Natural product-based treatment potential for type 2 diabetes mellitus and cardiovascular disease

BACKGROUND Type 2 diabetes(T2D)is a metabolic disease of impaired glucose utilization and a major cause of cardiovascular disease(CVD).The pathogenesis of both diseases shares common risk factors and mechanisms,and both are significant contributors to global morbidity and mortality.Supplements of natural products for T2D mellitus(T2DM)and CVD can be seen as a potential preventive and effective therapeutic strategy.AIM To critically evaluate the therapeutic potential of natural products in T2D and coronary artery disease(CAD).METHODS By using specific keywords,we strategically searched the PubMed database.Randomized controlled trials(RCTs)were searched as the primary focus that examined the effect of natural products on glycemic control,oxidative stress,and antioxidant levels.We focused on outcomes such as low blood glucose levels,adjustment on markers of oxidative stress and antioxidants.After screening fulllength papers,we included 9 RCTs in our review that met our inclusion criteria.RESULTS In the literature search on the database,we found that various natural products like plant secondary metabolites play a diverse role in the management of CAD.American ginseng,sesame oil and cocoa flavanols proved effective in lowering blood glucose levels and controlling blood pressure,which are key factors in managing T2DM and CVD.In diabetic patients Melissa officinalis effectively reduce inflammation and shows diabetes prevention.Both fish oil and flaxseed oil reduced insulin levels and inflammatory markers,suggesting benefits for both conditions.The lipid profile and endothelial function were enhanced by Nigella sativa oil and Terminalia chebula,which is significant for the management of cardiovascular risk factors in T2DM.Additionally Bilberry extract also showed promise for improving glycemic control in patients with T2DM.CONCLUSION The high level of antioxidant,anti-inflammatory,and anti-angiogenic properties found in natural products makes them promising therapeutic options for the management of CAD,with the potential benefit of lowering the risk of CAD.

Emerging roles of microRNAs as diagnostics and potential therapeutic interest in type 2 diabetes mellitus

BACKGROUND Type 2 diabetes mellitus(T2DM)is a metabolic disease of impaired glucose utilization.Uncontrolled high sugar levels lead to advanced glycation end products(AGEs),which affects several metabolic pathways by its receptor of advanced glycation end products(RAGE)and causes diabetic complication.MiRNAs are small RNA molecules which regulate genes linked to diabetes and affect AGEs pathogenesis,and target tissues,influencing health and disease processes.AIM To explore miRNA roles in T2DM's metabolic pathways for potential therapeutic and diagnostic advancements in diabetes complications.METHODS We systematically searched the electronic database PubMed using keywords.We included free,full-length research articles that evaluate the role of miRNAs in T2DM and its complications,focusing on genetic and molecular disease mechanisms.After assessing the full-length papers of the shortlisted articles,we included 12 research articles.RESULTS Several types of miRNAs are linked in metabolic pathways which are affected by AGE/RAGE axis in T2DM and its complications.miR-96-5p,miR-7-5p,miR-132,has_circ_0071106,miR-143,miR-21,miR-145-5p,and more are associated with various aspects of T2DM,including disease risk,diagnostic markers,complications,and gene regulation.CONCLUSION Targeting the AGE/RAGE axis,with a focus on miRNA regulation,holds promise for managing T2DM and its complications.MiRNAs have therapeutic potential as they can influence the metabolic pathways affected by AGEs and RAGE,potentially reducing inflammation,oxidative stress,and vascular complications.Additionally,miRNAs may serve as early diagnostic biomarkers for T2DM.Further research in this area may lead to innovative therapeutic strategies for diabetes and its associated complications.

SCN1A rs6732655A/T polymorphism:Diagnostic and therapeutic insights for drug-resistant epilepsy

BACKGROUND A significant subset of individuals with epilepsy fails to respond to currently available antiepileptic drugs,resulting in heightened mortality rates,psychosocial challenges,and a diminished quality of life.Genetic factors,particularly within the SCN1A gene,and the pro-inflammatory cytokine response is important in intricating the drug resistance in idiopathic epilepsy cases.In this extended study,we determined the correlation of rs6732655A/T single nucleotide polymorphism to understand the causative association of SCN1A gene with epilepsy drug resistance and inflammatory response.AIM To find the correlation of SCN1A gene rs6732655A/T polymorphism with the drug-resistant epilepsy and inflammatory response.METHODS The study enrolled 100 age and sex-matched patients of both drug-resistant and drug-responsive epilepsy cases.We analysed the rs6732655A/T polymorphism to study its association and causative role in drug-resistant epilepsy cases using restriction fragment length polymorphism technique.The diagnostic performance of interleukin(IL)-1β,IL-6,and high mobility group box 1(HMGB1)protein levels was evaluated in conjunction with genotypic outcome receiver operating characteristic analysis.RESULTS AT and AA genotypes of rs6732655 SCN1A gene polymorphism were associated with higher risk of drug resistance epilepsy.Serum biomarkers IL-6,IL1βand HMGB1 demonstrated diagnostic potential,with cutoff values of 4.63 pg/mL,59.52 pg/mL and 7.99 ng/mL,respectively,offering valuable tools for epilepsy management.Moreover,specific genotypes(AA and AT)were found to be linked to the elevated levels of IL-1βand IL-6 and potentially reflecting increased oxidative stress and neuro-inflammation in drug-resistant cases supporting the previous reported outcome of high inflammatory markers response in drug resistance epilepsy.CONCLUSION SCN1A genotypes AA and AT are linked to higher drug-resistant epilepsy risk.These findings underscore the potential influence of inflammation and genetics on epilepsy treatment resistance.

Discovering hidden patterns:Association rules for cardiovascular diseases in type 2 diabetes mellitus

BACKGROUND It is increasingly common to find patients affected by a combination of type 2 diabetes mellitus(T2DM)and coronary artery disease(CAD),and studies are able to correlate their relationships with available biological and clinical evidence.The aim of the current study was to apply association rule mining(ARM)to discover whether there are consistent patterns of clinical features relevant to these diseases.ARM leverages clinical and laboratory data to the meaningful patterns for diabetic CAD by harnessing the power help of data-driven algorithms to optimise the decision-making in patient care.AIM To reinforce the evidence of the T2DM-CAD interplay and demonstrate the ability of ARM to provide new insights into multivariate pattern discovery.METHODS This cross-sectional study was conducted at the Department of Biochemistry in a specialized tertiary care centre in Delhi,involving a total of 300 consented subjects categorized into three groups:CAD with diabetes,CAD without diabetes,and healthy controls,with 100 subjects in each group.The participants were enrolled from the Cardiology IPD&OPD for the sample collection.The study employed ARM technique to extract the meaningful patterns and relationships from the clinical data with its original value.RESULTS The clinical dataset comprised 35 attributes from enrolled subjects.The analysis produced rules with a maximum branching factor of 4 and a rule length of 5,necessitating a 1%probability increase for enhancement.Prominent patterns emerged,highlighting strong links between health indicators and diabetes likelihood,particularly elevated HbA1C and random blood sugar levels.The ARM technique identified individuals with a random blood sugar level>175 and HbA1C>6.6 are likely in the“CAD-with-diabetes”group,offering valuable insights into health indicators and influencing factors on disease outcomes.CONCLUSION The application of this method holds promise for healthcare practitioners to offer valuable insights for enhancing patient treatment targeting specific subtypes of CAD with diabetes.Implying artificial intelligence techniques with medical data,we have shown the potential for personalized healthcare and the development of user-friendly applications aimed at improving cardiovascular health outcomes for this high-risk population to optimise the decision-making in patient care.

Role of lymphocyte-to-monocyte ratio as a predictive marker for diabetic coronary artery disease: A cross-sectional study

BACKGROUND The lymphocyte to monocyte ratio(LMR)is considered a marker of systemic inflammation in cardiovascular disease and acts as predictor of mortality in coronary artery disease.AIM To investigate the predictive role of LMR in diabetic coronary artery disease patients.METHODS This cross-sectional study was conducted at tertiary care super-specialty hospital at New Delhi,India.A total of 200 angiography-proven coronary artery disease(CAD)patients were enrolled and grouped into two categories:Group I[CAD patients with type 2 diabetes mellitus(T2DM)and glycated hemoglobin(HbA1c)levels≥6.5%],and Group II(CAD patients without T2DM and HbA1c levels<6.5%).Serum lipoproteins,HbA1c,and complete blood count of enrolled patients were analyzed using fully automatic analyzers.RESULTS The logistic regression analysis showed an odds ratio of 1.48(95%CI:1.28-1.72,P<0.05)for diabetic coronary artery disease patients(Group I)in unadjusted model.After adjusting for age,gender,diet,smoking,and hypertension history,the odds ratio increased to 1.49(95%CI:1.29-1.74,P<0.01)in close association with LMR.Further adjustment for high cholesterol and triglycerides yielded the same odds ratio of 1.49(95%CI:1.27-1.75,P<0.01).Receiver operating characteristic curve analysis revealed 74%sensitivity,64%specificity,and 0.74 area under the curve(95%CI:0.67-0.80,P<0.001),suggesting moderate predictive accuracy for diabetic CAD patients.CONCLUSION LMR showed positive association with diabetic coronary artery disease,with moderate predictive accuracy.These findings have implications for improving CAD management in diabetics,necessitating further research and targeted interventions.

Comparative analysis of Nε-carboxymethyl-lysine and inflammatory markers in diabetic and non-diabetic coronary artery disease patients

BACKGROUND Coronary artery disease(CAD)is a major cause of death worldwide,and India contributes to about one-fifth of total CAD deaths.The development of CAD has been linked to the accumulation of Nε-carboxymethyl-lysine(CML)in heart muscle,which correlates with fibrosis.AIM To assess the impact of CML and inflammatory markers on the biochemical and cardiovascular characteristics of CAD patients with and without diabetes.METHODS We enrolled 200 consecutive CAD patients who were undergoing coronary angiography and categorized them into two groups based on their serum glycosylated hemoglobin(HbA1c)levels(group I:HbA1c≥6.5;group II:HbA1c<6.5).We analyzed the levels of lipoproteins,plasma HbA1c levels,CML,interleukin-6(IL-6),tumor necrosis factor alpha(TNF-α),and nitric oxide.RESULTS Group I (81 males and 19 females) patients had a mean age of 54.2 ± 10.2 years, with a mean diabetes duration of4.9 ± 2.2 years. Group II (89 males and 11 females) patients had a mean age of 53.2 ± 10.3 years. Group I had moresevere CAD, with a higher percentage of patients with single vessel disease and greater stenosis severity in the leftanterior descending coronary artery compared to group II. Group I also exhibited a larger left atrium diameter.Group I patients exhibited significantly higher levels of CML, TNF-α, and IL-6 and lower levels of nitric oxide ascompared with group II patients. Additionally, CML showed a significant positive correlation with IL-6 (r = 0.596,P = 0.001) and TNF-α (r = 0.337, P = 0.001) and a negative correlation with nitric oxide (r=-4.16, P = 0.001). Oddsratio analysis revealed that patients with CML in the third quartile (264.43-364.31 ng/mL) were significantlyassociated with diabetic CAD at unadjusted and adjusted levels with covariates.

Insights on antioxidant therapeutic strategies in type 2 diabetes mellitus:A narrative review of randomized control trials

BACKGROUND Type 2 diabetes mellitus(T2DM)is a metabolic disease of impaired glucose utilization.Imbalance in generation and elimination of free radicals generate oxidative stress which modulates glucose metabolism and insulin regulation,resulting in the occurrence and progression of diabetes and associated complications.Antioxidant supplements in T2DM can be seen as a potential preventive and effective therapeutic strategy.AIM To compare randomized controlled trials(RCTs)in which antioxidants have been shown to have a therapeutic effect in T2DM patients.METHODS We systematically searched the electronic database PubMed by keywords.RCTs evaluating the effect of antioxidant therapy on glycaemic control as well as oxidant and antioxidant status as primary outcomes were included.The outcomes considered were:A reduction in blood glucose;changes in oxidative stress and antioxidant markers.Full-length papers of the shortlisted articles were assessed for the eligibility criteria and 17 RCTs were included.RESULTS The administration of fixed-dose antioxidants significantly reduces fasting blood sugar and glycated hemoglobin and is associated with decreased malondialdehyde,advanced oxidation protein products,and increased total antioxidant capacity.CONCLUSION Antioxidant supplements can be a beneficial approach for the treatment of T2DM.

Indian perspective on childhood malnutrition:Prevalence,pathophysiology,risk factors,and prevention

BACKGROUND Childhood malnutrition contributes over half of the childhood mortality around the world,predominantly in South-Asian and sub-Saharan countries.AIM To summarize the childhood malnutrition epidemiology along with the comorbid factors associated with it and its management within the community.METHODS The data collection process involved conducting a comprehensive search using specific keywords such as child nutrition disorders and India with Boolean operators.The search was conducted in the Scopus and PubMed electronic databases.RESULTS Inadequate energy consumption initiates pathological alterations in the form of growth retardation,fat,visceral,and muscle loss,a reduction in basal metabolic rate,and a significant reduction in total energy expenditure.It has become evident that malnutrition shows an increased prevalence and incidence rate,despite available guidelines for the management of malnutrition.CONCLUSION Malnutrition can be a major player in the establishment of severe infections that result in significant post discharge mortalities in children.Future trials are required to fill the prime gaps in knowledge regarding the identification of other contributory factors in the pathogenesis of malnutrition and postdischarge infection.New biomarkers for early detection of malnutrition should be the priority of the scientific community for the early management of malnutrition.