15 research outputs found
Remission as an Emerging Therapeutic Target in Type 2 Diabetes in the Era of New Glucose-Lowering Agents: Benefits, Challenges, and Treatment Approaches
No full textType 2 diabetes mellitus (T2DM) is a progressive disease with a growing prevalence, associated with an increased risk of complications. The introduction of new classes of antidiabetic drugs into clinical practice has dramatically changed the landscape of diabetes therapy. However, despite the progress made in the pharmacotherapy of T2DM, mitigating the burden of the disease on individuals, societies and health care systems remains a challenge. Remission has recently emerged as a therapeutic target in T2DM, achievable through a wide range of interventions. Recent studies have shown that extensive lifestyle changes, such as weight reduction, bariatric surgery, and intensive glucose lowering therapy, can prompt the remission of diabetes, but some unanswered questions remain regarding its long-term effects on diabetic complications. Metabolic surgery and novel classes of glucose-lowering medications are currently the most effective interventions to induce weight loss and by extension remission in patients with diabetes; however, the ideal strategy to achieve the long-term maintenance of remission remains doubtful. In this narrative review, we discuss the available therapeutic approaches to target the remission of diabetes through personalized multimodal care, based on the latest evidence
Supplementary_File - Flaws in Anticoagulation Strategies in Patients With Atrial Fibrillation at Hospital Discharge
No full textSupplementary_File for Flaws in Anticoagulation Strategies in Patients With Atrial Fibrillation at Hospital Discharge by Anastasios Kartas, Athanasios Samaras, Dimitra Vasdeki, George Dividis, George Fotos, Eleni Paschou, Evropi Forozidou, Paraskevi Tsoukra, Eleni Kotsi, Ioannis Goulas, George Efthimiadis, Haralambos Karvounis, Apostolos Tzikas, and George Giannakoulas in Journal of Cardiovascular Pharmacology and Therapeutics</p
Above the Clouds with Diabetes: From Pathophysiological Considerations to Practical Recommendations for Safe Flights
No full textVasdeki, Dimitra, Georgios Tsamos, Kleoniki I. Athanasiadou, Vasiliki Michou, Evangelos Botsarakos, Michael Doumas, Kalliopi Kotsa, and Theocharis Koufakis. Above the clouds with diabetes: from pathophysiological considerations to practical recommendations for safe flights. High Alt Med Biol. 26:87-98, 2025. Background: The prevalence of diabetes mellitus has been following an increasing trend in the last decades, leading to a growing number of travelers with diabetes seeking pretravel advice from medical professionals. Methods: This narrative review summarizes the existing evidence on the intriguing association between diabetes and air travel, analyzes safety and certification protocols, and provides practical recommendations for the management of diabetes during flights. Results: During air travel, individuals with diabetes face challenges arising from inappropriate dietary options, restricted access to medications and healthcare services, disruption of medication dosing intervals, and exposure to hypobaric conditions in the airplane cabin. In addition, people with diabetes, especially those treated with insulin, have traditionally been considered ineligible to become professional pilots. However, this approach gradually changes and numerous countries are now implementing strict protocols to determine the eligibility of pilots with diabetes to operate flights. Conclusions: Given the increasing use of technology and new drugs in daily clinical practice, there is a need for further research in the field to shed light on existing knowledge gaps and ensure safe flights for people with diabetes. Copyright 2025, Mary Ann Liebert, Inc., publishers
Incidence, Prevention, and Management of Periprocedural Complications of Left Atrial Appendage Occlusion.
No full textMajor procedural complications related to left atrial appendage occlusion (LAAO) are relatively infrequent but may be associated with major morbidity and mortality. LAAO operators should be knowledgeable about these potential complications. Prompt recognition and treatment are necessary to avoid rapid deterioration and dire consequences. With stringent guidelines on operator training, competency requirements, and procedural-technical refinements, LAAO can be performed safely with low complication rates. This article focuses on commonly used devices, as well as prevention, treatment, and management of complications of LAOO
Unraveling of Molecular Mechanisms of Cognitive Frailty in Chronic Kidney Disease: How Exercise Makes a Difference
No full textAs our population ages, the medical challenges it faces become increasingly acute, with chronic kidney disease (CKD) becoming more prevalent among older adults. Frailty is alarmingly more common in CKD patients than in the general populace, putting the elderly at high risk of both physical and cognitive decline. CKD not only accelerates physical deterioration, but also heightens vascular dysfunction, calcification, arterial rigidity, systemic inflammation, oxidative stress, and cognitive impairment. Cognitive frailty, a distinct syndrome marked by cognitive deficits caused by physiological causes (excluding Alzheimer’s and other dementias), is a critical concern. Although cognitive impairment has been well-studied, the molecular mechanisms driving cognitive frailty remain largely uncharted. Comprehensive interventions, including cutting-edge pharmaceuticals and lifestyle changes, are pivotal and effective, especially in the early stages of CKD. Recent research suggests that systematic exercise could counteract cognitive decline by improving brain blood flow, boosting neuroplasticity through the brain-derived neurotrophic factor (BDNF), and by triggering the release of neurotrophic factors such as insulin-like growth factor (IGF-1). This review delves into the molecular pathways of cognitive frailty in CKD, identifies key risk factors, and highlights therapeutic approaches, particularly the potent role of exercise in enhancing cognitive health
Antiphospholipid Syndrome: A Comprehensive Clinical Review
No full textBackground: Antiphospholipid syndrome (APS) is a rare systemic autoimmune disease characterized by persistent antiphospholipid antibodies (aPL) in combination with recurrent thrombosis in the veins and/or arteries, obstetric morbidity, and various non-thrombotic associated complications. APS can be primary, as an isolated condition, or secondary in the context of another autoimmune disease, especially systemic lupus erythematosus. This comprehensive clinical review aims to summarize the current understanding of APS pathogenesis, diagnostic approaches, and treatment strategies for this unique clinical entity. Methods: A comprehensive review of the existing literature on APS was conducted, focusing on pathophysiological mechanisms, current diagnostic criteria, and therapeutic approaches. Results: APS pathogenesis involves complex interactions between aPL, phospholipid-binding proteins, and the coagulation cascade. Apart from the cardinal features of thrombosis and APS-related obstetric morbidity, APS is associated with a wide spectrum of clinical manifestations. Diagnosis remains challenging due to overlapping symptoms with other conditions, and clinicians should maintain a high index of suspicion in order to set the diagnosis. The recently published 2023 ACR/EULAR criteria although not definitive for clinical decision-making, these criteria offer clinicians a valuable tool to aid in determining whether further investigation for APS is warranted. Continued refinement of these criteria through ongoing feedback and updates is anticipated. Treatment strategies center on anticoagulation, but individualized approaches are necessary. Conclusions: Early diagnosis and multidisciplinary management of APS are critical to reducing morbidity and improving outcomes. Moreover, familiarization with the 2023 ACR/EULAR criteria is encouraged, recognizing that ongoing feedback and updates will contribute to their ongoing refinement and improvement. While VKAs remain the mainstay of treatment for most APS patients further research is needed to optimize treatment strategies and deepen our understanding of APS’s underlying disease mechanisms
Exercise Interventions in Breast Cancer: Molecular Mechanisms, Physical Benefits, and Practical Recommendations
No full textExercise interventions are increasingly recognized as effective non-pharmacological strategies to improve clinical outcomes in patients with breast cancer. This review provides a comprehensive framework linking physical activity with breast cancer risk reduction, disease progression, and survivorship. We first outline the robust epidemiological evidence demonstrating that regular exercise significantly reduces breast cancer incidence, recurrence, and disease-specific mortality. The review then delves into the molecular mechanisms by which exercise exerts its protective effects, including modulation of sex hormones, metabolic hormones, systemic inflammation, oxidative stress, circulating microRNAs, and breast cancer-related DNA methylation. Furthermore, we summarize findings from clinical trials evaluating the effects of exercise on cardiorespiratory fitness, functional capacity, and quality of life in breast cancer patients. Emerging research on the synergistic potential of exercise with conventional cancer treatments and bioactive dietary components, particularly polyphenols such as saffron and curcumin, is also discussed. Finally, we present evidence-based exercise recommendations tailored to breast cancer patients, emphasizing the importance of individualized prescriptions to optimize safety and therapeutic benefit. Collectively, this review highlights the multifaceted role of exercise in breast cancer prevention, treatment, and survivorship
Therapeutic Potentials of Reducing Liver Fat in Non-Alcoholic Fatty Liver Disease: Close Association with Type 2 Diabetes
No full textNonalcoholic fatty liver disease (NAFLD), the most widespread chronic liver disease worldwide, confers a significant burden on health systems and leads to increased mortality and morbidity through several extrahepatic complications. NAFLD comprises a broad spectrum of liver-related disorders, including steatosis, cirrhosis, and hepatocellular carcinoma. It affects almost 30% of adults in the general population and up to 70% of people with type 2 diabetes (T2DM), sharing common pathogenetic pathways with the latter. In addition, NAFLD is closely related to obesity, which acts in synergy with other predisposing conditions, including alcohol consumption, provoking progressive and insidious liver damage. Among the most potent risk factors for accelerating the progression of NAFLD to fibrosis or cirrhosis, diabetes stands out. Despite the rapid rise in NAFLD rates, identifying the optimal treatment remains a challenge. Interestingly, NAFLD amelioration or remission appears to be associated with a lower risk of T2DM, indicating that liver-centric therapies could reduce the risk of developing T2DM and vice versa. Consequently, assessing NAFLD requires a multidisciplinary approach to identify and manage this multisystemic clinical entity early. With the continuously emerging new evidence, innovative therapeutic strategies are being developed for the treatment of NAFLD, prioritizing a combination of lifestyle changes and glucose-lowering medications. Based on recent evidence, this review scrutinizes all practical and sustainable interventions to achieve a resolution of NAFLD through a multimodal approach
Vitamin D Supplementation: Shedding Light on the Role of the Sunshine Vitamin in the Prevention and Management of Type 2 Diabetes and Its Complications
No full textAs the incidence of type 2 diabetes mellitus (T2DM) continues to increase globally, researchers are keen to investigate various interventions to mitigate its impact. Among these, vitamin D supplementation has attracted significant attention due to its influence on insulin secretion from the pancreas and insulin receptors in body cells. A substantial body of evidence indicates that vitamin D supplementation can reduce low-grade inflammation, a critical factor in developing insulin resistance. In addition, vitamin D aids in sustaining low resting concentrations of reactive oxygen species and free radicals, normalizes Ca2+ signaling, diminishes the expression of cytokines that are pro-inflammatory, and enhances the production of cytokines that are anti-inflammatory. This review discusses the effects of vitamin D on the glycemic control of individuals with T2DM and evaluates the impact of vitamin D supplementation on glycemic markers in this population. The investigation employs a comprehensive analysis of the existing literature with a special focus on recent studies published in the past decade. Based on the findings in the literature, it can be concluded that vitamin D supplementation alongside anti-diabetic medications may enhance glycemic control and potentially reduce the risk of diabetic complications. The evidence supports the notion that vitamin D supplementation can be a valuable addition to pharmacological agents for the management of T2DM, potentially enhancing glycemic control and overall health outcomes in affected individuals
The Effects of Olive Oil Consumption on Biochemical Parameters and Body Mass Index of People with Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
No full textNonalcoholic fatty liver disease (NAFLD), the most common chronic liver disorder, is closely associated with insulin resistance, obesity, and metabolic syndromes. A body of research has proposed that olive oil, a basic component of the Mediterranean diet with antioxidant and anti-inflammatory properties, may alleviate metabolic disturbances and retard the progression of NAFLD. We conducted a systematic review and meta-analysis to assess the effectiveness of olive oil intake in people with NAFLD. We systematically searched the major electronic databases (PubMed/MEDLINE, Scopus, Cochrane Central Register of Controlled Trials), as well as grey literature sources, to identify randomized controlled trials (RCTs) investigating the effects of olive oil consumption on biochemical and anthropometric parameters of individuals with NAFLD. The quality of the studies was evaluated using the risk-of-bias tool 2.0 (RoB 2). The mean difference (MD) and the 95% confidence interval (CI) were calculated using fixed-effects and random-effects models. Seven RCTs involving 515 subjects were included in the analysis. In the random-effects model, no statistically significant differences were identified with respect to alanine transaminase (MD = −1.83 IU/L, 95% CI: −5.85, 2.19 IU/L, p = 0.37, I2 = 69%) and aspartate transaminase (MD = −1.65 IU/L, 95% CI: −4.48, 1.17 IU/L, p = 0.25, I2 = 72%) levels or waist circumference values (MD = −0.23 cm, 95% CI: −1.23, 0.76 cm, p = 0.65, I2 = 0%). However, a significant effect on body mass index was observed (MD = −0.57 kg/m2, 95% CI: −1.08, −0.06 kg/m2, p = 0.03, I2 = 51%) for subjects who received olive oil compared to those who received an alternative diet or placebo. The findings of the present meta-analysis suggest a modestly positive impact of olive oil intake on body weight in people with NAFLD
