiatric diseases. Decreased neuroplasticity is associated with cardiovascular disease (CVD) and a disease related to decreased neuroplasticity may confer a greater CVD risk. Diabetes mellitus (DM) is related to CVD and DM induces decreased neuroplasticity, which is manifested as depression, Alzheimer's disease and diabetic neuropathy. Therefore we conclude that DM may induce CVD by decreasing neuroplasticity.
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Affiliation(s)
- Zhihua Zheng
- Guangdong Province Pharmaceutical Association, Guangzhou, China
| | - Junyan Wu
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruolun Wang
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yingtong Zeng
- Guangdong General Hospital & Guangdong Academy of Medical Science, Guangzhou, China
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