A wearable electrochemical biosensor for the monitoring of metabolites and nutrients

Nature Biomedical Engineering, Год журнала: 2022, Номер 6(11), С. 1225 - 1235

Опубликована: Авг. 15, 2022

Язык: Английский

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A global view of the interplay between non-alcoholic fatty liver disease and diabetes

The Lancet Diabetes & Endocrinology, Год журнала: 2022, Номер 10(4), С. 284 - 296

Опубликована: Фев. 17, 2022

Язык: Английский

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Metformin: update on mechanisms of action and repurposing potential

Nature Reviews Endocrinology, Год журнала: 2023, Номер 19(8), С. 460 - 476

Опубликована: Май 2, 2023

Язык: Английский

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An Update on the Epidemiology of Type 2 Diabetes

Endocrinology and Metabolism Clinics of North America, Год журнала: 2021, Номер 50(3), С. 337 - 355

Опубликована: Авг. 13, 2021

Язык: Английский

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COVID-19 and metabolic disease: mechanisms and clinical management

The Lancet Diabetes & Endocrinology, Год журнала: 2021, Номер 9(11), С. 786 - 798

Опубликована: Окт. 6, 2021

Язык: Английский

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Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of fatigue in postacute sequelae of SARS‐CoV‐2 infection (PASC) patients

PM&R, Год журнала: 2021, Номер 13(9), С. 1027 - 1043

Опубликована: Авг. 4, 2021

Large numbers of individuals who have been infected with SARS-CoV-2, the virus responsible for COVID-19, continue to experience a constellation symptoms long past time that they recovered from acute stages their illness. Often referred as "long COVID," these symptoms, which can include fatigue, shortness breath, palpitations, cognitive dysfunction ("brain fog"), sleep disorders, fevers, gastrointestinal anxiety, depression, and others, persist months range mild incapacitating. Although still being defined, effects be collectively postacute sequelae SARS-CoV-2 infection (PASC).1 The magnitude this problem is not yet known, but given millions worldwide had, or will have, societal impacts are likely profound lasting.2-5 It widely acknowledged systematic study needed develop an evidence-based approach caring patients PASC. At present, there dearth rigorous scientific evidence regarding effective assessment treatment PASC prevents creation clinical guidelines. However, U.S. health system currently seeing increase in number presenting PASC, urgent need guidance treating patients. goal this, future statements, provide practical clinicians This Consensus Guidance Statement on fatigue first series focused most prominent symptoms. American Academy Physical Medicine Rehabilitation (AAPM&R) Multi-Disciplinary Collaborative ("PASC Collaborative") was created, part, expert recommendations established centers extensive managing following iterative, development achieve consensus Statements These statements were developed by diverse team experts, input patient representatives history integrate current expertise available tools There intentional focus equity disparities care outcomes critically important address. Beyond care, hope broadened understanding practices help identify areas research. A full description methodology also published issue.6 We acknowledge definition evolving, various factors contribute diagnosis. sought patient-led research initiatives inform recommendations. For example, previous literature has suggested defined continuation beyond 3 4 weeks onset infection.7 Other definitions lasting longer than months.8 Based feedback earlier evaluation, diagnosis, management improve access beneficial interventions, purpose Statement, we recommend expanded if improving 1 month after symptom onset. intended reflect practice assessment, testing, treatments. They should preclude judgment must applied context specific patient, adjustments preferences, comorbidities, other factors. Fatigue feeling weariness, tiredness, lack energy. physical, cognitive, emotional, severe, intermittent persistent, affect person's energy, motivation, concentration. negatively individual's sense well-being quality life generally lacks objective markers. during viral illness common; however often debilitating recovery illness.5 Further discussion impact found Institute Medicine's 2015 report chronic syndrome (Chapter 4).9 Individuals seeking COVID-19. Among nonhospitalized adults COVID-19 enrolled integrated Georgia, approximately two thirds had at least one outpatient medical encounter between 6 diagnosis.10 Approximately received new primary common based International Classification Diseases, Tenth Revision codes.10 In another describing long-term consequences hospitalized muscle weakness (63%) difficulties (26%).11 Anxiety depression common, reported 23% Greater 20% performances 6-minute walk test below lower-limit normal.11 Patient Led Research Collaborative, self-organized group conduct around COVID experience, conducted self-reported support groups PASC.12 majority (96%) completed survey self-identified having 90 days. early cough, headaches, aches, chest tightness, sore throat. frequent postexertional malaise, dysfunction. 85% experienced relapses exercise, physical mental activity, stress main triggers. addition, 42.5% requiring reduced work schedule compared pre-illness 22.3% working because conditions.12 among persistent both (p = 24.6%, confidence interval [CI] 20.11-29.72) those 37.1%, CI 26.54-49.06).13 improves over time, it months.2, 5, 7 As noted methodology,6 follow consensus. Specific approved tables followed additional (Table 1). basic lab workup considered without before visit including complete blood count differential, chemistries renal hepatic function tests, thyroid stimulating hormone, c-reactive protein erythrocyte sedimentation rate, creatinine kinase. laboratory tests may results concern comorbid conditions outlined Table 2. unusual fluctuating disease, particularly 2 months. involve components. document focuses subsequent issues. Additional post-COVID continuing initial onset, experiencing negative life. cases functionally limiting, monitored improvement part natural Symptoms: Chest pains, sweating, nausea, leg swelling, breath - rest/on exertion/lying flat/waking up night, dizziness standing, faint/fainting Signs: Pallor, tachypnea, tachycardia, diaphoresis, pulmonary rales, lower extremity edema, hypotensive sitting/standing orthostatic hypotension, presyncopal/syncopal, poor activity tolerance/endurance Shortness – exertion, wheeze, tolerance Tachypnea, hypoxia/low pulse oximeter, wheezes/rhonchi/"Velcro" Palpitations, dizziness, weight gain/loss, chills/fever, irregular menstrual cycle, diabetic control, excessive thirst/urination Tachycardia, tolerance, low/elevated temperature, elevated finger-stick/urine glucose, ketotic (fruity) Rash, joint/muscle pain stiffness, fever, mouth sores/ulcers, cold/pale/blue/red fingers, sharp pain, numbness/tingling/burning fingers/toes, blurry/decreased vision arthropathy swelling/warmth/decreased ROM, myopathy tenderness/weakness, Raynaud's phenomena, pleuritic deep breathing, altered sensation, decreased visual acuity Anxiety, irritability, low frustration mood swings, change memory/recall flat affect/low mood, emotional lability is, crying/laughing inappropriately, limited impulse psychosis Poor hard fall asleep/wakes frequently/wakes early, nonrestorative/refreshing "tired" waking, snoring, urination bad dreams/nightmares, falls asleep day, morning headaches Snoring, restless legs, observed apneic episodes, hypertension, arrhythmias, narcolepsy, congestive heart failure, impaired neurocognition, poorly controlled disorder consider evaluation diminished related distinct conditions. intersect, differential etiologies conjunction separate lowered tolerance. When evaluating etiology central contributing factors: endocrine nutritional infectious autoimmune/inflammatory cardiac respiratory psychiatric malignancies, drug reactions, adult-onset metabolic disorders (See 2). Diminished inability ability perform normally expected frequency, intensity level, duration people age, size, gender, mass. unusually severe postexercise vomiting, effects. dysfunctions pulmonary, cardiovascular, and/or neuromuscular systems. presentation appear similar myalgic encephalomyelitis/chronic (ME/CFS). ME/CFS complex occurs created diagnostic criteria 3.9 pathophysiology behind discovered. Centers Disease Control Prevention used PASC-related fatigue.18 more data understand manifestation represents process. Finally, note multifactorial unifying cause fatigue. any plan, encouraged discuss unknowns treatments, well pros cons therapeutic approach. helpful despite unknown course tends slowly time. initiated, response level function. options vary customized history, date. identified (see 2), addressed plan 4, Recommendation #4). clinics helped alleviate or, addressing, persist. details techniques summarized next. efficacy emerges, reviewed revised periodic basis. An individually titrated, symptom-guided program return recommended rehabilitation restore levels Until goals achieved, high aerobic exercises heavy weightlifting build strength endurance. If advanced too quickly intense, worsen lead malaise (PEM), criterion ME/CFS.9 titrated encourages activities submaximal avoid exacerbation PEM. Activity adjusted activity. Before starting program, crucial clinician educate recognizing perceived exertion use metrics such rate scales (such Borg Rating Perceived Exertion Scale) guide individual toward exertional activities. Smartphones trackers methods monitor activity.19 educating energy conservation strategies aid recovery. One framework "Four Ps": Pacing, Prioritizing, Positioning, Planning.23 Pacing concept avoiding push crash cycle Ways optimal pacing keeping reasonable, shorter, durations (or alternatively, giving rushing) scheduled rest breaks Patients pay attention body moderate prolonged periods. Prioritizing decide get done days postponed unnecessary do all) overexertion crashing. Positioning modifying make them easier perform. possible sit workspace comfortable height all necessary equipment within easy reach. Another example would shower chair bench rather standing showering. Planning day week recognize windows. Energy windows periods when tasks. aware window, throughout week. Asking keep diary good days, optimizing timing therapy such, breaks. elements planning determining steps completion tasks preparing ahead Daily routines helpful. consist gradual particular, returning physicians employers create vocational advised ways resume work, even accommodations capacity does significant Examples hours, home, adjusting (eg, seated instead standing/walking activities), using durable mobility walking tolerance), providing environment allowing park closer). tolerates. available, referral counselor structuring communicating employers. no "prescription" diet General patient's underlying comprehensive profile. nutrition guidelines suggest vegetables, fruits, whole grains, healthy fats, fish, poultry, beans eggs, dairy, intake red meats. Adequate water avoidance alcohol recommended. Acute symptomatic associated vigorous immune theorized persistence dysregulation. interest link proinflammatory states disease Single nutrients (polyunsaturated fatty acids, antioxidative vitamins [specifically A, B12, D], polyphenols, protein/amino acids) diets (whole grains fibers, polyphenol-rich omega-3 acid-rich foods) anti-inflammatory fatigue-reducing effects, although further confirmatory needed.24 Mast cell activation histamine release play role related-fatigue.25 proposed some tolerate present foods, thought result enzyme diamine oxidase, down leading increased amount intolerance. Symptoms headache, asthma, runny blocked nose, pressure, heartbeat, hives, itching, diarrhea, flushing, studies supporting benefit (often consisting cheeses, fruit, seafood, nuts, anecdotal reports individuals. worth noting challenges low-histamine reported. Some dietary made ME/CFS, eating little every foods glycemic index (more carbohydrates) order stable levels, balanced meat, beans, pulses legumes). sufficient supplements CFS multivitamins, B vitamins, magnesium, essential acids (omega-3s), carnitine, coenzyme Q10. autonomic specifically postural tachycardia (POTS), partially adequate salt intake.26, 27 Small meals better tolerated diets26 fiber carbohydrates reduce glucose (sugar) spikes lessen POTS due atrophy loss improved appropriate caloric intake. wide variation medications, herbal remedies PASC-collaborative pharmacologic agents whereas others conservative tried addressed. Further, express desire medications remedies/supplements so knowledge counseling. Supplements causes multiple sclerosis, fibromyalgia, ME/CFS) branched-chain amino omega vitamin C, D, L-carnitine, Q10, ginseng, echinacea, many others.28-30 system, inflammation, healing, case-by-case basis, evidence. Additionally, needs consideration out-of-pocket cost supplements, risk medication interactions, regulation, side several commonly populations cancer, brain injury, Parkinson disease) prescribe fatigue.31-34 Specifically, amantadine, modafinil, methylphenidate fatigue.35-38 antivirals/antibiotics/antiparasitics, antidepressants, cytokine inhibitors, galantamine, glucocorticoid steroids, immunoglobulins, rituximab.39-41 Controlled trials interventions exist inconclusive. approval Food Drug Administration examining population. none through our process therefore, adverse interactions each prior prescribing. acupuncture collaborative representative members direct its preliminary low-quality supports ME/CFS.42 equity, disparities, social determinants (SDOH). Along discussion, reference Appendix Table: Health Equity Considerations Post-Acute Sequelae Infection (PASC): about integration considerations World Organization defines "the absence unfair avoidable remediable differences population socially, economically, demographically geographically."43 Healthy People 2020 disparity "a particular type difference closely linked social, economic, environmental disadvantage" stated "adversely systematically greater obstacles racial ethnic group; religion; socioeconomic status; gender; age; health; sensory, disability; sexual orientation gender identity; geographic location; characteristics historically discrimination exclusion."44 recently awareness how SDOH inequities disparities. "nonmedical influence outcomes" "conditions born, grow, live, age wider set forces systems shaping daily life."45 economic policies, government agendas, norms. From perspective, includes education, status, employment, neighborhood safety nutritious food, To promote high-quality ensure resources equitably affected maintain health. information written oral language easily understands adapted someone disability), goods services, affordable timely testing tailored meet individualized people, especially marginalized communities. programs, equitable, reduced, prevented, society benefits. Whereas association race/ethnicity inequity now established, relatively unexplored.46 emerge, racial/ethnic accessing insurance, inequitable distribution hospital resources, Internet/broadband access, food insecurity, housing work-related exposures.46 female older groups.24 pregnant women47 pregnancy itself (and postpartum period) well-known host biologic behavioral minority baseline approach.48 Racial higher diseases non-Hispanic Black adults, Hispanic obesity, increases fatigue.46 Higher mass obesity PASC.49 status able off apply services. Vulnerable barriers demographic race/ethnicity, occupation, transport.50 structural cultural divide academic underrepresented communities bridged trusted sources that, cases, community organizations. Community organizations faith based, nonprofit, civic, related, education serve foundation engagement.51 Strategies culturally competent nuances population, community, family, vital reducing promoting Such approaches require local data-driven approaches, equitable partnerships across sectors, messaging resonates target audience(s), implementation policies United States.52 facing insurance coverage. disabling interfere people's therefore generate income themselves dependents. vulnerable less job security, flexibility roles, entitlement sick occupational services.53 address delivery, incorporate telemedicine, phone calls virtual visits, ongoing follow-up might burden concerns in-person visits travel, parking, facility fee charges). Virtual rapidly pandemic useful closing gaps ethnic/racial groups, rural communities, elderly.54 connected services assistance hardships financial, family illness, bereavement, caregiving) disability reasonable school, connections groups. affects physically, emotionally, cognitively. frustration. causing warrants detailed while acknowledging individual. coordinated represent large national multidisciplinary data, extrapolation conditions, combined thousands content consultation AAPM&R composed 30 Clinics (www.aapmr.org/PASC-guidance) contributed via Post COVID/PASC unique personal, capacity. views opinions expressed participants own view organization. like extend special thank you Kavitha Neerukonda Michael Graves, AAPM&R, relentless efforts formation directing constantly evolving aspects work. writing committees supported exclusively commercial support. Benjamin Abramoff honorarium educational lectures Medical Education Speakers Network. Sarah Sampsel consultant paid project management. John M. Barratta honoraria 2021 Spring Addiction Conference (Governor's Institute) examples post-acute Biologic Example: Pregnant women Gender Transgender Racial/Ethnic Minority Groups (including African-American), American-Indian/Alaska Native, Pacific Islander, Asian-American, Mixed Race, Latino/Hispanic (ethnicity) Justice Involved (Prisons/Detention Centers) incarcerated detained prisons, jails, youth detention centers, immigration internment camps facilities Disability impairments physical/mobility, psychological/mental health, vision, hearing, emotional/social relationships, cognitive/learning, speech communication, disabilities pandemic, marginalized, enduring care.HE-F-15 During participation public mandates travel restrictions, distancing, wearing face mask did allow lip reading. group, advocate treatment, funding, disability. federal laws protect rights disabled persons.HE-F-16 Clinicians familiarize Americans Disabilities Act (ADA), civil law guarantees equal (health coverage, transportation, state telecommunication, etc.). 1973 (Rehab Act) protects removal architectural, transportation receive assistance. appropriate, obtain home aide, bed, aids, communication devices) workplace/school modifications classroom workplace adaptations, lectures, notes test-taking, learning aids/special modified schedule), animal. dissemination visual, impaired. telemedicine augmented impaired, telephone smart phones, consistent Internet broadband operate video telecommunication. Immigration come country live States Religion shared belief what sacred, holy, divine, spiritual, reverent psychological disfavoring transfusion product anemia,HE-F-18 modestyHE-F-19 sensitive topics, moral injuryHE-F-20 global pandemic) committed religious practices. fasting Fasting activityHE-F-21and conditioning participate therapies. certain supplements,HE-F-22 remedies,HE-F-23 faith-based varying potential antioxidant properties treat decisions ideally professional deemed safe complementary manner Legend: table included list, relate demonstrates barriers, though patient. intersectional identities group), enhanced bias discrimination.

Язык: Английский

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Impaired ketogenesis ties metabolism to T cell dysfunction in COVID-19

Nature, Год журнала: 2022, Номер 609(7928), С. 801 - 807

Опубликована: Июль 28, 2022

Язык: Английский

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Pharmacological inhibition of fatty acid synthesis blocks SARS-CoV-2 replication

Nature Metabolism, Год журнала: 2021, Номер 3(11), С. 1466 - 1475

Опубликована: Сен. 27, 2021

Caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19 is a virus-induced inflammatory disease of the airways and lungs that leads to multi-organ damage death. Here we show cellular lipid synthesis required for SARS-CoV-2 replication offers an opportunity pharmacological intervention. Screening short-hairpin RNA sublibrary targets metabolic genes, identified genes either inhibit or promote viral infection, including two key candidate ACACA FASN, which operate in same pathway. We further screened several potent inhibitors fatty acid synthase (encoded FASN), US Food Drug Administration-approved anti-obesity drug orlistat, found it inhibits vitro variants, more contagious new such as Delta. In mouse model infection (K18-hACE2 transgenic mice), injections orlistat resulted lower levels lung, reduced lung pathology increased survival. Our findings identify candidates prevention treatment inhibiting replication. Clinical trials are needed evaluate efficacy repurposing humans. Pharmacological synthase, approved shown vivo.

Язык: Английский

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Innate metabolic responses against viral infections

Nature Metabolism, Год журнала: 2022, Номер 4(10), С. 1245 - 1259

Опубликована: Окт. 20, 2022

Язык: Английский

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Association of vitamin D status with COVID-19 and its severity

Reviews in Endocrine and Metabolic Disorders, Год журнала: 2022, Номер 23(3), С. 579 - 599

Опубликована: Янв. 4, 2022

Язык: Английский

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