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Biology Apr 2021Obesity caused by the overconsumption of calories has increased to epidemic proportions. Insulin resistance is often associated with an increased adiposity and is a... (Review)
Review
Obesity caused by the overconsumption of calories has increased to epidemic proportions. Insulin resistance is often associated with an increased adiposity and is a precipitating factor in the development of cardiovascular disease, type 2 diabetes, and altered metabolic health. Of the various factors contributing to metabolic impairments, nutrition is the major modifiable factor that can be targeted to counter the rising prevalence of obesity and metabolic diseases. However, the macronutrient composition of a nutritionally balanced "healthy diet" are unclear, and so far, no tested dietary intervention has been successful in achieving long-term compliance and reductions in body weight and associated beneficial health outcomes. In the current review, we briefly describe the role of the three major macronutrients, carbohydrates, fats, and proteins, and their role in metabolic health, and provide mechanistic insights. We also discuss how an integrated multi-dimensional approach to nutritional science could help in reconciling apparently conflicting findings.
PubMed: 33923531
DOI: 10.3390/biology10040336 -
Neurobiology of Stress May 2022Suicide is a leading cause of death and morbidity worldwide, yet few interventions are available to mitigate its risk. Barriers to effective treatments involve a limited... (Review)
Review
Suicide is a leading cause of death and morbidity worldwide, yet few interventions are available to mitigate its risk. Barriers to effective treatments involve a limited understanding of factors that predict the onset of suicidal thoughts and behaviors. In the context of suicide risk, stress is a precipitating factor that is largely overlooked in the literature. Indeed, the pathophysiology of stress and suicide are heavily interconnected, underscoring the need to target the stress system in suicide prevention. In this review, we integrate findings from the preclinical and clinical literature that links stress and suicide. We focus specifically on the effects of stress on underlying biological functions and processes associated with suicide, allowing for the review of research using animal models. Owing to the rapid anti-suicidal effects of ()-ketamine, we discuss its ability to modulate various stress-related endophenotypes of suicide, as well as its potential role in preventing suicide in those with a history of chronic life stress (e.g., early life adversity). We highlight future research directions that could advance our understanding of stress-related effects on suicide risk, advocating a dimensional, endophenotype approach to suicide research.
PubMed: 35685678
DOI: 10.1016/j.ynstr.2022.100450 -
International Journal of Cardiology Oct 2023Interest in clinical course preceding heart failure (HF) exacerbation has grown, with a greater emphasis placed on patients' clinical factors including precipitant... (Review)
Review
BACKGROUND
Interest in clinical course preceding heart failure (HF) exacerbation has grown, with a greater emphasis placed on patients' clinical factors including precipitant factor (PF). Large-scale studies with precise PF documentation and temporal-outcome variation remain limited.
METHODS
We reviewed prospectively collected 2412 consecutive patient-level records from a multicenter Japanese registry of hospitalized patients with HF (West Tokyo Heart Failure2 Registry: 2018-2020). Patients were categorized based on PFs: behavioral (i.e., poor adherence to physical activity, medicine, or diet regimen), treatment-required (i.e., anemia, arrhythmia, ischemia, infection, thyroid dysfunction or other conditions as suggested exacerbating factors), and no-PF. The composite outcomes of HF rehospitalization and death within 1 year after discharge and HF rehospitalization were individually assessed.
RESULTS
Median patient age was 78 years (interquartile range: 68-85 years), and 1468 (61%) patients had documented PFs, of which 356 (15%) were considered behavioral. The behavioral PF group were younger, more male and had past HF hospitalization history compared to those in the other groups (all p < 0.05). Although risk of in-hospital death was lower in the behavioral PF group, their risk of composite outcome was not significantly different from the treatment-required group (hazard ratio [HR] 1.19 [95% confidence interval {CI} 0.93-1.51]) and the no-PF group (HR 1.28 [95%CI 1.00-1.64]). Furthermore, the risk of HF rehospitalization was higher in the behavioral PF group than in the other two groups (HR 1.40 [95%CI 1.07-1.83] and HR 1.39 [95%CI 1.06-1.83], respectively).
CONCLUSION
Despite a better in-hospital prognosis, patients with behavioral PFs were at significantly higher risk of HF rehospitalization.
Topics: Humans; Male; Aged; Aged, 80 and over; Hospital Mortality; Precipitating Factors; Hospitalization; Prognosis; Hospitals; Heart Failure; Registries; Multicenter Studies as Topic
PubMed: 37437664
DOI: 10.1016/j.ijcard.2023.131161 -
World Journal of Hepatology Dec 2015Hepatic encephalopathy (HE) is a major complication of cirrhosis resulting in significant socioeconomic burden, morbidity, and mortality. HE can be further subdivided... (Review)
Review
Hepatic encephalopathy (HE) is a major complication of cirrhosis resulting in significant socioeconomic burden, morbidity, and mortality. HE can be further subdivided into covert HE (CHE) and overt HE (OHE). CHE is a subclinical, less severe manifestation of HE and requires psychometric testing for diagnosis. Due to the time consuming screening process and lack of standardized diagnostic criteria, CHE is frequently underdiagnosed despite its recognized role as a precursor to OHE. Screening for CHE with the availability of the Stroop test has provided a pragmatic method to promptly diagnose CHE. Management of acute OHE involves institution of lactulose, the preferred first-line therapy. In addition, prompt recognition and treatment of precipitating factors is critical as it may result in complete resolution of acute episodes of OHE. Treatment goals include improvement of daily functioning, evaluation for liver transplantation, and prevention of OHE recurrence. For secondary prophylaxis, intolerance to indefinite lactulose therapy may lead to non-adherence and has been identified as a precipitating factor for recurrent OHE. Rifaximin is an effective add-on therapy to lactulose for treatment and prevention of recurrent OHE. Recent studies have demonstrated comparable efficacy of probiotic therapy to lactulose use in both primary prophylaxis and secondary prophylaxis.
PubMed: 26692331
DOI: 10.4254/wjh.v7.i29.2871 -
PloS One 2022There was limited data on treatment outcomes among patients with diabetic ketoacidosis (DKA) in Ethiopia.
BACKGROUND
There was limited data on treatment outcomes among patients with diabetic ketoacidosis (DKA) in Ethiopia.
OBJECTIVE
The aim of the study was to determine the treatment outcomes of DKA patients attending Debre Tabor General Hospital.
METHOD
A retrospective study was conducted at Debre Tabor General Hospital and data were collected from June 1 to June 30 of 2018. Participants included in the study were all diabetic patients with DKA admitted from August 2010 to May 31, 2018. The primary outcomes were the treatment outcomes of DKA including (in-hospital glycemic control, the length of hospital stay and in-hospital mortality). The statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) version 22. Descriptive statistics was presented in the form of means with standard deviation and binary regression was conducted to determine factors that affect length of hospital stay among DKA patients.
RESULT
387 patients were included in the study. The mean age of patients was 33.30± 14.96 years. The most common precipitating factor of DKA was new onset diabetes mellitus 150(38.8%). The mean length of hospital stay was 4.64(±2.802) days. The mean plasma glucose at admission and discharge was 443.63(±103.33) and 172.94 (±80.60) mg/dL, respectively. The majority 370 (95.60%) of patients improved and discharged whereas 17 (4.40%) patients died in the hospital. Patients with mild and moderate DKA showed short hospital stay; AOR: 0.16 [0.03-0.78] and AOR:0.17[0.03-0.96] compared with severe DKA. Diabetic ketoacidosis precipitated by infection were nearly five times more likely to have long hospital stay than DKA precipitated by other causes; AOR: 4.59 [1.08-19.42]. In addition, serum glucose fluctuation during hospitalization increased the likelihood of long hospital stay, AOR: 2.15[1.76-2.63].
CONCLUSIONS
New onset type 1 diabetes was the major precipitating factor for DKA. Admitted DKA patients remained in hospital for a duration of approximately five days. About five out of hundred DKA patients ended up with death in the hospital. Infection, serum glucose fluctuations and severity of DKA were determinants of long hospital stay. Early prevention of precipitating factors and adequate management of DAK are warranted to reduce length of hospital stay and mortality.
Topics: Adolescent; Adult; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Ethiopia; Glucose; Hospitals; Humans; Middle Aged; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 35381004
DOI: 10.1371/journal.pone.0264626 -
Current Pain and Headache Reports Apr 2024In this narrative review, we aim to summarize recent insights into the complex interplay between environmental and genetic factors affecting the etiology, development,... (Review)
Review
PURPOSE OF REVIEW
In this narrative review, we aim to summarize recent insights into the complex interplay between environmental and genetic factors affecting the etiology, development, and progression of chronic migraine (CM).
RECENT FINDINGS
Environmental factors such as stress, sleep dysfunction, fasting, hormonal changes, weather patterns, dietary compounds, and sensory stimuli are critical triggers that can contribute to the evolution of episodic migraine into CM. These triggers are particularly influential in genetically predisposed individuals. Concurrently, genome-wide association studies (GWAS) have revealed over 100 genetic loci linked to migraine, emphasizing a significant genetic basis for migraine susceptibility. In CM, environmental and genetic factors are of equal importance and contribute to the pathophysiology of the condition. Understanding the bidirectional interactions between these elements is crucial for advancing therapeutic approaches and preventive strategies. This balanced perspective encourages continued research into the complex gene-environment nexus to improve our understanding and management of CM.
Topics: Humans; Genome-Wide Association Study; Migraine Disorders; Genetic Predisposition to Disease; Precipitating Factors; Sleep Wake Disorders
PubMed: 38363449
DOI: 10.1007/s11916-024-01228-4 -
Journal of Hepatology Jul 2021The transition from compensated to decompensated cirrhosis results from a complex interplay of predisposing and precipitating factors and represents an inflection point... (Review)
Review
The transition from compensated to decompensated cirrhosis results from a complex interplay of predisposing and precipitating factors and represents an inflection point in the probability of a patient surviving. With the progression of cirrhosis, patients accumulate multiple disorders (e.g. altered liver architecture, portal hypertension, local and systemic inflammation, bacterial translocation, gut dysbiosis, kidney vasoconstriction) that predispose them to decompensation. On the background of these factors, precipitating events (e.g. bacterial infection, alcoholic hepatitis, variceal haemorrhage, drug-induced liver injury, flare of liver disease) lead to acute decompensation (ascites, hepatic encephalopathy, variceal bleeding, jaundice) and/or organ failures, which characterise acute-on-chronic liver failure. In this review paper, we will discuss the current hypotheses and latest evidences regarding predisposing and precipitating factors associated with the transition to decompensated liver disease.
Topics: Acute-On-Chronic Liver Failure; Causality; Disease Progression; Humans; Liver Cirrhosis; Precipitating Factors; Prognosis
PubMed: 34039491
DOI: 10.1016/j.jhep.2020.12.005 -
Headache 2023This secondary analysis evaluated the information content exhibited by various measurement strategies of commonly perceived causes, or "triggers," of headache attacks.
OBJECTIVES
This secondary analysis evaluated the information content exhibited by various measurement strategies of commonly perceived causes, or "triggers," of headache attacks.
BACKGROUND
When evaluating triggers of primary headache attacks, the variation observed in trigger candidates must be measured to compare against the covariation in headache activity. Given the numerous strategies that could be used to measure and record headache trigger variables, it is useful to consider the information contained in these measurements.
METHODS
Using previously collected data from cohort and cross-sectional studies, online data sources, and simulations, the Shannon information entropy exhibited by many common triggers was evaluated by analyzing available time-series or theoretical distributions of headache triggers. The degree of information, reported in bits, was compared across trigger variables, measurement strategies, and settings.
RESULTS
A wide range of information content was observed across headache triggers. Due to lack of variation, there was little information, near 0.00 bits, in triggers like red wine and air conditioning. Most headache triggers exhibited more information when measured using an ordinal scale of presence/degree (e.g., absent, mild, moderate, severe) versus a present/absent binary coding. For example, the trigger "joy" exhibited 0.03 bits when assessed using binary coding but 1.81 bits when coded using an ordinal scale. More information was observed with the use of count data (0.86 to 1.75 bits), Likert rating scales (1.50 to 2.76 bits), validated questionnaires (3.57 to 6.04 bits), weather variables (0.10 to 8.00 bits), and ambulatory monitoring devices (9.19 to 12.61 bits).
CONCLUSIONS
Although commonly used, all binary-coded measurements contain ≤1.00 bit of information. Low levels of information in trigger variables make associations with headache activity more difficult to detect. Assessments that balance information-rich measurements with reasonable participant burden using efficient formats (e.g., Likert scales) are recommended to enhance the evaluation of the association with headache activity.
Topics: Humans; Information Theory; Cross-Sectional Studies; Headache; Surveys and Questionnaires; Precipitating Factors
PubMed: 37395303
DOI: 10.1111/head.14583 -
Journal of Affective Disorders Sep 2015Mania in bipolar disorder (BD) and partial (focal) seizures (PS) arising from the temporal lobes, have a number of similarities. Typically, a chronic course of the... (Comparative Study)
Comparative Study Review
OBJECTIVES
Mania in bipolar disorder (BD) and partial (focal) seizures (PS) arising from the temporal lobes, have a number of similarities. Typically, a chronic course of the disorders is punctuated by acute illness episodes. Common features of episodes may include sensory, perceptual, cognitive and affective changes. Both respond to anticonvulsant treatment. Common mechanisms imputed include neurotransmitters and kindling processes. Further investigation may improve understanding of the occurrence of both mania and PS, casting light on the relevance of temporal lobe mediated processes and pathology. One avenue of investigation is to compare aetiological factors and determine the extent of overlap which may indicate shared brain localization or pathophysiology. Aetiology includes predisposing, precipitating or perpetuating factors. This paper examines the literature on precipitating factors of mania, first or subsequent episode, and of PS in diagnosed epilepsy, which is the second or subsequent seizure, to identify the extent and nature of their overlap.
METHOD
Narrative review based on a literature search of PubMed and Google Scholar.
RESULTS
Precipitating factors for both mania and PS were stress, sleep deprivation, antidepressant medication and, tentatively, emotion. For mania alone, goal-attainment events, spring and summer season, postpartum, and drugs include steroids and stimulants. For PS alone, winter season, menstruation and specific triggers in complex reflex epilepsies. Those not substantiated include lunar phase and menopause. A wide range of chemicals may provoke isolated seizures but by definition epilepsy requires at least two seizures.
CONCLUSIONS
The overlap of precipitating factors in mania and PS imply that common brain processes may contribute to both, consistent with findings from neuroscience research.
Topics: Antidepressive Agents; Bipolar Disorder; Epilepsy; Female; Health Status; Humans; Male; Mental Fatigue; Precipitating Factors; Risk Factors; Seizures; Sleep Deprivation; Stress, Psychological
PubMed: 26001664
DOI: 10.1016/j.jad.2015.04.057 -
International Urology and Nephrology Mar 2017Acute kidney injury is a heterogeneous clinical syndrome encompassing a spectrum of risk factors and acute insults, occurring in multiple settings and affecting both... (Review)
Review
Acute kidney injury is a heterogeneous clinical syndrome encompassing a spectrum of risk factors and acute insults, occurring in multiple settings and affecting both short-term and long-term outcomes. Obesity has become an epidemic. The available literature suggests that AKI is common in critically ill surgical or medical obese patients and that obesity is a novel risk factor for this acute renal syndrome. The pathophysiology of obesity-associated AKI is not completely understood. Obesity-related factors combined with the burden of other comorbidities in elderly obese patients may interact with known precipitating factors such as hypotension, nephrotoxins or sepsis and increase the susceptibility of this population to AKI. Whether or not obesity may counterintuitively be protective and associated with better survival of critically ill patients with AKI ("reverse epidemiology") is a subject for debate. Further investigations exploring the role of novel biomarkers and optimal management are needed urgently.
Topics: Acute Kidney Injury; Body Mass Index; Comorbidity; Critical Illness; Humans; Obesity; Perioperative Period; Risk Factors; Treatment Outcome
PubMed: 27822672
DOI: 10.1007/s11255-016-1451-4