International journal of Complementary and Internal Medicine

Do refined carbohydrates, glycemic index, subclinical hypothyroidism, and insulin resistance contribute to the brain senescence of subjective cognitive decline in aging in man and animals? Here is what the lab rats are saying

Orien L Tulp — 2025-08-17

The onset and progression of subjective cognitive decline (SCD) in aging typically occurs gradually over an extended duration, often escaping recognition by friends and family during the early stages of the disorder. The incidence of SCD in developed counties, where the abundant consumption of refined carbohydrate sources is also commonplace, is virtually staggering, currently approaching over 10% of the population over age 45 with no definitive end in sight.1 The development of SCD has been associated with factors of socioeconomic, educational, metabolic and pathophysiological comorbidities, including diet and impaired insulin sensitivity common to obesity, Type 2 and 3 diabetes (T2DM; T3DM). While early intervention is preferable for the treatment of many illnesses and disorders, effective remedies for the senescence of aging and SCD remain a challenge for the practicing clinician, in part because the metabolic and nutritional factors which initiate the process remain largely unclear. The development of symptoms consistent with subclinical hypothyroidism (SCHT) are also commonplace among the aged. The independent contributions of thyroidal dysregulation and insulin resistance to dysregulation of energy balance, although strongly linked, some aspects remain unclear and incompletely known. Several
recent studies have now associated obesity and insulin resistance (IR) to brain senescence in aging congenic obese rats. Several studies also support a link between chronic hyperinsulinemia, epigenetic expression of obesity, brain shrinkage and decreased brain protein and cellular deoxyribose nucleic acid (DNA) content in a congenic rodent model of early onset obesity.

Aging congenic obese LA/Ntul//-cp rats develop obesity and hyperinsulinemia soon after weaning regardless of diet and which pathophysiologic stigmata persist throughout their lifespan. The stigmata of insulin resistance may become further aggravated when fed a high glycemic index diet. Groups of lean and obese rats were fed USDA-formulated nutritionally complete isoenergetic diets continuing cornstarch (ST) or sucrose (SUC) asthe only carbohydrate source from weaning until 10.5 months of age. Longevity of obese << lean in both sexes. Obese rats were found to exhibit SCHT and decreased brain mass associated with IR, and accompanied with proportionate decreases in brain lipid, protein and DNA content in the obese but not the lean phenotype. In addition, the decreases in brain mass, protein and DNA composition were of greater magnitude when fed the SUC vs the ST diets in both phenotypes. These observations are suggestive of an increased potential for a contribution of the metabolic sequelae of insulin resistance as a pathophysiologic factor in the progression of brain shrinkage and presumed cognitive decline in the aging obese, hyper insulinemic rat, analogous to clinical observations which may occur in senescence, dementia and Alzheimer’s disease in aging populations and implicate the glycemic index of the refined carbohydrate source as a contributory factor.

Macronutrients, Lifestyle, and Cognitive Ageing: Beyond Binary Interpretations

Chih-Yuan Ko — 2025-09-29

Inconsistent associations between macronutrient composition and cognitive ageing often reflect binary framings that ignore context. By binary interpretation we mean dichotomous framings that overlook dose response, substitution among macronutrients, and heterogeneity by diet quality, energy balance, and metabolic or genetic risk. We propose a context-informed framework that prioritises dietary quality, sets protein and carbohydrate targets by metabolic risk and body composition, and integrates nutrition with activity and sleep to support cognitive reserve. We distinguish model-specific findings in repair-deficient mice from population-
level evidence linking carbohydrate quality and prudent dietary patterns with healthier cognitive ageing. We outline pragmatic trials with prespecified cognitive outcomes, explicit substitution within high-quality patterns, risk stratification, adherence measurement, and clear reporting of energy balance. Macronutrient targets should be treated as context-dependent substitutions and tested accordingly.

Can Pulsed Electromagnetic Field Applications Help Ameliorate Chronic Osteoarthritis Degradation in Older Adults: A Brief 2025 Update of its Potential Restorative Role

Ray Marks — 2025-10-07

Osteoarthritis, a painful oftentimes disabling joint disorder is generally deemed incurable. Affecting more and more aging adults, here we examine the rationale for, and potential efficacy of applying pulsed electromagnetic fields clinically for purposes of reducing osteoarthritis pain and other related disease features, especially muscle. Based on selected English language literature published largely on PUBMED between January 2020 and September 2025, papers describing muscle specific observations and others and the impact of pulsed electrical stimuli are explored. These show efficacy trends that may facilitate function and decrease suffering and the need for narcotics and possible joint reparative processes among older adults with chronically disabling joint derangement and dysfunction.

A Rare Cause of Post-TURP Bladder Outlet Obstruction

Siddanagouda B Patil — 2025-10-07

Prostatic synechiae are rare fibrous adhesions within the prostatic urethra that can lead to bladder outlet obstruction (BOO) after transurethral resection of the prostate (TURP). This report presents a case of a 79-year-old male who developed recurrent lower urinary tract symptoms (LUTS) and acute urinary retention six months following an otherwise uneventful TURP. Cystoscopy revealed fibrous bands within the prostatic urethra consistent with prostatic synechiae. The adhesions were managed successfully with endoscopic resection. This case highlights the importance of considering synechiae in the differential diagnosis of recurrent BOO post-TURP and discusses the diagnostic and therapeutic approach to this uncommon complication.

Outcomes of Percutaneous Nephrolithotomy in Horseshoe Kidneys: A retrospective cohort study from a single centre in South India

Sandeep Kumar — 2025-10-08

Introduction

This study was undertaken to evaluate the outcomes and safety profile of percutaneous nephrolithotomy (PCNL) in HSK patients.

Materials and Methods

Between 2019 and 2024, individuals with stones in HSKs who received PCNL treatment at our institution were retrospectively reviewed.

Results

Between 2019 and 2024, 29 HSKs with stones underwent PCNL treatment at our institution. 39.9 ± 14.95 years was the average age. The mean body mass index (BMI) was 22.9 ± 4.5 kg/m2. The mean stone size was 25.07 ± 0.8mm. Calyceal access was obtained through the upper pole in 17 patients (58.6%), the inter pole in 10 patients (34.5%), and the lower pole in five patients (17.2%). A flexible nephroscope was done in four patients (13.8%). Postoperative complications occurred in five patients (17.2%) with Clavien Dindo scores less than three and one patient (3.4%) with a Clavien Dindo score of three.

The success rate following a single session of PCNL was 62%, with seven patients (24.1%) requiring ancillary procedures. After these additional interventions, the overall success rate increased to 86.2%. Analysis of variables affecting stone-free rates after PCNL in HSKs with stones revealed a direct correlation with stone size (p-value 0.04).

Conclusion

Our experience with percutaneous nephrolithotomy in horseshoe kidneys showed a comparable stone-free rate (86.2%) with no occurrence of significant complications. Although stone-free status is less affected by demographic and operative parameters, stone size played an important role in achieving stone-free status in this single-center analysis.

List Of Abbreviations

• HSK – Horseshoe kidney
• PCNL – Percutaneous Nephrolithotomy
• Fr – French
• BMI – Body Mass Index
• SD – Standard deviation
• IQR – Interquartile range
• SWL – Shock Wave Lithotripsy

Can Photobiomodulation Laser Therapy ‘Lighten’ Pain in Chronic Osteoarthritis? Facts and Opportunities

Ray Marks — 2025-11-19

Among the various non-pharmacological interventions shown to partially relieve joint pain, we elected to review the present 2025 photo or laser therapy data as applied to establishing its potential for alleviating pain in the aging musculoskeletal system. More specifically, we aimed to:
a) examine current 2025 related research on this topic, from the general standpoint of photo biomodulation or low-level laser applications as applied to preclinical or clinical osteoarthritis, the most common painful disease affecting older adults,
b) more specifically from laser application influences observed as regards various joint tissues and sites underpinning osteoarthritis pain,
c) how low-level laser affects pain. Results show consistent post-treatment pain associated improvements even in the face of verifiable osteoarthritis damage and destruction, but that the underlying mechanisms and optimal dosages for maximizing this effect are generally unclear. However, most researchers agree the topic warrants future study and will likely prove of high clinical significance.

Progressive Evolution of Ulcerative Colitis Toward Axial Spondyloarthritis and Pyoderma Gangrenosum: Case Report and Critical Literature Review

Marco Antonio Ditta — 2025-11-19

Inflammatory bowel disease (IBD) is a chronic inflammatory condition of multifactorial etiology that primarily includes ulcerative colitis (UC) and Crohn’s disease (CD). ¹ UC affects the colonic mucosa in a continuous pattern, whereas CD is characterized by a patchy, transmural involvement that can affect any segment of the gastrointestinal tract. ¹ Both entities typically follow a relapsing–remitting course and are associated with extraintestinal manifestations in up to 36% of cases, musculoskeletal involvement being the most frequent. ^2,3

The association between IBD and arthropathies has been recognized since the late 19th century. It is now understood that peripheral arthritis and IBD-related spondyloarthritis are part of the spectrum of seronegative spondyloarthritides, although HLA-positive variants have also been described. ^4,5 Peripheral arthritis is usually oligoarticular, asymmetric, and predominantly affects the lower limbs, while ankylosing spondylitis and sacroiliitis associated with IBD may progress independently of intestinal activity. ^6,7 Genetic factors such as
HLA-B27 and CARD15 polymorphisms, as well as mucosal immune mechanisms, have been implicated in the shared pathophysiology. ^8,9

In parallel, IBD is associated with several dermatological manifestations. Among these, pyoderma gangrenosum (PG) is an ulcerative neutrophilic dermatosis—rare but clinically significant—reported in up to 12% of IBD patients, most commonly in those with UC. ^10,11 PG presents as painful ulcers with violaceous borders and a chronic, relapsing course, whose pathogenesis involves innate immune dysfunction, abnormal neutrophilic recruitment, and overexpression of proinflammatory cytokines.^12,13

The management of extraintestinal manifestations in IBD remains a clinical challenge. Corticosteroids and immunomodulators are first-line therapies; however, anti-TNF biologics such as infliximab have demonstrated efficacy in simultaneously controlling intestinal inflammation, associated arthritis, and PG. ^14–17 Clinical reports have even documented complete remission of refractory cutaneous lesions and significant improvement in IBD-associated spondyloarthritis following infliximab initiation.^18,19 Given the complexity of these patients, a multidisciplinary approach involving gastroenterology, rheumatology, and dermatology—with close monitoring of both intestinal and extraintestinal disease activity—is strongly recommended.^20,21

In this context, we present the case of a patient with ulcerative colitis, axial and peripheral spondyloarthritis, and pyoderma gangrenosum treated with infliximab, illustrating the clinicopathogenic interaction between IBD and its extraintestinal manifestations, as well as the importance of biologic therapy in comprehensive management.

Beyond Eczema and Lupus: Sézary Syndrome with Chronic Cutaneous Presentation Mimicking Common Inflammatory Dermatoses

Carmen Cecilia Tamara Ariza — 2025-11-20

Sézary syndrome is an uncommon and aggressive leukemic variant of cutaneous T-cell lymphoma (CTCL), often misdiagnosed in its early stages due to its clinical resemblance to chronic inflammatory dermatoses such as eczema or cutaneous lupus erythematosus. We report the case of a 67-year-old woman who presented with chronic pruritic erythematous plaques initially diagnosed and treated as chronic eczema and later as systemic lupus erythematosus (SLE), delaying the correct diagnosis. The eventual identification of Sézary cells on peripheral smear and confirmatory immunophenotyping established the diagnosis of Sézary syndrome, underscoring the need for a high index of suspicion and a multidisciplinary diagnostic approach when evaluating chronic, treatment-refractory dermatoses.

The Effects of Pesticides on Liver Injury: Current Status on Pathophysiology

Subendu Sarkar — 2025-11-20

Increasing use of pesticide may be associated with severe hepatotoxicity. The underlying mechanism of pesticide - induced liver damage is poorly understood. Studies are selected by searching keyword pesticide, food and agriculture, pesticide and liver injury, herbicide, insecticide, fungicide. PubMed, Web of Science, Google Scholar, Embase, Scopus are used to obtain research articles, case studies, reviews in English language up to June 2025. It reveals that three main types of pesticides are commonly used: herbicides, insecticides, and fungicides. The toxicological effects of pesticides are linked to the development of non-alcoholic fatty liver disease (NAFLD), metabolic-associated fatty liver disease (MAFLD), non-alcoholic steatohepatitis (NASH), hepatitis, and hepatocellular carcinoma. Both in vivo and in vitro exposure to pesticides shows changes in hepatocyte morphology and cellular functions. Furthermore, pesticide exposure results in elevated liver enzyme activities, tissue inflammation, oxidative stress, leukocyte infiltration, and lipid accumulation. Pesticides can disrupt the gut-liver axis by diminishing beneficial gut microorganisms. These physiological alterations may be associated with significant liver injury. It can be inferred that improved safety protocols are crucial when applying hazardous pesticide agents. However, it would be wise to restrict the use of hazardous pesticides. Furthermore, the encouragement of organic farming should be promoted to mitigate pesticide-related liver damage. It is essential to prohibit the use of pesticides that demonstrate the greatest toxicity to humans, along with those that persist in the environment for extended durations. Additionally, it is vital to protect public health by setting maximum permissible limits for pesticide residues in food and water.

Effect Of Aging on Glucose Oxidation and Insulin Resistance in Diaphragm in Congenic Obese Rats

Orien L Tulp — 2025-12-08

The purpose of the current investigation was to determine the characteristics of glucose oxidation in diaphragm muscle in aging congenic, lean and obese rats from 4 to 24 months of age. Insulin resistance (IR) in the diaphragm muscle is a condition where the muscle may become less responsive to insulin, thereby impairing glucose uptake and potentially contributing to diaphragmatic weakness and respiratory dysfunction. Thus, IR may become a contributor to insulin resistance in muscle and adipose tissue depots particularly in conditions like obesity and type 2 diabetes (T2DM/NIDDM). While peripheral skeletal musculature groups often represents a primary locale of IR, the ongoing physiologic contractile activity of the diaphragm may escape much of the early impact of IR since it remains a more physiologically active muscle group than skeletal muscle throughout the lifespan in man and animals, and which may confer a measure of metabolic protection from more extensive features of IR. Groups of lean and obese female littermate LA/Ntul//-cp rats, a rodent model where obesity occurs independently of NIDDM were studied at 4, 14, and 24 months of age. Parameters of IR and glucose oxidation in diaphragm determined in the presence or absence of insulin (100 μU/ml; Medium glucose 10 mM). Relative adiposity was computed by the addition of the sum of dorsal and retroperitoneal adipose tissue depots as a proportion of final body weight. Body weight of lean animals was similar at all ages studied, while body weight of obese rats increased at each successive age studied in the obese phenotype. Fasting plasma glucose concentrations were similar in both phenotypes at all ages studied, but plasma insulin concentrations and the insulin: glucose ratios were markedly elevated in the obese phenotype. animals were markedly elevated, with only modest age-related improvement. Measures of glucose oxidation in diaphragm were consistent with age related decreases in baseline and insulin stimulated glucose oxidation in the lean phenotype. In contrast, baseline and insulin- stimulated glucose oxidation in the obese phenotype were consistent with IR. These results suggest that the capacity for insulin-stimulated glucose oxidation becomes decreased in aging, with further decreases in the obese phenotype.