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May 2026 DOI 10.14302/issn.2578-8590.ipj-26-6121
Aims Cardiac autonomic neuropathy is currently an untreatable progressive complication of type 1 diabetes (T1D). Impaired microcirculation is a suspected cause of nerve degeneration in TID. We investigated whether cardiovascular autonomic reflexes often used as indices of nerve functions, are associated with indices of microcirculatory function in young adults with T1D compared with non-diabetic controls. Methods In a cross-sectional study, 15 adults with T1D and 15 age-matched controls (20-40 years) underwent standardized cardiovascular autonomic reflex tests. Continuous recordings of electrocardiogram, cardiac vagal tone, beat-to-beat blood pressure and transcutaneous tissue oxygen (tcpO₂) and carbon dioxide partial pressures (tcpCO2) were done. Results Despite preserved baroreflex, parasympathetic, and sympathetic functions assessed using cardiovascular reflex tests, the individuals with T1D exhibited reduced baseline tcpO2 compared to the controls (37.5±3.75 vs. 49.6 mmHg). During the Valsalva manoeuvre, individuals with T1D exhibited a reduced systolic blood pressure response in phase I (31±10 vs. 43±18 mmHg) and early phase II (-1±15 vs. -18±17 mmHg), and an increased systolic (31±15 vs. 18±14 mmHg) and diastolic (45±11 vs. 33±16 mmHg) response in late phase II compared to controls. The early phase II diastolic response was inversely associated with baseline tcpO2. Conclusion The altered hemodynamic response to the Valsalva manoeuvre is suggestive of possible reduced arterial elasticity, higher vascular resistance, and splanchnic sympatho-vagal imbalance in T1D despite normal autonomic reflex ratios. The concomitant evidence of reduced tissue oxygenation and altered hemodynamics may represent early signs of dysautonomia but require longitudinal validation.
Dec 2025 DOI 10.14302/issn.2641-4538.jphi-25-5886
Objective Diabetes poses significant public health challenges, with many individuals remaining undiagnosed and at risk of complications. This study aimed to evaluate the performance of decision tree ensemble methods for predicting diabetes onset using the Framingham Heart Study Teaching Dataset and to explore sex-specific risk patterns relevant to AI-driven interventions. Methods We analyzed data from 11,627 participants, incorporating demographics, vital signs, smoking status, medication use, and laboratory measures. Random Forest classifiers were developed to predict diabetes incidence at approximately 6-year (Period 2) and 12-year (Period 3) follow-ups. Class imbalance was addressed using undersampling, oversampling, and the Synthetic Minority Over-sampling Technique (SMOTE). Results The models demonstrated robust performance, achieving an Area Under the Curve (AUC) of 0.856 in Period 2, and moderate predictive ability in Period 3 (AUC = 0.732 in males, 0.786 in females). Key predictors included glucose level, BMI, systolic blood pressure, age, and heart rate. Notably, differences emerged in predictive accuracy between men and women, suggesting potential sex-specific vulnerabilities that merit further study. Conclusion Machine learning approaches, particularly Random Forests, show promise for medium- and long-term diabetes risk prediction, supporting early identification and intervention efforts. Future work should focus on hyperparameter tuning and explainability techniques, such as SHapley Additive exPlanations (SHAP) values, to improve model precision, interpretability, and fairness. Equity-focused strategies remain critical to ensure AI-driven tools benefit diverse populations and do not exacerbate existing disparities in diabetes care.
Feb 2025 DOI 10.14302/issn.2641-4538.jphi-25-5420
South Asian women in the United States face disproportionate health challenges, including higher rates of intimate partner violence as well as higher rates of Type 2 diabetes and gestational diabetes compared to other racial and ethnic groups. This cross-sectional study examines the association between intimate partner violence (psychological, physical, and sexual) and the diagnosis of gestational diabetes and type 2 diabetes. A web-based survey recruited 2,634 South Asian women in the U.S., collecting data on socio-demographics, intimate partner violence experiences, stress levels, and diabetes diagnosis. Logistic regression models adjusted for significant sociodemographic factors revealed that women with a history of intimate partner violence were 5.82 significantly more likely to report a type 2 diabetes diagnosis and 3.91 more likely to report a gestational diabetes diagnosis. Furthermore, stress as measured by the perceived stress scale, was also higher among women with intimate partner violence, potentially moderating the relationship between intimate partner violence and adverse health outcomes through cortisol dysregulation. Despite high levels of educational attainment and employment, the prevalence of intimate partner violence was alarmingly high (66.7%), highlighting its pervasive impact on socioeconomic strata. These findings underscore the urgent need for culturally tailored interventions addressing intimate partner violence and its health consequences within South Asian communities. Further research is warranted to elucidate causal pathways and inform integrated public health strategies to mitigate disparities in chronic disease and intimate partner violence-related health outcomes.
Nov 2024 DOI 10.14302/issn.2574-4518.jsdr-24-5271
Background/Aim Obstructive Sleep Apnea (OSA) is a prevalent disorder characterized by recurrent respiratory disturbances during sleep. Patients with Type 2 Diabetes Mellitus (T2DM) and obesity exhibit a substantial susceptibility to OSA (23%–86%). People with OSA have a high risk of several comorbidities like insulin resistance, cardiovascular disease, depressed mood and hypertension. Thus, the objective was to comprehensively evaluate the risk of OSA among T2DM patients in India. Materials and Methods A cross-sectional survey was conducted across four cities in India involving 2,000 T2DM patients. The survey gathered data on patient demographics, clinical endpoints, and estimated the risk of OSA using an app which included the STOP BANG questionnaire. Multivariate logistic regression analysis was used to evaluate the association between OSA risk and key variables such as age, gender, BMI, and HbA1c. Result Overall, 63.9% of T2DM patients were identified as high risk and 27.3% were at intermediate risk for OSA development. Results of the multivariate logistic regression demonstrated that patients with high BMI ≥35 had significantly greater odds (OR: 5.70; p<0.00) of developing OSA; males had 2.75 times higher odds (p<0.00) and patients with HbA1c value >8% had higher odds (OR: 1.22; p<0.00) of developing OSA. Conclusion OSA risk and prevalence are significantly higher in T2DM patients than in the general population with a notable escalation in patients who are overweight/obese, older, and have prolonged diabetes duration. Early screening using digitalization with a highly sensitive, cost-efficient, and valid tool like STOP-BANG followed by appropriate intervention for OSA can not only reduce the eventual economic burden but can improve patient outcomes.
Feb 2024 DOI 10.14302/issn.2693-1176.ijgh-23-4879
Background Cancer and diabetes are risk factors for COVID-19 mortality rates. Remdesivir, dexamethasone, and vaccines are used to improve clinical outcomes. We aimed to evaluate the factors associated with COVID-19 mortality rates. Methods This retrospective study enrolled moderate to critical COVID-19 patients. The index day was the day of the COVID-19 diagnosis. Patients were followed up until either death or discharge. A two-way analysis of variance examined the interaction between independent mortality risk factors. Results A total of 205 patients were analyzed, and the mortality rate was 29.5% (n=60/205). The cumulative survival rate was significantly lower in patients with a CCI score ≥ 6, cancer, and diabetes. In multivariate analysis, critical illness, cancer, diabetes, chronic liver disease, a CCI score ≥ 6, unvaccinated, and early use of remdesivir/dexamethasone were independent risk factors for mortality. The onset of remdesivir/dexamethasone ≥ 2 days and < 3 doses of vaccinations were higher mortality rate, with its impact being more significant amongst patients with cancer/diabetes, compared to those without cancer/diabetes (p for interaction = 0.046/0.049, 0.060/0.042, and 0.038/0.048 respectively). Conclusions COVID-19 vaccination ≥ 3 doses and early administration of remdesivir and dexamethasone can significantly reduce mortality rates, particularly in patients with cancer or diabetes.
Jan 2024 DOI 10.14302/issn.2374-9431.jbd-23-4842
Over the past 20 years, the number of persons with diabetes has more than doubled globally. The purpose of this review article is to investigate the connection between certain vitamins and diabetes. Diabetes patients have been found to have decreased amounts of certain antioxidant vitamins including A, C, and E, presumably as a result of the requirement to control oxidative stress brought on by problems with glucose metabolism. Retinol-binding protein has regulatory and adipocytokine function. Thiamine, pyridoxine, and biotin levels are also decreased in diabetics. Studies have shown that it restricts the absorption of several nutrients, such as vitamins B9 and B12, thus diabetics must frequently replenish these vitamins. Low vitamin D levels increase the risk of developing diabetes and associated complications, such as cardiovascular disease. Although some studies indicate that vitamin K supplementation can enhance glucose metabolism, it is not known if vitamin K supplementation can prevent or repair oxidative damage. Numerous studies have demonstrated the detrimental consequences of excessive vitamin supplementation. The association between a few nutrients—specifically, vitamins A, D, C, B3, B6, B9, Zn, B12, E, B1/K, and irons—and the already mentioned pathways implicated in diabetes—as well as their potential regulatory activity—will be analyzed in the review that follows.
Oct 2023 DOI 10.14302/issn.2379-7835.ijn-23-4737
Bitter melon is a popular fruit cultivated in Southeast Asia and other tropical climate regions. Bitter melon has been used in traditional medicine because of its numerous medicinal benefits, including having hypoglycemic effects. This has an indication for diabetic patients, and several clinical trials have provided evidence that orally administered bitter melon extract can reduce A1C and blood sugar levels in diabetes patients. In vitro and in vivo mechanistic studies suggest that bitter melon’s anti-diabetic actions work through intra- and extra-pancreatic mechanisms. Herein we summarize and highlight these mechanistic and clinical studies that have demonstrated the hypoglycemic effects of bitter melon in type 2 diabetes patients.
Aug 2023 DOI 10.14302/issn.2379-7835.ijn-23-4688
Non-nutritive sweeteners are used as adjuncts in treating patients with diabetes to reduce carbohydrate intake. Monk fruit is an FDA-approved1 natural NNS2-. There is no information regarding the use of monk fruit in individuals with T2DM3. The primary objective was to compare the glycemic response to sucrose and monk fruit in individuals with and without T2DM. Twenty-six individuals with T2DM and 29 without DM4 underwent two oral glucose tolerance tests5 after a 250-ml sucrose- or monk fruit-sweetened beverage. Glucose levels were measured at 0, 30, 60, 90, and 120 minutes. An appetite scale was used before and after the procedure. Insulin levels were measured in ten randomly selected individuals from the control group. The glucose levels at 30 and 120 min were significantly lower in both groups in the monk fruit-OGTT. There was a peak response in the T2DM group at 90 min (median, IQR, 247 mg/dL, 203-293) with the sucrose OGTT, while no peak response was seen in the monk fruit OGTT. There were no differences between sweeteners in terms of appetite evaluation. The postprandial effect on insulin levels was flat with the monk fruit-sweetened beverage. In contrast, there was a significantly higher spike with the sucrose-sweetened beverage. In conclusion, monk fruit does not increase glucose levels in individuals with T2DM; thus, it could be a safe alternative as a substitute food sweetener.
May 2022 DOI 10.14302/issn.2379-7835.ijn-22-4170
Garden egg nutritional values are numerous. However, few nutritional and epidemiological data exist on the impacts of garden egg consumption on diabetes control. In this experimentally-control designed nutritional study, the effects of scarlet garden egg species (Solanum aethiopicum L.) on lipoglycemic profile, weight control and, pancreas histoarchitecture in diabetic male Wistar rats were examined. Twenty-One adult male Wistar rats inducted with diabetes were randomly categorized into three groups (n = 7, each): Diabetic control (DC); Diabetic treated with aqueous extract of garden egg (DEE) and Diabetic fed with garden egg-supplemented diet (DSE). Animals were fed for six weeks according to the experimental design. Glycemic status and body weights were assessed twice weekly while lipid analysis was conducted at the entry and 6th week of the study. Oral glucose tolerance (OGT) test was conducted. Gross analysis and tissue histology of the pancreas were assessed by Hematoxylin and Eosin (H&E) staining technique. Statistical analysis was done using analysis of variance, and the results were expressed as mean ± S.E.M. at P < 0.05. Garden egg reduced mean body weight gain (DSE: 14.53%; DEE: 10.58%; P value = 0.04) and decreased blood glucose concentrations (DEE: 37.33%; DSE: 18.68%; P = 0.03) with corresponding improved lipid profile, glycemic tolerance and control (DEE > DSE) and, preserved pancreas histoarchitecture in diabetic Wistar rats. Solanum aethiopicum (garden egg) consumption (as fresh fruit or supplemented diet) preserves pancreatic tissue histoarchitecture and improves lipoglycemic profile and weight control in diabetic Wistar rats.
Sep 2019 DOI 10.14302/issn.2574-450X.jom-19-3001
Gene therapy has entered a new era with the dawn of CRISPR/Cas9 technology which though were always available in nature but rediscovered to tame into a real-tlife genome editing tool. With the modernization upsurge and changes in ways the “homo sapiens” survived on this planet from hunger to current era of exuberance has led to multiple metabolic issues like type-2 diabetes. Notwithstanding the rapid emergence of medication to suppress the hyperglycemia and insulin resistance associated with this menace, need has definitely emerge to find more personalized and curative dimensions to therapeutics of type-2 diabetes mellitus. Gene therapy is one more addition to Type-2 Diabetes Mellitus (T2DM) therapy, where multiple options have emerged in the shape of microRNA, direct knocking out of cellular structures like proteins and enzymes and very recently the precision nucleases associated with CRISPR technologies. This mini-review attempt to summarize some of the recent examples of gene therapy with major focus on CRISPR/Cas technologies.
Aug 2019 DOI 10.14302/issn.2574-450X.jom-19-2987
Introduction It has been demonstrated that vitamin D deficiency is associated with type 2 diabetes mellitus (T2DM). We conducted a cross sectional study to investigate the prevalence severe vitamin D deficiency in patients with T2DM. Method A cross-sectional single centre study was conducted in 4053 patients with T2DM. Patients with T2DM attended the Diabetes Centre at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia between January 2018 and December 2018 were recruited. Results There were 4053 patients with T2DM, 1145 male and 2908 female (28 % vs.72% respectively). The mean age was 53.9 ±16.5 years. The mean and median 25-OHD concentrations were 57.8±30.5 and 51.9 respectively. Severe vitamin D deficiency (25-OHD<25 nmol/l) was found in 1916 (9.5%). Moreover, severe vitamin D deficiency was not statistically significant more prevalent among females than males with male to female ratio 1:2.3 (70% vs. 30% respectively, p=0.6). In addition, severe vitamin D deficient patients were statistically significant younger than non-vitamin D deficient (48.0±16.7 vs. 54.6±16.3 respectively, p<0.0001). Severe vitamin D deficient patients have statistically significant higher HbA1c than non-vitamin D deficient (8.3 ±2.3 vs. 7.6±1.9 respectively, p<0.0001). The mean 25-OHD was upward as age advanced with highest frequency of vitamin D deficiency was found in the age group ≥60 years (27%) with males statistically significant most frequent than females in the age group ≥60 years (39 s, 22 respectively, p=0.003). Regression analysis of odd ratio of risk factors for patients with severe vitamin D deficiency showed that age and HbA1c were statistically significant associated with vitamin D deficiency. Conclusions The prevalence of severe vitamin D deficiency in patients with T2DM is low and that more females with T2DM are affected with vitamin D deficiency than males.
Sep 2018
This letter presents a clinician's perspective on the biological basis of diabetes mellitus at the cellular level. Drawing on neurosurgical practice, the author argues that persistent dysglycemia hinders recovery and may reflect long-standing intracellular processes, calling for causal, interdisciplinary management beyond symptomatic care. The piece outlines testable hypotheses and invites further laboratory validation.
Feb 2018 DOI 10.14302/issn.3070-2313.jeh-17-1756
Objective We aimed to evaluate β-cell function of type 1 diabetic patients (T1DP)s based on fasting and stimulated C-peptide levels. Material and methods Study included 135 T1DPs and 31 healthy subjects. Fasting C-peptide levels were measured in healthy subjects and T1DPs. The Mixed-meal tolerance test (MMTT) was performed in T1DPs. Fasting and stimulated (90 minute post MMTT) C-peptide levels were measured via electrochemiluminescence assay. Two categorizations were made according to fasting (the first categorization ) and at 90th minute MMTT (the second categorization) C-peptide levels. For the first categorization; the groups were classified as follows: patients with undetectable ≤0.1ng/mL(group1); minimal 0.1-0.8ng/mL(group2); and sustained ≥0.8ng/mL (group3) C-peptide levels. For the second categorization, groups were as follows: patients with undetectable ≤0.1 ng/mL(group1); minimal 0.1-0.8 ng/ml (group2); and sustained ≥0.8ng/mL (group3) in which C peptide levels were increased to ≥150% of fasting C-peptide levels at the 90th minute after MMTT. Results For the first category; 41.5%, 40% and 18.5% of T1DPs were in group1, group2 and group3, respectively. For the second category; 34.8%, 20.7% and 44.4% were in group1, group2 and group3, respectively. In first categorization 58.5% and in second categorization 65.1% of T1DPs had detectable C-peptide levels. 44,4%of the T1DPs had a response to MMTT with C-peptide levels ≥0.8 ng/mL which increased to ≥150% of fasting C-peptide level at the 90th minute after MMTT as it is seen in non-diabetics. Conclusion The present study suggests the presence of functioning β-cells in T1DPs and 44.4 % of T1DPs have a response to MMTT as seen in non-diabetics. (ClinicalTrials.gov number: NCT02199470.)
Oct 2017 DOI 10.14302/issn.3070-5657.je-17-1513
Changes to proinflammatory cytokines as a result of gestational diabetes mellitus (GDM), and the pregnancy complications that these changes can cause, are of vital importance to the effective prevention and optimal management. Interleukin-6 (IL-6), interleukin-1 beta (IL-1β), and tumor necrosis factor alpha (TNF-α) are cytokines that are associated with gestational diabetes. Therefore, the aim of this review is to draw attention to the relationship between gestational diabetes and these diseases
Jul 2017 DOI 10.14302/issn.2474-3585.jpmc-17-1579
Objectives: Vitamin D (25(OH)D) status has been extensively evaluated in different populations and care settings. A negative relationship between glycated hemoglobin (HbA1c) and serum 25(OH)D levels in outpatients with diabetes has been reported, while data about 25(OH)D status in inpatients with diabetes are inconsistent. The aim of the study was to evaluate 25(OH)D levels in a large series of inpatients with type 1 and type 2 diabetes and in an age-, sex-, serum creatinine-, and HbA1c-matched group of outpatients with diabetes. Design: After the preliminary exclusion of patients with confounding factors, 540 subjects with diabetes were retrospectively evaluated in a 1:1 matched case-control study between inpatients and outpatients. Results: 25(OH)D levels resulted significantly lower in inpatients versus outpatients with diabetes (37.9 nmol/L, median, 25.3 interquartile range, vs 44.9, 31.8 nmol/L, respectively), regardless of season. 25(OH)D levels were inversely correlated with HbA1c levels and BMI in outpatients, and with fibrinogen and erythrocyte sedimentation rate in inpatients. Conclusions: Vitamin D deficiency is common in diabetic inpatients and more frequent than in diabetic outpatients. 25(OH)D status in diabetic inpatients is not related to glycemic control but is likely influenced by acute inflammatory condition.
May 2017 DOI 10.14302/issn.2374-9431.jbd-17-1465
Objectives: The present study investigated biopsychosocial predictors (HbA1c, self-efficacy, and social support) of self-management and health-related quality of life among patients with type 2 diabetes. Methods: 160 adults referred to the Iranian Diabetes Society participated in this study. Participants completed General Self-Efficacy Scale, Perceived Social Support, Diabetic Self-care Behaviors scale, and D-39 (diabetics’ quality of life). Results: Data were analyzed with SPSS-19 and Lisrel 8.8, utilizing statistical path analysis. Results revealed significant positive correlations between self-efficacy and social support subscales, self-care and health-related quality of life. Also, HbA1c had not correlation with HRQOL. The final path model fitted well and showed that direct self-care paths with (β = 0.24) and indirect social support with (β = 0.32) had the most effects on health-related quality of life. Conclusions: The results confirmed the theoretical model and scientific evidence for providing psychological solution to promote quality of life in patients with type 2 Diabetes.
May 2017 DOI 10.14302/issn.2474-7785.jarh-16-1350
The prevalence of type-2 diabetes (T2DM) among Mexican-American older adults along the U.S.-Mexico border region is at epidemic proportions. Healthcare reform is trending toward long-term home-based management of chronic conditions. Under the Mexican cultural norm of familism, daily care for elders is also often provided by family caregivers whose competence levels may vary. Adherence to the prescribed medication regimen is critical to attainment of optimal glucose control. However, there is a startling lack of literature that addresses the link between family medication administration and care recipients’ health outcome. This paper explores the role of culture in medication administration by family caregivers of elders with T2DM from the perspective of caregiver capabilities and caregiving demands. A critical review of the literature offers suggestions to guide future studies.
Feb 2017 DOI 10.14302/issn.2374-9431.jbd-17-1429
Objectives: To observe pregnancy outcomes in gestational diabetes mellitus (GDM) under treatment. Methods: Pregnant mothers (N=191) diagnosed with GDM (n=91, age: 27.44±4.91yr; body mass index, BMI: 26.88±4.16 kg/m2; mean±SD) on the basis of WHO 2013 criteria were compared with non-GDM (n=100, age: 26.01±4.81yr, BMI: 25.53±3.77 kg/m2, mean±SD) for pregnancy outcome irrespective of gestational age. HbA1c was also measured in all mothers. Gestational hypertension, preeclampsia, premature rupture of membrane (PROM), hydramnios, recurrent urinary tract infection (UTI), recurrent moniliasis, intrauterine growth retardation (IUGR), intra uterine death (IUD), mode of delivery, birth weight, birth injury, neonatal hypoglycemia, hyperbilirubinemia, respiratory distress syndrome (RDS), congenital anomaly were recorded at every trimester. 160 mothers (GDM=75, non-GDM=85) could be followed for outcomes to the end of pregnancy. All the GDM mothers were offered standard treatment throughout pregnancy period. Results: HbA1c was significantly higher in GDM than that in non-GDM (5.42±0.61 vs. 4.98±0.44%, mean±SD; p<0.001).Outcome events in GDM and non-GDM were: gestational hypertension- 3.6% vs. 2.3% (p=0.621), preeclampsia- 2.4% vs. 0% (p=0.150), PROM- 4.9% vs. 0% (p=0.037), hydramnios- none in any group, recurrent UTI- 12.3% vs. 4.7% (p=0.073), recurrent moniliasis- 0.0% vs. 2.3% (p=0.165), caesarian section- 85.3% vs. 72.9% (p=0.056), small for gestational age (SGA)- 26.4% vs. 36.7% (p=0.246), large for gestational age (LGA)- 1.4% vs. 0%, p=0.246, IUGR- 2.3 vs. 2.5% (p=0.952), neonatal hypoglycemia- 2.7% vs. 0.0% (p=0.130), hyperbilirubinemia- 12.0% vs. 11.8% (p=0.963), RDS- 0.0% vs. 2.4% (p=0.181) and birth injury- 0.0% vs. 1.2% (p=0.346), congenital anomaly- 4.0% vs. 1.2% (p=0.254) and abortion- 1.3% vs. 0.0% (p=0.286). Preterm delivery (12.0% vs. 7.1%, p=0.285) and caesarean section (85.3% vs. 72.9%, p=0.056) were more in GDM. Conclusions: Despite treatment, adverse events were relatively higher but non-significant in GDM.
Dec 2016 DOI 10.14302/issn.2474-3585.jpmc-16-1281
Objectives This study describes and compares the epidemiological criteria of children with diabetes from 2007 to 2014. Methods A prospective study conducted with 372 children with diabetes mellitus. An access program was used for data collection, and SPSS 17 was used to analyses the results. Results A total of 372 cases with diabetes were studied and were divided into three groups according age. The first age group was between one day and six years and comprised 128 (34.4%) patients. The second group aged 7- 12 years of age comprised 174 (46.7%) patients. The third group aged 13-18 years of age comprised 58 (15.59%) patients. The average age was 8.32 years. Females constituted 52 % (194 cases) of all cases. T1DM constituted 95.4%, equal to 355 patients, T2DM constituted 1.88%, equal to seven cases. Monogenic diabetes affected three patients or 0.79%, with one case of monogenic neonatal diabetes confirmed by genetic study, and two other cases suspected to be MODY. The highest incidence was observed in the autumn months, with 105 children affected, constituting 27.8 % cases. The year 2012 had the highest incidence rate, with 59 children and adolescents affected at an incidence rate of 25.48 / 100000.Al-Baha region had the highest number of cases constituting 37.7 % of cases. Diabetic ketoacidosis was the first presentation and constituted 44.2% of cases. Conclusion. Diabetes in children is increasing significantly in recent years, requiring more detailed analysis of its epidemiological factors to find out any significant correlations which may help in its prevention.
Oct 2016 DOI 10.14302/issn.2474-9273.jbtm-16-1308
Objectives: While Diabetes Mellitus (DM) affects cognitive functions and the Long Term Memory (LTM), several different strategies are designed to control harmful consequences of DM. This study is investigating whether having Mind Activity (MA) can make any difference in LTM function of individuals with DM. Design: The participants (n=80) were classified in 4 groups based on having DM or not and having MA or not. Methods: The LTM and MA were assessed respectively by the word-list of Tulving and Pearlstone, and a self-report form. The BG concentrations were measured in vitro. Results: The results showed a significant negative correlation between BG concentrations and LTM scores in group with DM. The LTM function is significantly lower in group with DM and no-Mind Activity (nMA) respectively than the group with no-Diabetes Mellitus (nDM) and with MA. Also the LTM scores of the groups with nDM&MA, nDM&MA, DM&MA, nDM&MA, nDM&nMA and nDM&MA which were respectively higher than those of the groups with nDM&nMA, DM&MA, DM&nMA, DM&nMA, DM&nMA and DM&MA were statistically significant. Conclusions: The weaker BG control in patients with DM, the higher LTM dysfunction; and LTM function is in close relationship with DM (negatively) and MA (positively). Patients with DM and individuals with nDM who have their minds active in elderly, may less likely confront LTM dysfunction than matched groups who do not have active minds.
Sep 2016 DOI 10.14302/issn.2574-450X.jom-16-1062
Background: Obese adults with Type 2 Diabetes (T2D) have shown differences in body composition and response to varying diets when compared to obese adults without T2D. This difference in body composition affects management options for obesity. Such studies have not been done on adolescents thus far. Objectives: To estimate differences in fat mass at baseline as well as following a two-week high protein liquid diet in obese adolescents with and without T2D. Methods: Thiswas a pilot study using a non-randomized, unblinded pre/post intervention design without a control group. We planned to recruit 40 subjects (20 per group, with and without T2D) from ages 10 – 19 years, with Body mass index (BMI) ≥ 95 percentile. Body fat mass was measured via the Bod Pod® at baseline and after two weeks of following the diet with Ensure High Protein shakes. Change in fat mass is presented as mean differences and 95% confidence intervals. Results: We recruited 28 subjects, 19 completed the study and 12 were compliant with the diet. The mean difference in fat mass percent from baseline in subjects who completed the study (n=19) and without T2D was 1.4 (95% confidence interval (CI): -2.1 to -0.8) and in subjects with T2D was 1.2 (95% CI: -3.6 to 1.24). Conclusion: We did not find any meaningful difference in fat mass at baseline or after following a two-week high protein diet between the groups. High dropout rate and noncompliance with the diet were major limitations.
Jun 2016
Earlier studies reported significant association of obesity, hypertension and Type2 Diabetes Mellitus (T2DM). Genetic and many disease-associated alleles have been identified through GWAS and applied to T2DM and indicated roles of renin-angiotensin system (RAS) in insulin signaling pathway and insulin resistance has been well documented. Angiotensin converting enzyme (ACE) gene catalyzes the conversion of angiotensin I to angiotensin II and also inactive the vasodilatation and hence renin-angiotensin system (RAS) in insulin signaling pathway and insulin resistance has been reported. To best of the knowledge we are reporting for the first time regarding association of ACE gene polymorphism with body composition, physiological and metabolic variables among any endogamous ethnic group (Kurmis) from of West Bengal, Eastern India. To achieve the purpose, total 197 (male 99 and female 98) randomly selected apparently healthy unrelated adult individuals of Kurmi population of Purulia District, West Bengal, India were incorporated in the present study. Anthropometric variables, physiological variables (blood pressure) and metabolic variables (PP blood sugar) have been collected using standard techniques. Extracted genomic DNA was PCR amplified and genotyped to understand ACE gene I/D polymorphism. The result demonstrated significant (p<0.05) sexual dimorphism in PBF. MAP and PP blood sugar found to be in normal range among the Kurmis. ACE gene polymorphism showed no deletion of the Kurmis and hence, only the prevalence of ACE II (insertion-Insertion) genotype has been noticed. The present study vindicated on the basis of body composition in terms of fat patterning, physiological and metabolic variables and ACE gene polymorphism that there is very low or no risk of T2DM among the Kurmis of West Bengal, India.
Mar 2016 DOI 10.14302/issn.2374-9431.jbd-16-939
Objective: To observe association of risk factors with gestational diabetes mellitus (GDM) in a tertiary care hospital of Bangladesh. Materials and Methods: Risk factors of GDM were evaluated in pregnant subjects (n=385; age: 26.4±4.9 yrs; body mass index, BMI: 25.3±4.3 kg/m2; mean ± SD) screened by 75 gram oral glucose tolerance test (OGTT) following WHO 1999 criterion irrespective of gestational age in the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU). BMI, maternal age, parity, trimester and family history of diabetes were considered as risk factors. Plasma glucose was measured by glucose-oxidase method on the same day. Results: GDM and normal glucose tolerance (NGT) showed significant difference for age (28.2±4.9 vs. 25.3±4.6 yrs, p<0.001), BMI (26.7±4.4 vs. 24.4±3.9 kg/m2, p˂0.001), family history of DM (55.5% vs. 43.0%, p=0.017) and number of gravida (p=0.048). There was no significant difference of frequencies of GDM among various trimesters (39.4% vs. 42.5% vs. 38.2%; χ2=0.653, p=0.721). OGTT performed before 24 weeks revealed GDM in about 44% (88/202). Multiple regression revealed age (p<0.001), BMI (p=0.007) and family history of DM (p=0.048) as independent predictors for GDM. Conclusion: It is concluded that age of mother, increased BMI, family history of diabetes as well as multigravidae are important predictors for GDM.
Jun 2015 DOI 10.14302/issn.2474-3585.jpmc-14-540
Objective Measuring coronary artery calcification (CAC) enables to optimize cardiovascular risk-stratification also in patients with type 2 diabetes mellitus (T2D), however the prevalence of CAC in randomly selected patients with T2D is uncertain. For this purpose we set out to examine and compare the occurrence of CAC in unselected T2D patients. Design A randomly selected cohort of 1825 individuals, men and women, either 50 or 60 years old, were invited to the screening study. Traditional risk factors were obtained and a non-contrast CT-scan was performed to assess the CAC score. Results A total of 1211 individuals participated, of whom 54 (4%) had T2D while 1157 (96%) were without diabetes. CAC was present in 62% of the patients with T2D versus 44% in those without (p=0.013). Also the prevalence of traditionally risk factors was high in patients with T2D as compared to subjects without T2D. When adjusting for age, gender, smoking, hypertension and hypercholesterolemia in multivariate logistic regression, T2D was not associated with presence of CAC (OR=1.0; 95% confidence interval 0.5 - 2.0, p=0.94). Conclusions One-third of patients with T2D did not have any CAC, and T2D per se was not associated to CAC.
Oct 2014 DOI 10.14302/issn.2374-9431.jbd-13-212
Diabetes mellitus type 2 (DMT2) is a complex polygenic disorder. DMT2 is a result of insulin resistance and destruction of pancreatic β-cell or dysfunction. Therefore, glucose builds up in the bloodstream, leading to nerve damage, blindness, organ failures and sometimes death. Recently, some recently discovered genes play a key role in regulating the sensitivity to insulin. Scientists have long known that the disease often runs in families, and other genetic links. Human genetic discoveries will keep improving our knowledge about diabetes for many years to come. Varieties of prospective diabetic researches were developed to diagnose and control DMT2. Researchers spent thousands of millions of dollars to address DMT2. Pioneers of advanced biotechnology developed bioinformatics tools that changed the course of research about the role of metabolomics in DMT2. It will facilitate the identification of possible causes of DMT2 in genome studies. The present article aimed at reviewing the research studies per training to metabolomics and bioinformatics in genome studies in relation to DMT2.
Feb 2014 DOI 10.14302/issn.2374-9431.jbd-13-312
Objective: This study assessed the baseline knowledge, perceptions, attitudes and behaviors of prediabetes patients in order to tailor a new technology-enhanced primary care-based lifestyle modification intervention. Methods: Patients with a diagnosis of prediabetes were enrolled in a randomized, controlled pilot study, Avoiding Diabetes Thru Action Plan Targeting (ADAPT), a technology-based intervention to promote action plan discussions around patient-selected behavior change goals. Results: A total of 54 adults (82% female) were enrolled in the pilot study. Most (89%) had comorbid conditions and mean BMI was 36. Participants exhibited significant levels of diabetes risk knowledge and diabetes risk perception, as well as high levels of willingness to make changes to decrease diabetes risk. Number of daily steps was inversely correlated with perceived physical activity (r=-0.35082, p<0.001). Poorer scores on diet quality were inversely correlated with BMI. Conclusion: Participants in this sample demonstrated requisite levels of knowledge, self-efficacy, motivation and risk perception for effective behavior change. These data suggest that primary care-based prediabetes interventions can move beyond educational goals and focus on enhancing patients’ ability to select, plan and enact action plans.
Sep 2013 DOI 10.14302/issn.2374-9431.jbd-13-218
The increased association between depression and diabetes mellitus is generally acknowledged. Recent studies suggest that depression leads to diabetes.However, the underlying molecular mechanisms for this association remain unclear.Literature and our data indicate that inflammatory and/or stress factors in depression up-regulate tryptophan (TRP) conversion into kynurenine (KYN), a substrate for nicotinamide adenine dinucleotide (NAD) biosynthesis. Deficiency of vitamin B6, a co-factor of the key enzymes of KYN – NAD pathway, shunts KYN metabolism from formation of NAD towards production of xanthurenic (XA) and kynurenic (KYNA) acids. Human and experimental studies reveal that XA, KYNA and their metabolites interfere with production, release and biological activity of insulin. We propose that inflammation- and/or stress-induced up-regulation of TRP – KYN metabolism in combination with vitamin B6 deficiency is one of the mechanisms mediating increased risk of diabetes in depression. Consequently, monitoring formation of diabetogenic KYN derivatives might help to identify subjects-at-risk for the development of diabetes. Pharmacological down-regulation of the TRP – KYN – NAD pathway and maintenance of adequate vitamin B6 status might help to prevent the development of diabetes in depression and other conditions associated with inflammation/stress–induced excessive production of KYN and vitamin B6 deficiency, e.g., obesity, cardiovascular diseases, aging, menopause, pregnancy, and hepatitis C virus infection.
Apr 2026 DOI 10.14302/issn.2640-6403.jtrr-26-6077
Delayed wound healing in diabetes is characterized by impaired angiogenesis, persistent inflammation, extracellular matrix dysregulation, and peripheral neuropathy. A preclinical study was conducted using a diabetic mouse delayed wound model to evaluate the surrounding tissue of a wound, (its periwound) and its tissue responses following treatment with the NerveStim™ Neuropathy System, a combination topical gel and neuromuscular electrical stimulation platform. Periwound tissue was harvested at Day 14 and analyzed using NanoString gene expression profiling. Treated animals demonstrated visibly increased periwound tissue thickness compared to untreated controls. Differential expression analysis identified 76 significantly upregulated and 17 downregulated genes. Upregulated pathways included angiogenesis (Vegfa, Fgf2, Pdgfb, Nos3), neurotrophic signaling (Ngf, Bdnf, Scn9a, Trpv1), macrophage polarization (Arg1, Mrc1, Il10), and extracellular matrix remodeling (Col1a1, Col3a1, Mmp9, Timp1). Downregulation of select pro-inflammatory mediators (Nos2, Mif) was observed. These coordinated transcriptional changes are consistent with activation of reparative immune, neurovascular, and matrix remodeling pathways in diabetic periwound tissue.
Dec 2025 DOI 10.14302/issn.2329-9487.jhc-25-5778
Calcium channel blockers (CCBs) are widely used for the treatment of arterial hypertension, but they differ in terms of pharmacology, tolerability, and pleiotropic actions. Lercanidipine, a highly lipophilic third generation dihydropyridine, reduces blood pressure (BP) effectively as monotherapy and in combination without inferiority to other major antihypertensive classes. We systematically searched PubMed and the Cochrane Library (last update: September 1, 2025) and screened reference lists for additional studies. Evidence from dose finding trials, randomized controlled studies, large observational cohorts, and meta analyses shows clinically meaningful reductions in office, home, and ambulatory BP with lercanidipine, including in patients with diabetes, obesity, chronic kidney disease, or high cardiovascular (CV) risk. Fixed- dose combinations with renin angiotensin system blockers (e.g., enalapril) provide greater BP reductions than monotherapy and are associated with favorable neurometabolic profiles. Beyond BP control, lercanidipine improves central hemodynamics and arterial stiffness, favors endothelial biology, and contributes to left ventricular hypertrophy regression. Across comparative trials, lercanidipine is generally better tolerated than older dihydropyridines. Presents lower rates of vasodilatory adverse events, less sympathetic activation, while discontinuations due to adverse events are uncommon. Overall, lercanidipine particularly within single pill combinations offers effective, durable BP lowering across diverse patient profiles with a favorable safety and tolerability profile and pleiotropic benefits that extend beyond BP reduction. Figure 1. Graphical Abstract: Pleiotropic effects of Lercanidipine
Sep 2024 DOI 10.14302/issn.2474-7785.jarh-24-5212
From an academic and clinical point of view, stem cell therapy represents one of the most promising advances in modern medicine, with the ability to partially induce the regeneration of acutely injured or chronically damaged tissues. Stem cell research provides new opportunities for the treatment of various conditions, among them diabetes mellitus, HIV, cardiovascular diseases, and neurodegenerative illnesses. Stem cell therapy is currently not FDA-approved in the US (except for certain blood cancers). While bioethics and religion have mostly discussed the source of cells, i.e., embryonic cells that require the destruction of embryos versus adult tissue for research purposes, we also discuss the controversies with regard to currently offered therapies, and marketing of unapproved procedures from a scientific, clinical, and religious viewpoint.
May 2024 DOI 10.14302/issn.2379-7835.ijn-24-5111
The purpose of this work is to emphasize the possible benefits of a microRNA-based diet in reducing the negative effects of a number of diseases, such as cancer, diabetes mellitus, obesity, hypertension, chronic respiratory conditions, and others.
Mar 2024 DOI 10.14302/issn.2379-7835.ijn-24-4921
Hippocrates trusted foodstuff, maybe medicine, and healthcare management, administration, and costing are important. Nutraceuticals, derived from "nutrition" and "pharmaceutical," cover differing healing areas like “antagonistic-hard, cold and cough, sleep difficulties, digestion, cancer prevention, osteoporosis, blood pressure, cholesterol management, pain relievers, depression, and diabetes”. “Stephen De Felice”, “founder of the Foundation for Innovation in Medicine, created the term in 1989”.Functional foods, like milk and orange juice, supply health benefits that surpass food, in the way that a better lifestyle and a lower risk of ailment. Nutraceuticals, in another way, involve fortified dairy products like milk that help avoid or cure illnesses and disorders apart from anaemia.Conventional arrangements like Solvents extraction , Soxhlet distillation ,maceration and “Non conventional designs” like ‘Microwave assisted origin’, Ultrasound Assisted Extraction are used to restore the bioactive material from plants for nutraceuticals.”The Indian Health and Dietary Supplement Association” supports drug, nutraceutical, herbaceous, and direct selling energies by categorising them based on chemical arrangement, food type, and conventional arrangement.This paper gives a brief review on nutraceuticals ,its history , its market trend , extraction techniques , benefits and its applications .
Jan 2024
Drug-resistant tuberculosis (DR-TB) is the most urgent public health problem to solve in Peru, according to the Ministry of Health 1. In the WHO Global TB Report 2021, Peru has the highest burden of DR-TB in the Americas (Table 1), with 38% of TB cases either RR or MDR. In addition, the Ministry reports an estimated prevalence rate of DR-TB of 5.7% in new cases and 24.2% in previously treated cases. A total of 2493 new cases of DR-TB were reported in 2022, with 18.5% treatment dropout in 2019 believed to have increased by at least 52% in 2022 1. The post-pandemic context has created additional challenges for the control of DR-TB in Peru. A complex multiplicity of factors connects this disease to groups with high vulnerability, such as populations in extreme poverty and overcrowding or deprived of freedom; those who have immune system disorders, such as HIV and diabetes; and isolated indigenous populations.
Sep 2023 DOI 10.14302/issn.2576-9383.jhhr-23-4713
A global increase in incidence of chronic liver disease (CLD) indicated the necessity of dietary and lifestyle modification. Low glycemic index (GI) diet was reported to have a significant role in controlling diabetes caused by liver dysfunction. The International Standards Organisation (ISO) has standardized the determination of GI of a food in healthy individuals. This study aimed to estimate GI value of a high protein, energy dense liver nutritional supplement. This cross-over randomized controlled study randomly allotted 15 participants to consume either reference food 27.5 gm glucose (glucose monohydrate) or 77 gm nutritional supplement (equivalent to 25 gm of available carbohydrates); switching to another arm was done after 3 days wash-out period. After overnight fast, blood samples were collected at 15, 30, 45 and 60 minutes post-consumption of s upplement or reference food. The GI was calculated from the incremental area under the blood glucose response elicited by the nutritional supplement as a percentage of the response after consumption of 27.5 gm of glucose (glucose monohydrate) by the same participant using a standard formula. Mean GI of the nutritional supplementwas estimated as 11.4 ± 2.4.With the consumption of this nutritional supplement, the blood glucose levels were reduced at all postprandial time points, compared to the reference food. The liver nutritional supplement tested has a low GI, and comparatively slower and more sustained blood glucose response. Therefore, it can be used in patients with CLD to prevent CLD-associated metabolic complications and improve health outcomes and quality of life.
Jul 2023 DOI 10.14302/issn.2574-450X.jom-23-4654
Background Nearly 40% of the adult population in the United States are considered obese by current standards, which equates to approximately 93 million people. Obesity is a chronic disease that is linked to more than 40 other diseases, including hypertension, heart disease, stroke, diabetes, and at least 13 distinct types of cancers. The direct and indirect costs of obesity have been estimated at up to $210 billion annually. Local Problem In Cumberland County, North Carolina, 34% of the adult population was considered obese. The aim of this quality improvement study was to increase effective care (screening, patient engagement, and referral to treatment) in adult patients with a BMI greater than 30 kg/m2 to 75% within 90 days. Methods A rapid cycle plan-do-study-act framework was used to evaluate four focus areas concurrently over 8 weeks with a small test of change completed in each 2-week cycle. Interventions An expanded screening with a checklist, shared decision-making tools (SDMTs), and a referral to treatment checklist were implemented. Activities from the team engagement plan were initiated. Results The effective care of patients increased by 42 percentage points while engaging both the patients and the staff. Conclusions Utilizing standardized communication, SDMTs, checklists, and management plans improved effective care while motivating and enabling patients to take control of their care and make sustainable lifestyle changes that enhance overall health.
Jan 2023 DOI 10.14302/issn.2329-9487.jhc-22-4362
Objective To describe the epidemiological, clinical and arterial Doppler ultrasound aspects of abdominal aortic aneurysm (AAA). Material and Methods This is a prospective study with descriptive and analytical aims carried out from January 2019 to March 2022 (3 years) at the cardiovascular exploration center (CEC) "Saint-Esprit" of the association of the people's doctors for the research on cardiovascular diseases (AMP-MCV), at the clinic "Le Printemps" and at the University Hospital of Kara. All patients who underwent arterial Doppler ultrasound of the lower limbs for any reason in these centers during the study period were included. Ultrasound scans were performed or confirmed by a physician with a diploma specializing in vascular Doppler ultrasound. Results We retained 32 Doppler ultrasound scans out of 739 performed for AAA with a frequency of 4.38%. The mean age was 73.5± 9.07 years. The sex ratio M/F was 1.4. The cardiovascular medical history (84.38%) found was: hypertension (33.33%), diabetes (18.52%), dyslipidemia (33.33%) and a combination of diabetes and hypertension (14.81%). The circumstances of discovery were: downstream MI ischemia (72%), incidental finding on abdominal ultrasound (15.63%) and De bakey sign (6.25%). The location of the aneurysms was subrenal (84.4%), suprarenal (9.4%) and both (6.2%). AAAs were fusiform (71.9%) and saccular (28.1%). The size of the aneurysms was greater than 5 cm in 78.17% of patients. High blood pressure increases the probability of the occurrence of subrenal AAA while dyslipidemia increases the occurrence of fusiform AAA. Diabetes increases the probability of occurrence of AAA larger than 7cm. AAAs were thrombosed in 75% of patients. There were extensions of the aneurysms to the iliac arteries in 70.59%. Downstream embolic complications represented 46.88%, in the form of occlusions and tight stenoses. Spontaneous mortality was 81.24%. Conclusion Arterial Doppler ultrasonography is a very important tool in the screening, positive and lesion diagnosis of AAA. The risk factors for AAA are: age over 60 years, male gender, hypertension, diabetes and dyslipidemia. Early detection remains essential, because the spontaneous prognosis is poor.
Sep 2022 DOI 10.14302/issn.2329-9487.jhc-22-4252
Background Prevalence of coronary artery disease is between 7-13 percent in urban and 2-7 % in rural India1. The alarm in rise in the prevalence of coronary risk factors like diabetes, hypertension, dyslipidemia, smoking, central obesity and physical inactivity2. The correlation between these risk factors and the severity of coronary atherosclerosis, assessed by angiography which may be either single or multivessel is less consistent with studies reporting conflicting results 3,4. Therefore our study aims to understand the proper correlation between risk factors and severity of coronary artery disease in an Indian population Methods This study was conducted in the department of cardiology, NIMS hospital Hyderabad which receives patients from the urban as well as rural areas of Telangana. the patients admitted in the department of cardiology, NIMS hospital Hyderabad that presented with acute coronary syndromes and diagnosed to have coronary artery disease (single vessel/multivessel disease) on coronary angiography taken for study. Sample Size is 150 Results Among the 150 subjects, males were 111(74%) and females were 39(26%). Mean age of the study population is 55.2 ± 11.4. Among SVD group 73.65% were males &26.3% were females. Among MVD group 76.2% were males & 23.7% were females. Mean age for SVD was 53±14.4 years, while mean age foe MVD was 58.6±14.5 years. For ACS mean age of presentation for females is 60.7±11.4 and for males mean age of presentation is 55.1±12.6. MVD (57.2%) were more common among smokers than SVD. In <45 years age group SVD (69.2%) were more common than MVD (30.8%). In 45- 70 years age group and >70 years age group MVD were more common than SVD with 69.6% and 66.6% respectively, which is statistically significant. MVD (60%) were more common among hypertensives than SVD. Among non-hypertensives MVD (41.8%) was less common than SVD (58.2%) MVD was common among all age groups, which is statistically signicant. Among STEMI group SVD (58.3%) was more common than MVD (41.7%). Among NSTEMI group MVD (62%) was more common than SVD (38%).Correlation between groups was statistically significant. Among SVD study group, LVEF was commonly between 30-45% & very few with LVEF <30% MVD was associated with more severe LV dysfunction as compared to SVD in acute MI. The difference in ejection fraction between the two groups was statistically significant P value=0.0002. In hospital MACE Among SVD there was 1 MI (due to stent thrombosis) who had to TVR (primary PCI) & rest were asymptomatic and discharged in normal state MVD there were in hospital deaths (due to refractory cardiogenic shock) rest were asymptomatic and were discharged in normal state. This difference between the two groups was statistically insignificant. Conclusion Multivessel disease in ACS were seen more commonly among elderly as compared to young subjects where single vessel disease were more common. Females especially elderly more commonly have multivessel disease. Mean age for multivessel disease was higher than single vessel disease. Among <45 years age group, SVD was more prevalent among smokers, obese and physically active. Multi vessel disease is more prevalent among patients with risk factors like diabetes, hypertension, dyslipidemia and physically inactive. Subjects with family history of premature CAD presented early and correlated well with prevalence of SVD.NSTEMI presented more with multi vessel disease. In echocardiographic wall motion analysis, a depressed regional segment of infarcted area with remote hyperkinesis predicted SVD where as remote area hypokinesis predicts more multivessel disease. In hospital outcomes were seen among multi vessel disease as compared to single vessel disease although not statistically significant.
Apr 2022 DOI 10.14302/issn.2379-7835.ijn-22-4155
The diabetic is most of the time admitted in emergency for acute complications. An inventory of these complications will guide promotional programs aimed at preventing the occurrence of these complications. This study was conducted with the aim of identifying acute complications and decompensation factors in diabetics admitted in emergency to the Souro Sanou University Hospital Center (CHUSS).It was an observational study, of descriptive transversal type, with prospective collection for 4 months. It concerned diabetics admitted to the medical and surgical emergency departments of the CHUSS. A total of 90 diabetics were included in the study. The average age was 58.81 ± 14.7 years. Type 2 diabetes accounted for 85.6% of cases. The diagnosis of diabetes was known in 74.4% of cases. The reasons for consultation were dominated by impaired conscientiousness and fever, 54.4% and 50% respectively. Metabolic complications were found in 44.4% of patients. They were dominated by hypoglycemia, which accounted for 55.3% of cases. Dietary error was the main decompensation factor in cases of hypoglycemia and was reported in 71.4% of cases. Metabolic complications are common in diabetics admitted in emergency at the CHUSS. Decompensation factors are mostly preventable.
Feb 2022
Introduction Calcium (Ca2+) plays an important role in the pathogenesis of ischemic cell damage. Intracellular Ca2+ accumulation leads to neuronal damage by triggering the cycle of cytotoxic events, however the relationship of serum Ca levels and the pathways involved in ischemic injury is unclear. Aim of Study To investigate the relationship of serum Ca2+ levels with severity of acute ischaemic stroke, serum calcium (Ca2+) levels were measured within the first 48 hours and were compared with the clinical severity of acute ischaemic stroke. Material and Methods A hospital based cross sectional study was performed among 100 patients of acute ischaemic stroke who fulfilled the inclusion criteria. The Study was done from July 2020 to August 2021 in SPRC & Neurology Hospital Dhaka, Bangladesh And BSMMU Hospital Dhaka, Bangladesh. After hospitalization presenting complaints, physical findings of the patients were recorded. Severity of stroke was measured by NIHSS scale. Serum calcium level of every patient was measured. Calcium level was divided into 3 groups by weighted average. Statistical analysis was carried out by a non-parametric Ruska Wallis test. Results Among the 100 patients 59% were male. Among all patients 57% of patients were found to be smokers (98% male, 2% female). Among all patients 63% patients were found hypertensive and 21% of all patients (24% male, 17% female) were diabetic. Mean cholesterol level was 257.98mg/dl with standard deviation 55.49 which is above the reference range suggesting hypercholesterolemia, Triglyceride was borderline and LDL cholesterol was slightly higher and HDL cholesterol was slightly lower. Calcium level was divided into 3 groups and NIHSS score was calculated for every patient in each group. The median NIHSS score for group1 (calcium level ≤8.8 mg/dl) was 9(2-20), for group 2 (calcium level 8.9-9.6 mg/dl) was 6 (1-17) and for group 3 (calcium level ≥9.7mg/dl) was 4 (1-16). Conclusion Commonest risk factor of ischaemic stroke is hypertension. Other risk factors are smoking, diabetes mellitus and hyperlipidemia, cardiac disease. Higher serum calcium level is associated with less severity of ischaemic stroke.
Dec 2021 DOI 10.14302/issn.2692-1537.ijcv-21-4025
Introduction The COVID-19 pandemic continues to affect a large swath of the global population. The Philippine records four hundred seventy-four thousand sixty-four (474, 064) confirmed COVID 19 cases since December 31 2020. The COVID 19 pandemic recently highlighted the role of systemic hyperferritenemia as a major cause of death. In this study, we were able to correlate the serum ferritin level and predict 30 day in hospital mortality in COVID 19 pneumonia. Objective The aim of the study is to investigate the correlation between serum ferritin level and disease mortality in COVID19 pneumonia with subset analysis on demographics and co-morbidities of patients with COVID 19 pneumonia. Methodology We reviewed the records of all laboratory confirmed COVID 19 patients from World Citi Medical Center from April 2020 up to April 2021.A statistically significant sample size of seventy nine (79) admitted patients were used in this study. A serum ferritin level was assayed using electrochemilumenescence immunoassay with a Roche COBAS analyzer. Results Result showed that high ferritin level is associated with in hospital mortality. With ferritin level of 1437.07ng/ml, poor clinical outcome and in hospital mortality was considered. We also observed that demographics and co morbidities of patients in this study were significant to predict in hospital mortality. Further sub-analysis of co morbidities such as Hypertensive cardiovascular disease, Type 2 Diabetes Mellitus, Chronic kidney disease, Liver disease, Chronic obstructive pulmonary disease and Cerebrovascular disease showed poor outcome which were directly related to ferritin levels with p value of <0.0001. Conclusion This study has demonstrated that elevated ferritin levels were shown to correlate with 30 day in hospital mortality as well as medical comorbidities such as Hypertensive Cardiovascular disease, Type 2 Diabetes Mellitus, and chronic kidney disease have shown significant evidence for in hospital mortality.
Apr 2021 DOI 10.14302/issn.2328-0182.japst-21-3772
Vitamin D3 (cholecalciferol) is a fat-soluble vitamin, which widely used for the prevention and treatment rickets, osteoporosis, arthritis, Parkinson’s and Alzheimer’s diseases, autoimmune disease, dementia, glucose intolerance, etc. The impact of the Trivedi Effect®-Consciousness Energy Healing Treatment on the structural properties and the isotopic abundance ratio of cholecalciferol were evaluated using LC-MS and GC-MS spectroscopy. The test sample cholecalciferol was divided into control and treated parts. Only, the treated cholecalciferol was received the Trivedi Effect®-Consciousness Energy Healing Treatment remotely by a renowned Biofield Energy Healer, Dahryn Trivedi. The LC-MS spectra of both the samples at retention time (Rt) ~22 minutes exhibited the mass of the molecular ion peak at m/z 385.25 (calcd for C27H45O+, 385.35). The LC-MS based isotopic abundance ratio of PM+1/PM in the treated cholecalciferol was increased by 0.74% compared with the control sample. But, the GC-MS based isotopic abundance ratio of PM+1/PM and PM+2/PM in the treated cholecalciferol was significantly increased by 66.39% and 62.69%, respectively compared with the control sample. Hence,13C, 2H, 17O, and 18O contributions from C27H44O+ to m/z 386 and 387 in the treated cholecalciferol were significantly increased compared with the control sample. The isotopic abundance ratios of PM+1/PM (2H/1H or 13C/12C or 17O/16O) and PM+2/PM (18O/16O) in the treated cholecalciferol were significantly increased as compared to the control sample. The increased isotopic composition of the Trivedi Effect®-Consciousness Energy Healing Treated cholecalciferol might have altered the neutron to proton ratio in the nucleus via the possible mediation of neutrino. The increased isotopic abundance ratio of the treated cholecalciferol may increase the intra-atomic bond strength, increase its stability. The new form of cholecalciferol would be better designing novel pharmaceutical formulations that might be more stable and more efficacious for the prevention and treatment of various diseases such as vitamin D deficiency, rickets, osteoporosis, arthritis, multiple sclerosis, cancer, diabetes mellitus, mental disorders, cardiovascular diseases, hypertension, infections, influenza, cognitive impairment in older adults, Parkinson’s and Alzheimer’s diseases, autoimmune disease, dementia, glucose intolerance, multiple sclerosis, etc.
Aug 2020 DOI 10.14302/issn.2474-7785.jarh-20-3425
The study was aimed to investigate the potential benefits of the Consciousness Energy Healing Treatment (the Trivedi Effect®) per se and Biofield Energy Healing treated novel test formulation in male Sprague Dawley rats for their antiaging activity by monitoring aging biomarkers such as brain-derived neurotrophic factor (BDNF), silent information regulator-1 (SIRT-1), and klotho protein. The test formulation was distributed into two parts. First part did not provide any Biofield Energy Treatment was denoted as the untreated sample, however the second part was received Biofield Energy Healing Treatment by a renowned Biofield Energy Healer, Mr. Mahendra Kumar Trivedi and defined as the Biofield Energy Treated sample. In this experiment, nine groups (n=10) were assigned, in which four were preventive maintenance groups. Among them, three groups of animals were also received Biofield Energy Healing Treatment per se (at day -15). BDNF was significantly increased by 25.83%, 19.35%, and 14.67% in the Biofield Energy Treated test formulation (G5), Biofield Energy Treatment per se at day -15 (G6), and Biofield Energy Treatment per se to animals plus Biofield Treated test formulation from day -15 (G8), respectively as compared to the disease control (G2) group. Moreover, expression of SIRT-1 protein was increased by 14.63% in the G5 group than the untreated test formulation (G4) group. Additionally, SIRT-1 activity was increased by 39.7%, 32.5%, 15.9%, and 136% in the G6, Biofield Energy Treated test formulation at day -15 (G7), G8, and Biofield Treatment per se (day -15) to animals plus untreated test formulation (G9) groups, respectively than the G4 group, while it was increased by 57.3% in the G9 group as compared to the G2 group. Besides, Klotho protein in kidney homogenate was significantly increased by 16.67% in the G5 group as compared to the G2 group. Altogether, the results showed a significant improvement of longevity mediators and antiaging biomarkers in the preventive maintenance groups. Therefore, results envisaged the significant slowdown of aging-related disorders and other complications in the preventive Biofield Energy Treatment group per se and/or Biofield Energy Treated Test formulation groups (viz. G6, G7, G8, and G9) comparatively with the disease control group and could be utilized against various aging-related disorders like Alzheimer's disease, hypertension, osteoporosis, cataracts, type 2 diabetes, cancer, etc. along with it could be used to extend the life-span, stress and immune-related disorders.
Jul 2020 DOI 10.14302/issn.2379-7835.ijn-20-3463
Background Evidence suggests that low birth weight (LBW) is associated with increased cardiovascular and metabolic risk in adulthood, including increased arterial stiffness, a marker of early vascular aging (EVA) assessable by pulse wave velocity (PWV), obesity and glucose homeostasis abnormalities. The present study aimed to explore the late impact of LBW on PWV and cardiometabolic phenotypes among young adult Cameroonians. Methods The study evaluated 120 subjects (mean age: 26 ± 5 years; 54% male sex) at the Cameroon Heart Institute, Douala, Cameroon, between January and June 2018. Birth weight (BW) and gestational age, sociodemographic, anthropometrics and fasting capillary blood glucose were recorded in all participants. Blood pressure (BP) and PWV were measured using an automatic oscillometric device (Mobil-O-Graph®). Multiple-adjusted linear regression was used to determine predictive factors for PWV. For assessment of potential impact of BW on EVA, PWV was adjusted for age, sex, body mass index (BMI) and mean arterial pressure (MAP). Results 28 participants (23.3%) of the study sample had LBW (<3000g). There was no gender difference between LBW or normal birth weight patients (NBW; controls). Age- and MAP-adjusted PWV (aPWV) were higher in women with LBW compared to NBW (5.6 m/s and 5.3 m/s respectively, P = 0.038). In men, aPWV was similar in LBW and NBW. In this study population, aPWV was higher (on average +15 cm/s) in LBW than in controls, although the difference was not statistically significant (P=0.083). Multivariate regression analysis showed age, male sex, BMI and MAP were independent determinants of PWV, but not LBW. Compared to NBW controls, the prevalence of overweight/obesity, impaired glucose homeostasis and diabetes was higher in LBW: 42.9% vs 37%; 10.7% vs 3.3%, and 3.6 % vs 1.1%, respectively. Moreover, compared with controls, LBW individuals who were overweight/obese in adulthood had a much higher mean fasting capillary glucose (1.54 ±0.17 g/l vs 0.87 ±0.11 g/l in NBW, p=0.003). Conclusion This study suggests that although LBW is associated with increased aortic stiffness in young adulthood, mainly in women, the association was predominantly driven by aging, MAP, BMI and male sex. In adulthood, LBW subjects exhibited higher obesity indices and altered glucose homeostasis.
May 2020 DOI 10.14302/issn.2575-7881.jdrr-20-3343
Background Anemia of chronic disease is anemia found in certain chronic disease states, is typically marked by the disturbance of iron homeostasis or hypoferremia. Chronic renal failure is currently known as Chronic Kidney Disease (CKD) or Chronic Renal Insufficiency (CRI) implies long-standing, progressive and irreversible renal parenchyma disease resulting in diminished renal function up to 40 to 60%. Often, chronic kidney disease is diagnosed as a result of screening of people known to be at risk of kidney problems, such as those with high blood pressure or diabetes and those with a blood relative with chronic kidney disease. This disease may also be identified when it leads to one of its recognized complications such as cardiovascular disease, anemia, or pericarditis. Methods Sysmex kx21 used to CBC and the Cobase411 used to iron profile. Enzyme-Linked immunoassay (ELISA) was used to determine the level of serum hepcidin. Sample preparation and PCR detection of HAMP DNA Polymorphisms: Restriction digestion of PCR products was done using Fast Digest. (Figure 1). Results Serum hepcidin levels higher in patients with anemia of chronic kidney disease compared with healthy controls mean. The polymorphisms of the hepcidin gene promoter in Sudanese patients with ACKD showed that the hepcidin HAMP AA genotype 70, AG 23, and GG 7 in 100 patients dialysis-dependent and AA 83, AG 17 and GG 0, and the allele A are more frequent in patients affected by ACKD. Significant statistical association observed between the hepcidin level and end-stage kidney disease. Conclusion This study evaluates for the first time the association between anemia of chronic kidney disease and hepcidin genes promoter polymorphisms and show that the hepcidin HAMP AA genotype and the allele A are more frequent in patients affected by ACKD, further investigation is needed, our data support the hypothesis and hepcidin HAMP are important in the pathophysiology of ACKD.
Apr 2020 DOI 10.14302/issn.2693-1176.ijgh-20-3269
Abdominal obesitywith a big belly is one of the worse type of morbid obesity that is associated with different health failure outcomes. Central obesity leads to an increased risk of health complications such as metabolic syndrome, hypertension, insulin resistance,type 2 diabetes, heart disease and various cancers. Abdominal obesity also can specifically cause to spinal nerve pain and backache. Depression and disability are other subsequent hazards of central fatness. More importantly ,excessive central body fat ultimately contributes in all-causes of early mortality. In regards to this, individuals with abdominal obesity is urgently needed to reduce central obesity using behavior modifications. Changes in diet and performing some exercise in everyday living are essential steps.
Mar 2020 DOI 10.14302/issn.2379-7835.ijn-20-3175
Local Nigerian men have been using AuriculariaPolytricha as a treatment for sexual dysfunction without supporting evidence from scientific experiments. This study was to investigate the effect of ethanolic extract of A. Polytricha on testicular DNA expression and some oxidative stress markers using STZ-Induced diabetic rats as a model. The experiment included six groups, Group A (Normal Control, treated with normal saline), Group B (treated with 65mg/kg.bw of STZ), Groups C, D, and E (treated with 250mg/kg.bw, 500mg/kg.bw, 1000mg/kg.bw AP after inducing diabetics), and Group F (treated with 40mg/kg.bw metformin after inducing diabetics). The experiment lasted for 35 days. After termination of the experiment, Fuelgen nuclear reaction was used for DNA demonstration to assess testicular DNA distribution while serum Superoxide Dimutase (SOD), Catalase and Melondialdehyde where evaluated using reagent based antioxidant enzyme assay. Results reveals that SOD and Melondialdehyde activities were remarkably (p<0.05) higher in diabetic control animals when compared with the normal control group. Values in Groups C, D and F that were administered with 250, 500mg/kg.bw A. polytricha and metformin respectively were also significantly (p<0.05) increased when compared with the normal control group. However, diabetic animals placed on 1000mg/kg.bw A. polytrichadid not show any statistical significance in comparison with normal control group but was remarkably (p<0.01) decreased when compared to the diabetic group that received low dose A. polytricha, an indication that the reversal is dose dependent. Catalase concentration in diabetic control animals was remarkably (p<0.05) higher when compared to the normal control but was not significantly (p<0.05) different in groups D (DM+500mg/kg.bw A. polytricha) and E (DM+1000mg/kg.bw A. polytricha) when compared with the normal control group. Diabetic control animals showed reduced magenta colour intensity of DNA and increased clustering and cross linking of DNA strands when compared with the normal control. However the degree of cross link in DNA strands was reduced in the diabetic animals placed on 1000mg/kg.bw A. polytrichawhen compared with the diabetic control group. Reversal in DNA damage and values of serum oxidative stress markers following administration of graded doses of A. polytricha could be attributed to essential phytochemical and therapeutic constituents in A. polytricha like polyphenol and flavonoid which can be found useful in prevention and treatment of diabetes induced testicular dysfunction. In summary, AP can contribute to a reversal in DNA damage and levels of serum oxidative stress markers in treating diabetes-induced testicular dysfunction.
Jan 2020 DOI 10.14302/issn.2379-7835.ijn-20-3159
Pyruvate holds superior biomedical properties in increase of hypoxia tolerance, correction of severe acidosis, exertion of anti-oxidative stress and protection of mitochondria against apoptosis, so that it improves multi-organ function in various pathogenic insults. Particularly, pyruvate preserves key enzyme: pyruvate dehydrogenase (PDH) activity through direct inhibition of pyruvate dehydrogenase kinas (PDK), as a PDH activator, in hypoxia. Therefore, pyruvate is robustly beneficial for cell/organ function over citrate, acetate, lactate, bicarbonate and chloride as anions in current medical fluids. Pyruvate-enriched oral rehydration salt/solution (Pyr-ORS) and pyruvate-based intravenous (IV) fluids would be more beneficial than WHO-ORS and current IV fluids in both crystalloids and colloids, respectively. Pyruvate-containing fluids as the new generation would be not only a volume expander, but also a therapeutic agent simultaneously in fluid resuscitation in critical care patients. Pyruvate may be also beneficial in prevent and treatment of diabetes, aging and even cancer. Pyruvate clinical applications indicates a new revolutionary medical advance, following the WHO-ORS prevalence, this century.
Jun 2019 DOI 10.14302/issn.2690-0904.ijoe-19-2792
In deaths and diseases attributed to tobacco smoke cardiovascular events exceed cancer and respiratory diseases. Second hand smoke promotes the development of arteriosclerosis and can trigger acute changes of endothelial function and blood coagulability. Indoor smoking bans reduced coronary syndrome and myocardial infarction 10-20% within one year and were followed by sustainable decreases of stroke and diabetes. With a smoke-free hospitality industry people recognized tobacco smoke as an air pollutant, smoking in public was denormalized and social acceptance of smoking in front of children and pregnant women decreased also in homes and cars. Combined effects with ambient air pollution are proven for active smoking and suspected for SHS. Contamination with third hand smoke (THS) persists for months in homes and cars, creating secondary pollutants that in some cases are more toxic (e.g. nitrosamines). Remnants found in air, dust, and on surfaces (carpets, wallpapers, upholstery, soft toys) were associated with their metabolites in saliva of children and in urine of nonsmokers residing in homes previously occupied by smokers. In animal experiments effects of THS were found on thrombogenesis, insulin resistance through oxidative stress, on the developing immune system, lipid metabolism and alterations in liver, lung, skin and behavior. Much less is known about health effects for bystanders from the aerosols exhaled during “vaping” of e-cigarettes, but nicotine and other toxins from e-cigarettes are certainly a hazard, which should be prevented by the use of dermal and oral nicotine products, which are safer for nicotine replacement and without risk for bystanders.
Mar 2019 DOI 10.14302/issn.2379-7835.ijn-19-2578
We present below a mechanistic cellular and molecular approaches for the development of Anti-Inflammatory biomarkersof Probiotic Bacteria in Fermented Foods. Probiotics are live microorganisms that promote human health by counteracting the noxious toxic gut microflora in human intestine, by modulating of the tight junctions, and by increasing mucin production, enforcing intestinal epithelial cell barrier function, modifying microbial community within the gut intestinal disorders, and improving immune responses associated with chronic inflammation in experimental animal models, collectively enhancing human health. Cytokine secretion by intestinal epithelial cells and macrophages are regulated by probiotics through key signaling pathways such as nuclear factor-κB and mitogen-activated kinases, resulting in alleviation of several disorders such as allergies, diabetes, obesity, heart diseases and cancer. MicroRNAs are small non-coding RNA molecules involved in transcriptional and post-translational regulation of gene expression by inhibiting gene translation. Using in vitro and in vivo approaches in cell lines and mice models to study effects of probiotic conditional media and heat-killed bacterial strains with anti-inflammatory effect to elucidate the mechanisms by which probiotics affect signaling pathways, and by using global cytokine and microRNA gene expression analyses approaches to develop biomarkers for studying different pro- and anti-inflammatory activities, and using statistical approaches to analyse the data, we show that cytokines and miRNAs have an essential role in regulation of cancerous and inflammatory pathways. This mechanistic approach will result in developing specific disease biomarkers for the early diagnosis of certain pathogenic states, as well as evaluating the effect of different dietary components on developed biomarkers in health states that will promote and enhance human health. Comparing the concordance of the in vitro to the in vivo research findings will confirm the correspondence of both approaches to each other. Moreover, this study will have a major public health relevance in elucidating the role of miRNAs and their targets in inflammation, paving the way to diagnosing and treating of pathogenic human disease stages.
Feb 2019 DOI 10.14302/issn.2374-9431.jbd-19-2613
Diabetes mellitus (DM) is a chronic metabolic disorder. Streptozotocin is a naturally occurring cytotoxic chemical, particularly toxic to the pancreas and insulin producing beta cells in mammals and induces diabetes. Glimepiride is a second generation sulfonylurea, used as second-line or add-on treatment options for type 2 diabetes. Fenugreek (Trigonella foenum graecum) seeds have been documented as a traditional plant treatment for diabetes. Soluble dietary fiber of Fenugreek significantly improved oral glucose tolerance in diabetic rats. It also exerts anti-diabetic effects mediated through the inhibition of carbohydrate digestion and absorption and the enhancement of peripheral insulin action. Most herbal remedies can interact with allopathic drugs resulting in altered activity and toxicity. At the same time, herbal remedies might produce the same kind of effects as the drug produce. Current published research information on herb-drug interactions is scanty. So, the aim of this study was to investigate the possible interaction between conventional drug used for the management of diabetes; (Glimepiride) and a traditional herbal remedy; Fenugreek aqueous extract in Streptozotocin induced diabetic male albino rats. In conclusion, combination therapy induces better hematological, biochemical effects and improves the oxidative stress biomarkers and antioxidant enzymes. Histological studies showed better results on some organ functions. The results emphasize the benefit of using the combination of Fenugreek seeds aqueous extracts as supportive complementary anti-diabetic therapy.
Nov 2018 DOI 10.14302/issn.2768-0207.jbr-18-2175
Non–information technology (IT) professionals and nonexpert casual users are increasingly adopting self-service business intelligence (SSBI) tools (such as Tableau, Qlik, and Power BI) to create data visualization dashboards. This study identified the most relevant dashboard design principles for SSBI tool users. The research approach included organizing a focus group in which most of the participants were non-IT professionals in health care, extracting recommended principles from the literature, applying these recommended principles by using data on quality of diabetes care to design relevant dashboards, and proposing the following 5S dashboard design principle framework: 1) seeing both the forest and trees, 2) simplicity through self-selection, 3) simplicity through significance, 4) simplicity through synthesis, and 5) storytelling. The third and fourth principles are novel and provide solutions to decision-making problems (such as conflicting results from excessive and discordant indicators) encountered by health care professional in the public sector as well as in other domains. The 5S dashboard design principles are easily memorized and practical and thus enable non-IT professionals and nonexpert casual users to design insightful dashboards efficiently by using SSBI tools.
Oct 2018 DOI 10.14302/issn.2576-6694.jbbs-18-2408
Improved economic and developed people with their lifestyle have created many challenges of health issues (obesity, osteoporosis, cancer, diabetes, allergies and dental problems), due to selection of different food habits (such as consumption of manifold junk foods). It has created number of health problem (development of many diseases) related to nutritional deficiencies food. Nowadays, people have developed the habit for shifting of synthetic food ingredients to organic foods and ingredients, obtained from natural sources. In this regards, nutraceuticals food or its food products can perform important role in controlling the diseases via fulfilling all the health benefits to many people at worldwide. Incredible dietary supplements as nutraceuticals food (involvement in nutritional, immunologic and physiological functions) can help in prevention or treatment of many diseases (mitigating of gastrointestinal (GI) tract problem), as it is synthesized from raw herbals and lots of rapidly growing industries are reported to synthesize these natural products. And around 100 million people are found to take these products (power of plant based materials) for getting health benefits. It can work as drugs as health benefit of nutraceuticals via regulation/ control for diseases. Global nutraceuticals market had been valued for US$ 165.62 billion in 2014 and it would be grow the value of US$ 278.96 billion by 2021 with compound annual growth rate of 7.3%. This proposed paper will discuss the different types of nutraceuticals food or its functional components involved in prevention or treatment of diseases.
Sep 2018 DOI 10.14302/issn.2377-2549.jndc-18-2315
Selenium is an essential micronutrient required for healthy metabolism, as well as prevention, and treatment of selenium deficiency diseases. The experiment aimed to evaluate the influence of the Trivedi Effect®-Consciousness Energy Healing Treatment on the physicochemical and thermal properties of selenium using modern analytical techniques. The selenium sample was divided into two parts, one part of the test sample was called the control sample, while the second part of the test sample received the Biofield Treatment remotely by a renowned Biofield Energy Healer, Gopal Nayak, and was called the treated sample. The particle size values were significantly decreased by 37.69% (d10), 14.36% (d50), 4.31% (d90), and 11.58% D(43), hence, the specific surface area was significantly increased by 33.64% in the treated sample compared to the control sample. The PXRD peak intensities and crystallite sizes were significantly altered ranging from 5.23% to 100% and 75% to 111.7%, respectively; whereas 7.81% significantly decreased the average crystallite size in the treated sample than the control sample. The latent heat of fusion of the treated sample was significantly increased by 12.37% compared with the control sample.The results suggested that the Trivedi Effect® might generate a new polymorphic form of selenium which would offer better solubility, bioavailability and be thermally more stable compared with the control sample. The Biofield Treated selenium would be more useful to design novel nutraceutical/pharmaceutical formulations and might offer an enhanced therapeutic response against cardiovascular disease, cancer, neuromuscular disorders, diabetes, stress, aging, male infertility, viral diseases, degenerative ailments, etc.
Aug 2018
Background: Co-morbidities are associated with increasing risk of mortality, hospitalizations and costs of treatment in Chronic Obstructive Pulmonary Disease patients. Identification of Co- morbidities related to COPD phenotypes may guide individualized therapies and achieve better prognosis. Methods: A prospective study of one hundred ten patients of confirmed COPD diagnosis were carried out and divided into five different phenotypes with related co-morbidities. History taking, clinical examination, Chest X-ray, Computed chest Tomography, laboratory investigations, arterial blood gas, Echocardiography and Electrocardiography were done for all patients. St. George’s Respiratory Questionnaire, COPD assessment test (CAT score) and BODEx (BMI, FEV1, dyspnea and exacerbations) were used for assessment of disease impact on quality of life, severity, and exacerbation respectively. Results: Emphysema group were 31% among all cases with mean age 61.8±9.1, frequent exacerbator group and Chronic bronchitis phenotype were 18% with mean age 64.4±11.3, and 48.8±9 respectively. COPD with bronchiectasis group were 19% with mean age 60.3±6 and Asthma COPD Overlap Syndrome (ACOS) were 12% with mean age 62.8±15.8. There was significant difference as regards age between different group of phenotypes P- value <0.001. There was significance difference in BODEx index and in (CAT) score among different COPD phenotypes P-value 0.020, 0.001 respectively. There was significant difference in all items of SGRQ among different COPD phenotypes P–value 0.001. Diabetes was commonly presented in 50 % ACOS cases, Ischemic heart disease was present more in Emphysema 22.9%, Osteoporosis was more in COPD with bronchiectasis 28.6%, Cor-pulmonale was more present in frequent excerbator 65%, and Anemia more common in COPD with bronchiectasis 23.8%. Depression was more common in frequent excerbator phenotype (45.0 %). Gastro-esophageal reflux was the most common co-morbidities (58 %) then cor-pulmonale 41.8%, systemic hypertension 40 % and pulmonary hypertension 28%. Conclusion: The presence of significant co-morbidities is important modifying risk factors for severity in COPD. They contribute to the overall severity in individual patients, have a major impact on quality of life, and major causes of hospitalization. Co-morbidities can be associated with any clinical phenotype.
Jul 2018 DOI 10.14302/issn.2638-4469.japb-18-2166
Diospyros malabarica (Desr.) Kostel synonym Diospyros peregrina Gurke (Family: Ebenaceae) is a medium sized evergreen tree commonly known as Kendu in Assamese. The plant has ethnomedicinal significance and used by various ethnic communities of North-East India to treat various disorders like dysentery, diabetes, diarrhea malaria, ulcer and wounds. However, detailed scientific information is not available to identify the plant material, in order to ascertain its quality and purity. Therefore, the present work was carried out to perform morpho-anatomical and physicochemical analysis of D. malabarica stem bark. The bark is externally dark brown to black in color and rough having characteristics odor and astringent taste. The microscopy of bark reveals the presence of polygonal thick walled cork, 3-4 layered phellogen, 7-8 layered phelloderm, stone cells, phloem fibers and medullary rays. Stem bark powder showed thick walled cork cells, thick walled elongated phloem fibers, lignified stone cells and rhomboidal crystals of calcium oxalate. Further, physicochemical analysis of the bark power showed loss on drying, total ash, water soluble ash, and acid insoluble ash as 6.2, 5.6, 1.1, 2.45, and 5.7% w/w respectively. The alcohol and water soluble extractives values of the stem bark were 10.6 and 16.8% w/w respectively. The result of preliminary phytochemical screening indicates presence of triterpenoids, saponins, tannins, flavonoids and sterols. The findings of this study will facilitate pharmacognostic standardization of the plant material and aid in the preparation of an herbal monograph for the species.
Mar 2018 DOI 10.14302/issn.2574-4518.jsdr-17-1785
Sleep is vital for the maintenance of physical health and mental wellbeing. Sleep also plays a cardinal role in the process of healing. It is estimated that 50 to 70 million Americans suffer chronically from sleep disturbances and insufficiency, which not only hinders daily functioning but also adversely affects health, quality of life and longevity.1 Deficient sleep is associated with an increased risk of developing chronic diseases such as hypertension, diabetes, obesity, heart disease, stroke, depression, frequent mental distress, as well as increased mortality, and reduced quality of life and productivity.1,2Aging, medical conditions, pain, and mental illness further aggravate sleep disturbances such as insomnia, sleep fragmentation and daytime sleepiness.3, 4, 5, 6, 7, 8 The a common treatment for sleep disturbances and insomnia is pharmacological therapy. Benzodiazepines may have negative long-term side effects including residual daytime sedation and tolerance development. Withdrawal difficulties may increase dependency. In the older patient there are safety issues related to daytime sedation including increase risk of falls. With the importance of sleep in hospital recovery and the side effects of sleep medication becoming more widely recognized, there has been an impetus to s use nonpharmacological alternatives , such as music.. This pilot study builds on the potential impact of music’s effectivity by introducing music therapy as a safe, cost effective and culturally sensitive intervention.
Feb 2018 DOI 10.14302/issn.2641-5518.jcci-17-1880
Objective: Presentation of rare case report of primary non-Hodgkin Lymphoma of temporal bone secondary to immunodeficiency after prolonged steroid administration in a diabetic patient. Then review the literature of similar case reports. Method: 49 years old female presented with hearing loss, facial paralysis and otalgia. Biopsy revealed high grade non Hodgkin’s B-lymphoma. She underwent chemotherapy and had remarkable response. Result: Rapidly progressive deafness, facial paralysis and otalgia are common presentations of external canal Non-Hodgkin lymphoma. The disease is common in middle age, females and has a fair response to chemotherapy, good to radiotherapy. Surgery is an alternative method in isolated lesions or recurrent cases. Conclusion: High dose steroid and type II diabetes are potential risks for acquired immunodeficiency. External Auditory canal lymphoma is uncommon sequel. Chemotherapy is very effective in treatment of isolated cases without B symptoms
Nov 2017 DOI 10.14302/issn.2641-5518.jcci-17-1806
Background Hypertension is one of the most prevalent risk factors for myocardial infarction, strokes, congestive cardiac failure and chronic kidney disease (CKD)and its prevalence is significantly higher inthe elderly population. Objectives To assess the demography, various presentations and the prevalence of risk factors among elderly hypertensive patients followed up in a tertiary care hospital in Sri Lanka. Materials and Methods This was a cross sectional descriptive study involving 250 patients whoseage was 60 years or above onantihypertensives for at least 6 months. Results Approximately 65.2% of the study population was female. The mean age was 70.17.Dizziness and chest pain were the most prevalent symptoms.The mean age at first detection was 58.17 years.Mean SBP and DBP were 128.5mmHg and 81.14mmHg respectively. The prevalence of alcohol consumption and smoking among men were 70.1% and 72.4% respectively. Approximately 54.7% were either overweight or obese.Approximately 81.6% females and 41.4% males had a waist circumference ofmore than therisk level with p-value<0.05. Approximately 36% had diabetes mellitus and 27.6% of the patients had at least one parent and 36.8% had at least one sibling diagnosed with hypertension. Approximately 61.3% of the patients hadadequate levels of physical activity while 31.8% had IHD,11.5% had stroke and 3.8% had CKD. Conclusion Dizziness and chest pain were the most disturbing symptoms while abdominal obesity among females,and alcohol consumption and smoking among males were the major risk factors in elderly hypertensive patients
Oct 2017 DOI 10.14302/issn.2381-862X.jwrh-17-1750
Background The prevalence of obesity and type 2 diabetes is escalating at an alarming rate in many developed as well as developing countries. Irisin is a novel muscle and adipose drived chemokine that is, proteolytically processed from the product of the FNDC5 (fibronectin type ш domain containing 5) gene. The purpose of this study is to examine the effect of three kind of training on irisin in sedentary obese women. METHODSː33 obese women (medium age: 37.99 ± 3.7 year, height: 1.55 ± 0.03 meter, BMI: 34.6 ± 5.07 kg/m2) participated in the study, on three groups, including endurance, resistance and concurrent. Results After 8 weeks exercise we did not find significant differences in fasting glucose, insulin, HOMA-IR and irisin between the groups (P>0.05), but glucose and insulin in resistance groups and irisin in all groups had significant changes (P<0.05). Conclusions In summery in this study in contrast to hypothesis there were no difference between groups of training. It can be hypothesise that the increase of irisin in obese people is one of the preventing ways against of obesity's side effects. Exercise could improve the signaling pathways and consume the fat accumulations, therefore at the end of exercise duration, irisin decreased.
Jul 2017 DOI 10.14302/issn.2574-4372.jesr-17-1705
Drug-induced cardiotoxicity is one of the predominant reasons for drug attrition and withdrawals. This is of critical concern when potentially cardiotoxic drugs are administered to individuals with inherited arrhythmogenic cardiac diseases or with metabolic diseases such as obesity and diabetes, which are key risk factors for cardiovascular diseases. Pathophysiological alteration prevalent under such conditions can alter or exacerbate cardiotoxic responses. The growing incidence of obesity, diabetes and metabolic syndrome subject a significant percentage of the population to drug treatments, thereby augmenting their risk for drug-induced cardiovascular toxicity. Hence, screening for drug-induced cardiotoxicity early in the preclinical stages of drug development, by using appropriate human disease models, can be effective in ensuring safety in clinical trials and preventing late stage and post-marketing drug withdrawals owing to cardiotoxicity. The advent of human pluripotent stem cells (hPSC) and induced pluripotent stem cell (iPSC)-derived cardiomyocytes are revolutionizing safety/toxicity screening in human cells by providing relevant human-specific, renewable model systems to explore human drug toxicity. The ability to generate patient-specific iPSCs that can model cardiac diseases, now offers a valuable option that can further improve drug safety assessments and enable a more accurate prediction of toxicity that occurs in the representative population that are prescribed the drugs. Use of appropriate disease models will not only provide cost savings by decreasing potential drug attrition and withdrawals, seen with many drugs, but will also be a promising option to advance precision medicine
Jun 2017 DOI 10.14302/issn.2379-7835.ijn-17-1548
A new approach to weight loss and weight loss maintenance is urgently needed, with the global epidemic of obesity leading to ever higher levels of chronic disease. This new approach should be cheap and simple, it should maintain essential nutrients and not deplete lean mass, should have minimal adverse effects and be carried out safely at home without support from the healthcare profession. This review looked at the forms of caloric restriction (CR) investigated in randomised controlled trials (RCTs) and found that supervised continuous and intermittent CR was more effective than other forms of weight loss over periods from 12 weeks to 2 years and could improve cardiovascular and diabetes risk factors. CR was equally as effective as bariatric surgery, suggesting that it is the post-surgery caloric restriction that has the impact on weight, rather than the surgery itself. Intermittent CR, including alternate day fasting (ADF), was as effective as continuous CR but may show improved compliance and higher lean mass. Unsupervised weight loss maintenance presents a greater problem, since in most weight loss regimens all the weight lost is ultimately regained. Although both continuous and intermittent CR can be effective, it has been found that ADF and a higher protein intake is more likely to maintain the weight loss. These results hold for all age groups and ethnicities and both genders. These findings suggest that intermittent CR, and particularly ADF, may be a viable form of weight loss and maintenance which fulfils all the criteria above. It is therefore recommended that larger RCTs investigate intermittent CR and ADF as a viable and cost effective form of weight loss and weight loss maintenance.
Apr 2017 DOI 10.14302/issn.2474-3585.jpmc-17-1449
Using proprietary data of patient records from four medical clinics in the Mississippi Delta, this research utilizes a natural experiment design to explore if the patient centered medical home (PCMH) has a positive effect on chronic disease maintenance for low SES, majority African-American patients in a rural and medically underserved region. The patients are divided into two cohorts, those attending PCMH clinics (level 2) and those attending non-PCMH clinics. Each cohort is comprised of similar demographic, socioeconomic, and health (large proportion of diabetics) characteristics. HbA1c scores of the cohorts are compared at two time periods, baseline and six-month follow-up. PCMH patients report more uncontrolled diabetes at baseline but the trend reverses at follow-up, providing evidence that the PCMH model of primary care produces positive health outcomes for patients with diabetes in the sample area.
Feb 2017 DOI 10.14302/issn.2574-4372.jesr-16-1382
Stem cell research is now emerging as most exciting and promising area of modern biomedical research which has enormous potential for easing suffering for many diseases such as Parkinson’s, Alzheimer’s, Diabetes,Cancer and many more. This is now recognized most promising alternate therapeutic choice for some of the diseases which currently have no other option of an effective therapy. The Stem cell therapy is now strengthened by cutting- edge technologies and rigorous standards of clinical research thus rapidly progressed from bench to the clinic.
Nov 2016 DOI 10.14302/issn.2324-7339.jcrhap-16-1271
Introduction The cardiovascular complications have became the 3rd cause of death and the 4th reason for hospitalization of the patients infected by the HIV. The objective of this work was to determine the frequency of asymptomatic myocardial ischemia among patients infected by the HIV receiving antiretroviral therapy. Patients and Methods It was a descriptive cross-sectional study which was conducted in November 2015. The patients infected by HIV1 receiving antiretroviral treatment, with asymptomatic myocardial ischemia were included in the study and they were followed up in the HIV clinic of the in Infectious diseases service of the University Hospital Souro Sanou of Bobo-Dioulasso(CHUSS).. The includes patients benefited from a collection of cardiovascular risk factors, and of two measurements of the blood pressure in a sitting position after 10 minutes of rest and an electrocardiogram 12 derivations after rest. Results A total sample of 123 patients infected by HIV1 was selected, with a median age of 42 years (IQR: 36-50). It was composed of 79% of female. The cardiovascular risk factors found were distributed as follows: HTA (31.7%), obesity (33%), dyslipidemia (10.57%), active smoking (0.8%), diabetes (0.8%). All the known hypertensive cases (5.7%) were insufficiently treated. The median duration of exposure to the antiretroviral therapy was 5.3 years (IIQ: 3-7.7). The disorders of the repolarization were observed in 26 cases (21.13%). They were divided into under epicardic ischemia in 20 cases (16.26%), under endocardic lesion in 2 cases (1.63%) and after-effect of necrosis in 4 cases (3.25%). The Left ventricular hypertrophywas observed in 12 cases (9.76%) and all of them were hypertensive patients. QTc was lengthened among 7 patients (5.69%) independently of the class of antiretroviral therapy administrated. Conclusion In this study about patients infected by HIV1, it emerges that asymptomatic myocardial ischemia is frequent. It would be advisable to reinforce its tracking by using more powerful tests of ischemia, in order to better specify its gravity in this population with an increased cardiovascular risk.
Nov 2016
The purpose of this paper is to review the literature linking schizophrenia with chronic inflammation and gluten sensitivity. In addition, the paper discusses the need for dietary interventions that may improve multiple health outcomes for patients. Individuals with schizophrenia are at much greater risk for the development of additional autoimmune disorders. Second generation anti-psychotic medications are the most effective treatment for schizophrenia, but there are numerous potential side effects to the medications. More specifically, individuals with schizophrenia who are treated with SGAs are at increased risk for obesity, diabetes, as well as elevated lipids and blood pressure. An effective evidence-based dietary intervention has the potential to improve numerous outcomes for individuals with schizophrenia.
Jul 2016 DOI 10.14302/issn.2381-862X.jwrh-15-806
Background and Objectives: The prevalence of abnormal cervical cytology in morbidly obese women using ThinPrep® liquid-based Pap Test™ and HPV DNA Test™ is unknown. We aimed to investigate whether women with morbid obesity have a higher frequency of abnormal Pap smears compared with nonobese women, and to explore the rate of Pap smear screening in morbidly obese women. Design and Setting: We conducted a retrospective study over five years in two general government hospitals in Dubai. Patients and Methods: We screened ThinPrep slides and HPV DNA of morbidly obese women and nonobese women. The age, ethnicity, demographic and socioeconomic backgrounds of the two groups were matched. We studied hypertension (HTN), diabetes (DM), infertility, sexually transmitted diseases (STD), connective tissue disease (CTD), immunosuppression and oral contraceptive pills (OCP) as potential risk cofactors. Results: Only 90 (29%) out of 310 morbidly obese women had had Pap tests. They showed more prevalence (P<0.05) of ASC-US, high-risk HPV DNA and LSIL 16 positive (18%) (95% CI: 7.0, and of endometrial AGCs {4 positive (4.5%) (95% CI: 0.3-13.5)} than the nonobese women (n=8175), {279 positive (3%) (95% CI: 3.0-3.8} , and {2 positive (0.024%) (CI:0.01-0.09)}. There were no endocervical AGCs, HSIL or squamous cancer in morbidly obese women. DM, HTN, OCPs, CTD and STD were more common in morbidly obese women having abnormal Pap smears. Conclusions: Low-grade squamous abnormalities, high-risk HPV, and endometrial AGCs are more frequent in morbidly obese women than in nonobese women. Women with morbid obesity have a low rate of cervical screening. This, among other factors, could increase the risk of these women to abnormal cervical cytology. This vulnerable group should benefit from more frequent cervical cytology screening. Appropriate clinical and educational measures should be implemented to encourage compliance to Pap smears. Weight reduction might help.
Jul 2016 DOI 10.14302/issn.2474-9273.jbtm-15-817
Objective: To examine whether having metabolic syndrome (MS) among seniors is associated with using anti-depression medication. Methods: A total of 1366 (617 men and 749 women) individuals aged 60+ years from the NHANES 2007/08 survey who had no reported heart disease and/or cancers but had information on prescribed medications in previous month were included in this analysis. All subjects were categorized into three prescribed drug use status, ie, none (group 1); no anti-depressants (group 2); and with anti-depressants (group 3). MS was defined with the criteria of the ATP III. Results: Over 80% of individuals reported taking prescribed medications with 6% of men and 16% of women respectively having used anti-depressants. About 36% of men and 40% of women respectively were considered to have MS. Results from multiple logistic regression analyses indicated that in comparing to group 1, the odds ratios (95% CI) of MS was 2.73 (1.96, 3.82) for group2 and 2.25 (1.07, 4.69) for group 3, respectively. Both group 2 and 3 had a similar metabolic risk profile, in comparing to group 1, they had higher odds of having diabetes and high level of blood pressures. Conclusion: Seniors with medications are more likely to be with MS, diabetes, and high level blood pressures. However, the observed the cardio-metabolic risk association seems similar between seniors using anti-depressant drugs and using other prescribed medications.
Jun 2016 DOI 10.14302/issn.2374-9431.jbd-15-647
Diabetes is a metabolic disorder that results in human body due to insulin deficiency, insulin resistance or both. In the management of diabetes, glucose monitoring technology has been used for the last three decades. The aim of this review article is to describe concise and organized information about different techniques of non-invasive continuous blood glucose monitoring. Many research groups have been working to develop wearable sensors for continuous blood glucose monitoring, but at present, there are to our knowledge no commercially successful non-invasive glucose monitors on the market. To achieve an acceptable sensor system, a glucose sensor should have accuracy better than 15mg/dl (0.8 mmol/l). In future development, continuous glucose sensor systems may become predictable, selective, reliable and acceptable for patient use.
Jun 2016 DOI 10.14302/issn.2471-2175.jdrt-15-836
Cellulitis is an acute, spreading pyogenic inflammation of the dermis and subcutaneous tissue, usually complicating a wound, ulcer, or dermatosis. Inappropriate diagnosis of cellulitis is a problem and would need prospective rather than retrospective studies to quantify the extent. There is one national guideline for the management of patients with cellulitis. The aim of this study is to determine the validity of Crest guideline in the patients with non-facial cellulitis. This prospective cohort study was conducted on all Adult patients with cellulites who were admitted at Resole-Akram and Sina emergency department between November 2013 and January 2014. Based on admission duration, the patients were randomly divided into two groups including primary and secondary outcome, <24-hours or >24-hours admission, respectively. Out of 89 admitted patients, 55% were hospitalized over 24 hours and 20% of them had significant systemic symptoms. The most patients (n= 42) had either systemically ill or systemically well or class II followed by classes I (n=28), III (n=18), and IV (n=1). There was significant relevancy between age, fever, PR, infected organ, leukocytosis, diabetes mellitus, IUDA, human bite, and primary outcome. In conclusion, factors associated with admission were age, presence of multiple comorbid conditions, diabetes mellitus, human bite, IUDA, infected organ, leukocytosis and fever. These results showed that the decision in the emergency department was mostly the same as Crest guideline and the prospection of admission and discharge of these patients was almost according to the educations of Crest guideline.
Apr 2016 DOI 10.14302/issn.2474-7785.jarh-15-699
Purpose Hospital readmission of patients with pluripathologies is frequent and costly. This study describes the impact of patients’ pluripathologies, functional capacity and social complexity on readmissions during a 12-month period following hospital discharge. Methods A prospective cohort study. Monthly monitoring of 111 patients over 12 months in Hospital of Riotinto. The primary endpoint was readmission rate. Predictive variables: age, gender, hospitalizations the year before, illnesses that define the pluripathology, medication prescribed on discharge, social situation (Gijón Scale), functional state (Barthel) and cognitive impairment (Pfeiffer). Results Readmissions accounted for 21.6% of the patients surveyed. Of those readmitted, the mean age was lower than those who did not return to hospital (75.4 vs.79.6) (p=0.031), the average amount of medication prescribed greater (10.5 vs.8.7) (p=0.014), the Barthel score higher (52.5 vs.50.6) and the Gijón value lower (13.8 vs.14.6), but no results was significant. The mean survival time (without readmission) was 310.9 days (95% CI, 289.4-332.5). Category B (chronic renal disease and vasculitis) and F (diabetes with microangiopathy and artery disease) had a lower average survival time (X2=7.02; p=0.008) (X2=7.07; p=0.008). The readmission risk was hazard ratio (HR) = 3.13 (95% CI, 1.37-7.14) for category B, and HR = 3.38 (95% CI, 1.37-8.36) for category F. Conclusions There is a high proportion of readmissions among patients with pluripathologies in the year following discharge from hospital. The greater risk occurs in patients with chronic renal insufficiency and diabetes with microvascular complications. Factors that can be modified are polymedication and the proper control of patients’ diabetes.
Feb 2016 DOI 10.14302/issn.2374-9431.jbd-15-890
Purpose Signal Transducer and Activator of Transcription 4 (STAT4) is important for signaling by interleukins (IL-12 and IL-23) and type 1 interferons and has been found to have several simple nucleotide polymorphisms (SNPs) associated with human disease. STAT4 SNPs were computationally examined with respect to changes in potential transcriptional factor binding sites (TFBS) and these changes were discussed in relation to human disease. Methods The JASPAR CORE and ConSite databases were instrumental in identifying the TFBS. The Vector NTI Advance 11.5 computer program was employed in locating all theTFBS in theSTAT4 gene from 4 kb upstream of the transcriptional start site to 8.3 kb past the 3’UTR. The JASPAR CORE database was also involved in computing each nucleotide occurrence (%) within the TFBS. Results The STAT4 SNPs in the 70 kb intron between exon 2 and 3 are in linkage disequilibrium and have previously been found to be significantly associated with several vasculitis diseases as well as diabetes. The SNP alleles were found to alter the DNA landscape for potential transcriptional factors (TFs) to attach resulting in changes in TFBS and thereby, alter which transcriptional factors potentially regulate the STAT4 gene. These STAT4 SNPs should be considered as regulatory (r) SNPs. Conclusion The alleles of each rSNP were found to generate unique TFBS resulting in potential changes in TF STAT4 regulation. These regulatory changes were discussed with respect to changes in human health that result in disease.
Feb 2016 DOI 10.14302/issn.2574-4488.jna-15-712
Background Dapagliflozin; the new oral hypoglycemic agent; is a sodium-glucose cotransporter-2 (SGLT2) inhibitor that acts by inhibiting glucose reabsorption in the proximal tubule of the nephron. Main reported side effects are osmotic diuresis, dehydration, urinary tract and genital infections. Here, we report a case of acute bilateral hydronephrosis after the introduction of dapagliflozin. Case Presentation A 52 year old nurse lady, with 15 year history of type2 diabetes mellitus (T2 DM) complicated by type4-renal tubular acidosis, hypertension, proteinuria, and hyperlipidemia. Patient had two episodes of UTI’s in 2011 required full urologic work up, were successfully treated with simple courses of oral antibiotics. CT pyelography done in 2011 was normal. Dapagliflozin was added to her therapeutic regimen in March 2015. Results Within 48 hours after starting dapagliflozin, she reported increased urine output. Ten days later; she developed severe bilateral loin and lower back pain, followed by suprapubic pain, dysuria and fever. Urine analysis and cultures confirmed E. coli urosepsis. Renal US revealed echogenic kidneys with 12 mm bilateral hydronephrosis, normal ureters and urinary bladder. Discontinuation of dapagliflozin in April 2015 resulted in resolution of symptoms. Repeat CT of the abdomen in July 2015 revealed no hydro nephrosis. Conclusions This is the first case report of reversible bilateral hydronephrosis after the use of dapagliflozin. The cause of hydronephrosis, could be explained by over-diuresis and/or by the unmasking of underlying subclinical obstruction in both uretero-pelvic junctions (UPJ).
May 2015 DOI 10.14302/issn.2470-0436.jos-14-527
A 66 year old Chinese male with a medical history of hypertension, diabetes mellitus and hepatitis B carrier was diagnosed with hepatocellular carcinoma in 2009. He underwent treatment with selective internal radiation spheres and sorafenib, and multiple cycles of chemotherapeutic agents such as bevacizumab, erlotinib, OXAFI ( intravenous oxaliplatin and doxorubicin given on days 1, 8 and 15 in a 28-day cycle, a daily continuous infusion of fluorouracil and subcutaneous interferon alfa-2b 5 million units administered thrice weekly), thalidomide, capecitabine, and rapamycin over the course of four years. Along the course of treatment, he developed pulmonary embolism and was initially started on anti-coagulation. Two months later, he developed hemoptysis and the anti-coagulants were stopped. During his routine ophthalmology visit for diabetic eye evaluation, he complained of blurring of vision of his left eye for the past four to five weeks. He was found to have central retinal vein occlusion (CRVO) of the left eye, associated with macular edema. Visual acuity was 6/15 for the right eye and 6/60 for the left eye. Eyelids, conjunctiva, cornea, anterior chamber, pupils, lens and ocular motility were normal. Humphrey visual field testing showed a superior arcuate and basal defect. This is the first reported case of CRVO in hepatocellular carcinoma. The etiology of CRVO is multifactorial, withhepatic malignancy, previous major surgery, multiple cycles of chemotherapy and cessation of anticoagulant therapyas possible aetiological factors. His background medical problems of diabetes and hypertension are further contributors.
May 2015 DOI 10.14302/issn.2574-4488.jna-14-601
Iodinated radiographic contrast agents (IRCA) are pharmaceutical agents used to improve the visibility of internal organs and structures in X-ray based imaging techniques. However, IRCA may have adverse unwanted effects, ranging from a mild inconvenience, such as itching, to a life-threatening emergency. The adverse effects of IRCA include delayed allergic reactions, anaphylactic reactions, and/or cutaneous reactions. But exposure to IRCA may be associated also with the development of either hyperthyroidism or hypothyroidism, presumably due to the effect of free, biologically active elemental iodine ions present in these agents. Among the side effects associated with the use of intravascular injection of IRCA, Contrast-induced nephropathy (CIN) is undoubtedly their most important and frequent well known adverse reaction. The pathogenesis of CIN is discussed in detail including the factors that increase the incidence of CIN, the main ones being pre-existing renal impairment, particularly when associated with diabetes mellitus. Finally, the measures to reduce the nephrotoxicity of IRCA are suggested beginning with monitoring renal function, discontinuation of potentially nephrotoxic drugs, use of either iodixanol or iopamidol at the lowest dosage possible. The main procedure for prevention of CIN is an adequate hydration of the patient with either isotonic sodium chloride or sodium bicarbonate solutions. A long list of references is provided that will enable readers a deep appreciation of the topic.
Feb 2015 DOI 10.14302/issn.2379-7835.ijn-14-461
Objective: To investigate the association of meat consumption with self-reported chronic diseases (heart disease, hypertension, diabetes (type I or type II) and dyslipidemia), according to demographic, social and anthropometric variables. Methods: This was a cross sectional study, conducted at the Heart Institute, University of São Paulo, with 549 adults (≥ 18 years) who answered a questionnaire to select people for The CARVOS Study (Carotid Atherosclerosis, Aortic Stiffness and Risk Factors in Vegetarians and Omnivorous Subjects). The variables analyzed were: age, gender, education level, meat consumption, self-reported coronary heart disease, hypertension, diabetes (type I or type II) and dyslipidemia, smoking and body mass index (BMI) (kg/m2). Study subjects were classified as omnivorous (OMN=consumption of meat or fish four or more times/week) (n=228, 41.5 %), semi-vegetarians (SV=consumption of meat or fish 1-3 times/week) (n=97, 17.7%) and vegetarians (VEG=no consumption of meat or fish) (n=224, 40.8%). The differences between mean values was calculated by T-ANOVA test. To test the association between the variables, chi-square test and multiple logistic regression were used (p<0.05; CI = 95%). Results: There was a greater prevalence of smokers among OM than SV and VEG respectively 56.5%, 14% and 29.4 %, p=0.009, and a higher prevalence of overweight (41.7%) in OMN in comparison with SV (29.2%) and VEG (29.0%), p=0.008. Being OM significantly increased the risk of referring hypertension, regardless of sex and age (OR 2.19; CI 95% 1.08-4.46), and was also associated with dyslipidemia, regardless of body mass index, smoking, sex and age (OR 1.78; CI 95% 1.03-3.08). Conclusion: Higher meat consumption was associated with a greater prevalence of risk factors for hypertension and dyslipidemiachronic diseases.
Oct 2014 DOI 10.14302/issn.2471-2140.jaa-14-423
There is increasing evidence of the prevalence manifestations of metabolic syndrome worldwide. Metabolic syndrome is a cluster of abnormalities characterized by hypertension, central obesity, insulin resistance, endothelial dysfunction, dyslipidemia and oxidative stress. All these alterations predispose individuals to type 2 diabetes and cardiovascular disease that are major contributing factors to earlier mortality among people. The investigation of food nutrients that could reverse the features of metabolic syndrome is an important aspect for dietary-based therapies that may ameliorate the burden of the disorder. Antioxidant micronutrients are of great interest due to the recent described association between obesity, cardiovascular alterations and oxidative stress. These antioxidant nutrients are also being considered in the management of metabolic syndrome due to their potential benefits on hypertension, insulin resistance and hypertriglyceridemia since growing evidence has emerged that point to a causal link between oxidative stress and metabolic syndrome. Thus, dietary antioxidant supplements could have favourable effect on the attenuation and prevention of the manifestations of metabolic syndrome traits. Therefore, the present review focuses on the importance of antioxidant micronutrients in the treatment and management of metabolic syndrome.
Nov 2013 DOI 10.14302/issn.2329-9487.jhc-13-253
Background: Western studies have shown that hypertension increases carotid intima media thickness (cIMT) as early as in childhood and adolescence. However, similar data from India is lacking. Indians have different genetic, racial, geographic, cultural and dietary patterns. Hence a similar trend may not be experienced among young Indian subjects. Methods: 46 young cases (age 16 – 35 years) of hypertension were recruited along with age, sex and BMI matched controls. Patients with body mass index (BMI) >25 kg/m2, diabetes mellitus and secondary causes of hypertension were ruled out. All patients underwent carotid ultrasonography for assessment of cIMT. Results: Mean age and BMI of cases was 25.4 years and 20.89 kg/m2 respectively. 67.4% were male. For all of the subjects combined (n=92), cIMT correlated with BMI (r = 0.244; P=0.019), office systolic blood pressure (SBP) (r = 0.556; p<0.001) and office diastolic blood pressure (DBP) (r =0.426; p<0.001). Among hypertensive subjects (n=46), there was a significant positive correlation between cIMT and SBP (r=0.611, p<0.001). In contrast to SBP, DBP correlated insignificantly with cIMT (r= 0.217; p = 0.14) in the hypertensive subjects. Conclusion: Elevated blood pressure, especially systolic, correlates with increased cIMT among young Indian hypertensives. This provides strong evidence that primary hypertension in early life also is associated with vascular pathology, independent of the effects of obesity and diabetes
Sep 2013 DOI 10.14302/issn.2374-9431.jbd-13-226
The number of individuals with diabetes is increasing worldwide and a large subset of those affected will develop diabetic nephropathy. Diabetic nephropathy is the leading cause of end-stage renal disease, has serious health consequences for affected individuals, and represents a major monetary cost to healthcare providers. Technological and analytical developments have enabled large-scale, collaborative studies that are revealing risk factors associated with diabetic nephropathy. However, much of the inherited predisposition and biological mechanisms underpinning risk of this disease remain to be identified. Meta-analyses and integrated pathway studies are becoming an increasingly important part of research for diabetic nephropathy including, genetic, epigenetic, transcriptomic, proteomic research, clinical observations and the development of animal models. This report highlights current bioinformatic resources and standards of reporting to maximise interdisciplinary research for diabetic nephropathy. The identification of an -Omics profile that can lead to earlier diagnosis and / or offer improved clinical evaluation of individuals with diabetes would not only provide significant health benefits to affected individuals, but may also have major utility for the efficient use of healthcare resources.