Chronic kidney disease induces a systemic microangiopathy, tissue hypoxia and dysfunctional angiogenesis

Chronic kidney disease (CKD) is associated with excessive mortality from cardiovascular disease (CVD). Endothelial dysfunction, an early manifestation of CVD, is consistently observed in CKD patients and might be linked to structural defects of the microcirculation including microvascular rarefaction. However, patterns of microvascular rarefaction in CKD and their relation to functional deficits in perfusion and oxygen delivery are currently unknown. In this in-vivo microscopy study of the cremaster muscle microcirculation in BALB/c mice with moderate to severe uremia, we show in two experimental models (adenine feeding or subtotal nephrectomy), that serum urea levels associate incrementally with a distinct microangiopathy. Structural changes were characterized by a heterogeneous pattern of focal microvascular rarefaction with loss of coherent microvascular networks resulting in large avascular areas. Corresponding microvascular dysfunction was evident by significantly diminished blood flow velocity, vascular tone, and oxygen uptake. Microvascular rarefaction in the cremaster muscle paralleled rarefaction in the myocardium, which was accompanied by a decrease in transcription levels not only of the transcriptional regulator HIF-1 alpha, but also of its target genes Angpt-2, TIE-1 and TIE-2, Flkt-1 and MMP-9, indicating an impaired hypoxia-driven angiogenesis. Thus, experimental uremia in mice associates with systemic microvascular disease with rarefaction, tissue hypoxia and dysfunctional angiogenesis

Perception of Psychological and Social Workers Regards to Addiction Services in Irada Hospital for Mental Health, Jizan 2022

Introduction: World health organization stated in 2109 report that 35 million people worldwide suffer from drug use disorders while only 1 in 7 people receive treatment. Further than the destructive effects for the person with drug addiction its negative effects can harm further people, pregnant mother affects her pregnancy. Materials and Methods: This is cross sectional study conducted between August to November 2022 in Jazan, it included all psychological and social workers in Iraha hospital for mental health, aiming to assess the perception of psychological and social workers about the of prevention services provided by Iradah hospital and the associated factors, data was collected with pre-structured and pre-tested questionnaire, and analyzed with Statistical backage of social science version 25. Results: (82.6%) were male, more than 80% fromage group 25 to 45, education levels varied from university level (78.9%) and post graduate (21.1%) , 81% were married and 66% lived in urban areas, only 35% of them think the addict have the knowledge about the addiction prevention services and 26.8% think the addict is willing to seek care those facilities. 87% of them agree about the role of family in prevention addiction as well as 87% agree that family breakdown leads to clutches of addiction, there is statistical significance between the sex of psychological and social workers (P-value 0.007) and their perception about the knowledge of addict in importance of addiction prevention services, 60% from both male and female agree about the role of different societies in addiction prevention with no statistical association (Pvalue 0.122) we found that female and age group ( 25-35) is an associated factors with a statistical significance (Pvalue.000) and (Pvalue.02) consecutively Conclusion: Psychological and social workers are a corner stone in addiction prevention and treatment services, they have a good perception about the role of family, community, education, sport and social  support , they participate actively in health education and awareness raising activities, more effort is needed to be involving in research and be up to date  countries experience in addiction prevention and treatment

Reduced microvascular density in omental biopsies of children with chronic kidney disease

Endothelial dysfunction is an early manifestation of cardiovascular disease (CVD) and consistently observed in patients with chronic kidney disease (CKD). We hypothesized that CKD is associated with systemic damage to the microcirculation, preceding macrovascular pathology. To assess the degree of "uremic microangiopathy", we have measured microvascular density in biopsies of the omentum of children with CKD.Omental tissue was collected from 32 healthy children (0-18 years) undergoing elective abdominal surgery and from 23 age-matched cases with stage 5 CKD at the time of catheter insertion for initiation of peritoneal dialysis. Biopsies were analyzed by independent observers using either a manual or an automated imaging system for the assessment of microvascular density. Quantitative immunohistochemistry was performed for markers of autophagy and apoptosis, and for the abundance of the angiogenesis-regulating proteins VEGF-A, VEGF-R2, Angpt1 and Angpt2.Microvascular density was significantly reduced in uremic children compared to healthy controls, both by manual imaging with a digital microscope (median surface area 0.61% vs. 0.95%, p<0.0021 and by automated quantification (total microvascular surface area 0.89% vs. 1.17% p = 0.01). Density measured by manual imaging was significantly associated with age, height, weight and body surface area in CKD patients and healthy controls. In multivariate analysis, age and serum creatinine level were the only independent, significant predictors of microvascular density (r2 = 0.73). There was no immunohistochemical evidence for apoptosis or autophagy. Quantitative staining showed similar expression levels of the angiogenesis regulators VEGF-A, VEGF-receptor 2 and Angpt1 (p = 0.11), but Angpt2 was significantly lower in CKD children (p = 0.01).Microvascular density is profoundly reduced in omental biopsies of children with stage 5 CKD and associated with diminished Angpt2 signaling. Microvascular rarefaction could be an early systemic manifestation of CKD-induced cardiovascular disease

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The key elements which have influenced faculty members' understanding and attitudes towards the use of educational technology in higher education with particular reference to Sultan Qaboos University, Oman

Available from British Library Document Supply Centre- DSC:DXN058439 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Integration of health assistants into interdisciplinary teams

The global healthcare landscape is facing significant challenges, including a shortage of primary care physicians alongside a rising demand for services. This has led to the implementation of team-based primary care models, which emphasize collaborative practice among a diverse range of healthcare professionals, such as nurse practitioners, registered nurses, and other clinical staff. The primary aim of this work is to provide an overview of the education, tasks, and remuneration of nurses and other primary care team members. By utilizing a framework of team organization that spans the care continuum, this study seeks to identify and compare the skill mix, education and training, responsibilities, and compensation of health professionals working within primary care. The research emphasizes the transition from ‘task delegation’ to a more collaborative ‘team care’ approach, recognizing the barriers posed by traditional role concepts, legal frameworks, and reimbursement systems. The findings reveal that nurses generally serve as the primary non-physician healthcare professionals collaborating with doctors across most countries assessed. However, the types and roles of nurses and other allied health professionals differ widely. The introduction of more allied health professionals and support workers, such as medical assistants, is becoming more common in primary care settings.

The significance of enhancing health workers' skills and knowledge in driving positive patient experiences

The significance of enhancing health workers' skills and knowledge in driving positive patient experiences cannot be overstated. As patient experience positions continue to evolve, hospitals and healthcare organizations must prioritize the development of skills and qualifications required for these roles. To deliver a positive patient experience in the ED, it is crucial to manage patient expectations and enhance their perception of the care received, given the unique position of EDs in shaping a patient's first impression. Therefore, investing in the skills and knowledge of healthcare workers to drive positive patient experiences is not only beneficial for the patients but also for the clinicians and the healthcare system as a whole

Vanillin abrogates ethanol induced gastric injury in rats via modulation of gastric secretion, oxidative stress and inflammation

Vanillin is commonly used as an additive in food, medicine and cosmetics, but its effect has not yet been studied in gastric injury. Therefore the effect of vanillin was studied in experimental gastric ulcer. Gastric secretion and acidity were studied in pylorus ligated rats. Ulcer index, levels of gastric mucus, malondialdehyde (MDA), myeloperoxidase activity (MPO), expression of nuclear factor kappa B (NF-κB) p65, and histopathological changes were determined in ethanol induced gastric ulcer. Pre treatment with vanillin significantly reduced gastric secretion (P < 0.001) and acidity (P < 0.0001) and gastric ulcer index scores (P < 0.001). and augmented the gastric mucosal defense. Vanillin significantly restored the depleted gastric wall mucus levels (P < 0.0001) induced by ethanol and also significantly attenuated ethanol induced inflammation and oxidative stress by the suppression of gastric MPO activity (P < 0.001), reducing the expression of NF-κB p65 and the increased MDA levels (P < 0.001). Vanillin was also effective in alleviating the damage to the histological architecture and the activation of mast cells induced by ethanol.Together the results of this study highlight the gastroprotective activity of vanillin in gastric ulcers of rats through multiple actions that include inhibition of gastric secretion and acidity, reduction of inflammation and oxidative stress, suppression of expression of NF-κB, and restoration of the histological architecture. Keywords: Gastric ulcers, Pylorus ligation, Ethanol, Vanillin, Inflammation, Oxidative stres

Ileal Bile Acid Transporter Inhibition Reduces Post-Transplant Diarrhea and Growth Failure in FIC1 Disease&mdash;A Case Report

Familial intrahepatic cholestasis 1 (FIC1) disease is a genetic disorder characterized by hepatic and gastrointestinal disease due to ATP8B1 deficiency, often requiring liver transplantation (LT). Extrahepatic symptoms, such as diarrhea, malabsorption, and failure to thrive, do not improve and instead may be aggravated after LT. We describe a patient with FIC1 disease who underwent LT at 2 years, 8 months of age. After LT, the child developed severe refractory diarrhea and failed to thrive. The response to bile acid resins was unsatisfactory, and the parents declined our recommendation for partial external biliary diversion (PEBD). Quality of life was extremely impaired, especially due to severe diarrhea, making school attendance impossible. Attempting to reduce the total bile acids, we initiated off-label use of the ileal bile acid transporter (IBAT) inhibitor Elobixibat (Goofice&trade;), later converted to Odevixibat (Bylvay&trade;). After six months of treatment, the patient showed less stool output, increased weight and height, and improved physical energy levels. The child could now pursue higher undergraduate education. In our patient with FIC1 disease, the use of IBAT inhibitors was effective in treating chronic diarrhea and failure to thrive. This approach is novel; further investigations are needed to clarify the exact mode of action in this condition