SGLT2 Inhibitors in the Management of Chronic Kidney Disease: An Expert Consensus

Despite the availability of multiple therapies for chronic kidney disease (CKD), there still exists an unmet need for better options to slow down disease progression and prevent complications. The Dapagliflozin and Prevention of Adverse Outcomes in CKD (DAPA-CKD) trial, which demonstrated the renoprotective effects of the sodium-glucose cotransporter-2 inhibitor (SGLT2i) dapagliflozin, independent of diabetes, with improved survival, even in patients with CKD with estimated glomerular filtration rate (eGFR) as low as 25 mL/min/1.73 m2 , has highlighted the potential beneficial role of SGLT2i in patients with CKD. These benefits were also achieved in patients who were already receiving optimal therapies for slowing the progression of CKD. The potential candidature of SGLT2i for CKD therapy is now being widely discussed in the nephrology community. Therefore, a consensus meeting was held in September 2020 with a group of expert nephrologists from India, to discuss the need to improve CKD management and assess the position of SGLT2i, based on compelling evidence from recent studies. This document summarizes the expert opinions and views on the position of SGLT2i in CKD management and aims to enhance the current understanding of the applicability of SGLT2i in patients with CKD. This will aid nephrologists and physicians across the country in decision-making on the management of patients with CKD using SGLT2i.

Isolation, Characterization and Screening of Lactic Acid Bacteria from Non-dairy Foods: An Attempt to Unveil their Probiotic Potential

The growing need for probiotics has emerged due to the imbalances in the gut microbiota. Changes in the microflora of the gut lead to various disorders. Hence, the consumption of probiotics is imperative and rewarding. They provide various benefits when consumed, including antagonistic activities against pathogens by lowering pH to inhibit the growth of other microorganisms, disease treatment, and prevention, as well as health restoration and maintenance. This study aimed to isolate, identify, and characterize various Lactic acid bacteria from non-dairy items to determine their probiotic potential. Five isolates were chosen and identified further using 16S rRNA gene sequencing. The chosen isolates were then tested in vitro for probiotic properties by employing various tests including tolerance to Bile salt, Sodium Chloride, Phenol, and pH. The culture’s supernatant of these isolates were also tested for their antibacterial efficacy against various pathogens. Five LAB isolates showed resistance to varying concentrations of Bile acid, NaCl, Phenol, and simulated gastric juice. Gelatinase and Hemolytic activities were absent in the isolates. They were resistant to several of the antibiotics examined. They also showed effective antibacterial activity against test pathogens. The isolated strains meet the criteria for being probiotic and safe for human consumption thus conferring various health benefits.

Andrographis Echioides Molecular Characterization and Phylogenetic Study Using DNA Barcoding Technique

With the advancement in various molecular diagnostic tools, DNA Barcoding has emerged as a gold standard molecular diagnostic tool across the globe. Since ancient times, medicinal plants have been widely used in Indian Ayurvedic medicine for treating a variety of ailments. Plants of the genus Andrographis have been extensively used for treating different types of ailments. In this study, rarely studied medicinal plant species were isolated, sequenced at the genetic level and studied for their evolutionary characteristics using phylogenetic analysis. In the present study, the identity of A. echioides was confirmed by targeting different barcoding genes such as ribulose-bisphosphate carboxylase, internal transcribed spacer, RNA polymerase-beta subunit, maturase K, and photosystem II protein D1 genes using a phylogenetic approach. After successful isolation and amplification of genomic DNA, specific primers were utilised for sequencing of each barcoding gene, followed by nucleotide BLAST analysis to determine the sequence percent identity of each gene with that from other plant species. The best homologs were then utilised for conducting phylogenetic analysis which confirmed the identity of the plant as Andrographis echioides.

Evaluation of Physiochemical Properties, Thermal Behavior and Phytopharmaceutical Potential of Citrus aurantium’s Essential Oil

The study investigates the therapeutic potential of the Citrus aurantium var. amara essential oil extracted from the blossoms of the bitter orange plant by examining its chemical composition, thermal stability, and potency against infectious disease-causing pathogens. Initially, the volatile components of the essential oil were evaluated by obtaining a chromatographic fingerprint using HPTLC and FTIR spectrum identification. Furthermore, a thermal profile of the essential oil was obtained using the thermogravimetric-differential thermal analysis and differential scanning calorimetric analysis. A predetermined set of antibiotic-resistant microorganisms were used to examine the antibacterial activity of the essential oil. Lastly, its anti-inflammatory activity was assessed using the albumin denaturation assay. The research concluded that the Citrus aurantium var. Amara essential oil exhibits potential therapeutic characteristics which can be further explored through in vivo studies.

Enterobious vermicularis induced infectious keratitis following penetrating keratoplasty

A 28-year-old man with a prior history of penetrating keratoplasty in the left eye for total corneal melt presented with a 3-day history of a red, painful left eye. On examination, he was found to have graft infiltrates. Microscopic examination of wet mount preparation of corneal scrapings revealed the presence of embryonated eggs of E. vermicularis. Cellophane (scotch) tape preparation from perianal region also revealed embryonated eggs of E. vermicularis as well as live adult worms. Ocular and adnexal involvement by E. vermicularis is extremely rare. Here, we report the first case of infection of a corneal graft with E. vermicularis.

Chronic kidney disease in disadvantaged populations

The increased burden of chronic kidney disease (CKD) in disadvantaged populations is due to both global factors and population-specific issues. Low socioeconomic status and poor access to care contribute to health care disparities and exacerbate the negative effects of genetic or biological predisposition. Provision of appropriate renal care to these populations requires a two-pronged approach: expanding the reach of dialysis through development of low-cost alternatives that can be practiced in remote locations, and implementation and evaluation of cost-effective prevention strategies. Kidney transplantation should be promoted by expansion of deceased donor transplant programs and use of inexpensive, generic immunosuppressive drugs. The message of World Kidney Day 2015 is that a concerted attack against the diseases that lead to end-stage renal disease, by increasing community outreach, better education, improved economic opportunity, and access to preventive medicine for those at highest risk, could end the unacceptable relationship between CKD and disadvantage in these communities.

Low dose cyclosporine-a therapy in severe aplastic anaemia.

OBJECTIVE: The present study was conducted to evaluate the efficacy of low dose cyclosporine-A in the patients of severe aplastic anaemia, who cannot afford allogenic bone marrow transplantation and immunosuppressive therapy with antithymocyte globulin. METHODS: The diagnosis of severe aplastic anaemia was established by standard criteria. Twelve patients were given cyclosporine-A orally at a dose of 6 mg/kg body weight in divided doses in two daily equal proportions for six months. Eleven patients were put on oral stanozolol in the dosage of 1 mg/kg body weight/day in divided doses. All surviving patients were evaluated at three and six months. RESULTS: At the end of six months, 41.66% of twelve patients responded to cyclosporine-A. One patient had complete response and four patients had partial response. Only one out of 11 patients receiving stanozolol responded. CONCLUSIONS: i) Cyclosporine-A is a viable therapeutic option in the treatment of severe aplastic anaemia, ii) Low dose cyclosporine-A is able to slow down the stormy course of the severe aplastic anaemia, iii) Androgens have very little effect on the survival of patients of severe aplastic anaemia.

Non-surgery related aspergillus native valvular endocarditis: report of two cases.

Two unusual cases of aspergillus valvular endocarditis without any history of cardiovascular surgery found at autopsy are reported. As there is a chance of dissemination, early diagnosis is important. Clinical awareness can lead to early recognition and effective treatment of this potentially lethal condition.

Renal amyloidosis in juvenile rheumatoid arthritis.

We report a child who developed juvenile rheumatoid arthritis at the age of 7 years and nephrotic syndrome due to renal amyloidosis within 2 years of the onset of arthropathy. Literature on the management and prognosis has also been reviewed.