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1.
Idiopathic pathological ketotic hypoglycemia: finding the needle in a haystack.
Wolfsdorf, JI, Derks, TGJ, Drachmann, D, Shah, P, Thornton, PS, Weinstein, DA
Hormone research in paediatrics. 2024
Abstract
Sick children often have a decreased appetite and experience vomiting and diarrhea; however, hypoglycemia (plasma glucose concentration ≤50 mg/dL or 2.8 mmol/L) is rare. Ketotic hypoglycemia (KH) is the most common cause of hypoglycemia presenting to an Emergency Department in a previously healthy child between 6 months and 6 years of age. Ketosis and hypoglycemia are now well understood to be normal physiologic responses of young children to prolonged fasting. There is now substantial evidence that the term KH describes a variety of conditions including both the lower end of the normal distribution of fasting tolerance in young children as well as numerous rare disorders that impair fasting adaptation. Recent advances in molecular genetic testing have led to the discovery of these rare disorders. Idiopathic pathological KH is a diagnosis of exclusion that describes rare children who have abnormally limited fasting tolerance, experience recurrent episodes of KH, or develop symptoms of hypoglycemia despite elevated ketone levels, and in whom an explanation cannot be found despite extensive investigation. This review provides an approach to distinguishing between physiological KH and pathological KH and includes recommendations for management.
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2.
Pharmacokinetics of vitamin dosage forms: A complete overview.
Sugandhi, VV, Pangeni, R, Vora, LK, Poudel, S, Nangare, S, Jagwani, S, Gadhave, D, Qin, C, Pandya, A, Shah, P, et al
Food science & nutrition. 2024;(1):48-83
Abstract
Vitamins are crucial for sustaining life because they play an essential role in numerous physiological processes. Vitamin deficiencies can lead to a wide range of severe health issues. In this context, there is a need to administer vitamin supplements through appropriate routes, such as the oral route, to ensure effective treatment. Therefore, understanding the pharmacokinetics of vitamins provides critical insights into absorption, distribution, and metabolism, all of which are essential for achieving the desired pharmacological response. In this review paper, we present information on vitamin deficiencies and emphasize the significance of understanding vitamin pharmacokinetics for improved clinical research. The pharmacokinetics of several vitamins face various challenges, and thus, this work briefly outlines the current issues and their potential solutions. We also discuss the feasibility of enhanced nanocarrier-based pharmaceutical formulations for delivering vitamins. Recent studies have shown a preference for nanoformulations, which can address major limitations such as stability, solubility, absorption, and toxicity. Ultimately, the pharmacokinetics of pharmaceutical dosage forms containing vitamins can impede the treatment of diseases and disorders related to vitamin deficiency.
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3.
Management of Patients With Kidney Disease Undergoing Bariatric Surgery: A Multidisciplinary Approach.
Kukla, A, Kudva, YC, Navratil, P, Sahi, SS, Benzo, RP, Fipps, DC, Erickson, AE, Majorowicz, RR, Clark, MM, Schinstock, CA, et al
Mayo Clinic proceedings. 2024;(3):445-458
Abstract
Bariatric surgery is increasingly recognized as a safe and effective treatment for obesity in patients with chronic kidney disease (CKD), including stages 4, 5, and 5D (on dialysis). Among the available surgical methods, sleeve gastrectomy (SG) is the most commonly performed weight loss procedure and is mainly done to facilitate kidney transplantation (KT). However, many KT candidates treated with SG remain on the transplant waiting list for months to years, with some never receiving a transplant. Therefore, appropriate candidates for SG must be selected, and post-SG management should address the unique needs of this population, with a focus on sustaining the metabolic benefits of surgery while minimizing potential side effects related to rapid weight loss which may inadvertently lead to muscle and bone catabolism. Multidisciplinary post-SG care in this population may lead to overall better health on the transplant waiting list, resulting in a higher percentage of post-SG patients ultimately receiving KT. To tailor the effective treatment for these patients, clinicians should acknowledge that patients with CKD stage 4-5D have different nutritional needs and are metabolically and psychosocially distinct from the general bariatric surgery population. Sarcopenia is highly prevalent and may be exacerbated by muscle catabolism following SG if not adequately addressed. Blood pressure, glucose, and bone metabolism are all affected by the CKD stage 4-5D, and therefore require distinct diagnostic and management approaches. Long-standing chronic disease, associated comorbidities, and low adherence to medical therapies require ongoing comprehensive psychosocial assessment and support. This paper aims to review and consolidate the existing literature concerning the intersection of CKD stage 4-5D and the consequences of SG. We also suggest future clinical outcome studies examining novel treatment approaches for this medically complex population.
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4.
Protein supplementation: the double-edged sword.
Patel, V, Aggarwal, K, Dhawan, A, Singh, B, Shah, P, Sawhney, A, Jain, R
Proceedings (Baylor University. Medical Center). 2024;(1):118-126
Abstract
Protein supplements are widely consumed by athletes as well as young adults and teenagers going to the gym and are an excellent source to increase protein intake, build muscle mass, and enhance recovery. They are available in the form of powders, gummies, protein bars, and ready-to-drink shakes and have been shown to have effects on almost every system in the body. Subjects consuming whey protein-based supplements regularly show significantly lower systolic blood pressure, while subjects who consume soy-based protein supplements have been reported to show a significant decrease in their systolic and diastolic blood pressures. Favorable effects of soy protein consumption have been observed on the serum lipid profile, with significant decreases in serum low-density lipoprotein and triglyceride levels. Lower postprandial glucose levels have been observed in diabetic subjects as well, which can be attributed to the lower glycemic index of these supplements. This can lead to an indirect decrease in diabetes-related complications. While these supplements affect the body positively, caution has to be exercised while consuming them in excess, as they have been shown to cause hyperfiltration and increased urinary calcium excretion which can, in turn, lead to chronic kidney disease development. This article focuses on the effects of protein supplementation on the human body, with emphasis on the cardiovascular, endocrine, and renal systems.
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5.
Standardised practices in the networked management of congenital hyperinsulinism: a UK national collaborative consensus.
Shaikh, MG, Lucas-Herald, AK, Dastamani, A, Salomon Estebanez, M, Senniappan, S, Abid, N, Ahmad, S, Alexander, S, Avatapalle, B, Awan, N, et al
Frontiers in endocrinology. 2023;:1231043
Abstract
Congenital hyperinsulinism (CHI) is a condition characterised by severe and recurrent hypoglycaemia in infants and young children caused by inappropriate insulin over-secretion. CHI is of heterogeneous aetiology with a significant genetic component and is often unresponsive to standard medical therapy options. The treatment of CHI can be multifaceted and complex, requiring multidisciplinary input. It is important to manage hypoglycaemia in CHI promptly as the risk of long-term neurodisability arising from neuroglycopaenia is high. The UK CHI consensus on the practice and management of CHI was developed to optimise and harmonise clinical management of patients in centres specialising in CHI as well as in non-specialist centres engaged in collaborative, networked models of care. Using current best practice and a consensus approach, it provides guidance and practical advice in the domains of diagnosis, clinical assessment and treatment to mitigate hypoglycaemia risk and improve long term outcomes for health and well-being.
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6.
Linking genotypic and phenotypic changes in the E. coli long-term evolution experiment using metabolomics.
Favate, JS, Skalenko, KS, Chiles, E, Su, X, Yadavalli, SS, Shah, P
eLife. 2023
Abstract
Changes in an organism's environment, genome, or gene expression patterns can lead to changes in its metabolism. The metabolic phenotype can be under selection and contributes to adaptation. However, the networked and convoluted nature of an organism's metabolism makes relating mutations, metabolic changes, and effects on fitness challenging. To overcome this challenge, we use the long-term evolution experiment (LTEE) with E. coli as a model to understand how mutations can eventually affect metabolism and perhaps fitness. We used mass spectrometry to broadly survey the metabolomes of the ancestral strains and all 12 evolved lines. We combined this metabolic data with mutation and expression data to suggest how mutations that alter specific reaction pathways, such as the biosynthesis of nicotinamide adenine dinucleotide, might increase fitness in the system. Our work provides a better understanding of how mutations might affect fitness through the metabolic changes in the LTEE and thus provides a major step in developing a complete genotype-phenotype map for this experimental system.
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7.
HFSA Expert Consensus Statement on the Medical Management of Patients on Durable Mechanical Circulatory Support.
Trachtenberg, B, Cowger, J, Jennings, DL, Grafton, G, Loyaga-Rendon, R, Cogswell, R, Klein, L, Shah, P, Kiernan, M, Vorovich, E
Journal of cardiac failure. 2023;(4):479-502
Abstract
The medical management of patients supported with durable continuous flow left ventricular assist device (LVAD) support encompasses pharmacological therapies administered in the preoperative, intraoperative, postoperative, and chronic LVAD support stages. As patients live longer on LVAD support, the risks of LVAD-related complications and progression of cardiovascular and other diseases increase. Using existing data from cohort studies, registries, randomized trials, and expert opinion, this Heart Failure Society of America Consensus Document on the Medical Management of Patients on Durable Mechanical Circulatory Support offers best practices on the management of patients on durable mechanical circulatory support, focusing on pharmacological therapies administered to patients on continuous flow LVADs. Although quality data in the LVAD population are few, the use of guideline-directed heart failure medical therapies and the importance of blood pressure management, right ventricular preload and afterload optimization, and antiplatelet and anticoagulation regimens are discussed. Recommended pharmacological regimens used to mitigate or treat common complications encountered during LVAD support, including arrhythmias, vasoplegia, mucocutaneous bleeding, and infectious complications, are addressed. Finally, this document touches on important potential pharmacological interactions from antidepressants and herbal and nutritional supplements of relevance to providers of patients on LVAD support.
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8.
Comparison of "My Tooth the Happiest" educational game with standard dietary counseling for preference toward non-cariogenic food items in preschool children: A Randomized control trial.
Saraf, T, Hegde, R, Shah, P
Journal of the Indian Society of Pedodontics and Preventive Dentistry. 2023;(1):35-42
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Abstract
BACKGROUND A change in food preferences is difficult to bring about, thus there is a need of an innovative tool which would cater to the developing cognition of the child but at the same time be fun and engaging. AIM: To assess and compare playing "My tooth the happiest" an educational game with standard dietary counseling in preschool children for preference for noncariogenic food items. SETTINGS AND DESIGN Randomized controlled trial. MATERIALS AND METHODS The parents of 51 children aged between 4 and 6 years, answered a preintervention questionnaire on the daily food preferences of their children and were scored as per the scale which depicted the frequency status of dietary preferences. In Group A, 25 children played the educational game "My tooth the Happiest" and Group B of 26 children were given verbal dietary counseling. A postintervention questionnaire was answered by the parents on the 8th, 16th, and 30th days and were scored as per the scale. STATISTICAL ANALYSIS The intergroup comparison of Group A and Group B was done by Mann-Whitney test and the intra-group analysis by Friedman's test. RESULTS The inter-group analysis showed a highly significant (P < 0.01) result at the 8th, 16th, and 30th day with lower mean scores in Group A than Group B. The intragroup analysis within both the groups showed a highly significant change (P < 0.01). CONCLUSIONS Playing an inexpensive, fun, educational game could be a "Game changer" for dietary counseling in pediatric dentistry for preschoolers.
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9.
Is Coffee and Tea a Threat or Ally to Cardiovascular Health?
Mendpara, V, Garg, S, Shah, P, Bhavsar, J, Anamika, F, Patel, M, Munjal, RS, Gupta, V, Garg, N, Jain, R
Cureus. 2023;(12):e49991
Abstract
Tea and coffee have become ingrained in our daily lives and have become the most widely consumed drinks after water. Their effects vary on an individual basis depending upon the amount of daily consumption, genetic polymorphisms, and the presence of comorbidities. Non-habitual individuals experience an initial, brief increase in blood pressure due to caffeine's vasoactive effects. Caffeine also appears to be protective against arrhythmias and heart failure. Along with having a generally cardioprotective profile, they have also demonstrated to have a favorable impact on insulin resistance and reduced risk of diabetes mellitus. Physicians often practice caution and advise patients with known cardiovascular diseases to refrain from drinking caffeine; however, studies have shown that drinking two to three cups a day has either no or some beneficial effects on both patients with or without cardiac disorders like arrhythmias. This article focuses on the effects of tea and coffee on the cardiovascular system as well as the potential mechanisms involved.
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10.
Glycerosomes: Novel Nano-Vesicles for Efficient Delivery of Therapeutics.
Sharma, D, Rani, A, Singh, VD, Shah, P, Sharma, S, Kumar, S
Recent advances in drug delivery and formulation. 2023;(3):173-182
Abstract
BACKGROUND The topical drug delivery system has gained more attention in recent years as compared to oral and parenteral drug delivery. However, owing to the barrier function of the skin's topmost layer, only a few drug molecules can be administered by this route. Therefore, encapsulating the drugs in glycerosomes is one potential solution to this problem. Glycerosomes are vesicular drug delivery systems primarily made up of large concentrations of glycerol, phospholipid, water, and other active ingredients. OBJECTIVE The main aim of this review is to summarize the most recent information on the encapsulated vesicular system used in cosmetic preparations, specifically glycerosomes made from both synthetic and naturally occurring plant bioactive substances. PURPOSE Glycerosomes offer many benefits, including increased efficacy, better stability, improve absorption, drug targeting at specific sites, and delivering the same at a predetermined rate. METHOD The mechanism behind the penetration of glycerosomes is the hydration and lipid fluidization of skin, fabricated by glycerol. RESULT Numerous methods have been reported for the formulation of glycerosomes, including the thin film hydration method, reverse-phase evaporation, solvent spherule, detergent removal method, and so on. CONCLUSION Researchers are currently investigating the potential of glycerosomes as nanocarriers for natural bioactive and synthetic drugs. This review describes the structure of glycerosomes, preparation techniques, applications, distinctions from liposomes, and benefits of glycerosomes.