Search Results (27,594)

Background/Objectives: Intracranial atherosclerosis (ICAS) is a major cause of ischemic stroke, disproportionately affecting populations with significant vascular risk factors. Although ICAS imposes a considerable health burden, research on this condition in Central Asia remains scarce, especially among the Kazakh population. This study analyzes demographic characteristics, treatment outcomes, and procedural challenges associated with ICAS in 216 patients treated at a single institution. Methods: This retrospective study included patients with ≥70% intracranial artery stenosis confirmed by imaging and presenting with ischemic symptoms. All patients underwent angioplasty and stenting with dual antiplatelet therapy (DAPT). Data collected included demographics, comorbidities, stenosis characteristics, procedural details, and outcomes assessed by the modified Rankin Scale (mRS). Results: The median age was 63.5 years (IQR: 57–68.6), and 73.7% were male. Hypertension was the most common comorbidity (98%), followed by ischemic heart disease (58%) and diabetes mellitus (40.9%). Multi-location ICAS was significantly associated with patients over 75 years of age (p = 0.025). Additionally, obesity and stenosis severity greater than 70% showed trends toward significance, with p-values of 0.064 and 0.079, respectively. Stenosis predominantly affected the internal carotid artery (54.5%) and vertebrobasilar system (31.6%). The average hospital stay was longer for posterior circulation stenosis (7.1 days) compared to anterior circulation (4.7 days). The periprocedural complication rate was 0.7%, with two deaths attributed to ischemic complications. At follow-up, four patients experienced worsening mRS scores (>2), particularly those with severe stenosis in the basilar artery and M1 segment. Conclusions: ICAS in the Kazakh population is strongly associated with hypertension and aging, with posterior circulation stenosis contributing disproportionately to worse outcomes. The low complication rates highlight the safety of modern endovascular techniques. However, further research is needed to optimize treatment strategies for severe and multi-location ICAS, particularly in Central Asian populations. Full article

Objectives: Given the considerable discrepancy in the literature regarding dietary protein and glucose homeostasis, we examined the prospective association between protein intake (total, animal, plant) and risk of type 2 diabetes mellitus or impaired fasting glucose (IFG). We also examined whether these associations differed by sex, body weight, or other risk factors. Methods: We included 1423 subjects, aged ≥ 30 years, in the Framingham Offspring Study cohort. Three-day dietary records at exams 3 and 5 were used to average protein intake and then adjusted for body weight residuals. Cox proportional hazard models were used to estimate hazard ratios (HR), adjusting for anthropometric, demographic, and lifestyle factors over ~16 years of follow-up. Results: Subjects with the highest total protein intakes (≥100 g men; ≥85 g women) had a 31% lower risk of type 2 diabetes/IFG (95% CI: 0.54, 0.87). The highest (vs. lowest) category of intake of animal protein was associated with a 32% lower risk of diabetes/IFG (95% CI: 0.55, 0.83), whereas plant protein was not. Beneficial trends of total protein, especially animal, were stronger for women (HR: 0.61; 95% CI: 0.42, 0.87) than for men (HR: 0.82; 95% CI 0.58, 1.15). Subjects with lower BMI who consumed more protein had the lowest risks of diabetes/IFG. Conclusions: Overall, in this prospective study, higher intake of total dietary protein, including the consumption of animal protein, particularly among individuals with lower BMI and higher physical activity levels, was inversely associated with risk of incident type 2 diabetes and IFG. Full article

Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease (CKD) and end-stage renal disease worldwide, affecting approximately 40% of individuals with type 2 diabetes (T2DM) and 30% of those with type 1 diabetes (T1DM). As the prevalence of diabetes continues to rise, the burden of DKD is expected to grow correspondingly. This review explores the roles of key molecular pathways, including the apelinergic system, vascular endothelial growth factor (VEGF)/VEGF receptor (VEGFR) axis, and nitric oxide (NO)/nitric oxide synthase (NOS) signaling, in DKD pathogenesis and potential therapeutic applications. The apelinergic system, involving apelin and its receptor (APLNR), influences endothelial function, glucose metabolism, and renal health. Preclinical studies highlight its dual role in renal protection and injury through anti-inflammatory and antioxidant pathways, while other evidence suggests that it may exacerbate DKD through podocyte damage and angiogenesis. Similarly, the VEGF/VEGFR axis demonstrates a complex contribution to DKD, where VEGF-A promotes pathological angiogenesis and glomerular damage, but its inhibition requires careful modulation to prevent adverse effects. The NO/NOS system, integral to vascular and renal homeostasis, also exhibits altered activity in DKD, with reduced bioavailability linked to oxidative stress and inflammation. This review underscores the intricate interplay between these pathways in DKD, revealing both challenges and opportunities in their therapeutic targeting. Further research is essential to refine strategies and develop effective interventions for DKD management. Full article

The chronotype, the personal predisposition towards morning or evening activities, significantly influences health conditions, sleep, and eating regulations. Individuals with evening chronotypes are often at a higher risk for weight gain due to misalignment between their natural tendencies of functioning and social schedules, resulting in insufficient sleep, disruptions in eating habits, and decreased physical activity levels. Often, impaired glucose tolerance and changes in melatonin, adiponectin, and leptin secretion, along with alterations in the clock gene functions in subjects with evening preferences, may be predisposed to obesity. These disturbances contribute to metabolic dysregulation, which may lead to the subsequent onset of obesity complications, such as hypertension, type 2 diabetes, sleep apnea, and liver diseases. Targeting critical components of the circadian system and synchronizing people’s chronotypes with lifestyle conditions could deliver potential strategies for preventing and treating metabolic disorders. Thus, it is recommended to take a personalized chronobiological approach to maintain a normal body weight and metabolic health. Nevertheless, future studies are needed to identify the clear mechanisms between the chronotype and human health. This article provides a narrative review and discussion of recent data to summarize studies on the circadian rhythm in the context of obesity. The manuscript represents a comprehensive overview conducted between August and November 2024 using the National Library of Medicine browser (Medline, Pub-Med, Web of Science). Full article

Background/Objectives: Women with polycystic ovarian syndrome (PCOS) are at higher risk for pregnancy complications. The PCOS population is heterogeneous, with different phenotypes linked to varying risks of adverse outcomes. However, literature on pre-conceptional hyperandrogenism is limited and based on small sample sizes. Methods: This multi-institutional registry-based retrospective cohort study included pregnant patients diagnosed with PCOS with or without pre-conceptional hyperandrogenism. Utilizing the TriNetX platform, one-to-one propensity score matching was conducted to adjust for confounding factors. Exclusion criteria included multiple pregnancies and patients who received assisted reproductive technology, oral contraceptives, or spironolactone. 571 patients with PCOS and pre-conceptional hyperandrogenism and 13,465 patients with PCOS without hyperandrogenism were identified. Post-propensity matching, each cohort consisted of 564 patients. Results: Pregnant women diagnosed with PCOS and pre-conceptional hyperandrogenism showed a higher risk of large for gestational age (6.6% vs. 3.9%, OR = 1.73, 95% CI [1.007–2.972], p-value = 0.045) and preterm birth (10.3% vs. 5.9%, OR = 1.844, 95% CI [1.183–2.876], p-value = 0.006), but had no significant increase in the risk of gestational hypertension, preeclampsia/eclampsia, gestational diabetes, missed abortion, intrauterine growth restriction, placenta abruption, or cesarean section. Conclusions: Women with PCOS and pre-conceptional hyperandrogenism have an increased risk of pregnancy complications, especially large for gestational age and preterm birth. Further research is needed to clarify the underlying mechanisms, and whether treatment can improve outcomes. Full article

Diabetic foot complications pose significant health risks, necessitating innovative approaches in orthotic design. This study explores the potential of additive manufacturing in producing functional footwear components with lattice-based structures for diabetic foot orthoses. Five distinct lattice structures (gyroid, diamond, Schwarz P, Split P, and honeycomb) were designed and fabricated using stereolithography (SLA) with varying strand thicknesses and resin types. Mechanical testing revealed that the Schwarz P lattice exhibited superior compressive strength, particularly when fabricated with flexible resin. Porosity analysis demonstrated significant variations across structures, with the gyroid showing the most pronounced changes with increasing mesh thickness. Real-time pressure distribution mapping, achieved through integrated force-sensitive resistors and Arduino-based data acquisition, enabled the visualization of pressure hotspots across the insole. The correlation between lattice properties and pressure distribution was established, allowing for tailored designs that effectively alleviated high-pressure areas. This study demonstrates the feasibility of creating highly personalized orthotic solutions for diabetic patients using additive manufacturing, offering a promising approach to reducing the plantar pressure in foot and may contribute to improved outcomes in diabetic foot care. Full article

AI/AN communities are disproportionately impacted by food insecurity and gestational diabetes mellitus (GDM). Decreasing the risk of GDM can interrupt the intergenerational cycle of diabetes in AI/AN families, and can decrease diabetes-related health disparities. The goal of this study was to explore ways of supporting holistic health and reducing the risk of GDM among young American Indian and Alaska Native (AI/AN) females prior to pregnancy. Semi-structured interviews were conducted with adult AI/AN women (>18 years) who had GDM or who have young female relatives (e.g., daughters) (n = 41), AI/AN females between 12 and 24 years (n = 18), and key experts in food/nutrition and health within AI/AN communities (n = 32). Three themes emerged: (1) guidance on how to support young females’ holistic wellness; (2) evidence that generations of colonial violence, including forced removal, forced poverty, and the imposition of a Western-based food system, causes deeper, systemic fracturing of traditional cultural food knowledge and practices; and the fact that (3) opportunities for improved adolescent female health are rooted in AI/AN values and how AI/AN people resist the impacts of anti-Indigenous racism through family-based, community-led, and holistic health. These themes suggest alternative understandings about the relationships between food insecurity and holistic pre-pregnancy health and can guide our next steps in decreasing health disparities in these communities. Full article

Background and Objectives: Diabetes has become a global epidemic, contributing to significant health challenges due to its complications. Among these, diabetes can affect sight through various mechanisms, emphasizing the importance of early identification and management of vision-threatening conditions in diabetic patients. Changes in the crystalline lens caused by diabetes may lead to temporary and permanent visual impairment. Since individuals with diabetes are at an increased risk of developing cataracts, which significantly affects their quality of life, this study aims to identify the most common cataract subtypes in diabetic patients, highlighting the need for proactive screening and early intervention. Materials and Methods: This study included 201 participants with cataracts (47.6% women and 52.4% men), of whom 105 also had diabetes. With the use of machine learning, the patients were assessed and categorized as having one of the three main types of cataracts: cortical (CC), nuclear (NS), and posterior subcapsular (PSC). A Random Forest Classification algorithm was employed to predict the incidence of different associations of cataracts (1, 2, or 3 types). Results: Cataracts have been encountered more frequently and at a younger age in patients with diabetes. CC was significantly more frequent among patients with diabetes (p < 0.0001), while the NS and PSC were only marginally, without statistical significance. Machine learning could also contribute to an early diagnosis of cataracts, with the presence of diabetes, duration of diabetes, or diabetic polyneuropathy (PND) having the highest importance for a successful classification. Conclusions: These findings suggest that diabetes may impact the type of cataract that develops, with CC being notably more prevalent in diabetic patients. This has important implications for screening and management strategies for cataract formation in diabetic populations. Full article

Background/Objectives: Vitamin K deficiency in chronic kidney disease (CKD) could potentially occur due to multiple factors, leading to an increased risk of vascular and valvular calcifications. Vitamin K status can be indirectly assessed by measuring the blood levels of vitamin K-dependent proteins (VKDPs), such as matrix GLA protein (MGP). This study aims to examine the relationship between the levels of inactive MGP (dp-uc MGP) and the presence of valvular calcifications, as well as its association with mortality in hemodialysis patients. Methods: We conducted a single-center study that included 45 CKD G5D patients (hemodialysis for 6 months to 10 years) followed up for 24 months. All patients have been assessed at baseline regarding cardiovascular disease (medical history, echocardiography). Moreover, using standard methods, we determined blood biochemistry, complete blood count, and matrix GLA protein. At 24 months of follow-up, we assessed all-cause mortality and cardiovascular mortality. Results: In the studied hemodialysis patients, mean dp-uc MGP was 3285.93 +/− 2092.85 pmol/L. Patients with valvular calcifications had higher levels of dp-uc MGP compared to those without (4521.08 +/− 2263.82 vs. 2487.53 +/− 1446.94 pmol/L, however not statistically significant). The presence and severity of valvular calcifications were significantly associated with the history of treatment with vitamin K antagonists (p < 0.05). After 24 months of follow-up, we found an all-cause mortality rate of 24.4%. The level of dp-uc MGP was higher in the group of patients that died (3884.81 +/− 2439.20 vs. 3133.09 +/− 1925.26 pmol/L, p > 0.05). Patients with more than one valvular calcification on echocardiography had a significantly higher all-cause mortality risk (p = 0.04). In terms of traditional risk factors, we observed an increased risk of all-cause mortality in patients with a history of diabetes mellitus (p = 0.02) and aortic stenosis (p = 0.01). However, other cardiovascular markers, such as coronary heart disease and ejection fraction < 50%, did not have a statistically significant impact on mortality in our patients. Conclusions: In our study, we found that vitamin K deficiency, measured indirectly using the level of VKDP, especially dp-uc MGP, is a predictor of valvular calcifications. Severe valvular calcifications, aortic stenosis, and the presence of diabetes mellitus are risk factors for all-cause mortality in hemodialysis patients. Full article

Background/Objectives: This study aimed to adapt evidence-based diabetes self-management education and support (DSMES) into a faith-based (FB) context for Hispanic communities and compare its effectiveness to a faith-placed (FP) approach using the church as a venue for DSMES delivery. Methods: A cluster-randomized trial was conducted among adults with type 2 diabetes from predominantly Hispanic churches. The churches were assigned to either the FB Group (nine churches, n = 146) or the FP Group (seven churches, n = 125). The FB Group, led by trained lay health leaders, received a health sermon, a six-session DSMES program, and a seven-session Healthy Bible Study. The FP Group, led by outside health professionals, received the same six-session DSMES and a seven-session partial attention control curriculum. Key outcomes, including hemoglobin A1c (HbA1c), waist circumference (WC), diabetes distress, self-care activities, and self-efficacy, were assessed at baseline, 6, 9, and 12 months. Results: The FB Group had lower HbA1c levels than the FP Group at 6 months (−0.3%, p < 0.01), with no within-group differences post-intervention. No significant between-group differences were found for other outcomes. Within-group comparisons from baseline showed that both groups reduced WC at 9 and 12 months. Both groups showed reductions in diabetes distress and increased self-efficacy at all time points post-intervention (p < 0.05). The FB Group increased self-care scores at all time points post-intervention, while the FP Group increased at 9 and 12 months. Conclusions: DSMES can be effectively delivered in church settings by trained lay leaders or health professionals in Hispanic communities. Adding a spiritual dimension to DSMES may enhance outcomes. Full article

Objectives: The aim of this study was to evaluate which anthropometric index, either body mass index (BMI) or weight-adjusted waist index (WWI), is more accurately associated with the prevalence of the most common chronic diseases and components of geriatric assessment in hospitalized older adults. Methods: The study included a total of 2945 hospitalized older adults (median age 82 years). The associations between the presence of chronic diseases and Comprehensive Geriatric Assessment (CGA) results were compared with WWI and BMI values. Results: The WWI was significantly higher in both sex groups suffering from hypertension, diabetes, osteoarthritis, and depression. In women, the parameter was increased among individuals with previous myocardial infarction, who presented heart failure symptoms or had chronic kidney disease diagnosed, whereas in men, among those with pulmonary diseases and osteoporosis, WWI was related to many CGA parameters oftentimes where BMI proved to fail. There was a positive correlation of WWI with the presence of depressive symptoms assessed with the geriatric depression scale (GDS) but no significant correlation with BMI. In multiple logistic regression models, WWI was a stronger predictor of depression as compared to waist circumference or the waist-to-height ratio. Conclusions: There is an association between a higher WWI and depression diagnosis as well as the presence of depressive symptoms according to the GDS in hospitalized older adults, both women and men. There is no such correlation between depression and BMI. Both high BMI and high WWI values seem to identify older patients with cardiometabolic diseases such as hypertension and diabetes. According to this study, WWI seems to be a promising indicator of depression risk and, similarly to BMI, a useful parameter for the assessment of cardiometabolic risk in older hospitalized adults. Full article

Background/Objectives: Decreased muscle strength and lower hand grip strength (HGS) values are observed in patients with type 2 diabetes (T2D). This study aimed to present the values of hand grip strength as a valuable tool in T2D treatment monitoring in the context of body size and lifestyle elements in 347 patients with type 2 diabetes from Ulaanbaatar, Mongolia. Methods: A retrospective cross-sectional study was performed at hospitals in Ulaanbaatar, Mongolia. The maximum grip strengths of the right and left hands were measured three times, alternatively, using a digital hand dynamometer. The maximum grip strength of the dominant hand was used for the analysis. Results: The values of HGS in both hands dropped with increased age, systolic blood pressure (SBP), the duration of diabetes, and low glucose blood levels, whereas they increased with height. Patients who smoked had the lowest three values of HGS (the average value for each hand), whereas patients who quit smoking had the highest values. Second-order interactions between diastolic blood pressure (DBP) and sex showed a significant effect on the average HGS of both hands and for the left hand in particular (where HGS decreased only in females, whereas it increased in males). Conclusions: HGS is influenced by important socioeconomic and anthropometric factors in patients with type 2 diabetes, making it a valuable indicator of general health. Full article

Objectives: This study aims to explore perspectives and opinions from healthcare professionals and people at risk of type 2 diabetes mellitus (T2DM) to inform the design of PREDIABETEXT, a new digital multifaceted intervention to prevent T2DM. Methods: in this qualitative study, we purposefully recruited 15 healthcare professionals (doctors and nurses) working in primary healthcare centers in Mallorca (Spain), and 15 of their patients at risk of T2DM (HbA1c 6–6.4%, and/or fasting plasma glucose 110–125 mg/dL). We collected the data through semi-structured phone interviews, using an interview guide aimed at gathering participants’ views about the two PREDIABETEXT proposed co-interventions (educational intervention targeted at professionals and delivered as an online training course, and behavioral intervention targeted at individuals at risk of T2DM and delivered using SMS short text messages). The interviews were audio-recorded, verbatim transcribed, and analyzed using a thematic analysis approach. Results: Primary healthcare professionals valued a prediabetes training course for standardizing care and supporting diabetes prevention. They preferred a blended format with content on early detection, intervention, and monitoring. They perceived SMS reminders to their patients as potentially useful for reinforcing guidelines and improving care. Individuals at risk of T2DM, who faced challenges maintaining a healthy diet and exercise routine, viewed SMS as potentially motivational and informative, offering suggestions on content, format, and frequency to enhance its intended benefits. Conclusions: This qualitative study provided valuable insights from primary care professionals and people at risk of T2DM that will inform the user-centered design of the PREDIABETEXT intervention. Full article

This narrative review explores the benefits and risks of cannabinoids in kidney health, particularly in individuals with pre-existing renal conditions. It discusses the roles of cannabinoid receptor ligands (phytocannabinoids, synthetic cannabinoids, and endocannabinoids) in kidney physiology. The metabolism and excretion of these substances are also highlighted, with partial elimination occurring via the kidneys. The effects of cannabinoids on kidney function are examined, emphasizing both their potential to offer nephroprotection and the risks they may pose, such as cannabinoid hyperemesis syndrome and ischemia-reperfusion injury. These complexities underscore the intricate interactions between cannabinoids and renal health. Furthermore, this review highlights the association between chronic synthetic cannabinoid use and acute kidney injury, stressing the need for further research into their mechanisms and risks. This article also highlights the growing prevalence of edible cannabis and hemp seed consumption, emphasizing their nutritional benefits, legal regulations, and challenges such as inconsistent labeling, potential health risks, and implications for kidney health. The review delves into the roles of CB1 and CB2 receptors in diabetic nephropathy, chronic kidney disease, and obesity-related kidney dysfunction, discussing the therapeutic potential of CB2 agonists and CB1 antagonists. Additionally, it examines the potential diuretic and anti-inflammatory effects of cannabinoids in preventing kidney stones, suggesting that cannabinoids could reduce crystal retention and lower the risk of stone formation. Cannabinoids’ effects on kidneys depend heavily on the characteristics of individual substances, as synthetic cannabinoids pose a major threat to the health of users. Cannabinoids offer therapeutic potential but require more research to confirm their benefits. Distinguishing between therapeutic cannabinoids and harmful synthetic variants is crucial for safe clinical application. Full article

Adipose tissue, particularly white adipose tissue (WAT), plays a central role in energy storage and metabolic regulation. Excess WAT, especially visceral fat, is strongly linked to metabolic disorders such as obesity and type 2 diabetes. The browning of WAT, whereby white fat cells acquire characteristics of brown adipose tissue (BAT) with enhanced thermogenic capacity, represents a promising strategy to enhance metabolic health. In this study, we investigated the effects of chronic supplementation with an infusion based on lyophilized, thin nectarines rich in abscisic acid (ABA), named AbaComplex, on promoting browning of WAT and activating BAT in mice. Over 30 days, C57BL/6 mice were treated with the ABA-rich infusion, and various metabolic and molecular parameters were assessed. The results showed that the AbaComplex significantly increased the expression of browning markers, such as UCP1 and PGC1-α, in both visceral and subcutaneous WAT. Additionally, mitochondrial biogenesis and function were enhanced, evidenced by elevated mitochondrial DNA content and activity. The treatment also reduced the weight of WAT (both visceral and subcutaneous) and BAT and significantly improved glucose uptake in WAT via upregulation of GLUT4, suggesting enhanced insulin sensitivity. Overall, the pronounced browning effect in WAT underscores the potential of AbaComplex as a natural approach for combating obesity and improving metabolic health. Full article