The gut microbiome is defined as an ecological community of commensal symbiotic and pathogenic microorganisms that exist in our body.Gut microbiome dysbiosis is a condition of dysregulated and disrupted intestinal bac...The gut microbiome is defined as an ecological community of commensal symbiotic and pathogenic microorganisms that exist in our body.Gut microbiome dysbiosis is a condition of dysregulated and disrupted intestinal bacterial homeostasis,and recent evidence has shown that dysbiosis is related to chronic inflammation,insulin resistance,cardiovascular diseases(CVD),type 2 diabetes mellitus(T2DM),and obesity.It is well known that obesity,T2DM and CVD are caused or worsened by multiple factors like genetic predisposition,environmental factors,unhealthy high calorie diets,and sedentary lifestyle.However,recent evidence from human and mouse models suggest that the gut microbiome is also an active player in the modulation of metabolic syndrome,a set of risk factors including obesity,hyperglycemia,and dyslipidemia that increase the risk for CVD,T2DM,and other diseases.Current research aims to identify treatments to increase the number of beneficial microbiota in the gut microbiome in order to modulate metabolic syndrome by reducing chronic inflammation and insulin resistance.There is increasing interest in supplements,classified as prebiotics,probiotics,synbiotics,or postbiotics,and their effect on the gut microbiome and metabolic syndrome.In this review article,we have summarized current research on these supplements that are available to improve the abundance of beneficial gut microbiota and to reduce the harmful ones in patients with metabolic syndrome.展开更多
The human gut is colonized by a community of microbiota,primarily bacteria,that exist in a symbiotic relationship with the host.Intestinal microbiota-host interactions play a critical role in the regulation of human p...The human gut is colonized by a community of microbiota,primarily bacteria,that exist in a symbiotic relationship with the host.Intestinal microbiota-host interactions play a critical role in the regulation of human physiology.Deleterious changes to the composition of gut microbiota,referred to as gut dysbiosis,has been linked to the development and progression of numerous diseases,including cardiovascular disease(CVD).Imbalances in host-microbial interaction impair homeostatic mechanisms that regulate health and can activate multiple pathways leading to CVD risk factor progression.Most CVD risk factors,including aging,obesity,dietary patterns,and a sedentary lifestyle,have been shown to induce gut dysbiosis.Dysbiosis is associated with intestinal inflammation and reduced integrity of the gut barrier,which in turn increases circulating levels of bacterial structural components and microbial metabolites,including trimethylamine-N-oxide and short-chain fatty acids,that may facilitate the development of CVD.This article reviews the normal function and composition of the gut microbiome,mechanisms leading to the leaky gut syndrome,its mechanistic link to CVD and potential novel therapeutic approaches aimed towards restoring gut microbiome and CVD prevention.As CVD is the leading cause of deaths globally,investigating the gut microbiota as a locus of intervention presents a novel and clinically relevant avenue for future research.展开更多
Lack of conclusive beneficial effects of strict glycemic control on macrovascular complications has been very frustrating for clinicians involved in care of patients with diabetes mellitus (DM). Highly publicized cont...Lack of conclusive beneficial effects of strict glycemic control on macrovascular complications has been very frustrating for clinicians involved in care of patients with diabetes mellitus (DM). Highly publicized controversy surrounding cardiovascular (CV) safety of rosiglitazone resulted in major changes in United States Food and Drug Administration policy in 2008 regarding approval process of new antidiabetic medications, which has resulted in revolutionary data from several large CV outcome trials over the last few years. All drugs in glucagon-like peptide-1 receptor agonist (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT-2) inhibitor classes have shown to be CV safe with heterogeneous results on CV efficacy. Given twofold higher CV disease mortality in patients with DM than without DM, GLP-1 RAs and SGLT-2-inhibitors are important additions to clinician’s armamentarium and should be second line-therapy particularly in patients with T2DM and established atherosclerotic CV disease or high risks for CV disease. Abundance of data and heterogeneity in CV outcome trials results can make it difficult for clinicians, particularly primary care physicians, to stay updated with all the recent evidence. The scope of this comprehensive review will focus on all major CV outcome studies evaluating CV safety and efficacy of GLP-1 RAs and SGLT-2 inhibitors.展开更多
BACKGROUND Diabetes mellitus(DM)is a progressively increasing metabolic disorder and a significant public health burden that demands immediate global attention.However,there is a paucity of data about adherence to ant...BACKGROUND Diabetes mellitus(DM)is a progressively increasing metabolic disorder and a significant public health burden that demands immediate global attention.However,there is a paucity of data about adherence to antidiabetic drugs among patients with type-2(T2)DM in Uttarakhand,India.Outpatient research reported that more than 50%of patients do not adhere to the correct administration and appropriate medicine dosage.It has been reported that patients with chronic diseases who adhere to treatment may experience improvement in quality of life(QoL)and vice versa.AIM To assess the adherence to antidiabetic medication and QoL among patients with T2DM.METHODS This cross-sectional descriptive study was conducted at a tertiary care hospital in Uttarakhand,India.The Medication Adherence Rating Scale and World Health Organization QoL-BREF scale were used to assess medication adherence and QoL.RESULTS Two hundred seventy-seven patients suffering from T2DM participated in the study.Their mean age was 50.80(±10.6)years,155(56%)had a poor adherence level and 122(44%)had a good adherence level to antidiabetic medications.After adjusting for sociodemographic factors,multiple linear regression analysis found patients who were adherent to antidiabetic medications had significantly higher mean overall perception of QoL and overall perception of health,with beta scores of 0.36 and 0.34,respectively(both P=0.000)points compared with nonadherent patients.CONCLUSION There was an association between medication adherence and QoL in patients with T2DM.Hence,there is a need to plan awareness and counseling programs followed by regular follow-up to motivate patient adherence to recommended treatment and lifestyle regimens.展开更多
Microorganisms including bacteria,viruses,protozoa,and fungi living in the gastrointestinal tract are collectively known as the gut microbiota.Dysbiosis is the imbalance in microbial composition on or inside the body ...Microorganisms including bacteria,viruses,protozoa,and fungi living in the gastrointestinal tract are collectively known as the gut microbiota.Dysbiosis is the imbalance in microbial composition on or inside the body relative to healthy state.Altered Firmicutes to Bacteroidetes ratio and decreased abundance of Akkermansia muciniphila are the predominant gut dysbiosis associated with the pathogenesis of type 2 diabetes mellitus(T2DM)and metabolic syndrome.Pathophysiological mechanisms linking gut dysbiosis,and metabolic diseases and their complications include altered metabolism of short-chain fatty acids and bile acids,interaction with gut hormones,increased gut microbial metabolite trimethylamine-N-oxide,bacterial translocation/Leaky gut syndrome,and endotoxin production such as lipopolysaccharides.The association between the gut microbiota and glycemic agents,however,is much less understood and is the growing focus of research and conversation.Recent studies suggest that the gut microbiota and anti-diabetic medications are interdependent on each other,meaning that while anti-diabetic medications alter the gut microbiota,the gut microbiota also alters the efficacy of anti-diabetic medications.With increasing evidence regarding the significance of gut microbiota,it is imperative to review the role of gut microbiota in the pathogenesis of T2DM.This review also discusses the interaction between gut microbiota and the various medications used in the treatment of T2DM.展开更多
Patients with coronavirus disease 2019(COVID-19)predominantly present with the pulmonary symptoms such as fever,cough,and shortness of breath.We present a case of an 83 years old patient with COVID-19 who presented wi...Patients with coronavirus disease 2019(COVID-19)predominantly present with the pulmonary symptoms such as fever,cough,and shortness of breath.We present a case of an 83 years old patient with COVID-19 who presented with only gastrointestinal symptoms without respiratory complaints.Our case raises the concern regarding our current lack of understanding of extrapulmonary manifestations of COVID-19.Given genetic homology between 2019 severe acute respiratory syndrome coronavirus(SARS-CoV)2 and SARS-CoV,our case underscores the urgent need for further studies to understand the role of the gastrointestinal system in 2019 SARS-CoV-2 transmission and COVID-19 pathogenesis.展开更多
文摘The gut microbiome is defined as an ecological community of commensal symbiotic and pathogenic microorganisms that exist in our body.Gut microbiome dysbiosis is a condition of dysregulated and disrupted intestinal bacterial homeostasis,and recent evidence has shown that dysbiosis is related to chronic inflammation,insulin resistance,cardiovascular diseases(CVD),type 2 diabetes mellitus(T2DM),and obesity.It is well known that obesity,T2DM and CVD are caused or worsened by multiple factors like genetic predisposition,environmental factors,unhealthy high calorie diets,and sedentary lifestyle.However,recent evidence from human and mouse models suggest that the gut microbiome is also an active player in the modulation of metabolic syndrome,a set of risk factors including obesity,hyperglycemia,and dyslipidemia that increase the risk for CVD,T2DM,and other diseases.Current research aims to identify treatments to increase the number of beneficial microbiota in the gut microbiome in order to modulate metabolic syndrome by reducing chronic inflammation and insulin resistance.There is increasing interest in supplements,classified as prebiotics,probiotics,synbiotics,or postbiotics,and their effect on the gut microbiome and metabolic syndrome.In this review article,we have summarized current research on these supplements that are available to improve the abundance of beneficial gut microbiota and to reduce the harmful ones in patients with metabolic syndrome.
文摘The human gut is colonized by a community of microbiota,primarily bacteria,that exist in a symbiotic relationship with the host.Intestinal microbiota-host interactions play a critical role in the regulation of human physiology.Deleterious changes to the composition of gut microbiota,referred to as gut dysbiosis,has been linked to the development and progression of numerous diseases,including cardiovascular disease(CVD).Imbalances in host-microbial interaction impair homeostatic mechanisms that regulate health and can activate multiple pathways leading to CVD risk factor progression.Most CVD risk factors,including aging,obesity,dietary patterns,and a sedentary lifestyle,have been shown to induce gut dysbiosis.Dysbiosis is associated with intestinal inflammation and reduced integrity of the gut barrier,which in turn increases circulating levels of bacterial structural components and microbial metabolites,including trimethylamine-N-oxide and short-chain fatty acids,that may facilitate the development of CVD.This article reviews the normal function and composition of the gut microbiome,mechanisms leading to the leaky gut syndrome,its mechanistic link to CVD and potential novel therapeutic approaches aimed towards restoring gut microbiome and CVD prevention.As CVD is the leading cause of deaths globally,investigating the gut microbiota as a locus of intervention presents a novel and clinically relevant avenue for future research.
文摘Lack of conclusive beneficial effects of strict glycemic control on macrovascular complications has been very frustrating for clinicians involved in care of patients with diabetes mellitus (DM). Highly publicized controversy surrounding cardiovascular (CV) safety of rosiglitazone resulted in major changes in United States Food and Drug Administration policy in 2008 regarding approval process of new antidiabetic medications, which has resulted in revolutionary data from several large CV outcome trials over the last few years. All drugs in glucagon-like peptide-1 receptor agonist (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT-2) inhibitor classes have shown to be CV safe with heterogeneous results on CV efficacy. Given twofold higher CV disease mortality in patients with DM than without DM, GLP-1 RAs and SGLT-2-inhibitors are important additions to clinician’s armamentarium and should be second line-therapy particularly in patients with T2DM and established atherosclerotic CV disease or high risks for CV disease. Abundance of data and heterogeneity in CV outcome trials results can make it difficult for clinicians, particularly primary care physicians, to stay updated with all the recent evidence. The scope of this comprehensive review will focus on all major CV outcome studies evaluating CV safety and efficacy of GLP-1 RAs and SGLT-2 inhibitors.
文摘BACKGROUND Diabetes mellitus(DM)is a progressively increasing metabolic disorder and a significant public health burden that demands immediate global attention.However,there is a paucity of data about adherence to antidiabetic drugs among patients with type-2(T2)DM in Uttarakhand,India.Outpatient research reported that more than 50%of patients do not adhere to the correct administration and appropriate medicine dosage.It has been reported that patients with chronic diseases who adhere to treatment may experience improvement in quality of life(QoL)and vice versa.AIM To assess the adherence to antidiabetic medication and QoL among patients with T2DM.METHODS This cross-sectional descriptive study was conducted at a tertiary care hospital in Uttarakhand,India.The Medication Adherence Rating Scale and World Health Organization QoL-BREF scale were used to assess medication adherence and QoL.RESULTS Two hundred seventy-seven patients suffering from T2DM participated in the study.Their mean age was 50.80(±10.6)years,155(56%)had a poor adherence level and 122(44%)had a good adherence level to antidiabetic medications.After adjusting for sociodemographic factors,multiple linear regression analysis found patients who were adherent to antidiabetic medications had significantly higher mean overall perception of QoL and overall perception of health,with beta scores of 0.36 and 0.34,respectively(both P=0.000)points compared with nonadherent patients.CONCLUSION There was an association between medication adherence and QoL in patients with T2DM.Hence,there is a need to plan awareness and counseling programs followed by regular follow-up to motivate patient adherence to recommended treatment and lifestyle regimens.
文摘Microorganisms including bacteria,viruses,protozoa,and fungi living in the gastrointestinal tract are collectively known as the gut microbiota.Dysbiosis is the imbalance in microbial composition on or inside the body relative to healthy state.Altered Firmicutes to Bacteroidetes ratio and decreased abundance of Akkermansia muciniphila are the predominant gut dysbiosis associated with the pathogenesis of type 2 diabetes mellitus(T2DM)and metabolic syndrome.Pathophysiological mechanisms linking gut dysbiosis,and metabolic diseases and their complications include altered metabolism of short-chain fatty acids and bile acids,interaction with gut hormones,increased gut microbial metabolite trimethylamine-N-oxide,bacterial translocation/Leaky gut syndrome,and endotoxin production such as lipopolysaccharides.The association between the gut microbiota and glycemic agents,however,is much less understood and is the growing focus of research and conversation.Recent studies suggest that the gut microbiota and anti-diabetic medications are interdependent on each other,meaning that while anti-diabetic medications alter the gut microbiota,the gut microbiota also alters the efficacy of anti-diabetic medications.With increasing evidence regarding the significance of gut microbiota,it is imperative to review the role of gut microbiota in the pathogenesis of T2DM.This review also discusses the interaction between gut microbiota and the various medications used in the treatment of T2DM.
文摘Patients with coronavirus disease 2019(COVID-19)predominantly present with the pulmonary symptoms such as fever,cough,and shortness of breath.We present a case of an 83 years old patient with COVID-19 who presented with only gastrointestinal symptoms without respiratory complaints.Our case raises the concern regarding our current lack of understanding of extrapulmonary manifestations of COVID-19.Given genetic homology between 2019 severe acute respiratory syndrome coronavirus(SARS-CoV)2 and SARS-CoV,our case underscores the urgent need for further studies to understand the role of the gastrointestinal system in 2019 SARS-CoV-2 transmission and COVID-19 pathogenesis.
