MEDDB: A medicinal plant database developed with the information gathered from tribal people in and around Madurai, Tamil Nadu

Tribal peoples are endowed with enriched traditional wisdom to use available nature resources around them. They are well versed in the usage of plant for treating various diseases. They have used powder or extract or paste form of the plant parts such as root, shoot, whole plant, fruits and leaves etc. The recipe known by the tribal people was passed on only to their family members and community through mouth to mouth practice. Hence, the knowledge is confined to particular people alone. It is always expedient to store information in the database, so that it will be accessible by everyone from everywhere. To achieve this, MEDDB has been developed, which stores the details of 110 plant species that are commonly used by tribes for fever, asthma, cold, cough, diabetes, diarrhea, dysentery, eye infections, stomach ache, wounds and snake bite. The details of each plant were collected from the literature and through web search to give comprehensive and exhaustive information. Each plant entry is compiled under the subheadings viz., common name, classification, physical characteristics, medicinal uses, active constituents, and references

The Major Pre- and Postmenopausal Estrogens Play Opposing Roles in Obesity-Driven Mammary Inflammation and Breast Cancer Development

Many inflammation-associated diseases, including cancers, increase in women after menopause and with obesity. In contrast to anti-inflammatory actions of 17β-estradiol, we find estrone, which dominates after menopause, is pro-inflammatory. In human mammary adipocytes, cytokine expression increases with obesity, menopause, and cancer. Adipocyte:cancer cell interaction stimulates estrone- and NFκB-dependent pro-inflammatory cytokine upregulation. Estrone- and 17β-estradiol-driven transcriptomes differ. Estrone:ERα stimulates NFκB-mediated cytokine gene induction; 17β-estradiol opposes this. In obese mice, estrone increases and 17β-estradiol relieves inflammation. Estrone drives more rapid ER+ breast cancer growth in vivo. HSD17B14, which converts 17β-estradiol to estrone, associates with poor ER+ breast cancer outcome. Estrone and HSD17B14 upregulate inflammation, ALDH1 activity, and tumorspheres, while 17β-estradiol and HSD17B14 knockdown oppose these. Finally, a high intratumor estrone:17β-estradiol ratio increases tumor-initiating stem cells and ER+ cancer growth in vivo. These findings help explain why postmenopausal ER+ breast cancer increases with obesity, and offer new strategies for prevention and therapy.This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 84510

Diagnosis and management of renal dysfunction in patients with cirrhosis

Renal dysfunction commonly occurs in patients with cirrhosis and is typically associated with poor prognosis. Several pathophysiologic mechanisms are responsible for renal disease in these patients, prompt identification permits individualized management. Pathophysiology, evaluation and differential diagnosis, management and prognosis of renal disease in patients with cirrhosis. Special focus on management of hepatorenal syndrome and indications for simultaneous liver-kidney transplantation. a detailed literature search was performed using PubMed without date restrictions. Published guidelines and position papers were also used and cross-referenced to identify additional studies. The prognostic significance of renal dysfunction in patients with cirrhosis is highlighted by the inclusion of serum creatinine in the model for end-stage liver disease (MELD). Both acute and chronic renal dysfunction result in increased mortality in patients with cirrhosis, although there are marked differences related to the etiology of renal disease. Early recognition and prompt intervention determined by the most likely etiology are key in the management of these patients. Simultaneous liver-kidney transplantation improves patient survival compared to isolated liver transplantation in patients with cirrhosis and persistent renal impairment; however, selection of candidates must be judicious and individualized due to the ongoing shortage of donor kidneys

944-P: Medicaid Insured Persons with Diabetes Have Increased Proportion of Missed Appointments and Poor Diabetes Control

Poor socioeconomic status and inadequate insurance coverage may affect an individual's ability to utilize healthcare services. This study was conducted to evaluate whether the type of insurance coverage is associated with missed appointments for diabetes care. Data analysis included all patients with diabetes mellitus (DM) managed at a major academic center between Jan 2015 and Dec 2020. Association between insurance coverage and proportion of missed appointments was evaluated using analysis of covariance with adjustments for demographic variables and social determinants of health. The relationship between proportion of missed appointments and glycemic control was also evaluated in multivariate analyses. The final dataset included 30,633 patients, out of which 14,064 (46%) reported commercial insurance, 13,376 (44%) reported Medicare and 3,193 (10%) reported Medicaid coverage. Medicaid group was identified to have the highest proportion of Spanish-speakers, African Americans, women, current smokers and single individuals. Proportion of missed appointments was 18.1 ± 18.1% in Medicaid covered patients as compared to 12.1 ± 15.3% among commercially insured and 10.2 ± 14.1% among Medicare covered patients (p <0.001) . Type of insurance was found to be a statistically significant predictor of the proportion of missed appointments after adjusting for age, race, preferred language, marital status, smoking, BMI, HbA1c and type of diabetes (p<0.001) . Proportion of missed appointments was associated with HbA1c with partial correlation coefficient +0.1 (p <0.001) after adjusting for age, race, gender, type of insurance, BMI and type of diabetes. We conclude that Medicaid covered patients with diabetes have higher proportion of missed clinic appointments and higher HbA1C. More research is needed to evaluate the root causes of inability to keep appointments in this population so that strategies for improved healthcare delivery can be designed

Medicaid insured persons with diabetes have increased proportion of missed appointments and high HbA1c

•Frequency of missed clinic appointments is associated with high HbA1c level.•Patients with diabetes who have Medicaid coverage have higher chances of missing a clinic appointment for diabetes.•The same group of patients also have high HbA1c.•Further studies need to explore the specific reasons for underutilization of health care services by Medicaid covered population. This study was conducted to evaluate whether the type of insurance coverage is associated with missed appointments and to evaluate the effect of missed appointments on diabetes control. All patients with diabetes mellitus (DM) managed at a major academic medical center between Jan 2015 and Dec 2020 were included in analysis. Association between insurance coverage and the proportion of missed appointments was evaluated with adjustments for demographic variables and social determinants of health. The relationship between proportion of missed appointments and glycemic control was also evaluated. The dataset included 30,633 patients, out of which 14,064 (46%) reported commercial insurance, 13,376 (44%) reported Medicare and 3,193 (10%) reported Medicaid coverage. Proportion of missed appointments was 18.1 ± 18.1% among Medicaid covered patients,12.1 ± 15.3% among commercially insured and 10.2 ± 14.1% among Medicare covered patients (p < 0.001). Type of insurance was found to be a significant predictor of proportion of missed appointments after adjusting for age, race, language, marital status, smoking, BMI, HbA1c and type of diabetes (p < 0.001) in series regression analysis. Proportion of missed appointments was associated with HbA1c with partial correlation coefficient +0.104 (p < 0.005) after adjusting for age, race, gender, type of insurance coverage, BMI and type of diabetes. Medicaid covered patients with diabetes have higher proportion of missed clinic appointments and higher HbA1c. More research is needed to evaluate the root causes of inability to keep appointments in this population so that strategies for improved healthcare delivery can be designed