Improving Rates of Nephrology Referral for Patients with Chronic Kidney Disease in Resident Clinic

According to the KDIGO (Kidney Disease Improving Global Outcomes), evaluation by a nephrologist is recommended for patients with CKD stage 4 or higher (corresponding to a GFR of 30 or lower). Studies have shown that patients who are not referred to a nephrologist or referred later suffer from increased complications of renal disease, accelerated progression to ESRD, and have an increased overall mortality rate. At Jefferson Hospital Ambulatory Practice (JHAP), we noted decreased rates of nephrology follow-up in our patients with chronic kidney disease stage 4 and 5. We identified that the most prevalent reason for the decreased referral rates is due to the lack of knowledge of the KDIGO guidelines. Our goals were to implement an intervention to educate our internal medicine residents and improve the referral rates for advanced chronic kidney disease in our practice

Fever in a returning traveler: A case and literature review of melioidosis

Burkholderia pseudomallei is an aerobic, motile, non-spore-forming gram-negative bacillus found in tropical endemic environments that causes the disease melioidosis. Melioidosis displays a diversity of clinical presentations ranging from septic shock to chronic latent infection, often with characteristic abscesses in multiple organs. Melioidosis is an opportunistic infection, with risk factors, including diabetes, alcohol use, chronic lung disease, and chronic renal disease, and these risk factors increase the severity of disease (Wiersinga et al., 2006) [1]. In this case report, we illustrate a case of a 32 year old man with several risk factors and recent travel to an endemic region presenting with melioidosis. Our case demonstrates the challenges in obtaining a diagnosis in a non-endemic location, highlights a complex presentation of this disease, and describes the multifaceted clinical management required to care for this patient. As global travel increases, there is an increased need for clinician awareness of this disease in non-endemic regions

Chitosan Nanoparticles as Seed Priming Agents to Alleviate Salinity Stress in Rice (<i>Oryza sativa</i> L.) Seedlings

Nanoparticle-based seed priming has opened new avenues in crop science due to their plant growth promoting potential. Similarly, biopolymers such as chitosan (CS) are widely studied as seed priming agents due to the biodegradable and biocompatible nature, ability to enhance germination percentage and overall seedling health. Therefore, priming with chitosan nanoparticles (CNPs) is a promising tool to enhance overall plant health. Here, we studied the effect of nanopriming with CNPs or CS (50 µg/mL) on morphological, physiological, and biochemical parameters of rice seedlings, grown in salinity stress conditions NaCl (0–250 mM). CNPs were synthesized using an ionic gelation method and characterized by scanning electron microscopy (50–100 nm), zeta potential analyser (Particle size distribution–373.5 ± 3.7 nm; polydispersity index- > 0.4; zeta potential–45.3 ± 2.5 mV) and profilometry (300–1500 nm hydrodynamic height). Morphological, physiological, and biochemical responses of rice seedlings grown from seeds primed with either CNPs or CS showed a positive effect on germination, seedling vigour, biochemical and antioxidant responses. Seeds primed with CNPs and CS demonstrated significantly higher germination potential and seedling vigour compared to control hydro-primed seeds when grown under increasing NaCl concentrations. These outcomes highlight that CNPs and CS can be used as potential seed priming agents to alleviate salinity stress in rice seedlings. However, further studies are warranted to understand the effect of CNPs and CS seed priming on the overall growth and development of rice plants as well as rice yield

Ethnomedicinal wisdom among local tribes in Hamirpur valley, Himachal Pradesh, India

The current investigation was focused on the documentation, analysis and interpretation of ethnomedicinal phytowisdom in Hamirpur district of Himachal Pradesh. The impoverished tribal and rural people of Hamirpur district (Himachal Pradesh, India) do not receive satisfactory primary healthcare. They have traditionally been exploiting the medicinal plants existing in their surrounding environment for diverse purposes including medicinal use. The objective of this study was to document ethnobotanical knowledge, primarily of notable herbs employed by the different backward people whether tribal or rural, in the area under study. Ethnomedicinal data was accessed through structural interviews, and discussions with the tribal/rural informants, healers, medicine-men/women, etc. aged 45-65. A minimum of five to eight informants was taken into consideration for each claim. This investigation brought on record that people of the study area (Hamirpur) generally utilize about 50 plant species belonging to several distinct families. Different plant parts such as leaves, flowers, fruit, stem-bark and root are most commonly employed. A fairly wide range of diseases is treated by people of Hamirpur district using local medicinal plants. These ethnomedicinal claims would aid in finding novel phytoconstituents for the welfare of mankind, and therefore begs further scientific exploration

Curcumin displays a potent caloric restriction mimetic effect in an accelerated senescent model of rat

Curcumin, a strong natural compound with numerous health benefits, is extracted from the Curcuma longa. According to recent research findings, it also acts as a calorie restriction mimetic. We examined established aging biomarkers in eryth- rocytes and plasma and tested a persistent oral dietary dose of curcumin in young and d-galactose-induced accelerated rat aging models. For four weeks, d-gal (300 mg/kg b.w. subcutaneously) and curcumin (200 mg/kg b.w. oral) were adminis- tered simultaneously to test the protective effects of curcumin against d-galactose-induced accelerated aging and oxidative stress. In the accelerated senescent rat model, we discovered a significant rise in protein carbonyl, malonaldehyde (MDA), and advanced oxidation protein products. Increased levels of catalase, superoxide dismutase, ferric-reducing antioxidant potential, and reduced glutathione (GSH) were observed. Our findings reveal that curcumin has characteristics resembling a calorie restriction mimic and can successfully maintain redox equilibrium throughout the aging process in rat erythrocytes and plasma

COVID-19 in Solid Organ Transplantation: Disease Severity and Clinical Update.

BACKGROUND: Solid organ transplant (SOT) recipients are a complex, immunocompromised population in whom greater coronavirus disease 2019 (COVID-19) mortality has been reported compared with the general population. METHODS: We examined a retrospective cohort of 58 SOT recipients with first-wave COVID-19, comparing patients with severe and nonsevere illness. Additionally, SOT recipients are compared with general patients with first-wave COVID-19. RESULTS: Organs transplanted included 38 kidneys, 8 livers, 5 hearts, and 3 pancreases. Average SOT recipient age was 57.4 years; 62% were male; 46.6% were African American 36.2% were white. Comorbidities included hypertension (86%), chronic kidney disease (86%), diabetes mellitus (50%), coronary artery disease (26%), and chronic obstructive pulmonary disease (14%). Twenty patients had severe COVID-19 (34.5%) and 38 had nonsevere disease (65.5%). Severe disease was more common in older SOT recipients with comorbidities and was associated with cough, dyspnea, pneumonia, C-reactive protein \u3e10 mg/L, and platelet count \u3c150/μL. Sex, race, body mass index, time from transplant, baseline immunosuppression, and diagnosis month did not differ among those with severe and nonsevere COVID-19. Seventy percent of SOT recipients were hospitalized vs 27.2% of general patients with COVID-19 and inpatient SOT recipients had a higher mechanical ventilation rate. Though a trend toward longer length of stay, higher intensive care unit admission, and greater inpatient mortality was observed (19.5% vs 14.8%), these differences were not significant. CONCLUSIONS: The severe acute respiratory syndrome coronavirus 2 has greatly impacted SOT recipients. One-third of our SOT recipients seen during the first wave had severe illness with associated standard risk factors for poor outcome. Compared with general first-wave patients, more SOT recipients were hospitalized, although inpatient COVID-19 mortality did not significantly differ

From the Editors

It is our honor to present the product of 22 years of resident-run tradition – the 2020-2021 annual edition of The Medicine Forum. In the world of Jefferson traditions, ours is a small one. There is no regalia, pomp and circumstance, or any such fanfare in this marking of the year’s close. Rather than the celebratory release of those other springtime occasions, this publication is a representation of the yearlong dedication and hard work of our residents and fellows in their academic pursuits. We at The Medicine Forum know that producing scholarly work even during what would constitute a normal year can be that added stressor that just feels like too much. In a year where we have continued to see high caseloads of COVID-19 (bearing the emotional toll that comes with it to providers), scrambled to vaccinate as many of our clinic patients as possible against the disease, and tried to balance a world attempting to go back to normal during clearly abnormal times, it amazes us what you all were able to produce. To our submission writers, thank you for sharing in – despite all this – perhaps medicine’s most important practice, the furthering and dissemination of medical knowledge. To our supporters, thank you for making this journal possible. And finally, to our readers, thank you for partaking in this, our small tradition, the 22nd edition of The Medicine Forum