Effect of Folic Acid Conjugated Silver Nanoparticles in Treatment of RA like Adjuvant Arthritis in Rats.

Objective: Nanomedicine has become one of the promising research areas, opening new horizons in disease diagnosis and treatment. Recent years have witnessed a surge in the development of nanomedicine for combating rheumatoid arthritis (RA), the most common autoimmune arthritis. RA is characterized by progressive inflammation and persistent synovitis, leading to joint destruction, functional incapability, and ultimately disability. Although there has been a tremendous evolution in disease assess­ment and treatment, many patients still fail to attain remission. Therefore, developing new drugs that specifically target inflamed joints and simultaneously attenuate other possible damages to healthy tissues is indispensable. This study was done to evaluate the potential of folic acid conjugated silver nanoparticles (FA-AgNPs) as RA therapy.Methods: In the CFA-arthritic rat model, FA-AgNPs & methotrexate were administered for 8 consecutive weeks. Therapeutic efficacy was evaluated by measuring paw volume, ESR, CRP, TNF-α, and IL-6 levels. For safety concerns, CBC, liver, and renal function tests were evaluated. Joints histological assessment was also carried out.Results: FA-AgNPs significantly reduced paw volume, paw weight, ESR, CRP, RF, TNF-α, and IL-6 levels compared with arthritic non-treated rats, demonstrating good anti-inflammatory activity. Likewise, histology of tarsal joints depicted comparatively lesser inflammatory cellular infiltration and diminished cartilage erosions. Methotrexate displayed comparable results. In contrast to methotrexate, FA-AgNPs showed normal CBC & significantly improved liver and renal function tests. Conclusion: FA-AgNPs exhibited substantial anti-arthritic activity. This notable anti-arthritic potential of FA-AgNPs was as good as the current standard treatment of MTX with higher biosafety.

Acute Polyarticular Gout due to Chronic Kidney Disease

Gout is a crystal deposition disorder that typically presents as an acute flare of the first metatarso-phalangeal joint of the great toe. Rarely gout can present as an acute poly-articular disease with involvement of multiple joints. Evaluation of patients with poly-articular arthropathy with appropriate investigations like uric acid levels, renal function tests and synovial fluid analysis helps in the early diagnosis of poly-articular gout. Immediate treatment with urate lowering agents during the acute flare provides immediate pain relief and prevents progression of disease & bone destruction.

Effectiveness and Safety of the Korean Medicine Senior Health Promotion Program Using Herbal Medicine and Acupuncture for Mild Cognitive Impairment: A Retrospective Study of 500 Patients in Seoul, Korea

Background. The management of mild cognitive impairment (MCI) is becoming increasingly important. The Korean Medicine Senior Health Promotion Program (KSHPP) was developed in 2016, and it has been in use to date. This study aimed to assess the effectiveness of KSHPP using herbal medicine and acupuncture for treating MCI and the safety of herbal medicine using liver and renal function tests. Methods. We retrospectively reviewed the medical records of the participants with MCI. We assessed the Korean version of the Montreal Cognitive Assessment (MoCA-K), the Mini-Mental State Examination-Dementia Screening (MMSE-DS), and the Geriatric Depression Scale Short Form-Korea version (GDSSF-K) scores before and after KSHPP to determine its effectiveness. To evaluate its safety, the liver and renal function tests were conducted before and after herbal treatment. Results. We enrolled 1002 participants, and 500 participants satisfied the inclusion criteria. Of 500 patients, 364 (72.8%) were depressed and 136 (27.2%) were not. The mean MoCA-K score significantly increased by 2.77 for the entire sample and 3.22 for the depressed sample (all P < 0.0001 ). The mean MMSE-DS score significantly increased by 2.19 for the entire sample and 2.51 for the depressed sample (all P < 0.0001 ); the mean GDSSF-K score significantly decreased by 1.73 for the entire sample and 2.68 for the depressed sample (all P < 0.0001 ). Conclusions. Our findings suggest that Korean medicine interventions can improve cognitive function and depression symptoms in patients with MCI. In addition, the results of the liver and renal function tests were analyzed as surrogate outcomes to assess the safety of herbal medicine. Based on these results, we expect that Korean medicine interventions can promote the cognitive and mental health of seniors. However, as there were several study limitations, particularly study design, practice effect, and short follow-up, these results must be interpreted with caution. We need a further long-term study with a rigorous design to retain confidence in the effectiveness and safety of KSHPP.

To Assess the Renal Functions and Common Risk Factors of its Impairment in A Group of General Population

Background: In Pakistan more than 25 million people are suffering from kidney diseases. Kidney damage can be detected at earlier stage by simple laboratory tests like renal function tests, proteinuria and estimated Glomerular Filtration Rate (GFR). Objective: To assess renal functions and common risk factors of its impairment in a group of general population on world kidney day 2018. Materials and Methods: It is a descriptive study conducted in Central Diagnostic Laboratory, Mayo Hospital/ King Edward Medical University (KEMU), Lahore It was carried out on 158 Healthy subjects without history of renal disease. All collected data was entered and analyzed by using Statistical package for social sciences (SPSS version 20). Results: 85(54%) were males and 73(46%) females. Mean + SD age was 44.3 ±13.9 years. 50(32%) were hypertensive, 30(19%) were hyperglycemic, 28(18%) had proteinuria, 30(19%) had Hyperuricemia and 18(12%) had increased creatinine levels. Mean ± SD glucose, creatinine and uric acid levels were 130± 30, 1.2± 0.7 and 4.5± 1.3 mg/dl respectively. Conclusion: Screening of subjects without renal known disease with diagnosed hypertension, diabetes or hyperuricemia as risk factors for CKD is required. 18 undiagnosed cases of CKD were identified in this survey. Keywords: risk factors, CKD, Renal function test.

A Meta-Analysis of Safety of Different Regimens of Remdesivir in COVID-19 Patients

: Remdesivir is an adenosine analogue drug that targets RNA dependent RNA polymerase enzyme and inhibits the viral replication. As on 22nd of October 2020, US FDA fully approved drug Remdesivir for the treatment of COVID-19 patients who requires hospitalisation. Many clinical studies reported the derangement in hepatic and renal function tests which is alarming considering the health conditions of the COVID-19 patients. In view of these results, the present study was envisaged to review the safety of Remdesivir in COVID-19 patients. The PubMed, Embase and Cochrane databases was searched using ‘Remdesivir’, ‘veklury’, ‘SARS’ and ‘COVID’ till 1st of December 2020. The studies included in this meta-analysis were either randomised or non-randomised studies that evaluated Remdesivir for the treatment of COVID-19 against Placebo [standard of care]. The Adverse events [AEs], Serious adverse events [SAEs] and Treatment Discontinuation due to Adverse Events (TDAE) was used as primary outcome measures. The quality of studies was evaluated by using the Cochrane Collaboration’s tool for assessment of RoB. Data analysis was performed by two authors (MK & DB) using statistical software Review manager [Revman] version 5.3. The pooled Risk Ratios (RR) and 95% Confidence Intervals (CI) were calculated by using a random-effects model for both primary and secondary outcomes. A total of four RCTs were included for the meta-analysis. Out of the four included clinical trials accepted for its methodological quality, three were of excellent quality and one study was of moderate quality. The pooled estimates of the three studies showed that Remdesivir had 24% lower risk of SAEs compared to placebo arm. However, the pooled estimates of two studies showed that 10 days of Remdesivir had 56% higher risk of SAEs compared to 5 days of Remdesivir regimen. Similarly, the 10 days of Remdesivir had two times higher risk of TDAEs compared to 5 days Remdesivir regimen. In conclusion, our meta-analysis demonstrated that Remdesivir is a safe therapeutic option. Our metanalysis revealed 5 days’ regimen have better safety profile than 10 days’ regimen of drug Remdesivir with respect to SAEs and TDAEs. For hospitalized patients, a 5-day course could be preferable with fewer safety concerns and lower drug costs.

Association of Serum Renal Function Levels with Heart Failure Disease in Iraqi Patients

Renal function tests are commonly used in clinical practice to look for renal disease, the most common includes the serum urea, uric acid and creatinine. Heart failure patients have a higher incidence of renal function test abnormalities than individuals who do not have heart failure disease. Fifty subjects of adults (male) were divided in to two groups, 25 subjects (healthy) as control (group1) and 25 subjects with heart failure (group 2). Our results indicate that serum uric acid, urea, and creatinine values were significantly elevated (P≤0.05) in patients group (2) compared with healthy group (1). The results also showed, the effect of age categories on uric acid blood urea nitrogen and creatinine values (P≤0.05) and there were no significant differences between age (41-60) years and (61-80) years. This study also shows a strong correlation between serum uric acid, urea and creatinine values (P≤0.05) in heart failure patients. Conclusion: It concluded from the above finding that there was effect of heart failure disease on renal function levels.

Serum and urinary soluble alpha klotho levels in patients with Chronic kidney disease

Background: Chronic kidney disease is an epidemic global health problem that leads to death. To prevent any disease progression and treatment, the diagnosis must be made in the early stage by studying renal damage. Klotho is a protein found in many organs of the human body, but it is mainly abundant in the kidney. This study aimed to evaluate klotho's clinical significance as an additional biomarker for diagnosing chronic kidney disease in its early stages. Methods: One hundred subjects were included in this study to measure their serum and urinary klotho. Forty patients with chronic kidney disease (pre-dialysis) and sixty normal subjects were enrolled in this study. Serum and urinary klotho were determined using the ELISA technique in addition to other renal function tests. Results : Serum and urinary alpha klotho were decreased in CKD patients when it compared with control subjects. A positive correlation was found between serum creatinine and urinary alpha klotho in the patients' group. Conclusion: Serum and Urinary alpha klotho levels were decreased significantly in patients with chronic kidney disease compared with healthy controls.