The quality of assessment of non-adherence to treatment in hypertensive is poor. Within this review, we discuss the different methods used to assess adherence to blood-pressure-lowering medications ...in hypertension patients. Subjective reports such as physicians’ perceptions are inaccurate, and questionnaires completed by patients tend to overreport adherence and show a low diagnostic specificity. Indirect objective methods such as pharmacy database records can be useful, but they are limited by the robustness of the recorded data. Electronic medication monitoring devices are accurate but usually track adherence to only a single medication and can be expensive. Overall, the fundamental issue with indirect objective measures is that they do not fully confirm ingestion of antihypertensive medications. Detection of antihypertensive medications in body fluids using liquid chromatography–tandem mass spectrometry is currently, in our view, the most robust and clinically useful method to assess non-adherence to blood-pressure-lowering treatment. It is particularly helpful in patients presenting with resistant, refractory or uncontrolled hypertension despite the optimal therapy. We recommend using this diagnostic strategy to detect non-adherence alongside a no-blame approach tailoring support to address the perceptions (e.g. beliefs about the illness and treatment) and practicalities (e.g. capability and resources) influencing motivation and ability to adhere.
•COVID vaccine and comorbidities play role in outcomes of casirivimab-imdevimab.•COVID vaccine lowers the risk and duration of hospital stay if hospitalized.•Higher number of comorbidities increase ...the risk of ED visit and hospitalization.
Several randomized trials and real-world studies depicted the role of monoclonal antibody infusion in reducing hospitalization, and halting progression from asymptomatic to symptomatic COVID pneumonia, viral titer, and death. No data exists to show outcomes of patients who received casirivimab-imdevimab infusion based on their vaccination status and underlying comorbidities. This study aims to provide outcomes of casirivimab-imdevimab treatment during the SARS-CoV-2 B1.617.2 (Delta) surge among fully vaccinated and not fully vaccinated individuals.
COVID-19-positive patients who received casirivimab-imdevimab infusion during the Delta surge were analyzed to compare their underlying comorbidities and the rate of 28-days all-cause and COVID-related ED visits or hospitalization, among fully vaccinated and not fully vaccinated individuals.
A total of 3,586 patients received casirivimab-imdevimab infusion. COVID-related hospitalizations were directly related to the number of comorbidities (OR:1.745, 95 % CI:1.469–2.074). Vaccinated patients with ≥3 comorbidities had lower rates of 28-day COVID-related ED visits or hospitalization (p = 0.044) and those with ≥4 comorbidities had lower rates of 28-day All-cause ED visits or hospitalization (p = 0.029). Hypertension (OR:2.418, 95 %CI:1.341–4.360), immunocompromised state (OR:5.250, 95 %CI: 1.912–14.417), age ≥ 65 (OR:4.045, 95 %CI:2.224–7.358) increased the probability of hospitalization due to COVID and being fully vaccinated lowered the likelihood of hospitalization (OR: 0.472, 95 %CI: 0.239–0.933). Vaccinated patients had a lower length of COVID-related hospitalization (2 days vs 4.5 days, p < 0.001).
COVID vaccination status and comorbidities are significant predictors of outcomes after casirivimab-imdevimab treatment. Despite having higher comorbidities, patients who were fully vaccinated at the time of casirivimab-imdevimab infusion had a lower length of hospitalization and reduced 28-day COVID ED visits or hospitalizations. Future trials should also compare outcomes based on the patient’s vaccination status.
The current study focuses on the stimulation of Bacoside A content of the Bacopa plant that played a potential role in the treatment of Alzheimer’s disease and epilepsy. The objective of the study ...was to explore the potential of the B. monnieri plant for metal tolerance when cultivated on tannery sludge-contaminated soil without compromising its phytochemical quality. Bacoside content of the plant gets 2 times higher than the control without any chemical additives. Bacosides are the alleged bioactive component and attribute to the neuroprotective function. Export-import bank of India acknowledged Bacopa monnieri as the second most crucial medicine as it has metabolites that can cure mental disorders and amnesia. The effect of tannery sludge on enzymatic and non-enzymatic antioxidant potential along with the effect on metabolite i.e. bacoside A content of the plant. The maximum transfer (known as translocation factor) from root to shoot for Cr, Cd, Co, Ni and Pb was 0.33, 0.28, 0.75, 0.69 and 0.43 respectively. This depicts that here in tannery sludge mixed soil, B. monnieri was not behaving like a hyperaccumulator plant. Although it sequestered a large portion of metal in the root region and showed high vegetative growth in a combination of 75:25 tannery sludge and soil. Superoxide dismutase, Catalase, peroxidase, malondialdehyde, proline & ascorbic acid scaled up with increasing tannery sludge in the treatment whereas in the case of chlorophyll a, b, and carotenoid content, a sharp decline trend was observed at 100% tannery sludge treatment. A similar trend was recorded in bacoside A content of the plant, and the highest was 2% that of control in a 75:25 ratio of tannery sludge and soil. Enzymatic antioxidant along with non-enzymatic antioxidants protects the plant from oxidative stress generated by tannery sludge. Principal components confirm our finding that the translocation factor plays a direct role in the activation of the photosynthetic machinery. Principal component-I contributes 59% of the total variance and Principal component-II contributes 33% of the total variance.
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•Bacopa monnieri acts as a phytoextractant grown on tannery sludge contaminated soil.•Translocation factor for Cr, Cd, Co, Pb and Ni was 0.38, 0.28, 0.75, 0.43 and 0.7.•Bacoside A content enhanced up to 21 mg g−1.•Antioxidant activity increases after tannery sludge treatment.
•Synthesis of s-triazine derivatives appended with medicinal potent scaffolds.•DFT studies of synthesized compounds.•Antimicrobial evaluation of synthesized compounds.•ADMET analysis.
This paper ...introduces a series of novel s-triazine analogues (designated as compounds (14–26) incorporating diverse bioactive heterocyclic scaffolds such as 1-adamantylamine, sulfamerazine, sulfadiazine, morpholine, 2-amino-5-methylthiazole, n-phenylpiperazine, and n-ethyl piperazine. These analogues were meticulously incorporated due to their potential medicinal relevance. Their antimicrobial properties were evaluated against Pseudomonas chlororaphis and Malassezia furfur. Notably, compounds 20 and 26, derived from distinct synthetic schemes, demonstrated the highest activity, with IC50 values of 57.66±0.47 and 17.33±0.47 µg/mL, respectively, against Pseudomonas chlororaphis, and IC50 values of 43.66±0.57 and 37.66±0.57 µg/mL, respectively, against Malassezia furfur. A comprehensive analysis utilizing Density Functional Theory (DFT) was employed to validate the experimental findings. This manuscript encapsulates the synthesis, biological assessment, and computational scrutiny of the novel s-triazine analogues, shedding light on their potential as antimicrobial agents and providing insights into their molecular characteristics. The ADMET analysis showed that the synthesized compounds had pharmacokinetic properties that are potentially suitable for clinical use.
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This study reports our experience of the first 4-way kidney exchange transplant combined with desensitization in India, which allows increased access to living-donor kidney transplant for sensitized ...patients.
Four-way kidney exchange transplant procedures were approved by the ethics committee of our institution and the Organ Transplantation Authorization Committee of state governments of India (as per the Transplantation of Human Organs Act of India). The protocols conformed to Declaration of Istanbul principles and the ethical guidelines of the 1975 Helsinki Declaration. Written informed consent was obtained from patients, donors, and their guardians.
In April 2016, our transplant team completed simultaneous 4-way kidney exchange transplant procedures without any medical (rejection and infections) or surgical complications. Reasons for being included for kidney exchange transplant were ABO incom-patible (2 recipients) and sensitization (2 recipients). All 4 recipients had stable graft function with no proteinuria and donor-specific antibody at 11-month follow-up on standard triple immunosup-pression. Patient and graft survival rates were both 100%.
To the best of our knowledge, this is the first single-center report of 4-way kidney exchange transplant combined with desensitization from India. This procedure has the potential to expand living-donor kidney transplant in disadvantaged groups (eg, sensitized patients). Recipients who are hard to match due to high panel reactive antibody and difficult to desensitize due to strong donor-specific antibodies can receive a transplant with a combination of kidney exchange and desensitization. Our study suggests that 4-way kidney exchange transplant can be performed in developing countries (India) similar to that shown in programs in developed countries with team work, kidney exchange registry, and counseling.
New class of substituted hetero-aryl guanidine derivatives were prepared as BL 11282 analog and screened in vitro for glucose-dependent insulinotropic activity.
Sulfonylureas stimulate insulin ...secretion independent of the blood glucose concentration and therefore cause hypoglycemia in type 2 diabetic patients. Over the last years, a number of aryl-imidazoline derivatives have been identified that stimulate insulin secretion in a glucose-dependent manner. In the present study, we have developed three series of substituted
N-(thieno2,3-
bpyridin-3-yl)-guanidine (
2a–
l),
N-(1
H-pyrrolo2,3-
bpyridin-3-yl)-guanidine (
3a–
l), and
N-(1
H-indol-3-yl)-guanidine (
4a–
l) as new class of antidiabetic agents. In vitro glucose-dependent insulinotropic activity of test compounds
2a–
l,
3a–
l, and
4a–
l was evaluated using RIN5F (Rat Insulinoma cell) based assay. All the test compounds showed concentration-dependent insulin secretion, only in presence of glucose load (16.7
mmol). Some of the test compounds (
2c,
3c, and
4c) from each series were found to be equipotent to BL 11282 (standard aryl-imidazoline), which indicated that the guanidine group acts as a bioisostere of imidazoline ring system.
Objectives : Adult patients undergoing tetralogy of Fallot (TOF) repair have a higher risk of mortality compared to pediatric patients. Pulmonary regurgitation (PR) further predisposes these patients ...to heart failure, arrhythmias, and sudden death. Pulmonary valve replacement (PVR) may improve the symptoms in these patients but, fails to reverse the other deleterious effects. Aim of our study was to evaluate the effect of concomitant PVR with TOF repair on right ventricular (RV) parameters, cardiopulmonary exercise capacity, and bioprosthetic valve durability at mid-term.
Materials and Methods: Between January 2013 and August 2018, 37 adolescents and adults with TOF who had hypoplastic pulmonary annulus underwent concomitant TOF repair with PVR at our institute. We retrospectively collected the data from the hospital records including follow-up.
Results : Mean age of the patients was 18.48 ± 7.53 years. Bioprosthetic valve size ranged from 19 mm to 25 mm. There was no early or late mortality. No patient had developed significant perioperative complications. At a mean follow-up of 53.3 ± 16.4 months, there was no significant change in mean QRS duration, RV function, RV end-systolic and end-diastolic dimensions, RV myocardial performance index, and functional status (including NYHA class and 6-min walk test) compared to at-discharge values. Four patients developed prosthetic valve degeneration with mild PR and without significant increase in gradient.
Conclusion : Concomitant PVR with TOF repair in adult provides excellent mid-term outcome, with a minimal rate of pulmonary valve degeneration. It not only eases the early postoperative course but also preserves the RV function as well as functional status at mid-term.
Behavioral economics provides insights about the development of effective incentives for physicians to deliver high-value care. It suggests that the structure and delivery of incentives can shape ...behavior, as can thoughtful design of the decision-making environment. This article discusses several principles of behavioral economics, including inertia, loss aversion, choice overload, and relative social ranking. Whereas these principles have been applied to motivate personal health decisions, retirement planning, and savings behavior, they have been largely ignored in the design of physician incentive programs. Applying these principles to physician incentives can improve their effectiveness through better alignment with performance goals. Anecdotal examples of successful incentive programs that apply behavioral economics principles are provided, even as the authors recognize that its application to the design of physician incentives is largely untested, and many outstanding questions exist. Application and rigorous evaluation of infrastructure changes and incentives are needed to design payment systems that incentivize high-quality, cost-conscious care.
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