Treatment Of Chronic Disease Research Articles

SAFETY ASSESSMENT OF A RANGE OF PLANT METABOLIC TOVES – ADVANCED GEROPROTECTORS IN VIVO RESEARCH

Background. Ageing is associated with progressive impairment of physical functions and increased risk of age-related chronic diseases. Polyphenols such as mangiferin, quercetin and trans-cinnamic acid are also used for the treatment and prevention of chronic diseases. Toxicological research was important in biomedical research, as some high-dose extracted polyphenols could contribute to the development and progression of cancer and other diseases. This study is aimed at assessing toxicological safety of previously isolated phenolic compounds from plants of the Siberian Federal District. Materials and methods. Rodents have been chosen as the model organism. The study of mutagenic and antimutagenic properties was carried out using a micronuclear test of bone marrow cell. Cytotoxicity in vitro was assessed using the MTT test. Results. Polyphenols studied at doses of 50.0 and 100.0 mg/kg are not mutagenic. Mangiferri and quercetin at a dose of 50.0 mg/kg do not have anti-thagenic effects. In this case, trans-cinnamic acid in the same concentration has antimutagenic effect. Mangiferin in concentrates from 4.2 to 16.7 ug/ml has a cytotoxic effect. Trans-cinnamic acid is not cytotoxic (at 2.1-33.3 ug/ml). Quercetin has a cytotoxic effect in concentrations of 0.21 and 1.67 ug/ml, and at concentrations of 3.33 ug/ml increases the viability of splenocytes, presumably due to antioxidant properties. Conclusion. Safety or low toxicity is a decisive advantage of the continued use of polyphenols as advanced heroic flow agents. Further study of biologically active substances (mangiferin, quercetin and trans-cinnamic acid) has been found to be ce-woody. The work was carried out by the state task on the topic «Development of biologically active additives consisting of metabolites of plant objects in vitro to protect the population from premature aging» (project FZSR-2024-0008) using the equipment of Center of Collective Use «Instrumental methods of analysis in the field of applied biotechnology» on the basis of KemSU.

Adalimumab induced psoriasis in a Crohn’s disease patient: a case report

Adalimumab is a human monoclonal antibody that selectively targets tumour necrosis factor-alpha (TNF- Alpha), a cytokine involved in the pathogenesis of various inflammatory and autoimmune disorders. Adalimumab has been approved worldwide for the treatment of several chronic immune-mediated diseases, including rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, and juvenile idiopathic arthritis. One of the adverse reactions caused by Adalimumab is psoriasis. This study reports the case of a 37-year-old male with palmoplantar psoriasis triggered by adalimumab for treatment of Crohn’s disease. This eruption resisted complete clearance with various potent corticosteroids. The patient was referred back to the treating rheumatologist to possibly change adalimumab to another type of therapy. Keywords: Adalimumab, psoriasis, Crohn’s disease, paradoxical psoriasis.

Expression and predictive value of serum core fucosylated low molecular weight kininogen and alpha-galactosylated antibodies in patients with hepatic fibrosis.

Hepatic fibrosis is a common pathological basis for many chronic liver diseases and can progress to cirrhosis, a leading cause of mortality in liver diseases. Early identification and reversal of hepatic fibrosis are key in the treatment of chronic liver disease. This study aims to compare the expression levels of serum core fucosylated low molecular weight kininogen (LMWK-Fc) and alpha-galactosylated (α-Gal) antibodies in patients with hepatic fibrosis at different stages, and to evaluate their diagnostic efficacy for hepatic fibrosis. A retrospective analysis was conducted on 275 patients with chronic liver disease who visited the Department of Infectious Diseases at the Second Xiangya Hospital of Central South University between June 2022 and March 2023. Among these, 115 patients underwent liver biopsy. Based on the extent of collagen deposition and its impact on liver structure and microcirculation, patients were staged from 0 to 4: S0 (no significant collagen deposition in liver tissues; liver structure and microcirculation are normal), S1 (mild collagen deposition in liver tissues, with partial disruption of lobule structure, but microcirculation remains largely normal), S2 (moderate collagen deposition in liver tissues, with partial disruption of lobule structure and microcirculation), S3 (extensive collagen deposition in liver tissues, with substantial disruption of lobule structure and microcirculation), and S4 (development of cirrhosis, with heavy collagen deposition, complete disruption of lobule structure, and severe impairment of microcirculation). Patients were grouped as no fibrosis (S0), fibrosis (S1-S2), and significant fibrosis (S3-S4). For the 160 patients without liver biopsy, they were categorized based on liver stiffness measurement (LSM) value: no fibrosis (F0: LSM<7.3 kPa), fibrosis (F1-F2: LSM 7.3-12.4 kPa), and significant fibrosis (F3-F4: LSM>12.4 kPa). Demographic data (age, gender) and laboratory indicators (alanine transaminase, aspartate transaminase, gamma-glutamyl transferase, alkaline phosphatase, alpha-fetoprotein, platelet count) were collected to calculate the fibrosis-4 index (FIB-4) and aspartate aminotransferase-to-platelet ratio index (APRI). Serum LMWK-Fc and α-Gal antibodies were measured and compared across the groups, and their correlation with fibrosis severity was analyzed. The receiver operating characteristic (ROC) curve was used to assess the predictive value of serum LMWK-Fc and α-Gal antibody levels for hepatic fibrosis. Among the 160 patients without complete liver biopsy, serum α-Gal antibody and LMWK-Fc levels increased progressively from the no fibrosis group to the significant fibrosis group, with statistically significant differences (P<0.05). Among the 115 patients with liver biopsy, serum LMWK-Fc levels were significantly higher in the fibrosis group and the significant fibrosis groups compared with the no fibrosis group, and α-Gal antibody levels were significantly higher in the significant fibrosis group compared with the no fibrosis group and the fibrosis group (P<0.001, P=0.032, respectively). Univariate and multivariate linear regression analyses showed that hepatic fibrosis was correlated with gender and LMWK-Fc levels (both P<0.05), but not with age, α-Gal antibody levels, FIB-4, or APRI (all P>0.05). The expression levels of serum LMWK-Fc and α-Gal antibodies vary across different stages of hepatic fibrosis, suggesting a potential association with fibrosis progression. LMWK-Fc levels have a certain predictive value for the diagnosis of hepatic fibrosis.

Clinical presentation, diagnosis, and treatment of chronic granulomatous disease.

Chronic granulomatous disease (CGD) is caused by an impaired respiratory burst reaction in phagocytes. CGD is an X-linked (XL) (caused by pathogenic variants in CYBB) or autosomal recessive inborn error of immunity (caused by pathogenic variants in CYBA, NCF1, NCF2, or CYBC1). Female carriers of XL-CGD and unfavorable lyonization may present with the partial or full picture of CGD. Patients with CGD are at increased risk for invasive bacterial and fungal infections of potentially any organ, but especially the lymph nodes, liver, and lungs. Pathogens most frequently isolated are S. aureus and Aspergillus spp. Autoinflammation is difficult to control with immunosuppression, and patients frequently remain dependent on steroids. To diagnose CGD, reactive oxygen intermediates (O2 - or H2O2) generated by the NADPH oxidase in peripheral blood phagocytes are measured upon in vitro activation with either phorbol-12-myristate-13-acetate (PMA) and/or TLR4 ligands (E. coli or LPS). Conservative treatment requires strict hygienic conduct and adherence to antibiotic prophylaxis against bacteria and fungi, comprising cotrimoxazole and triazoles. The prognosis of patients treated conservatively is impaired: for the majority of patients, recurrent and/or persistent infections, autoinflammation, and failure to thrive remain lifelong challenges. In contrast, cellular therapies (allogeneic stem cell transplantation or gene therapy) can cure CGD. Optimal outcomes in cellular therapies are observed in individuals without ongoing infections or inflammation. Yet cellular therapies are the only curative option for patients with persistent fungal infections or autoinflammation.

The Urinary Glycopeptide Profile Differentiates Early Cardiorenal Risk in Subjects Not Meeting Criteria for Chronic Kidney Disease.

Early diagnosis and treatment of chronic kidney disease (CKD) is a worldwide challenge. Subjects with albumin-to-creatinine ratio (ACR) ≥ 30 mg/g and preserved renal function are considered to be at no cardiorenal risk in clinical practice, but prospective clinical studies evidence increased risk, even at the high-normal (HN) ACR range (10-30 mg/g), supporting the need to identify other molecular indicators for early assessment of patients at higher risk. Following our previous studies, here we aim to stratify the normoalbuminuria range according to cardiorenal risk and identify the glycoproteins and N-glycosylation sites associated with kidney damage in subclinical CKD. Glycoproteins were analyzed in urine from hypertensive patients within the HN ACR range compared to control group (C; ACR < 10 mg/g) by mass spectrometry. A different cohort was analyzed for confirmation (ELISA) and sex perspective was evaluated. Patients' follow-up for 8 years since basal urine collection revealed higher renal function decline and ACR progression for HN patients. Differential N-glycopeptides and their N -glycosylation sites were also identified, together with their pathogenicity. N-glycosylation may condition pathological protein deregulation, and a panel of 62 glycoproteins evidenced alteration in normoalbuminuric subjects within the HN range. Haptoglobin-related protein, haptoglobin, afamin, transferrin, and immunoglobulin heavy constant gamma 1 (IGHG1) and 2 (IGHG2) showed increased levels in HN patients, pointing to disturbed iron metabolism and tubular reabsorption and supporting the tubule as a target of interest in the early progression of CKD. When analyzed separately, haptoglobin, afamin, transferrin, and IGHG2 remained significant in HN, in both women and men. At the peptide level, 172 N-glycopeptides showed differential abundance in HN patients, and 26 showed high pathogenicity, 10 of them belonging to glycoproteins that do not show variation between HN and C groups. This study highlights the value of glycosylation in subjects not meeting KDIGO criteria for CKD. The identified N-glycopeptides and glycosylation sites showed novel targets, for both the early assessment of individual cardiorenal risk and for intervention aimed at anticipating CKD progression.

Sodium-Glucose Cotransporter Inhibitors: Cellular Mechanisms Involved in the Lipid Metabolism and the Treatment of Chronic Kidney Disease Associated with Metabolic Syndrome.

Metabolic syndrome (MetS) is a multifactorial condition that significantly increases the risk of cardiovascular disease and chronic kidney disease (CKD). Recent studies have emphasized the role of lipid dysregulation in activating cellular mechanisms that contribute to CKD progression in the context of MetS. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated efficacy in improving various components of MetS, including obesity, dyslipidemia, and insulin resistance. While SGLT2i have shown cardioprotective benefits, the underlying cellular mechanisms in MetS and CKD remain poorly studied. Therefore, this review aims to elucidate the cellular mechanisms by which SGLT2i modulate lipid metabolism and their impact on insulin resistance, mitochondrial dysfunction, oxidative stress, and CKD progression. We also explore the potential benefits of combining SGLT2i with other antidiabetic drugs. By examining the beneficial effects, molecular targets, and cytoprotective mechanisms of both natural and synthetic SGLT2i, this review provides a comprehensive understanding of their therapeutic potential in managing MetS-induced CKD. The information presented here highlights the significance of SGLT2i in addressing the complex interplay between metabolic dysregulation, lipid metabolism dysfunction, and renal impairment, offering clinicians and researchers a valuable resource for developing improved treatment strategies and personalized approaches for patients with MetS and CKD.

Personalized compression therapeutic textiles: digital design, development, and biomechanical evaluation.

Physical-based external compression medical modalities could provide sustainable interfacial pressure dosages for daily healthcare prophylaxis and clinic treatment of chronic venous disease (CVD). However, conventional ready-made compression therapeutic textiles (CTs) with improper morphologies and ill-fitting of pressure exertions frequently limit patient compliance in practical application. Therefore, the present study fabricated the personalized CTs for various subjects through the proposed comprehensive manufacturing system. The individual geometric dimensions and morphologic profiles of lower extremities were characterized according to three-dimensional (3D) body scanning and reverse engineering technologies. Through body anthropometric analysis and pressure optimization, the knitting yarn and machinery variables were determined as the digital design strategies for 3D seamless fabrication of CTs. Next, to visually simulate the generated pressure mappings of developed CTs, the subject-specific 3D finite element (FE) CT-leg modelings with high accuracy and acceptability (pressure prediction error ratio: 11.00% ± 7.78%) were established based on the constructed lower limb models and determined tissue stiffness. Moreover, through the actual in vivo trials, the prepared customized CTs efficiently (Sig. <0.05; ρ = 0.97) distributed the expected pressure requirements referring to the prescribed compression magnitudes (pressure error ratio: 10.08% ± 7.75%). Furthermore, the movement abilities and comfortable perceptions were evaluated subjectively for the ergonomic wearing comfort (EWC) assessments. Thus, this study promotes the precise pressure management and clinical efficacy for targeted users and leads an operable development approach for related medical biomaterials in compression therapy.

Efficacy and cerebral mechanisms of acupuncture for chronic obstructive pulmonary disease: study protocol for a multicenter, randomized controlled neuroimaging trial.

Although acupuncture is recommended by chronic obstructive pulmonary disease (COPD) treatment guidelines owing to its effects on dyspnea, the underlying neurobiological mechanisms of these effects remain unclear. This study aims to evaluate the efficacy of acupuncture in patients with stable COPD and explore the possible involvement of specific brain regions. This is a prospective, multicenter, single-blind, randomized controlled trial. A total of 90 participants will be recruited from three centers and will be randomly assigned in a 1:1 ratio to undergo acupuncture at acupoints on the disease-affected meridian (DAM) or non-acupoints on the non-affected meridian (NAM), in addition to routine pharmacological treatments. All participants will undergo 30 min of acupuncture three times a week for 8 weeks and will be followed up for 12 months. The primary outcome will be the severity of dyspnea, as measured using the Borg Dyspnea Scale and a visual analog scale at rest and after exercise. The secondary outcomes will include the multidimensional profile of dyspnea using Dyspnea-12, the modified Medical Research Council Dyspnea Scale, and the COPD assessment test; quality of life assessments using St George's Respiratory Questionnaire and the Hospital Anxiety and Depression Scale; and additional measurements of exacerbation frequency, pulmonary function, and the 6-min walking distance. Magnetic resonance imaging (MRI) will be performed before and after exercise to explore the potential neurobiological mechanisms of exertional dyspnea. Anxiety and depression will be measured and analyzed for their correlation with the activation of specific brain areas involved in dyspnea. This randomized controlled trial aims to use a multidimensional evaluation of the efficacy of acupuncture in relieving dyspnea in patients with COPD in terms of emotion and quality of life and explore the neurobiological mechanisms underlying the effects of acupuncture on dyspnea from an imaging perspective. It is expected to provide strong evidence to support the use of acupuncture in relieving dyspnea in patients with COPD and those with aother diseases involving dyspnea. Additionally, it provides novel insights into the central mechanisms of acupuncture intervention and dyspnea. Chinese Clinical Trial Registry (https://www.chictr.org.cn/): ChiCTR2300071725.

The role of physical exercise in the treatment of chronic diseases: an epigenetic approach

The role of physical exercise in the treatment of chronic diseases: an epigenetic approach

An Ayurvedic Approach in Treatment of Chronic Kidney Disease: A Case Series

Background: Akidney damage or glomerular filtration rate (GFR) &lt; 60ml / min/1.73m for 3 months or more irrespective of cause is define as a chronic kidney disease. In many kidney diseases, kidney damage can be ascertained by the presence of albuminuria, defined as albumin – creatinine ratio &gt; 30 mg / gm in two of three spot urine specimens. Severity of kidney diseases is classified into five stages according to level of GFR from G1 to G5.  Methods- Case series of 10 patients were managed with Ayurvedic treatment. Assessment was done on the basis of KFT, CBC, ESR and GFR  Result- Improvement in GFR and Decreased Sr. creatinine and urea level will be stated in full paper.  Discussion and Conclusion- After administration of Ayurvedic drug changes in KFT observed with changes in GFR, which is mention in full paper. ON this we concluded that Ayurvedic treatment is beneficial in treatment of chronic kidney failure than acute kidney failure.

Advances in the Diagnosis, Treatment, and Prognosis of Chronic Kidney Disease: A Reflection on Recent Developments

Chronic kidney disease (CKD) remains a critical global health issue, affecting more than 840 million individuals globally [...]

Effect of Inhaler Technique Health Education in Improving Symptoms and Lung Function in COPD Outpatient in a Private Hospital in Gresik, Indonesia: Pilot Studies

Inhalers are the most effective therapy in the treatment of Chronic obstructive pulmonary disease (COPD). Research shows that a large number of COPD patients do not use inhalers properly. Incorrect inhaler use technique can reduce drug delivery and poor disease control. Education on how to use inhalers is an important part of COPD management. The study was conducted to determine the effect of education on symptom assessment, lung function assessment and inhaler use skill assessment in COPD patients. The research was in the form of a pre-experimental one-group pre-test post-test. The results showed that there was a significant difference in the effect of education on how to use the inhaler on the assessment of symptoms (p = 0.000), a significant difference in the assessment of lung function (p = 0.001) and a significant difference in the assessment of skills in using the inhaler (p = 0.000). Education on how to use inhalers has an influence on the assessment of symptoms, lung function and skills in using inhalers in COPD patients.

Clinical Study on Respiratory Medicine Treatment of Chronic Obstructive Pulmonary Disease Combined with Respiratory Failure

Objective: To explore the respiratory medicine treatment methods for treating chronic obstructive pulmonary disease (COPD) combined with respiratory failure. Methods: 70 cases of COPD patients with combined respiratory failure admitted to our hospital from January 2021 to January 2023 were selected as the study subjects, and randomly divided into the control group and the experimental group, each with 35 cases. The control group received only conventional treatment, and the experimental group received non-invasive positive pressure ventilation, and the treatment effects and changes in the levels of IL-18, hs-CRP, and CES2 inflammatory factors were observed and evaluated in the two groups. Results: There was no significant difference between the general data of the two groups (P &gt; 0.05); after treatment, the total effective rate of clinical efficacy of the observation group (91.43%) was significantly higher than that of the control group (71.43%), and the difference showed a significant correlation (P &lt; 0.05); after treatment, the level of inflammatory factor of the observation group was significantly reduced compared with that of the control group, and the difference showed a highly significant correlation (P &lt; 0.001). Conclusion: The non-invasive positive pressure ventilation treatment program significantly improves the therapeutic effect, effectively controls the level of inflammatory factors, and improves the health status of patients when dealing with patients with chronic obstructive pulmonary disease accompanied by respiratory failure, showing a good clinical application prospect.

A novel strategy with in vivo characterization, extraction, isolation and activity evaluation for discovery of absorbed anti-inflammatory oligosaccharides from Zhu-Ling decoction

Zhu-Ling decoction (ZLD), a classical traditional Chinese medicine (TCM) formula, is used for the treatment of chronic kidney diseases. However, the structure and activity of absorbed oligosaccharides (OSs) in ZLD are not clear. In this study, a novel strategy with in vivo characterization, extraction, isolation, activity evaluation was established and applied to identify absorbed anti-inflammatory OSs in ZLD. The results revealed that 30 OSs (22 reducing and 8 non-reducing OSs) and 11 OSs (7 reducing and 4 non-reducing OS) were characterized from ZLD in vitro and in vivo by using UPLC/Q-TOF-MS with PMP derivatization, respectively. Among them, a series of −1 → 3-β-D-Glcp-OSs were isolated and identified by HPLC-HILIC-UVD-ELSD, SPHPLC-HILIC-RID, monosaccharide composition, MS and 1D/2D-NMR spectroscopy, including laminaritriose, laminaritetraose, laminaripentaose, laminarihexaose, laminariheptaose, laminarioctaose and laminarinonaose. Moreover, the 4 non-reducing absorbed OSs were identified by comparison with reference standards, including sucrose, trehalose, raffinose and stachyose. Among them, laminaritriose, laminaritetraose and laminaripentaose significantly inhibited TNF-α and IL-6 levels in LPS-induced HK-2 cell and exerted significant anti-inflammatory effects via the NF-κB and Akt/mTOR signaling pathways. Together, our work provides a novel strategy for discovery of absorbed anti-inflammatory OSs and broadens new horizons for the discovery of in vivo pharmacodynamic substances in TCM formulas.

Preclinical Effects Of Melatonin On The Development Of Ehrlich's Tumor: A Biochemical, Cognitive, And Molecular Approach.

It has already been shown that melatonin is an antitumoral molecule that affects malignant cells via some mechanisms. The benefit played by this hormone on cancer is due to its antioxidant effects. This study aimed to evaluate the preclinical effects of melatonin in mice with the Ehrlich ascites tumor. Twenty Balb/ c male mice with Ehrlich tumor were treated with different melatonin doses. Their inflammatory and oxidative stress were accessed by gene expression. Hepatotoxicity and hematological parameters were also evaluated through biochemical analyses. Animal welfare was analysed weekly from the categories guided by the NC3Rs. Gene expression analyses have shown that only Tnfα and Sod1 were expressed in all groups studied. Only the M-3 group showed increased Tnfα expression compared to the control. All groups treated with melatonin showed decreased Sod1 expression compared to the control. No signs of hepatotoxicity were caused by any of the melatonin doses used in the treatment. In animals with Ehrlich´s tumor treated with melatonin, a decrease in oxidative stress, an amelioration in welfare and in cognitive tasks could be observed, even if the treatment has not reduced the size of the tumor itself. In parallel with the already patented use of melatonin in the treatment of sleep disorders or chronic kidney disease, our results propose its use to improve the general well-being of breast cancer patients.

The potential protective role of carotenoids from saffron: A focus on endoplasmic reticulum stress‐related organ damage

AbstractThe anticancer, antioxidant, and immunomodulatory properties of carotenoids from saffron or apocarotenoids (e.g., crocin, safranal, crocetin, and picrocrocin) have prompted research into their benefits. Apocarotenoids seem to be effective compound for the treatment of chronic diseases, such as neurodegenerative, cardiovascular, cancer, respiratory, and metabolic disorders. Endoplasmic reticulum (ER) is an essential organelle found in the cytoplasm of eukaryotic cells that participates in the biosynthesis of proteins, lipids, and steroid hormones. Given the role of the ER in the regulation of several fundamental biological processes, including metabolic pathways and immune responses, aberrant ER function can have a significant influence on these vital processes and result in serious pathological consequences. Exposure of cell to adverse environmental challenges, such as toxic agents, ischemia, and so on, causes accumulation of unfolded or misfolded proteins in the ER lumen, also called ER stress. There is a growing evidence to suggest that ER disturbance in the form of oxidative/nitrosative stress and subsequent apoptotic cell death plays major roles in the pathogenesis of many human diseases, including cardiovascular diseases, diabetes mellitus, neurodegenerative diseases, and liver diseases. Apocarotenoids with their unique properties can modulate ER stress through PERK/eIF2α/ATF4/CHOP (protein kinase R (PKR)‐like ER kinase/eukaryotic initiation factor 2α/activating transcription factor 4/C/EBP /homologous protein) and X‐Box Binding Protein 1/activating transcription factor 6 (XBP1/ATF6) pathways. In addition, they suppress apoptosis through inhibition of endoplasmic and mitochondrial‐dependent caspase cascade and can stimulate SIRT1 (silent information regulator 1) and Nrf2 (nuclear factor erythroid 2‐related factor 2) expression, thereby leading to protection against oxidative stress. This review summarizes the potential benefits of apocarotenoids in various ER‐stress‐related disorders.

Changes in Cardiac Structure and Function of Recipients after Kidney Transplantation.

Background: Chronic kidney disease (CKD) elevates the risk of cardiovascular disease (CVD) and mortality. Uremic cardiomyopathy, frequently observed in CKD and end-stage renal disease (ESRD), involves alterations in cardiac structure and function, which may reverse post-kidney transplantation, although data remain controversial. This study examines the relationship between graft function and changes in cardiac parameters pre- and post-transplantation in kidney transplant recipients. Methods: A total of 145 pediatric and adult recipients of living or deceased donor kidney transplants were enrolled at Gazi Yaşargil Training and Research Hospital. This cohort study utilized transthoracic echocardiographic (TTE) imaging pre-transplant and at least two years post-transplant. Echocardiographic parameters were analyzed using standard techniques. Results: The mean age of the participants was 35 years, with 60% male. The average dialysis duration prior to transplantation was 27 months. Most recipients (83.4%) received kidneys from living donors. Left ventricular diastolic dysfunction increased significantly post-transplant (p < 0.05), while other cardiac dimensions and functions, such as ejection fraction and pulmonary artery pressure, showed no significant change (p > 0.05). Notably, diastolic dysfunction worsened in patients with dysfunctional grafts (GFR < 45), correlating with increased pulmonary artery pressure post-transplant. The rate of antihypertensive drug use and the prevalence of diabetes mellitus increased significantly post-transplant (p < 0.05). Conclusions: This study demonstrates that left ventricular diastolic dysfunction present before kidney transplantation continues to persist post-transplantation in patients with end-stage renal disease undergoing chronic kidney disease treatment. Furthermore, it shows an increased rate of pulmonary artery pressure and pericardial effusion in patients with dysfunctional grafts after transplantation. Further research is required to explore strategies to reverse uremic cardiomyopathy and reduce cardiovascular risk in these patients.

Optimising a clinical decision support tool to improve chronic kidney disease management in general practice

BackgroundEarly identification and treatment of chronic disease is associated with better clinical outcomes, lower costs, and reduced hospitalisation. Primary care is ideally placed to identify patients at risk of, or in the early stages of, chronic disease and to implement prevention and early intervention measures. This paper evaluates the implementation of a technological intervention called Future Health Today that integrates with general practice EMRs to (1) identify patients at-risk of, or with undiagnosed or untreated, chronic kidney disease (CKD), and (2) provide guideline concordant recommendations for patient care. The evaluation aimed to identify the barriers and facilitators to successful implementation.MethodsFuture Health Today was implemented in 12 general practices in Victoria, Australia. Fifty-two interviews with 30 practice staff were undertaken between July 2020 and April 2021. Practice characteristics were collected directly from practices via survey. Data were analysed using inductive and deductive qualitative analysis strategies, using Clinical Performance - Feedback Intervention Theory (CP-FIT) for theoretical guidance.ResultsFuture Health Today was acceptable, user friendly and useful to general practice staff, and supported clinical performance improvement in the identification and management of chronic kidney disease. CP-FIT variables supporting use of FHT included the simplicity of design and delivery of actionable feedback via FHT, good fit within existing workflow, strong engagement with practices and positive attitudes toward FHT. Context variables provided the main barriers to use and were largely situated in the external context of practices (including pressures arising from the COVID-19 pandemic) and technical glitches impacting installation and early use. Participants primarily utilised the point of care prompt rather than the patient management dashboard due to its continued presence, and immediacy and relevance of the recommendations on the prompt, suggesting mechanisms of compatibility, complexity, actionability and credibility influenced use. Most practices continued using FHT after the evaluation phase was complete.ConclusionsThis study demonstrates that FHT is a useful and acceptable software platform that provides direct support to general practice in identifying and managing patients with CKD. Further research is underway to explore the effectiveness of FHT, and to expand the conditions on the platform.

Including the voice of children

Despite evidence of the benefits of including children's voices in global health research, they continue to be underrepresented. Implementation of how to include children's voices appears to remain an obstacle to their inclusion in global health research. In this manuscript, we present an epistemological frame that advocates children as experts of their own experiences and knowledge-bearers. Then we provide four case studies, to illustrate ongoing efforts to build equity in the design and execution of paediatric health research. Ensuring children's equitable inclusion requires recognizing them as active participants in their health and wellbeing, and empowering them to employ their agency in all interactions with researchers, while recognizing the dialogical nature of those interactions. Successfully involving children in global health research can lead to important psychosocial and clinical insights, that could be leveraged to inform future treatment and care practices. We present four case studies describing the inclusion of children in research and research development related to prevention, treatment and/or care of chronic and acute diseases (tuberculosis, HIV, cervical and other forms of cancer) in a number of global settings including India, Philippines, South Africa, United States, Zambia. The exemplars detail novel applications of a diversity of arts-based methods that are rooted in frameworks for participatory action research. They highlight the need to invest funds, training, time and resources for early and sustained engagement with children throughout the research process. We conclude by offering principles for equitably engaging children in global health research.

Bio-Activity of Crude Alcoholic Extracts of Buffel Grass in different Solvents against some Pathogenic Microbes

Background: Natural products have long been the focus of researchers aiming to improve human health, develop medicines with minimal adverse effects, and extend human lifespans. These products, derived from plants, animals, marine life, and microorganisms, contain secondary metabolites known as phytochemicals, which exhibit various biological activities. The current investigation aimed to assess the phytochemical properties and antimicrobial potential of Cenchrus ciliaris Linn. (CAZRI-358) against significant human pathogenic bacteria and fungi. Objective: The objective of this study was to conduct a phytochemical analysis and evaluate the inhibitory potential of crude alcoholic extracts of Cenchrus ciliaris Linn. against six important human pathogenic bacteria and three fungal strains. Methods: The plant material of Cenchrus ciliaris was shade-dried, crushed into powder, and successively extracted with methanol (CCWPM), hexane (CCWPH), and chloroform (CCWPC) using Soxhlet extraction. The antimicrobial activity of the extracts was assessed using both disc diffusion and serial dilution methods. The minimum inhibitory concentration (MIC) and zone of inhibition (IZ) were calculated. The bacterial strains tested included Shigella sonnei, Pseudomonas aeruginosa, Escherichia coli (Gram-negative), Staphylococcus aureus, Streptococcus pyogenes, and Bacillus subtilis (Gram-positive). The fungal strains tested included Microsporum canis, Aspergillus clavatus, and Candida albicans. Standard drugs imipenem (for bacteria) and miconazole (for fungi) were used as positive controls. Results: The highest yield was found in the methanolic extract (41.25 mg/g). Methanolic extracts showed maximum antibacterial activity with MIC values of 90.98 ± 0.05 µg/mL and IZ of 39 mm against Escherichia coli, 92.11 ± 0.06 µg/mL and IZ of 39 mm against Pseudomonas aeruginosa, and 95.33 ± 0.06 µg/mL and IZ of 39 mm against Streptococcus pyogenes. The methanolic extract also exhibited significant antifungal activity with an MIC of 91.97 ± 0.03 µg/mL and IZ of 40 mm against Microsporum canis. Other extracts demonstrated notable but lesser antimicrobial activities. Conclusion: Cenchrus ciliaris Linn. contains vital bioactive components with significant antimicrobial properties, particularly in methanolic extracts. These findings suggest its potential in developing treatments for infections, chronic diseases, and conditions like Benign Prostatic Hyperplasia (BPH). Further research is needed to isolate specific bioactive compounds and understand their mechanisms of action.