The Ontario Renal Network (ORN), a provincial government agency in Ontario, Canada, launched an initiative in 2012 to increase home dialysis use province-wide. The initiative included a new modality-based funding formula, a standard mandatory informatics system, targets for prevalent home dialysis rates, the development of a ‘network’ of renal programmes with commitment to home dialysis and a culture of accountability with frequent meetings between ORN and each renal programme leadership to review their results. It also included funding of home dialysis coordinators, encouragement and funding of assisted peritoneal dialysis (PD), and support for catheter insertion and urgent start PD. Between 2012 and 2017, home dialysis use rose from 21.9% to 26.5% and then between 2017 and 2019 stabilised at 26% to 26.5%. Over 7 years, the absolute number of people on home dialysis increased 40% from 2222 to 3105, while the number on facility haemodialysis grew 11% from 7935 to 8767. PD prevalence rose from 16.6% to 20.9%, a relative increase of 25%. The initiative showed that a sustained multifaceted approach can increase home dialysis utilisation.
A 28-year-old man in 2004 was identified with a spontaneous pseudoaneurysm and distal left cervical internal carotid artery (ICA) dissection. The patient was followed conservatively for 12 years with cross-sectional imaging. The patient was initially diagnosed with an acute left ICA dissection, with significant luminal narrowing. Follow-up imaging revealed the dissection was not completely healed, and a small pseudoaneurysm, about 4 mm in size, was formed in the distal left cervical ICA. During the 12-year observation period, the patient’s pseudoaneurysm expanded from 4.0 mm to 9.0 mm, and the patient presented with ptosis, anisocoria and myosis. Flow diverter embolisation resulted in a radiographic cure of the pseudoaneurysm and resolution of Horner’s syndrome.
Herein, we report the aggregation properties of metabolites of urea cycle and uric acid pathway. The aggregation/ self-assembly properties of these metabolites were studied extensively via microscopic techniques. In this context the self-assembling properties of citrulline, ornithine, xanthine, hypoxanthine, cytosine and uracil were studied by assessing its aggregation under varying ageing time from fresh to day 15 of incubation. Interestingly, the metabolites exhibited tendency to aggregate and form soft fibril assembly during the course of ageing and gradually changes to crystalline structures on prolonged incubation. The results presented in this manuscript may have important implications in the pathogenesis of diseasescause urea and uric acid pathway metabolic dysfunction like HHH syndrome, Citrullinemia, Xanthinuria, Lesh Nyahn syndrome and Gout caused by accumulation of these metabolites.
Aggregation of amino acids to amyloid like structures is known to have implications in the pathophysiology of single amino acids based inborn-errors of metabolism (IEMs). Studying the aggregation properties of amino acids is of crucial interest also to understand the association of these IEMs to amyloid associated diseases. Hence, herein we have studied the self-assembly of different non-aromatic charged/uncharged polar amino acids namely L-Glutamine (Gln), L-Aspartic acid (Asp), L-Glutamic acid (Glu) L-Histidine (His), L-Arginine (Arg), L-Serine (Ser) and L-Threonine (Thr) whose amyloid characteristics have still not been explored by ageing them for varying time intervals from 0-15 days in aqueous solution. The structure formation by the self-assembly of these amino acids were then studies by microscopy., Notably, of all amino acids glutamine revealed amyloid like febrile morphologies as observed in case of aromatic amino acids. The MTT assay also revealed a relatively more cytotoxic nature of glutamine assemblies as compared to other amino acid aggregates and suggests it may have amyloid like characteristics. Along with Gln, Asp and Glu also revealed formation of some unique self-assembled structures. The thioflavin T assay suggests these aggregates may have amyloid nature. Hence, the aggregation studies of these amino acids may have important implication in the pathogenesis of disease caused by the accumulation of glutamine, aspargine and aspartic acid.
Herein we report the antimicrobial activity of the self-assembled structures formed by protected single amino acids (SAAs) and also their application as a tool for overcoming antibiotic resistance. Interestingly, SAAs modified with simple protecting groups like -Fmoc, -Boc, -Cbz exhibit antibacterial activity and is useful in overcoming the antibiotic resistance in wide spectrum of bacterial strains namely Escherichia coli, Staphylococcus aureus, Bacillus subtilis, P. aeruginosa, Vibrio cholera and Enterococcus faecalis as in there presence the concentration of antibiotic required to inhibit bacterial strain was decreased manifold . The SAAs themselves exhibited antimicrobial activity albeit higher doses of the SAAs as compared to chloramphenicol alone was required for inhibition. However, in presence of antibiotics the concentration required for SAAs as well as antibiotic was lowered manifold particularly in case of S. Aureus, P. aeruginosa and E. Faecalis the IC50 value of peptides alone was even less than chloramphenicol. When peptides were used in combination with chloramphenicol antibiotic resistance was overcome in wide spectrum of bacterial strains and the concentration of chloramphenicol required was drastically reduced.
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