Use of Dark Chocolate for Diabetic Patients: A Review of the Literature and Current Evidence

Dietary changes are a major lifestyle factor that can influence the progression of chronic diseases such as diabetes. Recently, flavanols, a subgroup of plant-derived phytochemicals called flavonoids, have gained increasing attention, due to studies showing an inverse correlation between dietary intake of flavanols and incidence of diabetes. Flavanoids in the cocoa plant may ameliorate insulin resistance by improving endothelial function, altering glucose metabolism, and reducing oxidative stress. Oxidative stress has been proposed as the main culprit for insulin resistance. The well-established effects of cocoa on endothelial function also points to a possible effect on insulin sensitivity. The relationship between insulin resistance and endothelial function is a reciprocal one. Overall, the evidence from these studies suggests that cocoa may be useful in slowing the progression to type 2 diabetes and ameliorating insulin resistance in metabolic syndrome. Additionally, results from several small studies indicate that cocoa may also have therapeutic potential in preventing cardiovascular complications in diabetic patients. Studies highlighting the potential of cocoa-containing diets, in large-randomized controlled trials should be performed which might give us a better opportunity to analyze the potential health-care benefit for reducing the risk of complications in diabetic patients at molecular level

Il-21: The Future Of Medicine

Interleukin-21 (IL-21), a T-cell-derived cytokine, is a signaling molecule secreted by a subpopulation of T cells called follicular T helper (Tfh) cells. Studies have proved that IL-21 co-stimulates T cell proliferation by mediating enhanced T cell viability. This is done when IL-21 binds to its receptor, activating the phosphatidylinositol-3 kinase (PI-3K) signaling pathway and inducing B-cell Lymphoma-2 (Bcl-2) expression. Besides the B and T cells, IL-21 also regulates several Natural Killer (NK) cell functions. Due to its multi-faceted effects on different receptors, IL-21 has been used in multiple diseases. However, it was recently found that IL-21 had potent effect on various viruses including Lymphocytic Choriomeningitis Virus (LCMV), influenza virus and Vesicular Stomatitis Virus (VSV). The study proved that both B and CD4+ T cells need IL-21 signaling for generating long-term humoural immunity by generating long-lived plasma cells, thus, highlighting the importance of IL-21 in humoural immunity to viruses. These findings highlight how IL-21 could be important in the development of antiviral vaccines and vaccines for other potential life-threatening diseases leading scientists to design future vaccines to incorporate IL-21 directly or to use the ability to stimulate IL-21 as a gauge of vaccine activity. It is the need of the hour to go for larger studies which will be needed to better elucidate the cause and effect relationship and to demonstrate the effect size. It may possibly yield appreciable results in the future for untreatable diseases like HIV/AIDS

IL-21: The Future of Medicine

Interleukin-21 (IL-21), a T-cell-derived cytokine, is a signaling molecule secreted by a subpopulation of T cells called follicular T helper (Tfh) cells. Studies have proved that IL-21 co-stimulates T cell proliferation by mediating enhanced T cell viability. This is done when IL-21 binds to its receptor, activating the phosphatidylinositol-3 kinase (PI-3K) signaling pathway and inducing B-cell Lymphoma-2 (Bcl-2) expression. Besides the B and T cells, IL-21 also regulates several Natural Killer (NK) cell functions. Due to its multi-faceted effects on different receptors, IL-21 has been used in multiple diseases. However, it was recently found that IL-21 had potent effect on various viruses including Lymphocytic Choriomeningitis Virus (LCMV), influenza virus and Vesicular Stomatitis Virus (VSV). The study proved that both B and CD4+ T cells need IL-21 signaling for generating long-term humoural immunity by generating long-lived plasma cells, thus, highlighting the importance of IL-21 in humoural immunity to viruses. These findings highlight how IL-21 could be important in the development of antiviral vaccines and vaccines for other potential life-threatening diseases leading scientists to design future vaccines to incorporate IL-21 directly or to use the ability to stimulate IL-21 as a gauge of vaccine activity. It is the need of the hour to go for larger studies which will be needed to better elucidate the cause and effect relationship and to demonstrate the effect size. It may possibly yield appreciable results in the future for untreatable diseases like HIV/AIDS

Topical vasodilator response in skeletonized internal mammary artery: Is there really a difference?

Aim of the Study: Coronary artery bypass graft surgery is the gold standard for the treatment of multivessel and left main coronary artery disease. However, there is considerable debate that whether left internal mammary artery (IMA) should be taken as pedicled or skeletonized. This study was conducted to assess the difference in blood flow after the application of topical vasodilator in skeletonized and pedicled IMA. Materials and Methods: In this study, each patient underwent either skeletonized (n = 25) or pedicled IMA harvesting (n = 25). The type of graft on each individual patient was decided randomly. Intraoperative variables such as conduit length and blood flow were measured by the surgeon himself. The length of the grafted IMA was carefully determined in vivo, with the proximal and distal ends attached, from the first rib to IMA divergence. The IMA flow was measured on two separate occasions, before and after application of topical vasodilator. Known cases of subclavian artery stenosis and previous sternal radiation were excluded from the study. Results: The blood flow before the application of topical vasodilator was similar in both the groups (P = 0.227). However, the flow was significantly less in pedicled than skeletonized IMA after application of vasodilator (P < 0.0001). Similarly, the length of skeletonized graft was significantly higher than the length of pedicled graft (P < 0.0001). Conclusion: Our study signifies that skeletonization of IMA results in increased graft length and blood flow after the application of topical vasodilator. However, we recommend that long-term clinical trials should be conducted to fully determine long-term patency rates of skeletonized IMA

Using left ventricular assist devices in advanced heart failure patients

Advanced Heart Failure (AHF) is a complex syndrome that affects the physiology of the heart to maintain efficient blood circulation resulting in multiorgan failure and, eventually, death. Left Ventricular Assist Devices (LVADs) have become the cornerstone therapy for AHF patients, both as a bridge to transplantation and as a decisive therapy. Recently the results of the MOMENTUM 3 Trial were published. The trial compared HeartMate 3 LVAD with HeartMate II LVAD in a randomized trial in The Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3 (MOMENTUM 3). Of 366 patients, 190 were assigned to the centrifugal-flow pump group (HeartMate 3) and 176 to the axial-flow (HeartMate II) pump group. In the intention-to-treat population, the primary end point occurred in 151 patients (79.5%) in the centrifugal-flow pump group, as compared with 106 (60.2%) in the axial-flow pump group (P < 0.001 for noninferiority). Reoperation for pump malfunction was less frequent in the centrifugal-flow pump group than in the axial-flow pump group (P < 0.001).The results of the MOMENTUM 3 Trial are a big achievement in the cardiovascular world. Any improvement in LVADs that reduces the risk of stroke, perhaps the most feared complication of these devices, would be meaningful. Besides, given the observed lower rate of pump thrombosis and reoperation for pump malfunction, it already seems likely that the HeartMate 3 will supplant the HeartMate II in clinical practice. In addition, the risks that are associated with reoperation undoubtedly counterbalanced any unintentional bias in performing that intervention

Use of dark chocolate for diabetic patients: a review of the literature and current evidence

Dietary changes are a major lifestyle factor that can influence the progression of chronic diseases such as diabetes. Recently, flavanols, a subgroup of plant-derived phytochemicals called flavonoids, have gained increasing attention, due to studies showing an inverse correlation between dietary intake of flavanols and incidence of diabetes. Flavanoids in the cocoa plant may ameliorate insulin resistance by improving endothelial function, altering glucose metabolism, and reducing oxidative stress. Oxidative stress has been proposed as the main culprit for insulin resistance. The well-established effects of cocoa on endothelial function also points to a possible effect on insulin sensitivity. The relationship between insulin resistance and endothelial function is a reciprocal one. Overall, the evidence from these studies suggests that cocoa may be useful in slowing the progression to type 2 diabetes and ameliorating insulin resistance in metabolic syndrome. Additionally, results from several small studies indicate that cocoa may also have therapeutic potential in preventing cardiovascular complications in diabetic patients. Studies highlighting the potential of cocoa-containing diets, in large-randomized controlled trials should be performed which might give us a better opportunity to analyze the potential health-care benefit for reducing the risk of complications in diabetic patients at molecular level

Atrial fibrillation and heart failure- results of the CASTLE-AF trial

Congestive Heart Failure (HF) and Atrial Fibrillation (AFIB) often coexist. Catheter ablation is a well-established option for symptomatic AFIB that is resistant to drug therapy in patients with otherwise normal cardiac function. This has been seen in various studies where catheter ablation was associated with positive outcomes in patients with HF. Recently, the study results from the Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation (CASTLE-AF) trial were published. After a median follow-up of more than 3 years, patients getting catheter ablation for AFIB had significantly fewer hospital admissions as well as death from worsening HF. In addition, 63% of patients in the ablation group were in sinus rhythm, as compared with 22% of those in the medical-therapy group (P < 0.001). This trial may represent a significant additional therapeutic tool in the clinical prevention and management of cardiovascular mortality and morbidity. While catheter ablation does not eliminate the AFIB per se, it can limit the ventricular rate by eliminating triggers and altering electrophysiological connections in the heart in a similar fashion to rate control anti-arrhythmic drugs. Longer-duration normal sinus rhythm may improve outcomes by means of a number of mechanisms, including greater atrial emptying, all of which translate into improved cardiac output. A better understanding is needed as to why a decrease in density, but not complete elimination of atrial fibrillation, is sufficient for reverse remodelling. It is anticipated that the results of the CASTLE-AF trial will soon be implemented in international guidelines