Archives of internal medicine research最新文献

{"title":"Etiology, Pathophysiology, and Treatment Strategies in the Prevention and Management of Metabolic Syndrome.","authors":"Ritika Patial, Irene Batta, Manish Thakur, Ranbir Chander Sobti, Devendra K Agrawal","doi":"10.26502/aimr.0184","DOIUrl":"10.26502/aimr.0184","url":null,"abstract":"<p><p>Metabolic Syndrome (MetS) is a complex cluster of metabolic irregularities that significantly increase the risk of developing chronic conditions, such as hypertension, type 2 diabetes, cardiovascular diseases, and other related disorders. This review aims to provide a comprehensive overview of the current understanding of MetS, its etiology and underlying pathogenesis, and the management strategies. MetS is characterized by central obesity, high blood pressure, insulin resistance, hyperglycemia, hypertriglyceridemia, and low high-density lipoprotein cholesterol levels. The prevalence of MetS is remarkably high, affecting approximately 25% of the global population, particularly in developed nations with inactive lifestyles and high-calorie diets. The development of MetS involves genetic and acquired factors, resulting in an inflammatory state that enhances the risk for cardiovascular disease. The biochemical alterations observed in MetS establish pathological connections between MetS, diabetes, and cardiovascular and neurodegenerative conditions. Despite its clinical importance, there is still debate regarding the precise components and pathophysiological associations among MetS elements. However, advancements in therapeutic measures, including drug therapies, surgical options, and experimental methods present promising avenues for managing and potentially reversing MetS. Further investigation of the MetS is critical because of its significant implications for public health and its connection to other clinical conditions and severe health outcomes, placing a substantial burden on healthcare system and society.</p>","PeriodicalId":519871,"journal":{"name":"Archives of internal medicine research","volume":"7 4","pages":"273-283"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11580789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142690335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular and Perivascular Role in the Regulation of Angiogenesis: Impact on Arteriovenous Fistula Maturation.","authors":"Fanya Xia, Vikrant Rai, Devendra K Agrawal","doi":"10.26502/aimr.0185","DOIUrl":"10.26502/aimr.0185","url":null,"abstract":"<p><p>Arteriovenous fistula (AVF) is a surgical connection between an artery and a vein created in patients with end-stage renal disease needing dialysis. A major concern with AVF is maturation failure which results, while creating a new AVF, a troublesome process for the patients. Thus, maturation of AVF is important which is achieved by outflow tract outward remodeling. However, vessel stenosis, hypoxia, endothelial dysfunction, and thrombosis contribute to AVF failure. Vascular stenosis and thrombosis after intimal injury due to intimal hyperplasia followed by plaque formation are major factors contributing to AVF maturation failure. Angiogenesis during plaque formation is important and plays a critical role but is also involved in vessel stenosis if uncontrolled. This suggests the dual role of angiogenesis and its effects on AVF maturation. Thus, it is critical to understand the factors regulating neoangiogenesis after the creation of AVF. Not only the angiogenesis in the plaque area but also in the adjoining tissues including muscles due to injury and the factors released by the perivascular structure may influence the angiogenesis and AVF maturation process. This review article comprehensively and critically discusses the role of neoangiogenesis in AVF maturation and the role of various factors regulating angiogenesis (pro- and anti-angiogenic factors) with their potential role in AVF maturation.</p>","PeriodicalId":519871,"journal":{"name":"Archives of internal medicine research","volume":"7 4","pages":"284-296"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic Lupus Erythematous: Gene Polymorphisms, Epigenetics, Environmental, Hormonal and Nutritional Factors in the Consideration of Personalized Therapy.","authors":"Nejma Wais, Devendra K Agrawal","doi":"10.26502/aimr.0188","DOIUrl":"10.26502/aimr.0188","url":null,"abstract":"<p><p>Systemic Lupus Erythematosus (SLE) is a chronic illness that can affect many tissues through the production of autoantibodies. A definite etiology has not been conclusively established, but current research points to the influences which include genetic, hormonal and environmental factors. SLE is difficult to treat due to its multifactorial pathogenesis and heterogeneity in clinical manifestations. Current treatment mainly includes anti-malarial medications, glucocorticoids, and biologics, but many patients still struggle in achieving remission. Additionally, there is no definite cure for SLE as of now, which further emphasizes the need for personalized treatment approaches. We analyzed genetic polymorphisms, DNA methylation, and other environmental, hormonal and nutritional factors in the development of SLE. We considered how such factors affect the processes of the disease pathogenesis and may provide insight on targets for potential personalized therapy. In this article, we criticaly reviewed the literature for compelling evidence connecting SLE and specific genes and epigenetic changes. We also explored environmental triggers such as UV exposure, and hormonal influences on their connection to SLE, working toward understanding the disease's complex nature. A critical evaluation is presented on the use of already accredited biologics in SLE that are beneficial to patients, including anifrolumab and belimumab. The reports on many factors that may influence SLE pathophysiology, along with success with recent biologics/targeted therapies, suggest that precision medicine, tailored to individual genetic and environmental profiles, may hold promise for enhancing remission rates and quality of life for SLE patients. The findings contribute to the field by addressing the need for an integrative approach to SLE treatment and offer more evidence for the potential critical benefit of personalized management strategies that may provide long-term solutions in this challenging and complex disease.</p>","PeriodicalId":519871,"journal":{"name":"Archives of internal medicine research","volume":"7 4","pages":"331-340"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes and Abdominal Aortic Aneurysm: Is the Protective Effect on AAA Due to Antidiabetic Medications Alone, Due to the Disease Alone, or Both?","authors":"Gaithrri Shanmuganathan, Devendra K Agrawal","doi":"10.26502/aimr.0169","DOIUrl":"10.26502/aimr.0169","url":null,"abstract":"<p><p>Diabetes is a metabolic disease that may result in multiple microvascular and macrovascular diseases. Interestingly, many studies have demonstrated the inverse relationship between diabetes and the development and expansion of abdominal aortic aneurysm (AAA). One hypothesis is that the aortic wall stiffness resulting from hyperglycemia and advanced glycation end products could delay the development and growth of AAA. Other studies have proposed that the concurrent use of antidiabetic medications which promote anti-inflammatory cytokines while hindering pro-inflammatory cytokines may potentially be the reason for this protective effect of diabetes on AAA. Contrastingly, the presence of diabetes has been found to have a negative effect on the outcome of AAA following its repair which may be due to elevated blood glucose negatively affecting the healing process. The current literature has also demonstrated the negative impact of the use of fluoroquinolones on AAA. This comprehensive review critically reviewed and summarized the role of diabetes, anti-diabetes medications and fluoroquinolones on AAA, and on the effect of diabetes and certain anti-diabetes medications on outcomes following its repair.</p>","PeriodicalId":519871,"journal":{"name":"Archives of internal medicine research","volume":"7 2","pages":"104-113"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11156236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Scoping Review on the Impact of COVID 19 on Vulnerable Populations: LGBTQ+ Persons, Persons Experiencing Homelessness, and Migrant Farm Workers in the US.","authors":"Donald J Alcendor, Paul D Juarez, Aramandla Ramesh, Katherine Y Brown, Mohammad Tabatabai, Patricia Matthews-Juarez","doi":"10.26502/aimr.0172","DOIUrl":"10.26502/aimr.0172","url":null,"abstract":"<p><strong>Purpose: </strong>The goal of the National Center for Medical Education Development and Research Center (NCMEDR) is to support the education and training of medical students in the care of vulnerable populations. Access to primary care services in the US is fundamental to the health and wellness of all people regardless of their socioeconomic status. LGBQ+ persons, (lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority), Persons Experiencing Homelessness (PEH), and Migrant Farm Workers (MFW) are among the most underserved, marginalized, and socially vulnerable groups in the US. NCMEDR in the Department of Family and Community Medicine at Meharry Medical College was established in part, with funding from the Department of Health and Human Services (DHHS) and the Health Resources and Services Administration (HRSA). NCMEDR was developed to provide educational pathways for transforming medical education and clinical practice in the US by ascertaining whether medical students were being trained to provide primary care, and behavioral health services to LGBTQ+ persons, PEH, and MFW. Here we focus on the impact of the COVID-19 pandemic on these specific populations because they represent marginalized groups that have been heavily impacted by the pandemic, have poor social determinants of health (SDOH), and are more likely to be uninsured, and are less likely to engage primary care providers outside of emergency room care.</p><p><strong>Methods: </strong>In this study, a scoping literature review was conducted to assess the impact of COVID-19 on primary care of LQBTQ+ persons, PEH, and MFW.</p><p><strong>Results and discussion: </strong>The pandemic provided a serious health disparities gap for the defined vulnerable populations under review by the NCMEDR. The pandemic identified the need for transformative measures for clinical practices, medical education, and health care policies required for implementation to improve health care for vulnerable groups. We make recommendations for interventions with defined populations that may influence clinical, environmental health, and SDOH in the COVID era.</p><p><strong>Conclusions: </strong>The COVID pandemic directed the need for medical schools, health care and social organizations to intervene in new and different ways in vulnerable and marginalized communities. The recommendations provide a model for advancing health equity, access, quality, utilization, care coordination, and treatment.</p>","PeriodicalId":519871,"journal":{"name":"Archives of internal medicine research","volume":"7 3","pages":"136-145"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NLRP3 Inflammasome and Gut Dysbiosis Linking Diabetes Mellitus and Inflammatory Bowel Disease.","authors":"Ugljesa Malicevic, Vikrant Rai, Ranko Skrbic, Devendra K Agrawal","doi":"10.26502/aimr.0178","DOIUrl":"https://doi.org/10.26502/aimr.0178","url":null,"abstract":"<p><p>Diabetes mellitus and inflammatory bowel disease are chronic conditions with significant overlap in their pathophysiology, primarily driven by chronic inflammation. Both diseases are characterized by an aberrant immune response and disrupted homeostasis in various tissues. However, it remains unclear which disease develops first, and which one contributes to the other. Diabetes mellitus increases the risk of inflammatory bowel disease and inflammatory bowel disease may increase the risk of developing diabetes. This review focuses on comprehensively discussing the factors commonly contributing to the pathogenesis of diabetes mellitus and inflammatory bowel disease to draw a relationship between them and the possibility of targeting common factors to attenuate the incidence of one if the other is present. A key player in the intersection of diabetes mellitus and inflammatory bowel disease is the NLRP3 inflammasome, which regulates the production of pro-inflammatory cytokines leading to prolonged inflammation and tissue damage. Additionally, toll-like receptors via sensing microbial components contribute to diabetes mellitus and inflammatory bowel disease by initiating inflammatory responses. Gut dysbiosis, a common link in both diseases, further intensifies inflammation and metabolic dysfunction. Alterations in gut microbiota composition affect intestinal permeability and immune modulation, perpetuating a vicious cycle of inflammation and disease progression by changing protein expression. The overlap in the underlying inflammatory mechanisms has led to the potential of targeting mediators of chronic inflammation using anti-inflammatory drugs and biologics that benefit both conditions or attenuate the incidence of one in the presence of the other.</p>","PeriodicalId":519871,"journal":{"name":"Archives of internal medicine research","volume":"7 3","pages":"200-218"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11426418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radical versus Local Surgical Excision for Early Rectal Cancer: A Systematic Review and Meta-Analysis.","authors":"Sarah El-Nakeep, Samragnyi Madala, Anusha Chidharla, Balarama Krishna Surapaneni, Subhrajit Saha, Benjamin Martin, Anup Kasi","doi":"10.26502/aimr.0160","DOIUrl":"https://doi.org/10.26502/aimr.0160","url":null,"abstract":"<p><strong>Background: </strong>Radical excision (RE) for rectal cancer carries a higher risk of mortality and morbidity, while local excision (LE) could decrease these postoperative risks. However, the long-term benefit of LE is still debatable.</p><p><strong>Aim: </strong>To study the effectiveness of LE versus RE in T1 and T2 rectal cancer.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted using key databases like PubMed and ClinicalTrials.gov. Only cohort studies and randomized controlled trials were included. RevMan 5.4 tool was used for data analysis. Both clinical and statistical heterogeneity of the studies were assessed, and I² >75% was considered as highly heterogeneous. The primary outcomes being measured were 5-year overall survival (OS) and 5-year disease free survival (DFS). A subgroup analysis of patients with T1-only was also conducted, without adjuvant chemo/radiotherapy.</p><p><strong>Results: </strong>A total of 18 studies were included for final meta-analysis. Four were RCTs, while the other 15 were retrospective cohort studies. One included study had data from both RCT and non-RCT study groups. Nine studies were multicentered or national studies while nine were unicentral.There was no difference in risk ratio (RR) between OS: RR 0.95, 95% Confidence Interval (CI) [0.91, 0.99] and DFS: RR 0.93, 95% CI [0.87, 1.01]. There were lower hazards ratios in OS: RR 1.41, 95% CI [1.14, 1.74] and DFS: RR 1.95, 95% CI [1.36, 2.78] with radical, as compared to LE. Lower recurrence rate was associated with RE. Random effect model was used due to clinical heterogeneity between studies (different surgical procedures, tumor staging, adjuvant chemo or radiotherapy).</p><p><strong>Conclusions: </strong>LE for early-stage rectal cancer has lower 5-year OS and DFS than RE, with higher local recurrence rate. However, LE is associated with lower early postoperative mortality, morbidity and length of stay as compared to RE.</p>","PeriodicalId":519871,"journal":{"name":"Archives of internal medicine research","volume":"7 1","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11008054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140867096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}