Transcatheter aortic valve replacement in patients with chronic kidney disease: a multi-centre retrospective study.

Background: Chronic kidney disease (CKD) is a common comorbid condition in patients undergoing transcatheter aortic valve replacement (TAVR). Reported outcome studies on the association of baseline CKD and mortality is currently limited. Objectives: To determine the prevalence of chronic kidney disease in patients undergoing TAVR and analyse their overall procedural outcomes. Methods: This retrospective observational study was conducted at 43 publicly funded hospitals in Hong Kong. Severe aortic stenosis patients undergoing TAVR between the years 2010 and 2019 were enroled in the study. Two groups were identified according to the presence of baseline chronic kidney disease. Results: A total of 499 patients (228, 58.6% men) were enroled in the study. Baseline hypertension was more prevalent in patients with CKD (82.8%; P=0.003). As for primary end-points, mortality rates of CKD patients were significantly higher compared to non-CKD patients (10% vs. 4.1%; P=0.04%). Gout and hypertension were found to be significantly associated with CRF. Patients with gout were nearly six times more likely to have CRF than those without gout (odds ratio = 5.96, 95% CI = 3.12-11.29, P<0.001). Patients with hypertension had three times the likelihood of having CRF compared to those without hypertension (odds ratio=2.83, 95% CI=1.45-6.08, P=0.004). Conclusion: In patients with severe aortic stenosis undergoing TAVR, baseline CKD significantly contributes to mortality outcomes at long-term follow up.

Assessment of Xenoestrogens in Jordanian Water System: Activity and Identification.

Sex hormone disruptors (xenoestrogens) are a global concern due to their potential toxicity. However, to date, there has been no study to investigate the presence of xenoestrogen pollutants in the Jordanian water system. Samples in triplicates were collected from six locations in Jordan, including dams, surface water, tap or faucet water, and filtered water (drinking water-local company). Xenoestrogens were then extracted and evaluated with a yeast estrogen screen utilizing Saccharomyces cerevisiae. Later, possible pollutants were mined using ultrahigh-performance liquid chromatography (UPLC) coupled with a Bruker impact II Q-TOF-MS. Possible hits were identified using MetaboScape software (4000 compounds), which includes pesticide, pharmaceutical pollutant, veterinary drug, and toxic compound databases and a special library of 75 possible xenoestrogens. The presence of xenoestrogens in vegetable samples collected from two different locations was also investigated. The total estrogen equivalents according to the YES system were 2.9 ± 1.2, 9.5 ± 5, 2.5 ± 1.5, 1.4 ± 0.9 ng/L for King Talal Dam, As-Samra Wastewater Treatment Plant, King Abdullah Canal, and tap water, respectively. In Almujeb Dam and drinking water, the estrogenic activity was below the detection limit. Numbers of identified xenoestrogens were: As-Samra Wastewater Treatment Plant 27 pollutants, King Talal Dam 20 pollutants, Almujeb Dam 10 pollutants, King Abdullah Canal 16 pollutants, Irbid tap water 32 pollutants, Amman tap water 30 pollutants, drinking water 3 pollutants, and vegetables 7 pollutants. However, a large number of compounds remained unknown. Xenoestrogen pollutants were detected in all tested samples, but the total estrogenic capacities were within the acceptable range. The major source of xenoestrogen pollutants was agricultural resources. Risk evaluations for low xenoestrogen activity should be taken into account, and thorough pesticide monitoring systems and regular inspections should also be established.

The anti-hepatitis B virus and anti-hepatotoxic efficacies of solanopubamine, a rare alkaloid from Solanum schimperianum.

Chronic liver disease caused by hepatitis B virus (HBV) remains an important health issue. Though there are effective HBV-polymerase inhibitors (e.g., lamivudine), their prolonged use leads to emergence of drug-resistant (polymerase mutant) strains. Several herbal formulations and phytochemicals have been therefore, reported as potential anti-HBV agents with no sign of resistance in experimental and clinical settings. In this study, we assessed the anti-HBV as well as hepatoprotective salutations of solanopubamine, a rare alkaloid isolated from S. schimperianum. In cultured HepG2.2.15 cells, solanopubamine showed marked anti-HBV activity in a time and dose-dependent manner. Solanopubamine (30 µM) efficiently inhibited HBsAg and HBeAg expressions by 66.5%, 70.5%, respectively as compared to 82.5% and 86.5% respective inhibition by lamivudine (2 µM) at day 5. Molecular docking analyses of solanopubamine revealed formations of stable complexes with lamivudine-sensitive as well as lamivudine-resistant polymerase through interactions of catalytic 'YMDD/YIDD' motif residues. Moreover, solanopubamine attenuated DCFH-induced oxidative and apoptotic damage and restored HepG2 cell viability by 28.5%, and downregulated caspase-3/7 activations by 33%. Further docking analyses of solanopubamine showed formation of stable complexes with caspase-3/7. Taken together, our data demonstrates promising anti-HBV and anti-hepatotoxic therapeutic potential of solanopubamine, and warrants further molecular and pharmacological studies.

Coxiella burnetii Endocarditis in a Patient with Systemic Lupus Erythematosus: A Case Report of a Diagnostic Challenge.

BACKGROUND There is a close association between Q fever and autoimmune disease, with some case reports in the literature of Q fever presenting as systemic lupus erythematosus (SLE) and others documenting their coexistence. However, making the correct diagnosis remains challenging and Q fever often is overlooked. Therefore, it is essential to review such a rare presentation to help in accurate diagnosis in future cases. This report is of a case of endocarditis due to Coxiella burnetii in a patient with Q fever and a history of SLE. CASE REPORT We report the case of a 43-year-old man with a history of SLE and rheumatic heart disease, status post-valve replacement. The patient initially presented with an acute kidney injury in the setting of a history of full-house lupus membranous nephropathy, which was diagnosed on kidney biopsy. The patient had been on immunosuppressive therapy for 2 years. Shortly after he was admitted, echocardiography was ordered because the patient had progressive dyspnea, revealing infective endocarditis involving multiple valves. He underwent valve repair surgery and was placed on an extended course of antibiotic therapy. His symptoms gradually resolved, with normalization of his immunological markers. The patient's immunosuppressive regimen was eventually discontinued. He remains on lifelong antibiotic suppression therapy. CONCLUSIONS This case highlights the importance of awareness of infectious causes of endocarditis in patients with underlying autoimmune diseases such as SLE. This rare case of C burnetii endocarditis may have been associated with underlying valvular SLE.

Effect of Air Pollution on Glutathione S-Transferase Activity and Total Antioxidant Capacity: Cross Sectional Study in Kuwait.

BACKGROUND: Air pollution poses a significant threat to human health worldwide. Investigating potential health impacts is essential to the development of regulations and legislation to minimize health risks. OBJECTIVES: The aim of the present study was to investigate the potentially hazardous effect of air pollution on the Ali Sabah Al Salem residential area in Kuwait by comparing the pollution level to a control area (Al-Qirawan) by assessing two biomarkers: erythrocyte glutathione S-transferases (e-GST) and total blood antioxidant, and then correlating the activity to pollution-related oxidative stress. METHODS: The average concentrations of several airborne gases were measured at Ali Sabah Al Salem and Al-Qirawan, including ozone, carbon monoxide, nitrogen dioxide, nitrogen oxides, particulate matter less than 10 µm (PM10), sulfur dioxide, ammonia, carbon dioxide, hydrogen sulfide, methane, and non-methane hydrocarbon. A total of fifty-eight participants were sampled from two different areas and divided into two groups. The study group was composed of 40 residents exposed to polluted ambient air in the Ali Sabah Al Salem residential area. A reference group composed of 18 residents in the Al-Qairawan area living far from major pollution sources was also tested. RESULTS: All measured gases were higher in concentration at Ali Sabah Al Salem compared to the Al-Qirawan area. Furthermore, PM10 and sulfur dioxide were higher than World Health Organization (WHO) guidelines. The e-GST activity was lower among participants of the Ali Sabah Al Salem residential area compared to participants living in the Al-Qairawan area. The total antioxidant capacity in whole blood of Ali Sabah Al Salem residents was significantly (p<0.0001) higher than in control subjects. CONCLUSIONS: Residents in Ali Sabah Al Salem are exposed to a high level of air pollution that has a serious impact on glutathione S-transferases levels. Subsequently, regulations on pollution sources are needed to lower current health risks. Furthermore, the present study provides evidence that finger-prick blood sampling is a quick, non-invasive method suitable for screening e-GST activity and total antioxidants which may be applied for surveillance purposes. PARTICIPANT CONSENT: Obtained. ETHICS APPROVAL: The study was approved by the Scientific Research Committee of the Public Authority for Applied Education and Training, Kuwait. COMPETING INTERESTS: The authors declare no competing financial interests.

Antibacterial Silver Nanomaterial Synthesis From Mesoflavibacter zeaxanthinifaciens and Targeting Biofilm Formation.

Considering the significance of biological and eco-friendly nanomaterials, in the present study, we have synthesized silver nanoparticles from the exopolysaccharide of recently recovered bacterial strain CEES51 from the Red Sea coastal area of Jeddah, Saudi Arabia. 16S ribosomal RNA gene sequencing was used to characterize the isolated bacteria, and it was identified as Mesoflavibacter zeaxanthinifaciens and assigned an accession number MH707257.1 GenBank. The bacterial strain is an excellent exopolysaccharide producer and survived at hypersaline (30%) and high-temperature (50°C) conditions. The bacterial exopolysaccharides were employed for the fabrication of silver nanoparticles at room temperature. UV-visible spectrophotometer optimized the synthesized nanoparticles, and their size was determined by Nanophox particle size analyzer and dynamic light scattering. Additionally, the X-ray powder diffraction and Fourier-transform infrared spectroscopy studies also approved its crystalline nature and the involvement of organic functional groups in their formation. The synthesized nanomaterials were tested for their antibacterial and antibiofilm properties against pathogenic microorganisms Bacillus subtilis and methicillin-resistant Staphylococcus aureus. The antimicrobial property showed time, and dose-dependent response with a maximum of zone inhibition was observed at around 22 and 18 mm at a dose of 50 µg/well against B. subtilis and S. aureus and a minimum inhibitory concentration of 8 and 10 µg/ml, respectively. Furthermore, the synthesized silver nanoparticles possessed a substantial antibiofilm property and were also found to be biocompatible as depicted by red blood cell lysis assay and their interaction with peripheral blood mononuclear cells and human embryonic kidney 293 cells. Therefore, Mesoflavibacter zeaxanthinifaciens is found to be an excellent source for exopolysaccharide synthesis that assists in the silver nanoparticle production.