Audit on data accuracy of the Malaysian Dialysis and Transplant Registry (MDTR).

Diabetes mellitus is the main aetiology of end stage kidney disease (ESKD) in Malaysia. However, there may be concerns of over-reporting of diabetes mellitus as the cause of ESKD in the Malaysian Dialysis and Transplant Registry (MDTR). The objective of this audit is to assess the accuracy of data collected in the MDTR. There were 151 centres/source data providers (SDP) with a total of 1977 patients included in this audit. The audit showed that 80.2% of doctors' records matched the MDTR data. The results were comparable with published validation studies in other countries.

The eyes that saw the kidneys.

Renal involvement in sarcoidosis is very uncommon and often diagnosed through renal biopsy. It is a chronic and multisystem disease with unknown aetiology and can affect all organs of the body with strong predilection to the lungs. Although glucocorticoids are effective in the treatment of sarcoidosis, the mainstay of management includes supportive hydration and prevention of nephrotoxins. We report a case of a young man who was admitted with an ocular and renal impairment secondary to sarcoidosis.

The Effect of Intensity Soccer Training Sessions on Marked Biochemical Indicators of Blood Acidity of Saudi Young Soccer Players.

Purpose: To assess the effect of low-to-moderate-intensity exercise on specific blood biomarkers and blood acidity in young Saudi Arabian professional soccer players. Methods: A total of 43 professional soccer players participated in the current study. A cross-sectional research method was used to compare the changes in the following blood biomarkers: calcium, magnesium, glucose, anion-gap metabolic acidosis, and carbon dioxide, after a range of low-to-moderate intensity training sessions. Measurements were taken in two soccer training sessions (Day 1, and Day 2). The exercise intensity was estimated by heart rate percentage of maximal heart rate. Wilcoxon signed-rank testing was used to analyze the results. Results: Significant differences were found between and pre-and post-training sessions for anion-gap metabolic acidosis: Day 1: 12.55 vs 15.4 mmol/L; Day 2: 14.15 vs 16.35 mmol/L; and magnesium: Day 1: 0.82 vs 0.74 mmol/L; Day 2: 0.85 vs 0.74 mmol/L. Exercise caused anion-gap metabolic acidosis concentrations to rise post-training; magnesium levels decreased after training sessions on Day 1 and Day 2. Conclusion: The concentrations of anion-gap metabolic acidosis and magnesium were significantly affected by exercise intensity in the subjects, the former rose post-training while the latter fell. More studies are required to investigate the effects of different exercise intensities on other blood biomarkers in soccer players.

Levels of trace elements and rare earth elements in honey from Jordan.

Honey is a common sweetener in the Jordanian diet with an annual consumption of approximately one thousand tons, two-thirds of which are imported. It is believed that the elemental profile of honey is an indicator of safety and botanical and geographic origin. In the literature, there are a lack of studies concerning the levels of major and trace elements in honey in Jordan. A total of 46 elements, including 15 rare earth elements (REEs), were analyzed by inductively coupled plasma-mass spectrometry (ICP-MS) in 18 monofloral and multifloral imported honey samples and 12 multifloral local samples. Regarding monofloral samples, Black Forest samples had the highest total metal content, while acacia samples had the lowest total metal content. Local multifloral honey had the largest Sr and total REE levels, while it had the lowest Mn levels. Very low levels of toxic elements were found in all samples, indicating the safety of honey in Jordan for human consumption. The results of this study showed that a large number of samples (> 100) and the application of advanced statistical models are required to discriminate between multifloral imported and local honey.

HDL associates with insulin resistance and beta-cell dysfunction in South Asian families at risk of type 2 diabetes.

OBJECTIVE: Dyslipidemia precedes type 2 diabetes (T2D) and worsens with increasing glucose intolerance. First degree relatives of T2D patients have an increased risk to develop dyslipidemia and glucose intolerance. The aim of the present study was to assess the relation between the development of dyslipidemia and glucose intolerance in first-degree relatives of T2D patients. RESEARCH DESIGN AND METHODS: Fasting lipoprotein profiles were determined by density gradient ultracentrifugation in T2D patients and their first-degree relatives (42 Caucasians and 33 South Asians), and in 29 normoglycemic controls from non-T2D families. Glucose tolerance, insulin sensitivity index (ISI) and insulin disposition index (DI) were assessed by an extended, frequently sampled oral glucose tolerance test (OGTT), and fractional insulin synthesis rate (FSR) was measured by 13C-leucine enrichment in urinary C-peptide during the OGTT. RESULTS: Of the first-degree relatives, 40, 16 and 19 had NGT, prediabetes and T2D, respectively. NGT family members had lower plasma HDL-cholesterol (HDLC) (1.34 ± 0.07 vs 1.58 ± 0.06 mmol/L; p = 0.015), HDL2-C (0.41 ± 0.05 vs 0.57 ± 0.05 mmol/L; p = 0.021) and HDL3-C (0.62 ± 0.03 vs 0.72 ± 0.02 mmol/L; p = 0.043) than controls. HDL2-C levels tended to decrease with increasing glucose intolerance state. In South Asians, buoyant LDL-C levels decreased with increasing glucose intolerance state (p = 0.006). In South Asian families, HDL-C correlated with both ISI and DI (ß 0.42; p = 0.04 and ß 0.53; p = 0.01, respectively), whereas HDL2-C and HDL3-C levels correlated with DI (ß 0.64; p = 0.002 and ß 0.57; p = 0.005, respectively). HDL2-C and plasma triglyceride correlated with FSR (ß 0.48; p = 0.033 and ß -0.50; p = 0.029, respectively). CONCLUSIONS: Low HDL2-C and HDL3-C levels are present in NGT first-degree relatives of T2D patients, and HDL2-C tend to decrease further with increasing glucose intolerance. In South Asian families HDL2-C and HDL3-C levels linked predominantly to deteriorating beta cell function.

Levels of Trace Elements in Human Breast Milk in Jordan: a Comparison with Infant Formula Milk Powder.

Human breast milk and infant formula milk powder (IFMP) are the main nutritional sources for infants. In the literature, there is a lack of studies concerning levels of trace elements in human milk and IMP in Jordan. The aim of this research was the determination of levels of 24 trace elements in human breast milk from Jordanian mothers (n = 76) and IFMP from Jordanian market (n = 22). Elements were classified to essential (Mg, Fe, Zn, Cu, Mn, Ni, Cr, Mo, Co, and Se), non-essential (Al, Ag, Ba, Bi, Cs, Ga, Li, Rb, Sr, U, and V), and potentially toxic (As, Cd, and Pb). Inductively coupled plasma-mass spectrometry (ICP-MS) following a microwave digestion of samples with concentrated nitric acid and hydrogen peroxide was performed. Our results featured levels of each targeted element in human milk and IFMP (mean, standard deviation (SD), median, and range). Statistical analysis included a one-way analysis of variance (ANOVA), and Pearson's correlations. A sample toxicological analysis study for toxic elements As, Cd, and Pb was performed, and results were inspected. Levels of most elements including toxic elements are larger than in human milk samples, and comparable to in IFPMs to literature results. Mean levels of majority of the elements (17 out of 24) in human milk were significantly different than respective means in IFMP solutions. Positive correlation was observed between total toxic elements and Al, Cu, and Fe in human milk samples. Results of toxicological analysis demonstrated that most of IFMP samples do not represent a health hazard to infants regarding As, Cd, and Pb. The same applies for Cd in human milk samples. However, levels of As and Pb in 70% of human milk samples exceed the provisional tolerable weekly intake (PTWI) for As and Pb.

ABO-Incompatible Living-Donor Kidney Transplantation in a Developing Country: A Multicenter Experience in Malaysia.

Malaysia has a low deceased-donor donation rate and has not embarked on a paired kidney exchange program; therefore, ABO-incompatible and HLA-incompatible transplantation remain the main contributor to the sustainability of the national kidney transplantation (KT) program. There were 26 cases of ABO-incompatible KTs performed from 2011 to 2018 in 3 major transplant centers, namely, Hospital Kuala Lumpur, University Malaya Medical Centre, and Prince Court Medical Centre. We collected perioperative and follow-up data through June 2019. The desensitization protocol varies and is center specific: the localized Japanese protocol and Swedish protocol with a target anti-A/B isoagglutinin titer of 16 or 32 on the day of transplant. The induction and tacrolimus-based maintenance protocol was nearly identical. The median follow-up time was 62.3 months (interquartile range, 37.0-79.7). Fifteen subjects had the highest predesensitization anti-A/B titer of ≥32 (57.7%). The acute cellular rejection and antibody-mediated rejection incidence were 12.5% (3 cases) and 8.3% (2 cases), respectively. Patient, graft, and death-censored graft survival rates were 96.2%, 92.3%, and 96.0%, respectively, 1 year post-living-donor KT (LDKT) and 96.2%, 87.2%, and 90.7%, respectively, 5 years post-LDKT. Our experience shows that ABO-incompatible LDKT using a suitable desensitization technique could be a safe and feasible choice for LDKT even with varied desensitization regimens for recipients with relatively high baseline isoagglutinin titers.

NO Signaling in the Cardiovascular System and Exercise.

Nitric oxide (NO) is a small molecule implicated in multiple signal transduction pathways thus contributing to the regulation of many cellular functions. The identification of NO synthase (NOS) isoforms and the subsequent characterization of the mechanisms of cell activation of the enzymes permitted the partial understanding of both the physiological and pathological processes. NO bioavailability plays an important role in the pathophysiology of cardiovascular disease and its reduction in endothelial cells is strictly associated to endothelial dysfunction which, in turn, correlates with cardiovascular mortality. Indeed, endothelial NO synthase (eNOS) has a key role in limiting cardiac dysfunction and remodeling in heart diseases, in part by decreasing myocyte hypertrophy. Conversely, exercise training is recommended to prevent and treat cardiovascular diseases-associated disorders at least by enhanced NO synthase activity and expression, and increased production of antioxidants, which prevents premature breakdown of NO. Exercise training may cause an improvement in endothelial function for both experimental animals and humans; Studies in both healthy subjects and patients with impaired NO-related vasorelaxation remarked exercise training ability to improve vascular structure and function and endothelial homeostasis. This chapter will briefly consider the importance of NO signaling in the maintenance of cardiovascular physiology, and discuss recent insights into the effect of exercise training on the signaling pathways that modulate NO synthesis and degradation in health and cardiovascular disease. In addition, we will highlight the molecular mechanisms via which microRNAs (miRs) target NO signaling in the cardiovascular system, and NO as a candidate molecule for development of new therapies.

Processable dodecylbenzene sulfonic acid (DBSA) doped poly(N-vinyl carbazole)-poly(pyrrole) for optoelectronic applications.

A soluble poly (n-vinyl carbazole)-polypyrrole (PNVC-Ppy) copolymer was prepared through oxidative chemical polymerization wherein dodecyl benzene sulfonic acid (DBSA) was used as a dopant to facilitate polymer-organic solvent interaction and ammonium persulfate (APS) was used as an oxidant. Compared with undoped PNVC-Ppy, the DBSA-doped PNVC-Ppy copolymer showed higher solubility in some selected organic solvents. The composition and structural characteristics of the DBSA-doped PNVC-Ppy were determined by Fourier transform infrared, ultraviolet-visible, and X-ray diffraction spectroscopic methods. Field emission scanning electron microscopic method was employed to observe the morphology of the DBSA-doped PNVC-Ppy copolymer. The electrical conductivity of the DBSA-doped PNVC-Ppy copolymer was measured at room temperature. The conductivity increased with increasing concentration of APS oxidant, and the highest conductivity was recorded at 0.004 mol/dm3 APS at a polymerization temperature of -5 °C. The increased conductivity can be explained by the extended half-life of pyrrole free radical at a lower temperature and a gradual increase in chain length over a prolonged time due to the slow addition of APS. Furthermore, the obtained soluble copolymer exhibits unique optical and thermal properties different from those of PNVC and Ppy.

Improvement of N-phthaloylchitosan based gel polymer electrolyte in dye-sensitized solar cells using a binary salt system.

A binary salt system utilizing lithium iodide (LiI) as the auxiliary component has been introduced to the N-phthaloylchitosan (PhCh) based gel polymer electrolyte consisting of ethylene carbonate (EC), dimethylformamide (DMF), tetrapropylammonium iodide (TPAI), and iodine (I2) in order to improve the performance of dye-sensitized solar cell (DSSC) with efficiency of 6.36%, photocurrent density, JSC of 17.29mAcm-2, open circuit voltage, VOC of 0.59V and fill factor, FF of 0.62. This efficiency value is an improvement from the 5.00% performance obtained by the DSSC consisting of only TPAI single salt system. The presence of the LiI in addition to the TPAI improves the charge injection rates and increases the iodide contribution to the total conductivity and both factors contribute to the increase in efficiency of the DSSC. The interaction behavior between polymer-plasticizer-salt was thoroughly investigated using EIS, FTIR spectroscopy and XRD.

Lomitapide affects HDL composition and function.

BACKGROUND: Lomitapide reduces low-density lipoprotein-cholesterol (LDL-C) but also high-density lipoprotein-cholesterol (HDL-C) levels. The latter may reduce the clinical efficacy of lomitapide. We investigated the effect of lomitapide on HDL-C levels and on cholesterol efflux capacity (CEC) of HDL in patients with homozygous familial hypercholesterolemia (HoFH). METHODS AND RESULTS: Four HoFH patients were treated with increasing dosages of lomitapide. Lomitapide decreased LDL-C (range -34 to -89%). Total HDL-C levels decreased (range -16 to -34%) with a shift to buoyant HDL. ABCA1-mediated CEC decreased in all patients (range -39 to -99%). The changes of total, ABCG1- and SR-BI-mediated CEC were less consistent. CONCLUSION: Lomitapide decreased LDL-C and HDL-C levels. Our report raises the hypothesis that the anti-atherogenic potential of HDL seems to be unaffected as total CEC did not seem to change consistently. Combined with the reduction of atherogenic lipoproteins, the net effect of lomitapide appears to be beneficial in HoFH patients.

A new thio-Schiff base fluorophore with copper ion sensing, DNA binding and nuclease activity.

Copper ion recognition and DNA interaction of a newly synthesized fluorescent Schiff base (HPyETSC) were investigated using UV-vis and fluorescent spectroscopy. Examination using these two techniques revealed that the detection of copper by HPyETSC is highly sensitive and selective, with a detection limit of 0.39 µm and the mode of interaction between HPyETSC and DNA is electrostatic, with a binding constant of 8.97×10(4) M(-1). Furthermore, gel electrophoresis studies showed that HPyETSC exhibited nuclease activity through oxidative pathway.

Levels of perfluorinated compounds in human breast milk in Jordan: the impact of sociodemographic characteristics.

There is scarcity in literature in regards to the exact levels of such compounds in the Middle Eastern region including Jordan. This study was conducted to measure the presence and levels of perfluoroalkyl substances (PFASs) (perfluoroocane sulfonate (PFOS) and perfluorooctanoic acid (PFOA)) in human milk and local fresh cow milk in northern Jordan and also to investigate the relationship between levels of PFASs and some sociodemographic characteristics of breastfeeding mothers and their infants as well as usage of Teflon kitchenware products. Seventy-nine milk samples were collected from breastfeeding women and 25 samples from local fresh cow milk in northern Jordan. Levels of PFOS and PFOA were liquid/liquid extracted (LLE) by acetone followed by purification on an Oasis hydrophilic-lipophilic balance (HLB) solid-phase extraction (SPE). Separations and detections were performed by liquid chromatography-tandem mass spectrometry. Limits of quantitation (LOQs) were 10 ng/L for both PFOA and PFOS. The measured concentrations ranged between non-detectable (ND) and 178 ng/L for PFOS and between 24 and 1120 ng/L for PFOA in human milk and between ND-178 ng/L and LOQ-160 ng/L in fresh cow milk, respectively. Median concentrations of PFOS in human milk samples from Jordan in this study were lower than those found in a recent study from Italy. Moreover, mean concentrations of PFOA and PFOS were significantly higher in milk samples provided by older women. Also, mean concentrations of PFOA was much higher in multiparas and those who have younger infants. The mean rank of PFOA was twice as high in the milk of women who had older Teflon products in kitchen compared to those who had relatively new Teflon products.

Lipoprotein(a) levels are associated with aortic valve calcification in asymptomatic patients with familial hypercholesterolaemia.

OBJECTIVES: Lipoprotein(a) [Lp(a)] is an independent risk factor for aortic valve stenosis and aortic valve calcification (AVC) in the general population. In this study, we determined the association between AVC and both plasma Lp(a) levels and apolipoprotein(a) [apo(a)] kringle IV repeat polymorphisms in asymptomatic statin-treated patients with heterozygous familial hypercholesterolaemia (FH). METHODS: A total of 129 asymptomatic heterozygous FH patients (age 40-69 years) were included in this study. AVC was detected using computed tomography scanning. Lp(a) concentration and apo(a) kringle IV repeat number were measured using immunoturbidimetry and immunoblotting, respectively. Univariate and multivariate logistic regression were used to assess the association between Lp(a) concentration and the presence of AVC. RESULTS: Aortic valve calcification was present in 38.2% of patients, including three with extensive AVC (>400 Agatston units). Lp(a) concentration was significantly correlated with gender, number of apo(a) kringle IV repeats and the presence and severity of AVC, but not with coronary artery calcification (CAC). AVC was significantly associated with plasma Lp(a) level, age, body mass index, blood pressure, duration of statin use, cholesterol-year score and CAC score. After adjustment for all significant covariables, plasma Lp(a) concentration remained a significant predictor of AVC, with an odds ratio per 10-mg dL(-1) increase in Lp(a) concentration of 1.11 (95% confidence interval 1.01-1.20, P = 0.03). CONCLUSION: In asymptomatic statin-treated FH patients, plasma Lp(a) concentration is an independent risk indicator for AVC.

PRAME gene expression in childhood acute lymphoblastic leukemia: impact on prognosis.

BACKGROUND: The PRAME (preferentially expressed antigen of melanoma) gene is frequently overexpressed in a wide variety of malignant diseases, including acute myeloid leukemia (AML) and acute B-cell malignancies. AIM: To study the expression of PRAME gene and clarify its prognostic impact on disease outcome. METHODS: Screening for PRAME gene expression was assessed using real-time reverse transcriptase polymerase chain reaction in 55 pretreated ALL bone marrow samples. RESULTS: PRAME positivity was found in 14 (31.3%) of 45 patients. No significant correlation could be observed between PRAME expression and clinical characteristics. Positive PRAME expressers had a statistically higher CR (p = 0.001), lower relapse (p = 0.02), lower mortality (p < 0.001), a trend towards lower Refractory disease (p = 0.10), and a statistically longer DFS and OS (p < 0.001, < 0.001, respectively) in comparison to negative PRAME expressers. CONCLUSIONS: Our results suggested that PRAME was a predictor for better outcome, could be a useful target for immunotherapy, and might represent a candidate marker for the monitoring of minimal residual disease.

Determination of phthalates in Jordanian bottled water using GC-MS and HPLC-UV: environmental study.

A simple, accurate and reliable method was presented and validated for the simultaneous monitoring of six phthalates at trace level concentrations in seven different brands of commercial bottled mineral water from Jordan. Liquid-liquid extraction with a mixture of methylene chloride-petroleum ether (20:80, v/v) was used for isolation and enrichment of the phthalates and sample cleanup. This was followed by gas chromatography-mass spectrometry (GC-MS) for identification and high-performance liquid chromatography (HPLC) with ultraviolet detection for quantification. The linear range of the GC-MS calibration curve was 0.3-1.2 µg/L with a mean correlation coefficient (R(2)) of 0.9920 ± 0.0063, the detection limit was < 0.1 µg/L and the percentage recovery was >90%. For HPLC, the linear range was 0.5-10 mg/L with R(2) = 0.9985 ± 0.0012 and an average detection limit of 0.20 ± 0.15 µg/L. The results indicated that the Jordanian bottled water was contaminated with dibutyl-, di-2-ethylhexyl- and di-n-octyl-phthalate, with total phthalate concentrations between 8.1 and 19.8 µg/L. Increasing the storage temperature of the bottled water increased the content of leached phthalates in the water (total concentration of 23-29.2 µg/L).

Chromatographic behavior of co-eluted plasma compounds and effect on screening of drugs by APCI-LC-MS(/MS): Applications to selected cardiovascular drugs.

Chromatographic behavior of co-eluted compounds from un-extracted drug-free plasma samples was studied by LC-MS and LC-MS/MS with positive APCI. Under soft gradient, total ion chromatogram (TIC) consisted of two major peaks separated by a constant lower intensity region. Early peak (0.15-0.4 min) belongs to polar plasma compounds and consisted of smaller mass ions (m/z<250); late peak (3.6-4.6 min) belongs to thermally unstable phospholipids and consisted of fragments with m/z<300. Late peak is more sensitive to variations in chromatographic and MS parameters. Screening of most targeted cardiovascular drugs at levels lower than 50 ng/mL has been possible by LC-MS for drugs with retention factors larger than three. Matrix effects and recovery, at 20 and 200 ng/mL, were evaluated for spiked plasma samples with 15 cardiovascular drugs, by MRM-LC-MS/MS. Average recoveries were above 90% and matrix effects expressed as percent matrix factor (% MF) were above 100%, indicating enhancement character for APCI. Large uncertainties were significant for drugs with smaller masses (m/z<250) and retention factors lower than two.

Relationship between NRAMP1 gene polymorphism and efficacy of BCG vaccine in a helminth-infected population.

Infection of mothers with schistosomiasis and filariasis has been shown to influence infant responses to neonatal Bacille Calmette-Guérin (BCG) immunization. The genetic makeup of infants is also considered an important determinant for the activity of BCG vaccine. The effect of natural resistance-associated macrophage protein 1 (NRAMP1) gene polymorphism on the efficacy of BCG vaccine was examined in neonates with helminth-infected mothers (63 infants) and the results were compared with neonates of uninfected mothers (187 infants). After BCG vaccination, assessment of scar presence, tuberculin test, stool analysis, and IgE level was performed. Polymorphism of the NRAMP1 gene was investigated by PCR amplification followed by RFLP analysis. We found that patients with heterozygosity of intron 4 (GC) and/or maternal infection with helminth parasites showed reduced efficacy of BCG vaccine against tuberculosis.

ATR-FTIR studies on ion interaction of lithium perchlorate in polyacrylate/poly(ethylene oxide) blends.

The interaction behaviours between components of polyacrylate (PAc)/poly(ethylene oxide) (PEO) and lithium perchlorate (LiClO(4)) were investigated in detail by Attenuated Total Reflectance (ATR)-Fourier Transformed Infrared (FTIR) spectroscopy. Solution cast films of the PAc/PEO and PAc/PEO/LiClO(4) were examined. No obvious shifting of the characteristic ether and ester group stretching modes of PEO and PAc was observed, indicating incompatibility of the binary PAc/PEO blend. The spectroscopic studies on the PAc/PEO/LiClO(4) blends reveal that Li(+) ions coordinate individually to the polymer components at the ether oxygen of PEO and the C-O of the ester group of PAc. Frequency changes observed on the nu(C-O-C) and omega(CH(2)) of PEO confirm the coordination between PEO and Li(+) ions resulting in crystallinity suppression of PEO. The absence of experimental evidence on the formation of PEO-Li(+)-PAc complexes suggests that LiClO(4) does not enhance the compatibility of PAc/PEO blend.

Pyrrolizidine alkaloids from Echium glomeratum (Boraginaceae).

The methanolic extract of the whole plant of Echium glomeratum Poir. (Boraginaceae) has afforded five pyrrolizidine alkaloids, three that were (7S, 8R)-petranine (1), (7S, 8S)-petranine (2), and (7R, 8R)-petranine (3a) or (7R, 8S)-petranine (3b), comprising a tricyclic pyrrolizidine alkaloids subclass; and two that were known but to the species: 7-angeloylretronecine (4) and 9-angeloylretronecine (5). All compounds were tested against a human tumor panel for cytotoxicity; no activity was observed (EC50 values>20microg/ml).