Digital health platforms expand access and improve care for male androgenetic alopecia.

INTRODUCTION: Digital health solutions, specifically direct-to-consumer platforms, have been touted to make care accessible and convenient for patients. The aim of this article is to evaluate patients' reported reasons for choosing a platform for the treatment of hair loss and their experience. This platform (Keeps) is focused exclusively on the treatment of male pattern hair loss (MPHL) with approved medications such as oral finasteride and topical minoxidil. METHODS: In order to evaluate patients' motivations to choose the platform and their experience, we administered two distinct questionnaires, with a total of 8983 respondents. RESULTS: The results showed that patients on the platform report positive health outcomes at approximately 6 months, as 81% of respondents report hair regrowth or cessation of hair loss, and 91% never or rarely miss their medication. Additionally, the platform is expanding the market through education and awareness, as nearly 1 in 3 new patients, mostly in their 20s and early 30s, had never considered treating their hair loss before learning about this virtual care model. CONCLUSION: Such a model provides further insights into how digitally enabled care focused on a chronic condition, backed by quality and evidence-based initiatives, can expand access and improve care for androgenetic alopecia (AGA).

Sustainable Drug Delivery of Famotidine Using Chitosan-Functionalized Graphene Oxide as Nanocarrier.

This work mainly focuses on the graphene oxide (GO)-assisted sustainable drug delivery of famotidine (FMT) drug. Famotidine is loaded onto GO and encapsulated by chitosan (CH). UV-visible spectroscopy, field emission scan electron microscopy, and atomic force microscopy confirm the loading of FMT on GO. An interaction of FMT with GO and CH through amine functionalities is confirmed by Fourier-transform infrared spectroscopy. Differential scanning calorimetric and cyclic voltammetric investigations confirm the compatibility of FMT and its retaining activity within chitosan-functionalized graphene oxide (CHGO) composite. Encapsulation efficiency of FMT is determined for various CHGO-FMT combinations and found to be higher at 1:9 ratio. The in vitro drug release profile is studied using a dissolution test apparatus in 0.1 m phosphate buffer medium (pH = 4.5), which shows sustainable drug release up to 12 h, which is greater than the market product (Complete release within 2 h). Comparative study of drug encapsulated with CH and without GO elucidates that GO is responsible for the sustainable release. The "n" value obtained from slope using Korsmeyer-Peppas model suggests the super case-II transport mechanism.

Tacrolimus as the first-line agent in adult-onset minimal change disease: A randomized controlled study.

Steroids have been the cornerstone of first-line therapy in adult-onset minimal change disease (MCD). The period of exposure to high dose steroids may be longer in adult MCD patients and would result in higher rates of steroid-related side effects. Although tacrolimus (TAC) is known to be effective in steroid-dependent/resistant MCD as well as in nephrotic syndrome due to other causes, there are minimal data available for assessing the effectiveness of TAC as the first-line agent in adult MCD. This is a prospective, open-label, randomized controlled study conducted from April 2014 to March 2016. Patients were randomized into two groups A and B which received TAC for 12 months and oral steroids for six months, respectively. Primary outcomes were remission rates, drug resistance was measured at 6, 12,and 18 months in each group and secondary outcomes were relapse rates, sustained remission rates, dependency, and adverse effects were measured at 18 months in both groups. At six months, total response (TR, i.e., complete and partial remission) was achieved in 80% in the TAC group and 78.26% in the steroid group (P = 1.000). At 12 months, TR was 60% in the TAC group and 43.48% in the steroid group (P = 0.386). At 18 months, TR rate was 44% in the TAC group and 43.48% in the steroid group (P = 1.000). About 32% in the TAC group and 39.13% in steroid group had relapsed by 18 months. Serious adverse effects were similar in the two groups, but overall adverse effects were more in the steroid group. TAC as a primary agent is not inferior to steroids in inducing remission. TAC may be considered as an alternative agent to steroid in high-risk groups such as elderly patients, uncontrolled diabetes and young females as a primary agent in the management of adult MCD.

Spectrum of renal allograft biopsy: A five-year experience at a tertiary care center of Eastern India.

Renal allograft dysfunction (RAD) can have myriad causes and presentations. Allograft biopsy remains the gold standard for optimum management. This is a retrospective study carried out at a tertiary care institute from August 2011 to March 2016. Details of the renal allograft biopsy requisitions were recorded and analyzed. Two hundred and two patients had undergone kidney transplantation (KT) during the study period. One hundred and twenty-six had undergone renal biopsy for RAD. The acute asymptomatic rise of serum creatinine was the most common clinical presentation (47.61%) followed by chronic RAD (CRAD) (19.84%), proteinuria (15.87%), immediate graft dysfunction (10.31%), and persistent active urinary sediments (6.34%) in that order. The incidence of delayed graft function was 1.98%. The overall incidence of biopsy-proven rejection was 8.41% within oneyear and 8.91% beyond oneyear of transplant. Acute cellular rejection (ACR) [with or without antibody-mediated rejection (AMR)] was found in 65%; AMR was found in 40% and 15% had both ACR and AMR. Borderline acute cell-mediated rejection was found in 22.5% of biopsies. CRAD was due to chronic rejection and chronic calcineurin inhibitor toxicity in only about one-fourth of the cases. Incidence of glomerulo-nephritis was 10.89% and most of these occurred two years after KT. Renal allograft biopsy was associated with minor complications in 3.17% of cases. Clinical presentations do not reliably distinguish the various causes of RAD. Allograft biopsy is a mainstay in the diagnosis of RAD and is safe. Results of live donor first transplantation using complement-dependent cytotoxi-city crossmatch are comparable to those programs using newer methods like solid-phase assays. However, the direct comparison of these results with other studies may not be completely applicable.

Post renal transplant pure red cell aplasia-is tacrolimus a culprit?

Anemia is not uncommon in the post-renal transplant period and has been reported in up to 40% of renal transplant recipients. It is commonly due to drugs and infections. While post-transplantation anemia is usually due to graft dysfunction and drugs such as mycophenolate and cotrimoxazole, tacrolimus is an uncommon cause. Tacrolimus is usually not believed to be significantly myelosuppressive, but it can cause anemia due to thrombotic microangiopathy. A literature review shows a very small number of reported cases of pure red cell aplasia (PRCA) where tacrolimus seemed to be a causative agent. We report a case series of three renal transplant recipients who were on tacrolimus and presented with chronic transfusion requiring anemia due to PRCA.

Influence of hydrogen bonding effects on methanol and water diffusivities in acid-base polymer blend membranes of sulfonated poly(ether ether ketone) and base tethered polysulfone.

Atomistic molecular dynamics simulations were used to study the water and methanol diffusivities in acid-base polymer blend membranes consisting of sulfonated poly(ether ether ketone) (SPEEK) and polysulfone tethered with different bases (2-amino-benzimidazole, 5-amino-benzotriazole, and 1H-perimidine). Consistent with experimental trends, methanol and water diffusivities in all the SPEEK-based systems were found to be lower than those in Nafion. When the base group attached to the polysulfone was varied, the methanol diffusivities were found to exhibit the same trends as observed in the experimentally measured crossover current densities. Such trends were however observed only when we explicitly accounted for hydrogen bonding interactions between the hydrogen attached to the nitrogen of the base and the oxygen of the sulfonate of SPEEK. Furthermore, in almost all cases, methanol diffusivities were found to be highly correlated with the pore sizes of the membranes, which, in the case of blends, were found to be influenced by the strength of parasitic hydrogen bonding interactions between the sulfone oxygen of polysulfone and H(N-base). The influence of pore sizes on the methanol diffusivity behavior was rationalized by using both the coordination behavior and the residence time distributions of methanol in various regions of pores. Together, our results unravel the physicochemical origins of methanol diffusivities in acid-base blend membranes and highlight the crucial role played by the hydrogen bonding interactions in influencing methanol transport in acid-base polymer blend membranes.

Atomistic simulations of structure of solvated sulfonated poly(ether ether ketone) membranes and their comparisons to nafion: II. Structure and transport properties of water, hydronium ions, and methanol.

The results of extensive all-atom molecular dynamics (MD) simulations of water- and methanol-solvated SPEEK (sulfonated poly(ether ether ketone)) are reported. In this Part II of the two-part article, we present results elucidating the spatial distributions of hydronium ion (vehicular proton) and methanol and the transport properties of water, hydronium ions, and methanol. Our results suggest that hydronium ions escape attraction shells of sulfonic groups with increasing water and methanol contents but move closer to sulfur with an increase in temperature. The localization of the hydronium ion near sulfonate anion was seen to be significantly more pronounced than in Nafion, suggesting stronger basicity of sulfonate anion and therefore weaker acidity of its conjugate acid in SPEEK than in Nafion. In contrast with Nafion, methanol competes with hydronium ions and water to solvate sulfonate anion and also lies closer to aromatic backbone. Water diffusion coefficients follow experimentally observed trends where they are lower in SPEEK than in Nafion at low water weight percent but approach the Nafion values at higher water weight percent. The vehicular proton diffusivity, as quantified by hydronium ion diffusivity, was found to be an order of magnitude lower than that in Nafion. The transport results are rationalized based on the structural insights presented in Part I and the present article.

Atomistic simulations of structure of solvated sulfonated poly(ether ether ketone) membranes and their comparisons to nafion: I. Nanophase segregation and hydrophilic domains.

The results of extensive all-atom molecular dynamics (MD) simulations of water- and methanol-solvated SPEEK (sulfonated poly(ether ether ketone)) are reported. In this Part I of the two-part article, we present results elucidating the key structural features of hydrophilic domains with varying water, methanol content, and temperature. With increasing hydration, the membrane was observed to swell appreciably and transform from a state containing a large number of water clusters containing just few molecules at low water content to very large water clusters encompassing almost all molecules at the highest water contents. In comparison with the results reported for Nafion, SPEEK was observed to be characterized by more isolated and smaller sized water clusters and less pronounced percolation than Nafion at lower water contents, but the percolation characteristics became comparable to Nafion at higher water content. Water confined in SPEEK showed less internal structure than bulk water or water confined in Nafion. With increasing water content, solvation of sulfonic acid groups was noted. The average sulfur-sulfur separation in SPEEK was found to be higher compared with the results reported for Nafion. The backbone of SPEEK was found to be more rigid and more hydrophobic than that of Nafion. These observations suggest that the nanophase segregation in SPEEK is less pronounced than that in Nafion, which may contribute to the diminished crossover characteristics of SPEEK noted in experiments on direct methanol fuel cells (DMFC) and reported in Part II of this work.