Diabetic Renal Disease Research Articles

Progression of Type 2 Diabetic Nephropathy and Serum Monocyte Chemoattractant Protein-1 (MCP-1) Levels

Diabetic nephropathy is an important complication that develops from diabetes mellitus. The chemotactic cytokine Monocyte Chemoattractant Protein-1 (MCP-1) exhibits selective binding and activation of the C-C motif Chemokine Receptor 2 (CCR2). MCP-1 has been consistently observed to play a role in the pathogenesis of chronic and diabetic renal disease in clinical settings, regardless of the different stages and phenotypes. The main goal of this study was to assess and contrast the levels of monocyte chemoattractant protein-1 (MCP-1/CCL2) in individuals with diabetic nephropathy and those who show healthy state to examine the possibility of the usefulness of MCP-1/CCL2 as a biomarker of prognosis for early identification in patients developing albuminuria. The study involved the study of a sample of ninety patients diagnosed with type 2 diabetic nephropathy, while a control group of thirty individuals was also included for comparison purposes. The study recruited participants requesting from Baghdad and Maysan in Iraq. Urine specimens were obtained to determine the urinary protein concentration. Samples of blood and serum were collected to measure the levels of serum creatinine (s-Cr), fasting plasma glucose (F.P.G.), glycohemoglobin A1c (Hba1c) and serum MCP-1. The results of the statistical analysis indicate that there were significant differences (P < 0.001) in the levels of MCP-1 between the microalbuminuric (stage 2) and macroalbuminuric (stage 3) when compared with the control group and between the stage 2 and stage 3 groups. Based on these findings, it can be concluded that MCP-1 levels may serve as biochemical indicators for disease progression of D.N.

Resolvin E1 heals injured cardiomyocytes: Therapeutic implications and H-FABP as a readout for cardiovascular disease & systemic inflammation

The purpose of this study is to investigate heart-fatty acid binding protein (H-FABP) leakage from cardiomyocytes as a quantitative measure of cell membrane damage and to test healing by Resolvin E1 (RVE1) as a potential therapeutic for patients with inflammatory diseases (cardiovascular disease and comorbidities) with high morbidity and mortality. Our quantitative ELISA assays demonstrated H-FABP as a sensitive and reliable biomarker for measuring cardiomyocyte damage induced by lipopolysaccharide (LPS) and healing by RvE1, a specialized pro-resolving mediator (SPM) derived from the Omega-3 fatty acid, eicosapentaenoic acid (EPA), a dietary nutrient that balances inflammation to restore homeostasis. RvE1 reduced leakage of H-FABP by up to 86%, which supports our hypothesis that inflammation as a mechanism of injury can be targeted for therapy. H-FABP as a blood biomarker was tested in 40 patients admitted to Boston Medical Center for respiratory distress, (20 patients with and 20 patients without COVID infection). High levels of H-FABP correlated with clinically diagnosed CVD, diabetes, and end-stage renal disease (ESRD) in both patient groups. The level of H-FABP indicates not only CVD damage but is a valuable measure for patients with increased inflammation disease comorbidities.

Clinical Features Associated With Rate of Fractures in Patients With Systemic Sclerosis: A US Cohort Study.

Systemic sclerosis (SSc) is associated with several specific risk factors for fracture due to the complications of the disease and related medications. The present study was undertaken to examine the relationship between SSc-associated clinical features and fracture rate in a large US cohort. Participants with SSc in FORWARD, The National Databank for Rheumatic Diseases, were included (1998-2019). Age- and sex-matched individuals with osteoarthritis (OA) from the same database were included as comparators. The primary end point was self-reported major osteoporotic fracture. Cox proportional hazards models were used to study the associations between risk factors and fractures. The study included 922 individuals (SSc patients, n=154; OA patients, n=768). Eighty-seven percent were female, with a mean age of 57.8 years. Fifty-one patients developed at least 1 fracture during a median of 4.2 years (0.5-22.0 years) of follow-up. Patients with SSc had more frequent fractures compared to OA comparators (hazard ratio [HR] 2.38 [95% confidence interval (95% CI) 1.47-3.83]). Among patients with SSc, a higher Rheumatic Disease Comorbidity Index score (HR 1.45 [95% CI 1.20-1.75]) and a higher Health Assessment Questionnaire disability index score (HR 3.83 [95% CI 2.12-6.93]) were associated with more fractures. Diabetes mellitus (HR 5.89 [95% CI 2.51-13.82]) and renal disease (HR 2.43 [95% CI 1.10-5.37]) were independently associated with fracture among SSc patients relative to SSc patients without these comorbidities. Our findings highlight factors associated with fracture among patients with SSc. Disability as measured by the HAQ DI is a particularly strong indicator of fracture rate in SSc. Improving SSc patients' functional status, where possible, may lead to better long-term outcomes.

Ferroptosis: a new strategy for Chinese herbal medicine treatment of diabetic nephropathy.

Diabetic nephropathy (DN) is a serious microvascular complication of diabetes. It has become a leading cause of death in patients with diabetes and end-stage renal disease. Ferroptosis is a newly discovered pattern of programmed cell death. Its main manifestation is the excessive accumulation of intracellular iron ion-dependent lipid peroxides. Recent studies have shown that ferroptosis is an important driving factor in the onset and development of DN. Ferroptosis is closely associated with renal intrinsic cell (including renal tubular epithelial cells, podocytes, and mesangial cells) damage in diabetes. Chinese herbal medicine is widely used in the treatment of DN, with a long history and definite curative effect. Accumulating evidence suggests that Chinese herbal medicine can modulate ferroptosis in renal intrinsic cells and show great potential for improving DN. In this review, we outline the key regulators and pathways of ferroptosis in DN and summarize the herbs, mainly monomers and extracts, that target the inhibition of ferroptosis.

Non-Diabetic Renal Diseases in Diabetic Patients with Emphasis on Infection-Related Glomerulonephritis

ABSTRACT Background: Non -diabetic renal diseases (NDRDs) in diabetics are treatable and therefore have better prognosis. Infection-related glomerulonephritis (IRGN) is being frequently reported as NDRD. Objective: We attempt to study the clinicopathologic spectrum of diabetic patients with biopsy proven IRGN. Materials and Methods: This was a retrospective analysis of renal biopsies performed in diabetic patients from January 2014 to June 2021. Demographic data, clinical features, and other laboratory findings were collected. The renal biopsies were classified into diabetic nephropathy (DN) and NDRD. The patients with diagnosis of IRGN were studied in detail. Results: Of the 1972 renal biopsies done in diabetic patients, 537 were NDRD and 1233 were DN. The commonest NDRD was tubulo-interstitial nephritis (n = 173) followed by IRGN (n = 74). The IRGN cases were in the age range of 5-78 years (median-53.5) with M: F = 3.4:1. The median duration of diabetes was six years, with median HbA1c = 7.5. Proteinuria ranged from 0.041 to 13 g/day (median = 1.95) with median serum creatinine of 3.7 mg%. History of preceding infection was present in nine cases. These patients presented with rapidly progressive renal failure (RPRF, 17), nephritic syndrome (27), nephrotic syndrome (27), and asymptomatic proteinuria (3). Median C3-level was 47 mg/dl. The biopsies showed classic endocapillary hypercellularity with neutrophils in mesangium, 45 cases had associated DN. Immunofluorescence performed in 54 cases showed coarse granular deposits of C3C. Conclusions: IRGN should be kept in mind in diabetic patients presenting with RPRF or nephrotic proteinuria. The biopsy and immunofluorescence helps in accurate diagnosis.

Hypothyroidism among Pregnant Women Attending the Outpatient Department of Obstetrics in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Hypothyroidism is a common endocrine disorder occurring in pregnancy. Maternal and fetal complications are present in these patients. Timely identification and treatment help in the prevention of complications. The aim of this study was to find out the prevalence of hypothyroidism among pregnant women attending the Outpatient Department of Obstetrics in a tertiary care centre. A descriptive cross-sectional study was conducted in a tertiary care centre after taking ethical approval from the Institutional Review Committee (Reference number: 08/2021). Data from 1 January 2016 to 31 December 2020 were collected between 1 November 2021 to 31 November 2021. All pregnant women who had undergone thyroid level assessment in each trimester (first, second and third) and had delivered in the same centre were included in the study. However, pregnant women with comorbidities like hypertension, overt diabetes mellitus, hyperthyroidism, renal disease, cardiac disease, and neurological disorder were excluded. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Among 216 pregnant patients, the prevalence of hypothyroidism was 74 (34.25%) (27.92-40.57, 95% Confidence Interval). Maternal complications were seen in 33 (44.59%). The commonest complication was oligohydramnios 10 (13.51%) followed by preterm delivery 8 (10.81%). The prevalence of hypothyroidism among pregnant women was found to be higher than other studies done in similar settings. complications; hypothyroidism; miscarriage; pregnancy; thyroid.

Survival status and predictors of mortality among COVID-19 patients admitted to intensive care units at COVID-19 centers in Addis Ababa, Ethiopia: a retrospective study.

This study included 508 COVID-19 patients retrospectively who were under follow-up. The work has been reported in line with the STROCSS (strengthening the reporting of cohort, cross-sectional and case-control studies in surgery) criteria. The data were collected through a systematic sampling from patients' charts. Kaplan-Meier survival curves and logrank test, and Cox's regression analyses were conducted to check the difference among categories of covariates and to identify predictors of mortality, respectively. All patient charts were reviewed and the information was recorded. The average age (mean+SD) of these patients was 62.1+13.6 years. Among study participants, 422 deaths occurred and the mortality rate was 64.1 per 1000 person-days. The median survival time was 13 days [interquartile range (IQR): 10-18]. The significant predictors for this survival were: Age>45 years [adjusted hazard ratio (AHR)=4.34, 95% CI: 2.46-7.86], Diabetes mellitus (AHR=1.37, 95% CI: 1.05-1.77), Hypertension (AHR=1.39, 95% CI: 1.09-1.79), Renal disease (AHR=1.86, 95% CI: 1.01-3.43), Hypotension (AHR=1.71, 95% CI: 1.28-2.27), Electrolyte treatment (AHR=0.78, 95% CI: 0.63-0.97). The median survival of COVID-19 patients after their admission was 13 days, and predictors for this time were advanced age, preexisting comorbidities (like diabetes mellitus, hypertension, and renal disease), hypotension, and electrolyte therapy.

Uric acid and neurological disease: a narrative review.

Hyperuricemia often accompanies hypertension, diabetes, dyslipidemia, metabolic syndrome, and chronic renal disease; it is also closely related to cardiovascular disease. Moreover, several epidemiological studies have linked hyperuricemia and ischemic stroke. However, uric acid may also have neuroprotective effects because of its antioxidant properties. An association between low uric acid levels and neurodegenerative diseases has been suggested, which may be attributed to diminished neuroprotective effects as a result of reduced uric acid. This review will focus on the relationship between uric acid and various neurological diseases including stroke, neuroimmune diseases, and neurodegenerative diseases. When considering both the risk and pathogenesis of neurological diseases, it is important to consider the conflicting dual nature of uric acid as both a vascular risk factor and a neuroprotective factor. This dual nature of uric acid is important because it may help to elucidate the biological role of uric acid in various neurological diseases and provide new insights into the etiology and treatment of these diseases.

Objective assessment of mobility among adults with diabetes and end-stage renal disease using walking aid: A cross-sectional cohort study

BackgroundThis cross-sectional study aimed to compare physical activity levels, plantar sensation, and fear of falling between individuals with diabetes undergoing hemodialysis, with or without walking aids. MethodsSixty-four participants were recruited, with 37 not using walking aids (age = 65.8 ± 0.7 years, 46% female) and 27 using walking aids (age = 69.2 ± 1.2 years, 63% female). Physical activity was measured using validated pendant sensors over two consecutive days. Concern for falling and plantar numbness were assessed using the Falls Efficacy Scale-International and vibration perception threshold test, respectively. FindingsParticipants using walking aids exhibited a greater fear of falling (84% vs. 38%, p < 0.01) and fewer walking bouts (p < 0.01, d = 0.67) and stand-to-walk transitions (p < 0.01, d = 0.72) compared to those not using walking aids. The number of walking bouts was negatively correlated with concern for falling scores (ρ = −0.35, p = 0.034) and vibration perception threshold (R = −0.411, p = 0.012) among individuals not using walking aids. However, these correlations were not significant among those using the walking aid. There was no significant group difference in active behavior (walking + standing %) and sedentary behavior (sitting + lying %). InterpretationThose undergoing hemodialysis often lead sedentary lives, with mobility affected by fear of falling and plantar numbness. Using walking aids can help, but it doesn't guarantee more walking. A combined psychosocial and physical therapy approach is key for managing fall concerns and improving mobility.

Diabetes Management and Outcomes among Patients with Type 2 Diabetes Attending a Renal Service.

Patients with comorbid type 2 diabetes mellitus (T2DM) and renal disease, particularly those treated with insulin, often require complex pharmacological treatment and management of other diabetes complications. To assess the achievement of metabolic targets and compare the current management of renal service attenders with insulin- and noninsulin-treated T2DM. Single-centre retrospective cross-sectional study involving medical record review of patients with T2DM aged ≥18 years who visited a metropolitan renal outpatient clinic in 2017. Univariable analysis and multivariable logistic regression were used to identify factors associated with insulin treatment. Among 268 patients (45.5% insulin-treated), mean HbA1c was higher in insulin-treated vs. noninsulin-treated patients (8.0 ± 1.8% (64 mmol/mol) vs. 6.8 ± 1.2% (51 mmol/mol), p < 0.001). Significantly fewer insulin-treated patients had HbA1c ≤ 7.0% (53 mmol/mol; 31.8% vs. 69.3%, p < 0.001). More insulin-treated patients had ischaemic heart disease (46.7% vs. 33.6%, p = 0.028), diabetic foot disease (15.6% vs. 4.8%, p = 0.003), retinopathy (40.2% vs. 11.0%, p < 0.001), and emergency attendance for severe hypoglycaemia (3.8% vs. 0% p = 0.042). Insulin treatment was more associated with chronic kidney disease stages 4-5 (adjusted odds ratio (aOR) 2.41, 95% CI 1.07-5.43), retinopathy (aOR 3.10, 95% CI 1.04-9.27), and podiatry review (aOR 5.06, 95% CI 1.20-21.38). Only 38 (14.2%) individuals were seen by a colocated public multidisciplinary diabetes service in 2017. Renal clinic attenders with T2DM, particularly if insulin-treated, remained at increased risk of diabetes-related complications, including severe hypoglycaemia, with limited input from the colocated hospital diabetes team. Approaches to increase coordination of diabetes care among renal patients should be investigated.

Increased body fat, physical inactivity, and hypertension are associated with poor quality of life in patients with type 2 diabetes.

Diabetes is a significant health problem that affects quality of life in the medium and long term. To identify the association between quality of life with comorbidity, metabolic control, and lifestyle in patients with type 2 diabetes. A cross-sectional study was performed in 392 patients. Glycosylated hemoglobin, fasting glucose, lipid profile, blood pressure, weight, waist circumference and body composition were measured. Diabetic neuropathy, renal disease, visual health, diet and physical exercise were measured. Health-related quality of life (HRQoL) was measured with the 36-item Short Form survey (SF-36). The mean age was 54.6 years, 68 % were women, median years of diabetes diagnosis was 7 years. Eighty percent had a good HRQoL (SF-36 ≥ 50). The dimension with the highest score was physical function (81.0), and vitality the lowest (46.5). Body fat was associated with more impairments in the SF-36 dimensions (p < 0.05). Factors associated with worse HRQOL are physical inactivity (odds ratio [OR]: 2.7; 95% confidence interval [95%CI]: 1.10-6.62; p = 0.009), arterial hypertension (OR: 1.78; 95% CI: 1.05-3.02; p = 0.032) and being female (OR: 2.7; 95% CI: 1.45-5.27; p = 0.002). Poor quality of life is associated with higher fat percentage, physical inactivity and hypertension in patients with type 2 diabetes.

Genetics of myocardial interstitial fibrosis in the human heart and association with disease.

Myocardial interstitial fibrosis is associated with cardiovascular disease and adverse prognosis. Here, to investigate the biological pathways that underlie fibrosis in the human heart, we developed a machine learning model to measure native myocardial T1 time, a marker of myocardial fibrosis, in 41,505 UK Biobank participants who underwent cardiac magnetic resonance imaging. Greater T1 time was associated with diabetes mellitus, renal disease, aortic stenosis, cardiomyopathy, heart failure, atrial fibrillation, conduction disease and rheumatoid arthritis. Genome-wide association analysis identified 11 independent loci associated with T1 time. The identified loci implicated genes involved in glucose transport (SLC2A12), iron homeostasis (HFE, TMPRSS6), tissue repair (ADAMTSL1, VEGFC), oxidative stress (SOD2), cardiac hypertrophy (MYH7B) and calcium signaling (CAMK2D). Using a transforming growth factor β1-mediated cardiac fibroblast activation assay, we found that 9 of the 11 loci consisted of genes that exhibited temporal changes in expression or open chromatin conformation supporting their biological relevance to myofibroblast cell state acquisition. By harnessing machine learning to perform large-scale quantification of myocardial interstitial fibrosis using cardiac imaging, we validate associations between cardiac fibrosis and disease, and identify new biologically relevant pathways underlying fibrosis.

Influence of dialysis-related stigma on health-related indicators in Japanese patients undergoing hemodialysis.

Focusing on impacts to health-related indicators in older Japanese patients, this study analyzed both the direct influence of dialysis-related stigma and influences of its intersectionality with other stigmatized characteristics. Data were collected through a cross-sectional survey of 7461 outpatients in dialysis facilities. Other stigmatized characteristics include lower income, lower education, disabled activities of daily living, and diabetic end-stage renal disease (ESRD) as a cause for starting dialysis treatment. The average rate of an "agree" response on dialysis-related stigma items was 18.2%. Dialysis-related stigma significantly influenced all three health-related indicators, including suspected depression, informal networks, and compliance with dietary therapy. In addition, each interaction between dialysis-related stigma and educational attainment, gender, and diabetic ESRD significantly influence one health-related indicator. These results suggest that dialysis-related stigma has both a significant direct and synergic influence with other stigmatized characteristics on health-related indicators.

Blood pressure status affects atrial fibrillation in diabetic end-stage renal disease.

The prevalence of atrial fibrillation (AF) is increasing as the elderly population continues to increase. Chronic kidney disease, diabetes, and hypertension are known risk factors for AF. Since multimorbidity exists in chronic kidney disease, it is difficult to determine the impact of hypertension alone. Furthermore, little is known about the impact of hypertension on predicting AF in diabetic end-stage renal disease (ESRD). Here, we evaluated the effect of differential blood pressure control on AF prevalence among the diabetic ESRD population. From the Korean National Health Insurance Service database, 2 717 072 individuals with diabetes underwent health examinations during 2005-2019. Exactly 13 859 individuals with diabetic ESRD without a prior history of AF were selected and included in the analysis. Based on blood pressure level and previous hypertension medication history, we subdivided them into five groups: normal (normotensive), pre-hypertension, new onset hypertension, controlled hypertension, and uncontrolled hypertension. AF risk according to the blood pressure groups was estimated using Cox proportional-hazards models. Among the five groups, the new onset hypertension, controlled hypertension, and uncontrolled hypertension groups showed a higher AF risk. In patients on antihypertensives, diastolic blood pressure ≥100 mmHg was significantly associated with AF risk. High pulse pressure showed a significant risk for AF in patients on antihypertensives. In patients with diabetic ESRD, overt hypertension and a history of hypertension impacts AF. AF risk was higher in the ESRD population with diastolic blood pressure ≥100 mmHg and pulse pressure >60 mmHg.

Sodium in the Skin: A summary of the physiology and scoping review of disease associations.

A large and growing body of research suggests that the skin plays an important role in regulating total body sodium, challenging traditional models of sodium homeostasis that focused exclusively on blood pressure and the kidney. In addition, skin sodium may help to prevent water loss and facilitate macrophage-driven antimicrobial host defense, but may also trigger immune dysregulation via upregulation of pro-inflammatory markers and downregulation of anti-inflammatory processes. We performed a systematic search of PubMed for published literature on skin sodium and disease outcomes and found that skin sodium concentration is increased in patients with cardiometabolic conditions including hypertension, diabetes, and end-stage renal disease; autoimmune conditions including multiple sclerosis and systemic sclerosis; and dermatologic conditions including atopic dermatitis, psoriasis, and lipedema. Several patient characteristics are associated with increased skin sodium concentration including older age and male sex. While animal evidence suggests that increased salt intake results in higher skin sodium levels, there are conflicting results from small trials in humans. Additionally, limited data suggest that pharmaceuticals such as diuretics and SGLT-2 inhibitors approved for diabetes, as well as hemodialysis may reduce skin sodium levels. In summary, emerging research supports an important role for skin sodium in physiologic processes related to osmoregulation and immunity. With the advent of new non-invasive MRI measurement techniques and continued research on skin sodium, it may emerge as a marker of immune-mediated disease activity or a potential therapeutic target.

Clinico-pathological features of diabetic and non-diabetic renal diseases in type 2 diabetic patients: a retrospective study from a 10-year experience in a single center.

To compare clinical and pathological characteristics as well as prognosis between diabetic nephropathy (DN) and non-diabetic renal disease (NDRD) so as to explore potential diagnostic criteria of DN and provide some guidance for the treatment of type 2 diabetes mellitus (T2DM) patients with kidney involvement. T2DM patients with renal impairment who underwent kidney biopsy were included in this study, who were classified into 3 groups (DN, NDRD, DN with NDRD) based on their renal pathological diagnosis. Baseline clinical characteristics as well as follow-up data were collected and analyzed among 3 groups. Logistic regression was performedto determine the best predictors for DN diagnosis. Additional 34 MN patients without diabetes were enrolled by propensity score matching method to compare serum PLA2R antibody titer and kidney outcomes between diabetic MN patients and MN alone. Among 365 patients with type 2 diabetes who underwent kidney biopsy, 179 (49.0%) patients were diagnosed with NDRD alone and 37 (10.1%) patients with NDRD combined DN. Risk factors for DN development in T2DM patients were longer time since diabetes diagnosis, higher level of serum creatinine, absence of hematuria and presence of diabetic retinopathy by multivariate analysis. Lower rate of proteinuria remission and higher risk of renal progression were observed in DN group compared with NDRD group. Membranous nephropathy was the most common NDRD in diabetic patients. There was no difference in serum PLA2R antibody positiveness or titer between MN patients with or without T2DM. There was lower remission rate but similar renal progression in diabetic MN when age, gender, baseline eGFR, albuminuria and IFTA score were adjusted. Non-diabetic renal disease is not uncommon in T2DM patients with renal impairment, which has better prognosis with proper treatment. Coexisting diabetic status does not exert negative impact on renal progression in MN patients, and immunosuppressive agents should be administered when necessary.

Cigarette Smoking: Risk Factor for Kidney Injury

There are various kinds of serious diseases caused by our poor lifestyle and unhealthy habits. Renal diseases are one of the major issues in the current scenario. The prevalence of diabetic and non-diabetic renal disease has increased, and smoking has become a significant modifiable risk factor for both the progression of acute kidney injury from micro-albuminuria and proteinuria, elevated blood creatinine, and ultimately, renal failure in both acute and chronic renal diseases. Endothelial cell dysfunction was also observed in many research studies, especially in smokers. Renal hemodynamic are abnormal and cause harm to the kidney by cigarette smoking, which has been shown to play a significant role in both short-term and long-term research. In a retrospective case-control analysis, smokers were reported to be at increased risk of progression to end-stage renal disease (ESRD) with immunological (glomerulonephritis) and non-immune autosomal dominant polycystic kidney disease (ADPKD) renal disorders. Smokers are at risk not only for kidney disease, but also for lung and heart disease. Smokers are more prone to many diseases. So advising them to quit smoking can reduce their chance of kidney issues as well as renal injury.

Long-Term Outcomes in Patients With Peripheral Arterial Disease Who Undergo Free Flap Reconstruction for Chronic Lower Extremity Wounds.

Free tissue transfer (FTT) is critical for limb salvage of chronic lower extremity (LE) wounds. In patients with peripheral arterial disease (PAD), FTT LE reconstruction can be challenging due to limited vessel selection for anastomosis. The study aims to evaluate our surgical and functional outcomes after FTT to LE in patients with PAD. A retrospective review identified patients who underwent LE free flap reconstruction between 2011 and 2021. All patients underwent preoperative arteriogram and subsequent FTT. Patients were classified into PAD or non-PAD cohorts, based on the presence of LE arterial stenoses or occlusions identified on arteriogram. Primary outcomes included complications, flap success, need for post-FTT vascular reintervention, limb salvage, and ambulatory status. A total of 253 patients underwent FTT to LE, with 84 patients (33.2%) in the PAD cohort. Patients with PAD had a higher prevalence of diabetes (83.3% vs 39.1%, P < 0.001) and end-stage renal disease (8.3% vs 2.4%, P = 0.028). Osteomyelitis was more common in the PAD group (73.8% vs 55.0%, P = 0.004). Free tissue transfer donor sites and flap composition were similar between cohorts. At a mean follow-up of 21.1 months, limb salvage rates were similar between non-PAD and PAD cohorts (90.5% vs 84.5%, P = 0.158), with no significant differences in ambulatory status or mortality. Higher complication rates occurred in the PAD cohort (38.1% vs 20.7%, P = 0.003), of which partial flap necrosis was more prevalent in the PAD group (6.0% vs 0.6%, P = 0.016). There was no difference in flap success rates between groups (P = 0.430). More postflap angiograms were performed in the PAD group (29.8% vs 7.1%, P < 0.001), with repeat percutaneous endovascular intervention performed in 68.0% of the PAD group versus 33.3% of the non-PAD group (P < 0.001). This is the largest study to demonstrate excellent long-term limb salvage outcomes in patients with PAD who undergo FTT to LE. Percutaneous endovascular intervention and FTT are effective methods to achieve limb salvage in vasculopathic patients with chronic LE wounds.

Systemic comorbidities in patients of psoriasis

Background There is paucity of Indian studies on comprehensive assessment of systemic comorbidities in psoriasis. This study aimed at assessing the systemic comorbidities in patients of psoriasis in India. Patients and methods A case–control study was conducted from September 2019 to August 2021. Study participants of more than 18 years, with 30 psoriasis patients as cases and 30 healthy individuals as controls. Assessment of Psoriasis Area Severity Index in cases, BMI, waist circumference, blood pressure, and detailed systemic index evaluation was done in both the groups. Analyses were done using χ 2 test and independent t test. Analysis of variance test is used to compare continuous variables among more than two groups. Odds ratio (OR) and 95% confidence interval were calculated. Results The mean age of psoriasis cases was 45.03±13.1 years with 73.3% of male and 26.7% of female population. Mean duration of psoriasis observed is 6.9±4.2 years with the mean Psoriasis Area Severity Index of 17.73±6.389. Comparison of systemic indices demonstrated significant increase in neutrophil count (P=0.006), erythrocyte-sedimentation rate (P&lt;0.0001), glycated hemoglobin (P=0.037), low-density lipoprotein (P=0.0418), T3 (P&lt;0.0001), and T4 (P=0.018). No significant difference in the liver-function test and renal-function test was seen in both the groups. Comparison of the prevalence of diseases associated with psoriasis, shows that the prevalence of metabolic syndrome (60 vs. 30%, OR=3.5, P=0.021), nonalcoholic fatty liver disease (26.6 vs. 6.6%, P=0.002, OR=14), increase in the carotid artery intimal thickness on both sides (right P=0.007, OR=5; left P=0.005, OR=7), and the inflammatory marker C-reactive protein (70 vs. 33.3%, P=0.005, OR=4.66) is significantly increased in cases as compared with controls. Other diseases like obesity (BMI: OR=2.0417, P=0.187; waist circumference: OR=2.25, P=0.123), type-2 diabetes mellitus (P=0.56, OR=1.40), hypertension (P=0.78, OR=1.15), and renal disease (P=1, OR=1) is found to have greater risk in psoriasis patients than controls, but the reflecting difference is not statistically significant. Conclusion The study revealed that the patients of psoriasis are more likely to have systemic comorbidities as compared with patients without psoriasis.

Hippophae rhamnoides L. leaf extracts alleviate diabetic nephropathy via attenuation of advanced glycation end product-induced oxidative stress in db/db mice.

Diabetes mellitus leads to chronic complications, such as nephropathy. Diabetic complications are closely related to advanced glycation end products (AGEs). Excessive formation and accumulation of AGEs in diabetic renal diseases lead to excessive oxidative stress, resulting in chronic renal failure. The leaves of Hippophae rhamnoides L. (sea buckthorn leaves; SBL) show biological benefits, including antioxidant effects. This study aimed to evaluate the effect of SBL on kidney damage in db/db mice. The SBL extract was orally administered at 100 and 200 mg kg-1 for 12 weeks to db/db mice. Histological changes and the urine albumin/creatinine ratio were relieved, and the accumulation of AGEs in kidney glomeruli decreased following SBL treatment. Moreover, the SBL extract reduced the expression of AGEs, the receptor for AGEs, and NADPH oxidase 4, but upregulated glyoxalase 1 in the diabetic renal tissue. Urinary excretion levels and expression of 8-hydroxy-2'-deoxyguanosine as a biomarker of oxidative stress decreased after SBL treatment in the renal tissue. Furthermore, SBL attenuated oxidative stress in diabetic kidneys by reducing AGE accumulation, thereby ameliorating renal damage. Therefore, from these results, we infer that the SBL extract can act as a potential therapeutic agent for diabetic renal complications caused by AGEs.