Introduction: In uncontrolled hyperglycemia, lungs, tongue, oropharyngeal and nasopharyngeal airways having increased glycosylated angiotensin-converting enzyme 2 (ACE2) can serve as good viral ...binding sites for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leading to a greater tendency and considerable risk of prolonged life-threatening disease. This review was written with the objective to extract the recent advances, updates, and discoveries about the effects of coronavirus disease-2019 (COVID-19) on patients with diabetes and its microvascular complications. It was further written with the aim to discuss the current state of knowledge that has not yet been confirmed or unconfirmed, leading to various debatable issues about COVID-19-associated with microvascular complications in diabetes mellitus. Materials and Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched scientific sites related to our review article such as Web of Science, Embase, PubMed, Scopus, Google Scholar, and MEDLINE of last nearly two and half years. Results: The individuals who are suffering from type 2 diabetes mellitus experience more organ damage by SARS-Cov-2 due to cytokine storm. The pro-inflammatory state, lower primary immune system response, and increased ACE2 level with dysregulation of vascular function and the prothrombic state in patients with diabetes may increase the vulnerability for COVID-19 and worsened prognosis. The patients have reduced prognosis leading to microvascular complications such as diabetic nephropathy, neuropathy and retinopathy. In diabetes retinopathy, it induces the changes in the vasculature of the retinal veins. These viruses can directly affect the nervous tissue and/or can indirectly via activating the immune system-mediated mechanisms leading to diabetic neuropathy as well. Conclusions and Implications: During the cytokine storm the amount of D-dimer in the serum gets significantly increased, due to increased activating plasmin at the early stage of inflammation. Uncontrolled hyperglycemia leads to diabetic complications leading to increased mortality rate in patients with COVID-19. Thus, diabetes and its associated microvascular complications may lead to the severity and mortality in the patients with COVID-19. More of clinical practice and further studies should be implicated through this review article. Laboratory findings and clinical records are of much help in patients with diabetes and COVID-19. Worldwide studies from different countries apart from China should be considered to reach a conclusion about the conditions of patients with diabetes and microvasculature complications around the world.
Background: Type 2 diabetes mellitus (T2DM) leads to a substantial elevation in the occurrence of various micro- and macrovascular complications. Approximately one-third of patients of both type 1 ...diabetes and T2DM develop diabetes nephropathy (DN). Emerging findings in epigenetic modifications indicate that differences in DNA methylation patterns could have a more substantial impact when assessing the susceptibility to type 2 diabetes mellitus (T2DM) in contrast to genetic variations. Methods: The study involved 298 participants, encompassing 75 individuals with type 2 diabetes mellitus (T2DM), 74 individuals with diabetes nephropathy (DN), and 149 healthy control subjects aged between 20 and 70 years. The concentrations of circulating adiponectin, insulin-like growth factor (IGF) 1, and IGF2 were quantified using enzyme-linked immunoassay. The amount of RNA in each sample (control, T2DM, and DN) was quantified, and its purity was checked using nanodrop. Real-time analysis of Adiponectin, IGF1, IGF2, and GAPDH genes was conducted using the SYBR Green polymerase chain reaction Master Mix assay. Results: Circulating levels of IGF1 level were significantly lower in both T2DM and DN, whereas it was slightly higher in T2DM than the DN. IGF2 circulating level was higher in both T2DM and DN as compared to control, whereas it was lower in T2DM when compared to DN. The gene expression level of adiponectin was reduced in both T2DM and DN when compared to the control group; however, it was higher in T2DM than in DN. The gene expression level of IGF1 was decreased in both T2DM and DN compared to the control group, with a more significant decrease in DN compared to T2DM. Conclusion: The measurement of circulatory levels of adiponectin, IGF1, and IGF2 in serum, along with gene expression analysis, provides valuable insights for predicting the progression from T2DM to DN. Consequently, these markers hold the potential to enhance early diagnosis, guide treatment strategies, and serve as innovative prognostic indicators for DN diagnosis.
Abstract Background: This study investigates the impact of blue light-emitting diode (LED) lighting on the physiological responses of Wistar rats. The circadian system plays a vital role in ...regulating physiological functions, allowing organisms to anticipate and adapt to environmental rhythms. The synchronization of endogenous circadian clocks with external cues, such as light-dark cycles, is essential for optimal performance. However, emerging technologies, like blue LED lighting, present new challenges to circadian rhythms, highlighting the need for continued research in this area. Methods: The study, approved by the Animal Ethics Committee, involved a total of 12 male Wistar rats, which were divided into two groups: a Control group and a blue light (BL) treated group, each consisting of six rats. The BL model was established by subjecting the rats to 12 h of BL exposure daily for a period of 3 months. Half of the rats were sacrificed at the end of this period, while the remaining rats were transitioned to normal light (NL) conditions for another 3 months before being euthanized. Blood and tissue samples were collected for analysis, including measurements of body weight, blood glucose, insulin, melatonin, lipid profile, as well as messenger RNA expression by reverse transcription-polymerase chain reaction and global DNA methylation by enzyme-linked immunosorbent assay. Results: The study found that BL exposure led to a higher monthly increase in body weight, elevated blood glucose levels, and decreased insulin and melatonin levels compared to controls. BL also caused a decrease in total cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein. Gene expression analysis revealed downregulation of Period1, Cryptochrome1, and brain and muscle arnt-like protein 1 (Bmal1) in blood and hypothalamus, with significant upregulation upon returning to NL conditions. BL exposure induced hypermethylation in DNA sequences, which partially reverted after returning to NL conditions. Conclusion: Our study reveals the broad impact of BL/artificial light contributing to a higher incidence of obesity and metabolic disorders. With the rise of blue-rich LED lighting, more research is needed to understand its long-term effects on health. This study contributes to a deeper understanding of the intricate relationship between BL exposure and metabolic health, emphasizing the importance of informed decisions regarding lighting technologies to mitigate potential health risks.
Hepcidin is being extensively studied for anemia and inflammation in chronic kidney disease (CKD) patients. Hepcidin is thought to regulate iron metabolism by iron blockade through various ...mechanisms. Patients with CKD have early cardiac mortality due to anemia and subclinical inflammation; hence, we studied hepcidin as a biomarker in patients with early stage of CKD in relation to anemia and inflammation. In our cross-sectional study, a total of 80 patients were enrolled of whom, there were 25, 26, and 29 patients in CKD stages 1, 2, and 3, respectively. Patients were divided into normal iron level (39), functional iron deficiency (FID) (18), and absolute iron deficiency (AID) (23) based on transferrin saturation and ferritin. We found significantly high level of hepcidin (P <0.05) and high-sensitivity C-reactive protein (hsCRP) (P <0.05) in FID as compared to AID as well as normal iron level. We also found other inflammatory markers such as albumin, transferrin, and ferritin to be significantly associated with FID. In univariate analysis, hemoglobin (Hb) varied significantly with serum total iron-binding capacity (r = 0.40, P <0.001), log hsCRP (r = -0.32, P <0.01), and log ferritin (r = -0.23, P <0.05); however, Hb was not affected significantly with log hepcidin (r = -0.07, P >0.05). The study indicates that among early CKD patients with FID, there was high level of hepcidin along with other inflammatory parameters, which may be associated with poor cardiovascular disease outcome due to increased inflammation.
Background and Objectives: Insulin action of reducing blood glucose has been found to be enhanced by trace elements. Material and Methods: This was a cross sectional study including 150 patients with ...Type 2 Diabetes Mellitus (T2DM) and 50 controls. Serum concentrations of zinc, copper, chromium, selenium and magnesium was measured by colorimetric kit. Fasting Blood Glucose and Glycated Haemoglobin (HbA1c) were assayed using the standard kit. Results: Out of 150 patients, 85.4% (n = 128) of the cases had uncontrolled blood sugar with HbA1c ≥7 and only 14.6% (n = 22) had good control of blood sugar with HbA1c <7%. Hypertension (42%) and hypothyroidism (14%) were the most commonly associated comorbidities among patients with T2DM. Following percentage of diabetic patients had complications such as peripheral neuropathy (45.3%), diabetic retinopathy (36.7%), coronary artery disease (20.7%), diabetic nephropathy (17.3%), peripheral vascular disease (8.7%), and cerebrovascular accident (6%) respectively. The mean level of zinc, copper, selenium and magnesium was significantly lower in patients with T2DM than the control cases (62.89 vs. 74.95 μg/dL, P < 0.05; 116.30 vs. 150.39 μg/dL, P < 0.001; 8.57 vs. 16.16 μg/dL, P < 0.001; 1.92 vs. 2.31 mg/dL, P < 0.05, respectively). Multivariate analysis showed that there was a significant trend between levels of zinc, copper, selenium, and magnesium and the prevalence of T2DM. Conclusions: The levels of selenium, zinc, copper, and magnesium were significantly lower in patients with T2DM when compared to healthy counterparts.
Abstract Introduction: A high incidence of cardiovascular disease (CVD) events and premature mortality is observed in patients with chronic kidney disease (CKD). Thus, new biomarkers that may help ...predict the development of CVD in early stages of CKD are being investigated along with other traditional risk factors. Objective: To investigate cathepsin S as an early biomarker for CVD in patients with CKD. Methods: A total of 64 patients with CKD were included and classified into 2 groups: CKD patients with established CVD and CKD patients with non-established CVD. All patients were submitted to routine investigations including complete blood count, random blood sugar, glycated hemoglobin (HbA1c), serum electrolytes, urea, creatinine, total protein, total albumin, calcium total, phosphorous, uric acid, vitamin D, parathormone, lipid profile, liver function test, measurement of serum cathepsin S (Cat S), and 2D Echo of the heart. Results: The level of serum Cat S was increased in CKD patients with CVD (p <0.05) as well as in later stages of CKD (p <0.05). CVD was also more common in patients in early stage CKD. In early stages CKD, Cat S and CVD were positively correlated. Conclusion: These findings suggest that serum Cat S might be useful as an early biomarker for CVD in CKD patients.
Resumo Introdução: Uma alta incidência de eventos de doença cardiovascular (DCV) e mortalidade prematura é observada em pacientes com doença renal crônica (DRC). Assim, novos biomarcadores que podem ajudar a prever o desenvolvimento de DCV nos estágios iniciais da DRC estão sendo investigados juntamente com outros fatores de risco tradicionais. Objetivo: Investigar a catepsina S como um biomarcador precoce para DCV em pacientes com DRC. Métodos: Um total de 64 pacientes com DRC foram incluídos e classificados em 2 grupos: pacientes com DRC com DCV estabelecida e pacientes com DRC com DCV não estabelecida. Todos os pacientes foram submetidos a investigações de rotina incluindo hemograma completo, glicemia aleatória, hemoglobina glicada (HbA1C), eletrólitos séricos, ureia, creatinina, proteína total, albumina total, cálcio total, fósforo, ácido úrico, vitamina D, paratormônio, perfil lipídico, teste de função hepática, medição da catepsina S sérica (Cat S), e Eco 2D do coração. Resultados: O nível de Cat S sérica esteve aumentado em pacientes com DRC com DCV (p <0,05), bem como em estágios posteriores da DRC (p <0,05). A DCV também foi mais comum em pacientes com DRC em estágio inicial. Em estágios iniciais da DRC, a Cat S e a DCV foram positivamente correlacionadas. Conclusão: Estes achados sugerem que a Cat S sérica pode ser útil como um biomarcador precoce para DCV em pacientes com DRC.
Background: Liver cirrhosis is among the leading causes of morbidity and mortality worldwide. Although liver biopsy is the gold standard for the assessment of liver fibrosis in cirrhosis, it has its ...own limitations. Therefore, noninvasive methods to detect liver fibrosis are widely preferred. However, they also have their own limitations. Thus, there is always a need to extend the battery of serum-based assays. Kallistatin is a protein synthesized primarily in the liver. As it is a negative acute-phase protein, its blood level decreases with a decline in liver function. In our study, we explored the relationship between serum kallistatin and radiological evidence of liver fibrosis by transient elastography to determine if kallistatin levels can be used as a diagnostic marker of liver fibrosis. Materials and Methods: A cross-sectional study of 1-year duration was conducted at a leading tertiary care hospital in northern India. Patients between 15 and 75 years of age having evidence of chronic liver disease were enrolled. All enrolled patients were evaluated by detailed history, physical examination, and relevant investigations. Serum kallistatin levels were quantified using the ELISA method. Grading of liver fibrosis was done using transient elastography. A FibroScan scoring card was used to convert FibroScan results measured in kPa into the Metavir scale F1-F4. Results: A total of 128 subjects, including 64 patients with cirrhosis and 64 healthy controls, were enrolled. Our study suggested that FibroScan values were significantly higher in cases as compared to controls. The kallistatin level of cases was significantly lower than that of controls. An inverse correlation was found between FibroScan value and kallistatin level among cases. Conclusion: We conclude that serum kallistatin levels are low in patients with liver fibrosis and can be used as a potential marker of liver fibrosis.
Background: Coronavirus disease-19 (COVID-19) pandemic caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) is a novel disease. Objectives: Our healthcare sector is at the ...epicentre of this unprecedented global pandemic challenge and we are not fully aware of it's management. Here we have discussed our learning experience in managing and tackling the COVID-19 pandemic at our institute which will set an example for other hospitals as well as instill confidence in our primary care physicians who are the frontline warriors. Methods and Results: For combating COVID-19, dedicated teams for its management including logistic support was streamlined. Our capacity was built up for 200 isolation beds including 40 ventilator equipped beds and 645 defined quarantine rooms, to be implemented in phased manner. Till date more than 200 COVID-19 patients have been admitted here. Fever and cough were common presentations. Mortality was high in patients with advanced age or who had multiple co-morbid conditions. Efficient training and infection prevention control have resulted in a satisfactory outcome. Conclusion: In the wake of this pandemic all hospital setup, with collective responsibility should follow a specified protocol so that our hospital is not converted to the hotspot. COVID-19 has imposed a new challenge where not only patients have to be managed but our health care workers also need to be protected. Telemedicine and our primary care physicians will play a crucial role. Here at a medical institute, medical teaching, and learning atmosphere has to be created amidst the pandemic apprehension for our budding medicos.
On March 11, 2020 World Health Organization (WHO) declared corona virus disease (COVID-19) to be a pandemic disease, which is caused by a novel coronavirus "severe acute respiratory syndrome ...coronavirus-2 (SARS CoV- 2)" and till now it has affected about 213 countries. A nationwide lockdown was announced by the Honorable Prime Minister of India on 24th March 2020 for 21 days to prevent the spread of the COVID-19. Our nation, being a developing nation and emerging market, there was a vast socio-economic consequence of this lockdown. Our health care services were at the war front. Due to this step, there was a reduction in the rate of the spread of COVID- 19. Other health hazards due to pollution, road traffic accidents, crimes including robberies, rapes, murders, thefts, etc., were decreased substantially. People learned good hygiene and family bonding, which was further strengthened. Negatively affected sectors were trading companies, schools, and education, economy, stock markets, ongoing events in sports, politics, entertainment industry, transportation, and activities related to religious places, tourists, and hotels. Due to starvation, poor people were worst affected as they were daily bread earners though, the government tried to provide money and food. Finally, it was the primary care physician, termed "corona warriors," who suffered socially, economically, mentally, and physically. Despite all these hardships, the primary care physician learned the innovative way to help patients and ease their suffering with proper advice and awareness.
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