Diabetes mellitus(DM)is characterized by persistently elevated blood glucose concentration that lead to multisystem complications.There are about 400 medicinal plants cited to have a beneficial effect on DM.We must ch...Diabetes mellitus(DM)is characterized by persistently elevated blood glucose concentration that lead to multisystem complications.There are about 400 medicinal plants cited to have a beneficial effect on DM.We must choose products wisely based on data derived from scientific studies.However,a major obstacle in the amalgamation of herbal medicine in modern medical practices is the lack of clinical data on its safety,efficacy and drug interaction.Trials of these herbal products often underreport the side effects and other crucial intervention steps deviating from the standards set by Consolidated Standards of Reporting Trials.Due to a lack of knowledge of the active compounds present in most herbal medicines,product standardization is difficult.Cost-effectiveness is another issue that needs to be kept in mind.In this mini-review,we focus on the antihyperglycemic effect of herbal products that are commonly used,along with the concerns stated above.展开更多
Chronic pancreatitis(CP)is characterized by progressive inflammation and fibrosis of the pancreas that eventually leads to pancreatic exocrine and endocrine insufficiency.Diabetes in the background of CP is very diffi...Chronic pancreatitis(CP)is characterized by progressive inflammation and fibrosis of the pancreas that eventually leads to pancreatic exocrine and endocrine insufficiency.Diabetes in the background of CP is very difficult to manage due to high glycemic variability and concomitant malabsorption.Progressive beta cell loss leading to insulin deficiency is the cardinal mechanism underlying diabetes development in CP.Alpha cell dysfunction leading to deranged glucagon secretion has been described in different studies using a variety of stimuli in CP.However,the emerging evidence is varied probably because of dependence on the study procedure,the study population as well as on the stage of the disease.The mechanism behind islet cell dysfunction in CP is multifactorial.The intra-islet alpha and beta cell regulation of each other is often lost.Moreover,secretion of the incretin hormones such as glucagon like peptide-1 and glucose-dependent insulinotropic polypeptide is dysregulated.This significantly contributes to islet cell disturbances.Persistent and progressive inflammation with changes in the function of other cells such as islet delta cells and pancreatic polypeptide cells are also implicated in CP.In addition,the different surgical procedures performed in patients with CP and antihyperglycemic drugs used to treat diabetes associated with CP also affect islet cell function.Hence,different factors such as chronic inflammation,dysregulated incretin axis,surgical interventions and anti-diabetic drugs all affect islet cell function in patients with CP.Newer therapies targeting alpha cell function and beta cell regeneration would be useful in the management of pancreatic diabetes in the near future.展开更多
Pancreatic cancer(PC)is often associated with a poor prognosis.Long-standing diabetes mellitus is considered as an important risk factor for its development.This risk can be modified by the use of certain antidiabetic...Pancreatic cancer(PC)is often associated with a poor prognosis.Long-standing diabetes mellitus is considered as an important risk factor for its development.This risk can be modified by the use of certain antidiabetic medications.On the other hand,new-onset diabetes can signal towards an underlying PC in the elderly population.Recently,several attempts have been made to develop an effective clinical tool for PC screening using a combination of history of new-onset diabetes and several other clinical and biochemical markers.On the contrary,diabetes affects the survival after treatment for PC.We describe this intimate and complex two-way relationship of diabetes and PC in this review by exploring the underlying pathogenesis.展开更多
Incretin-based therapies like glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors help maintain the glycaemic control in patients with type 2 diabetes mellitus with additional systemic bene...Incretin-based therapies like glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors help maintain the glycaemic control in patients with type 2 diabetes mellitus with additional systemic benefits and little risk of hypoglycaemia.These medications are associated with low-grade chronic pancreatitis in animal models inconsistently.The incidence of acute pancreatitis was also reported in some human studies.This inflammation provides fertile ground for developing pancreatic carcinoma(PC).Although the data from clinical trials and population-based studies have established safety regarding PC,the pathophysiological possibility that low-grade chronic pancreatitis leads to PC remains.We review the existing literature and describe the relationship between incretin-based therapies and PC.展开更多
BACKGROUND Acute pancreatitis(AP)presenting as an initial manifestation of primary hyperparathyroidism(PHPT)is uncommon,and its timely diagnosis is crucial in preventing recurrent attacks of pancreatitis.AIM To determ...BACKGROUND Acute pancreatitis(AP)presenting as an initial manifestation of primary hyperparathyroidism(PHPT)is uncommon,and its timely diagnosis is crucial in preventing recurrent attacks of pancreatitis.AIM To determine the clinical,biochemical,and radiological profile of PHPT patients presenting as AP.METHODS This is a retrospective observational study,51 consecutive patients admitted with the diagnosis of PHPT during January 2010 and October 2021 at a tertiary care hospital in Puducherry,India was included.The diagnosis of AP was established in the presence of at least two of the three following features:abdominal pain,levels of serum amylase or lipase greater than three times the normal,and characteristic features at abdominal imaging.RESULTS Out of the 51 consecutive patients with PHPT,twelve(23.52%)had pancreatitis[5(9.80%)AP,seven(13.72%)chronic pancreatitis(CP)].PHPT with AP(PHPT-AP)was more common among males with the presentation at a younger age(35.20±16.11 vs 49.23±14.80 years,P=0.05)and lower plasma intact parathyroid hormone(iPTH)levels[125(80.55-178.65)vs 519.80(149-1649.55,P=0.01)]compared to PHPT without pancreatitis(PHPT-NP).The mean serum calcium levels were similar in both PHPT-AP and PHPT-NP groups[(11.66±1.15 mg/dL)vs(12.46±1.71 mg/dL),P=0.32].PHPT-AP also presented with more gastrointestinal symptoms like abdominal pain,nausea,and vomiting with lesser skeletal and renal manifestations as compared to patients with PHPT-NP.CONCLUSION AP can be the only presenting feature of PHPT.Normal or higher serum calcium levels during AP should always draw attention towards endocrine causes like PHPT.展开更多
Dipeptidyl peptidase-4 inhibitors(DPP-4i)have an important place in the management of type 2 diabetes.The DPP-4 enzyme is ubiquitously distributed throughout the human body and has multiple substrates through which it...Dipeptidyl peptidase-4 inhibitors(DPP-4i)have an important place in the management of type 2 diabetes.The DPP-4 enzyme is ubiquitously distributed throughout the human body and has multiple substrates through which it regulates several important physiological functions.DPP-4 regulates several immune functions,including T-cell activation,macrophage function,and secretion of cytokines.Studies have reported an increase in autoimmune diseases like bullous pemphigoid,inflammatory bowel disease,and arthritis with DPP-4i use.The relationship of DPP-4i and autoimmune diseases is a complex one and warrants further research into the effect of DPP-4 inhibition on the immune system to understand the pathogenesis more clearly.Whether a particular cluster of autoimmune diseases is associated with DPP-4i use remains an important contentious issue.Nevertheless,a heightened awareness from the clinicians is required to identify and treat any such diseases.Through this review,we explore the clinical and pathophysiological characteristics of this association in light of recent evidence.展开更多
Metformin is the first-line drug for the treatment of type 2 diabetes mellitus,but its role in gestational diabetes mellitus(GDM)management is not clear.Recent evidence suggests a certain beneficial effect of metformi...Metformin is the first-line drug for the treatment of type 2 diabetes mellitus,but its role in gestational diabetes mellitus(GDM)management is not clear.Recent evidence suggests a certain beneficial effect of metformin in the treatment of GDM,but a high treatment failure rate leads to the initiation of additional medications,such as insulin.Moreover,since metformin crosses the placental barrier and reaches a significant level in the fetus,it is likely to influence the fetal metabolic milieu.The evidence indicates the long-term safety in children exposed to metformin in utero except for mild adverse anthropometric profiles.Diligent follow-up of metformin-exposed offspring is warranted from the clinician’s point of view.展开更多
Ocular cells like,retinal pigment epithelium(RPE)is a highly specialized pigmented monolayer of post-mitotic cells,which is located in the posterior segment of the eye between neuro sensory retina and vascular choroid...Ocular cells like,retinal pigment epithelium(RPE)is a highly specialized pigmented monolayer of post-mitotic cells,which is located in the posterior segment of the eye between neuro sensory retina and vascular choroid.It functions as a selective barrier and nourishes retinal visual cells.As a result of high-level oxygen consumption of retinal cells,RPE cells are vulnerable to chronic oxidative stress and an increased level of reactive oxygen species(ROS)generated from mitochondria.These oxidative stress and ROS generation in retinal cells lead to RPE degeneration.Various sources including mtDNA damage could be an important factor of oxidative stress in RPE.Gene therapy and mitochondrial transfer studies are emerging fields in ocular disease research.For retinal degenerative diseases stem cell-based transplantation methods are developed from basic research to preclinical and clinical trials.Translational research contributions of gene and cell therapy would be a new strategy to prevent,treat and cure various ocular diseases.This review focuses on the effect of oxidative stress in ocular cell degeneration and recent translational researches on retinal degenerative diseases to cure blindness.展开更多
文摘Diabetes mellitus(DM)is characterized by persistently elevated blood glucose concentration that lead to multisystem complications.There are about 400 medicinal plants cited to have a beneficial effect on DM.We must choose products wisely based on data derived from scientific studies.However,a major obstacle in the amalgamation of herbal medicine in modern medical practices is the lack of clinical data on its safety,efficacy and drug interaction.Trials of these herbal products often underreport the side effects and other crucial intervention steps deviating from the standards set by Consolidated Standards of Reporting Trials.Due to a lack of knowledge of the active compounds present in most herbal medicines,product standardization is difficult.Cost-effectiveness is another issue that needs to be kept in mind.In this mini-review,we focus on the antihyperglycemic effect of herbal products that are commonly used,along with the concerns stated above.
文摘Chronic pancreatitis(CP)is characterized by progressive inflammation and fibrosis of the pancreas that eventually leads to pancreatic exocrine and endocrine insufficiency.Diabetes in the background of CP is very difficult to manage due to high glycemic variability and concomitant malabsorption.Progressive beta cell loss leading to insulin deficiency is the cardinal mechanism underlying diabetes development in CP.Alpha cell dysfunction leading to deranged glucagon secretion has been described in different studies using a variety of stimuli in CP.However,the emerging evidence is varied probably because of dependence on the study procedure,the study population as well as on the stage of the disease.The mechanism behind islet cell dysfunction in CP is multifactorial.The intra-islet alpha and beta cell regulation of each other is often lost.Moreover,secretion of the incretin hormones such as glucagon like peptide-1 and glucose-dependent insulinotropic polypeptide is dysregulated.This significantly contributes to islet cell disturbances.Persistent and progressive inflammation with changes in the function of other cells such as islet delta cells and pancreatic polypeptide cells are also implicated in CP.In addition,the different surgical procedures performed in patients with CP and antihyperglycemic drugs used to treat diabetes associated with CP also affect islet cell function.Hence,different factors such as chronic inflammation,dysregulated incretin axis,surgical interventions and anti-diabetic drugs all affect islet cell function in patients with CP.Newer therapies targeting alpha cell function and beta cell regeneration would be useful in the management of pancreatic diabetes in the near future.
文摘Pancreatic cancer(PC)is often associated with a poor prognosis.Long-standing diabetes mellitus is considered as an important risk factor for its development.This risk can be modified by the use of certain antidiabetic medications.On the other hand,new-onset diabetes can signal towards an underlying PC in the elderly population.Recently,several attempts have been made to develop an effective clinical tool for PC screening using a combination of history of new-onset diabetes and several other clinical and biochemical markers.On the contrary,diabetes affects the survival after treatment for PC.We describe this intimate and complex two-way relationship of diabetes and PC in this review by exploring the underlying pathogenesis.
文摘Incretin-based therapies like glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors help maintain the glycaemic control in patients with type 2 diabetes mellitus with additional systemic benefits and little risk of hypoglycaemia.These medications are associated with low-grade chronic pancreatitis in animal models inconsistently.The incidence of acute pancreatitis was also reported in some human studies.This inflammation provides fertile ground for developing pancreatic carcinoma(PC).Although the data from clinical trials and population-based studies have established safety regarding PC,the pathophysiological possibility that low-grade chronic pancreatitis leads to PC remains.We review the existing literature and describe the relationship between incretin-based therapies and PC.
文摘BACKGROUND Acute pancreatitis(AP)presenting as an initial manifestation of primary hyperparathyroidism(PHPT)is uncommon,and its timely diagnosis is crucial in preventing recurrent attacks of pancreatitis.AIM To determine the clinical,biochemical,and radiological profile of PHPT patients presenting as AP.METHODS This is a retrospective observational study,51 consecutive patients admitted with the diagnosis of PHPT during January 2010 and October 2021 at a tertiary care hospital in Puducherry,India was included.The diagnosis of AP was established in the presence of at least two of the three following features:abdominal pain,levels of serum amylase or lipase greater than three times the normal,and characteristic features at abdominal imaging.RESULTS Out of the 51 consecutive patients with PHPT,twelve(23.52%)had pancreatitis[5(9.80%)AP,seven(13.72%)chronic pancreatitis(CP)].PHPT with AP(PHPT-AP)was more common among males with the presentation at a younger age(35.20±16.11 vs 49.23±14.80 years,P=0.05)and lower plasma intact parathyroid hormone(iPTH)levels[125(80.55-178.65)vs 519.80(149-1649.55,P=0.01)]compared to PHPT without pancreatitis(PHPT-NP).The mean serum calcium levels were similar in both PHPT-AP and PHPT-NP groups[(11.66±1.15 mg/dL)vs(12.46±1.71 mg/dL),P=0.32].PHPT-AP also presented with more gastrointestinal symptoms like abdominal pain,nausea,and vomiting with lesser skeletal and renal manifestations as compared to patients with PHPT-NP.CONCLUSION AP can be the only presenting feature of PHPT.Normal or higher serum calcium levels during AP should always draw attention towards endocrine causes like PHPT.
文摘Dipeptidyl peptidase-4 inhibitors(DPP-4i)have an important place in the management of type 2 diabetes.The DPP-4 enzyme is ubiquitously distributed throughout the human body and has multiple substrates through which it regulates several important physiological functions.DPP-4 regulates several immune functions,including T-cell activation,macrophage function,and secretion of cytokines.Studies have reported an increase in autoimmune diseases like bullous pemphigoid,inflammatory bowel disease,and arthritis with DPP-4i use.The relationship of DPP-4i and autoimmune diseases is a complex one and warrants further research into the effect of DPP-4 inhibition on the immune system to understand the pathogenesis more clearly.Whether a particular cluster of autoimmune diseases is associated with DPP-4i use remains an important contentious issue.Nevertheless,a heightened awareness from the clinicians is required to identify and treat any such diseases.Through this review,we explore the clinical and pathophysiological characteristics of this association in light of recent evidence.
文摘Metformin is the first-line drug for the treatment of type 2 diabetes mellitus,but its role in gestational diabetes mellitus(GDM)management is not clear.Recent evidence suggests a certain beneficial effect of metformin in the treatment of GDM,but a high treatment failure rate leads to the initiation of additional medications,such as insulin.Moreover,since metformin crosses the placental barrier and reaches a significant level in the fetus,it is likely to influence the fetal metabolic milieu.The evidence indicates the long-term safety in children exposed to metformin in utero except for mild adverse anthropometric profiles.Diligent follow-up of metformin-exposed offspring is warranted from the clinician’s point of view.
基金The authors would like to thank the Science and Engi・neering Research Board(ECR/2018/000718)Indian Council of Medical Research(File No.2018-2786/CMB/Adhoc-BMS)and Countil for Scie ntific and In dustrial Research((Ref No.:27(0353)/19/EMR-ll),Government of India,New Delhi for providing necessary funding to complete this review article successfully.
文摘Ocular cells like,retinal pigment epithelium(RPE)is a highly specialized pigmented monolayer of post-mitotic cells,which is located in the posterior segment of the eye between neuro sensory retina and vascular choroid.It functions as a selective barrier and nourishes retinal visual cells.As a result of high-level oxygen consumption of retinal cells,RPE cells are vulnerable to chronic oxidative stress and an increased level of reactive oxygen species(ROS)generated from mitochondria.These oxidative stress and ROS generation in retinal cells lead to RPE degeneration.Various sources including mtDNA damage could be an important factor of oxidative stress in RPE.Gene therapy and mitochondrial transfer studies are emerging fields in ocular disease research.For retinal degenerative diseases stem cell-based transplantation methods are developed from basic research to preclinical and clinical trials.Translational research contributions of gene and cell therapy would be a new strategy to prevent,treat and cure various ocular diseases.This review focuses on the effect of oxidative stress in ocular cell degeneration and recent translational researches on retinal degenerative diseases to cure blindness.
