Hypokalemia Due to Ectopic Adrenocorticotropic Hormone.

Hypokalemia is a common disorder in clinical practice. The underlying pathophysiology can be attributed to 3 main mechanisms: insufficient potassium intake, excessive urinary or gastrointestinal losses, and transcellular shift. Renal loss is the most common cause of hypokalemia. Renal loss of potassium can occur due to diuretics, mineralocorticoid excess or hypercortisolism (Cushing syndrome). Among patients with Cushing syndrome, ectopic adrenocorticotropic hormone (ACTH) is the most frequent cause. We present a case of hypokalemia and hypertension due to ectopic ACTH production leading to Cushing syndrome.

Ultrasound assisted extraction of phytochemicals from Piper betel L.

Piper betel contains phytochemicals with diverse pharmacological effects. The objective of this study was to enhance the extraction efficiency of phytochemicals and the chlorophyll content using ultrasonication. The Box-Behnken design was employed to optimize the time (10, 20, 30 min), temperature (20, 30, and 40 °C), and solid-solvent ratio (1:10, 1:20, 1:30) by utilizing response surface methods with three independent variables. Multiple parameters, including extract yield, total phenol, total flavonoid, antioxidant activity, and chlorophyll content were used to optimize the conditions. The linear relationship between power intensity and responses was determined to be statistically significant, with a p-value less than 0.01. The interaction effect of temperature, time, and ratio of solid solvent was shown to be statistically significant (p < 0.05) for all the obtained results. The optimal parameters for achieving the highest extract yield were as follows: a temperature of 40 °C, a sonication time of 30 min, and a solid solvent ratio of 1:10. These conditions result in an extract yield of 21.99 %, a total flavonoid content of 44.97 mg/GAE, a total phenolic content of 185.05 mg/GAE, a DPPH scavenging activity of 99.1 %, and a chlorophyll content of 49.95 mg/ml. This study highlights the significance of customized extraction methodologies for optimizing the bioactive capacity of phytochemicals derived from betel leaves. The elucidation of extraction parameters and the resultant phytochemical profiles serves as a fundamental framework for the advancement of innovative pharmaceuticals and nutraceuticals, capitalizing on the therapeutic attributes of this traditional medicinal botanical.

Association of Circulating 25-Hydroxyvitamin D and Recurrence of Glomerulonephritis in Kidney Transplant Recipients: The Wisconsin Allograft Recipient Database (WisARD).

Background: Recurrence of glomerulonephritis (GN) is a significant contributor to long-term allograft failure among kidney transplant recipients (KTRs) with kidney failure because of GN. Accumulating evidence has revealed the role of vitamin D in both innate and adaptive immunity. Although vitamin D deficiency is common among KTRs, the association between 25-hydroxyvitamin D (25[OH]D) and GN recurrence in KTRs remains unclear. Methods: We analyzed data from KTRs with kidney failure caused by GN who received a transplant at our center from 2000 to 2019 and had at least 1 valid posttransplant serum 25(OH)D measurement. Survival analyses were performed using a competing risk regression model considering other causes of allograft failure, including death, as competing risk events. Results: A total of 67 cases of GN recurrence were identified in 947 recipients with GN followed for a median of 7.0 y after transplant. Each 1 ng/mL lower serum 25(OH)D was associated with a 4% higher hazard of recurrence (subdistribution hazard ratio [HR]: 1.04; 95% confidence interval [CI], 1.01-1.06). Vitamin D deficiency (≤20 ng/mL) was associated with a 2.99-fold (subdistribution HR: 2.99; 95% CI, 1.56-5.73) higher hazard of recurrence compared with vitamin D sufficiency (≥30 ng/mL). Results were similar after further adjusting for concurrent urine protein-creatinine ratio, serum albumin, and estimated glomerular filtration rate (eGFR). Conclusions: Posttransplant vitamin D deficiency is associated with a higher hazard of GN recurrence in KTRs. Further prospective observational studies and clinical trials are needed to determine any causal role of vitamin D in the recurrence of GN after kidney transplantation. More in vitro and in vivo experiments would be helpful to understand its effects on autoimmune and inflammation processes.

Bioactive properties of clove (Syzygium aromaticum) essential oil nanoemulsion: A comprehensive review.

Syzygium aromaticum, commonly called clove, is a culinary spice with medical uses. Clove is utilized in cosmetics, medicine, gastronomy, and agriculture due to its abundance of bioactive components such as gallic acid, flavonoids, eugenol acetate, and eugenol. Clove essential oil has been revealed to have antibacterial, antinociceptive, antibacterial activities, antifungal, and anticancerous qualities. Anti-inflammatory chemicals, including eugenol and flavonoids, are found in clove that help decrease inflammation and alleviate pain. The anti-inflammatory and analgesic qualities of clove oil have made it a popular natural cure for toothaches and gum discomfort. Due to its therapeutic potential, it has been used as a bioactive ingredient in coating fresh fruits and vegetables. This review article outlines the potential food processing applications of clove essential oil. The chemical structures of components, bioactive properties, and medicinal potential of clove essential oil, including phytochemical importance in food, have also been thoroughly addressed.

New Insights Into Pyridoxal Kinase Inhibitors and Their Antileukemic Effects.

Pyridoxal kinase (PDXK) plays a pivotal role as an essential enzyme in cellular processes. It catalyzes the phosphorylation of pyridoxal, pyridoxamine, and pyridoxine to generate pyridoxal 5'-phosphate (PLP), the bioactive form of vitamin B6. An intriguing link has emerged between elevated expression levels of PDXK and PLP and various types of carcinomas, including leukemia. Leukemic cells have an increased need for vitamin B6 to sustain their survival and rapid growth, highlighting the potential of targeting PDXK-PLP as a promising therapeutic target in cancer treatment. To discover a novel and promising PDXK inhibitor, we conducted a comprehensive screening of compounds derived from both natural sources and drug-like databases. Our approach involved employing structure-based virtual screening and molecular docking techniques to attenuate the phosphorylation of PLP. Among the top six compounds, ZINC095099376 (referred to as C03) emerged as the most potent inhibitor of PDXK, primarily due to its exceptional binding affinity and remarkable specificity for the target protein. Furthermore, our investigation revealed that compound C03 establishes crucial interactions with key residues within the substrate binding site, indicating that it binds at the same site as the co-crystallized ligand. Remarkably, compound C03 inhibited the endogenous PDXK expression, showed anti-proliferative activity, and triggered an intrinsic pathway for apoptosis via the activation of key apoptotic factors in leukemic cells. In summary, these findings strongly indicate that compound C03 holds promise as a novel inhibitor of PDXK, offering the potential for the development of effective treatments for leukemia.

Bioinspired fabrication of zinc hydroxide-based nanostructure from lignocellulosic biomass Litchi chinensis leaves and its efficacy evaluation on antibacterial, antioxidant, and anticancer activity.

Zinc-based nanostructures are known for their numerous potential biomedical applications. In this context, the biosynthesis of nanostructures using plant extracts has become a more sustainable and promising alternative to effectively replace conventional chemical methods while avoiding their toxic impact. In this study, following a low-temperature calcination process, a green synthesis of Zn-hydroxide-based nanostructure has been performed using an aqueous extract derived from the leaves of Litchi chinensis, which is employed as a lignocellulose waste biomass known to possess a variety of phytocompounds. The biogenic preparation of Zn-hydroxide based nanostructures is enabled by bioactive compounds present in the leaf extract, which act as reducing and capping agents. In order to evaluate its physicochemical characteristics, the produced Zn-hydroxide-based nanostructure has been subjected to several characterization techniques. Further, the multifunctional properties of the prepared Zn-hydroxide-based nanostructure have been evaluated for antioxidant, antimicrobial, and anticancer activity. The prepared nanostructure showed antibacterial efficacy against Bacillus subtilis and demonstrated its anti-biofilm activity as evaluated through the Congo red method. In addition, the antioxidant activity of the prepared nanostructure has been found to be dose-dependent, wherein 91.52 % scavenging activity could be recorded at 200 µg/ml, with an IC50 value of 45.22 µg/ml, indicating the prepared nanostructure has a high radical scavenging activity. Besides, the in vitro cytotoxicity investigation against HepG2 cell lines explored that the as-prepared nanostructure exhibited a higher cytotoxic effect and 73.21 % cell inhibition could be noticed at 25.6 µg/ml with an IC50 of 2.58 µg/ml. On the contrary, it was found to be significantly lower in the case of HEK-293 cell lines, wherein ~47.64 % inhibition could be noticed at the same concentration. These findings might be further extended to develop unique biologically derived nanostructures that can be extensively evaluated for various biomedical purposes.

Bacterial cellulase production via co-fermentation of paddy straw and Litchi waste and its stability assessment in the presence of ZnMg mixed-phase hydroxide-based nanocomposite derived from Litchi chinensis seeds.

Co-fermentation via co-cultured bacterial microorganisms to develop enzymes in solid-state fermentation (SSF) is a promising approach. This strategy is imperative in a series of sustainable and effective approaches due to superior microbial growth and the use of a combination of inexpensive feedstocks for enzyme production wherein mutually participating enzyme-producing microbial communities are employed. Moreover, the addition of nanomaterials to this technique may aid in its prominent advantage of enhancing enzyme production. This strategy may be able to decrease the overall cost of the bioprocessing to produce enzymes by further implementing biogenic, route-derived nanomaterials as catalysts. Therefore, the present study attempts to explore endoglucanase (EG) production using a bacterial coculture system by employing two different bacterial strains, namely, Bacillus subtilis and Serratia marcescens under SSF in the presence of a ZnMg hydroxide-based nanocomposite as a nanocatalyst. The nanocatalyst based on ZnMg hydroxide has been prepared via green synthesis using Litchi waste seed, while SSF for EG production has been conducted using cofermentation of litchi seed (Ls) and paddy straw (Ps) waste. Under an optimized substrate concentration ratio of 5:6 Ps:Ls and in the presence of 2.0 mg of nanocatalyst, the cocultured bacterial system produced 1.6 IU/mL of EG enzyme, which was ~1.33 fold higher as compared to the control. Additionally, the same enzyme showed its stability for 135 min in the presence of 1.0 mg of nanocatalyst at 38 °C. The nanocatalyst has been synthesized using the green method, wherein waste litchi seed is used as a reducing agent, and the nanocatalyst could be employed to improve the production and functional stability of crude enzymes. The findings of the present study may have significant application in lignocellulosic-based biorefinaries and cellulosic waste management.

Bioremediation of polycyclic aromatic hydrocarbons: An updated microbiological review.

A class of organic priority pollutants known as PAHs is of critical public health and environmental concern due to its carcinogenic properties as well as its genotoxic, mutagenic, and cytotoxic properties. Research to eliminate PAHs from the environment has increased significantly due to awareness about their negative effects on the environment and human health. Various environmental factors, including nutrients, microorganisms present and their abundance, and the nature and chemical properties of the PAH affect the biodegradation of PAHs. A large spectrum of bacteria, fungi, and algae have ability to degrade PAHs with the biodegradation capacity of bacteria and fungi receiving the most attention. A considerable amount of research has been conducted in the last few decades on analyzing microbial communities for their genomic organization, enzymatic and biochemical properties capable of degrading PAH. While it is true that PAH degrading microorganisms offer potential for recovering damaged ecosystems in a cost-efficient way, new advances are needed to make these microbes more robust and successful at eliminating toxic chemicals. By optimizing some factors like adsorption, bioavailability and mass transfer of PAHs, microorganisms in their natural habitat could be greatly improved to biodegrade PAHs. This review aims to comprehensively discuss the latest findings and address the current wealth of knowledge in the microbial bioremediation of PAHs. Additionally, recent breakthroughs in PAH degradation are discussed in order to facilitate a broader understanding of the bioremediation of PAHs in the environment.

Post-transplant idiopathic immune complex membrano-proliferative glomerulonephritis: Characteristics and outcomes.

BACKGROUND: There is little published information on the natural history and the treatment of immune complex membrano-proliferative glomerulonephritis (IC-MPGN) of unknown cause in the transplanted kidney. MATERIALS AND METHODS: From 01/2004 to 12/2018, 41 patients had the diagnosis of post-transplant idiopathic IC-MPGN and were included in the study. RESULTS: The mean age of the cohort at the time of transplant was 50 ± 13 years. The most common presentation was increased proteinuria, followed by kidney dysfunction. Fewer than 50% of patients had hematuria at presentation. 25 patients (61%) had no change in their baseline immunosuppression after the diagnosis of idiopathic IC-MPGN. Eight patients (19.5%) received steroids alone, and 8 patients (19.5%) received rituximab with (7) or without (1) steroids. The patients who received rituximab had better uncensored graft survival than the patients who received no treatment (p = 0.02), but the benefit of steroids compared to no treatment did not reach statistical significance (p = 0.05). The multivariate analysis retained eGFR < 30 mL/min/1.73m2 at time of diagnosis (HR = 3.30, p = 0.02; 95% Cl 1.15 - 9.46) as a significant predictor of graft loss. In this analysis, treatment of idiopathic IC-MPGN was associated with lower graft loss (HR = 0.22, p = 0.02; 95% Cl 0.06 - 0.78). CONCLUSION: To the best of our knowledge, this is the largest clinic-pathological series of post-transplant idiopathic IC-MPGN. Treatment of idiopathic IC-MPGN may be associated with better graft outcomes.

Post-COVID green supply chain management of used products: a study towards awareness for vaccination.

In the era of digital media, there is rapid spread of information. During coronavirus (COVID-19) pandemic situation, the government and other administrative bodies were highly dependent on media outlets, as direct contact was not feasible. Visual communication tools are used to spread awareness and encourage people towards vaccination. The circulation of wrong information may lead to confusion, which may cause denying the vaccine. There was a need to know the extent for contribution of visual communication tools for spreading correct information and motivating the society towards vaccination in post COVID times. In the present study, survey questionnaires were framed specific to which media (print or digital) was more effective to deliver the correct information to the targeted audience. The present study objectives to answer the questions through a survey of 312 people of different age groups, and the data was collected about their families. The obtained data was tested through hypothesis, and fact-checked was performed adopting analysis of variance (ANOVA). The results from the study highlighted that different age groups prefer different mediums of communication. The reach and adoption of digital media have tremendously increased, and it helped to achieve the sustainable development goals (SDGs) by efficient green supply chain management (GSCM) of daily plastic and paper wastage during post-pandemic.

Sustainable approaches towards green synthesis of TiO2 nanomaterials and their applications in photocatalysis-mediated sensing to monitor environmental pollution.

Nanomaterials are gaining enormous interests due to their novel applications that have been explored nearly in every field of our contemporary society. In this scenario, preparations of nanomaterials following green routes have attracted widespread attention in terms of sustainable, reliable, and environmentally friendly practices to produce diverse nanostructures. In this review, we summarize the fundamental processes and mechanisms of green synthesis approaches of TiO2 nanoparticles (NPs). We explore the role of plants and microbes as natural bioresources to prepare TiO2 NPs. Particularly, focus has been made to explore the potential of TiO2 -based nanomaterials to design a variety of sensing platforms by exploiting the photocatalysis efficiency under the influence of a light source. These types of sensing are of massive importance for monitoring environmental pollution and therefore for inventing advanced strategies to remediate hazardous pollutants and offer a clean environment.

Home call during nephrology fellowship: Burden or benefit?

BACKGROUND: Home call is one of the factors that can influence physician wellness. Nephrology fellows at the University of Wisconsin tracked home call activities in an attempt to quantify the impact of sleep to identify areas for improvement. MATERIALS AND METHODS: Each of the 6 nephrology fellows filled out a daily survey between November 9, 2020, and January 31, 2021, to address total hours, quality of sleep, and if the fellows reported to the hospital. RESULTS: The average amount of sleep per night was 5.3 hours. When necessary to report to the hospital (50%), the average hours of sleep dropped to 4.3 hours. However, if not called in, sleep increased to 5.8 hours per night. Sleep quality during night call was described as restful for 55% of nights. CONCLUSION: Obtaining an understanding of how a call can impact a learner is essential to making decisions about programmatic structural changes. Programs might use this data to compare their programs when making decisions about call structure. Hospital culture or overnight management changes can be made to impact the number of phone calls or needs to report to the hospital.

Kinetics investigation of phenolic pollutant degradation via Serratia marcescens ABHI 001 and its application in wastewater treatment.

In the present work, kinetic study has been conducted in order to effectively eliminate the p-cresol from wastewater employing isolated bacterial strain Serratia marcescens ABHI001 under batch shake flasks in the concentration varying from 50 to 500 mg/L. Further, effects of various parameters including p-cresol concentration, inoculum dosage, temperature, pH and agitation have been investigated. It was found that 10% v/v inoculum of 24 h age, was effective in degrading p-cresol. Beside this, it was noticed that the concentration of P-cresol above 100 mg/L exhibited an inhibitory effect. The maximum specific growth rate (µmax) was obtained to be 0.360 h-1 for 100 mgL-1 concentration. Further, the experimental results were well fitted with Halden's and Andrew's models and kinetic parameters µmax, KS and Ki in case of Haldane model were calculated to be 0.9697 h-1, 88.07 mgL-1 and 219.9 mgL-1, respectively whereas the corresponding values in case of Andrews's constants were 0.6917 h-1, 62.83 mgL-1 and 307.4 mgL-1, respectively. The yield coefficient for the growth on p-cresol was found to be 0.82.

Polyhydroxybutyrate (PHB) produced from red grape pomace: Effect of purification processes on structural, thermal and antioxidant properties.

Red grape pomace was used as a source for poly(3-hydroxybutyrate) (PHB) production, which was then subject to a range of purification processes. The different PHB biopolymers were characterized for chemical structure, crystallinity, thermal properties, colour, release of compounds into different food simulants and antioxidant inhibition, and comparisons were made with a commercially available PHB. An increase in purification steps did not have a significant effect on the high thermal stability of the extracted biopolymer, but it decreased the degree of crystallinity and the presence of amino acids and aromatic compounds. With additional purification, the PHB powders also whitened and the number of components released from the biopolymer into food simulants decreased. The released compounds presented antioxidant inhibition, which has not been previously reported in the literature or with commercially available polyhydroxyalkanoates. This is of great interest for food packaging and biomedical industries where the addition of antioxidant additives to improve PHB functional properties may not be necessary and could be avoided.

Health economics of kidney replacement therapy in Singapore: Taking stock and looking ahead.

The prevalence of end-stage kidney disease (ESKD) in Singapore remains high and continues to rise. We continue to face major challenges in containing the rising incidence of ESKD and providing sustainable kidney replacement therapy. Our cost projections provide an insight into the present and future, urging a call to action to augment existing initiatives to address the emergent issues.

Multidisciplinary Lupus Nephritis Clinic Reduces Time to Renal Biopsy and Improves Care Quality.

OBJECTIVE: Patients with lupus nephritis (LN) have a 26-fold higher mortality rate compared with their peers. Kidney biopsy, the gold standard diagnostic method for LN, may have an average wait time of more than 50 days. Other gaps in quality process measures during LN visits have also been reported. A subspecialty multidisciplinary clinic (MDC) can provide better care and quality in LN; therefore, we aimed to examine how an LN MDC impacted time to biopsy, time to treatment, and other quality measures. METHODS: We included all validated patients with LN who underwent diagnostic kidney biopsies between the 2011 to 2017 pre-MDC period and the 2018 to 2020 post-MDC period. We compared time to biopsy and treatment and quality measures between the two periods and examined factors associated with timely LN diagnosis, defined as a biopsy within 21 days. RESULTS: During the pre- and post-MDC periods, 53 and 21 patients with LN underwent a diagnostic biopsy, respectively. We found a decrease in the median time to biopsy from 26 days to 16 days after starting the LN clinic (P = 0.014). Beyond clinical factors, the presence of social factors, such as being of a non-White race and having food insecurity, were associated with 54% lower odds of timely diagnosis (adjusted Hazards Ratio [aHR] = 0.46; 95% confidence interval: 0.22-0.93; P = 0.031). We found higher odds of quality measure performance during the post- versus pre-MDC period. CONCLUSION: Wait times to diagnose LN decreased by 40% and higher quality measure performance was noted after establishing an LN MDC. Systemic and social barriers predicted delays in diagnosis that may be addressed by MDCs.