ABDUL AHAD KHAN’s Post

DIABETIC COMPLICATIONS: D-ribose contributes more than D-glucose to the glycation of serum proteins. Diabetes is characterized by hyperglycemia resulting from deficiency in insulin secretion and/or insulin activity. Many diabetic patients develop acute or chronic complications, including damage to the blood vessels, brain, and kidney. Diabetic complications are partly due to the role of hyperglycemia in the nonenzymatic glycation of proteins, which leads to increased molecular oxidation in diabetes mellitus. Glycation occurs at the side chains (amino groups) of a protein, such as the lysine residue, and produces advanced glycation end products (AGEs) that include a series of heterogeneous compounds such as carboxymethyllysine (CML), carboxyethyllysine (CEL) and pyrraline. AGEs in vivo act as an aging factor and contribute to the pathophysiology of degenerative diseases, such as chronic kidney disease and Alzheimer's disease. D-Ribose is active in glycation and rapidly produces advanced glycation end products, leading to cell death and to cognitive impairment in mice. Glycated serum protein (GSP) is a relatively short-term biomarker for glycemic control in diabetes mellitus. However, whether D-ribose is related to GSP is unclear. The aim of this work, published in open access by Rongqiao He, et al., in Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease, was to identify the contribution of D-ribose to GSP versus D-glucose. https://lnkd.in/dr74vxXW Here, the authors demonstrated that the yield of human serum albumin glycated with D-ribose was at least two-fold higher than that with D-glucose in a 2-week incubation. Glycation of human serum albumin (HSA) with D-ribose was much faster than with D-glucose, as determined by monitoring changes in the fluorescent intensity of the glycation products over time. Intraperitoneal injection of D-ribose significantly increased GSP levels in Sprague Dawley rats, but D-glucose injection did not. The D-ribose level was more positively associated with GSP than the D-glucose level in streptozotocin-treated rats. In diabetic patients, both D-ribose and D-glucose levels were closely related to GSP levels. Together, these in vitro and in vivo results indicated that D-ribose is an important contributor to protein glycation. serum, compared to D-glucose. To evaluate GSP levels in diabetes mellitus, we should consider the contribution of D-ribose, which plays a non-negligible role. #diabetes #hyperglycemia #DiabeticComplications https://lnkd.in/dr74vxXW

Diagnosing autoimmune diseases can be challenging due to their wide-ranging symptoms that often overlap with other conditions. Here are some common steps and tests involved in diagnosing autoimmune diseases: 1. Medical History and Physical Examination :A doctor will start with a detailed medical history and a thorough physical exam to understand symptoms and their progression. Family history of autoimmune diseases is also considered. 2. Symptom Review:Symptoms like fatigue, joint pain, skin rashes, and fever are noted, as they can indicate autoimmune activity. 3. Blood Tests:Several blood tests are used to detect markers of inflammation and autoimmunity: - Antinuclear Antibody (ANA) Test: A positive ANA test can indicate an autoimmune disorder, but it is not specific to any one disease. - Rheumatoid Factor (RF) and Anti-Cyclic Citrullinated Peptide (anti-CCP):These are often used in diagnosing rheumatoid arthritis. - Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP):These tests measure inflammation in the body. - Specific Autoantibody Tests:Such as anti-double-stranded DNA (anti-dsDNA) and anti-Smith antibodies for lupus, or anti-thyroid antibodies for Hashimoto’s thyroiditis. 4. Imaging Tests: X-rays, CT scans, or MRIs may be used to assess joint damage or organ involvement. 5. Biopsy: In some cases, a tissue biopsy, such as a skin or kidney biopsy, can provide definitive evidence of an autoimmune condition. 6. Specialist Consultation:Referral to a specialist, such as a rheumatologist, endocrinologist, or dermatologist, may be necessary for further evaluation and diagnosis. Diagnosis often requires correlating laboratory results with clinical findings, as no single test can definitively diagnose most autoimmune diseases. Additionally, diagnosis can take time, as symptoms may evolve over time.

🫀 Investigation of Cardiovascular Risk Factors in Diabetic and Nondiabetic Patients with Nonalcoholic Fatty Liver Disease (NAFLD) 🫀 📚 Published in the Journal of Research in Medical Sciences (August 2024) 📚 Study Overview: This cross-sectional study evaluates the cardiovascular risk factors (CVRFs) in patients with nonalcoholic fatty liver disease (NAFLD), comparing those with type 2 diabetes mellitus (T2DM) to those with normal blood glucose (NBG) levels. With NAFLD being a prevalent hepatic disorder linked to various metabolic and cardiovascular risk factors, understanding the differences between these two groups can guide better management and treatment strategies. Key Findings: Out of 691 NAFLD patients studied, 48.8% (337 patients) had T2DM. Significant differences in CVRFs were observed between NAFLD patients with T2DM and those with NBG: Body Mass Index (BMI): Higher in T2DM group (31.2 ± 4.6 kg/m²) compared to NBG group (29.9 ± 4.3 kg/m², P = 0.001). Waist Circumference: Greater in T2DM group (102.2 ± 10.2 cm) than in NBG group (97.6 ± 10.6 cm, P < 0.001). Systolic Blood Pressure: Higher in T2DM group (123.3 ± 15.6 mmHg) versus NBG group (119.6 ± 13.6 mmHg, P = 0.043). Triglyceride Levels: Elevated in T2DM patients (191.9 ± 104.7 mg/dL) compared to NBG group (176.5 ± 89.6 mg/dL, P = 0.042). Prevalence of Comorbidities: Cardiovascular disease (CVD), hypertension, and metabolic syndrome (MS) were significantly more common in NAFLD patients with T2DM (P < 0.001) compared to the NBG group. Odds ratios (adjusted for age, sex, BMI, smoking, and physical activity): CVD: 2.18 times higher in T2DM patients. Hypertension: 2.12 times higher. MS: 6.63 times higher in T2DM patients compared to NBG. Conclusion: This study highlights the elevated cardiovascular risk factors in NAFLD patients with T2DM compared to those with normal blood glucose levels. These findings underscore the need for targeted interventions to manage both NAFLD and cardiovascular risks, particularly in diabetic patients. 🔗 Read the full article for more insights: https://lnkd.in/dPcCGPpN #NAFLD #T2DM #CardiovascularRisk #MedicalResearch #JournalOfResearchInMedicalSciences

🌟 Understanding the Impact of Long-Term PPI Use 🌟 A patient is recently diagnosed with a gastrinoma in her pancreas. Since the tumor size is small, her clinician recommends therapy with a proton-pump inhibitor (PPI). But what are the long-term effects of PPI usage? 🤔 Interactive Questions: What do you think is a significant adverse effect of long-term PPI use? Have you or someone you know experienced any side effects from PPI therapy? What measures can be taken to mitigate the risks associated with long-term PPI use? 📊 Interactive Poll: What do you believe is the most concerning adverse effect of long-term PPI use? Osteoporosis and increased risk of bone fractures Vitamin B12 deficiency Magnesium deficiency Kidney disease Increased risk of gastrointestinal infections 📚 Case Study: Case: A patient is recently diagnosed with a gastrinoma in her pancreas. Since the tumor size is small, her clinician recommends therapy with a PPI. Question: What is a significant adverse effect of long-term PPI usage? Answer: Osteoporosis and increased risk of bone fractures. 📍 Teaching Points: PPIs Mechanism of Action: PPIs work by irreversibly blocking the hydrogen/potassium ATPase pump on the luminal surface of gastric parietal cells, making them the most potent inhibitors of gastric acid secretion. Clinical Use: PPIs are effective in treating peptic ulcer disease, GERD, Zollinger-Ellison syndrome, NSAID-associated ulcers, and Helicobacter pylori infection. Adverse Effects: Long-term PPI use can lead to malabsorption (hypomagnesemia, iron deficiency, hypocalcemia, vitamin B12 deficiency), small intestine bacterial overgrowth (SIBO), fundic gland polyps, acute interstitial nephritis, bone fractures, dementia, and community-acquired pneumonia. 📝 Call to Action: Learn: Stay informed about the benefits and risks of long-term PPI therapy. Discuss: Share your experiences and questions in the comments below. Act: Talk to your healthcare provider about your PPI use and explore alternative treatments if necessary. Join the conversation and help raise awareness about the potential risks of long-term PPI usage! 💬🔍

🧪 PROTEINURIA vs. ALBUMINURIA 🔬 📍both characterized by proteins in urine 📍share similarities, have distinct differences in underlying causes & clinical implications 📍Understanding differences = essential for nurse practitioners in primary care. 🔑 KEY DIFFERENTIATING POINTS 🔑 🔸 PROTEINURIA 🔸 📍DEFINITION: Proteinuria refers to the presence of excess proteins, including albumin and other proteins, in the urine. 📍CAUSES: Proteinuria can result from various conditions, including: - kidney damage - systemic diseases (e.g., diabetes, hypertension) - UTI - certain medications 📍DX: Diagnosis of proteinuria involves urine dipstick testing, urine protein-to-creatinine ratio (PCR), or 24-hour urine collection for protein quantification. 📍CLINICAL IMPLICATIONS 📣Proteinuria may indicate underlying kidney dysfunction or systemic diseases and is associated with an increased risk of kidney disease progression and cardiovascular events. 🔸Albuminuria:🔸 📍DEFINITION: Albuminuria specifically refers to the presence of excess albumin, one type of protein, in the urine. 📍CAUSES: Albuminuria is primarily associated with kidney damage, particularly glomerular injury, which impairs the filtration barrier and leads to increased albumin leakage into the urine. 📍DX: Diagnosis of albuminuria involves urine albumin-to-creatinine ratio (ACR) testing, which quantifies the amount of albumin relative to creatinine in a spot urine sample. 📍CLINICAL IMPLICATIONS 📣Albuminuria is a hallmark sign of kidney disease, particularly diabetic nephropathy and hypertensive nephropathy, and serves as a marker for increased cardiovascular risk and progression of kidney disease. ⭕️⭕️⭕️⭕️⭕️⭕️⭕️⭕️⭕️⭕️⭕️⭕️⭕️⭕️⭕️⭕️ 📍National Kidney Foundation. (2022). Understanding Urinalysis: Protein, Glucose, and pH. Retrieved from [https://lnkd.in/dp5aYu5c) 📍Levey, A. S., & Becker, C. (2005). [Proteinuria and albuminuria as predictors of cardiovascular risk: a systematic review and meta-analysis.](https://lnkd.in/dAjw9dym) American Journal of Kidney Diseases, 48(1), 8-9. 📍KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. (2021). Kidney International Supplements, 11(1), e77-e82. ⭕️⭕️⭕️⭕️⭕️⭕️⭕️⭕️⭕️⭕️⭕️⭕️⭕️⭕️⭕️⭕️ #nursepractitioner #PrimaryCare #NP #NPStudent #ckd #chronickidneydisease

Untargeted serum metabolic profiling of diabetes mellitus among Parkinson's disease patients Type 2 diabetes mellitus (T2DM) is a common comorbidity among Parkinson's disease (PD) patients. Yet, little is known about dysregulated pathways that are unique in PD patients with T2DM. We applied high-resolution metabolomic profiling in serum samples of 636 PD and 253 non-PD participants recruited from Central California. We conducted an initial discovery metabolome-wide association and pathway enrichment analysis. After adjusting for multiple testing, in positive (or negative) ion mode, 30 (25) metabolic features were associated with T2DM in both PD and non-PD participants, 162 (108) only in PD participants, and 32 (7) only in non-PD participants. Pathway enrichment analysis identified 17 enriched pathways associated with T2DM in both the PD and non-PD participants, 26 pathways only in PD participants, and 5 pathways only in non-PD participants. Several amino acid, nucleic acids, and fatty acid metabolisms were associated with T2DM only in the PD patient group suggesting a possible link between PD and T2DM. Source: NPJ Parkinsons Dis https://lnkd.in/e3-HRFiS

Impact of Vonoprazan on Non-Erosive Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis We are humbled to share the findings of our recent publication in “Clinics and Research in Hepatology and Gastroenterology” (leading journal in Europe with impact factor nearly 3) which highlights the efficacy of vonoprazan compared to conventional proton pump inhibitors (PPIs) in managing non-erosive esophagitis. Our systematic review and meta-analysis, sourced from standard databases, included nine pivotal studies. Key Findings: 1. Gastrointestinal Reflux Disease (GERD) Score: Vonoprazan treatment resulted in a significant reduction in the GERD score, with a mean difference of -3.88 (95% CI: -5.48, -2.28, p<0.01, I2=95%). 2. ⁠Epigastric Pain Score: Treatment with vonoprazan significantly reduced epigastric pain, showing a mean difference of -3.02 (95% CI: -5.41, -0.63, p=0.01, I2=75%). 3. ⁠Post-Prandial Distress Score: There was also a significant decrease in the post-prandial distress score, with a mean difference of -2.82 (95% CI: -3.51, -2.12, p<0.01, I2=0%)—all reflecting moderate GRADE evidence. Conclusion: Vonoprazan not only demonstrated a robust reduction in various symptoms of non-erosive GERD but also showed an excellent safety profile. Its potent and prolonged inhibitory effects on gastric acid secretion and rapid onset of action make it a promising therapeutic alternative to traditional PPIs, particularly in the context of the challenges associated with PPI therapy such as variable night-time acid suppression and patient-specific metabolic differences. We believe that vonoprazan represents a significant advancement in the treatment of acid-related diseases. As it prepares to enter the Indian market, its potential to improve treatment outcomes over conventional PPIs offers a new hope for patients suffering from these conditions. We look forward to discussing these findings with our peers and invite comments and insights on our research. Link for our article: https://lnkd.in/gFt_xbYC #gastroenterology #clinicalpharmacology

📍 The Impact of Semaglutide on Liver Fat in Patients with Type 2 Diabetes Excerpt: There is increasing prevalence of hepatic steatosis. Hepatic steatosis is increasingly recognized as the independent risk factor for cardiovascular mortality. However, there are limited options for the treatment of fatty liver. In this study we evaluated the effect of semaglutide on liver fat as measured by non-contrast cardiac CT scans. STOP is a randomized controlled trial that evaluated semaglutide treatment effect on coronary atherosclerosis progression (STOP) in type 2 diabetes. We utilized unenhanced cardiac CT scans to quantify liver fat based on CT Hounsfield attenuation method. A total of 114 subjects qualified for this study of the 140 subjects randomized, 59 in semaglutide group and 55 in the placebo group and were followed for 12 months. Multivariate regression models were used to evaluate the change in liver fat content overtime. 114 subjects were included in the study, 61% male, mean age of 57.8±8.1 years and mean BMI of 32.0±6.7. The average of the three liver measures showed an improvement in the semaglutide group 1.4±9.0 versus worsening in the placebo group of 1.9±9.5 mean HU. The multivariable linear regression models including age, gender, BMI, hypertension, hyperlipidemia, past smoking and baseline liver attenuation, showed that the semaglutide group average liver attenuation measures improved by 4.4 HU versus placebo across the trial, p=0.002 indicating improvement in the liver fat content in treatment group. In type 2 diabetes patients with hepatic steatosis, treatment with semaglutide resulted in a significant improvement in fatty liver resolution compared to placebo. ➡ https://lnkd.in/eRb-ks2B #diabetestype2 #fattyliver #semaglutide #ctscan #cardiacctscan #Ozempic #Wegovy #Rybelsus

🌟 Efficacy and Safety of SGLT2 Inhibitors With and Without GLP-1 Receptor Agonists 🌟 A recent meta-analysis published in The Lancet Diabetes & Endocrinology explores the efficacy and safety of SGLT2 inhibitors, with or without GLP-1 receptor agonists (GLP-1 RAs). The results are promising for patients with diabetes, cardiovascular, and kidney conditions. 🔍 Case Study: Patient Profile: Name: David Age: 60 Diagnosis: Type 2 Diabetes with Cardiovascular Disease Current Treatment: SGLT2 inhibitor + GLP-1 RA Outcome: Reduced risk of major adverse cardiovascular events (MACE) Decreased hospitalizations for heart failure Slowed progression of chronic kidney disease Discussion Questions: What are the main benefits of combining SGLT2 inhibitors with GLP-1 RAs in managing type 2 diabetes? How do SGLT2 inhibitors improve cardiovascular outcomes in patients with diabetes? What considerations should be made when prescribing these medications together? Interactive Q&A: Q1: How do SGLT2 inhibitors reduce the risk of major adverse cardiovascular events (MACE)? A1: SGLT2 inhibitors reduce MACE by improving glycemic control, lowering blood pressure, and promoting natriuresis, which collectively reduce cardiovascular stress. Q2: Are there any specific patient populations that benefit the most from the combination of SGLT2 inhibitors and GLP-1 RAs? A2: Patients with type 2 diabetes who have a high risk of cardiovascular disease or existing cardiovascular conditions benefit significantly from this combination therapy. Poll: Which outcome is most important to you when choosing a diabetes medication? Cardiovascular protection Kidney health Blood sugar control Weight management Call to Action: 🔗 Learn more about the study here and join our live Q&A session with Dr. Priyadarshini Balasubramanian on the benefits of SGLT2 inhibitors and GLP-1 RAs in diabetes management. Don’t miss this opportunity to get your questions answered! #DiabetesManagement #SGLT2Inhibitors #GLP1RAs #CardiovascularHealth #KidneyHealth #TheLancet #MedicalResearch #Endocrinology #PatientCare References: Priyadarshini Balasubramanian, MD. "Efficacy and Safety of SGLT2 Inhibitors With and Without GLP-1 Receptor Agonists." The Lancet Diabetes & Endocrinology. Stay informed and be part of the conversation! 🌐

Olezarsen, a hepatocyte-targeted, GalNAc-modified antisense oligonucleotide that decreases plasma levels of apolipoprotein C-III (apoC-III) and triglyceride-rich lipoproteins (TRLs), was found to be meeting the primary endpoints of hypertriglyceridemia treatment. Olezarsen is being administered once a month through a subcutaneous injection. In the recent phase 2b clinical trial, triglyceride levels decreased by around 50% as compared with placebo (P<0.001) among moderate hypertriglyceridemia at elevated cardiovascular risk. The median baseline triglyceride level was 241.5 mg/ dL and there was no change in terms of LDL level at 6 months of follow-up. In the recent phase 3 clinical trial, at 6 months of follow-up, triglyceride levels decreased by 43.5% as compared with placebo (P<0.001) among familial chylomicronemia syndrome. One episode of acute pancreatitis was seen in the treatment group whereas 11 in the placebo group. The mean (±SD) baseline triglyceride level among the patients was 2630±1315 mg/dL, and 71% had a history of acute pancreatitis within the previous 10 years. https://lnkd.in/e_uqBxwu https://lnkd.in/eiufPUcJ Volanesorsen, the olezarsen precursor, demonstrated some favorable effects on hepatic steatosis. Let's see if olezarsen may be beneficial for metabolic dysfunction-associated liver disease as well.