Urinary sulfate excretion and risk of late graft failure in renal transplant recipients - a prospective cohort study

Hydrogen sulfide (H2S), produced from metabolism of dietary sulfur-containing amino acids, is allegedly a renoprotective compound. Twenty-four-hour urinary sulfate excretion (USE) may reflect H2S bioavailability. We aimed to investigate the association of USE with graft failure in a large prospective cohort of renal transplant recipients (RTR). We included 704 stable RTR, recruited at least 1 year after transplantation. We applied log-rank testing and Cox regression analyses to study association of USE, measured from baseline 24 h urine samples, with graft failure. Median age was 55 [45–63] years (57% male, eGFR was 45 ± 19 ml/min/1.73 m2). Median USE was 17.1 [13.1–21.1] mmol/24 h. Over median follow-up of 5.3 [4.5–6.0] years, 84 RTR experienced graft failure. RTR in the lowest sex-specific tertile of USE experienced a higher rate of graft failure during follow-up than RTR in the middle and highest sex-specific tertiles (18%, 13%, and 5%, respectively, log-rank P < 0.001). In Cox regression analyses, USE was inversely associated with graft failure [HR per 10 mmol/24 h: 0.37 (0.24–0.55), P < 0.001]. The association remained independent of adjustment for potential confounders, including age, sex, eGFR, proteinuria, time between transplantation and baseline, BMI, smoking, and high sensitivity C-reactive protein [HR per 10 mmol/24 h: 0.51 (0.31–0.82), P = 0.01]. In conclusion, this study demonstrates a significant inverse association of USE with graft failure in RTR, suggesting high H2S bioavailability as a novel, potentially modifiable factor for prevention of graft failure in RTR

High plasma guanidinoacetate-to-homoarginine ratio is associated with high all-cause and cardiovascular mortality rate in adult renal transplant recipients

l-Arginine:glycine amidinotransferase (AGAT) is the main producer of the creatine precursor, guanidinoacetate (GAA), and l-homoarginine (hArg). We and others previously reported lower levels of circulating and urinary hArg in renal transplant recipients (RTR) compared to healthy subjects. In adults, hArg emerged as a novel risk factor for renal and cardiovascular adverse outcome. Urinary GAA was found to be lower in children and adolescents with kidney transplants compared to healthy controls. Whether GAA is also a risk factor in the renal and cardiovascular systems of adults, is not yet known. In the present study, we aimed to investigate the significance of circulating GAA and the GAA-to-hArg molar ratio (GAA/hArg) in adult RTR. We hypothesized that GAA/hArg represents a measure of the balanced state of the AGAT activity in the kidneys, and would prospectively allow assessing a potential association between GAA/hArg and long-term outcome in RTR. The median follow-up period was 5.4 years. Confounders and potential mediators of GAA/hArg associations were evaluated with multivariate linear regression analyses, and the association with all-cause and cardiovascular mortality or death-censored graft loss was studied with Cox regression analyses. The study cohort consisted of 686 stable RTR and 140 healthy kidney donors. Median plasma GAA concentration was significantly lower in the RTR compared to the kidney donors before kidney donation: 2.19 [1.77-2.70] mu M vs. 2.78 [2.89-3.35] mu M (P <0.001). In cross-sectional multivariable analyses in RTR, HDL cholesterol showed the strongest association with GAA/hArg. In prospective analyses in RTR, GAA/hArg was associated with a higher risk for all-cause mortality (hazard ratio (HR): 1.35 [95% CI 1.19-1.53]) and cardiovascular mortality (HR: 1.46 [95% CI 1.24-1.73]), independent of potential confounders. GAA but not GAA/hArg was associated with death-censored graft loss in crude survival and Cox regression analyses. The association of GAA and death-censored graft loss was lost after adjustment for eGFR. Our study suggests that in the kidneys of RTR, the AGAT-catalyzed biosynthesis of GAA is decreased. That high GAA/hArg is associated with a higher risk for all-cause and cardiovascular mortality may suggest that low plasma hArg is a stronger contributor to these adverse outcomes in RTR than GAA

USAHAWAN SISWA : MEMETA HALUAN, MELAKAR JAYA

Pembentukan masyarakat Malaysia yang berpemikiran keusahawanan merupakan asas dalam menjadikan Malaysia sebagai sebuah negara keusahawanan unggul menjelang 2030. Penerapan budaya keusahawanan melalui pelaksanaan enam Teras Strategik di bawah Dasar Keusahawanan Negara (DKN) merupakan pemangkin kepada proses transformasi ekonomi inklusif dan komuniti keusahawanan negara. Sejajar dengan hasrat kerajaan melalui pembentukan DKN yang melibatkan pelaksanaan program pembangunan keusahawanan yang merangkumi kemudahan pembiayaan, pembangunan infrastruktur, aktiviti penyelidikan dan latihan serta kemahiran di kesemua Institusi Pengajian Tinggi (IPT) di Malaysia supaya ia mampu menjadi platform untuk melahirkan dan mencipta para graduan berminda keusahawanan kelas pertama. Penglibatan mahasiswa dalam aktiviti keusahawanan telah memberi nilai tambah bukan sahaja dalam bidang berkaitan semata-mata, namun ia juga turut mendedahkan mereka dengan pelbagai kemahiran keusahawanan melalui penciptaan produk dan perkhidmatan baharu sekali gus menyokong pembangunan dan pertumbuhan ekonomi negara serta menjadi pencipta pekerjaan (job creator). Selari dengan matlamat Pelan Tindakan Keusahawanan IPT 2021-2025, buku ini telah digarap berdasarkan enam kategori utama perniagaan berteraskan inovasi dan teknologi iaitu perniagaan kosmetik dan kesihatan, perkhidmatan fotografi dan audiografi, produk makanan dan minuman, aktiviti peruncitan, bidang seni kreatif dan tekstil serta perkhidmatan pengkhususan. Seramai 39 usahawan dalam kalangan mahasiswa dan graduan yang berjaya menempa nama dengan meraih pelbagai anugerah dan kejayaan melalui pembentukan inovasi produk, proses, pemasaran, peralatan dan pembungkusan melalui pemikiran kreatif dan inovatif. Selain itu, buku ini turut menceritakan tentang perjalanan suka dan duka mereka sepanjang bergelar usahawan yang boleh dijadikan iktibar dan contoh tauladan yang baik kepada individu yang ingin menceburkan diri dalam dunia keusahawanan. Semoga penerbitan buku Usahawan Siswa: Memeta Haluan, Melakar Jaya ini, mampu menjadi wadah ilmu yang berguna sekali gus menjadi perangsang kepada jiwa-jiwa yang dahagakan perubahan dan menjadi inspirasi khususnya kepada para mahasiswa untuk menerokai bidang keusahawanan sebagai satu kerjaya pilihan

How to teach intramuscular injection through virtual learning environment in Covid-19 pandemic time for nursing students

During the pandemic COVID-19 spread and the temporary lockdown of universities, there has been a global shift toward online learning. Some universities were not prepared for such circumstances, and they began attempting to meet this unprecedented task for not missing the academic year. Recently, there has been a project that is currently working on the same issue regarding teaching nursing students how to deliver intramuscular (IM) injection using online in a virtual learning environment. The objective of this study was to create a simulation in an online course using a three-dimensional (3D) learning management system (LMS) in a virtual learning environment (VLE). That can replace IM injection traditional teaching method. This LMS intended to supplement the existing lab practice to nursing undergraduate students by creating a simulated online clinic with a nurse and patient avatars. Theoretical content in the form of reading material and related videos was also provided for students’ cognitive base before they start the 3D simulation training. This new course was founded on the Galvis panqueva method that resulted in a product called Online-3DIMI-VLE. Various validation processes undertook for multiple development processes involving nursing content specialists and computer multimedia. The pilot results showed that this LMS could replace the traditional way of teaching and support online learning during the normal education environment as well as in this COVID-19 pandemic time

A virtual learning environment for teaching intramuscular injection: a focus group discussion analysis

The teaching of Intramuscular Injection (IMI) is an essential topic for nursing students and consider one of the daily routines job for any nurse. However, the traditional teaching of IMI has shown some limitations to help the students acquire injection skills. Since the advancement of technology available instruments and applications available in the virtual stores, it seems employing an advanced computer technology would be more suitable in the present era, particularly with a large number of students. Content experts among nursing lecturers were invited to discuss the advantages and disadvantages of the traditional teaching method and the need to create an online program to teach IMI in a Virtual Learning Environment (VLE). A combination of structured and open-ended questions based on related literature was used in the focus group discussion to explore different opinions from the content experts. All the participants recognized the limitations of the traditional teaching of IMI and agreed to the need to create an online computer software as an alternative teaching method to teach the nursing students on IMI. Thus, since the traditional teaching method of IMI administration has the limitations, teaching and practicing IMI virtually and interactively would be more appropriate for the nursing program in producing nursing students who are competent in IMI