Medicine
A Comprehensive Review on the Antimicrobial Activities and Structure-Activity Relationships (SARs) of Rhodanine Analogues
Rhodanines are five-member heterocyclics having sulfur nitrogen and oxygen atoms in their ring structure and exhibit potent as well as a broad range of pharmacological activities. They are thiazolidine derivatives and are well-known in medicinal chemistry for their wide spectrum of antimicrobial activities. Various modifications can be made to the structure of the rhodanine ring. Studies in recent years have validated the possibility of the potential of rhodanine derivatives to exhibit antimicrobial activity against both Gram-positive and Gram-negative bacterial strains as well as mycobacterial and fungal strains. In this review the synthesis biological activity and Structure-activity Relationships (SARs) of molecules based on rhodanine against different microbes have been described
Dating Violence, Lifestyle and Risk of Type 2 Diabetes in Mexican Women University Students
Dating violence is a prevalent issue among Mexican women as is the incidence and prevalence of Type 2 diabetes mellitus (T2DM). The effects of dating violence can negatively impact lifestyle and consequently increase the risk of T2DM.
This study aimed to explore the influence of dating violence on lifestyle and the risk of T2DM in women university students from Mexico.
The study employed a cross-sectional and correlational design. The study population consisted of women university students. The sample size included 255 participants. Women aged 18 to 39 with current dating relationships and residency in Mexicali Baja California Mexico were included. Data collection was conducted from February to May 2023. Correlations and multiple linear regression models were conducted.
A total of 255 women participated with an average age of 21.6 years (SD = 3.2) and 32.2% had a history of intrafamily violence during childhood. 58.8% of the participants exhibited some level of risk of T2DM and 56.7% of the lifestyle was mostly categorized as poor/fair. Detachment was the most prevalent type of dating violence followed by coercion. Dating violence was correlated with lifestyle (r = -.430) and the risk of T2DM (r = .321). In the multiple linear regression model dating violence influenced the risk of T2DM.
Women who reported higher levels of dating violence have a less healthy lifestyle and a greater risk of T2DM. It is important to consider dating violence to improve lifestyle and prevent T2DM in Mexican women university students.
Conceptual Overview of Prevalence of Prediabetes
Prediabetes increases the risk of type 2 diabetes metabolic syndrome chronic renal disease and cardiovascular disease in a person. In current practice five alternative definitions of prediabetes are utilized each based on different HbA1c fasting glucose and 2-hour glucose cut points. Prediabetes is a common condition that occurs between normal glycemia and diabetes. It is more common in elderly and obese people. The prevalence of prediabetes and diabetes can be influenced by a variety of individual family and societal variables. Additionally as diabetes is the primary contributor to non-communicable diseases (NCD) it is crucial to identify the key temporal variables for diabetes early diagnosis. In turn effective prediabetes and diabetes awareness control and preventive programs may be created by policymakers and public health professionals worldwide. Popular pathogenic pathways in prediabetes include insulin resistance inflammation and sensitivity to insulin. HBA1c OGTT and FPG are discussed as the diagnostic criteria in order of frequency. The most commonly researched therapies in the realm of prediabetes are metformin exercise and physical activity. Physiological markers including BMI blood pressure and waist circumference prompted relatively significant concern. Despite declining trends the study demonstrates that prediabetes and diabetes are widely prevalent. In order to prevent non-communicable illnesses the research suggests encouraging healthy lifestyles and regular screenings.
Analytical and Bioanalytical Methods for the Determination of Dipeptidyl Peptidase-4 Inhibitors in Various Matrices: A Comprehensive Review
DPP-4 inhibitors or gliptins are new oral antidiabetic drugs for type 2 diabetes. They help to regulate insulin and glucagon. These drugs have the advantage of a lower risk of hypoglycemia compared to some other diabetes medications and are typically prescribed when metformin and sulphonylureas have become less effective.
This review analyses a range of analytical and bioanalytical methods for DPP-4 inhibitors that use spectroscopic techniques chromatographic and hyphenated techniques for analysis. So far no review comprising all DPP-4 inhibitors has been presented. The primary objective of this review is to present the analysts with various analytical and bioanalytical methods for the quantification and estimation of DPP-4 inhibitors in different matrices.
To improve understanding a review was carried out by creating a database of pre-existing research from digital sources such as ScienceDirect and PubMed. The methodology is shown in the flowchart of the literature selection process.
The comprehensive assessment of methods for analysing DPP-4 inhibitors can be a valuable resource for researchers and healthcare practitioners. Hitherto no review encompassing all DPP-4 inhibitors has been presented. Therefore gaps in the data available on a particular subject need to be required to collect data on a particular construct. The review suggests that chromatographic techniques were majorly used for analysis wherein solvents like acetonitrile methanol and buffer solutions were used as mobile phases that can deteriorate HPLC columns and equipment. So scientists could investigate new methods for the assessment of DPP-4 inhibitors using more eco-friendly solvents.
Probiotic Supplementation during Pregnancy: Evaluating the Current Clinical Evidence against Gestational Diabetes Mellitus
Gestational diabetes mellitus (GDM) constitutes a common metabolic disorder that could lead to deleterious short- and long-term complications in both the mother and her infant. Probiotic supplementation seems to exert diverse healthy effects by acting as a preventive agent against various human diseases including GDM.
The purpose of the current narrative review was to critically summarize and scrutinize the available clinical studies during the last 15 years (2008-2023) concerning the use of probiotic supplementation during pregnancy as a protecting agent against GDM.
A thorough and in-depth search was performed in the most accurate scientific databases e.g. PubMed. Scopus Web of Science and Google Scholar applying effective and relevant keywords.
There are currently some clinical studies suggesting the potential beneficial impact of probiotic supplementation in the prevention and/or co-treatment of GDM. Nevertheless there is a high heterogeneity amongst the available clinical studies concerning the dosage the administration duration the probiotic species types the method designs and protocols and the study populations.
Probiotic supplementation at conventional dosages and in combination with a balanced healthy diet and lifestyle seems to reduce the the risk of developing GDM while ameliorating the severity of its symptoms. Further clinical studies taking into account the above considerations should be performed to establish conclusive results while the future meta-analyses should include studies with the feasibly lowest heterogeneity.
Impaired Fibroblast Growth Factor 21 (FGF21) Associated with Visceral Adiposity Leads to Insulin Resistance: The Core Defect in Diabetes Mellitus
The Central nervous system (CNS) is the prime regulator of signaling pathways whose function includes regulation of food intake (consumption) energy expenditure and other metabolic responses like glycolysis gluconeogenesis fatty acid oxidation and thermogenesis that have been implicated in chronic inflammatory disorders. Type 2 diabetes mellitus (T2DM) and obesity are two metabolic disorders that are linked together and have become an epidemic worldwide thus raising significant public health concerns. Fibroblast growth factor 21 (FGF21) is an endocrine hormone with pleiotropic metabolic effects that increase insulin sensitivity and energy expenditure by elevating thermogenesis in brown or beige adipocytes thus reducing body weight and sugar intake. In contrast during starvation conditions FGF21 induces its expression in the liver to initiate glucose homeostasis. Insulin resistance is one of the main anomalies caused by impaired FGF21 signaling which also causes abnormal regulation of other signaling pathways. Tumor necrosis factor alpha (TNF-α) the cytokine released by adipocytes and inflammatory cells in response to chronic inflammation is regarded major factor that reduces the expression of FGF21 and modulates underlying insulin resistance that causes imbalanced glucose homeostasis. This review aims to shed light on the mechanisms underlying the development of insulin resistance in obese individuals as well as the fundamental flaw in type 2 diabetes which is malfunctioning obese adipose tissue.
Risk of Type 1 Diabetes Mellitus in SARS-CoV-2 Patients
Recent studies have found that a link between people with type 1 diabetes mellitus (T1DM) are at higher risk of morbidity as well as mortality from COVID-19 infection indicating a need for vaccination. T1DM appears to impair innate and adaptive immunity. The overabundance of pro-inflammatory cytokines produced in COVID-19 illness that is severe and potentially fatal is known as a “cytokine storm.” Numerous cohorts have revealed chronic inflammation as a key risk factor for unfavorable COVID-19 outcomes. TNF-α interleukin (IL)-1a IL-1 IL-2 IL-6 and other cytokines were found in higher concentrations in patients with T1DM. Even more importantly oxidative stress contributes significantly to the severity and course of COVID-19's significant role in the progression and severity of COVID-19 diseases. Severe glucose excursions a defining characteristic of type 1 diabetes are widely recognized for their potent role as mediating agents of oxidative stress via several routes such as heightened production of advanced glycation end products (AGEs) and activation of protein kinase C (PKC). Furthermore persistent endothelial dysfunction and hypercoagulation found in T1DM may impair microcirculation and endothelium which could result in the development of various organ failure and acute breathing syndrome.
Downregulation of Tnf-α and Cat Expression in a Wistar Rat Diabetic Model during Diabetes Onset
Diabetes Mellitus (DM) is a metabolic disorder characterized by persistent hyperglycemia and/or insulin resistance. If left uncontrolled it can lead to a combination of cardiac and renal alterations known as cardiorenal syndrome. Additionally oxidative stress and inflammation contribute to tissue damage thereby reducing the life expectancy of individuals with diabetes.
The aim of this study was to identify early molecular markers associated with cardiorenal syndrome oxidative stress and inflammation and to investigate their correlation with the duration of exposure to DM.
An experimental DM model was employed using Wistar rats. The rats were divided into four groups: diabetic rats at 7 days (DM7) diabetic rats at 30 days (DM30) control sham at 7 days (CS7) and control sham at 30 days (CS30). Blood and brain tissue from the brainstem region were collected at 7 and 30 days after confirming DM induction. Gene expression analysis of Bnp Anp Cat Gpx Sod Tnf-α and Il-6 was performed.
The analysis revealed lower expression values of Cat in the brainstem tissue of the DM7 group compared to the NDS7 group. Moreover diabetic animals exhibited statistically lower levels of Tnf-α in their peripheral blood compared to the control animals.
This study concluded that DM alters the oxidative balance in the brainstem after 7 days of DM induction resulting in lower Cat expression levels. Although some genes did not show statistical differences after 30 days of DM induction other genes exhibited no expression values indicating possible gene silencing. The study identified an imbalance in the studied pathways and concluded that the organism undergoes a compensatory state in response to the initial metabolic alterations caused by DM.
Review on Advances in Pediatric Endoscopy in the Management of Inflammatory Bowel Disease
Over the past decades an increased importance has been given to gastrointestinal (GI) endoscopy in the management of children with inflammatory bowel diseases (IBD) considering that mucosal healing has been recognized as the optimal endpoint in the treat-to-target paradigm. The recent advances in technology and anesthesia have facilitated the comprehensive evaluation of the GI tract. In this review we will discuss the role of ileocolonoscopy upper GI endoscopy and device-assisted enteroscopy in the work-up and management of pediatric Crohn’s disease (CD) and ulcerative colitis with particular attention on non-invasive endoscopic techniques such as wireless capsule endoscopy. We will also analyze the most commonly used endoscopic scoring systems including small bowel scoring systems and endoscopic recurrence grading of neo-terminal ileum CD. Moreover we will focus on the endoscopic management of complications such as strictures that commonly require surgery. Lastly we will discuss cancer surveillance in children with IBD with particular consideration of the role of high-definition endoscopic equipment and chromoendoscopy in dysplasia detection rates.
Effect of Per and Poly-fluoroalkyl Substances on Pregnancy and Child Development
Childhood obesity is significantly influenced by maternal exposure to Per and Poly-Fluoroalkyl Substances (PFAS) during pregnancy. PFAS exposure occurs through the Peroxisome Proliferator-Activated Receptor (PPAR-γ) receptor leading to increased fat deposition and profound health effects in child growth and development. Despite ongoing investigations the relationship between maternal serum PFAS concentration and child obesity requires further exploration.
This study aimed to review the possible effects of Per and poly-fluoroalkyl substances exposure and their mechanism in overweight/obese children from pregnant ladies.
A detailed literature survey was conducted using online databases including Science Direct Google Scholar Scopus Cochrane and PubMed. The study focused on the diverse effects of PFAS on maternal and child health with particular emphasis on neurological complications.
Child growth development depends upon breastfeeding and placenta health which is disrupted by PFAS exposure ultimately destroying the body mass index of the child. Neurotoxicity testing utilized the SH-SY5Y human-derived cell line as an in vitro model revealing PFAS-induced increases in adipocyte number reduced cell size altered lipid conglomeration increased adiposity and changes in liver function. in vivo studies in mice and human cell lines indicated PPAR-γ and ER-α activation leading to adiposity and weight gain through Estrogen signaling and Lipid metabolism. PFAS concentrations positively correlated in maternal sera analyzed by liquid chromatography/quadrupole mass spectrometry.
PFAS with a long half-life of 3.5-8.5 years is commonly found in the serum of pregnant women crossing the placenta barrier. This exposure disrupts placental homeostasis negatively impacting mechanisms of action and potentially leading to deterioration in pregnancy and child health. Further research is needed to comprehensively understand the complex interplay between PFAS exposure and its implications for maternal and child well-being.
Prevalence and Outcomes of Infections in Critically-ill Paediatric Oncology Patients: A Retrospective Observation Study
The survival of paediatric oncology patients has improved substantially in the past decades due to advances in the field of oncology. Modern cancer treatments often come with life-threatening complications of which infection is one of the most common causes in this patient population. This study aims to investigate the prevalence and outcomes of common infections in haemato-oncology patients during their stay in paediatric intensive care unit (PICU) and to identify any factors associated with these infections.
A retrospective observational study was conducted on all children with a haemato-oncology diagnosis or who underwent haematopoietic stem cell transplantation (HSCT) and who were admitted to the Hong Kong Children’s Hospital PICU over a one-year period. Infection characteristics and patient outcomes were evaluated and compared between different sub-groups. Univariable and multi-variable analyses were employed to identify risk factors associated with the development of active infection.
Forty-five (36.3%) of 124 critically ill haemato-oncology admissions to PICU were associated with infections of which 31 (25%) admissions involved bacterial infections 26 (20.9%) involved viral infections and 6 (4.8%) involved fungal infections. Bloodstream infection was the most common type of infection. More than half (61.3%) of the bacterial infections were due to an antibiotic-resistant strain. After adjusting for confounding variables post-HSCT status and neutropenia were significantly associated with active infections.
Infections in critically-ill haemato-oncological patients are associated with post haematopoietic stem cell transplant status and neutropenia. Further study is warranted to review effective strategies that may mitigate the likelihood of infection in this patient population.
Iodine Status in Cyprus and Neighboring Countries: A Review Article
Despite the implementation of global iodine supplementation initiatives in the past decade the problem of iodine deficiency persists as a significant public health concern in numerous countries. Although cretinism is now rare in developed countries iodine deficiency can still lead to less severe cognitive deficits which can negatively impact academic achievement intellectual capacity and work productivity. There is a scarcity of studies regarding the status of Cyprus and the global database does not have any information pertaining to the prevalence of iodine deficiency in Cyprus. The geographical setting of the research is of importance as it pertains to the separation of Cyprus into two distinct areas. One region is predominantly inhabited by Greek Cypriots where the practice of salt iodization is not mandatory. Conversely the other region is primarily inhabited by Turkish Cypriots who may potentially experience higher amounts of iodine contact due to their reliance on food imports from Turkey where salt-iodisation is compulsory. The main objective of this study is to provide an overview of recent research conducted on the prevalence of iodine deficiency in Cyprus and neighboring Mediterranean nations. In this study we assess the current method and subsequently offer public health recommendations for future research endeavors.
Clinical Picture, Diagnosis, Management of NEC, and Effects of Probiotics on its Prevention: A Narrative Review
Preterm newborns represent a population at risk of developing intestinal dysbiosis as well as being predisposed to sepsis and Necrotizing Enterocolitis. Necrotizing Enterocolitis is a condition burdened by many complications and mortality due to an alteration of the intestinal barrier an immaturity of the immune system and intestinal dysbiosis. Low gestational age at birth low birth weight and early use of antibiotics are other predisposing factors. Instead breast milk and probiotics are protective factors in providing intestinal homeostasis and microbiome regulation. In this mini-review we analysed the protective role of probiotics in the onset of Necrotizing Enterocolitis in preterm populations.
Laryngeal Mask for Minimally-invasive Surfactant Administration: A Narrative Review
The cornerstone of treatment for respiratory distress syndrome in preterm infants is surfactant administration traditionally performed through an invasive procedure involving tracheal intubation and mechanical ventilation. Consequently there has been a growing interest in exploring less invasive methods of surfactant delivery to mitigate the associated risks. Currently several techniques are under evaluation including intratracheal instillation using a thin catheter aerosolized or nebulized administration and guided administration by supraglottic airway devices. One such method is surfactant administration through laryngeal or supraglottic airway which involves placing a laryngeal mask without the need for laryngoscopy and administering surfactant through the device. The simplicity of laryngeal mask insertion could potentially streamline the surfactant delivery process eliminating the necessity for advanced skills. This narrative review aimed to assess the current evidence in the literature regarding the benefits and risks associated with surfactant administration through a laryngeal supraglottic airway.
Prevalence of Bruxism in Children and Adolescents with Cerebral Palsy: Systematic Review and Meta-analysis
To perform a systematic review and meta-analysis compiling data on the prevalence of bruxism in children and adolescents with cerebral palsy.
Searches were carried out in PubMed/Medline Web of Science and Scopus databases to identify the articles published by February 2023. Two independent reviewers and in duplicate employed a two-stage process to select publications. The same two reviewers performed the data extraction. Studies were included when the following eligibility criteria were met: performed in children and/or adolescents with cerebral palsy and reporting bruxism. Potentially eligible studies were read in full and excluded that: not presented numerical data on the prevalence of bruxism; not reported how the bruxism was assessed; not reported data about the cerebral palsy; and not an observational study. The risk assessment of bias was assessed by the Newcastle-Ottawa Scale. After reading the titles and abstracts of the 358 identified articles eight articles from 1966 to 2020 were included. The main reason for not including the studies was not to report data about bruxism (59.3%) and 44.5% were excluded for not reporting data from patients with cerebral palsy. The studies were carried out in schools university hospitals or centers for patients with special needs (Brazil the United States and Egypt). The pooled prevalence of bruxism in children and adolescents with cerebral palsy was 46% (95%CI: 0.38-0.55) after removing one study.
The pooled prevalence of bruxism in children with cerebral palsy can be considered high since almost half of the studied population is affected by this condition. PROSPERO #CRD42021225781.
CRD42021225781.
Malignant and Benign Head and Neck Tumors of the Pediatric Age: A Narrative Review
Malignant tumors of the head and neck are rare in children but it is important to know these lesions and identify them early in order to have a good outcome for these patients. Benign lesions of the head and neck are much more frequent and have an excellent prognosis. For this reason it is necessary to recognize the warning signs and symptoms and understand when to refer the patient to a reference center for the treatment of these pathologies. The clinical presentation of both benign and malignant lesions in children may be similar as usually both categories have compressive effects. This confirms the fact that the clinical diagnosis is not sufficient and always requires instrumental investigations and biopsies. In this narrative review we analyzed both malignant lesions such as lymphoma rhabdomyosarcoma thyroid tumors salivary gland tumors neuroblastoma and nasopharyngeal carcinoma and benign ones such as cystic dermoid teratoma hemangioma juvenile angiofibroma and fibrosis dysplasia. Indeed we set out to discuss the most common lesions of this site by evaluating their characteristics to highlight the differentiation of malignant tumors from benign lesions and their correct clinical-therapeutic management. A literature search was carried out in the PubMed and Google Scholar databases to identify all narrative reviews addressing malignant and benign head and neck tumors of the pediatric age. In conclusion the care of children affected by head and neck benign lesions and malignancy must be combined and multidisciplinary. It is essential to recognize the diseases early in order to differentiate and intervene as soon as possible for the correct clinical-therapeutic management.
Comparison of the Effectiveness of Beraksurf and Curosurf Exogenous Surfactants in the Treatment of Respiratory Distress Syndrome in Preterm Neonates: A Double-blind Randomized Study in the West of Iran
To date few studies have compared the effectiveness of exogenous surfactant therapy with Curosurf and Beraksurf in the treatment of respiratory distress syndrome (RDS) in preterm neonates.
Since surfactant has a significant impact on the treatment of neonates with RDS this study was conducted to introduce a more effective method for treating preterm neonates with RDS.
The present clinical trial was conducted on 140 preterm neonates with RDS in the NICU department of two specialized university hospitals in Hamadan western Iran. In one group we used the Iranian-made surfactant Beraksurf and in another group we used the Italian-made surfactant Curosurf. In the end the checklist for the two groups was completed. Data analysis was performed using SPSS version 22 and a significance level of 5% was considered for all tests.
The comparison of the frequency distribution of maternal corticosteroid administration response to treatment and need for re-intubation associated disorders and mortality among neonates of the two groups of Beracsurf and Curosurf surfactant did not show a significant difference (p=0.962 0.763 0.725 and 0.149 respectively). Further the comparison of the mean number of days requiring respiratory support days free from respiratory support and hospitalization days among neonates of the two groups of Beracsurf and Curosurf surfactant injection did not show a significant difference (p=0.910 0.725 and 0.898 respectively). Additionally the comparison of the time of initiation of feeding and the time of reaching maximum feeding among neonates of the two groups of Beracsurf and Curosurf surfactant injection also did not show significant differences (p=0.881 and 0.903 respectively).
Based on the fact that Beracsurf and Curosurf surfactants did not show significant differences in the treatment outcomes of RDS in preterm neonates it is suggested that the Iranian- made surfactant Beracsurf should be used for the treatment of these neonates due to its cost-effectiveness and availability compared to Curosurf.
IRCT20200812048381N1.
Brain-derived Neurotrophic Factor Level and Gene Polymorphism as Risk Factors for Depression in Patients with type 2 Diabetes Mellitus- A Case-Controlled Study
Diabetes mellitus and depression are comorbidities that can be caused by each other. Brain-derived neurotrophic factor (BDNF) functions as a neuronal growth factor. It maintains the functional integrity of the nervous system.
To study the possible association between BDNF levels and gene polymorphism with depression in patients diagnosed with type 2 diabetes mellitus.
The Elisa technique measured BDNF and rs6265 gene polymorphism was detected using real-time PCR. Depression was assessed utilizing a clinical interview tool designed to establish the diagnosis of depression and differentiate it from other psychiatric diseases.
BDNF levels were significantly lower in patients with type 2 diabetes mellitus and symptoms of depression than in patients with type 2 diabetes mellitus and no symptoms of depression (82.6±16.1. vs. 122± 17.47 P˂ 0.001). There was a statistically significant difference in BDNF levels in patients with diabetes among the three genotypes of the BDNF gene (P-value < 0.001). Val/ Val carriers had the highest serum BDNF levels and Met/ Met carriers had the lowest serum BDNF levels. Subgroup analysis showed statistically significant genotype-related differences in serum BDNF levels among the three subgroups in the Depression group. Val/ Val carriers had the highest serum BDNF levels and Met/ Met carriers had the lowest serum BDNF levels. BDNF Val66Met polymorphism had no significant association with the presence of depression yet there was a trend towards significance (p = 0.05).
In this pilot Low levels of BDNF were associated with depression in patients with type 2 diabetes. Carriers of the Met/ Met allele have the lowest serum BDNF levels. Multi-center studies with more participants are required.
Stem Cells Reprogramming in Diabetes Mellitus and Diabetic Complications: Recent Advances
The incidence of diabetes mellitus (DM) is dramatically increasing worldwide and it is expected to affect 700 million cases by 2045. Diabetes influences health care economics human quality of life morbidity and mortality which were primarily seen extensively in developing countries. Uncontrolled DM which results in consistent hyperglycemia may lead to severe life-threatening complications such as nephropathy retinopathy neuropathy and cardiovascular complications.
In addition to traditional therapies with insulin and oral anti-diabetics researchers have developed new approaches for treatment including stem cell (SC) therapy which exhibits promising outcomes. Besides its significant role in treating type one DM (T1DM) and type two DM (T2DM) it can also attenuate diabetic complications. Furthermore the development of insulin-producing cells can be achieved by using the different types of SCs such as embryonic stem cells (ESCs) induced pluripotent stem cells (iPSCs) and multiple types of adult stem cells such as pancreatic hepatic and mesenchymal stem cells (MSC). All these types have been extensively studied and proved their ability to develop insulin-producing cells but every type has limitations.
This review aims to enlighten researchers about recent advances in stem cell research and their potential benefits in DM and diabetic complications.