Diabetic Foot Infections and Problems in Guyana

Diabetes mellitus (DM) is a major global metabolic disorder currently affecting more than 465 million people. If diagnosed late or left untreated, DM can induce a number of long-term complications which are due to DM-induced hyperglycaemia leading to nephropathy, cardiomyopathy, neuropathy, retinopathy, impotence, foot ulcers and amputations. Diabetic foot problems (DFB) are major concerns for the patients as they affect their quality of life and exert great financial burden on them, especially for people from a low income developing country as Guyana. In 2019, it was estimated that the expenditure for diagnosis, treatment and care for diabetic foot patients was USAD$75 million in Guyana. Both obesity and diabetes are on the increase in Guyana with almost 11 - 12% of the adult population have DM, due to obesity (diabesity) and more women compared to men. Moreover, there is an unacceptable high rate of amputations due to lack of organised foot-care programme and the absence of national guidelines in its management. There are various aspects of good diabetic foot care and this article now reviews what has been achieved and what needs prioritisation to improve the management of diabetic foot problems in Guyana among patients with diabetes mellitus. ’The Guyana Diabetes and Foot Care Project” has made significant improvement in this area but the lack of specialist vascular surgical service is obvious

Effects of Diabetes Mellitus on the Conduction System of the Heart: Mini-Review

Diabetes mellitus can induce substantial damage to the conduction system of the heart, especially the sinoatrial node. This is due to hyperglycemia leading to bradyarrhythmia. DM, via the elevation of HG, generates the production of a number of insulting agents in the myocardium known as reactive oxygen species and reactive carbonyl species, which elicit direct damage to neuro-filament-M and β2-adrenergic receptors in the conducting system as well as a number of cardiac contractile, cation transporting and channel proteins. One cation channel protein is the hyperpolarization-activated cyclic nucleotide-gated potassium channel. It encodes the protein responsible for the hyperpolarizing-activated current or the “funny current” that participates in spontaneous diastolic membrane depolarization in sinoatrial node cells. Gene expression of these proteins and their physiological functions are decreased in the diabetic heart, which affects the generation of electrical impulses or action potentials resulting in increases in RR and PR intervals and QRS complex duration of the electrocardiogram. The heart rate and force of contraction of the myocardium are decreased leading to bradyarrhythmia and sudden cardiac death. This review attempts to explain the cellular mechanism(s) involved in diabetes-induced bradyarrhythmia with emphasis on cation-transporting proteins, especially the hyperpolarization-activated cyclic nucleotide-gated channels pacemaker current channels

Mechanisms of Diabetes Mellitus-Induced Sudden Cardiac Death

More than 450 million people worldwide have diabetes mellitus (DM), a metabolic disorder characterized by an increase in blood glucose level (hyperglycemia) that arises from insufficient insulin secretion or resistance to insulin’s action. More than 70% of individuals with chronic DM will develop cardiovascular diseases (CVDs) including atherosclerosis and coronary artery diseases (CADs), hypertension, cardiac arrhythmias, cardiomyopathy (heart failure), stroke, and chronic kidney disease. A significant number of these individuals will also succumb to sudden cardiac death (SCD). SCD usually occurs in early morning from abnormal heart rhythms or arrhythmias and ventricular fibrillation. When the pumping action of the heart becomes erratic, a reduction in oxygenated blood to the brain leads to unconsciousness and brain damage. SCD is independent of age and sex and positively correlates with impairment in cardiac metabolism, muscle damage, fibrosis, apoptosis, hypertrophy, ischemia, and deranged cation signaling. This review centers on mechanisms by which intracellular cations (Na+, K+, and Ca2+) handling, inflammation, and oxidative and carbonyl stresses due to diabetes-induced hyperglycemia can lead to the deterioration of excitation/contraction coupling (ECC), impaired contractility, arrhythmias, and SCD in DM patients. It also discusses the beneficial effects of exercise training to attenuate the risk of SCD

Medicinal and anti-oxidant effects of Bitter Melon (Momordica charantia) in the treatment of diabetic cardiomyopathy

Obesity is a major risk factor for diabetes mellitus (DM), which is a major global metabolic health disorder currently affecting over 460 million people and this number is rising rapidly. Heart failure (HF) is the major cause of death among diabetic patients. The disorder is due to elevated blood glucose or hyperglycemia (HG) beyond physiological level, which in turn leads to a number of long-term or end-organ complications over time and over 80% of all diabetics will eventually die from either HF or cardiomyopathy if left untreated. Treatment of DM is very costly and as such, patients turn to non-pharmacological or alternative forms of treatment, including weight loss, diet modifications and plant-based medicines, which are more cost-effective. There are several medicinal plants, which are currently used to treat for DM and they are known to exhibit anti-diabetic properties. One such plant is Momordica charantia, or bitter melon, which is used in many tropical countries as a traditional functional food and medicine, especially for the treatment of obesity, DM, hypertension and cancer. This review is related to the anti-oxidant beneficial effect of Momordica charantia in the treatment of diabetic cardiomyopathy (DCM). The beneficial effects of Momordica charantia in the treatment of obesity, diabetes and cardiovascular diseases (CVDs) have been reported in clinical and experimental animal studies and this review addresses some of these useful effects. However, the cellular and molecular mechanisms underlying its therapeutic antidiabetic effects of M charantia via its anti-oxidant activities are not fully known and further research studies need to be done

Bitter Melon in Combination with Diet Modification and Regular Exercise Can Prevent and Treat Obesity and Hypertension Cost-Effectively

hronic diseases (CDs), including hypertension, obesity and diabetes, are responsible for a large number of global deaths annually. This is due to current life style habits, including sedentary life style, smoking, excess alcohol intake, sugar and fast-food consumption, genetic factors, stress and others. This study investigated the effect of daily consumption of bitter gourd/melon (Momordica charantia) combined with life style changes to reduce body weight, systolic and diastolic blood pressure (SDBP), blood glucose and lipid levels in the body. The study recruited 32 obese male (16) and female (16) subjects with an average age of 42 years (±4.5 years) and the majority of them had secondary education. They were divided into four groups (4 men and 4 women per group). Group 1 (diet only) was asked to reduce daily food intake and avoided snaking or binging for 6 weeks. Group 2 (diet and bitter melon) did the same as group 1 but combined with the consumption of 20 g of bitter melon juice (vol/weight) daily for 6 weeks. Group 3 (diet, exercise and bitter melon) did the same as group 1 but combined with daily exercise involving walking, stretching or bicycle riding or a combination for 30 min plus the consumption of 20 g of bitter melon daily for 6 weeks. Group 4 (diet and exercise) did the same as group 1 plus daily exercise involving walking, stretching or bicycle riding or a combination for 30 min Initially, at week 1 the subjects were weighed and their height and SDBP taken. Blood samples were taken for the measurements of fasting blood glucose (FBG), HBA1c, total cholesterol and triglyceride. Their BMI and blood pressure were measured weekly over 6 weeks and another blood sample for each subject was taken at the end of week 6 for analysis as in week one for comparison. The results showed that all four interventions were associated with marked decreases in BMI but with little or no change in HBA1c and FBG compared week 1 with week 6. However, significant (p <0.05) decreases were observed in SDBP, total cholesterol and triglyceride comparing week 1 with week 6. It is concluded that life style changes including dieting, regular exercise and daily intake of bitter melon can help to reduce blood pressure and lipids and the weight of obese subjects leading to a better quality of life

Cellular and Biochemical Mechanisms Driving the Susceptibility of Obese Subjects to Covid-19 Infection

Overweight is a major global health problem currently affecting almost 2 billion people worldwide. An additional 800 million are obese. These figures showed that 40% of the global adult population aged 18 years, and over are overweight while 14% are obese. What is now worrying is that more than 40 million children worldwide, as young as 5 years of age are either overweight or obese. Individuals with a body mass index (BMI) of 25–29 kg/m2 are considered to be overweight while obesity is the term used when the BMI is 30 kg/m2 and over. Obesity is an imbalance between calorie intake and calorie expenditure. In general, obesity can be caused by excessive eating and reduced physical activity. Obesity is a major risk factor for non-communicable diseases such as diabetes mellitus, respiratory and liver dysfunctions, sleep apnea, chronic inflammation, compromised immune system, renal failure, cancer, musculoskeletal disorders, cardiovascular diseases and others. Obesity is also a major risk factor for coronavirus disease 19 (Covid-19), which can induce severe cases of pneumonia and sepsis or acute respiratory distress syndrome. In many cases, Covid-19 causes severe and long-lasting damage to the lungs and other vital organs of the body resulting in death. This review describes the cellular and biochemical mechanism(s) whereby obese patients become susceptible to Covid-19 infection. It also outlines how obesity on its own can affect the lungs, which in turn become more compromised in cases of Covid-19 disease resulting in the imminent death of the patient

Diabetes-induced chronic heart failure is due to defects in calcium transporting and regulatory contractile proteins: cellular and molecular evidence

Heart failure (HF) is a major deteriorating disease of the myocardium due to weak myocardial muscles. As such, the heart is unable to pump blood efficiently around the body to meet its constant demand. HF is a major global health problem with more than 7 million deaths annually worldwide, with some patients dying suddenly due to sudden cardiac death (SCD). There are several risk factors which are associated with HF and SCD which can negatively affect the heart synergistically. One major risk factor is diabetes mellitus (DM) which can cause an elevation in blood glucose level or hyperglycaemia (HG) which, in turn, has an insulting effect on the myocardium. This review attempted to explain the subcellular, cellular and molecular mechanisms and to a lesser extent, the genetic factors associated with the development of diabetes- induced cardiomyopathy due to the HG which can subsequently lead to chronic heart failure (CHF) and SCD. The study first explained the structure and function of the myocardium and then focussed mainly on the excitation-contraction coupling (ECC) processes highlighting the defects of calcium transporting (SERCA, NCX, RyR and connexin) and contractile regulatory (myosin, actin, titin and troponin) proteins. The study also highlighted new therapies and those under development, as well as preventative strategies to either treat or prevent diabetic cardiomyopathy (DCM). It is postulated that prevention is better than cure