Urinary complement biomarkers in immune-mediated kidney diseases.

The complement system, an important part of the innate system, is known to play a central role in many immune mediated kidney diseases. All parts of the complement system including the classical, alternative, and mannose-binding lectin pathways have been implicated in complement-mediated kidney injury. Although complement components are thought to be mainly synthesized in the liver and activated in the circulation, emerging data suggest that complement is synthesized and activated inside the kidney leading to direct injury. Urinary complement biomarkers are likely a better reflection of inflammation within the kidneys as compared to traditional serum complement biomarkers which may be influenced by systemic inflammation. In addition, urinary complement biomarkers have the advantage of being non-invasive and easily accessible. With the rise of therapies targeting the complement pathways, there is a critical need to better understand the role of complement in kidney diseases and to develop reliable and non-invasive biomarkers to assess disease activity, predict treatment response and guide therapeutic interventions. In this review, we summarized the current knowledge on urinary complement biomarkers of kidney diseases due to immune complex deposition (lupus nephritis, primary membranous nephropathy, IgA nephropathy) and due to activation of the alternative pathway (C3 glomerulopathy, thrombotic microangiography, ANCA-associated vasculitis). We also address the limitations of current research and propose future directions for the discovery of urinary complement biomarkers.

Harnessing Green Electricity from Food: A Split Black Gram-Based Triboelectric Nanogenerator for a Self-Powered Autonomous Lighting System and Portable Electronics.

Triboelectric nanogenerators (TENGs) represent a promising solution to mounting environmental concerns associated with battery disposal amid the escalating demand for portable electronics. However, prevailing TENG fabrication predominantly relies on nonbiodegradable, nonbiocompatible, and synthetic materials, posing a grave ecological threat. To mitigate this, there is a pressing need to develop eco-friendly and green TENGs leveraging sustainable, naturally occurring materials. This study pioneers the use of split black gram (SBG) as a tribo-positive material for TENGs. SBG's effectiveness as a tribo-positive material stems from its abundance of oxygen-containing functional groups, as confirmed by FTIR analysis, facilitating electron donation during the triboelectric process. SBG offers compelling advantages, including widespread availability, cost-effectiveness, biodegradability, and hydrophobic and adhesive properties due to its richness in starch and protein, positioning it as an optimal choice for eco-conscious TENG manufacturing. The fabrication process of an SBG-TENG is not only economical and facile but also solvent-free, requiring no specialized tools. Demonstrating commendable performance, the SBG-TENG achieves a maximum power density of 15.36 µW/cm2 at 1 MΩ, with an open circuit voltage of 84 V and short circuit current of 28 µA, comparable to recent studies. In practical applications, the SBG-TENG seamlessly integrates with LEDs and portable electronic devices via a full bridge rectifier, successfully powering them postcapacitor charging. Moreover, an autonomous lighting system is developed by embedding the SBG-TENG in a foot mat, enabling wireless light control through human stepping on the mat, introducing power-saving functionality for residential and office environments. In essence, the introduction of the SBG-TENG not only delivers cost-effectiveness but also minimizes the environmental impact by harnessing sustainable energy from food sources.

Adolopment of clinical practice guidelines and creation of referral pathways for psychiatric conditions in Pakistan.

Psychiatric disorders are highly prevalent in Pakistan and burdens the scarce number of psychiatrists present in the country. The establishment of evidence-based clinical practice guidelines (EBCPGs) and primary-care referral pathways within the local context is imperative to make the process efficient. In this Health Policy, we aimed to develop EBCPGs and primary-care referral pathways that are specific to Pakistan's primary-care setting, with the aim of facilitating the management of psychiatric conditions. Ten EBCPGs were created through the GRADE-ADOLOPMENT process; two recommendations were adopted with minor changes, 43 were excluded, and all others were adopted without any changes. Ten primary-care referral pathways for managing ten psychiatric disorders were created and 23 recommendations were added which will help to bridge the gap in care provision. These psychiatric referral pathways and EBCPGs will bring Pakistan's healthcare system a step closer to achieving optimal health outcomes for patients.

Impact of Ebola and COVID-19 on maternal, neonatal, and child health care among populations affected by conflicts: a scoping review exploring demand and supply-side barriers and solutions.

INTRODUCTION: Armed conflicts have a severe impact on the health of women and children. Global health emergencies such as pandemics and disease outbreaks further exacerbate the challenges faced by vulnerable populations in accessing maternal, neonatal, and child healthcare (MNCH). There is a lack of evidence that summarizes the challenges faced by conflict-affected pregnant women, mothers, and children in accessing MNCH services during global health emergencies, mainly the Ebola and COVID-19 pandemics. This scoping review aimed to analyze studies evaluating and addressing barriers to accessing comprehensive MNCH services during Ebola and COVID-19 emergencies in populations affected by conflict. METHODS: The search was conducted on PubMed, Scopus, and Web of Science databases using terms related to Ebola and COVID-19, conflicts, and MNCH. Original studies published between 1990 and 2022 were retrieved. Articles addressing the challenges in accessing MNCH-related services during pandemics in conflict-affected settings were included. Thematic analysis was performed to categorize the findings and identify barriers and solutions. RESULTS: Twenty-nine studies met the inclusion criteria. Challenges were identified in various MNCH domains, including antenatal care, intrapartum care, postnatal care, vaccination, family planning, and the management of childhood illnesses. Ebola-related supply-side challenges mainly concerned accessibility issues, health workforce constraints, and the adoption of stringent protocols. COVID-19 has resulted in barriers related to access to care, challenges pertaining to the health workforce, and new service adoption. On the demand-side, Ebola- and COVID-19-related risks and apprehensions were the leading barriers in accessing MNCH care. Community constraints on utilizing services during Ebola were caused by a lack of trust and awareness. Demand-side challenges of COVID-19 included fear of disease, language barriers, and communication difficulties. Strategies such as partnerships, strengthening of health systems, service innovation, and community-based initiatives have been employed to overcome these barriers. CONCLUSION: Global health emergencies amplify the barriers to accessing MNCH services faced by conflict-affected populations. Cultural, linguistic, and supply-side factors are key challenges affecting various MNCH domains. Community-sensitive initiatives enhancing primary health care (PHC), mobile clinics, or outreach programs, and the integration of MNCH into PHC delivery should be implemented. Efforts should prioritize the well-being and empowerment of vulnerable populations. Addressing these barriers is crucial for achieving universal health coverage and the Sustainable Development Goals.

Prevalence of visual dysfunction and ocular motility disorders in developmentally delayed patients.

Objective: To evaluate the prevalence of reduced visual acuity (VA), refractive errors (RE), reduced contrast sensitivity and strabismus in developmentally delayed (DD) patients. Methods: This descriptive cross sectional study was carried out in Ophthalmology Departments of Mayo Hospital, Lahore, The Children's Hospital, Lahore and The Children's Hospital, Multan from June 2019 to December 2019. We recruited 257 patients of either gender, between the ages of 06-16 years having intelligence quotient (IQ) ≤ 80 by Wechsler Intelligence Scale for Children (WISC) from the out-patient departments. Detailed systemic and ophthalmic history was taken and through anterior and posterior segment examination was carried out. VA was assessed with age matched VA charts. Cycloplegic refraction with 1% cyclopentolate was carried out. Contrast sensitivity was measured with hiding Heidi charts. Strabismus was assessed with Hirschberg and covers /uncover tests. Results: The mean age of the patients was 8.88 years with standard deviation (SD) of ± 2.70. The prevalence of reduced VA, RE, strabismus and reduced contrast sensitivity in these children were 43.58%, 52.92%, 52.14% and 32.7% respectively. Out of these 52.92% RE, 56 (21.79%) were myopic, 66 (25.68%) were hyperopic and 14 (05.45%) were astigmatic. The percentage of esotropia was 72 (28.02%) and exotropia was 62 (24.12%). Conclusion: The results of our study in DD children have shown that a significant number of children have reduced VA, RE, strabismus and reduced contrast sensitivity. Apart from general management of DD children by a pediatrician, the ophthalmic management of these problems must be carried out by a pediatric ophthalmologist to improve their quality of life.

Exogenously applied nicotinic acid alleviates drought stress by enhancing morpho-physiological traits and antioxidant defense mechanisms in wheat.

Across the globe, the frequent occurrence of drought spells has significantly undermined the sustainability of modern high-input farming systems, particularly those focused on staple crops like wheat. To ameliorate the deleterious impacts of drought through a biologically viable and eco-friendly approach, a study was designed to explore the effect of nicotinic acid on different metabolic, and biochemical processes, growth and yield of wheat under optimal moisture and drought stress (DS). The current study was comprised of different levels of nicotinic acid applied as foliar spray (0 g L-1, 0.7368, 1.477, 2.2159 g L-1) and fertigation (0.4924, 0.9848, and 1.4773 g L-1) under normal conditions and imposed drought by withholding water at anthesis stage. The response variables were morphological traits such as roots and shoots characteristics, yield attributes, grain and biological yields along with biosynthesis of antioxidants. The results revealed that nicotinic acid dose of 2.2159 g L-1 out-performed rest of treatments under both normal and DS. The same treatment resulted in the maximum root growth (length, fresh and dry weights, surface area, diameter) and shoot traits (length, fresh and dry weights) growth. Additionally, foliar applied nicotinic acid (2.2159 g L-1) also produced as the highest spike length, grains spike-1, spikelet's spike-1 and weight of 1000 grains. Moreover, these better yield attributes led to significantly higher grain yield and biological productivity of wheat. Likewise in terms of physiological growth of wheat under DS, the same treatment remained superior by recording the highest SPAD value, relative water content, water potential of leaves, leaf area, stomatal conductance (292 mmolm-2S-1), internal carbon dioxide concentration, photosynthesis and transpiration rate. Interestingly, exogenously applied nicotinic acid remained effective in triggering the antioxidant system of wheat by recording significantly higher catalase, peroxidase, superoxide dismutase and ascorbate peroxidase.

Association of cumulative social risk and gestational diabetes mellitus in the US, 2007-2018.

AIMS: Little is known regarding the association of multiple social risk factors and gestational diabetes mellitus (GDM). METHODS: We analyzed the 2007-2018 National Health and Nutrition Examination Surveys including 10,439 women aged ≥20 years (8 % with history of GDM). We created a cumulative social risk score (CSR) by adding scores assigned to each of the following: race/ethnicity, citizenship status and country of birth, education, and family income (score of 0 used as reference group). Using logistic regression, we assessed the associations of individual social risk factors (education, income, race/ethnicity and citizenship status) and CSR score with GDM, adjusting for age, parity, insurance status, care access, smoking, diet, physical activity, and body mass index. RESULTS: Among individual social risk factors, being a non-U.S. citizen (OR:1.51, 95% CI: 1.06-2.15) or belonging to a minority racial/ethnic group (OR:1.30, 95% CI: 1.04-1.59) was significantly associated with a greater odds of GDM. When examining the combined effects of social risk factors, a CSR score ≥3 was associated with an increased odds of GDM (OR:1.64, 95% CI: 1.22-2.1). CONCLUSIONS: Women with a greater burden of social risk factors are more likely to have GDM, thus should be the focus of interventions to prevent and treat GDM.

Is peri-transplant blood transfusion associated with worse transplant outcomes? A retrospective study.

BACKGROUND: Blood transfusion is common during the peri-transplantation period. The incidence of immunological reactions to blood transfusion after kidney tran splantation and their consequences on graft outcomes have not been extensively studied. AIM: To examine the risk of graft rejection and loss in patients who received blood transfusion in the immediate peri-transplantation period. METHODS: We conducted a single-center retrospective cohort study of 105 kidney recipients, among them 54 patients received leukodepleted blood transfusion at our center between January 2017 and March 2020. RESULTS: This study included 105 kidney recipients, of which 80% kidneys were from living-related donors, 14% from living-unrelated donors, and 6% from deceased donors. Living-related donors were mostly first-degree relatives (74.5%), while the rest were second-degree relatives. The patients were divided into transfusion (n = 54) and non-transfusion (n = 51) groups. The average hemoglobin level at which blood transfusion was commenced was 7.4 ± 0.9 mg/dL. There were no differences between the groups in terms of rejection rates, graft loss, or death. During the study period, there was no significant difference in creatinine level progression between the two groups. Delayed graft function was higher in the transfusion group; however, this finding was not statistically significant. A high number of transfused packed red blood cells was significantly associated with increased creatinine levels at the end of the study. CONCLUSION: Leukodepleted blood transfusion was not associated with a higher risk of rejection, graft loss, or death in kidney transplant recipients.

Enhancing drought stress tolerance in Camelina (Camelina sativa L.) through exogenous application of potassium.

The current study was performed under controlled conditions to study the effects of exogenous potassium application on carotenoid contents and drought tolerance in Camelina. Water deficit levels such as 100% FC (control) and 40% FC (drought stress) were imposed after germination of Camelina plants grown to maturity, and different treatments of exogenous K+ were applied at the vegetative stage. We have reported 17 traits of plant growth, physiology, antioxidant enzyme activity, focusing on carotenoids in Camelina to explore their potential yield and yield components. For this purpose, we used multivariate analysis techniques (descriptive statistics, correlation matrix, analysis of variance [ANOVA] and principal components analysis [PCA] to determine the best relation between potassium and studied traits). The results showed a large number of variations in the studied trait under control and water deficit condition. Plant fresh weight (g) was negatively correlated with shoot length and SOD insignificantly correlated with plant fresh weight (g) under water deficit conditions. Potassium loading predicted that foliar application (3 mM K2 SO4 ), foliar application (6 mM KNO3 ), foliar application (12 mM KNO3 ) and foliar application (12 mM K2 SO4 ) are the important doses that contribute the most to enhance the growth, physiological and biochemical activities and carotenoids to improve the Camelina yield under water deficit condition. These doses should be considered in the future to improve the Camelina yield under semi-arid conditions with increased genetic diversity (varietal selection).

Effect of Exogenous Application of Nicotinic Acid on Morpho-Physiological Characteristics of Hordeum vulgare L. under Water Stress.

Abiotic stresses, such as high temperature and drought conditions, greatly influence the development of plants and the quality and quantity of products. Barley (Hordeum vulgare L.) crop production is largely impacted by drought, affecting growth, yield, and ultimately the productivity of the crop in hot arid/semi-arid conditions. The current pot experiment was directed to observe the outcome of nicotinic acid (NA) treatments on barley's physiological, biochemical, and production attributes at two capacity levels, i.e., 100% normal range and withholding water stress. Randomized complete block design (RCBD) was used during the experimentation with the two-factor factorial arrangement. NA was applied exogenously by two different methods, i.e., foliar and soil application (fertigation). NA solution contained various application levels, such as T1 = control, foliar applications (T2 = 0.7368 gL-1, T3 = 1.477 gL-1, T4 = 2.2159 gL-1), and soil applications (T5 = 0.4924 gL-1, T6 = 0.9848 gL-1, and T7 = 1.4773 gL-1). Results depicted that, overall, foliar treatments showed better effects than control and soil treatments. Plant growth was preeminent under T4 treatment, such as plant height (71.07 cm), relative water content (84.0%), leaf water potential (39.73-MPa), leaf area index (36.53 cm2), biological yield (15.10 kgha-1), grain yield (14.40 kgha-1), harvest index (57.70%), catalase (1.54 mmolg-1FW-1), peroxidase (1.90 g-1FWmin-1), and superoxide dismutase (52.60 µgFW-1) were superior under T4 treatment. Soil plant analysis development (54.13 µgcm-2) value was also higher under T4 treatment and lowest under T7 treatment. In conclusion, NA-treated plants were more successful in maintaining growth attributes than non-treated plants; therefore, the NA foliar treatment at the rate of 2.2159 gL-1 is suggested to find economical crop yield under drought conditions. The present study would contribute significantly to improving the drought tolerance potential of barley through exogenous NA supply in water deficit areas.

An Intelligent Proposed Model for Task Offloading in Fog-Cloud Collaboration Using Logistics Regression.

Smart applications and intelligent systems are being developed that are self-reliant, adaptive, and knowledge-based in nature. Emergency and disaster management, aerospace, healthcare, IoT, and mobile applications, among them, revolutionize the world of computing. Applications with a large number of growing devices have transformed the current design of centralized cloud impractical. Despite the use of 5G technology, delay-sensitive applications and cloud cannot go parallel due to exceeding threshold values of certain parameters like latency, bandwidth, response time, etc. Middleware proves to be a better solution to cope up with these issues while satisfying the high requirements task offloading standards. Fog computing is recommended middleware in this research article in view of the fact that it provides the services to the edge of the network; delay-sensitive applications can be entertained effectively. On the contrary, fog nodes contain a limited set of resources that may not process all tasks, especially of computation-intensive applications. Additionally, fog is not the replacement of the cloud, rather supplement to the cloud, both behave like counterparts and offer their services correspondingly to compliance the task needs but fog computing has relatively closer proximity to the devices comparatively cloud. The problem arises when a decision needs to take what is to be offloaded: data, computation, or application, and more specifically where to offload: either fog or cloud and how much to offload. Fog-cloud collaboration is stochastic in terms of task-related attributes like task size, duration, arrival rate, and required resources. Dynamic task offloading becomes crucial in order to utilize the resources at fog and cloud to improve QoS. Since this formation of task offloading policy is a bit complex in nature, this problem is addressed in the research article and proposes an intelligent task offloading model. Simulation results demonstrate the authenticity of the proposed logistic regression model acquiring 86% accuracy compared to other algorithms and confidence in the predictive task offloading policy by making sure process consistency and reliability.

Willingness for Solid-Organ Donation in Saudi Arabia: A Skyscape View.

OBJECTIVES: The number of patients with organ failure in Saudi Arabia is increasing annually, and transplantation offers the best outcome for these patients. However, the number of donors does not meet these needs. MATERIALS AND METHODS: A questionnaire was distri-buted to assess the behavior of participants in Saudi Arabia toward different types of organ donation. The questionnaire examined general willingness to donate, deceased donation, living donation, and refusal to donate, as well as paired-exchange donation and next-of-kin consenting. RESULTS: Of the 1099 participants, most were men (64%) and middle-aged (46%, 31-45 years old), with 36% of participants currently willing to donate or already registered as donors. Although 592 participants (54%) were not yet willing to donate, they believed they could consider making donations in specific circumstances (eg, when a relative is in need). In all circumstances, 10% (n = 108) of the participants refused to donate. With regard to deceased donation, 74% of participants accepted this, but only 29% (n = 322) agreed to consent for donation as next of kin. Of 1099 participants, 143 (13%) were willing to accept altruistic donation. Paired-exchange donation was widely accepted in a cohort study (n = 725, 65%), as opposed to list exchange (n = 540, 49%). Religious beliefs were the main reason behind the refusal of donation in the study cohort (n = 37, 37%). Female participants were less likely to refuse organ donation (odds ratio: 0.562; 95% CI, 0.407-0.775; P < .001), whereas older participants (> 60 years) were more likely to refuse organ donation (odds ratio: 5.457; 95% CI, 1.894-15.722; P = .002). CONCLUSIONS: This study described the willingness of the Saudi population to donate organs in general and under special conditions, such as deceased donation, living-unrelated donation, altruistic donation, paired-exchange donation, list exchange donation, and next-of-kin consent.

Practice Patterns in the Acceptance of Medically Complex Living Kidney Donors with Obesity, Hypertension, Family History of Kidney Disease, or Donor-Recipient Age Discrepancy.

Background To assess the practice patterns of the acceptance of medically complex living kidney donors (MCLKDs). Methods We distributed a survey to nephrologists and transplant surgeons (TS) across the world through major international transplant societies. The survey contained questions regarding obesity, abnormal blood glucose profile, mild hypertension, donor-recipient age discrepancy, or family history of kidney disease of unknown etiology. Results In total, 239 respondents from 29 countries (42% were nephrologists and 58% were TS). Most respondents would allow donations from obese donors, especially if they intended to lose weight but would be cautious if these donors had abnormal blood glucose or family history of diabetes mellitus. In hypertensive donors, future pregnancy plans mattered in decisions regarding the acceptance of female donors. Most respondents would allow young donors but would be more cautious if they had a future risk of hypertension or a family history of kidney disease of unknown etiology. They would also allow donations from an older person if prolonged waiting time was anticipated. We found multiple areas of consensus of practice among the diverse members of international transplant societies, with some interesting variations among nephrologists and TS. Conclusions This survey highlights the practice patterns of the acceptance of MCLKDs among the international community. In the absence of clear guidelines, this survey provides additional information to counsel kidney donors with these conditions.

Practice Patterns for the Acceptance of Medically Complex Living Kidney Donors with Hematuria, Sickle Cell Trait, Smoking, Illegal Drug Use, or Urological Issues: A Multinational Survey.

Background To review the practice patterns for the acceptance of medically complex living kidney donors (MCLKD) among the transplant providers of the international transplant community. Methods We distributed a survey globally, through major international transplantation societies, among nephrologists and transplant surgeons (TS). The survey contained questions regarding potential donors with microscopic hematuria, sickle cell trait, renal cysts, kidney stones, smoking, or illegal drug use. Results There were 239 respondents from 29 countries, including nephrologists (42%) and TS (58%). Although most respondents would investigate microscopic hematuria, one-third of them indicated they would decline these potential donors without investigation. Interestingly, most respondents accepted heavy smokers, intermittent illegal drug users (with advice to quit), and those with incidentally identified kidney stones, remote history of renal colic or simple renal cysts. We found multiple areas of consensus in practice with some interesting differences between nephrologists and TS. Conclusions This survey highlights the practice patterns of the acceptance of MCLKDs among the international community. In the absence of clear guidelines, this survey provides additional information to counsel kidney donors with microscopic hematuria, sickle cell trait, renal cysts, kidney stones, heavy smoking, or illegal drug use.

Role of nitrogen and magnesium for growth, yield and nutritional quality of radish.

Nitrogen (N) affects all levels of plant function from metabolism to resource allocation, growth, and development and Magnesium (Mg) is a macronutrient that is necessary to both plant growth and health. Radish (Raphanus sativus L.) occupies an important position in the production and consumption of vegetables globally, but there are still many problems and challenges in its nutrient management. A pot trial was conducted to investigate the effects of nitrogen and magnesium fertilizers on radish during the year 2018-2019. Nitrogen and magnesium was applied at three rates (0, 0.200, and 0.300 g N kg-1 soil) and (0, 0.050, and 0.100 g Mg kg-1 soil) respectively. The experiment was laid out in a completely randomized design (CRD) and each treatment was replicated three times. Growth, yield and quality indicators of radish (plant height, root length, shoot length, plant weight, total soluble sugar, ascorbic acid, total soluble protein, crude fiber, etc.) were studied. The results indicated that different rates of nitrogen and magnesium fertilizer not only influence the growth dynamics and yields but also enhances radish quality. The results revealed that the growth, yield and nutrient contents of radish were increased at a range of 0.00 g N. kg-1 soil to 0.300 g N. kg-1 soil and 0.00 g Mg. kg-1 soil to 0.050 g Mg. kg-1 soil and then decreased gradually at a level of 0.100 g Mg. kg-1 soil. In contrast, the crude fiber contents in radish decreased significantly with increasing nitrogen and magnesium level but increased significantly at Mg2 level (0.050 g Mg. kg-1 soil). The current study produced helpful results for increasing radish quality, decreasing production costs, and diminishing underground water contamination.

Novel Approach to Support Rapid Data Collection, Management, and Visualization During the COVID-19 Outbreak Response in the World Health Organization African Region: Development of a Data Summarization and Visualization Tool.

BACKGROUND: The COVID-19 pandemic has created unprecedented challenges to the systematic and timely sharing of COVID-19 field data collection and management. The World Health Organization (WHO) is working with health partners on the rollout and implementation of a robust electronic field data collection platform. The delay in the deployment and rollout of this electronic platform in the WHO African Region, as a consequence of the application of large-scale public health and social measures including movement restrictions and geographical area quarantine, left a gap between data collection and management. This lead to the need to develop interim data management solutions to accurately monitor the evolution of the pandemic and support the deployment of appropriate public health interventions. OBJECTIVE: The aim of this study is to review the design, development, and implementation of the COVID-19 Data Summarization and Visualization (DSV) tool as a rapidly deployable solution to fill this critical data collection gap as an interim solution. METHODS: This paper reviews the processes undertaken to research and develop a tool to bridge the data collection gap between the onset of a COVID-19 outbreak and the start of data collection using a prioritized electronic platform such as Go.Data in the WHO African Region. RESULTS: In anticipation of the implementation of a prioritized tool for field data collection, the DSV tool was deployed in 18 member states for COVID-19 outbreak data management. We highlight preliminary findings and lessons learned from the DSV tool deployment in the WHO African Region. CONCLUSIONS: We developed a rapidly deployable tool for COVID-19 data collection and visualization in the WHO African Region. The lessons drawn on this experience offer an opportunity to learn and apply these to improve future similar public health informatics initiatives in an outbreak or similar humanitarian setting, particularly in low- and middle-income countries.

Role of MicroRNAs in Establishing Latency of Human Immunodeficiency Virus.

Acquired immunodeficiency syndrome (AIDS) emerged as an epidemic in Africa in 1981, and now it has become a most destructive global pandemic. Human immunodeficiency virus (HIV) is responsible for the pathogenesis of AIDS, and it is usually transmitted through unsafe sexual activities. HIV is a lentivirus that can remain latent in the host cells for a long period, and it has various mechanisms to establish latency. The HIV genome encodes several microRNAs (miRNA-TAR, miRNA-H1, miRNA-H3, and miRNA-Nef-367) that act as posttranscriptional control by targeting mRNA sequences. The miRNA-TAR, miRNA-Nef-367, and miRNA-H1 have established roles in HIV latency, whereas miRNA-H3 can activate the latent reservoirs of HIV. The human genome also encodes several miRNAs that have defensive roles against infections. Cellular miRNAs (miRNA-29a, miRNA-146a, miRNA-34c-5'p, miRNA-186, miRNA-210 and miRNA-222) also contribute to viral latency. The most challenging hurdle in the development of effective HIV therapeutics is viral latency. A complete understanding of latency will enable us to develop efficient therapeutics and to eradicate HIV from the globe.

Consensus guidelines of cardiovascular risk assessment in kidney transplantation in Saudi Arabia: Review of current practice, evidence, and recommendations.

Screening for cardiovascular (CV) disease before transplant is common. However, the clinical utility of screening asymptomatic transplant candidates remains unclear. There is a large degree of variation among the practices of the different transplant centers in the Kingdom of Saudi Arabia (KSA) and among the international guidelines. Opinions are mostly based on mixed observational data with a great potential for bias. When compared to the Western countries, renal-transplant candidates in the KSA are likely to have longer dialysis vintage, higher prevalence of catheter use, higher rate of uncontrolled hyperparathyroidism, and high prevalence of diabetes. These factors are likely to expose renal-transplant candidates to a higher CV risk than those in Western countries. In the absence of any published guideline for CV risk assessment of the renal-transplant candidate in the KSA, we present these guidelines as the first published guidelines in the KSA. These guidelines review the pertinent aspects from the most recent American College of Cardiology/American Heart Association guidelines for cardiac disease evaluation and management among kidney-transplant candidates and reflect on the local practices in the KSA. These guidelines overview many of the daily- encountered challenges in renal transplantation such as the indications for stress testing, screening coronary angiogram and prophylactic revascularization, screening and management of pulmonary hypertension, cardiac surveillance while on the waiting list and duration of dual-antiplatelet therapy before renal transplant. These guidelines were reviewed by a team of consultant nephrologists, cardiologists, anesthesiologists, and transplant surgeons from six major transplant centers in the KSA. The guidelines aim to standardize the practices of CV risk assessment in kidney transplantation in the KSA, according to the most up-to-date available evidence. The expected impact of these guidelines on the current practices is also reviewed here.