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.

Factors associated with mortality in patients affected by COVID-19

Cindhy Mífia da Silva Moreira — 2025-08-17

Objective: To investigate the clinical conditions and sociodemographic characteristics associated with mortality due to COVID-19 during the first year of the pandemic in an intensive care unit in a capital city in northeastern Brazil.

Method: This was an exploratory, retrospective documentary study based on secondary data obtained from medical records of patients admitted to an intensive care unit of a public hospital in northeastern Brazil. Data collection occurred between July and September 2021. The data were analyzed via descriptive and inferential statistics. The chi-square test, Fisher's exact test, Student's t test, and binary logistic regression modeling were employed. The study was approved by the Research Ethics Committee.

Results: A total of 274 patients, predominantly male, mixed-race, and aged over 65 years, were included. The variables male sex, age 65 years or older, marital status (married), and length of hospital stay were significantly associated with clinical outcomes. Logistic regression analysis revealed that male individuals, those aged 65 years or older, those requiring invasive mechanical ventilation, and patients in the prone position had higher odds of mortality as an outcome.

Conclusions: Observing the factors associated with mortality outcomes in patients affected by novel coronavirus infection can aid healthcare professionals and public health managers in decision-making.

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