Myths related to eating Desserts in Diabetes – Dr Ankit Jain

Ensuring HbA1c remains below 7% is essential for people with diabetes. The HbA1c test assesses average blood sugar levels, offering a comprehensive perspective on diabetes control. This target reflects well-managed blood sugar, lowering the risk of complications like heart disease and kidney issues.

Contrary to the popular myth that individuals with diabetes cannot indulge in desserts or chocolate, it’s crucial to emphasize that moderation and mindful choices allow for enjoyment. While managing carbohydrate intake is important, incorporating treats into a well-balanced meal plan is feasible. Diabetics can savor their favorite sweets by considering portion sizes, opting for sugar-free alternatives, and monitoring blood sugar levels.

In this video, Dr Ankit Jain, physician from Delhi discusses the HbA1c test done for Diabetes and the importance of keeping the level of HbA1c below 7% while dispelling the myth that individuals with Diabetes cannot eat desserts or chocolates.

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JnJ gets USFDA nod for Bi-weekly dose of blood cancer therapy Tecvayli

United States: The U.S. Food and Drug Administration has approved a bi-weekly dose of Johnson & Johnson’s blood cancer therapy Tecvayli, the drugmaker said on Tuesday.

The approval allows the therapy to be used in a reduced dosing of 1.5 milligrams per kilogram every two weeks, in patients who have achieved and maintained a complete response or better for a minimum of six months.
Tecvayli was first approved in October 2022 for the treatment of adults with multiple myeloma that is hard to treat, or has come back after receiving at least four prior lines of certain classes of therapies.
Multiple myeloma is a type of blood cancer that affects types of white blood cells called plasma cells, found in bone marrow.
Read also: USFDA grants Breakthrough Therapy Designation for JnJ Nipocalimab for individuals at high risk for severe hemolytic disease of fetus, newborn

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Debunking myths related to eating fried food in diabetes – Dr Abhirup Banerjee

Diabetes is a chronic condition where the body either does not produce enough insulin or cannot effectively use the insulin it produces, leading to elevated levels of glucose in the blood. Managing diabetes is crucial because, over time, high blood sugar levels can cause serious health complications, including heart disease, kidney failure, vision loss, and nerve damage. Therefore, understanding and managing diabetes is essential for maintaining long-term health and quality of life.

Contrary to the popular myth that individuals with diabetes must avoid fried foods entirely, they can enjoy them in moderation with proper care. It’s important to acknowledge that fried foods are often high in unhealthy fats and calories, which can lead to blood sugar spikes. However, with mindful choices, like using healthier cooking oils, controlling portion sizes, and not making fried foods a regular part of the diet, people with diabetes can indulge occasionally without significant harm. The key is balanced meal planning and monitoring blood sugar levels to ensure that occasional treats like fried foods are accommodated within overall diabetes management.

In this video, Dr Abhirup Banerjee, an Endocrinologist from NRS Medical College Kolkata, discusses Diabetes and its complications while dispelling the myth that people with Diabetes must avoid fried food.

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Traditional health care systems has played significant role in modern age: Mansukh Mandaviya

Latur: ”The preventive and promotive approach of our traditional health care systems has played a significant role in modern age today, proving itself to be instrumental in a crisis such as the recent pandemic.” 

This was stated by Dr Mansukh Mandaviya, Union Minister for Health & Family Welfare as he inaugurated Vivekananda Cancer & Super Speciality Extension Hospital of Vivekanand Medical Foundation and Research Centre in Latur, Maharashtra yesterday in the presence of Shri Mohan Madhukar Rao Bhagwat, Sarsanghchalak, Rashtriya Swayamsevak Sangh.

Also Read:One AIIMS, One Card: Union Health Minister launches AIIMS-SBI smart card for cashless payments

Speaking on the occasion, Dr Mandaviya stressed that the world has many health models, however, India must strengthen its own health model aligned with Indian genetics, and focus on continental patterns of diseases relevant to its geography. He emphasized that “we must reflect on our roots and traditional ways of living inherent in the lifestyle, food that was that norm in those days, and therein we will find solutions to many of the health issues prevalent today.”

Reflecting on the increase in cancer and mental health patients over the last five years, the Union Minister further added, “Traditional system of living and food provide many medicinal insights and can play a pivotal role in mitigation of these alarming changes in health care scenarios.” He emphasized that India’s heritage and roots underlying India’s health model carry the knowledge to counter and treat various illness.”

Addressing the gathering, Dr Mandaviya said, “Under the visionary leadership of the Prime Minister, Shri Narendra Modi, the government strives to foster equality in healthcare services, striving to make them affordable and accessible through multitude of healthcare initiatives ensuring last-mile delivery.

Appreciating the commitment of Indian healthcare professionals towards providing service to humanity, the Union Minister said that this tradition is rooted in our age-old culture which is now recognised by the world. He said, “The COVID crisis has shown the world not only India’s strengths in medical and pharmaceutical sector but also its values of ‘Vasudhaiva Kutumbakam’. Reiterating that health is perceived as a service in India, he highlighted that nation aspires to create a people-centric, value-based system of healthcare. He further stated “Our culture taught us to serve people. Health is not a commerce but a service which is inherent in our culture.”

Underscoring India’s contribution and promotion of health services to the world, Dr Mandaviya stated “3 out of 10 medical research professionals abroad are Indians.” Dr. Mandaviya further added, “India’s medical and healthcare services extend beyond our borders, embracing the entire world.” The Union Health Minister added, “Our goal is to work holistically in the health sector with synergy between preventive healthcare and modern medical facilities and lead the momentum with Jan Andolan initiatives to ensure that healthcare reaches all in the nation.”

Also Read:Union Health Minister unveils Trauma Centre at AIIMS Bhubaneswar

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Crisaborole may significantly improve stasis dermatitis, finds innovative study

Crisaborole may significantly improve stasis dermatitis, finds aninnovative study published in the Journal of the American Academy of Dermatology.

Crisaborole ointment, 2%, is a nonsteroidal topical phosphodiesterase 4 inhibitor approved for the treatment of mild-to-moderate atopic dermatitis. A study was done to evaluate the efficacy and safety of crisaborole in stasis dermatitis (SD). In this randomized, double-blind, vehicle-controlled, decentralized phase 2a study (NCT04091087), 65 participants aged ≥45 years with SD without active ulceration received crisaborole or vehicle (1:1) twice-daily for 6 weeks. The primary end point was percentage change from baseline in total sign score at week 6 based on in-person assessment.

Results: Crisaborole-treated participants had significantly reduced total sign score from baseline versus vehicle based on in-person (nondermatologist) assessment (−32.4% vs −18.1%, P = .0299) and central reader (dermatologists) assessment of photographs (−52.5% vs −10.3%, P = .0004). Efficacy according to success and improvement per Investigator’s Global Assessment score and lesional percentage body surface area reached statistical significance based on central reader but not in-person assessments. Skin and subcutaneous tissue disorders were common all-causality treatment-emergent adverse events with crisaborole. Small sample size and short treatment duration were key limitations. In-person assessment was not conducted by dermatologists. Crisaborole improved signs and symptoms of SD and was well tolerated. Central reader assessment represents a promising approach for siteless clinical research.

Reference:

Jonathan I. Silverberg, Robert S. Kirsner, David J. Margolis, Michael Tharp, Daniela E. Myers, Karen Annis, Daniela Graham, Chuanbo Zang, Bonnie L. Vlahos, Paul Sanders,Efficacy and safety of crisaborole ointment, 2%, in participants aged ≥45 years with stasis dermatitis: Results from a fully decentralized, randomized, proof-of-concept phase 2a study,Journal of the American Academy of Dermatology,2024, ISSN 0190-9622. https://doi.org/10.1016/j.jaad.2023.12.048.(https://www.sciencedirect.com/science/article/pii/S0190962224000525)

Keywords:

Crisaborole, stasis dermatitis, Jonathan I. Silverberg, Robert S. Kirsner, David J. Margolis, Michael Tharp, Daniela E. Myers, Karen Annis, Daniela Graham, Chuanbo Zang, Bonnie L. Vlahos, Paul Sanders, crisaborole ointment, 2%, chronic venous insufficiency; crisaborole; decentralized study; phosphodiesterase-4 inhibitor; pruritus; stasis dermatitis; topical ointment; total sign score

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Removing, freezing, and then reimplanting ovarian tissue may delay menopause, finds study

Removing, freezing, and then reimplanting ovarian tissue may delay menopause suggests a new study published in the American Journal of Obstetrics and Gynecology.

Ovarian tissue cryopreservation has been proven to preserve fertility against gonadotoxic treatments. It has not been clear how this procedure would perform if planned for slowing ovarian ageing. This study aimed to determine the feasibility of cryopreserving ovarian tissue to extend the reproductive life span and delay menopause by autotransplantation near menopause. Based on the existing biological data on follicle loss rates, a stochastic model of primordial follicle wastage was developed to determine the years of delay in menopause (denoted by D) by ovarian tissue cryopreservation and transplantation near menopause. The model accounted for (1) age at ovarian tissue harvest (21–40 years), (2) the amount of ovarian cortex harvested, (3) transplantation of harvested tissues in single vs multiple procedures (fractionation), and (4) posttransplant follicle survival (40% [conservative] vs 80% [improved] vs 100% [ideal or hypothetical]). Results: The model predicted that, for most women aged <40 years, ovarian tissue cryopreservation and transplantation would result in a significant delay in menopause. The advantage is greater if the follicle loss after transplant can be minimized. As an example, the delay in menopause (D) for a woman with a median ovarian reserve who cryopreserves 25% of her ovarian cortex at the age of 25 years and for whom 40% of follicles survive after transplantation would be approximately 11.8 years, but this extends to 15.5 years if the survival is 80%. As another novel finding, spreading the same amount of tissue to repetitive transplants significantly extends the benefit. For example, for the same 25-year-old woman with a median ovarian reserve, 25% cortex removal, and 40% follicle survival, fractionating the transplants to 3 or 6 procedures would result in the corresponding delay in menopause (D) of 23 or 31 years. The same conditions (3 or 6 procedures) would delay menopause as much as 47 years if posttransplant follicle survival is improved to 80% with modern approaches. An interactive Web tool was created to test all variables and the feasibility of ovarian tissue freezing and transplantation to delay ovarian ageing (here). The model predicts that with harvesting at earlier adult ages and better transplant techniques, a significant menopause postponement and, potentially, fertile life span extension can be achieved by ovarian tissue cryopreservation and transplantation in healthy women.

Reference:

Joshua Johnson, Sean D. Lawley,John W. Emerson, Kutluk H. Modeling delay of age at natural menopause with planned tissue cryopreservation and autologous transplantation.American Journal of obstetrics and Gynecology. Published:January 04, 2024DOI:https://doi.org/10.1016/j.ajog.2023.12.037

Keywords:

Removing, freezing, and then reimplanting ovarian tissue may delay menopause, American Journal of Obstetrics and Gynecology, Joshua Johnson, Sean D. Lawley,John W. Emerson, Kutluk 

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J-shaped curve apparent between dietary thiamine and worsening mental acuity

There seems to be a J-shaped curve between dietary thiamine (vitamin B1) and worsening mental acuity among cognitively healthy older people, suggests research published in the open access journal General Psychiatry.

The sweet spot seems to be a daily intake of 0.68 mg, below which there is relatively little impact. But higher daily intake was strongly associated with cognitive decline, with the optimal maintenance dose 0.6 to less than 1 mg/day, the findings show.

Thiamine is an essential water-soluble B vitamin involved in energy metabolism and brain neurotransmitter activity. Good dietary sources include whole grains, fortified breakfast cereals, legumes, liver, and salmon.

Small previously published studies suggest that high doses can improve cognitive function in people with mild cognitive impairment or early stage dementia. But it’s not clear if usual dietary intake is associated with slowing, or speeding up, cognitive decline.

To explore this further, the researchers used publicly available data from the China Health and Nutrition Survey (CHNS), a long term multipurpose study which began in 1989, and which included nearly half the country’s population by 2011.

In 1997, 2000, 2004 and 2006, mental acuity was repeatedly assessed for cognitively healthy participants aged 55 and above. The current study is based on 3106 participants, with an average age of 63, and at least two rounds of survey data.

Information on diet was collected in each survey round, supplemented by detailed data on personal dietary intake over 24 hours on 3 consecutive days of the week, and collected in person by trained investigators. Nutrient intake was calculated using the Chinese food composition tables.

Three tests of immediate and delayed recall of a 10-word list, counting backwards from 20, and serial subtraction of 7 five times from 100, taken from the Telephone Interview for Cognitive Status–modified (TICS-m), were used to evaluate verbal memory, attention, and numerical fluency, respectively.

A higher score for each item (including verbal memory [0-20 points], attention [0-2 points] and calculation [0-5 points]) indicates better cognitive function, with a global cognitive score ranging from 0 to 27 points and also a composite score ranging from -1.82 to 1.67 standard units.

The average monitoring period was nearly 6 years, during which time a J-shaped association emerged between dietary thiamine intake and the pace of decline in cognitive function over 5 years.

Average thiamine intake was 0.93 mg/day, but the threshold seemed to be a daily intake of 0.68 mg. There was no significant association with cognitive decline below this level.

But above 0.68 mg/day, each daily unit (1 mg/day) increase in thiamine intake was associated with a significant fall of 4.24 points in the global cognitive score and 0.49 units in the composite score within 5 years. Since the global cognitive score ranges from 0 to 27 points, a decline of about 4 points means a decline in cognitive function of at least 15%

These associations were stronger among those who were obese, had high blood pressure or who were non-smokers, although after further in depth analysis, the modifying effect of high blood pressure and smoking became statistically insignificant,

To further explore the optimal range of dietary thiamine for maintaining cognitive function, intake was further divided into 0.4, 0.6, 0.8, 1, 1.2 and 1.4 mg/day.

This showed that the lowest risk was associated with a thiamine intake of 0.6 to less than 1 mg/day. Similar patterns were also observed after accounting for daily intake of other B vitamins (riboflavin and niacin) and other foods, such as red or processed meat.

None of the other variables, including age, sex, alcohol consumption and dietary intake of fat, protein or carbohydrate, significantly changed the findings.

This is an observational study, and as such, can’t establish cause, acknowledge the researchers. And 24-hour dietary recall only captures information on specific days and may not be completely accurate. The study also focused on older people in China, so the findings may not be applicable to other nationalities and age groups, they add.

“Thiamine deficiency may lead to an insufficient supply of energy to the neurons of the brain and decreased acetylcholine signalling in the brain, which may impair cognitive function,” suggest the researchers, by way of an explanation for their findings.

“If substantiated by further research, our study highlights the importance of maintaining optimal dietary thiamine intake levels in the general older population to prevent cognitive decline.”

Reference:

https://gpsych.bmj.com/lookup/doi/10.1136/gpsych-2023-101311

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Advances in pediatric sepsis biomarkers: A pediatric investigation review

Sepsis is a life-threatening condition triggered by a severe infection. Severe sepsis and septic shock are progressive stages of sepsis, associated with multi-organ failure and death. Mortality for pediatric sepsis ranges from 4% to 50%, depending on illness severity, risk factors, and geographic location. The risk of recurrence after surviving severe sepsis is significantly high in most cases.

One of the persistent challenges in treating sepsis is the lack of timely diagnosis. Non-symptomatic children can rapidly present morbid symptoms in a short span of 36 to 72 hours. Current practices rely on broad-ranged biomarkers such as CRP (C-reactive protein, an inflammation marker), PCT (procalcitonin, a pro-hormone), and lactate for the detection of sepsis. Despite recent advances in science and technology, there is currently no singular diagnostic test that reliably detects sepsis.

Their review, published in Pediatric Investigation, systematically classifies biomarkers according to the sepsis progression stage in patient samples and provides a comprehensive overview of research advancements across various omics levels. The study authors emphasize that timely and precise identification and treatment are crucial for minimizing the risk of sepsis and enhancing the prognosis. Multi-omics profiling technology, encompassing genomics, transcriptomics, proteomics, and metabolomics, is employed to identify reliable biomarkers.

The combined summary is as follows: Genomics delves into genetic variations linked to sepsis susceptibility, spotlighting primary immunodeficiency disease (PID) gene variants, along with polymorphisms in genes such as PAI-1 and CD143. Transcriptomics, focusing on transcription patterns, identifies diagnostic targets of some mRNAs or miRNAs. For proteomics, it was observed that IL-27 screening combined with procalcitonin enhanced the predictability of sepsis screening. The review also took stock of metabolites, chemicals released by cells during cellular processes, as potential biomarkers. Similar to lactate, which has already been established as a sepsis biomarker, 2-hydroxybutyrate, 2-hydroxyisovalerate, creatine, and glucose, are common metabolites that may detect sepsis severity. However, these potential sepsis biomarkers still require validation in a large patient cohort in the future.

An ideal sepsis biomarker should enable the detection of the infection group, provide insights into the progression stage of sepsis, and highlight the susceptibility of high-risk patients. Early detection of sepsis can aid in targeted treatment rather than broad-spectrum antibiotic, antiviral, or antifungal therapies.

The complexity of genomic factors and analysis of differentially expressed genes and co-expression networks reveals potential biomarkers for distinguishing pediatric sepsis patients. While high-throughput screening identifies immune factors and gene expression patterns, further validation and larger sample sizes are needed for robust biomarker assessment in pediatric sepsis. The integration of multilevel omics data, aided by artificial intelligence, holds promise for discovering sepsis biomarkers. While no single biomarker serves as the gold standard, a panel of genes or markers may enhance early diagnosis, treatment, and prognosis, emphasizing the need for further research and clinical validation.

Reference:

Xinyu Wang, Rubo Li, Suyun Qian, Dan Yu, Multilevel omics for the discovery of biomarkers in pediatric sepsis, Pediatric Investigation, https://doi.org/10.1002/ped4.12405.

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Pannexin channel protein may protect against obesity-related hypertension, researchers suggest

USA: A recent study published in Science Signaling has revealed that a pannexin channel protein may be protective against obesity-related hypertension.

Endothelial pannexin 3 (Panx3) and Bcl6 abundance were reduced in hypertensive, obese individuals, indicating that reductions in endothelial Panx3 may drive obesity-associated hypertension.

“Our findings provide insight into a channel-independent role of Panx3 wherein its interaction with Bcl6 determines vascular oxidative state, particularly under the adverse conditions of obesity,” Abigail G. Wolpe, University of Virginia School of Medicine, Charlottesville, VA, USA, and colleagues wrote.

Obesity induces endothelial dysfunction that can result in hypertension. Dr. Wolpe and the team uncovered a role for Panx3 as a scaffolding protein that limits oxidative stress in the endothelium and hypertension.

Panx3 bound to and stabilized the transcriptional repressor Bcl6, which suppressed Nox4 expression, the gene encoding a hydrogen peroxide–producing enzyme. Mice lacking Panx3 in endothelial cells or treated with a peptide that disrupted the Panx3-Bcl6 interaction demonstrated greater oxidative stress in the endothelium and developed hypertension. Furthermore, there was a decrease in Panx3 mRNA expression and Bcl6 protein abundance, and Nox4 mRNA expression was increased in mice with diet-induced obesity, but not in mice with pharmacologically induced hypertension.

In the study, the researchers report that the abundance of endothelial Bcl6 is determined by its interaction with Golgi-localized Panx3 and that Bcl6 transcriptional activity protects against vascular oxidative stress.

Key observations were as follows:

  • Consistent with data from obese, hypertensive humans, mice with an endothelial cell–specific deficiency in Panx3 had spontaneous systemic hypertension without obvious changes in channel function, as assessed by Ca2+ handling, ATP amounts, or Golgi luminal pH.
  • Panx3 bound to Bcl6, and its absence reduced Bcl6 protein abundance, suggesting that the interaction with Panx3 stabilized Bcl6 by preventing its degradation.
  • Panx3 deficiency was associated with increased gene expression encoding the H2O2-producing enzyme Nox4, normally repressed by Bcl6, resulting in H2O2-induced oxidative damage in the vasculature.
  • Catalase rescued impaired vasodilation in mice lacking endothelial Panx3. Administration of a newly developed peptide to inhibit the Panx3-Bcl6 interaction recapitulated the increase in Nox4 expression and blood pressure in mice with endothelial Panx3 deficiency.
  • Panx3-Bcl6-Nox4 dysregulation occurred in obesity-related hypertension, but not when hypertension was induced in the absence of obesity.

Using pharmacological and genetic approaches, the researchers demonstrated the Panx3-Bcl6 interaction as a regulator of vascular oxidative stress and systemic blood pressure. The study findings illuminate the dysregulation of Panx3/Bcl6/Nox4 as a pathway by which obesity can drive endothelial dysfunction and hypertension.

“Together, these data suggest that Panx3 oligomers exhibit diverse stoichiometric,” the research group concluded. “In the endothelium, there is no direct evidence for channel functionality, and we instead posit that Golgi-localized Panx3 protects against oxidative stress in the cardiovascular system through protein-protein interactions with Bcl6.”

Reference:

Wolpe, A. G., Luse, M. A., Baryiames, C., Schug, W. J., Wolpe, J. B., Johnstone, S. R., Dunaway, L. S., Juśkiewicz, Z. J., Loeb, S. A., Askew Page, H. R., Chen, L., Sabapathy, V., Pavelec, C. M., Wakefield, B., Cifuentes-Pagano, E., Artamonov, M. V., Somlyo, A. V., Straub, A. C., Sharma, R., . . . Isakson, B. E. (2024). Pannexin-3 stabilizes the transcription factor Bcl6 in a channel-independent manner to protect against vascular oxidative stress. Science Signaling. https://doi.org/adg2622

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Anorexia nervosa can be life threatening in males

Anorexia nervosa affects males as well as females, and affected males have a sixfold higher mortality rate than males in the general population. A new article published in CMAJ (Canadian Medical Association Journal) aims to raise awareness of this life-threatening eating disorder. 

“Early identification and prompt treatment are essential,” writes Dr. Basil Kadoura, a specialist in adolescent health, British Columbia Children’s Hospital and University of British Columbia, Vancouver, BC, with coauthors.

Five things to know about anorexia nervosa in males:

1.Up to 0.3% of males will be diagnosed with anorexia nervosa. Stigma, poor mental health literacy and gendered stereotypes reduce help-seeking behaviours and lead to delayed treatment and worse outcomes.

2. Certain adolescent males are at higher risk. Athletes involved in body- and strength-focused sports like cycling, running, and wrestling, are a higher risk of developing the disorder, as are racially and ethnically diverse males and gay, bisexual, trans, and queer people.

3. Screening for muscle-enhancing goals and behaviours is important to assess for anorexia nervosa. Diet changes, vomiting, over-exercising, and supplement and anabolic steroid use are potential red flags. The Muscularity Oriented Eating Test is a tool used to assess for these eating behaviours.

4. Complications can be life threatening. These include vital sign instability, slower than normal heart rate, electrolyte abnormalities and other conditions. A detailed history, physical examination and bloodwork will help identify serious medical issues and guide treatment.

5. Family-based treatment is recommended for outpatients. In this guideline-recommended approach, parents are considered experts in their adolescent and lead in re-nourishing their child.

“Most adolescent males with anorexia nervosa can be treated as outpatients with family-based treatment and ongoing medical monitoring. However, some adolescents may require treatment in hospital,” write the authors.

Reference:

Basil Kadoura, Kyle T. Ganson and Debra K. Katzman, Anorexia nervosa in adolescent males, CMAJ February 20, 2024 196 (6) E191; DOI: https://doi.org/10.1503/cmaj.230001.

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