Anaphylaxis Epidemiology and Risk Factors.

Insilico engineering of transaminase variants for enhanced biocatalytic conversion of an ACE inhibitor precursor.

Mechanistic enzyme-oriented investigation of benzimidazole derivatives associated with kidney dysfunction: synthesis, molecular docking and in vivo toxicological evaluation.

Identification and mechanistic characterization of novel ACE-inhibitory peptides derived from Nattokinase.

Background: Renin-Angiotensin-Aldosterone System (RAAS) acceleration commonly occur in Heart Failure (HF). Drugs such as Angiotensin-Converting Enzyme Inhibitors (ACEI) and Angiotensin Receptor-Neprilysin Inhibitors (ARNI) become essential part of HF treatment. Long-term consumption may impair kidney function and potassium imbalance, which could potentially limit the therapy, therefore we conducted this study to assess the effects of ACEI and ARNI on renal function and potassium level in Indonesian patients with heart failure with reduced ejection fraction (HFrEF), as no local studies exist. Method: A prospective cohort was performed in Banda Aceh, which comprise of 40 ACEI and 40 ARNI patients on standard therapy. Left ventricular ejection fraction (LVEF), serum creatinine level then converted into estimated Glomerular Filtration Rate (eGFR), and serum potassium level were measured at baseline and after 3 months into the therapy. Independent t-test was applied to compare groups. Result: Both ARNI and ACEI groups showed significant improvement in eGFR (p < 0.005). The intergroup difference was 11 mg/dL (p = 0.038) showed that ACEI had a better outcome in eGFR improvement compare with ARNI. Potassium rose slightly in both groups, with an intergroup difference of 0.082 mmol/L (p = 0.623), indicating no meaningful difference. Conclusion: Both ACEI and ARNI improved eGFR after 3 months, with a modest potassium increase. Keyword : ACEI; ARNI; Heart Failure; Potassium; Renal Function.

Abstract Background Sarcoidosis-associated hypercalcemia can cause acute kidney injury (AKI); however, reports of severe cases superimposed on advanced chronic kidney disease (CKD) stage G4 requiring hemodialysis (HD) are rare. We report a case that offers important clinical insights into diagnostic pitfalls in patients with CKD and the clinical approach to identify reversible “treatable AKI.” Case presentation A man in his seventies with baseline CKD stage G4 (serum creatinine [Cr] 2.3–2.6 mg/dL, estimated glomerular filtration rate [eGFR] 19.0–23.0 mL/min/1.73m 2 ) due to nephrosclerosis was emergently admitted for moderate hypercalcemia (corrected serum calcium 13.3 mg/dL) and AKI (Cr 5.15 mg/dL, eGFR 9.3 mL/min/1.73m 2 ). Endocrinological examination revealed suppressed intact parathyroid hormone (PTH) and elevated 1,25-dihydroxyvitamin D (1,25(OH) 2 D), leading to a diagnosis of PTH-independent, vitamin D-dependent hypercalcemia. Although serum angiotensin-converting enzyme (ACE) levels were within the normal range, this was considered to be masked by the chronic use of an ACE inhibitor (imidapril). A clinical diagnosis of sarcoidosis was made on the basis of markedly elevated soluble IL-2 receptor and lysozyme levels and mediastinal lymphadenopathy. Owing to his poor general condition, tissue biopsy could not be performed. Emergency HD was promptly initiated, followed by corticosteroid therapy with prednisolone (30 mg/day) once the clinical diagnosis was strongly suspected. Following treatment, hypercalcemia normalized rapidly, and kidney function gradually improved, allowing liberation from dialysis after five HD sessions. Conclusions When encountering unexplained AKI with hypercalcemia in patients with CKD, clinicians should consider sarcoidosis as a potential underlying cause. Additionally, clinicians will perform a multifaceted evaluation including 1,25(OH) 2 D measurement. Even in severe cases requiring dialysis, early diagnosis and appropriate treatment can render the condition a “treatable AKI.”

Abstract Background: Hypertension remains one of the most prevalent chronic diseases globally. Despite several evidence-based guidelines, blood pressure (BP) control remains suboptimal, particularly in developing countries. Objectives: To study the demographic, clinical profile, and treatment practice pattern in patients of systemic hypertension attending LNCT Medical College and Sewakunj Hospital, Indore. Materials and Methods: A cross-sectional study was conducted at LNCT Medical College and Sewakunj Hospital, Indore, between January 2023 and December 2023. A total of 401 consenting hypertensive adults were enrolled. Clinical data and complete drug-prescription details were recorded. Results: Among the 401 patients, 52.6% were male and 44.4% belonged to the middle-aged group (46–64 years). Diabetes mellitus was present in 19%, coronary artery disease in 18%, and cerebrovascular accidents in 13.7%. Only 10.2% of patients had adequately controlled BP, while 71.3% had stage 2 hypertension. Target organ damage was present in 32.1% of patients, most commonly left ventricular strain pattern (20.7%), followed by retinopathy (16.5%) and nephropathy (12%). Angiotensin-converting enzyme (ACE) inhibitors were the most commonly prescribed class (15.7% as monotherapy). However, diuretics were markedly underused and absent as monotherapy. Combination therapy was widely used, particularly ACE inhibitor + beta-blocker (10.4%), calcium channel blocker (CCB) monotherapy (9.9%), and CCB + diuretic (9.4%). Conclusion: Despite the availability of effective medications, BP control in this tertiary care setting remains poor. Diuretics—strongly recommended as the first-line therapy—were significantly underutilized. Greater physician awareness, adherence to guidelines, and improved patient education are required to achieve better hypertension control.

Hypertension is a risk factor for urological tumors. However, the impact of antihypertensive drugs on these tumors is unclear. We used summary statistics from genome-wide association studies (GWASs) of urological tumors, along with expression data for antihypertensive drug target genes from GWASs and eQTLGen. We employed two-sample Mendelian randomization and summary-based Mendelian randomization (SMR) to assess the associations between antihypertensive drugs, target genes, and urological tumors. Two-step MR analysis was performed to investigate the mediating role of protein in these associations. We further verified this finding through co-localization analysis and differential expression analysis. We also mined the US Food and Drug Administration Adverse Event Reporting System database and Phenome-Wide Association Study to study the adverse effects of antihypertensive drugs and their target genes. Angiotensin-II receptor antagonist, PSDs, and aldosterone antagonists increase the risk of testicular cancer. Angiotensin-converting enzyme inhibitors decrease the risk for prostate cancer. Genetically, PPARG increases the risk of testicular cancer, as confirmed by SMR (PPARG: P = 2.1×10-2, odds ratio [OR] 1.91; 95% confidence interval [CI] 1.11-3.30), two-sample Mendelian randomization (PPARG: P = 0.01, OR 2.74, 95% CI 1.23-6.11), co-localization analysis, and differential expression analysis. PPP1R1A and TAPBPL mediate the effects of PPARG on testicular cancer. The adverse reactions of antihypertensive drugs mainly affect the digestive system, especially digestive system tumors. Antihypertensive drugs and target genes are significant in the development of urological tumors and crucial for the development of treatment strategies.

Hypertension in the elderly increases the risk of cardiovascular disease and reduces quality of life. In addition to pharmacological therapy, garlic (Allium sativum) as a complementary herbal therapy has the potential to lower blood pressure through its allicin and S-allylcysteine ​​content, which act as vasodilators, antioxidants, and angiotensin-converting enzyme inhibitors. This study aims to systematically review the effectiveness of garlic therapy in lowering blood pressure in the elderly with hypertension. The research method used was a literature review with a narrative-descriptive approach. Articles were searched through PubMed, ScienceDirect, Google Scholar, and Scopus databases for publications from 2020 to 2025. A total of 19 articles that met the inclusion criteria were analyzed, including randomized controlled trial designs, quasi-experimental, and pre-experimental. The variables studied included dosage form, dose, duration of administration, changes in systolic and diastolic blood pressure, and side effects. Results showed that various forms of garlic, such as tea, decoction, capsules, black garlic, and aged garlic extract, consistently lowered systolic blood pressure by 10–30 mmHg and diastolic blood pressure by 5–20 mmHg in older adults with hypertension. Reported side effects were generally mild. It was concluded that garlic is potentially effective and safe as a complementary therapy for hypertension in older adults, although further standardized research is needed.

False-positive iFOBT in colorectal cancer screening: Association with prescription drug use in The Malaysian Cohort.

Hypertension And Diabetes Mellitus Frequently Coexist And Represent A Major Public Health Concern Due To Their Synergistic Role In Increasing Cardiovascular Morbidity And Mortality. Rational Prescribing Has A Paramount Role To Play In Achieving Optimization Of Therapeutic Results And Ensuring That Fewer Side Effects Are Encountered With This Kind Of A Patient. The Current Research Is An Evaluation Process Of The Prescription Pattern Among Patients With Hypertension With Co-Morbid Diabetes In A Territory Care Hospital By Utilizing World Health Organization (Who) Core Prescribing Indicators. It Was Conducted As A CrossSectional Observational Study, Which Is Over A Stipulated Period, Where It Looked At Prescriptions Which Were Taken In Outpatient And An Inpatient Department. Major Who Prescribing Indicators Such As The Number Of Drugs Per Encounter Mean, Proportion Of Drugs Prescribed Using Generic Names, Proportion Of Encounters Involving Antibiotics And Injections, And Proportion Of Drugs Discharged Using Essential Medicines List Were Evaluated. The Results Showed That Polypharmacy Was Very Prevalent And The Mean Prescription Having Over Three Drugs. The Most Frequently Prescribed Antihypertensive Medications Were Angiotensin-Converting Enzyme Inhibitors And Angiotensin Receptor Blockers But Metformin Was Still The Mainstay Of Antidiabetic Therapy. The Generic Prescribing Was Moderate And The Ability To Comply With The Essential Medicines List Was Different Amongst Departments. The Research Points To The Instances Of Irrational Use Of Prescription Methods, Such As Excesses Of Polypharmacy And Lack Of Usage Of Generic Medications. Findings Indicate The Urgency Of Adopting Conventional Treatment Advice And Stimulating Rational Drug Utilization By Means Of Steady Medical Training And Prescription Auditing. The Research Will Help Interpret The Trends Connected To The Prescribing Of Comorbid Conditions And Will Shed Some Light On How To Enhance The Healthcare Quality In A Tertiary Care Environment.

Aim . To summarize the available data on the effects of first-line antihypertensive agents – angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) – on serum uric acid (UA) levels in adults with (arterial hypertension) AH, with the goal of optimizing pharmacotherapy in patients with AH and asymptomatic hyperuricemia. Material and methods . A comprehensive search was conducted in PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL) within the Cochrane Library, eLIBRARY, Google Scholar, and the National Institutes of Health clinical trials registry ClinicalTrials.gov. The systematic review was prepared in accordance with PRISMA guidelines. No restrictions were placed on the year of publication during the search and analysis. Results . Analysis of nine randomized controlled trials of ACEIs showed that enalapril, captopril, and fosinopril demonstrated neutrality with respect to UA levels, whereas other drugs in this class may increase UA concentrations. Analysis of eleven randomized controlled trials of ARBs showed that only losartan exhibits a uricosuric effect, while irbesartan, valsartan, and eprosartan are metabolically neutral. Conclusion . Among ACEIs, enalapril, low-dose ramipril, and fosinopril exhibit the most favorable safety profile and the greatest neutrality regarding UA levels. ARBs are generally metabolically neutral with respect to UA, with the exception of losartan, which possesses a uricosuric effect.

This study aimed to retrospectively analyze the demographic data, presenting complaints, physical examination, echocardiographic and radiologic findings, treatments, and clinical course of 12 patients who were admitted to the Department of Pediatric Cardiology and diagnosed with Marfan syndrome (MS) according to the Ghent criteria between January 2017 and July 2023, in order to determine the importance of structural heart disease, accompanying findings, and duration of illness from diagnosis. In total, 9 of the 12 patients were male, 3 were female, and their ages ranged between 18 months and 17 years (10.6 ± 5.1 years). The median duration of illness from diagnosis was 36 months (12-120 months) in all patients. When cardiovascular findings were analyzed, 6 (50%) of the patients had aortic root dilatation. All of these patients had aortic root dilation accompanied by mitral valve prolapse and mitral regurgitation (MR). Three of them also had tricuspid valve prolapse and moderate tricuspid regurgitation. Three other patients had mitral valve prolapse and mild MR, and 1 patient had only aortic regurgitation. This is due to aortic valve leaflet prolapse or elongation resulting from intrinsic connective tissue weakness, which disrupts diastolic coaptation. Echocardiographic examination was normal in 2 patients. Among the patients with severe aortic root dilation and severe MR, 2 patients underwent valve-sparing aortic root replacement surgery, and surgery was decided for the other patient. A total of 4 patients with severe aortic root dilation, including these 3, were clinically monitored with angiotensin receptor blockers, beta-blockers, and angiotensin-converting enzyme inhibitors. Patients with MS have significant structural heart disease. Since the incidence of skeletal system and ocular findings increases, especially in patients with aortic root dilatation, regular multidisciplinary follow-up of the patients in related specialties is extremely important.

Impact of Different Antihypertensive Drug Classes on Incident Dementia in Older Adults: A Systematic Review and Meta-Analysis.

The Turkish Hypertension Consensus Report (THCR) was first published in 2015 and subsequently updated in 2019 to provide practical guidance for clinicians involved in the diagnosis and management of hypertension in outpatient clinical settings. The report was prepared as a joint initiative of the Turkish Society of Cardiology, the Turkish Society of Internal Medicine, the Turkish Society of Endocrinology and Metabolism, the Turkish Society of Nephrology, and the Turkish Society of Hypertension and Renal Diseases. In recent years, substantial changes have occurred in the definition and staging of hypertension, and various professional organizations have proposed different blood pressure thresholds and cardiovascular risk scoring systems in their guidelines. These developments necessitated a further update of the consensus report. In addition to the original five societies, the Turkish Academic Geriatrics Society and the Turkish Association of Family Physicians contributed to the preparation of the 2025 update of the THCR. In the updated 2025 report, 'normal blood pressure' was defined as systolic blood pressure (SBP) <120 mmHg and diastolic blood pressure (DBP) <80 mmHg, based on measurements obtained in outpatient clinical settings. SBP values of 120-139 mmHg or DBP values of 80-89 mmHg were classified as 'elevated blood pressure,' whereas SBP ≥140 mmHg or DBP ≥90 mmHg was defined as 'hypertension.' Hypertension was categorized as Stage 1 (SBP 140-159 mmHg or DBP 90-99 mmHg) and Stage 2 (SBP ≥160 mmHg or DBP ≥100 mmHg). In addition to office blood pressure measurements, the use of home and ambulatory blood pressure monitoring in the diagnosis of hypertension was emphasized. Laboratory investigations were updated and categorized into baseline tests and additional tests aimed at detecting target organ damage in hypertensive patients, and the diagnostic criteria for secondary hypertension were revised. Age- and frailty-based treatment thresholds and blood pressure targets were defined independently of comorbidities for three subgroups: patients aged 18-79 years (treatment threshold ≥140/90 mmHg; target 120-130/70-80 mmHg), patients aged ≥80 years (threshold ≥140 mmHg; target 130-140 mmHg), and frail patients (threshold ≥160 mmHg; target 140-150 mmHg). Immediate initiation of combination antihypertensive therapy was recommended for all patients with SBP/DBP ≥140/90 mmHg (Stage 1 and Stage 2 hypertension). In the elevated blood pressure treatment subgroup (SBP 130-139 mmHg, DBP 80-89 mmHg), antihypertensive therapy was recommended if blood pressure remained uncontrolled despite three months of lifestyle modification in the presence of diabetes mellitus (age >40 years, diabetes duration >10 years, diabetes-related complications, or additional risk factors such as obesity or active smoking), chronic kidney disease (albuminuria >30 mg/day or spot urine albumin-to-creatinine ratio >30 mg/g), established cardiovascular disease (coronary artery disease, peripheral artery disease, heart failure), stroke, or increased cardiovascular risk as assessed by SCORE2 (>15%) or SCORE2-OP (>20%). A stepwise combination treatment algorithm was provided based on angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), thiazide or thiazide-like diuretics, and mineralocorticoid receptor antagonists (MRAs). The algorithm includes initiation with low- or full-dose dual therapy ('ACEI or ARB + CCB' or 'ACEI or ARB + diuretic') as the first step; escalation to full-dose dual therapy (for those started on low doses) or to low- or full-dose triple therapy (ACEI or ARB + CCB + diuretic) as the second step; escalation to full-dose triple therapy as the third step; and use of quadruple therapy (ACEI or ARB + CCB + diuretic + MRA) as the fourth step. Monotherapy was recommended primarily in selected clinical situations, including patients aged >80 years, frail patients, those with elevated blood pressure, and patients with orthostatic hypotension. Overall, seven new sections were added to the 2025 report: frailty assessment in hypertension, resistant hypertension, isolated systolic hypertension, isolated diastolic hypertension, orthostatic hypotension, hypertensive emergencies, and recommendations addition, four supplementary files were provided, addressing key considerations for patients and physicians during manual aneroid and ambulatory blood pressure measurements, medications and substances that may increase blood pressure, definitions of frailty and fitness and their implications for antihypertensive therapy, and non-cardiovascular drugs that may lower blood pressure below target levels during antihypertensive treatment. Although the evidence-based recommendations presented in this report are applicable to most hypertensive outpatients, clinical decision-making by the treating physician remains essential for the delivery of individualized, patient-centered care.

Design and rationale of the WARRIOR ancillary study for coronary CT angiographic analysis.

A 3-year-old boy presented with dark-colored urine for 4months. His history was negative for infections, but he was taking oral methylcobalamin treatment for a persistent deficiency. His parents were first-degree cousins, and a female cousin had proteinuria of unknown etiology. A physical examination and laboratory examination revealed no abnormalities except for non-orthostatic nephritic proteinuria and low levels of vitamin B12. Albumin was the main protein in the urine. Kidney biopsy showed nonspecific changes. Genetic analysis identified a homozygous pathogenic AMN mutation, confirming Imerslund-Grâsbeck syndrome (IGS). Angiotensin-converting enzyme inhibitor was prescribed but discontinued due to stable protein levels. After 4years, kidney function remained stable. Imerslund-Grâsbeck syndrome is a rare autosomal recessive disorder that affects vitamin B12 and protein, particularly albumin absorption. While typically presenting with megaloblastic anemia, AMN mutations show variable phenotypes. Proteinuria is resistant to ACE inhibitors, and currently, there is no specific treatment.

Comparison of clinical outcomes between biodegradable polymer sirolimus-eluting stents and durable polymer everolimus-eluting stents in octogenarian patients.

Canine leishmaniosis is a zoonotic disease with diverse clinical manifestations; renal involvement is among the most severe. In light of the lack of recommendations for managing canine Leishmania-associated proteinuria across LeishVet disease stages, climate change and the associated risk of Leishmania infantum becoming endemic in Switzerland, a targeted evaluation of disease awareness and current therapeutic strategies is needed. This study investigated treatment strategies used by Swiss veterinarians for managing canine leishmaniosis, focusing on proteinuria. An online survey was conducted using LimeSurvey®. A total of 817 veterinarians were contacted, and 149 fully completed questionnaires were analyzed (response rate: 18,2 %). Most respondents reported following LeishVet guidelines in their treatment of leishmaniosis. Urinalysis is performed by 84,6 % of participants. In LeishVet stage 2B (urinary protein:creatinine ratio 0,5-1), 43 % initiate antiproteinuric treatment; in stage 4 (urinary protein:creatinine ratio > 5), 80 % treat proteinuria. Angiotensin-converting enzyme inhibitors are the most frequently used medications, preferred over angiotensin II receptor blockers. Interestingly, the latter are mainly used in advanced stages of the disease. In summary, only a minority of veterinarians initiate antiproteinuric treatment in LeishVet stage 2B (urinary protein:creatinine ratio 0,5-1), although this would be the optimal time for slowing the progression of renal disease. Possible reasons include additional costs and a lack of awareness of the potential negative consequences of proteinuria. The results also show heterogeneity in treatment decisions and highlight the need for clear, stage-based recommendations for the management of proteinuria in canine leishmaniosis.

Despite advances in therapy, heart failure (HF) remains a syndrome characterized by high morbidity and mortality. The PONTE-HF/ACS registry aims to assess the outcomes of a structured outpatient follow-up between hospital and community care for patients with HF or recently hospitalized for acute coronary syndrome. The purpose of this study is to evaluate one of the main process indicators of the registry for patients with HF, namely the prescribed pharmacological therapy, with particular reference to therapy with angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) or angiotensin receptor-neprilysin inhibitors (ARNi), beta-blockers, mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter 2 inhibitors (SGLT2i). Between January 2024 and September 2025, 1203 patients were enrolled: 496 with HF and reduced ejection fraction (HFrEF), 189 with HF and mildly reduced ejection fraction (HFmrEF), 302 with HF and preserved ejection fraction (HFpEF), and 216 with HF and improved ejection fraction. In HFrEF patients, after enrollment, therapy was prescribed as follows: ACEi/ARB/ARNi in 89% of cases (64% ARNi), beta-blockers in 97%, MRA in 85%, and SGLT2i in 85%. Quadruple therapy with and without ARNi was prescribed in 69% and 51% of cases, respectively. The percentage of patients receiving at least 50% of the recommended dose was 63% for ARNi, 41% for ACEi/ARB, 70% for beta-blockers, and 98% for MRA. The PONTE-HF/ACS registry shows good optimization of therapy in enrolled patients with HFrEF. Achieving this important process indicator highlights the quality of care provided by the HF outpatient network in the Apulia region and confirms the relevance of the registry for the analysis and optimization of diagnostic-therapeutic pathways in patients with HF.