Archives of medical research最新文献

Background: Although current clinical practice guidelines recommend shared decision-making among patients, families, and healthcare teams, the process remains insufficiently understood in real-world practice. This study analyzed the criteria that guide dialysis modality selection among patients undergoing renal replacement therapy (RRT) at the Instituto Mexicano del Seguro Social (IMSS).

Methods: A cross-sectional, multicenter study was conducted with 958 patients who initiated dialysis. Data on demographics, clinical characteristics, dialysis settings, prescriptions, and participation in modality choice were collected and analyzed.

Results: Of the 958 patients, 26.2% were on automated peritoneal dialysis (APD), 34.2% on continuous ambulatory peritoneal dialysis (CAPD), and 39.5% on hemodialysis (HD). CAPD patients were older, and more frequently female and diabetic. They also had lower education levels and income. In contrast, APD patients were predominantly male with higher education levels and income. Chronic kidney disease (CKD) was diagnosed more frequently, with a faster transition to PD. Patients on HD were less informed and trained than those on PD. Of the patients that participated in the selection of the modality of dialysis, 64.1% were on APD, 66.0% on CAPD, and 47.7% on HD. Dependence on caregivers was lowest in APD and highest in CAPD. HD patients experienced longer travel times and used more expensive private transportation.

Conclusion: Patients are assigned to dialysis modalities according to an a priori criteria considered by dialysis committees, such as independence, clinical condition, and socioeconomic level. However, among patients starting RRT in private hospitals, the IMSS clinical practice guidelines are not consistently followed, particularly for those assigned to HD. Whether each modality offers real-world advantages in terms of survival or cost-effectiveness remains to be determined.

Background: Few studies have examined the relationship between dietary patterns and microvascular complications in patients with type 2 diabetes (T2D) to develop targeted management strategies.

Objective: To evaluate the association of dietary patterns and chronic microvascular complications in patients with T2D.

Methods: A nested case-control study of 5,154 patients with T2D diagnosed for <15 years, treated in primary care units in Mexico City and its metropolitan area. Microvascular complications (retinopathy, neuropathy, and nephropathy) were evaluated. Dietary data were obtained using a validated food frequency questionnaire. Principal component analysis identified dietary patterns, and multivariate analysis evaluated the association between microvascular complications and dietary patterns, adjusting for confounding variables.

Results: A total of 3,423 patients were included, 59.1% of whom had microvascular complications. Six dietary patterns were identified, three of which were associated with microvascular complications. After adjusting for glycemic control (glycated hemoglobin <7 %), sex, blood pressure, body mass index, antihypertensive and lipid-lowering treatment, physical activity, and lipid profile, the highest quartile of the "Legumes and fats" pattern (OR: 2.191; 1.789-2.684; p <0.001) and the "Mexican food" pattern (OR: 1.231; 95% CI: 1.004-1.510; p = 0.046) were associated with an increased risk of microvascular complications. Conversely, high consumption of the "Healthy" pattern (OR: 0.81; 95% CI: 0.66-0.98; p = 0.037) was associated with a reduced risk.

Conclusion: The consumption of the "Legumes and fats" and "Mexican food" dietary patterns was associated with microvascular complications, while a higher consumption of the "Healthy" pattern was protective. These findings may be useful for providing specific nutritional recommendations in the management for patients with T2D.

Reproductive disorders may originate from many factors including exposure to environmental chemicals in the womb or during the early stages of postnatal life. Throughout these stages, the exposure to endocrine-disrupting chemicals (EDCs), such as bisphenols, can disrupt reproductive function. These compounds cross the placenta and cause long-term epigenetic alterations in the fetus. Bisphenols are a large class of chemicals mainly used in the plastic industry and epoxy resin production. Bisphenol A (BPA) was the first and most widely used compound; however, it acts as a hormone by binding to estrogen receptors (ERs), affecting estrogen-dependent functions. As a result, BPA has been replaced by analogues or similar compounds, such as bisphenol F (BPF), bisphenol S (BPS), bisphenol B (BPB), and bisphenol AF (BPAF), among others. Although these compounds were originally synthesized to be safe for human use, they have also exhibited endocrine-disrupting activity similar to BPA, which affects reproductive function. BPA analogues also induce epigenetic changes, such as DNA methylation, histone modification, chromatin remodeling, and non-coding RNA regulation. These changes can lead to reproductive disorders and negative long-term and transgenerational consequences. This narrative review includes in vivo, in vitro, and human cohort studies that examine how BPA and its analogues affect male and female reproductive function through epigenetic mechanisms. Through this pathway, these chemical compounds have the potential to modify developmental programming.

Background: Current clinical guidelines recommend the use of topical nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen, to treat hand and knee osteoarthritis and other musculoskeletal disorders. However, detailed insights into naproxen's cutaneous pharmacokinetics remain underexplored.

Aim: This study aims to provide quantitative in vivo evidence that naproxen skin penetration follows Fick's law of diffusion. In addition, it seeks to explore whether the penetration profile is compatible with localized presystemic retention, which could improve therapeutic efficacy and limit systemic exposure.

Methods: Five healthy volunteers participated in this proof-of-concept study. A commercially available 5.5% naproxen sodium gel was applied to the volar surface of the forearm, and naproxen penetration kinetics were determined. The naproxen penetration versus time profiles were fitted to a mathematical model assuming Fick's law of diffusion, and the model's predictive performance was evaluated.

Results: Naproxen skin penetration increased during the first 4 h reaching a plateau that indicated equilibrium was achieved and a presystemic drug reservoir was formed, limiting systemic exposure. The experimental data were adequately fitted by a mathematical model based on Fick's law of diffusion. Maximal naproxen release (M_∞), expressed as a percentage of the actually applied dose, was 23.85 ± 1.81%. The penetration rate constant (k) was 0.73 ± 0.18 h^-1, and the penetration half-life (t_1/2) was 0.99 ± 0.21 h.

Conclusion: This study demonstrates that topical naproxen follows predictable Fickian kinetics and shows a potential tissue-level reservoir after penetration. This supports its use as a safe and effective topical agent for localized inflammatory conditions.

Objective: To address the major public health problems of increased body weight and obesity, causing conditions such as hypertension and diabetes. Early obesity in childhood and adolescence has more severe long-term health consequences. The Developmental Origins of Health and Disease (DOHaD) concept examines how early overfeeding and other factors affect health throughout life. This study hypothesized that a short-term metformin treatment during puberty could reduce metabolic dysfunction caused by neonatal overfeeding. We investigated whether the same intervention would have a similar effect on metabolic programming in adulthood.

Methods: Male Wistar rats raised in small (SL, three pups per mother) and normal (NL, 9 pups per mother) litters were used as models of early overfeeding. Some of the SL and NL animals received intraperitoneal injections of metformin (NL-M and SL-M), whereas the controls received saline (NL-C and SL-C) from days 35-42 (puberty) or 70-81 (adulthood).

Results: Two months after the intervention, at both puberty and adulthood, the SL animals exhibited metabolic dysfunction, and were significantly heavier with greater tissue fat accumulation than the NL animals (p <0.0001). SL-M animals treated during puberty exhibited significant reductions in white adipose tissue and liver weight, as well as lower weight gain (p <0.05). In contrast, metformin treatment in adulthood did not alter metabolism.

Conclusion: These findings suggest that short-term metformin treatment in rats during puberty can mitigate adult metabolic dysfunction induced by neonatal overnutrition. However, this intervention in adulthood did not result in long-term metabolic changes, which confirms the DOHaD concept.

Aim: Radiation-induced hepatotoxicity is a major challenge during radiotherapy. This study aims to evaluate the potential ameliorative outcome and underlying mechanisms of liraglutide (LIRA) in mitigating acute liver injury caused by radiation exposure in vivo.

Methods: Animals were administered LIRA subcutaneously (50 µg/kg/twice daily) for two weeks, and then exposed to whole body γ-radiation (6 Gy) 1 h after the last LIRA dose.

Results: The results revealed that LIRA efficiently ceased radiation-induced hepatotoxicity. Autophagy is a vital process for maintaining cellular balance and LIRA boosted it by upregulating the expression of the autophagy markers AMPK (adenosine monophosphate-activated protein kinase) and LKB1 (liver kinase B1), and downregulating mTOR (mammalian target of rapamycin). Furthermore, LIRA maintained liver enzyme levels close to baseline, and inhibited oxidative stress by decreasing lipid peroxidation and stimulating the production of antioxidant enzymes and reduced glutathione (GSH). Moreover, Western blotting confirmed that LIRA blocked the inflammatory response in liver tissues by decreasing the expression of nuclear factor kappa B (NF-κB) and interleukin-1 beta (IL-1β), and increasing the expression of nuclear factor erythroid 2-related factor 2 (Nrf₂) relative proteins. Histological analysis using hematoxylin and eosin (H&E) staining proved that LIRA effectively restored liver tissue architecture.

Conclusion: Collectively, LIRA attenuated radiation-induced hepatotoxicity by modulating the LKB1/AMPK/mTOR pathway, and could be a promising radioprotector during radiotherapy.