Long-term Health Complications Research Articles

Prediabetes: A Review of Current Trends

Different organizations have used different criteria to define prediabetes. In order to define prediabetes, the World Health Organization (WHO) use two specific parameters: Impaired Glucose Tolerance (IGT), Oral Glucose Tolerance Test (OGTT). A person who has impaired glucose tolerance or fasting glucose and at high risk of developing type 2 diabetes is said to have prediabetes. Changes in lifestyle, such as losing weight and exercising or taking metformin is considered as the first line treatments for prediabetes. Nearly 8% of the world’s population is expected to have prediabetes by 2040, and 70% of those people will eventually develop type 2 diabetes. Before fully developing diabetes, most people go through a stage of prediabetes. HbA1c or fasting plasma glucose should be used to screen for diabetes in people over 40 and other high-risk individuals. Despite its preventable nature, prediabetes often goes undiagnosed, leading to delayed interventions that can result in long-term health complications. This underscores the importance of widespread awareness, effective screening methods, and access to healthcare resources for early diagnosis and management. Moreover, emerging evidence suggests a link between prediabetes and cognitive decline, indicating that the ramifications of this condition extend beyond physical health. This short overview speaks about risk factors, diagnosis and therapy of prediabetes.

Initial Experiences with Invasive Meningococcal Disease: Insights from Survivors and Their Caregivers.

Invasive meningococcal disease (IMD) has a low incidence but is a life-threatening illness with a 10-15% mortality rate. Even with timely treatment, survivors may experience acute and long-term health complications. While meningococcal vaccines are recommended for adolescents and young adults in the USA, vaccination coverage remains uneven across serotypes. This study investigated the physical, social, psychological, and economic burden of IMD on survivors and their caregivers in the USA during the acute phase (Part1, presented in this manuscript) and the long-term phase (Part2, presented in a separate manuscript) of IMD. This study implemented a non-interventional, mixed-methods approach using a bespoke survey and qualitative interviews (designed on the basis of a preliminary conceptual model of IMD) with US survivors and their caregivers. A total of 11 survivors (1 adolescent, 10 adults) and 3 caregivers participated in the study. Survivors contracted IMD during infancy (n = 2), childhood (n = 3), or adulthood (n = 6), and often described leading healthy lives pre-IMD. At IMD onset, interactions with the healthcare system impacted participants' experiences; confusion and care delays were common, and procedures were often invasive (e.g., amputations). Survivors commonly experienced symptoms including skin rash (7/11), fever (6/11), and unconsciousness (6/11), consistent with caregivers' reports. Survivors able to report on the short-term impacts of IMD (n = 9) described functional limitations (9/9), emotional impacts (6/9) such as fear and trauma, and school (6/9), work (4/9), and financial (5/9) challenges. Caregivers also experienced emotional impacts (3/3) and family (2/3), work (3/3), and financial (3/3) impacts during the acute phase. IMD places a significant humanistic burden on survivors and their caregivers during the acute phase. Results from Part1 of this study indicate a need for increased disease awareness and healthcare provider education, expeditious diagnosis, and improved access to prevention methods such as available meningococcal vaccines. A video abstract is available with this article. Video abstract (MP4 1,24,432kb).

Efficacy of digital interventions for smoking prevention among children: a systematic review

Abstract Background Smoking remains a leading preventable cause of morbidity and mortality globally, with initiation often occurring in childhood. Early smoking onset is linked to increased difficulty in quitting and higher risk of long-term health complications. Traditional prevention strategies have not fully succeeded in curbing youth smoking rates, highlighting the need for innovative approaches. Digital interventions (DI), such as gamified education, social media campaigns, and virtual reality, offer a novel avenue for engagement and education. This systematic review aims to assess the efficacy of DI in preventing smoking, and improving knowledge and awareness about smoking damages, among children. This review is part of the PRIN project, whose goal is to evaluate the effectiveness of a DI aimed at school-aged children, intended to increase knowledge about the negative effects of smoking and prevent its use. Methods On the 18th of March 2024, PubMed, Scopus, and PsycINFO were surfed for trials and observational studies evaluating DI for smoking prevention among children aged 6-12 years. Study quality will be evaluated using the Cochrane Risk of Bias Tool and New Castle-Ottawa scale. The protocol has been registered in PROSPERO. Results From 3,081 initially identified articles, 328 papers were removed because duplicate. The screening process is ongoing. Conclusions DI are a promising tool for engaging young populations through platforms they are familiar with and receptive to. By leveraging the high penetration of digital technology in the daily lives of children, these interventions have the potential to deliver smoking prevention messages in a compelling and interactive manner. Understanding the effectiveness of DI in smoking prevention can significantly contribute to public health by providing viable alternatives to traditional methods and potentially reducing future smoking-related health burdens. Key messages • Evaluating digital strategies for smoking prevention among children could offer vital alternatives to traditional methods, potentially reducing long-term health risks. • Digital interventions (DI) offer promising new ways to engage young audiences on smoking prevention using familiar platforms, potentially reshaping public health approaches.

Self-compassion as a protective factor against post-traumatic stress symptoms induced by adverse childhood experiences: A cross-sectional study among Japan air self-defense force new recruits

Adverse childhood experiences (ACEs) may result in long-term mental health complications, including post-traumatic stress disorder (PTSD). ACEs are known to be more frequent among military personnel, despite their need to maintain their mental health to accomplish their missions. Self-compassion, or treating oneself with kindness and understanding, can mitigate the psychological effects of adversity but is also affected by adversity. This cross-sectional study aimed to identify the complex relationships between ACEs, self-compassion, and PTSD symptoms among 752 new recruits of the Japan Air Self-Defense Force, of whom 537 with ACEs completed the PTSD Checklist for DSM-5. Hierarchical multiple regression analysis was used to examine the independent effect of self-compassion, measured using the Self-Compassion Scale, on PTSD symptoms. Mediation effect analysis with self-compassion as a mediator was conducted on the relationship between ACEs and PTSD symptoms. We confirmed high levels of ACEs among our participants compared to a healthy population of a previous study, and approximately 6% presented PTSD symptoms above a threshold. Self-compassion was significantly negatively associated with PTSD symptoms (β = −.22, 95% confidence interval [CI], −.34 to −.11). Mediation effect analysis revealed that self-compassion partially mediated the relationship between ACEs and PTSD symptoms, explaining 6.9% of this effect, and ACEs were negatively associated with self-compassion (β = −.13, 95% CI, −.22 to −.04). These findings suggested that self-compassion is a protective factor against PTSD symptoms, whereas ACEs can decrease self-compassion. Further research should explore educational interventions to enhance self-compassion among individuals with ACEs to mitigate PTSD symptoms.

Hypoxic Effects of Heroin and Fentanyl and Their Basic Physiological Mechanisms.

Respiratory depression that diminishes oxygen delivery to the brain is the most dangerous effect of opioid drugs. While plethysmography is a valuable tool to examine drug-induced changes in respiration, the primary cause of brain abnormalities induced by opioids is the global decrease in brain oxygen levels. The primary goal of this review is to provide an overview and discussion on fluctuations in brain oxygen levels induced by opioids, with a focus on heroin and fentanyl. To evaluate fluctuations in brain oxygen levels we used oxygen sensors coupled with high-speed amperometry in awake, freely moving rats. First, we provide an overview of brain oxygen responses induced by natural physiological stimuli and discuss the mechanisms regulating oxygen entry into brain tissue. Then, we present data on brain oxygen responses induced by heroin and fentanyl and review their underlying mechanisms. These data allowed us to compare the effects of these drugs on brain oxygen regarding their latency, potency, time-dependency, and potential lethality at high doses as well as their relationships with peripheral oxygen responses. We also discuss data on the effects of naloxone on brain oxygen responses induced by heroin and fentanyl in the paradigms of both the pre-treatment and treatment, when naloxone is administered at different times after the primary opioid drug. Although most data discussed were obtained in rats, they may have clinical relevance for understanding the mechanisms underlying the physiological effects of opioids and developing rational treatment strategies to decrease acute lethality and long-term health complications of opioid misuse.

Prevalence And Severity Of High Blood Pressure In Morocco

Background: Hypertension, also known as high blood pressure (HBP), is a chronic medical condition characterized by persistently elevated blood pressure in the arteries. Although it may not always exhibit noticeable symptoms, hypertension can lead to serious long-term health complications, including an increased risk for coronary artery disease, stroke, heart failure, atrial fibrillation, peripheral vascular disease, vision loss, chronic kidney disease, and dementia. The objective of this study is to determine the prevalence and severity of hypertension among patients in Rabat, Morocco. Methods: This is a retrospective descriptive study that included all patients diagnosed with hypertension at the Military Hospital Mohammed V of Rabat (Morocco), during the period between 2004 and 2018. A standardized questionnaire was completed for each patient. Prior to data collection, patients were informed about the objectives of the study, and measures were taken to protect their confidentiality and anonymity. The study parameters included age, gender, time elapsed since hypertension diagnosis, and hypertension severity. Results: A total of 10,929 individuals were included in the study, with half being male. The mean age of the patients was 71 ± 17 years. The age group most affected was those aged 65 years or older, representing 62% of all groups. Of the hypertensive cases, 70% were classified as moderate hypertension. Furthermore, hypertension significantly increased with age (p˂0.001). Conclusion: Adopting positive lifestyle changes and adhering to prescribed medications are key strategies that can effectively lower blood pressure and reduce the risks of severe health complications commonly associated with hypertension. Examples of effective lifestyle changes include weight loss, regular physical exercise, reduced salt and alcohol consumption, and a healthy diet. Medications for managing hypertension may also be necessary in some cases.

Hepatitis C virus infection and Parkinson’s disease: insights from a joint sex-stratified BioOptimatics meta-analysis

Hepatitis C virus (HCV) infection poses a significant public health challenge and often leads to long-term health complications and even death. Parkinson’s disease (PD) is a progressive neurodegenerative disorder with a proposed viral etiology. HCV infection and PD have been previously suggested to be related. This work aimed to identify potential biomarkers and pathways that may play a role in the joint development of PD and HCV infection. Using BioOptimatics-bioinformatics driven by mathematical global optimization-, 22 publicly available microarray and RNAseq datasets for both diseases were analyzed, focusing on sex-specific differences. Our results revealed that 19 genes, including MT1H, MYOM2, and RPL18, exhibited significant changes in expression in both diseases. Pathway and network analyses stratified by sex indicated that these gene expression changes were enriched in processes related to immune response regulation in females and immune cell activation in males. These findings suggest a potential link between HCV infection and PD, highlighting the importance of further investigation into the underlying mechanisms and potential therapeutic targets involved.

Mercury Screening for At-Risk Populations

This article discusses the risks associated with mercury exposure, particularly focusing on at-risk populations in Canada, such as those living in remote areas, individuals living near toxic spills, and those who rely on fish consumption year-round. It underlines the detrimental health effects of mercury exposure, including liver and kidney damage, neurological changes, and developmental issues. The lack of awareness and screening for elevated mercury levels is identified as a significant issue along with the need for greater education regarding possible exposures to mercury. A screening pathway is proposed to aid primary care providers in identifying individuals at risk of elevated mercury levels, with the aim of preventing long-term health complications. Overall, the paper highlights the importance of proactive measures to mitigate mercury exposure and safeguard public health.

The role of microRNAs in pregnancies complicated by maternal diabetes.

With the global prevalence of diabetes increasing, more people of reproductive age are experiencing hyperglycaemic pregnancies. Maternal Type 1 (T1DM) or Type 2 (T2DM) diabetes mellitus, and gestational diabetes mellitus (GDM) are associated with maternal cardiovascular and metabolic complications. Pregnancies complicated by maternal diabetes also increase the risk of short- and long-term health complications for the offspring, including altered fetal growth and the onset of T2DM and cardiometabolic diseases throughout life. Despite advanced methods for improving maternal glucose control, the prevalence of adverse maternal and offspring outcomes associated with maternal diabetes remains high. The placenta is a key organ at the maternal-fetal interface that regulates fetal growth and development. In pregnancies complicated by maternal diabetes, altered placental development and function has been linked to adverse outcomes in both mother and fetus. Emerging evidence suggests that microRNAs (miRNAs) are key molecules involved in mediating these changes. In this review, we describe the role of miRNAs in normal pregnancy and discuss how miRNA dysregulation in the placenta and maternal circulation is associated with suboptimal placental development and pregnancy outcomes in individuals with maternal diabetes. We also discuss evidence demonstrating that miRNA dysregulation may affect the long-term health of mothers and their offspring. As such, miRNAs are potential candidates as biomarkers and therapeutic targets in diabetic pregnancies at risk of adverse outcomes.

Impact of iron overload on incidence of diabetes mellitus, cardiac disease, and death in congenital hemolytic anemias

AbstractIron overload and its complications are recognized to be morbid and fatal in patients with congenital hemolytic anemias. In patients with iron overload caused by congenital hemolytic anemias, there has been no study evaluating the dose-response relationship between serum markers of iron overload and long-term health complications. Filling this critical gap was the aim of this study. We evaluated outcomes in a 5-hospital observational cohort study of adults with congenital hemolytic anemias diagnosed with iron overload over a 40-year period and assessed associations between depth and duration of iron overload, as well as clinical complications including diabetes, heart disease, malignancy, bone density disorders, and death. One hundred seventy patients with congenital hemolytic anemias developing iron overload were included. More years experienced of ferritin >500 ng/mL and >1000 ng/mL were associated with the development of diabetes mellitus, with adjusted odds ratios (ORs) of 2.61 per 10-year increment (P = .034) and 3.24 per 10-year increment (P = .035), respectively. More years experienced of ferritin >1000 ng/mL were associated with the development of heart disease (adjusted OR, 5.30 per 10-year increment; P = .002). Peak lifetime ferritin of >10 000 ng/mL was associated with sixfold odds of developing diabetes (P = .04) and 10-fold odds of developing heart disease (P = .007). A peak ferritin >10 000 ng/mL was associated with an increase in mortality (adjusted OR, 6.77; P = .033). In conclusion, iron overload in patients with congenital hemolytic anemias is associated with diabetes mellitus, cardiac disease, and death. Prolonged exposure to relatively modest iron overload was associated with nearly threefold increased odds of diabetes.

Evaluating the Risk-Benefit Profile of Corticosteroid Therapy for COVID-19 Patients: A Scoping Review.

The 2019 coronavirus (COVID-19) outbreak was declared a global pandemic in March 2020. It quickly spread across all continents, causing significant social, environmental, health, and economic impacts. During the pandemic, there has been consideration of repurposing and repositioning of medications, such as corticosteroids, for the treatment of hospitalised COVID-19 patients. To assess and summarise corticosteroid regimens used for hospitalised COVID-19 patients, focusing on dosage, route of administration, and clinical outcome from clinical trials. PubMed and Embase databases and the grey literature were searched to identify randomised controlled trials (RCTs) that evaluated the efficacy of corticosteroids in hospitalised patients with COVID-19 between January 2020 and January 2023. This scoping review was conducted in line with the PRISMA extension for scoping reviews (PRISMA-ScR) checklist. A total of 24 RCTs were eligible for inclusion. There was variation in the steroid regimens used for treatment across COVID-19 trials. Despite the heterogeneity of included RCTs, the overall results have shown the benefits of improving lung function and a lower all-cause mortality rate in hospitalised COVID-19 patients treated with systematic corticosteroids. Corticosteroids have proven to be an effective treatment for COVID-19 patients in critical condition. However, comparative effectiveness studies should be conducted to assess the efficacy and safety of optimal corticosteroid treatment at the population level. Moreover, the global burden of long COVID is significant, affecting millions with persistent symptoms and long-term health complications. Thus, it is also necessary to evaluate the optimal steroid regimen for long COVID treatment.

Distinct protein patterns related to postnatal development in small for gestational age preterm infants.

Preterm infants, especially those born small for gestational age (SGA), are at risk of short-term and long-term health complications. Characterization of changes in circulating proteins postnatally in preterm infants may provide valuable fundamental insights into this population. Here, we investigated postnatal developmental patterns in preterm infants and explored protein signatures that deviate between SGA infants and appropriate for gestational age (AGA) infants using a mass spectrometry (MS)-based proteomics workflow. Longitudinal serum samples obtained at postnatal days 0, 3, 7, 14, and 28 from 67 preterm infants were analyzed using unbiased MS-based proteomics. 314 out of 833 quantified serum proteins change postnatally, including previously described age-related changes in immunoglobulins, hemoglobin subunits, and new developmental patterns, e.g. apolipoproteins (APOA4) and terminal complement cascade (C9) proteins. Limited differences between SGA and AGA infants were found at birth while longitudinal monitoring revealed 69 deviating proteins, including insulin-sensitizing hormone adiponectin, platelet proteins, and 24 proteins with an annotated function in the immune response. This study shows the potential of MS-based serum profiling in defining circulating protein trajectories in the preterm infant population and its ability to identify longitudinal alterations in protein levels associated with SGA. Postnatal changes of circulating proteins in preterm infants have not fully been elucidated but may contribute to development of health complications. Mass spectrometry-based analysis is an attractive approach to study circulating proteins in preterm infants with limited material. Longitudinal plasma profiling reveals postnatal developmental-related patterns in preterm infants (314/833 proteins) including previously described changes, but also previously unreported proteins. Longitudinal monitoring revealed an immune response signature between SGA and AGA infants. This study highlights the importance of taking postnatal changes into account for translational studies in preterm infants.

Investigating the Role of Sulfur Mustard in Triggering Molecular Inflammatory Mechanisms

Sulfur mustard, a chemical warfare agent, that has been used in the Iraq-Iran conflict, exerts its devastating effects through multifaceted biochemical pathways. Its primary mode of action involves the alkylation of cellular macromolecules, particularly DNA and proteins, leading to cellular dysfunction and damage. DNA alkylation by sulfur mustard results in the formation of adducts, causing genetic mutations, chromosomal aberrations and ultimately cell death or malignant transformation. Similarly, protein alkylation disrupts cellular signaling pathways and homeostasis, contributing to tissue damage and dysfunction. Additionally, sulfur mustard exposure induces the generation of reactive oxygen species, exacerbating cellular damage, inflammation, and oxidative stress. This triggers the activation of inflammatory pathways, including NF-κB, MAPK, JAK/STAT and inflammasome activation, leading to the production of cytokines, adhesion molecules, chemokines, activator protein-1 (AP-1), and other inflammatory mediators. The inflammatory cascade initiated by sulfur mustard exposure perpetuates tissue damage, immune cell recruitment and systemic effects, enhancing acute symptoms and potential long-term health complications.

Correlation Between Serum and Tear Fluid Interleukin 6 Levels in Day and Night Shift Health Care Workers

Background: Night shift work is associated with several long-term health complications including metabolic syndrome and cardiovascular disease along with various adverse health effects. This study was planned and conducted to learn the impact of Interleukin-6 (IL-6), a chronic inflammatory cytokine among day and night shift health care workers, and to correlate the relationship between the serum and tear fluid IL 6. Aim and Objective: To correlate the relationship between serum and tear fluid Interleukin-6 (IL-6) in day and night shift healthcare workers at a tertiary care hospital. Materials and Methods: This is a Cross-Sectional study with 100 (fifty-day shift and fifty-night shift) participants including medical, paramedical students, and lab technicians. Blood and tear samples were collected from both groups. SPSS version 26.0 was used to analyze the data using Pearson’s correlation, chi-square test, and ROC. An Independent student’s t-test was used to examine the differences between the mean scores. p-value < 0.05 is considered significant. Results: Serum and tear IL-6 levels were significantly increased in night shift workers when compared to day shift workers with p-value < 0.0001. There was a positive correlation between tear and serum IL-6 levels (r value 0.732 and 0.624) among day and night shift workers respectively. A high prevalence of dry eye syndrome in night shift workers (40%) when compared to day shift workers (14%). In ROC analysis, tear IL-6 shows the highest area under the curve (0.935) compared to serum IL-6 (0.883) which reveals the superiority of tear fluid analysis and suggests that tear fluid can be used as a minimally invasive technique to analyze IL-6 alternative to serum IL-6 analysis. Conclusion: This study concludes that tear and serum Interleukin-6 (IL-6) is proportionately increased in night shift workers compared to day shift workers with a positive correlation. It also suggests that tear fluid can be used as a minimally invasive technique and a superior method to analyze IL-6.

Evaluation of Heavy Metal and Specific Trace Elements Levels Among Fast-Food Workers and Their Susceptibility to Atherosclerosis.

Fast-food workers in Iraq face significant health risks due to exposure to heavy metals from fumes and dust during cooking activities. Heavy metals, such as lead (Pb), cadmium (Cd), and nickel (Ni), are toxic to cells even at low concentrations and can cause health risks, including atherosclerosis, due to oxidative stress and reduced antioxidant activity. To the best of our knowledge, this is the first study assess the levels of heavy metals in fast-food workers and investigate their potential link to atherosclerosis development by monitoring the levels of copper (Cu), zinc (Zn), magnesium (Mg), manganese (Mn), and iron (Fe). A total of 120 male participants aged between 20 and 40 years were included in the study, with 40 fast-food workers, 40 patients with atherosclerosis, and 40 healthy individuals evaluated. The levels of Pb, Cd, Ni, Cu, Zn, Mg, Mn, and Fe in all blood samples were determined using atomic absorption spectrometry. Results showed that the fast-food worker group had significantly higher levels of Pb, Cd, Cu, and Fe compared to the healthy control group, with increases of 57%, 75%, 30%, and 55%, respectively. Conversely, their levels of Zn and Mg were significantly lower, decreasing by 15% and 16%, respectively. On the other hand, the atherosclerosis patients' group had significantly higher levels of Pb, Cd, Cu, and Fe, with increases of 47%, 74%, 34%, and 28%, respectively, as well as significantly lower levels of Zn and Mg, decreasing by 17% and 21%, respectively, compared to the control group. These findings suggest that fast-food workers are at risk of developing atherosclerosis due to exposure to high levels of heavy metals and imbalances in essential trace elements. The results showed a significant increase in the levels of Pb and Cd in the sera of these workers, which was expected because of the long duration and high intensity of exposure to toxic heavy metals. This is a serious indicator that must be considered, as it has been previously established that increased levels of Pb and Cd in the body are linked to the risk of atherosclerosis. Additionally, an association between Pb and Cd levels and an imbalance in trace element levels (Cu, Zn, Mg, and Fe) were observed. The Implementation of stricter regulations and guidelines for maintaining cleanliness and safety in fast-food restaurants may be crucial for protecting workers and preventing long-term health complications.

A single-center, assessor-blinded, randomized controlled clinical trial to test the safety and efficacy of a novel brain-computer interface controlled functional electrical stimulation (BCI-FES) intervention for gait rehabilitation in the chronic stroke population

BackgroundIn the United States, there are over seven million stroke survivors, with many facing gait impairments due to foot drop. This restricts their community ambulation and hinders functional independence, leading to several long-term health complications. Despite the best available physical therapy, gait function is incompletely recovered, and this occurs mainly during the acute phase post-stroke. Therapeutic options are limited currently. Novel therapies based on neurobiological principles have the potential to lead to long-term functional improvements. The Brain-Computer Interface (BCI) controlled Functional Electrical Stimulation (FES) system is one such strategy. It is based on Hebbian principles and has shown promise in early feasibility studies. The current study describes the BCI-FES clinical trial, which examines the safety and efficacy of this system, compared to conventional physical therapy (PT), to improve gait velocity for those with chronic gait impairment post-stroke. The trial also aims to find other secondary factors that may impact or accompany these improvements and establish the potential of Hebbian-based rehabilitation therapies.MethodsThis Phase II clinical trial is a two-arm, randomized, controlled, longitudinal study with 66 stroke participants in the chronic (> 6 months) stage of gait impairment. The participants undergo either BCI-FES paired with PT or dose-matched PT sessions (three times weekly for four weeks). The primary outcome is gait velocity (10-meter walk test), and secondary outcomes include gait endurance, range of motion, strength, sensation, quality of life, and neurophysiological biomarkers. These measures are acquired longitudinally.DiscussionBCI-FES holds promise for gait velocity improvements in stroke patients. This clinical trial will evaluate the safety and efficacy of BCI-FES therapy when compared to dose-matched conventional therapy. The success of this trial will inform the potential utility of a Phase III efficacy trial.Trial registrationThe trial was registered as ”BCI-FES Therapy for Stroke Rehabilitation” on February 19, 2020, at clinicaltrials.gov with the identifier NCT04279067.

Understanding the Health Implications of Spice Adulterations

Spice adulteration is a growing concern in India, with recent reports indicating that 15-20% of spices in the market are adulterated. This study explores the various types of spice adulteration prevalent in India, including substitution, color, weight, non-edible substance, quality degradation, chemical, and flavor adulterations. The impact of spice adulteration on human health is also examined, with a focus on the potential risks associated with consuming adulterated spices. The study draws insights from Ayurveda, which emphasizes the importance of using pure and authentic spices for their medicinal properties. The adulteration of spices not only compromises their quality and flavor but also poses significant health risks, such as exposure to toxic substances, gastrointestinal issues, and long-term health complications. The globalization of the spice trade and inadequate enforcement of regulations are identified as factors contributing to the persistence of this issue. The study highlights the need for stringent quality control measures, regular testing, and consumer awareness to combat spice adulteration.

Assessment of a community pharmacist remote monitoring service in patients using continuous glucose monitors

BackgroundDiabetes is the eighth leading cause of death and has a substantial impact on the U.S. health care system. Recent changes to major insurance formularies allow for increased access to continuous glucose monitors (CGMs). Community pharmacists routinely assist and educate patients about diabetes care, including usage of CGM. ObjectivesThe purpose of this study was to evaluate the clinical impact of a community pharmacist remote CGM monitoring service on patients’ glycemic metrics. Patient completion of comprehensive diabetes standards of care and pharmacist interventions and recommendations were assessed as secondary objectives. MethodsThis study was a prospective, feasibility study conducted at two pharmacies within 1 regional division of a large community pharmacy chain between November 2022 and June 2023. A pharmacist conducted patient enrollment visits and remotely monitored CGM glycemic metrics via cloud-based platforms per the study protocol. CGM glycemic metrics were evaluated for each patient 3 months pre- and post-study enrollment, including time above range (TAR), time in range (TIR), time below range, glucose management indicator, average glucose, CGM utilization rate, and glucose variability. Metrics were evaluated for statistical significance using the Wilcoxon signed-rank test and descriptive statistics. ResultsPharmacists enrolled 36 patients in this study with 20 patients completing the full 3-month study period per protocol. There was a statistically significant improvement in three of eight glycemic metrics (very high TAR, TIR, and average glucose). Specifically, TIR had the largest improvement from 61.8% pre-enrollment to 69.9% (P < 0.006) postenrollment. All other pertinent glycemic metrics displayed improvements but were not statistically significant. ConclusionThe results demonstrate clinically and statistically significant improvements in several glycemic metrics for patients who participated in the community pharmacist-led remote CGM monitoring service, which may result in improved diabetes control and fewer long-term diabetes-related health complications.

Exosomal small RNA profiling in first-trimester maternal blood explores early molecular pathways of preterm preeclampsia.

Preeclampsia (PE) is a severe obstetrical syndrome characterized by new-onset hypertension and proteinuria and it is often associated with fetal intrauterine growth restriction (IUGR). PE leads to long-term health complications, so early diagnosis would be crucial for timely prevention. There are multiple etiologies and subtypes of PE, and this heterogeneity has hindered accurate identification in the presymptomatic phase. Recent investigations have pointed to the potential role of small regulatory RNAs in PE, and these species, which travel in extracellular vesicles (EVs) in the circulation, have raised the possibility of non-invasive diagnostics. The aim of this study was to investigate the behavior of exosomal regulatory small RNAs in the most severe subtype of PE with IUGR. We isolated exosomal EVs from first-trimester peripheral blood plasma samples of women who later developed preterm PE with IUGR (n=6) and gestational age-matched healthy controls (n=14). The small RNA content of EVs and their differential expression were determined by next-generation sequencing and further validated by quantitative real-time PCR. We also applied the rigorous exceRpt bioinformatics pipeline for small RNA identification, followed by target verification and Gene Ontology analysis. Overall, >2700 small RNAs were identified in all samples and, of interest, the majority belonged to the RNA interference (RNAi) pathways. Among the RNAi species, 16 differentially expressed microRNAs were up-regulated in PE, whereas up-regulated and down-regulated members were equally found among the six identified Piwi-associated RNAs. Gene ontology analysis of the predicted small RNA targets showed enrichment of genes in pathways related to immune processes involved in decidualization, placentation and embryonic development, indicating that dysregulation of the induced small RNAs is connected to the impairment of immune pathways in preeclampsia development. Finally, the subsequent validation experiments revealed that the hsa_piR_016658 piRNA is a promising biomarker candidate for preterm PE associated with IUGR. Our rigorously designed study in a homogeneous group of patients unraveled small RNAs in circulating maternal exosomes that act on physiological pathways dysregulated in preterm PE with IUGR. Therefore, our small RNA hits are not only suitable biomarker candidates, but the revealed biological pathways may further inform us about the complex pathology of this severe PE subtype.

Assessment of diabetes self-care behaviors and knowledge among Marshallese adults with type 2 diabetes in the Republic of the Marshall Islands

AimsThe aim of this study is to assess and document engagement in type 2 diabetes mellitus (T2DM) self-care behaviors and self-reported diabetes knowledge among Marshallese adults living in the Republic of the Marshall Islands (RMI). MethodsThe study uses data from a T2DM health screening study completed in the RMI; survey and biometric data were captured as part of the health screenings. Study objectives were examined using descriptive statistics to describe the characteristics of the participants, their diabetes self-care behaviors, and their levels of self-reported diabetes knowledge. ResultsResults indicate many Marshallese diagnosed with T2DM did not engage in adequate self-care behaviors, including blood sugar checks and foot examinations. Participants reported having forgone needed medical care and medication due to issues with cost and/or access, and participants reported low levels of diabetes knowledge. ConclusionsThe results demonstrate the need for further work in improving engagement in diabetes self-care by Marshallese living in the RMI. Increased engagement in self-care and diabetes education programs may help Marshallese with T2DM to improve control of their glucose and avoid long-term health complications, as well as reduce costs to the healthcare system.