Tag Archives: Kidney

‘Common’ treatment-related harm in New Zealand – the Otago study | Instant News


Older people and those prescribed multiple drugs are most at risk of exposure to treatment-related harm, a new study from the University of Otago shows.

The study, published in the British Journal of General Practice, reviewed the electronic records of 9,076 randomly selected patient records from 44 general practices in New Zealand in an attempt to identify and explain all treatment-related hazards.

Dr. Sharon Leitch.

Lead author Dr Sharon Leitch, senior lecturer in the Department of Public Practice and Rural Health, said while the study found the dangers associated with treatment were “common, most are minor and thought to be preventable”, nearly 20 percent of the hazards are preventable and that area needs to be addressed.

In the three years from 2011 to 2013, 7,308 out of 9,076 patients had undergone treatment by a general practitioner. Nearly a quarter (24 percent) of these recipes caused damage.

Damage was assessed as minor (such as rash or vomiting), moderate (such as untreated anemia, poor diabetes control), severe (including renal failure, pulmonary embolism or morphine overdose) and death.

Most of the damage was minor (80 percent), but one in five was moderate or severe and in three cases fatal. Eighteen patients were admitted to the hospital.

“This is an area we need to try to address through targeted patient safety initiatives.

“Medicine can be both harmful and healing. This study highlights the importance of taking medication only when needed and reinforces the need for alertness and care even in routine medication use, ”said Dr Leitch.

Patients most at risk for treatment-related harm are older, and those who have multiple consultations and multiple prescriptions. Patients between the ages of 60 and 74 were twice as likely to have been injured, while those over 75 were three times as likely.

“Identifying these patients can help inform joint decision-making when prescribing and targeting risk monitoring. Patients should discuss any concerns about their medication and health with their healthcare provider. Sometimes it is useful to include whanau in the discussion. “

This is the first time such research has been conducted.

“We did this research to find out what is happening in general New Zealand practice, to determine the risks posed by treatment in the real world.

“Treatment safety is a health care priority – we want to help patients, not hurt them. “General practice has been considered a safe place for patients, without much research in this area,” said Dr Leitch.

Read the full journal article published in the British Journal of General Practice

/ Public Release. This material comes from the original organization and may be point-in-time, edited for clarity, style and length. view more here.

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The residents of the house at Kidney Hill Park were told to vacate within three days | Instant News



The Karachi Metropolitan Corporation (KMC) anti-encroachment department has given three days notice to the bungalows being built on Kidney Hill Park land prior to anti-encroachment operations.

The notification was issued on Friday. Meanwhile, the corporation also began marking encroachment around Gujjar Nullah. KMC’s Senior Anti-Encroachment Director Bashir Siddiqui and others visited the park at the direction of KMC administrators on Friday and asked the bungalow residents to vacate their residential buildings within three days.

Meanwhile, at the direction of the Supreme Court, Siddiqui said two two-story buildings had been demolished at the Manzoor Colony Nullah on Friday. “The buildings were demolished with care, so that the surrounding buildings did not suffer any damage,” he explained, adding that 80 percent of encroachment on both sides of the canal had been cleared.

In the Central District, action was taken on Friday against encroachment in the Ghareebabad area of ​​Liaquatabad. Several tea shops, hotels and stalls were removed from walkways and highways. Stoves, iron grills, stairs, chairs and hotel tables were also confiscated.

Describing how encroachment is marked at Gujjar Nullah in the Central District, Siddiqui said Gujjar Nullah is a natural channel in the city that flows from New Karachi to the Chona Depot in Haji Mureed Goth, where it falls into the Lyari River.

Nullah crossed Rashid Minhas Street at Shafiq Morr and headed towards Café Piyala Hotel, getting to Ziauddin Hospital before falling into the Lyari River.

The corporation has so far marked nearly 1,100 homes on both sides of the rainwater channel. The KMC anti-encroachment department will begin demolishing this structure upon completion of work on the Manzoor Colony channel.

KMC will change Sharea Faisal Karachi Metropolitan Corporation (KMC) will change Sharea Faisal and the area around Jinnah International Airport.

KMC administrator Laeeq Ahmed directed officials on Friday to make cleaning arrangements in Sharea Faisal and the area around the city’s airport. He said that these areas were the first place to see the city for foreigners.

The area around the airport is made exceptional for visitors around the world, he said, adding that Karachi is the face of Pakistan and it will take a lot of work to repair the city in a limited time.

This statement was made by the administrator while visiting Sharea Faisal, Nathakhan Bridge, Jalan Drig, and the area near Jinnah Karachi International Airport.

Director General of Works Syed Shabeeh-ul-Hassan Zaidi, Director General of Taman Taha Saleem and other officials also attended the occasion. Administrators directed relevant officials to make street lights work in Sharea Faisal and other places for passenger comfort.

He also issued a directive to remove all types of billboards and flags of political parties. “Tree pruning must also be done to make the city more beautiful. Seasonal crops, including marigolds, should be grown in greenbelt, ”he said.

Ahmed said officials from various countries came to Karachi to participate in the program on February 5, and it was important to give them a good image of the city. During the briefing, administrators were told that 250 lights had been installed from Drigh Street to Sharea Faisal, 200 of which had been activated, while the rest would be lit in three days. Ahmed directed the director of work and services to repair walkways, in addition to a cemetery near the airport in Sharea Faisal, as people visiting the cemetery faced difficulties.

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Express Delivery: Italian police transport kidneys for transplant in Lamborghini | Instant News


Which policeman in the world wouldn’t dream of having a Lamborghini in their fleet? For the Italian police department, this is a reality and for patients waiting for a new kidney, it is a lifesaver.

Reaching speeds of up to 230 kilometers per hour (143 miles per hour), police officers drove a blue and white Lamborghini Huracian LP610-4 from the northern city of Padova, 500 kilometers (310 miles) south to a hospital in Rome in order to deliver the kidney right at time to hospital is very much waiting to perform surgery on patients. Departing at 10.30, they arrived more than a few hours later, a journey that usually took about six hours.

The police department has responded to requests for assistance because local authorities were unable to deliver organs fast enough.

The Huracian can go from 0-100 kph in just 3.2 seconds and can reach a maximum speed of 325 kph.

Not only did the police own the Lamborghini, but the “pimps.” Unlike those available to those with enough cash to buy them, the Huracian police have an onboard tablet with a computer and a recording-capable camera. It is also equipped with a special cooler for transporting organs.

In fact, any criminal out there can relax a little; Lamborghini’s primary function is to move transplanted organs, plasma and vaccines across the country and not engage in high-speed car chases.

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How COVID-19 affects the nervous system | Instant News


A new paper published in the journal JAMA Neurology in May 2020 discussed the presentation and complications of COVID-19 with respect to the nervous system.

The COVID-19 pandemic has caused hundreds of thousands of cases of severe pneumonia and respiratory disorders, in 188 countries and regions in the world. The causative agent, SARS-CoV-2, is a new coronavirus, with well-recognized lung complications. However, evidence is increasing that the virus also affects other organs, such as the nervous system and heart.

The Coronaviruses: A Glimpse

That corona virus is a group of large spread RNA viruses that infect animals and humans. Human infections are known to be caused by 7 coronaviruses, namely human coronavirus (HCoV) –229E, HCoV-NL63, HCoV-HKU1, HCoV-OC43, MERS-CoV, SARS-CoV-1, and SARS-CoV-2.

Among these, the last three are known to cause severe human disease. While HCoV is more associated with respiratory manifestations, three of them are known to infect neurons: HCoV-229E, HCoV-OC43, and SARS-CoV-1.

Current research aims to contribute to the knowledge of the SARS-CoV-2 neurotropism, as well as post-infectious neurological complications. This virus infects humans through ACE2 receptors in various tissues, including airway epithelium, kidney cells, small intestine, proper lung tissue, and endothelial cells.

Because endothelium is found in blood vessels throughout the body, this offers a potential route for CoV to be localized in the brain. In addition, a recent report shows that ACE2 is also found in brain neurons, astrocytes, and oligodendrocytes, especially in areas such as substantia nigra, ventricles, middle temporal gyrus, and olfactory bulb.

Interestingly, ACE2 in neuron tissue is expressed not only on the surface but also in the cytoplasm. This finding could imply that SARS-CoV-2 can infect neuronal and glial cells in all parts of the central nervous system.

How does neuroinvasion occur with SARS-CoV-2?

Current knowledge indicates the possibility of nerve cell virus invasion by several mechanisms. These include the transfer of viruses across synapses of infected cells, entering the brain through the olfactory nerve, infection of endothelial blood vessels, and migration of infected white blood cells across the blood-brain barrier (BBB).

The corona virus has been shown to spread back along the nerves from the edge of the peripheral nerves, across synapses, and thus into the brain, in several small animal studies. This is facilitated by a pathway for endocytosis or exocytosis between motor cortex neurons, and other secretory vesicular pathways between neurons and satellite cells.

Axonal transport occurs rapidly using axonal microtubules, which allow the virus to reach the body of neuron cells with a retrograde version of this mechanism.

The possibility of spreading the olfactory route is marked by the occurrence of isolated anosmia and age. In such cases, the virus can pass through the latticed plate to enter the central nervous system (CNS) of the nose. However, more recent unpublished research shows that olfactory neurons lack ACE2, whereas cells in the olfactory epithelium do so. This could mean that a viral injury to the olfactory epithelium, and not the olfactory neuron, is responsible for anosmia, but further studies will be needed to confirm this.

Cross the BBB

This virus can also pass through the BBB through two separate mechanisms. In the first case, infected vascular endothelial cells can move the virus across blood vessels to neurons. Once there, the virus can start to bud and infect more cells.

The second mechanism is through infected white blood cells that pass through the BBB – a mechanism called Trojan horse, which is famous for its role in HIV. Inflamed BBB allows the entry of immune cells and cytokines, and even, possibly, viral particles into the brain. T-lymphocytes, however, do not allow viruses to replicate even though they can be infected.

Neurological features of COVID-19

From limited data on neurological manifestations related to COVID-19, it is clear that headaches, anosmia, and age are among the most common symptoms. However, other findings include stroke and an abnormal state of consciousness.

While headaches occur in up to one third of confirmed cases, anosmia or age shows a much more varied prevalence. In Italy, about one fifth of cases show this symptom, while almost 90% of patients in Germany have such symptoms.

The researchers said, “Given the reports of anosmia that appear as early symptoms of COVID-19, specific testing for anosmia can offer the potential for early detection of COVID-19 infection.”

Impaired consciousness can occur in up to 37% of patients, due to various mechanisms such as infection and direct brain injury, metabolic-toxic encephalopathy, and demyelinating disease. Encephalitis has not been documented as a result of COVID-19.

Toxic-metabolic encephalopathy can occur due to a number of disorders of metabolic and endocrine function. These include electrolyte and mineral imbalances, kidney disorders, and cytokine storms, hypo or hyperglycemia, and liver dysfunction. Patients who are elderly, ill, or already have symptoms of dementia, or are malnourished, are at higher risk for this condition.

Less common neurological complications include Guillain-Barre syndrome, which is a post-viral acute inflammatory demyelinating disease, and cerebrovascular events, including stroke.

Is COVID-19 Therapy Related to Neurological Manifestations?

Nowadays, many different drugs are used to treat this condition.

Chloroquine and hydroxychloroquine, for example, can cause psychosis, peripheral neuropathy, and the latter can worsen the symptoms of myasthenia gravis. Tocilizumab, an IL-6 blocker, is intended to reduce excessive cytokine release that occurs in severe inflammation. Although admission to CNS is limited, it can sometimes cause headaches and dizziness.

Precautions for COVID-19 Patients with Neurological Conditions

If a patient already has a neurological condition that requires special treatment, they tend to be at higher risk for COVID-19, due to existing lung, heart, or liver conditions, having kidney disease (dialysis), if they are overweight, or at immunosuppressive drugs. Also, it is likely that they may be in nursing homes, where many countries have reported severe outbreaks.

This study concludes: “Doctors must continue to monitor patients closely for neurological diseases. Early detection of neurological deficits can lead to improved clinical outcomes and better treatment algorithms. “

Journal reference:

  • Zubair, A. S. et al. (2020). Neuropathogenesis and Neurological Manifestations of Coronavirus in the Coronavirus Era 2019: Overview. JAMA Neurology. doi: 10.1001 / jamaneurol.2020.2065.

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Heparin can stop host cells that infect SARS-CoV-2 | Instant News


Researcher at Sheffield University has developed a new test that can be used to assess the attachment of viruses to host cells and to test the potential inhibitors of viral infections.

Using the test, the team was able to demonstrate the binding of a spike protein in acute coronavirus 2 (SARS-CoV-2) respiratory syndrome to human cells expressing the angiotensin 2 converting enzyme (ACE2).

Spike proteins are the main structure used by SARS-CoV-2 to bind ACE2 receptors expressed on target cells, before infecting them and potentially causing coronavirus 2019 (COVID-19).

The SARS-CoV-2 virus binds to ACE-2 receptors in human cells, the initial stage of COVID-19 infection. Illustrated credit: Kateryna Kon / Shutterstock

The researchers also found that incubating cells with unfracted heparin stopped the surge of proteins that bind them.

The pre-printed version of paper can be accessed on the server bioRxiv*, while this paper underwent peer review.

SARS-CoV-2 infection mechanism

On binding to ACE2, the spike protein undergoes proteolytic division of the host cell into two subunits: S1, which contains receptor binding domains (RBD) and S2, which allow fusion with the host cell membrane and virus infusion.

“Serine host cell surface protein, TMPRSS2 [transmembrane serine proteinase 2]”It was also thought to be involved in virus entry and it was proposed to split S1 and S2, which led to the activation of the fusion machine,” wrote Peter Monk and colleagues.

The new test uses cells that express ACE2 and TMPRSS2

To investigate SARS-CoV-2 that binds to host cells, the team developed a new test using a transitional urinary bladder RT4 carcinoma cell line, which expresses ACE2 and TMPRSS2.

They found that the intact recombinant form of the viral surge protein containing both S1 and S2 (S1S2), but not only in the S1 domain, binds strongly to RT4 cells in a temperature-dependent manner.

The binding activity increased sharply at 37 ° C, indicating that proteolytic cleavage might be involved, the team said.

Are there other mechanisms for virus entry?

Monk and colleagues say that most cell types only express ACE2 levels that are low enough, suggesting that the surge protein might also interact with other receptor sites to get virus entry.

Certain viruses such as herpes simplex are known to bind to the host glycosaminoglycan called sulfuric deposits, the team said.

In addition, a study by one group suggested that soluble glycosaminoglycan heparin could inhibit the entry of SARS CoV-2 into “Vero” cells – cell lines derived from monkey kidney epithelium.

“These authors also demonstrated that heparin can interact with recombinant S1 RBD and cause conformational changes, leading to the suggestion that SARS-CoV-2 might use sulfate liver hosts as an additional site for attachment during infection,” the researchers wrote.

Unfracted heparin completely stops the bond

Given that the new test seems to mimic some features of SARS-CoV-2 infection, the researchers used it to test the effect of incubating RT4 cells with heparin at 37 ° C.

The team reports that unfrracted heparin (UFH) actually inhibits the binding of S1S2 cells to RT4.

Treating cells with two low molecular weight heparin (LMWHs) that has been used clinically also inhibits binding, but only partially and not as strongly.

“This shows that heparin, especially the non-diffracted form, can be considered to reduce the clinical manifestations of COVID-19 by inhibiting ongoing viral infections,” wrote Monk and the team.

Can spike proteins also bind to the host cell’s sulfate supply?

The authors say the interaction they observed between heparin and protein spike suggests that it might also bind to sulfate liver cells.

To test this hypothesis, they treated RT4 cells with a mixture of heparinase I and III, enzymes that degrade sulfate molecules, before testing the binding of S1S2.

Treatment did not result in a significant reduction in RT4 cell binding, indicating that sulfate exposure did not play a significant role in the attachment of the SARS-CoV-2 surge protein to host cells:

“Although our data support UFH inhibitory activity, it does not support the notion that sulfate deposits are very important for viral infections,” the team wrote.

What are the implications of this research?

The researchers say that LMWHs, which have been used to treat COVID-19 patients and have been shown to improve results, are much smaller than UFH and have a more predictable pharmacokinetics.

Monks and colleagues argue that their research shows that previous use of heparin should be considered when a viral infection is still an important factor in influencing the severity of the disease.

“The use of UFH rather than LMWH must also be considered, although we note that the administration and safety profile of UFH might prevent this in some cases,” they added.

Finally, the researchers said their newly developed flow cytometric test to assess the binding of SARS-CoV-2 spike protein to the host cell supports the previous findings that heparin can inhibit viral attachment to monkey kidney epithelial cells.

“Our new test could be the first screen to be useful for new inhibitors of coronavirus infection,” concluded the team.

* Important Notification

bioRxiv publishing initial scientific reports that are not reviewed by colleagues and, therefore, should not be considered conclusive, guide clinical practice / health-related behaviors, or be treated as pre-existing information.

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