Diabetes and glucose disorders in liver patients

Diabetes and glucose disorders in liver patients

by | مرداد 22, 1402 | Articles

Diabetes and Impaired Glucose Tolerance in Liver Patients

Disruption in carbohydrate metabolism is quite common in patients with cirrhosis. Disturbances in glucose metabolism in cirrhotic patients have been frequently discussed in references and articles, particularly regarding fasting and food consumption.

Prevalence of Diabetes and Glucose Tolerance Disorders: The prevalence of diabetes and glucose intolerance in these patients varies widely. In fact, laboratory methods and diagnostic criteria for glucose metabolism disorders in various studies have not been uniform, and these criteria have been revised several times in recent decades. This article examines diabetes and glucose disorders in liver patients.

Liver Disease and Glucose Tolerance: Many studies examining the relationship between liver disease and glucose tolerance have noted that several potential factors influencing the onset of diabetes, which could be considered intervening factors, have not been addressed. In this study, we examine the prevalence of diabetes and glucose intolerance in patients with chronic liver disease using the latest diagnostic criteria. The independent relationship between chronic liver disease and diabetes, considering other potential risk factors for diabetes, is also explored. Additionally, this study investigates factors specifically related to the onset of diabetes in liver patients.

Onset of Diabetes: Before or After Liver Disease? Since both diabetes and chronic liver disease are often asymptomatic until advanced stages, it is generally difficult to determine whether:

  • Diabetes onset occurs before or after liver disease?

Researchers have gathered information showing that, in some patients, diabetes is diagnosed either simultaneously with or after cirrhosis.

Importance and Necessity of Screening: The prevalence of diabetes in cirrhosis and chronic hepatitis groups is significantly related to the severity of liver disease. This finding suggests that liver fibrosis, rather than necessarily cirrhosis, may initiate the process of glucose intolerance. It’s interesting to note that although the exact mechanism of glucose intolerance in cirrhosis is not yet fully understood, insulin resistance and reduced receptor sensitivity have been observed.

Insulin Resistance: Insulin resistance is observed in the early stages of chronic hepatitis. Another study examining chronic hepatitis patients with normal glucose tolerance showed a strong correlation between insulin resistance and the degree of fibrosis.

Chronic Hepatitis as an Independent Factor for Diabetes: All these findings confirm that chronic hepatitis is an independent factor for diabetes, and the development of diabetes in these patients is related to the severity of liver disease.

Diabetes and Liver Disease: This study did not find a relationship between diabetes and the cause of liver disease. Some studies have reported a correlation between Hepatitis C infection and higher rates of diabetes, but these findings are not yet definitive. A retrospective study involving 1,117 patients with chronic HCV hepatitis found a relatively strong relationship between diabetes and HCV infection. This study suggested that, independent of its role in chronic liver disease, HCV may play an important role in the onset of diabetes. However, there are also studies presenting findings contrary to this conclusion.

Development of Diabetes in Cirrhotic Patients: The prevalence of diabetes in cirrhosis patients caused by Hepatitis C was significantly higher than in those with cholestatic liver disease. However, there was no significant difference in the rate of diabetes in Hepatitis C cirrhosis patients compared to alcohol-related cirrhosis patients. This suggests that the development of diabetes in cirrhotic patients is closely related to the underlying cause of liver disease. A study did not find a correlation between the cause of liver disease and diabetes in either the cirrhosis or chronic hepatitis groups. However, future studies will likely provide more insights into the relationship between diabetes and the underlying liver disease.

BMI as an Independent Variable: In patients with chronic hepatitis, BMI was identified as an independent variable related to diabetes. Some studies have shown that obesity may be a potential risk factor for liver fibrosis in chronic hepatitis. However, our study found that high BMI may play a distinct role in the pathogenesis of diabetes in chronic hepatitis, independent of liver fibrosis. Furthermore, serum lipids, including plasma free fatty acids and glycerol concentrations, were found to be higher in diabetic cirrhotic patients.

Family History as a Factor in Diabetes: Family history of diabetes is a well-known risk factor. Our study showed that even when the variable of family history of diabetes was included in the regression model, the relationship between cirrhosis and chronic hepatitis with diabetes remained significant. Other studies have confirmed this result, suggesting that liver injury in chronic liver disease is an independent risk factor for diabetes, with family history only acting as a secondary factor.

Age as a Risk Factor for Type 2 Diabetes: Age is a well-known risk factor for Type 2 diabetes, and it was expected that this would also be true for chronic liver disease patients. However, the relative risk of cirrhosis and chronic hepatitis was found to be higher than that of age, indicating a stronger relationship between liver disease and diabetes.

Onset of Diabetes During Interferon Treatment: Some studies have previously reported the onset of diabetes during interferon treatment, but evidence is still lacking. In our study, interferon treatment did not significantly affect the prevalence of diabetes.

Conclusion: Overall, the results indicate a relatively high prevalence of diabetes in patients with chronic liver disease. Given that a significant number of these patients are unaware of their condition, regular screening is highly recommended. For advanced cases, shorter intervals for screening should be considered due to the higher risk of developing diabetes. Weight reduction in chronic hepatitis patients could potentially prevent the onset of diabetes, and doctors should advise these patients to engage in continuous weight reduction measures. Based on the findings of this study, further research should focus on identifying the pathophysiology of diabetes in chronic liver disease patients and the role of viral hepatitis and liver disease severity in the development of diabetes and possibly insulin resistance.

References:

  • Alavian S M, Hajarezadeh B, Nematizadeh F, Larijani B. DIABETES AND IMPAIRED GLUCOSE TOLERANCE IN CHRONIC LIVER DISEASE. ijdld 2004; 3 (1): 57-70.
Effects of Curcumin on Muscle Strength Improvement

Effects of Curcumin on Muscle Strength Improvement

by | مرداد 15, 1402 | Articles

Effects of Curcumin on Muscle Strength Improvement

This article investigates the effects of curcumin on improving muscle strength, preventing damage to oligodendrocytes and myelin in the brain, and studying its impact in an animal model of multiple sclerosis (MS).

Introduction to Multiple Sclerosis (MS)

Multiple sclerosis (MS) is one of the most common neurodegenerative diseases. During this disease, the body’s immune system attacks oligodendrocytes and the myelin sheath of neurons in the central nervous system. This condition leads to disruptions in nerve signal conduction, causing symptoms such as:

  • Weakness and fatigue
  • Visual and motor disturbances
  • Tremors
  • Ataxia
  • Bladder dysfunction
  • Depression
  • Cognitive impairment

Main Mechanism of Disability Development

The progressive destruction of myelin due to apoptosis of oligodendrocytes, which occurs following localized inflammation in the nervous system, is one of the main mechanisms responsible for these disabilities.

Prevalence of the Disease

The prevalence of MS is approximately 120 cases per 100,000 people. The rate of occurrence is twice as high in women compared to men. MS predominantly affects young adults aged between 20 and 40 years, while the incidence is lower in children and the elderly. The exact cause of MS remains unknown, but factors such as:

  • Genetics
  • Environment
  • Immunological aspects

play a role in its development.

New Treatment Methods

Due to the production of inflammatory factors and anti-myelin antibodies, most researchers consider MS to be an autoimmune disease. Therefore, the treatment of MS usually relies on using immunosuppressive agents and reducing inflammation in the nervous system. Immunosuppressive treatment, however, exposes MS patients to other infectious and viral diseases. As a result, the use of new therapies, such as stem cell therapy and supplementary compounds, is essential.

Introduction to Curcumin

Recently, the use of herbal medicine to advance therapeutic goals in neurodegenerative diseases has gained particular attention. Among these, curcumin, the main component of turmeric, has been highlighted. This plant has relatively low inherent toxicity, and its medicinal properties have been widely reported, including its potent antioxidant and neuroprotective effects in neurodegenerative diseases such as:

  • Alzheimer’s disease
  • Parkinson’s disease
  • Epilepsy

How Does Curcumin Work?

Curcumin can play a significant role in treating MS by inhibiting the activity and secretion of interferon-gamma and reducing lymphocyte-activating factors.

Effects of Nano-Curcumin Polymerase

Studies using nano-curcumin polymerase have shown that this compound can pass the blood-brain barrier, balance the expression of pro-inflammatory and anti-inflammatory genes, and reduce oxidative stress, leading to a reduction in inflammation and improvement of the myelin repair process in the spinal cord.

Curcumin’s Mechanisms of Action

In summary, curcumin reduces neuronal and neuroglial apoptosis and improves neuroprotection in neurodegenerative diseases through the following mechanisms:

  • Inhibition of migration
  • Microglial activation
  • Generation of a specific microglial phenotype with anti-inflammatory properties
  • Neuroprotection
  • Reduction of nitric oxide synthesis and caspase 3 activity
  • Improvement in mitochondrial function
  • Increase in myelin sheath numbers

Curcumin’s Effect on Myelin Tissue Damage Prevention

Since the effect of curcumin on preventing damage to oligodendrocytes and myelin tissue in a toxic model of MS has not been studied, this study explores curcumin’s role in preventing damage to oligodendrocyte precursor cells and mature oligodendrocytes in the brain of rats using the cuprizone MS model. Apoptosis of oligodendrocytes and progressive myelin damage are considered key mechanisms in the development of neurological problems in MS patients. Recently, plant compounds like curcumin have attracted attention for their potential in preventing and treating neurodegenerative diseases.

Study Methodology

A total of 28 rats (200 mg) were randomly assigned to four groups:

  • Control
  • Sham (DMSO)
  • Cuprizone
  • Curcumin

In the curcumin group, cuprizone (0.6%) and curcumin (200 mg/kg) were administered together for four weeks. During the study, muscle strength was assessed using the basket test, the percentage of cells expressing the markers 5 A2B and MBP were evaluated by immunohistochemistry, and myelin density was assessed using Luxol Fast Blue staining.

Study Results

Cuprizone, a copper chelator, is capable of inducing oligodendrocyte death. Four weeks after cuprizone administration, immunohistochemical analysis revealed a significant reduction in oligodendrocyte precursor and mature cells in the cuprizone and sham groups. Cuprizone is known to induce apoptosis through mechanisms such as oxidative and nitrosative stress.

How Does Cuprizone Work?

Cuprizone induces apoptosis by reducing superoxide dismutase activity and increasing nitric oxide levels. This leads to a decrease in mature oligodendrocyte populations. These results align with a study from 2001, where it was shown that cuprizone administration could cause oligodendrocyte death, especially in mature cells. Furthermore, after discontinuing cuprizone, a significant increase in oligodendrocyte precursor cells was observed. Curcumin, a polyphenolic compound, has preventive and therapeutic properties against various neurodegenerative diseases.

Effects of Cuprizone

This study demonstrated that curcumin mitigates the destructive effects of cuprizone on oligodendrocytes. Immunofluorescence analysis showed that curcumin treatment resulted in significantly higher levels of oligodendrocyte precursor cells (A2B5) and mature oligodendrocytes (Olig2) compared to cuprizone and sham groups.

Curcumin’s Mechanisms

Curcumin’s ability to pass the blood-brain barrier allows it to reduce oxidative stress and protect oligodendrocytes from death by increasing glutathione levels.

Nitric Oxide Reduction

Furthermore, researchers have shown that curcumin reduces nitric oxide levels, thereby decreasing oligodendrocyte apoptosis. In contrast, many other studies suggest curcumin may induce apoptosis in certain circumstances.

Pro- and Antioxidant Effects

Curcumin exhibits dual pro- and antioxidant effects, which may contribute to its effectiveness in treating various diseases. Cuprizone can also increase microglial activation and induce apoptosis in oligodendrocytes through other mechanisms.

Apoptotic Effects of Cuprizone

The study confirmed that curcumin can reduce the apoptotic effects of cuprizone. Cuprizone triggers inflammation and oligodendrocyte death by stimulating interleukins such as CD3 and IL-17. Thus, the observed reduction in oligodendrocyte levels in cuprizone and sham groups could be attributed to the inflammatory effects of cuprizone. The number of oligodendrocytes was higher in the curcumin group.

Reducing Enzyme Activity with Curcumin

Curcumin inhibits the activity of enzymes such as cyclooxygenase-2 and lipoxygenase, decreases the production of TNF-α, and reduces the production of interleukins, which help to suppress inflammation and prevent oligodendrocyte death.

Experimental Model of Encephalomyelitis

A 2010 study on an encephalomyelitis model showed that curcumin significantly reduced serum levels of IL-17, IL-6, and IL-21, decreasing disease severity and inflammatory cell infiltration into nervous tissue. Histological analysis with Luxol Fast Blue staining showed that curcumin could prevent myelin destruction and improve sensory-motor function. Muscle strength in the cuprizone and sham groups began to significantly decrease from the third week, likely due to oligodendrocyte death and myelin damage. The curcumin group showed little change in muscle strength, likely due to curcumin’s neuroprotective effects.

Conclusion

Given the beneficial effects of curcumin in promoting oligodendrocyte survival, preventing myelin degradation, and improving sensory-motor function, as well as its anti-inflammatory, anti-apoptotic effects, and ability to cross the blood-brain barrier, curcumin is recommended for the diet of MS patients or those at risk of developing the disease.

References Bagheri E, Marandi S M, Ghasemi N. Evaluation of curcumin effects on improvement of muscle strength, prevention of oligodendrocytes and myelin damage in brain, in an animal model of multiple sclerosis (MS). SJKU 2018; 23 (5):55-64.

The effect of vitamin B6 on reducing symptoms of premenstrual syndrome.

The effect of vitamin B6 on reducing symptoms of premenstrual syndrome.

by | مرداد 10, 1402 | Articles

The occurrence and repetition of a series of physical and psychological symptoms during the luteal phase has been recognized as a phenomenon for centuries. This phenomenon, known as premenstrual syndrome (PMS), varies in severity and encompasses a wide range of physical, psychological, and behavioral symptoms with an unclear cause.

Epidemiological Findings Epidemiological studies indicate that approximately 75% of women experience physical and psychological symptoms before menstruation, but severe cases are reported in only 5% of instances. Although premenstrual behavioral changes were described by Hippocrates, the term “premenstrual syndrome” was first used in 1950 to describe physical and psychological symptoms that begin around two weeks before menstruation and subside with the onset of menstrual bleeding.

Importance of Symptoms The significance of these symptoms is such that they can lead to the breakdown of family relationships, personal matters, and disruption of professional functioning. A single etiology cannot explain all symptoms, and many specialists consider this syndrome a multifactorial disorder. Numerous potential causes have been suggested for these symptoms, none of which have been definitively proven. PMS is diagnosed when mood, behavioral, or physical symptoms, or a combination of them, consistently occur during the luteal phase of the menstrual cycle and resolve shortly after the onset of menstruation. It must not be present for at least a week during the follicular phase and cause disruption to daily activities.

Disagreement About Treatment In addition to disagreement about the causes of these symptoms, there is also a lack of consensus regarding their treatment, with over 300 different treatments suggested. Some believe that low magnesium levels in the red blood cells of women with PMS symptoms may be the cause. Daily vitamin B6 supplementation, based on studies, may be effective in treating premenstrual syndrome. In Europe, the use of vitamin B6 supplements as a treatment has been accepted, though results in this area are inconclusive. Further studies are required to confirm the effects of vitamin B6 on PMS symptoms.

Role of the Syndrome Given the impact of this syndrome on individual and social problems, as well as the affordability, accessibility, and safety of vitamin B6, this research aims to determine the effect of vitamin B6 on premenstrual syndrome.

Research Results The findings of this study indicate a positive effect of vitamin B6 on reducing PMS symptoms. Data analysis suggests that vitamin B6 plays a positive role in reducing symptoms of:

  • Depression
  • Anxiety
  • Restlessness
  • Breast tenderness

Most studies conducted on this subject also report a positive effect of vitamin B6 on reducing PMS symptoms. The acceptance of the role of pyridoxine phosphate (the active form of vitamin B6) in the proper synthesis of various neurotransmitters can explain the reduction in symptoms like depression, anxiety, restlessness, sleepiness, and breast tenderness observed in this study.

Results of Other Studies Although research in this area shows mixed results, the number of studies supporting the positive effect of vitamin B6 on controlling PMS symptoms is notable. To improve PMS symptoms, high doses of vitamin B6 are needed for a prolonged period (throughout the entire menstrual cycle). Researchers have indicated that a decrease in red blood cells may contribute to PMS symptoms, possibly through a reduction in brain dopamine and an increase in aldosterone. This deficiency can be corrected with pyridoxine. Given the role of pyridoxine in water metabolism, regulation of adrenal hormones, and synthesis of some amino acids as cofactors, vitamin B6 supplementation throughout the menstrual cycle can reduce PMS symptoms.

Findings from Other Studies Some researchers conducted a study on 124 participants with a dose of 150 mg and observed a significant reduction in all symptoms in both the intervention and control groups. Other studies have reported similar results.

It seems that differences in the results reported by studies may be due to variations in the characteristics of the women participants, the dosage of vitamin B6, the duration of treatment, and the methods of data analysis.

Benefits of Vitamin B6 Vitamin B6 is a useful, inexpensive, and moderately effective treatment for PMS symptoms. Although there are many antidepressants available for treating psychological symptoms, they are more expensive and have numerous side effects.

Conclusion Based on the findings of this research, the use of vitamin B6 throughout the menstrual cycle is recommended to control PMS symptoms, although high doses of this medication should be used with caution.

References Salehi L, Salehi F. Comparative study of vitamin B6 versus placebo in premenstrual syndrome. SJKU 2007; 12 (3): 42-49

Evaluation of Zinc Levels in Pregnant Women

Evaluation of Zinc Levels in Pregnant Women

by | مرداد 8, 1402 | Articles

Evaluation of Zinc Levels in Serum of Women with a History of Recurrent Spontaneous Abortions

This article examines the zinc levels in the serum of women with a history of recurrent spontaneous abortions. Spontaneous abortion refers to the loss of pregnancy during the first 20 weeks of gestation, occurring naturally without medical intervention. This type of abortion generally happens in the early weeks of pregnancy, before the 20th week, and is typically caused by genetic issues, improper fetal development, structural problems in the uterus, hormonal imbalances, or immune system disorders. It generally occurs in approximately 1 in 300 pregnancies before the 20th week.

Research on Zinc Levels in Pregnant Women

Scientific studies have shown that the serum zinc levels in women with a history of recurrent miscarriage may be lower than in healthy women. This reduction in zinc levels can lead to increased anxiety and depression, which in turn might reduce the body’s absorption of zinc.

Factors Contributing to Recurrent Miscarriage

  • Pregnancy age
  • Genetic factors
  • Anatomical issues of the uterus
  • Endocrine hormones
  • Presence of infections
  • Alcohol and tobacco use
  • Suspended lead particles in polluted air
  • Ionizing radiation from harmful rays
  • Immunological factors

Importance of Micronutrients During Pregnancy

One of the most critical micronutrients that can directly affect fetal growth and cellular development is zinc. Zinc is essential for the body, and its deficiency can cause significant harm. Zinc plays a crucial role in cellular division, muscle growth, thyroid hormone function, blood clotting, and wound healing. Children require zinc for normal growth, puberty, and the development of sexual organs.

Deficiency in zinc can lead to menstrual irregularities in women, and since zinc is necessary for testosterone production, its low levels may result in decreased sperm count and sexual dysfunction. Zinc deficiency may also directly impact fetal development.

During pregnancy, zinc is essential for brain development, and its need increases during the third trimester, although plasma zinc levels tend to decrease.

Effects of Zinc Deficiency During Pregnancy

Zinc deficiency during pregnancy can lead to extended gestation, restricted fetal growth, and fetal death. Zinc is crucial for immune cell activity, including humoral and cellular immunity, macrophages, and neutrophils. A deficiency in zinc can disrupt immune functions and contribute to miscarriage. Furthermore, it may affect fetal growth and development.

Zinc’s Role in Maternal Immune Function

Adequate immune cell function during pregnancy is essential for regulatory mechanisms that preserve the fetus. Studies indicate that women with recurrent miscarriages often suffer from immune system regulation issues, possibly due to a lack of necessary nutrients like zinc. Zinc supplementation has been shown to enhance the immune response, including increasing T cells and antibody production after vaccination. A deficiency in zinc can reduce immune responses, affecting pregnancy outcomes.

Zinc and Fetal Health

Zinc plays a crucial role in the proper development of the fetus, including protection from oxidative stress. Zinc helps protect the fetus and placenta from damage and is involved in more than 200 enzymatic processes in the body, including protein, carbohydrate, fat, and nucleic acid metabolism. One such enzyme, superoxide dismutase, provides antioxidant protection to the fetus.

Zinc Deficiency and Health Risks

  • Fetal Growth: Zinc deficiency during pregnancy can result in reduced fetal weight and the underdevelopment of body parts.
  • Preterm Birth: Adequate zinc intake can reduce the risk of premature birth.
  • Maternal Health: Zinc deficiency can increase the risk of breast infections and reduce immune function in mothers.
  • Psychological Health: Zinc deficiency in pregnancy is associated with depression and other psychological issues.
  • Future Physical and Mental Health of the Child: Zinc deficiency can lead to developmental issues in the child, both physically and mentally.

Research Findings

In developing countries, zinc deficiency is prevalent among pregnant women, with lower serum zinc levels compared to normal levels. Although some studies have examined the relationship between zinc deficiency and preeclampsia, few have focused on zinc levels in women with recurrent spontaneous abortions. Animal studies have shown a connection between low serum zinc and miscarriage in cows. A human study also observed low serum zinc levels in women with recurrent miscarriage.

Lab Tests for Zinc Levels

To assess zinc levels in the serum of women with a history of recurrent miscarriage, a serum zinc test is required. Blood samples are taken, and the zinc concentration is measured. However, these results are specific to the individual, and further studies are needed to determine the exact cause of recurrent miscarriage. Other potential causes, such as uterine abnormalities, hormonal imbalances, or immune system dysfunction, should also be considered.

Zinc Supplements

Effervescent zinc tablets are commonly used as dietary supplements to enhance zinc absorption. However, zinc supplementation during pregnancy should be done cautiously. While zinc is essential for both maternal and fetal health, excessive intake can be harmful.

Zinc-Rich Foods

  • Red Meat: A significant source of zinc.
  • Fish: Salmon, trout, tuna, and other fish contain zinc.
  • Poultry: Chicken is also a good source.
  • Legumes: Chickpeas, beans, lentils, and peas contain zinc.
  • Cereals: Oats, wheat, corn, and rice are zinc-rich.
  • Vegetables: Spinach, kale, and other greens have zinc.
  • Dried Fruits: Dates, apricots, cherries, and almonds contain zinc.

Conclusion

Zinc deficiency may play a significant role in the mechanisms of recurrent miscarriage by disrupting normal placental and fetal functions or indirectly affecting immune system regulation. Further research is required to confirm these findings and explore how zinc supplementation may aid in preventing recurrent miscarriages. Women with a history of recurrent miscarriage or those planning to conceive should monitor their zinc levels and consult with a healthcare provider to ensure they maintain appropriate zinc levels throughout pregnancy.

The effects of cranberry supplement on urinary tract infection.

The effects of cranberry supplement on urinary tract infection.

by | تیر 28, 1402 | Articles

The Impact of Cranberry Juice Consumption on Bacteriuria

One of the common complications experienced by individuals with spinal cord injuries is urinary tract infections (UTIs). These infections, caused by various types of bacteria in the urine, can make treatment challenging. In these patients, due to antibiotic resistance, there is a need to find appropriate alternatives for treating these infections. Therefore, the aim of this study was to investigate the impact of cranberry juice consumption on bacteriuria and pyuria in patients with spinal cord injury and neurogenic bladder. The study was conducted with the goal of finding a suitable solution for treating urinary infections in spinal cord injury patients.

Spinal Cord Injuries

Spinal cord injuries can occur at any part of the spinal cord. Depending on the location and severity of the injury, it can lead to various neurological problems. For instance, damage to the cervical spinal cord may result in complete or partial paralysis from the neck down. Similarly, damage to the thoracic spinal cord can lead to respiratory issues, muscle weakness, and loss of sensation in the affected areas.

Types of Spinal Cord Injuries

Spinal cord injuries can be either temporary or permanent. The treatment varies based on the severity, location of the injury, and the duration since the injury occurred. Treatment may include physiotherapy, medication, and surgery.

Prevalence of Spinal Cord Injuries

The prevalence of spinal cord injuries varies from country to country. However, the global incidence of this condition is 40 cases per million population. Patients with spinal cord injuries live many years with severe disabilities. Most of these injuries are seen in individuals aged 34 and younger. Although life expectancy in individuals with spinal cord injuries has increased, these patients are at high risk of various diseases and secondary complications.

Common Complications

The most common complication leading to frequent hospitalizations for these patients is urinary tract infections. These infections, manifested as symptomatic urinary tract infections, cause significant pain and make it more difficult for these patients to tolerate their disabilities. These infections threaten their survival, have a long-term negative impact on their health, increase their dependency, and reduce their quality of life. Additionally, they impose a significant financial burden on both the patients and the healthcare system.

Urinary Tract Infection (UTI)

Urinary tract infection (UTI) refers to infections affecting any part of the urinary system, including the kidneys, bladder, urinary tract, and prostate (in men). UTIs are primarily caused by bacteria, although fungi and viruses can also cause these infections.

Causes and Risk Factors for UTIs

Most UTIs are caused by bacteria that move from the intestines to the urinary tract. Women are more prone to UTIs than men because their urinary tracts are shorter, making it easier for bacteria to travel to the bladder. Other risk factors for developing UTIs include pregnancy, old age, diabetes, urinary tract obstructions, and the use of urinary catheters.

Factors Contributing to UTIs in Spinal Cord Injury Patients

Several factors contribute to the occurrence of UTIs in spinal cord injury patients, including invasive procedures without antibiotic prophylaxis, cervical injuries, neurogenic bladder, urinary retention, the use of urinary catheters, increased bladder pressure, urinary and fecal incontinence, structural and functional urinary disorders, hydronephrosis, reflux, and urinary stones. These factors contribute to recurrent and chronic bacteriuria, resulting in symptomatic or asymptomatic urinary infections. In spinal cord injury patients, UTIs are often polymicrobial and resistant to treatment.

Treatment and Prevention of UTIs

UTIs are typically treated with antibiotics. To help prevent UTIs, patients are advised to drink plenty of water, empty their bladder when necessary, and avoid irritant chemicals in soaps and powders. If you experience UTI symptoms, it’s important to consult a healthcare professional, as untreated UTIs can lead to more severe infections and kidney damage.

Complications of Long-Term Antibiotic Prophylaxis

On the other hand, long-term antibiotic prophylaxis is not always very effective in these patients. The presence of multi-drug-resistant bacteria poses a life-threatening risk. Concerns about overuse of antibiotics in spinal cord injury patients highlight the need for alternative methods to treat recurrent UTIs. Studies have shown that spinal cord injury patients use cranberry supplements for their preventive effects and believe they are beneficial for urinary health.

Review of Studies Conducted

Numerous studies have been conducted to assess the effectiveness of cranberry in preventing UTIs in at-risk patients. In one study, consumption of cranberry juice three times a day reduced the microbial biofilm load in the bladder of 15 spinal cord injury patients. Another study confirmed the role of cranberry in preventing UTIs in women with recurrent UTIs. A study by Heitz and colleagues, aimed at evaluating the effect of cranberry capsules in preventing UTIs in children with neurogenic bladders due to myelomeningocele, showed the positive impact of this intervention.

Sterilizing the Urine

Maintaining sterile urine in spinal cord injury patients with functional or anatomical urinary system defects is more critical than in healthy individuals. Preventing the colonization of pathogenic microbes that cause UTIs, without antibiotic treatment, is extremely important and valuable in these patients.

Clinical Trial Results

This clinical trial, a double-blind, randomized, controlled study, was conducted on 60 spinal cord injury patients who were randomly assigned to control and test groups. Before the intervention, a complete urinalysis and urine culture were performed for patients in both groups. The test group consumed 250 to 300 ml of diluted 30% cranberry syrup for two weeks. The control group consumed the same volume of placebo syrup. After two weeks, urinalysis and urine culture were performed for both groups.

Results of the Current Study

The present study showed that cranberry juice consumption had no effect on urinary pH, contrary to previous assumptions that cranberry’s effect on UTI treatment was due to the presence of benzoic acid, which is excreted in urine as hippuric acid and prevents bacterial growth by acidifying the urine. In the current study, cranberry consumption had a greater effect in patients who did not have an indwelling urinary catheter or who used intermittent catheterization or condom catheters, compared to those with permanent urinary catheters or condom catheters. The most common complaints among spinal cord injury patients were urinary problems, urinary retention, and foul-smelling urine. The findings showed that cranberry juice was effective in reducing foul-smelling urine.

Conclusion

In conclusion, short-term cranberry juice consumption in spinal cord injury patients with normal filtration, especially in cases where they do not have an indwelling urinary catheter or a permanent urinary drainage system, reduces pyuria and bacteriuria and is effective in reducing the odor of urine. It also does not cause intolerable gastrointestinal or systemic side effects.

References Rajaei M, Hafize M, Noorian K. Evaluation of cranberry juice on bacteriuria and pyuria in spinal cord injured patients with neurogenic bladder. Armaghanj 2014; 19 (8): 662-674.

The effect of eight weeks of chitosan supplementation

The effect of eight weeks of chitosan supplementation

by | تیر 12, 1402 | Articles

Cardiovascular diseases are part of preventable chronic diseases that are related to lifestyle changes. The prevalence of cardiovascular diseases is increasing globally. According to the World Health Organization’s report, over 17.5 million people die annually due to cardiovascular diseases. This article examines the impact of eight weeks of chitosan supplementation and combined exercise on blood pressure and lipid profile in women with high blood pressure.

Main Risk Factors for Cardiovascular Diseases

Hypertension, dyslipidemia, and abnormal increases or decreases in serum lipid levels are major risk factors for cardiovascular diseases and cause over 80% of deaths and disabilities in low- and middle-income countries. Hypertension is common worldwide, with one in three adults in the United States diagnosed with high blood pressure. Moreover, 90% of individuals in middle-aged and elderly populations are at risk of developing high blood pressure.

The Relationship Between Cardiovascular Diseases and Dyslipidemia

In most cases, cardiovascular diseases are associated with dyslipidemia. There are widespread changes in serum lipid profiles across various population groups worldwide, with increased levels of:

  • Total serum cholesterol
  • Triglycerides
  • Low-density lipoprotein (LDL)
  • Decreased high-density lipoprotein (HDL)

These changes are linked to the main risk factors for cardiovascular diseases.

Promoting Heart and Vascular Health

Lifestyle changes should be considered as a guide to reducing inactivity and promoting healthy dietary patterns. It is evident that inactivity and high-fat diets lead to:

  • Insulin resistance
  • Fat oxidation
  • Dyslipidemia

In contrast, regular exercise increases maximum oxygen uptake, boosts energy from fat reserves, and reduces dyslipidemia. Optimizing lifestyle is the first line of treatment for overweight or obese patients. Some foods may also help manage and treat metabolic syndrome components like:

  • Obesity
  • Hypertension
  • Lipid disorders

Moreover, regular physical activity is an effective adjunctive treatment for managing and controlling blood pressure.

Controlling Blood Pressure with Exercise

Regular aerobic and resistance exercises are fundamental for blood pressure control. Studies have shown that combined exercise programs lead to:

  • Increased muscular strength
  • Favorable lipid profile changes
  • Increased apolipoprotein levels

Research supports the beneficial effects of regular physical activity on cholesterol levels. When combined exercise is implemented in older patients with coronary artery disease, it has the most positive impact on blood lipid profiles. These positive changes in blood lipids are associated with weight and body fat loss. Changes in metabolism, such as using lipids instead of glycogen, may also contribute to these improvements.

Introduction to Chitosan

Chitosan is a natural polysaccharide derived from glucosamine residues in chitin, the second most abundant biopolymer on Earth, sourced primarily from the exoskeletons of crustaceans or fungal cell walls. Chitosan is derived from deacetylation of chitin and is recommended as a weight loss supplement and adjunctive treatment for:

  • Blood lipids
  • Blood glucose
  • Blood pressure

Natural or functional food products with protective heart and vascular properties may help patients achieve and maintain cardiovascular health and improve lipid disorders through novel mechanisms.

Mechanism of Chitosan

Chitosan is not digested in the digestive system. It swells and induces satiety by physically filling the stomach. By inhibiting pancreatic lipase activity, chitosan can reduce fat absorption in the intestines. It can also bind to fat and deposit it in the intestines, preventing absorption. Chitosan cations bind to the carboxyl groups of fatty acids and bile acids, disrupting the emulsification of neutral lipids like cholesterol and other sterols by creating hydrophobic interactions. This reduces the absorption of fat and cholesterol in the digestive tract.

Adverse Biochemical Effects of Chitosan

One of the adverse biochemical effects of chitosan is the reduced absorption of minerals and fat-soluble vitamins. In addition to trapping lipids and cholesterol, chitosan gels formed in the intestines bind to minerals and vitamins. When chitosan is administered with sodium ascorbate to rats fed a high-fat diet for two weeks, it led to a significant decrease in the absorption of minerals, which was associated with reduced bone mineral content.

Investigating the Effects of Exercise in Individuals with Cardiovascular Disease

Extensive research has examined the effects of exercise in individuals with cardiovascular disease, but there is limited research on women with hypertension. The choice of a combined exercise program for this study was based on the potential additive effects of aerobic and resistance training in reducing cardiovascular risk factors. Combined exercise results in temporary reductions in blood pressure, even after a single session, due to a phenomenon known as post-exercise hypotension (PEH). Factors such as:

  • Intensity
  • Duration
  • Type of exercise
  • Resting blood pressure levels

may influence the range and duration of PEH and lead to various cardiovascular system responses that significantly alter blood pressure in acute, subacute, and chronic phases after exercise.

Clinical Trials on Chitosan Supplementation

Previous clinical trials have investigated the effects of chitosan supplementation on blood pressure and lipid profiles, either alone or combined with a simple exercise program. This study aimed to explore the additive effect of chitosan supplementation and combined aerobic and resistance exercise on blood pressure and lipid profile. This innovative approach could serve as an adjunctive treatment for managing hypertension and lipid profile issues as part of a healthy lifestyle with proper medical supervision.

Research Results

Given the importance of hypertension, with one in three adults affected by the condition, the results of this study emphasize the significant impact of chitosan supplementation in both the chitosan group and the combined chitosan-exercise group on systolic and diastolic blood pressure. Chitosan may thus be considered a new adjunctive treatment for hypertension alongside a healthy lifestyle. Moreover, based on the observed properties in previous studies and the changes observed in this clinical trial on lipid profile indicators such as:

  • Total cholesterol
  • Triglycerides
  • LDL
  • HDL
  • VLDL
  • Weight reduction
  • Improved body composition index

Chitosan could be regarded as a dietary supplement in conjunction with weight loss programs and even independently when combined with regular exercise.

Reference: Rasouli Jokar E., & Shamlou Kazemi S. The Effect of Eight-Weeks Chitosan Supplementation and Combined Exercise on Blood Pressure and Lipid Profile of Women With Hypertension. Journal of Sport Biosciences. 2023; 15 (1): 37-46.