Aim: To compare the rate of acute kidney injury (AKI) associated with non-steroidal anti-inflammatory drugs (NSAIDs) through two consecutive decades in patients with gout and to study factors associated with AKI events. Methods: Retrospective analysis of data from Jan 1994 to Dec 2024. Data on AKI and upper gastrointestinal bleeding (UGB) were collected during the same period (2005–2024), along with general (age, gender, time from onset), gout-related (tophi, imaging, clinical distribution, number of flares), treatment-related (diuretic and urate-lowering medications, exposure to the triple whammy), and comorbidities-related variables (hypertension, hyperlipidemia, diabetes, chronic kidney disease). Analysis was made for the whole cohort and comparing decades with each other. Survival analysis was performed to evaluate those variables independently associated with a higher risk of AKI. Results: 1,207 cases were available for analysis. The overall cumulated rate of AKI was 13.3%, showing an increase from 9.9% to 16.1% from the first to the second decades, respectively, but no change in the severity of AKI was observed. In contrast, there was no change in the rate of UGB through the two decades (close to 2%). There was an increase in the frequency of gout severity variables, triple whammy exposure, and comorbid conditions through the two decades. Age, tophaceous gout, chronic kidney disease, triple whammy exposure, were variables independently associated with a higher risk of AKI, while urate-lowering prescription was associated with a lower risk. Conclusions: An increase in the rate of AKI was observed through the two decades studied, associated with an increase in gout severity, comorbidity, and exposure to triple whammy. Chronic kidney disease and exposure to triple whammy in older patients with severe (tophaceous) gout seem to define the combination for the highest risk, in whom the avoidance of NSAIDs should be carefully considered.

Disclosure: O. Ginnard: None. A.D. Nguyen: None. R. Schneider Aguirre: None.Sodium-glucose cotransport-2 inhibitors (SGLT2i) have shifted the paradigm type 2 diabetes (T2D), heart failure, and chronic kidney disease treatment and have a well-known profile of benefits and possible adverse events in adults. Unsurprisingly, the question of translatability to the pediatric population arose. Until June, 2023, when empagliflozin was approved for use in pediatric T2D, any use of SGLT2i in pediatrics was off-label. Thus, the real-world risk profile in the pediatric population is not nearly as well-known. To better understand the safety profile in pediatrics, a retrospective study was undertaken in patients treated with SGLT2i at a major children’s hospital system at the time of SGLT2i initiation. Patient demographics, anthropomorphic data, vitals, medications, indication for SGLT2i use, laboratories and any studies performed were collected. A total of 32 patients were reviewed. The average age of treatment start was 17 years (range: 4.5-22.4), 44% were male, 78% were white, 23% were black, 56% were Hispanic. Indications for SGLT2i use included: diabetes (type 2 or steroid-induced, 22%), cardiac disease alone (22%), renal disease alone (3%), combination of cardiac disease and diabetes (41%), combination of diabetes and renal disease (3%), and unclear indication (9%). SGLT2i used included dapagliflozin (78%), empagliflozin (13%), and canagliflozin (9%). The mean duration of SGLT2i use was 12.05 months with a range from 0.03 months to 14.9 months. 42% were on other diabetes medications such as metformin, liraglutide, and/or insulin. 58% were on other cardiology medications such as anti-platelet or anticoagulants, cholesterol, hypertension, diuretic, anti-mineralocorticoid, semaglutide and/or anti-arrhythmia medications. 6% were on other renal medications such as ACE-I/ARB or hypertensive medications. Adverse events did not cause discontinuation in any patient although in some, lack of insurance coverage prevented continuation after hospital discharge. There were 0 hospitalizations and 0 deaths attributed to SGLT2i use. During treatment, there were 4 individuals with volume depletion, 7 with acute kidney injury (AKI), 0 fractures, 0 amputations, 0 episodes of symptomatic hypoglycemia, 1 episode of DKA, 0 episodes of Fornier’s gangrene, 2 episodes of urinary tract infections, and 0 mycotic infections. None of these episodes were explicitly attributed to SGLT2i use in the chart and at least 1 AKI was attributed to venous congestion and need for increased diuresis. The one incident of DKA occurred in a patient with known diabetes prior to SGLT2i treatment. Based upon this chart review, the real world risk profile of SGLT2i in a pediatric population is similar to adults with no major new safety signals identified, thus substantiating the safety of another promising therapy for diabetes, cardiac, and renal treatment in the pediatric population.Presentation: Monday, July 14, 2025

Concerns about medication failure and the high rates of morbidity and mortality linked to the distribution and use of fake, counterfeit, and inferior medications are major concerns for patients, healthcare providers, and drug regulatory agencies. To provide the intended therapeutic effect, a medication must include the appropriate quantity of the active pharmacological ingredient in addition to the necessary physical properties. One popular and effective diuretic medication that is mostly used to treat oedema and hypertension is furosemide. The market today offers a wide variety of furosemide formulations intended for oral consumption. The purpose of this study is to examine a number of Furosemide tablet brands sold in Al Bayda, Libya, to confirm that they comply with the regulatory requirements specified by the US Pharmacopoeia and the British Pharmacopoeia as well as label claims. Furosemide tablets of six different brands were chosen at random from several local pharmacies in Al Bayda, Libya. In addition to other significant evaluation criteria like weight variation, hardness, friability, disintegration time, dissolution test, and drug content assay, the samples' visual qualities were also analyzed. The findings verified that all brands were deemed to be of good quality and met the requirements of the official Pharmacopoeias. Additionally, they had dissolution profiles that were comparable to the innovator's, enabling their interchangeability.

Rapid quantification of 21 antihypertensive and diuretic drugs in plasma by UPLC-MS/MS: Application to clinical and forensic cases.

Background Hypertension is a global health concern, and antihypertensive medications are vital for its management. This study examined evolving trends in antihypertensive medication usage among adults with hypertension from 1999 to 2020. Methods Data from 10 National Health and Nutrition Examination Survey (NHANES) survey cycles were obtained for adults aged 18 years and older with hypertension. The study analysed demographic, drug classification and demographic variables. All statistical analyses, including logistic regression, were used to assess trends. Results Among 18,221 hypertensive participants, diverse characteristics were observed. The use of angiotensin-converting enzyme inhibitors increased from 26.18% in 1999 to 32.76% in 2020 (linear p = 0.001). Angiotensin receptor blocker use rose from 10.36% to 26.57%. Beta blocker usage increased from 28.98% in 1999 to 42.50% in 2010, plateauing at approximately 40% from 2011 to 2020 (quadratic p < 0.001). Calcium channel blocker (CCB) utilisation increased from 16.70% in 1999 to 20.46% in 2020 (linear p < 0.001). Diuretic (DU) use decreased from 32.70% in 1999 to 26.34% in 2020 (quadratic p = 0.009). The use of antihypertensive medications varies across different demographic groups and comorbidities. Conclusions ACEI, ARB and CCB usage increased, while DU usage decreased. BB utilisation stabilised at a high rate. Antihypertensive drug use displayed diverse trends across demographic groups and comorbidities.

Long-term diuretic medication is an independent predictor of posthepatectomy liver failure.

The goal of the current study was to look at the leaves of Lumnitzera racemosa (Family: Combretaceae) and aerial part of Eclipta alba (Family: Asteraceae) for its phytochemical constituents and selected pharmacological activities (diuretic and antidiabetic). Diuretic medications are used to treat hypertension. Diabetes and hypertension are two common disease of geriatric patients and our aim was to explore medicinal plants of Sundarbans to find therapeutic of these diseases. The presence of carbohydrates, glycosides, reducing sugar, tannins, flavonoids, alkaloids, proteins, gum, steroids, saponin, and acidic chemicals was shown by phytochemical study of L. racemosa and E. alba showed the existence of tannin, saponin, flavonoid, gum, alkaloid, steroid, and terpenoid. Both plants extract was fractionated depending on polarity using n-hexane (non-polar), ethyl acetate (medium-polar) and water (polar). In the diuretic activity assay using Swiss Albino mice, none of the fractions of L. racemosa and E. alba showed diuretic activity but n-hexane 500 mg/kg of E. alba exhibited little diuretic activity compared to the standard frusemide. Swiss Albino mice were used to assess the oral glucose tolerance test (OGTT) in order to measure antidiabetic activity. In OGTT, water fraction 500 mg/kg of L. racemosa and E. alba showed blood glucose lowering activity compared to the standard Glibenclamide. We had performed in silico study among reported eight (08) compounds of L. racemosa against 1V4S (human glucokinase) protein. In comparison to classic glibenclamide (-8.5 kcal/mol), myricitrin had a good docking score of -8.4 kcal/mol. Based on these findings, we hypothesized that L. racemosa and E. alba could be a possible source of therapeutic leads for hypertension and hyperglycemia.

The study aimed to compare the effectiveness of various antihypertensive drugs in preventing strokes in hypertensive patients. We conducted a comprehensive search of PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov to identify randomized controlled trials (RCTs) investigating the efficacy of antihypertensive drugs in stroke prevention from inception until April 2023. A network meta-analysis in a Bayesian framework was performed using the random-effects model. This study included 88 RCTs involving 487,076 patients to investigate the effects of antihypertensive drugs in preventing stroke. Among these trials, 58 RCTs specifically focused on comparing the impact of such drugs on hypertensive subjects. In overall population, Angiotensin-converting enzyme inhibitor (ACEIs), Angiotensin receptor blockers (ARBs), Calcium channel blockers (CCBs), and Diuretics (DIs) demonstrated superiority over placebo in in reducing stroke, all-cause mortality, and cardiovascular mortality. CCBs and DIs outperformed β adrenergic receptor blockers (BBs), ACEIs, and ARBs in stroke reduction. However, when focusing on hypertensive patients, ACEIs, CCBs, and DIs proved superior to placebo in reducing stroke, all-cause mortality, and cardiovascular mortality. ARBs reduced stroke and all-cause mortality but lacked efficacy in reducing cardiovascular mortality. Of the various CCB subclasses, only the Dihydropyridines displayed efficacy in preventing stroke, all-cause mortality, and cardiovascular mortality. Among diuretic subclasses, thiazide-type DIs exhibited no efficacy in preventing all-cause mortality. ACEIs+CCBs were more effective than ACEIs or ARBs monotherapy in reducing stroke, more effective than ACEIs, ARBs, CCBs, or DIs monotherapy in reducing all-cause mortality, and more effective than ARBs in reducing cardiovascular mortality. These findings suggest that ACEIs, dihydropyridine CCBs, and thiazide-like diuretics may provide superior prevention against stroke, all-cause mortality, and cardiovascular mortality in hypertensive patients. Combinations of ACEIs and CCBs may provide enhanced protection of stroke than ACEIs or ARBs monotherapy.

Hypertension is the predominant pathology underlying nonlobar intracerebral hemorrhage (ICH), and antihypertensive agents have distinct biological implications for cerebral microvasculature. It is unknown if the class of antihypertensive medications initiated after ICH affects functional outcome beyond blood pressure (BP) control. To ascertain the association between the class of antihypertensive agents initiated during hospitalization and 90-day functional outcome in nonlobar ICH. This cohort study uses data from the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study, a case-control cohort study investigating ICH risk factors among Hispanic, non-Hispanic Black (hereafter Black), and non-Hispanic White (hereafter White) populations at 42 US hospitals from 2010 to 2015. Data for this analysis were examined from May to September 2024. ERICH study participants were selected for the present analysis if they survived hospitalization and had available covariate and outcome data. Individuals with complications that would limit antihypertensive choice were excluded. Initiation of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), calcium channel blocker, β-blocker, thiazide diuretic, and other antihypertensive medications during index hospitalization. Primary outcome was a favorable functional outcome, defined as a 90-day (follow-up) modified Rankin Score score of 0 to 2 (score range: 0 [indicating no disability] to 6 [indicating death]). Mixed-effects logistic regression adjusted for demographic characteristics, medical history, ICH characteristics, BP measurement, total number of antihypertensive medications, and hospitalization site was used to calculate the odds of favorable functional outcome. Of the 1561 ERICH study participants in the analytic cohort, 1079 had nonlobar and 482 had lobar ICH. Among the 1079 participants in the nonlobar ICH group (mean [SD] age, 58.5 [12.9] years; 676 males [62.6%]; 429 Hispanic [39.8%], 388 Black [36.0%], and 262 White [24.4%] individuals), a total of 407 (37.7%) ACEIs or ARBs, 419 (38.8%) β-blockers, 503 (46.6%) calcium channel blockers, 180 (16.7%) thiazide diuretics, and 277 (25.7%) other antihypertensive classes were initiated during hospitalization (median [IQR], 3 [2-3] agents at discharge). At follow-up, 481 participants (44.6%) had a favorable functional outcome. Initiation of ACEI or ARB was associated with higher odds of favorable functional outcome (adjusted OR [AOR], 1.49; 95% CI, 1.08-2.05; P = .01). No other antihypertensive class was associated with functional outcome. Findings were consistent across several sensitivity analyses. The interaction with ACEI or ARB was mediated by the presence of radiographic features of cerebral small vessel disease (AOR, 3.04; 95% CI, 1.01-9.19; P = .049). No association with class of antihypertensive agent was observed in lobar ICH. This large cohort study found that initiation of ACEI or ARB was associated with favorable 90-day functional outcomes after nonlobar ICH. This finding supports a medication class-specific benefit in hypertensive arteriopathy.

A novel micelle-augmented spectrofluorimetric method is proposed for the ultrasensitive estimation of bumetanide (BUM) at nanoscale concentrations. The method utilizes the unique properties of micelles to enhance the fluorescence intensity of BUM and measures its native fluorescence at 415 nm after excitation at 267 nm. The proposed method was optimized by evaluating the effect of organized media, buffer pH, and diluting solvent. The method validity was further assessed following the ICH guidelines, where excellent linearity was obtained over a concentration range of 40.0-400.0 ng mL-1, with a correlation coefficient of 0.9999 and a low limit of detection (LOD) of 5.31 ng mL-1. The method was further applied for the determination of BUM in different dosage forms with % recoveries greater than 98%, as well as for content uniformity testing. Ultimately, a comprehensive assessment of the method's environmental impact was performed using different metrics, highlighting the eco-friendly nature of the method and underlining its potential for sustainable analytical practices in pharmaceutical research and beyond.

Nephrotic syndrome (NS) is a prevalent kidney disease in children. Acute kidney injury (AKI) is a severe complication of NS and has the potential to be life-threatening. The aim of this study was to analyze the prevalence and risk factors of AKI in children with NS, and to provide an evidence-based medical basis for the early identification of high-risk children in the clinic. A comprehensive search was conducted in publicly available databases, namely PubMed, Embase, Web of Science, Scopus, and the Cochrane Library, covering the period from the inception of each database until May 2024. The analysis involved examining basic characteristics (age, sex), the concomitant diseases (hypertension, infections), NS disease characteristics (steroid susceptibility classification, pathologic classification), laboratory test (e.g., serum albumin), and the use of nephrotoxic drugs. Traditional and network meta-analyses were performed for analysis. A total of 11 studies were included in the analysis, revealing an incidence of AKI of 29% (95% CI: 23%-37%). The analysis of factors indicated that the age of NS onset [standardized mean difference (SMD): 0.31; 95% confidence interval (CI): 0.08, 0.54; p = 0.009], sex [odds ratio (OR): 1.49; 95% CI: 1.03, 2.16; p = 0.035], serum albumin level (SMD: -0.43; 95% CI: -0.85, -0.02; p = 0.041), response to steroid treatment (OR: 0.52; 95% CI: 0.33, 0.80; p = 0.003), infection (OR: 3.60; 95% CI: 1.91, 6.78; p < 0.001), hypertension (OR: 4.02; 95% CI: 2.94, 5.51; p < 0.001), and nephrotoxic drug application (OR: 4.43; 95% CI: 1.86, 10.53; p = 0.001), were all significantly associated with the incidence of AKI. Furthermore, the results of the network meta-analysis suggested that the pathologic type of minor glomerular abnormalities (MGA)/diffuse mesangial proliferation (DMP), the type of infrequent relapses (IFRNS)/steroid-sensitive NS (SSNS), and the use of diuretic medications were associated with a relatively low risk of AKI occurrence. Factors upon admission of children with NS are associated with the onset of AKI. Emphasis should be placed on populations with a heightened risk of AKI in clinical practice. Further research is warranted to confirm the findings due to the limitations of this study. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024571170, PROSPERO (CRD42024571170).

Globally, hypertension is a major noncommunicable disease that contributes to significant fatalities and morbidity. Evaluation of trends in the prescription of antihypertensives and their adherence to the Joint National Commission 8 (JNC 8) recommendations can provide perspective on the dissemination of local and international guidelines in real-world clinical practice. An ambispective observational study was conducted over a duration of 6 months. Among the three-drug combinations, angiotensin receptor blockers (ARB) + beta-blocker (BB) + calcium channel blocker (CCB) (10%), followed by ARB + CCB + diuretic (DU) (8%), were primarily prescribed. BB + diuretic (DU) (20%) was the most prescribed in two-drug combination therapy, followed by ARB + BB (19%). BB (46%) were the most prescribed drugs, followed by diuretics (25%) as monotherapy. Combination therapy is as efficient as single-drug therapy. Among patients with hypertension and heart failure with reduced ejection fraction (HFrEF), the ARNI/ARB combination is effective in HFrEF patients. ARNI/ARB + antihypertensives were most commonly prescribed (40%), followed by ARNI/ARB + ivabradine + antihypertensives (35%). Adherence to the JNC 8 guidelines varied between 71 and 92%. Ninety-two percent of the prescriptions were adherent to initiating pharmacological treatment in patients aged over 60 years with a BP goal of <140/90, with thiazide/loop diuretics, CCB, and ACEI/ARB as first-line therapy. The pattern of prescribed drugs was in accordance with clinical guidelines. Compliance with JNC 8 guidelines was optimal. However, studies including larger patient populations, drug dosages used, and physician perspectives on prescribing need to be studied further.

Chronic kidney disease (CKD) is a substantial global health issue with high morbidity and mortality. Yishen Paidu Pills (YSPDP) are effective concentrated water pills composed of four herbs developed by Wuhan Union Hospital to treat CKD. However, the mechanism of YSPDP action is largely unknown. This study combined metabolomics, network pharmacology, transcriptomics, and experimental verification to elucidate and identify the effects and potential mechanisms of YSPDP against CKD. Firstly, we used metabolomics analyses to identify the chemical components of YSPDP. Then, network pharmacology was conducted and indicated the predicted signaling pathways regulated by YSPDP. Next, we conducted a 5/6 subtotal nephrectomy (5/6 SNx) rat model and treated these rats with YSPDP or Losartan for 10weeks to evaluate the effect of YSPDP on CKD. To further analyze the underlying mechanism of YSPDP in CKD, the kidney tissues of 5/6 SNx rats treated with vehicle and YSPDP were performed with transcriptome sequencing. Finally, the western blot was performed to validate the signaling pathways of YSPDP against CKD. Twenty-four classes of chemicals were identified by metabolomics in YSPDP. YSPDP markedly hindered CKD progression, characterized by the restoration of body weight and serum albumin levels, improved renal function, diminished tissue injury, and hampered renal fibrosis in 5/6 SNx rats. The efficacy of YSPDP in ameliorating the progression of CKD was comparable to that of losartan. Furthermore, network pharmacology, transcriptomics, and functional enrichment analysis indicated the PI3K/AKT/mTOR signaling pathway was the key pathway regulated by YSPDP. Western blot validated the inhibition of PI3K/AKT/mTOR signaling in the kidney of 5/6 SNx rats treated by YSPDP. The study identified the chemicals of YSPDP and revealed that YSPDP prevented the progression of CKD by inhibiting PI3K/AKT/mTOR signaling in 5/6 SNx rats.

Abstract It is estimated that over 90,000 patients in Ireland have a diagnosis of Heart Failure. The HeartCare at Home study was commenced in 2021 as a collaboration between Centric Health and Roche Diagnostic. The study aimed to examine the feasibility of implementing a remote monitoring programme for patients with heart failure, through primary care, and the impact on hospitalisations, A&amp;E attendances, and GP visits. Patients were referred to the study by their GP. Patients were provided with a blood pressure monitor, weighing scales and smart device in line with the study protocol. The remote monitoring app, a CE-certified Medical Device Class IIa, was provided by Luscii Healthtech. Patients were requested to input their weight, blood pressure, heart rate and symptoms for two weeks after a undergoing a clinical onboard to establish a baseline. Thereafter, readings were entered by patients twice weekly. Patients participated for a minimum of 12 months. If measurements fell outside pre-determined parameters or a deterioration was noted, the team was alerted through the Luscii app dashboard. Where clinically appropriate and in line with cardiologist approved protocols, the team supported the patient to titrate their diuretic medication at home for a maximum of 3 days, with continuous daily monitoring. The patient’s GP was informed of all deteriorations and changes in the patient’s condition and of all recommendations made by the HeartCare at Home team. One hundred and sixty-two patients were onboarded to the programme while 120 patients completed one year follow up (42% female; median age 76 years, range 31-100 years). Thirty five percent of patients had a diagnosis of HFrEF, 13% HFpEF, and 6% HFmrEF while 43% were undifferentiated. Seventy five percent of patients had a NYHA I or II classification. Over 95,000 clinical measurements were recorded through the Luscii app over the course of the study. Of the decompensations managed directly by the HeartCare at Home team with medication titration and daily monitoring, 70% were clinically resolved following the HeartCare at Home protocol. Adherence to inputting monitoring data remained strong throughout the intervention period with over 89% of participating patients continuing to upload readings as scheduled at 12 months. Using established and secure communication pathways, such as HealthLink and Healthmail, the clinical team were able to interact with each patients GP to ensure continuity of care and optimised patient treatment. The HeartCare at Home study demonstrates the feasibility of implementing a remote monitoring programme through primary care. Remote monitoring with direct access to clinical support has potential benefits for patients, clinicians, and the health service at large. Further research, in a larger cohort, and examination of the cost of implementation of remote monitoring in primary care, is warranted.

Abstract Hydrochlorothiazide has been utilized clinically for the past half-century, which is popularly known as a “water pill” as it produces increased urine output. The advancement of bioanalytical methods brought a dynamic field with exciting opportunities for future research. The current review emphasis the bioanalytical methods employed for the quantitative estimation of Hydrochlorothiazide as monotherapy and its popularly used combinational medications available from 1956 to till date. A fixed dose of 25 mg of hydrochlorothiazide with 43 combinational medications is currently available in the market and these combinations are widely employed in the treatment of hypertensive people; those whose blood pressure does not respond effectively to monotherapy of hydrochlorothiazide and also for the treatment of edema (excess fluid in the body) caused by illness such as heart failure, liver problems, and renal disease. It has been convincingly demonstrated that the combination of any two antihypertensive medications belonging to different groups of the same category, significantly lowers blood pressure, in comparison with the effect produced by increasing the dose of a single medicament. Among the various analytical techniques employed for the estimation of Hydrochlorothiazide, the review portrays that hyphenated technique, in specific liquid chromatography coupled with mass spectroscopy was widely employed. The validation parameters namely linearity, LOD, LOQ for individual drug and their combinations, were successfully calibrated. The effectiveness of analytical approaches was evaluated and enhanced for chemical factors. The involvement of green chemistry in the optimized methods for the evaluation of Hydrochlorothiazide for the future development, are suggested.

Epidemiology of heart failure presentations to United States emergency departments from 2016 to 2023

Background: The main cause of hospitalization in patients with heart failure is hypervolemia. Therefore, the primary treatment strategy involves diuretic therapy using intravenous loop diuretics to achieve decongestion and euvolemia. Some patients with acutely decompensated heart failure (ADHF) do not respond well to diuretic treatment, which may be due to diuretic resistance (DR). Such cases require high doses of diuretic medications and combination therapy with diuretics of different mechanisms of action. Although certain predisposing factors for diuretic resistance have been identified (such as hypotension, type 2 diabetes, impaired renal function, and hyponatremia), further research is needed to identify other pathophysiological markers of DR. Objective: This study aims to identify admission markers that can predict a high requirement for intravenous diuretics in hospitalized patients with decompensated heart failure. Methods: This study included 102 adult patients hospitalized for ADHF. At admission, patients underwent clinical assessment, laboratory parameter evaluation (including the N-terminal prohormone of brain natriuretic peptide [NT-proBNP] levels), and hemodynamic assessment using impedance cardiography (ICG). Hemodynamic profiles were based on the use of parameters such as heart rate (HR), blood pressure (BP), and thoracic fluid content (TFC) as markers of volume status. The analysis included 97 patients with documented doses of intravenous diuretic use. Patients were stratified into two groups based on median diuretic consumption (equivalent to 540 mg of intravenous furosemide): the high-loop diuretic utilization (LDU) group (n = 49) and the low-LDU group (n = 48). Results: Compared to low-LDU patients, high-LDU patients had greater thoracic fluid content at admission, both quantitatively (37.4 ± 8.1 vs. 34.1 ± 6.9 kOhm-1; p = 0.024) and qualitatively (TFC ≥ 35 kOhm-1: 59.2% vs. 33.3%; p = 0.011). Anemia was more common in the high-LDU group (67.4% vs. 43.8%; p = 0.019), as was elevated NT-proBNP (≥median of 3952 pg/mL: 60.4% vs. 37.5%; p = 0.024). High LDU was associated with a significantly longer hospitalization duration (12.9 ± 6.4 vs. 7.0 ± 2.6 days; p < 0.001). Logistic regression analysis identified anemia, elevated NT-proBNP, and high TFC as predictors of high LDU (HR: 2.65, 2.54, and 2.90, respectively). In a multifactorial model, only high TFC remained an independent predictor (HR: 2.60, 95% CI 1.04-6.49; p = 0.038). Conclusions: TFC was the sole independent admission marker of a high requirement for intravenous diuretics in patients hospitalized for decompensated heart failure. An objective assessment of volume status by impedance cardiography may support intensive personalized decongestion therapy.

Background and Objectives: The endothelin ETA/ETB receptor antagonist aprocitentan (APRO) decreased blood pressure (BP) in patients with confirmed resistant hypertension (RHT) in the PRECISION study. 19.6% of the overall population (143 subjects) had a reported history of Heart Failure (HF). It is well known that in subjects with RHT, HF is often underdiagnosed. In PRECISION, NT-proBNP (a marker of HF) was measured. Here we report the efficacy and safety of APRO in patients with increased NT-proBNP. Methods: 730 patients with RHT were switched to a standardized fixed-dose combination of amlodipine/valsartan/hydrochlorothiazide from their existing anti-hypertensive and diuretic medication and then randomized to APRO (12.5 mg or 25 mg) or placebo in PRECISION. This analysis considers subjects with baseline blood levels of NT-proBNP &gt;125 pg/mL. Change in BP, incident cases of edema/fluid retention and change in body weight were assessed. Descriptive statistics are presented. Results: 236 enrolled subjects (32.3%) had NT-proBNP levels from 125–1125 pg/mL. At Week 4, APRO 12.5 mg decreased trough sitting systolic BP (SiSBP) by mean (SD) 14.2 (16.7) mm/Hg, APRO 25 mg by 15.8 (13.5) mm/Hg and placebo by 9.9 (18.0) mm/Hg, confirming that the effect was greater for APRO than placebo with no apparent difference between 12.5 and 25 mg, as observed in the overall population enrolled in PRECISION. The effect was maintained with APRO 25 mg at Week 36 with a decrease of 18.4 (15.2) mm/Hg versus baseline. Adverse events of edema/fluid retention were reported with an incidence of 13.4%, 25.7% and 1.2% in the 12.5 mg, 25 mg and placebo group, respectively, at Week 4. During the SB part up to 36 weeks edema/fluid retention was reported by 26.1% of subjects with 25 mg. Body weight change at Week 4 was +0.5, +0.7 and -0.2 Kg with 12.5 mg, 25mg and placebo, respectively. This weight increase was reversible: a subsequent decrease resulted in a difference versus baseline of 0.4 kg at Week 36. NT-proBNP ratio vs baseline (geometric mean) was 0.94, 0.86 and 0.78 with 12.5 mg, 25 mg and placebo, respectively, at Week 4. There was no increase over time, the ratio vs baseline was still below 1 (0.91) at Week 36. Conclusion: Aprocitentan is effective in patients with RHT and elevated NT-proBNP. Edema and fluid retention are more common in this sub-group compared with the overall population included in PRECISION, but it is not linked to significant weight gain or increase of NT-proBNP.

Background: Cirrhotic ascites significantly affects patients' daily living activities. Family involvement in patient care is a newly emerging mitigation strategy. Aim of the study: To evaluate the effect of a family-involved educational approach on diuretic medication adherence, ascites severity, and activities of daily living (ADL) among liver cirrhosis patients. Study design: Preposttest quasi-experimental design. Tools: Five tools were used: I) Structured Interviewing Questionnaire covering socio-demographic and medical history, II) Knowledge Assessment Tool (0-50 points, satisfactory ≥80%), III) Morisky Medication Adherence Scale (MMAS-8) for adherence levels, IV) Ascites Degree Tool for grading ascites severity and V) ADL scale to evaluate functional abilities. Sample: Purposive sample of 60 liver cirrhosis patients and 114 family members from Minia University Hospital, Egypt. Results: Patients were predominantly male (65%), with a mean age of 52.5 years. The majority of family members were wife/husband (44.7%) or son/daughter (39.4%). The percentage of participants with high medication adherence increased from 12% at baseline to 73% at 8 weeks (χ² = 62.5, p < 0.001). Severe ascites decreased from 40% to 15% (χ² = 27.3, p < 0.001), and satisfactory ADL improved from 18% to 68% (f = 5.8, p = 0.022). Patients with more involved family members and a shorter disease duration exhibited significantly better health outcomes. Conclusion: The family-involved educational approach significantly improved medication adherence, reduced ascites severity, and enhanced ADL. Recommendation: Incorporating family-based educational interventions into standard care can improve outcomes in liver cirrhosis patients. Replication of the study in diverse populations and different research designs.

The paper deals with ethnomedicinal information on 54 plant species (belonging to 33 families) collected from field survey amongst three tribes viz., Gond, Korku and Gaiki of Betul district, Madhya Pradesh. An analysis of data has indicated that eight plant species are employed as antidote to snake bite and scorpion sting, six to treat fever. five for rheumatism, four to treat cold, cough, skin diseases, as anthelmintic and tonic, and three for stomach diseases while two species to treat impotency, cuts, wounds and as diuretic. On the other hand, only single species has been referred for a number of other ailments like eye diseases, spermatorrhoea, spleen enlargement, tuberculosis, mouth sore, boil, asthma, liver disorder, toothache, bone fracture, abortifacient, antifertility, and in veterinary. Further, a comparison with the concerned literature has revealed that 23 ethnomedicinal uses of plants have not been reported earlier.