Hypertension, end-stage renal disease and mesangiocapillary glomerulonephritis in methamphetamine users

Background: Methamphetamine abuse has risen dramatically in South Africa. The chronic effects of abuse on the kidneys and blood pressure have not been documented. This study reviewed patients referred for evaluation of kidney disease and/or hypertension, who had been abusing methamphetamines.Methods: The records of patients referred to the renal unit between 2005 and 2013 who had been using methamphetamines were retrospectively reviewed. Patient demographics, biophysical parameters, blood pressure, renal function, renal ultrasound and biopsy findings, complications of chronic kidney disease and comorbidities were recorded.Results: Forty-seven patients were included in the study. Their mean age was 29 years. Hypertension was present in 42 (89.4%) of patients, with malignant hypertension in 21 (44.7%). Forty-five (95.7%) had chronic kidney disease (CKD), and 26 (55.3%) had end-stage renal disease. Renal biopsies were performed in 24 patients. Twelve (50.0%) of the biopsies showed hypertensive changes and 14 (58.3%) mesangiocapillary glomerulonephritis type 1, with deposition of IgM and C3 complement.Conclusion: Methamphetamine use is associated with severe hypertension, mesangiocapillary glomerulonephritis and CKD

Therapeutic drug monitoring of amlodipine and the Z-FHL/HHL ratio: Adherence tools in patients referred for apparent treatment-resistant hypertension

Background. Non-adherence to antihypertensives is a cause of ‘pseudo-treatment-resistant’ hypertension. Objective. To determine whether monitoring plasma amlodipine concentrations and inhibition of angiotensin-converting enzyme (ACE) can be adjunct adherence tools. Methods. Patients with hypertension who were prescribed enalapril and amlodipine were enrolled. Blood pressures (BPs) were monitored and an adherence questionnaire was completed. Steady-state amlodipine was assayed using liquid chromatography-mass spectrometry and degree of ACE inhibition using the Z-FHL/HHL (z-phenylalanine-histidine-leucine/hippuryl-histidine-leucine) ratio. Results. One hundred patients (mean (standard deviation) age 50.5 (12) years, 46% male) were enrolled. Based on plasma assays, 26/97 patients (26.8%) were unsuppressed by enalapril and 20/100 (20%) were sub-therapeutic for amlodipine. There were significant BP differences based on plasma levels of the medication: 21/20 mmHg lower in the group with suppressed ACE and 26/20 mmHg in the group with steady-state amlodipine concentrations. Conclusions. Monitoring antihypertensive adherence by assaying plasma medication concentrations is a feasible option for evaluating true v. pseudo-resistant hypertension.S Afr Med J 2017;107(10):887-89

Genomic identification of chemokines and cytokines in Opossum

The cytokine repertoire of marsupials is largely unknown. The sequencing of the opossum genome has expedited the identification of many immune genes. However, many genes have not been identified using automated annotation pipelines because of high levels of sequence divergence. To fill gaps in our knowledge of the cytokine gene complement in marsupials, we searched the genome assembly of the gray short-tailed opossum for chemokine, interleukin, colony-stimulating factor, tumor necrosis factor, and transforming growth factor genes. In particular, we focused on genes that were not previously identified through Ensembl's automatic annotations. We report that the vast majority of cytokines are conserved, with direct orthologs between therian species. The major exceptions are chemokine genes, which show lineage-specific duplication/loss. Thirty-six chemokines were identified in opossum, including a lineage-specific expansion of macrophage inflammatory protein family genes. Divergent cytokines IL7, IL9, IL31, IL33, and CSF2 were identified. This is the first time IL31 and IL33 have been described outside of eutherian species. The high levels of similarities between the cytokine gene repertoires of therians suggest that the marsupial immune response is highly similar to eutherians

Modeling the Determinants of Employee Belief and Attitude for the Adoption of Green IT

This study offers a theoretical explanation of the underlying factors for employee’s engagement in Green IT. The proposed model examines engagement in sustainable IT practices from the perspective of employee’s adoption of GIT and suggests the role of attitude in enabling such. Drawing on the belief–action–outcome (BAO) framework, this study delineates the micro- and macro-level factors underlying the formation of employee’s beliefs and attitude toward GIT, which in turn leads to the adoption of GIT. The proposed model contributes to the extant literature in GIT adoption by suggesting the role of personal competence, and organizational structure and culture in employee’s engagement in environmental sustainability initiatives

Transgender employees: workplace impacts on health and well-being

Given that research consistently finds transgender individuals sustaining worse health outcomes than cisgender individuals, it is important to understand the workplace health and well-being experiences of trans employees in order to develop and support trans-sensitive Human Resources policies and interventions. We take an employee journey perspective to explore the experiences of trans individuals as they navigate organizational processes such as recruitment and selection, managing change, co-worker relationships, performance and termination. What the literature demonstrates is that transgender workers face many barriers to physical and psychological health, safety and well-being at work. These barriers can range from organisational oversights such as lack of access to appropriate bathroom facilities to social exclusion and/or verbal harassment from co-workers and physical attacks from customers. Anticipation of mistreatment generates psychological strain and anxiety and lowers trans workers’ career aspirations and career-building behaviours such as applying for jobs or promotions. Trans workers often conceal their transgender identity at work as a coping strategy for avoiding discrimination and harassment, but this in turn produces strain and fatigue arising from the cognitive and emotional effort involved in constructing and maintaining facades. Although HR staff should be the first point of contact for trans employees to develop their plans for coming out and for gender transition if applicable, our review indicates that in many cases, HR may not know how to initially or adequately respond