Green Tea from the Far East to the Drug Store: Focus on the Beneficial Cardiovascular Effects

Cardiovascular diseases (CVD) are the leading cause of death worldwide. Evidence from observational and randomized controlled studies showing the potential benefits of green tea on lowering CVD risk has been emerging rapidly during the past few decades. These benefits include reduced risk for major cardiovascular events, lowering of blood pressure, decreased LDL cholesterol levels and weight loss. At the same time, the understanding of the physiological mechanisms behind these alterations is advancing. Consumption of green tea originated from China thousands of years ago, but since then, it expanded all over the world. Recent advances in understanding the role of tea polyphenols, mainly catechins, as mediators of tea's health benefits, have caused the emergence of various types of green tea extracts (GTE) on the market. While taking green tea is generally considered safe, there are concerns about the safety of using tea extracts. The present article reviews the current evidence of green tea consumption leading to reduced CVD risk, its potential biological mechanisms and the safety of using GTE

Charcot Foot: An Update on Diagnosis, Treatment, and Areas of Uncertainty

Background and aims: Charcot neuroosteoarthropathy (CN) is considered a rare complication of diabetic neuropathy. Due to its insidious mode of presentation, CN may be difficult to diagnose timely and a high index of suspicion is required from both, the diabetic patient (especially those with neuropathy) and their physicians for the early diagnosis and treatment to prevent major complications. Methods: We planned a narrative review and searched MEDLINE database to identify evidence regarding CN incidence, treatment options, and recent guidelines. As practitioners do not commonly treat CN, a characteristic clinical case is also presented. Results: The available evidence for diagnosis and treatment remains of low quality. On the one hand, there is an urgent need for action to increase awareness of the disease in both practitioners and people with diabetes. On the other hand, prospective nationwide registries of patients with diabetic neuropathy will help clarify the prognostic factors that may predispose to this complication, and more randomized clinical trials are needed to identify whether medical treatment may improve CN outcomes. For the time being, offloading of the foot to stop the perpetuation of trauma, and inflammation, and importantly to arrest the progression to a deformed nonfunctional foot is the cornerstone of medical therapy of CN. Multidisciplinary assessment between diabetologists and radiologists is fundamental for prompt diagnosis. Conclusions: To avoid potentially deleterious delays in diagnosis and treatment, every physician should bear in mind that every patient with diabetic neuropathy presenting with a warm swollen foot should be treated as having CN until proven otherwise

Brain Glucose Metabolism in Health, Obesity, and Cognitive Decline-Does Insulin Have Anything to Do with It? A Narrative Review

Imaging brain glucose metabolism with fluorine-labelled fluorodeoxyglucose ([18F]-FDG) positron emission tomography (PET) has long been utilized to aid the diagnosis of memory disorders, in particular in differentiating Alzheimer's disease (AD) from other neurological conditions causing cognitive decline. The interest for studying brain glucose metabolism in the context of metabolic disorders has arisen more recently. Obesity and type 2 diabetes-two diseases characterized by systemic insulin resistance-are associated with an increased risk for AD. Along with the well-defined patterns of fasting [18F]-FDG-PET changes that occur in AD, recent evidence has shown alterations in fasting and insulin-stimulated brain glucose metabolism also in obesity and systemic insulin resistance. Thus, it is important to clarify whether changes in brain glucose metabolism are just an epiphenomenon of the pathophysiology of the metabolic and neurologic disorders, or a crucial determinant of their pathophysiologic cascade. In this review, we discuss the current knowledge regarding alterations in brain glucose metabolism, studied with [18F]-FDG-PET from metabolic disorders to AD, with a special focus on how manipulation of insulin levels affects brain glucose metabolism in health and in systemic insulin resistance. A better understanding of alterations in brain glucose metabolism in health, obesity, and neurodegeneration, and the relationships between insulin resistance and central nervous system glucose metabolism may be an important step for the battle against metabolic and cognitive disorders

Marcato aumento delle concentrazioni di procalcitonina dopo idroclorotiazide-edema polmonare indotta

Introduction: In the Medline database there are approximately 60 cases reporting toxic pulmonary edema, a life-threatening event, induced after consumption of hydrochlorothiazide, one of the most common antihypertensive drugs. Moreover, increased procalcitonin concentrations have been reported after cardiogenic pulmonary edema. We report the rare case of a hydrochlorothiazide-induced pulmonary edema, which was followed by a marked increase of the procalcitonin concentrations. Clinical case: A middle-aged woman was admitted to the Emergency Department for severe dyspnea and chills. Such symptoms began 30 minutes after consumption of hydrochlorothiazide. Her physical examination and chest-X-ray were compatible with pulmonary edema, however her brain natriuretic peptide levels and echocardiogram were almost normal. Interestingly she had extremely elevated procalcitonin concentrations with normal white blood cells count and C-reactive protein levels only mildly increased. We hypothesized toxic pulmonary edema and started treatment with non-invasive mechanical ventilation, with the patient presenting rapid clinical improvement. Conclusions: Even if extremely rare, hydrochlorothiazide may induce pulmonary edema; significant increase of procalcitonin concentrations may occur in this condition and perhaps in other cases of toxic pulmonary edema. Practitioners should be aware of this condition in order to spare expensive and useless, in this case, investigations such as blood cultures and treatments (antibiotics) if other signs of infection are absent

Pleiotropic Effects of Secretin: A Potential Drug Candidate in the Treatment of Obesity?

Secretin is the first hormone that has been discovered, inaugurating the era and the field of endocrinology. Despite the initial focus, the interest in its actions faded away over the decades. However, there is mounting evidence regarding the pleiotropic beneficial effects of secretin on whole-body homeostasis. In this review, we discuss the evidence from preclinical and clinical studies based on which secretin may have a role in the treatment of obesity

Vitamin D Supplementation as a Therapeutic Strategy in Autoimmune Diabetes: Insights and Implications for LADA Management

Latent autoimmune diabetes of adults (LADA) is the most prevalent form of autoimmune diabetes (AI-D) in adulthood; however, its accurate diagnosis and optimal treatment remain challenging. Vitamin D deficiency (VDD) is commonly observed in LADA patients, while increased vitamin D exposure through supplementation and dietary intake is associated with a reduced incidence of LADA. Although limited, case reports, case-control studies, and randomized clinical trials have examined the effects of vitamin D supplementation—alone or combined with dipeptidyl peptidase-4 inhibitors (DPP4-is)—on glucose regulation, residual β-cell function, and glutamic acid decarboxylase antibody (GADA65) levels. Findings, while preliminary, indicate that vitamin D supplementation may enhance glycemic control, preserve β-cell function, and reduce autoimmune activity. Given its accessibility, affordability, and relative safety, vitamin D supplementation presents an attractive adjunct treatment option for LADA patients. This narrative review discusses current evidence on the potential therapeutic benefits of vitamin D supplementation in patients with AI-D, including LADA, who are also vitamin D deficient. Beginning with an exploration of the epidemiological patterns, clinical presentation, and diagnostic framework essential for understanding and identifying LADA, this review then examines the proposed mechanisms through which vitamin D may influence autoimmune modulation of pancreatic β-cells, integrating recent data pertinent to LADA pathology. By distilling and consolidating existing research, we aim to provide a platform for advancing targeted investigations within this distinct patient population