Diabetes Research Articles

Factors Affecting the Pattern of Health Service Receipt in Patients with Diabetes Mellitus at the Pangirkiran Health Center, Padang Lawas Utara Regency

Background: Diabetes Mellitus (DM) is a global health problem, with an increasing prevalence rate. In Padang Lawas Utara Regency, especially at the Pangirkiran Health Center, DM sufferers face various obstacles in receiving optimal health services. Objective: The study aims to analyze the factors that affect the pattern of receiving health services for people with diabetes mellitus. Methods: This type of quantitative research with a cross sectional study design was conducted at the Pangirkiran Health Center, Padang Lawas Utara Regency. The population and sample were all 136 patients with diabetes mellate with an exhaustive sampling technique. Data collection using a research questionnaire. The data was processed and analyzed using chi-square tests and logistic regression as well as the presentation of data with tables accompanied by explanations. Results: The results of the study prove that knowledge (p=0.007) and socio-cultural (p=0.008) have a significant effect on the pattern of receiving health services for people with diabetes mellitus. The most influential variable is Exp knowledge (B)=4.942. Conclusion: The conclusion was obtained that knowledge factors about diabetes mellitus and socio-culture play a significant role in determining the pattern of health service receipt. Therefore, it is important for the Pangirkiran Health Center to improve health education programs, improve access to services, and involve families in the process of managing diabetes mellitus. This research is expected to provide policy recommendations to improve the quality of health services for people with diabetes mellitus in the region.

DIABETES MELLITUS TIPO 2 COMO FATOR DE RISCO PARA O AGRAVO DA COVID-19 NA POPULAÇÃO BRASILEIRA: UMA REVISÃO SISTEMÁTICA

INTRODUCTION: The novel coronavirus, named SARS-CoV-2, is the etiological agent of COVID-19, a highly contagious infectious disease that primarily affects the lower respiratory tract. Type 2 diabetes mellitus may be a factor worsening this condition. OBJECTIVE: To identify the prevalence of diabetes mellitus as a risk factor for COVID-19 in Brazil from 2019 to 2023, assess the severity of cases in different states, analyze the sociodemographic factors affecting prognosis, and clarify the role of pharmacists in monitoring and managing the therapy of these patients. METHODOLOGY: This is a systematic review study using the PRISMA method, divided into four stages. The first stage involved searching for scientific works to answer the question about the frequency of worsening COVID-19 cases associated with type 2 diabetes mellitus in Brazil. The databases consulted were Scielo, PubMed, and the Virtual Health Library (BVS), using keywords such as “Diabetes mellitus,” “COVID-19,” “Brazil,” “Worsening,” and “Death.” RESULTS: Seveteen articles that met the inclusion criteria were selected. The studies indicate that diabetes mellitus is a significant risk factor for the severity and mortality of COVID-19 in Brazil, with mortality rates between 40% and 55% among diabetic patients. Additionally, the disease is associated with other comorbidities, such as hypertension and obesity, contributing to the need for ICU admissions and longer hospital stays. CONCLUSION: Type 2 diabetes mellitus is a significant risk factor for complications and mortality in COVID-19 patients, resulting in higher ICU admission rates and deaths, highlighting the need for rigorous glycemic control. The pharmacist's role is essential in monitoring glycemic levels and educating patients about treatment, contributing to reducing complications and improving clinical outcomes.

Combined Coronary Artery Bypass Grafting and Orthopedic Fixation in a Patient with Multiple Comorbidities: A Case Report

Background: Coronary artery disease (CAD) is a prevalent cardiovascular condition and leading cause of morbidity and mortality worldwide. The management of orthopedic injuries requiring surgical fixation is particularly complex in patients with comorbidities such as diabetes mellitus (DM) and hypertension (HTN). Coordinating the sequence, timing, and execution of coronary artery bypass grafting (CABG) and orthopedic fixation requires careful consideration of the patient’s overall health, surgical risks, and recovery potential. Case presentation: A 55-year-old male presented with a right distal tibial fracture following a fall. His medical history included HTN, type 2 diabetes mellitus (T2DM), and Kyrle’s skin disease. During his hospital stay, he was diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI). Severe multivessel CAD was confirmed by catheterization. After interdisciplinary consultation, simultaneous CABG and open reduction and internal fixation (ORIF) of the tibial fracture were performed. He was discharged in good condition and showed positive recovery during a one-month follow-up. Discussion: This case highlights the complexities of managing patients with multiple comorbidities who require both cardiac and orthopedic surgeries. This simultaneous approach allows for efficient treatment, leading to a shorter hospital stay and recovery period. This report supports the feasibility and benefits of simultaneous surgery in complex clinical scenarios, although further studies are required to establish broader guidelines. Conclusion: Our case emphasizes the importance of a multidisciplinary approach for managing patients with multiple comorbidities who require concurrent surgical intervention. Preoperative planning and specialty coordination ensured optimal outcomes. Further research is needed to develop standardized guidelines for intraoperative care of patients undergoing simultaneous procedures.

Discovery of α-amylase and α-glucosidase dual inhibitors from NPASS database for management of Type 2 Diabetes Mellitus: A chemoinformatic approach.

Postprandial hyperglycemia, typical manifestation of Type 2 Diabetes Mellitus (T2DM), is associated with notable global morbidity and mortality. Preventing the advancement of this condition by delaying the rate of glucose absorption through inhibition of α-amylase and α-glucosidase enzymatic activities is of utmost importance. Finding a safe antidiabetic drug is essential since those that are currently on the market have drawbacks like unpleasant side effects. The current study utilized computer-aided drug design (CADD), as a quick and affordable method to find a substitute drug template that can be used to control postprandial hyperglycemia by modulating the activity of α-amylase and α-glucosidase enzymes. The Natural Products Activity and Species database (NPASS) (30,926 compounds) was screened in silico, with a focus on evaluating drug-likeness, toxicity profiles and ability to bind on a target protein. Two molecules NPC204580 (Chrotacumine C) and NPC137813 (1-O-(2-Methoxy-4-Acetylphenyl)-6-O-(E-Cinnamoyl)-Beta-D-Glucopyranoside) were identified as potential dual inhibitors for α-amylase and α-glucosidase with free binding energies of -14.46 kcal/mol and -12.58 kcal/mol for α-amylase, and -8.42 kcal/mol and -8.76 kcal/mol for α-glucosidase, respectively. The molecules showed ionic, H-bonding and hydrophobic interactions with critical amino acid residues of both enzymes. Moreover, 100 ns molecular dynamic simulations showed that both molecules are stable on the receptors' active sites based on root mean square deviation (RMSD), root mean square fluctuation (RMSF), and the Generalized Born surface area (GBSA) energy calculated. The two compounds are thus promising therapeutic agents for T2DM that merit further investigation due to their excellent binding energies, encouraging pharmacokinetics, toxicity profiles, and stability as demonstrated in simulated studies.

Humoral response 24 months after the first COVID-19 vaccination in people with HIV with and without diabetes

People with HIV (PWH) and people with diabetes mellitus have increased risk of severe COVID-19, but little is known about humoral response to COVID-19 vaccines in PWH with DM. We investigated SARS-CoV-2 antireceptor-binding domain (anti-RBD) immunoglobulin G (IgG) geometrical concentrations and neutralizing antibody capacity (nAB) in PWH with and without diabetes mellitus. Anti-RBD IgG and nAB in COVID-19-vaccinated PWH were not associated with diabetes mellitus-status or HbA1c 24 months after the initial COVID-19 vaccination.

EFFECTIVE MANAGEMENT STRATEGIES FOR TREATEMENT OF DIABETIC FOOT ULCER

Background: Diabetes mellitus is a rapidly rising disease worldwide. It has many complications affecting the overall health status of diabetic individuals as well as their life quality. Peripheral vascular and neuropathy are among the devastating complications of diabetes. They result in diabetic foot ulcer development. This should be prevented initially by preventative strategies which include annual screening of diabetic-foot and patient’s education of self-care. When ulcers happen, different approaches could be takento manage patients. Aim: the aim of this review article is to spots light on different management methods to treat diabetic foot ulcers.Material & Methods: PRISMA method is used to collect the articles from different data bases such as web of science, Scopus.Total 608 articles found relevant after applying inclusion exclusion criteria and duplication criteria total 27 articles were included in theanalysis. Findings: From the literature review eight factors are found which are discussed in detail in the paper. Conclusions: Diabetes mellitus is a long-term condition that can lead to serious complications. In their lifetime, around one-third of diabetic people may develop foot ulcers

Chromium supplementation and type 2 diabetes mellitus: an extensive systematic review.

Diabetes is a global public health concern with increasing prevalence worldwide. Chromium (Cr), a trace element found in soil, water, and food, has been proposed to have a possible positive effect in glucose metabolism and diabetes mellitus prevention. However, the relationship between trivalent chromium [Cr(III)] exposure, mainly through the consumption of diet supplements, and type 2 diabetes mellitus (T2DM) remains controversial. An extensive systematic review of the current literature on randomized controlled studies (RCTs) was conducted from 1 January 2000, to January 2024 using the databases PubMed, Scopus, ScienceDirect, and Cochrane, with specific keywords and inclusion as well as exclusion criteria. After close screening of the research studies retrieved from the mentioned websites was conducted, the most related studies were included in the final systematic review. The studies were evaluated for the degree of relevance, quality, and risk bias, using appropriate quality assessment tools. Several of the included RCT studies reported possible benefits of Cr(III) supplementation, mainly in the form of chromium picolinate (CrPic), chromium yeast (CY), chromium chloride (CrCl3), and chromium nicotinate (CrN). The dosage of chromium was between 50 and 1000μg/day and it was consumed from 2 to 6months. Glycemic control markers, including FPG, insulin, HbA1C, and HOMA-IR levels, significantly decrease following chromium supplementation, mainly in studies with a longer intervention period. Supplementing with chromium (Cr) indicated that could significantly improve lipid profile by raising high-density lipoprotein and lowering triglyceride and total cholesterol while having little effect on low-density lipoprotein. However, most research findings include significant limitations, such as inconsistent dosage and type of chromium, formulation of supplements, and study duration. Further well-designed and high-quality research is needed to fully understand the role of chromium dietary supplementation and the potential risks related to its mechanisms of action, type, and dose, in the prevention and treatment of type 2 diabetes mellitus.

Preliminary guidelines for the detection and management of drug-related problems in cancer patients with type 2 diabetes mellitus: a practical resource for oncology pharmacists.

The prevalence of type 2 diabetes mellitus (T2DM) in cancer patients is high. During the medication review process, clinical pharmacists could detect and manage drug-related problems (DRP) to optimize pharmacotherapy but there is a need to standardize pharmacists' interventions (PI) especially for T2DM-related DRP. The present study aims to describe DRP in cancer patients with T2DM undergoing anticancer treatment (AT) and to propose related preliminary guidelines to manage T2DM-related DRP. The study was conducted in one oncology outpatient hospital where a clinical pharmacy team performs medication reviews to detect and manage DRP by performing PI in cancer patients undergoing AT. All the data from November 23rd, 2015 to November 23rd, 2019 were extracted and demographic, clinical, oncological, and biological data were collected and analyzed. Based on these results and a literature review, a working group (2 pharmacists and one diabetologist) was constituted to propose a first set of preliminary guidelines clinical pharmacists that were then reviewed using the Delphi method by an expert panel of oncologists and pharmacists. A total of 161 T2DM cancer patients were included in the study (19.7% of all cancer patients screened). Overall, 152 DRP (mean 1.67/patient) were detected (49.3% drug interaction) and 152 PI were performed by clinical pharmacists, mainly drug monitoring (48.0) and drug discontinuation (25.7%). Specifically, there was 24 T2DM-related DRP (including 29.2% drug interactions). Twenty-four DRPs were directly related to T2DM status. The five proposed guidelines reached a consensus after revisions and a sixth has been added. DRPs were frequent among cancer patients with T2DM and we hypothesize that the preliminary guidelines should improve the detection of DRPs directly related to T2DM. The implementation of the preliminary guidelines should now be assessed in clinical practice.

Teachers' knowledge about the principles of dealing with a student with type 1 diabetes mellitus.

A proper self-management and therapy process, and the involvement of patients and their carers in this process, influences the effectiveness of T1DM therapy. The responsibility for the self-management process lies with children and adolescents with T1DM, as well as their parents and other carers. The aim of this study was to assess the level of teachers' knowledge of the principles of the treatment and self-management of T1DM in children and to demonstrate the influence of various factors influencing teachers' knowledge. A cross-sectional survey was conducted among the teachers in the Pomeranian Voivodeship. The first part of the survey contained questions on sociodemographic data, the second part contained questions on personal attitudes towards a student with T1DM, and the third part contained twenty-nine questions assessing the basic knowledge of the self-management and treatment principles of T1DM. Tests were conducted with 698 (86.4%) female teachers and 110 (13.6%) male teachers. The median (25thQ ÷ 75thQ) score of the test on the teachers' knowledge was 20 (18 ÷ 21) points, with a maximum of 29 and a minimum of 0 points. Male teachers, aged between 26-40years, with 6-10years of seniority, working in rural areas, having a person with T1DM in their immediate environment or having a student with T1DM in their class had a higher knowledge level. Teachers who worked in schools where no nurse was employed and those who had not completed specific training on the principles of caring for a child with T1DM at school had a lower level of knowledge. 1. Knowledge of teachers is insufficient to ensure safe stay at school for a child with T1DM. 2. The ongoing training of teachers on the principles of the self-management and treatment of T1DM is necessary to improve and increase the safety of children and adolescents with T1DM in school units. 3. There is a need to improve the quality of health care for children with T1DM in the learning environment by increasing the number of school nurses and improving their knowledge, and by the ongoing training of teachers and other staff in school units. 4. Detailed care plans should be developed for children with T1DM, adapted to the school conditions.

Exploring the Relationship Between Refractive Errors and Common Chronic Diseases Via Blood Biochemistry Tests: A Large Prospective Cohort Study.

The purpose of this study was to examine the association between refractive errors and common chronic diseases using blood biochemistry tests, and to investigate the associated modifiable risk factors, with the goal of informing and developing effective preventive strategies. A total of 116,245 participants with refractometry at baseline enrolled in the UK Biobank were included in this prospective cohort study. Restricted cubic spline and Cox proportional hazards models were used to detect associations between refractive error, blood biochemistry tests, and common chronic diseases. Interaction effects on the additive scale and effect modification analysis were used to explore excess modifiable risk factors for disease prevention. Spherical equivalent significantly associated with vitamin D, sex hormone binding globulin, apolipoprotein A, blood glucose, and aspartate aminotransferase levels. Subjects with myopia demonstrated a 13% higher risk of type 2 diabetes mellitus (T2DM) incidence compared to those without myopia (hazard ratio [HR] = 1.13, 95% confidence interval [CI] = 1.08-1.19) throughout a median follow-up of 9.12years. Interaction analysis revealed 15% (95% CI = 9%-21%) of this risk was due to myopia-obesity interaction. However, active engagement in physical activity could potentially mitigate this risk (HR = 1.06, 95% CI = 0.93-1.20). Refractive errors were associated with specific blood indicators, particularly noting the association between myopia and higher T2DM incidence in middle-aged and elderly populations. This effect interacts with obesity, and promoting physical activity among myopia individuals provides greater benefits in the prevention of T2DM compared to non-myopic individuals.

A Systemic Review on Phytochemicals and Novel Approaches for the Management of Hepatic Cancer

Introduction: Hepatic cancer, an aggressive tumour that often develops along with cirrhosis and chronic liver disease like infections with the hepatitis B and hepatitis C viruses, while nonalcoholic steatohepatitis, is linked to metabolic syndrome or diabetes mellitus. It is the third most prevalent cause of cancer-related mortality globally and ranks fifth in cancer incidence. According to GLOBOCON, the prevalence is expected to rise by 55.0% and the fatalities by 56.4% in the near future. Objective: The present review offered natural plant-based substances and compounds having curative effects on liver cancer, along with novel drug delivery systems and nanocarrier-based therapies. Methods: The literature has been taken from PubMed, Google Scholar, SciFinder, Springer Nature, Bentham Science, PLOS one, or other internet sites. Result: Treatment for heterogeneous malignancy is multidimensional, and care guidelines differ depending on the specialty and location. Several nutritional herbal remedies and their active phytoconstituents may have an abundance of impacts on the management of liver cancer, including preventing the growth and spread of tumor cells, shielding the body from liver carcinogens, boosting the effects of chemotherapy and immunomodulating the body. Conclusion: The treatment of liver cancer involves multidisciplinary and multimodel therapy. The literature is a compilation of extract, compounds, and novel approaches like nanoparticles, microsphere, liposomes, niosomes, phytosomes and microparticles. These approaches not only manage cancer but also boost the immunity of the individuals.

Intensive care unit admissions following enhanced recovery video-assisted thoracoscopic surgery lobectomy.

Video-assisted thoracoscopic surgery (VATS) lobectomy combined with enhanced recovery after surgery (ERAS) protocols has improved postoperative outcomes, yet concerns persist regarding complications and readmissions. Limited research has explored intensive care unit (ICU) admissions and outcomes within this context. This study aimed to analyze ICU admissions following VATS lobectomy within an established ERAS protocol. Consecutive patients who underwent VATS lobectomy between 2018-2023 were included. Patient data were obtained from our prospective institutional database, while ICU data were extracted from electronic patients' records. Of 2099 patients included, 48 (2.3%) required ICU admission. Median-age was 70 (IQR : 64-76), with ICU patients being older and predominantly male (73%). Overall 30-day-mortality was 1.0% with an ICU mortality of 31%. Multiple logistic regression revealed significant associations between ICU admission and male gender (p = <0.001), diabetes mellitus (p = 0.026), heart failure (p = 0.040), DLCO%(0.013). Median time to ICU admission was 4 days (IQR : 2-10). Respiratory failure was the primary reason for ICU admission (60%). Severe surgical complications accounted for 8.3% of all ICU-admissions. In an ERAS setting, the incidence of ICU admission following VATS lobectomy was 2.3%, with a mortality rate of 31%. Respiratory failure was the leading cause of ICU admission.

Chronobiological disruptions: unravelling the interplay of shift work, circadian rhythms, and vascular health in the context of stroke risk.

Shift work, particularly night shifts, disrupts circadian rhythms and increases stroke risk. This manuscript explores the mechanisms connecting shift work with stroke, focusing on circadian rhythms, hypertension, and diabetes. The circadian system, controlled by different mechanisms including central and peripheral clock genes, suprachiasmatic nuclei (SCN), and pineal gland (through melatonin production), regulates body functions and responds to environmental signals. Disruptions in this system affect endothelial cells, leading to blood pressure issues. Type 2 diabetes mellitus (T2DM) is significantly associated with night shifts, with circadian disturbances affecting glucose metabolism, insulin sensitivity, and hormone regulation. The manuscript examines the relationship between melatonin, insulin, and glucose balance, highlighting pathways that link T2DM to stroke risk. Additionally, dyslipidemia, particularly reduced HDL-c levels, results from shift work and contributes to stroke development. High lipid levels cause oxidative stress, inflammation, and endothelial dysfunction, increasing cerebrovascular risks. The manuscript details the effects of dyslipidemia on brain functions, including disruptions in blood flow, blood-brain barrier integrity, and neural cell death. This comprehensive analysis emphasizes the complex interplay of circadian disruption, hypertension, diabetes, and dyslipidemia in increasing stroke risk among shift workers. Understanding these mechanisms is essential for developing targeted interventions to reduce stroke susceptibility and improve cerebrovascular health in this vulnerable population.

Harnessing the therapeutic potential of exercise in extracellular vesicle-based therapy in metabolic disease associated cardiovascular complications.

Cardiovascular disease (CVD) is a leading cause of mortality, affecting ∼18 million individuals each year. Obesity and type 2 diabetes mellitus in particular, both chronic metabolic disorders, are risk factors for CVD. The salutary effects of physical activity in preventing and ameliorating CVD have long been acknowledged, as it improves glucose and lipid homeostasis, alongside attenuating oxidative damage, increasing mitochondrial function, and ultimately improving cardiac function. Exercise serves as a catalyst for the secretion of extracellular vesicles (EVs), facilitating inter-tissue communication, by which tissues can deliver important signals from one tissue to another. In recent years, an increasing number of studies have focused on the cargo encapsulated within exercise-derived EVs, as well as the orchestration of inter-tissue crosstalk aimed at modulating metabolism and tissue function in CVDs. The precise mechanisms underpinning the cardioprotective properties of exercise-derived EVs, however, remains only partially elucidated. This review explores novel EV based therapeutic options in CVD and, in particular, EVs derived from models of exercise to alter metabolism and enhance cardiovascular outcomes.

Neuregulin 4 attenuates pancreatic β-cell apoptosis induced by lipotoxicity via activating mTOR-mediated autophagy

ABSTRACT Neuregulin 4 (Nrg4) is a brown fat-enriched endocrine factor that ameliorates lipid metabolism disorders. Autophagy is critical for pancreatic β-cell to counteract lipotoxicity-induced apoptosis. This study aimed at exploring whether Nrg4 attenuates lipotoxicity-induced β-cell apoptosis by regulating autophagy. The mouse pancreatic β-cell line MIN6 was cultured in palmitic acid (PA) with or without Nrg4 administration. Apoptosis rate, together with anti-apoptotic and pro-apoptotic protein levels, was investigated. Autophagic flux and autophagy-related protein levels along with related signaling pathways that regulate autophagy were also evaluated. Results showed that Nrg4 decreased PA-induced MIN6 apoptosis, enhanced anti-apoptotic protein B-cell lymphoma 2 (Bcl-2) expression and reduced pro-apoptotic proteins Bcl-2-associated X protein (Bax) and cleaved-caspase 3 expressions. Autophagy levels in MIN6 also decreased with PA treatment and Nrg4 administration reactivated autophagy. Further, Nrg4 administration activated autophagy via the mammalian target of rapamycin (mTOR) signaling pathway. In addition, when the mTOR pathway was stimulated or autophagy was suppressed, the beneficial effects of Nrg4 administration on MIN6 apoptosis were diminished. These results imply that Nrg4 administration attenuates MIN6 apoptosis by promoting mTOR-dependent autophagy and thus may lead to a new therapeutic method for type 2 diabetes mellitus (T2DM).

Simvastatin reduces chronic kidney disease and renal failure risk in type 2 diabetes patients: post hoc ACCORD trial analysis.

Type 2 diabetes mellitus (T2DM) poses a substantial global health concern. Statins are widely used among T2DM patients for managing dyslipidemia, preventing cardiovascular disease (CVD), and offering renal protection. However, the extent to which their renal protective effects contribute to reducing the incidence of severe renal complications, including chronic kidney disease (CKD) and renal failure, is not well-defined. This investigation scrutinizes the impact of simvastatin versus placebo on renal outcomes among T2DM patients utilizing data from the ACCORD trial. It encompasses incidence rate comparisons, Kaplan-Meier estimates, Cox proportional hazards models, and mediation analyses. The study consisted of 3,619 individuals diagnosed with T2DM, among which 2,753 were treated routinely with simvastatin, while 866 did not receive any statin therapy. After adjusting for baseline characteristics and time-dependent covariates, simvastatin treatment was associated with a 71% reduction in the risk of CKD (HR 0.29, 95% CI 0.27-0.31, p < 0.01) and a 47% reduction in the risk of renal failure (HR 0.53, 95% CI 0.44-0.65, p < 0.01) compared to the statin-free group. Further subgroup analysis, accounting for the initial lipid and kidney profiles, indicated variable impacts of simvastatin on CKD and renal failure outcomes. Nevertheless, a consistent reduction in CKD risk was observed across all subgroups within the statin-treated population. Additional mediation analysis revealed that the reduction in low-density lipoprotein cholesterol (LDL-C) may be a potential mediator in the association between simvastatin and CKD, with a mediation effect of 14.9%, (95% CI 0.11-0.19, p < 0.01). Administering statins, specifically simvastatin, to T2DM patients at elevated risk for CVD, is likely to offer augmented renal advantages, notably in lowering the occurrence of CKD and renal failure. This protective effect against CKD manifests regardless of initial lipid profiles, albuminuria, and estimated glomerular filtration rate (eGFR) levels. The association between simvastatin and CKD may be partially mediated by LDL-C reduction.

Metabolic Regulation of Inflammation: Exploring the Potential Benefits of Itaconate in Autoimmune Disorders.

Itaconic acid and its metabolites have demonstrated significant therapeutic potential in various immune diseases. Originating from the tricarboxylic acid cycle in immune cells, itaconic acid can modulate immune responses, diminish inflammation, and combat oxidative stress. Recent research has uncovered multiple mechanisms through which itaconic acid exerts its effects, including the inhibition of inflammatory cytokine production, activation of anti-inflammatory pathways, and modulation of immune cell function by regulating cellular metabolism. Cellular actions are influenced by the modulation of metabolic pathways, such as inhibiting succinate dehydrogenase (SDH) activity or glycolysis, activation of nuclear-factor-E2-related factor 2 (Nrf2), boosting cellular defences against oxidative stress, and suppression of immune cell inflammation through the NF-κB pathway. This comprehensive review discusses the initiation, progression, and mechanisms of action of itaconic acid and its metabolites, highlighting their modulatory effects on various immune cell types. Additionally, it examines their involvement in immune disease like rheumatoid arthritis, multiple sclerosis, type 1 diabetes mellitus, and autoimmune hepatitis, offering greater understanding for creating new therapies for these ailments.

Intravenous Immunoglobulin Therapy for Pyoderma Gangrenosum: A Multicenter Retrospective Analysis in 81 Patients.

Pyoderma gangrenosum (PG) is rare neutrophil skin disease causing painful, progressively enlarging ulcers. Among the treatment options, intravenous immunoglobulin (IVIG) is a therapy of first choice for paraneoplastic PG. Otherwise, it is used in therapy-refractory courses. To assess the efficacy and safety of IVIG therapy in patients with PG. A retrospective chart review for patients in five dermatologic wound centres in Germany was performed. Overall, 81 patients were included. IVIG was used as adjunct therapy with (methyl-) prednisolone and/or a steroid sparing therapy in 77 (95.1%) cases. Response to treatment (combined complete and partial, defined as tendency to heal and cessation of lesion progression, respectively) was 49.3% 1 month after initiation of IVIG. In total 18.8% had a complete response after 6 months. Statistically significantly higher response rates were observed in patients with diabetes mellitus and thyroid disease [odds ratio (OR) 3.49, confidence interval (CI) 1.13-10.80 and OR 6.64, CI 1.01-43.57, respectively]. Patients with solid malignancy tended to have better response (OR 4.36, CI 0.79-23.91). A higher IVIG dose was also associated with a tendency towards better response rates (OR 2.70, CI 0.84-8.63). In total, 1 (1.2%) severe adverse event (myocardial infarction with consequent death) was observed as well as three moderate adverse events, with two thromboembolic events (2.5%) and one acute kidney injury (1.2%). Other adverse events were mild or unlikely to be associated with IVIG therapy, with 14 events in 10 patients overall (12.3%). This multicentre retrospective study shows the important role of adjunctive IVIG therapy in patients with PG with recalcitrant courses. Identifying subgroups with a higher probability of response could improvefuture response rates and save patients from ineffective treatment and potential adverse events.

Clinical Profile and Outcomes of All Admitted COVID-19 Positive Patients with Primary Lung Cancer in a Tertiary Government COVID-19 Referral Center: A Retrospective Cohort Study

Background. COVID-19 infection poses a continuing challenge especially to those already with prior lung disease. To analyze such patients’ profile is essential in today’s health care management. Objective. The study aimed to compare the outcomes of COVID-19 confirmed patients with and without primary lung cancer in terms of hospital stay, recovery, and mortality. Methods. The study employed a retrospective cohort design. Chart review of all adult COVID-19 patients in Philippine General Hospital from January 2021 to June 2021 was done. A matched cohort study was conducted between COVID-19 patients with and without primary lung cancer. Results. Among the 953 COVID-19 patients, there were 14 patients with primary lung cancer. In terms of length of hospital stay, patients with primary lung cancer had shorter days from 1.32 to 15.1 days compared to 2.28 to 18.36 days in patients without primary lung cancer (p-value 0.271). Furthermore, they had 64% recovery rate compared to 78% in those without primary lung cancer (p-value 0.118). In terms of overall mortality rate, primary lung cancer patients had 36% rate as compared to 22% in the non-lung cancer group (p-value 0.119). Diabetes mellitus, mild to severe COVID, Remdesivir, and antibiotic use were associated with longer hospital stay while oxygen support via nasal cannula and invasive ventilation led to shorter hospital stay. Age above 50 years, chronic liver disease, other malignancy, shortness of breath, oxygen support via face mask, high flow nasal cannula, invasive ventilation, antibiotic use, hemoperfusion and nebulization showed a decrease chance of recovery while on contrary, Remdesivir showed an increase chance of recovery. An increase mortality rate was seen among age above 50 years, chronic liver disease, other malignancy, shortness of breath, oxygen support via facemask, high flow nasal cannula, invasive ventilation, antibiotics, hemoperfusion, and nebulization, in contrast to a decrease in Remdesivir therapy. Conclusions. Among all admitted COVID-19 patients, primary lung cancer patients were associated with shorter hospital stay (8.21+6.89days), lower rate of recovery (64%), and higher mortality rate (36%) as compared to those without primary lung cancer. However, based on the computed p-values for each outcome, these differences are not statistically significant.

Impact of Gut Microbiome Interventions on Glucose and Lipid Metabolism in Metabolic Diseases: A Systematic Review and Meta-Analysis

Background: The gut microbiome is increasingly recognized as a key player in metabolic health, influencing glucose and lipid metabolism through various mechanisms. However, the efficacy of gut microbiota-targeted interventions, such as probiotics, prebiotics, fecal microbiota transplantation (FMT), and diet-based treatments, remains unclear for specific metabolic outcomes. In this study, the aim was to evaluate the impact of these interventions on the glucose and lipid parameters in individuals with metabolic diseases such as diabetes mellitus (DM), obesity, and metabolic syndrome. Methods: This systematic review and meta-analysis included 41 randomized controlled trials that investigated the effects of gut microbiota-targeted treatments on metabolic parameters such as fasting glucose, glycated hemoglobin (HbA1c), homeostatic model assessment for insulin resistance (HOMA-IR), total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides. A comprehensive search was conducted using databases like PubMed, Google Scholar, and Scopus, focusing on interventions targeting the gut microbiota. A meta-analysis was performed using random-effects models, with effect sizes calculated for each outcome. Risk of bias was assessed using the Cochrane Risk of Bias tool. Results: Gut microbiota-targeted interventions significantly reduced fasting glucose, HbA1c, HOMA-IR, total cholesterol, LDL-C, and triglycerides, with moderate heterogeneity observed across studies. The interventions also led to modest increases in HDL-C levels. Probiotic and synbiotic interventions showed the most consistent benefits in improving both glucose and lipid profiles, while FMT yielded mixed results. Short-term interventions showed rapid microbial shifts but less pronounced metabolic improvements, whereas longer-term interventions had more substantial metabolic benefits. Conclusions: In this study, it is demonstrated that gut microbiota-targeted interventions can improve key metabolic outcomes, offering a potential therapeutic strategy for managing metabolic diseases. However, the effectiveness of these interventions varies depending on the type, duration, and population characteristics, highlighting the need for further long-term studies to assess the sustained effects of microbiota modulation on metabolic health.