The effects of angiotensin-converting enzyme gene polymorphism on the progression of immunoglobulin A nephropathy in Malaysian patients

Introduction: Angiotensin-converting enzyme (ACE) gene polymorphism, especially the deletion/deletion (DD) genotype, is associated with the disease progression of immunoglobulin A (IgA) nephropathy patients in various studies from both Asia Pacific and European populations. However, recent studies within the same populations were unable to reproduce the same results. Hence, we had studied the distribution of the DD genotype, the association between ACE gene polymorphism and the disease progression, and the factors (other than ACE gene polymorphism) which were involved in the disease progression of our local patients. Methods: This was a cross-sectional study of biopsy-proven IgA nephropathy patients attending the Nephrology Clinic, Hospital Universiti Kebangsaan Malaysia. Both biochemical and urine tests at the time of first presentation were compared to those at the time of the study, and the disease progression was analysed. The ACE gene polymorphism was identified via PCR-amplification technique, and patients were then categorised into the DD and the non-DD groups for detailed analysis. Histological severity of each renal biopsy was scored according to the predetermined criteria and medications used were recorded. The association between the gene polymorphism and disease progression was then determined. The patients who were stable or had renal function deterioration, were respectively regrouped into Groups 1 and 2, to identity those factors (other than ACE gene polymorphism), which were involved in the disease progression. Results: 60 patients with adequate renal histopathological examination were recruited. Their mean age was 40.9 +/− 12.3 years and the follow-up duration was 4 +/− 3 years (range 6 months–20 years). More than two-thirds of them were treated with ACE inhibitors or angiotensin receptor blockers and 8.3 percent received the combination treatment. The DD genotype was noted in 13.3 percent of study patients, insertion/insertion in 48.3 percent and insertion/deletion genotype in 38.3 percent. Although the estimated glomerular filtration rate (eGFR) of both groups were the same during their initial presentation, the DD patients had more severe disease compared to the non-DD patients at the time of the study. Their serum creatinine and eGFR was 178 (IQR 31.3) μmol/L and 42.1 +/− 31.1 ml/min/1.73 square metres, whereas the non-DD patients had serum creatinine and eGFR of 79 (IQR: 88.3) μmol/L and 76.6 +/− 42.1 ml/min/1.73 square metres, respectively (p-value is less than 0.01). The DD patients were also found to have more severe vascular damage in their renal biopsies compared to the non-DD patients. The annual rate of decline in eGFR was not significantly different between the two groups. It was −5.7 +/− 2.2 ml/min/1.73 square metres/year for the DD group and −4.8 +/− 2.0 ml/min/1.73 square metres/year for the non-DD group (p-value is equal to 0.5). They also had severe proteinuria with UPCI of 0.09 (IQR 0.2) g/mmol creatinine vs. 0.04 (IQR 0.10) g/mmol creatinine (p-value is less than 0.01). The study also confirmed that patients who had higher systolic blood pressure, greater proteinuria and longer follow-up duration had significant renal function deterioration compared to those who did not. Conclusion: The DD genotype, although found in a minority of the patients, might have adversely affected the disease progression of our IgA nephropathy patients. Higher systolic blood pressure, greater proteinuria and longer follow-up duration were the other prognostic factors in IgA nephropathy patients. However, appropriate treatment, especially prompt use of renin-angiotensin-aldosterone system blockade, should stabilise the disease regardless of their genotyp

Introduction to smart grid architecture

The smart grid that is a new concept introduced at the beginning of the 2000s intends to include bidirectional communication infrastructure to conventional grids in order to enable information and communication technologies (ICTs) at any stage of generation, transmission, distribution, and even consumption sections of utility grids. This chapter introduces essential components and novel technologies of smart grids such as sensor networks, smart metering and monitoring systems, smart management systems, wired and wireless communication technologies, security requirements, and standards and regulations for this concept. First of all, this chapter focuses on the main components of smart grids such as smart sensors and sensor networks, phasor measurement unit (PMU), smart meters (SMs), and wireless sensor networks (WSNs). Then, smart grid applications and main requirements are explained on the basis of advanced metering infrastructure (AMI), demand response (DR), station and substation automation, and demand-side management (DSM). Later, communication systems of smart grid are presented in which the communication systems are classified into two groups as wired and wireless communication systems, and they are comprehensively analyzed. Furthermore, the area networks related to smart grid concept such as home area network (HAN), building area network (BAN), industrial area network (IAN), neighborhood area network (NAN), field area network (FAN), and wide-area network (WAN) are presented in a logical way beginning from generation systems to the user side

Natural compounds extracted from Moringa oleifera and their agricultural applications

Natural bio-active compounds synthesized by plants as secondary metabolites are well known and established. Today, their application in various fields such as medicine in the form of drugs and biopesticides in agriculture is well documented. In recent times, the delivery of such compounds is achieved through nanodelivery technology, which is gaining acceptability in both field of drugs and agrochemical industries. The bio-active compounds with chemical diversity are obtained from nature either as homogenous plant crude extracts or as purified compounds. Crude plant extracts exist as a combination of different bio-active compounds with various polarities, and their partition remains a challenge in the process of characterization and identification. Extraction of these compounds from plant species is achieved by different solvents and extraction methods. Analytical methods like HPLC have commonly been utilized with GC-MS and LC-MS/MS chromatography methods to identify the compounds. Crude extracts from different morphological parts of plant species including Moringa oleifera are increasingly becoming important in the context of agricultural pest management and human medicine. M. oleifera is a medicinal plant that synthesizes such metabolites which include phenolic acids, carotenoids, quinones, antraquinones, flavonoids, flavonols, flavones, tannins, alkaloids, coumarins, terpenoids, amines, cyanogenic glycosides, triterpenoids, non-protein amino acids, glucosinolates, polyacetylenes, polyketides, phenylpropanes, steroids and saponins. They exert biological activities and can potentially be used to retard microbial activities. Other uses of M. oleifera are medicinal uses and other purposes such as water purification, fertilizer, biogas and biopesticides. The aim of this chapter is to highlight the uses and profiling of bio-active compounds of M. oleifera, their mode of action and prospects in commercial biopesticides for agricultural applications

Age-sex differences in the global burden of lower respiratory infections and risk factors, 1990-2019: results from the Global Burden of Disease Study 2019

Background The global burden of lower respiratory infections (LRIs) and corresponding risk factors in children older than 5 years and adults has not been studied as comprehensively as it has been in children younger than 5 years. We assessed the burden and trends of LRIs and risk factors across a groups by sex, for 204 countries and territories.Methods In this analysis of data for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we used dinician-diagnosed pneumonia or bronchiolitis as our case definition for LRIs. We included International Classification of Diseases 9th edition codes 079.6, 466-469, 470.0, 480-482.8, 483.0-483.9, 484.1-484.2, 484.6-484.7, and 487-489 and International Classification of Diseases 10th edition codes A48.1, A70, B97.4 B97.6, 109-115.8, J16 J16.9, J20-121.9, J91.0, P23.0 P23.4, and U04 U04.9. We used the Cause of Death Ensemble modelling strategy to analyse 23109 site-years of vital r *stration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian metaregression tool, to analyse age sex-specific incidence and prevalence data identified via systematic reviews of the literature, population-based survey data, and daims and inpatient data. Additio y, we estimated age sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors.Findings Globally, in 2019, we estimated that there were 257 million (95% uncertainty interval [UI] 240-275) LRI incident episodes in males and 232 million (217-248) in females. In the same year, LRIs accounted for 1.30 million (95% UI 1.18-1.42) male deaths and 1.20 million (1.07-1.33) female deaths. Age-standardised incidence and mortality rates were 1.17 times (95% UI 1.16-1.18) and 1.31 times (95% UI 1.23-1.41) greater in males than in fe es in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups and an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older having the highest increase in LRI episodes (126.0% [95% UI 121.4-131.1]) and deaths (100.0% [83.4-115.9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest dedine was observed for LRI deaths in males younger than 5 years (-70.7% [-77.2 to 61.8]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths in children younger than 5 years were attributable to child wasting (population attributable fraction [PAF] 53.0% [95% UI 37.7-61.8] in males and 56.4% [40.7-65.1] in females), and more than a quarter of LRI deaths among those aged 5-14 years were attributable to household air pollution (PAF 26.0% [95% UI 16.6-35.5] for males and PAF 25.8% [16.3-35.4] for females). PAFs of male LRI deaths attributed to smoking were 20.4% (95% UI 15.4-25.2) in those aged 15-49 years, 305% (24.1-36. 9) in those aged 50-69 years, and 21.9% (16. 8-27. 3) in those aged 70 years and older. PAFs of female LRI deaths attributed to household air pollution were 21.1% (95% UI 14.5-27.9) in those aged 15-49 years and 18 " 2% (12.5-24.5) in those aged 50-69 years. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11-7% (95% UI 8.2-15.8) of LRI deaths.Interpretation The patterns and progress in reducing the burden of LRIs and key risk factors for mortality varied across age groups and sexes. The progress seen in children you - than 5 years was dearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to the achievement of multiple Sustainable Development Goals targets, induding promoting wellbeing at all ages and reducing health inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would prevent deaths and reduce health disparities.Copyright 2022 The Author(s). Published by Elsevier Ltd