Overview of Methamphetamine-Associated Pulmonary Arterial Hypertension

TOPIC IMPORTANCE

The global surge in methamphetamine (MA) use is a critical public health concern, particularly due to its robust correlation with MA-associated pulmonary arterial hypertension (MA-PAH). This association raises urgent alarms about the potential escalation of MA-PAH incidence, posing a significant and imminent challenge to global public health.

REVIEW FINDINGS

This comprehensive review meticulously explores MA-PAH, offering insights into its epidemiology, pathophysiology, clinical presentation, diagnostic intricacies, and management strategies. The pathogenesis, yet to be fully described, involves complex molecular interactions, including alterations in serotonin signaling, reduced activity of carboxylesterase 1, oxidative stress, and dysregulation of pulmonary vasoconstrictors and vasodilators. These processes culminate in the structural remodeling of the pulmonary vasculature, resulting in pulmonary arterial hypertension (PAH). MA-PAH exhibits a more severe clinical profile in functional class and hemodynamics compared with idiopathic pulmonary arterial hypertension. Management involves a multifaceted approach, integrating pulmonary vasodilators, cessation of MA use, and implementing social and rehabilitation programs. These measures aim to enhance patient outcomes and detect potential relapses for timely intervention.

SUMMARY

This review consolidates our understanding of MA-PAH, pinpointing knowledge gaps for future studies. Addressing these gaps is crucial for advancing diagnostic accuracy, unraveling mechanisms, and optimizing treatment for MA-PAH, thereby addressing the evolving landscape of this complex health concern.

Polymeric immunoglobulin receptor and galectin-3-binding protein are raised in biliary atresia: Reveals a proteomic-based study

To identify and evaluate differentially expressed plasma proteins in biliary atresia (BA), we performed plasma proteome profiling using liquid chromatography with tandem mass spectrometry (LC-MS/MS) in 20 patients with BA and 10 control children. Serological assays validated the most significant and highly upregulated proteins in a cohort of 45 patients and 15 controls. Bioinformatics tools were used for functional classification and protein-protein interactions of differentially expressed proteins (DEPs). Of 405 proteins detected in patients and 360 in controls, 242 proteins, each with ≥2 unique peptides (total of 3230 peptides), were common in both groups. Compared to controls, 90 proteins in patients were differentially expressed and were dysregulated. Twenty-five were significantly upregulated with polymeric immunoglobulin receptor (PIgR), galectin-3-binding protein (Gal-3BP), complement C2, the most prominent, and 15 had low expression. The bioinformatic analysis revealed functional interaction between DEPs and their role in an inflammatory immune response. Enzyme immunoassay for PIgR and Gal-3BP in patients' plasma showed their levels raised significantly (p = 0.0021 and p = 0.0369, respectively). The PIgR and Gal-3BP are novel proteins upregulated in BA and may be tested further for their utility as potential circulating disease biomarker(s). SIGNIFICANCE: The study shows that plasma PIgR and GAL-3BP levels are significantly raised in infants with BA within the first 3 months of life. If tested in a larger cohort, these proteins may be found to have their diagnostic potential and utility as disease biomarkers. The study also provides valuable information on the involvement of several DEPs in innate immune response, chronic inflammation, and fibrosis. This strengthens the hypothesis that the immune-mediated inflammatory processes are responsible for the progressive nature of BA.

Notch3 deletion regulates HIV-1 gene expression and systemic inflammation to ameliorate chronic kidney disease

Antiretroviral therapy (ART) has profoundly decreased HIV-1 associated morbidity. However, despite ART, immune cells remain latently infected and slowly release viral proteins, leading to chronic inflammation and HIV associated comorbidities. Thus, new strategies are needed to reduce the inflammatory effects of HIV-1. In previous studies we found that gamma secretase inhibitor (GSIXX) ameliorated renal lesions of HIV-Tg26 mice carrying replication defective HIV-1 PNL4-3 by inhibiting Notch activation. Since gamma secretase inhibition is not a safe strategy in humans, here we examined the specific role of the Notch3 pathway in the pathogenesis of the renal lesions and outcome of HIV-Tg26 mice. We found that Notch3 is activated in podocytes and other renal cells in HIV-Tg26 mice and human biopsies with HIV-1 associated Nephropathy (HIVAN). Knockdown of Notch3 in HIV-Tg26 mice revealed a marked reduction in the mortality rate, improvement in renal injury and function. RNA sequencing and immunolabeling data revealed that Notch3 deletion drastically reduced infiltrating renal macrophages in HIV-Tg-N3KO mice in association with renal reduction of HIV-nef mRNA expression levels. In fact, bone marrow derived macrophages from HIV-Tg26 mice showed a significant activation of Notch3 signaling. Further, systemic levels of TNF-alpha and MCP-1 and other inflammatory chemokines and cytokines were reduced in Tg-N3KO mice as compared to HIV-Tg26 mice and this translated to a marked reduction of HIV-induced skin lesions. Taken together, these studies strongly point to a dual inhibitory/therapeutic effect of Notch3 inhibition on HIV-induced systemic, skin and renal lesions independently of ART.

Association of Micronutrients with Tuberculosis Development in HIV Infected Patients

Human immunodeficiency virus (HIV) infection associated with weakened immune system due to decreased CD4 T cell count favors development of tuberculosis. Effector immune responses are also associated with micronutrient status due to their prominent role in maintaining immune functions. Micronutrient deficiencies are quite common among HIV patients that further result into compromised immunity thus making the conditions even more favorable for mycobacteria to establish disease. So, current study was designed to assess association of different micronutrients with development of TB in HIV patients. Micronutrient levels were measured in asymptomatic HIV patients who were monitored for the development of TB during follow up period (incident TB) within one month to one year and also in symptomatic microbiologically confirmed HIV-TB patients. Among various micronutrients assessed, levels of ferritin were found to be significantly increased (p < 0.05) with significant decreased zinc (p < 0.05) and selenium (p < 0.05) levels in incident TB group as well as in HIV-TB subjects compared to asymptomatic HIV patients who did not develop TB in the follow up period. Importantly, increased levels of ferritin and decreased levels of selenium were significantly associated with development of tuberculosis in HIV patients.

Persistent circulation of soluble and extracellular vesicle-linked Spike protein in individuals with postacute sequelae of COVID-19

SARS-CoV-2, the causative agent of COVID-19 disease, has resulted in the death of millions worldwide since the beginning of the pandemic in December 2019. While much progress has been made to understand acute manifestations of SARS-CoV-2 infection, less is known about post-acute sequelae of COVID-19 (PASC). We investigated the levels of both Spike protein (Spike) and viral RNA circulating in patients hospitalized with acute COVID-19 and in patients with and without PASC. We found that Spike and viral RNA were more likely to be present in patients with PASC. Among these patients, 30% were positive for both Spike and viral RNA; whereas, none of the individuals without PASC were positive for both. The levels of Spike and/or viral RNA in the PASC+ve patients were found to be increased or remained the same as in the acute phase; whereas, in the PASC-ve group, these viral components decreased or were totally absent. Additionally, this is the first report to show that part of the circulating Spike is linked to extracellular vesicles without any presence of viral RNA in these vesicles. In conclusion, our findings suggest that Spike and/or viral RNA fragments persist in the recovered COVID-19 patients with PASC up to 1 year or longer after acute SARS-CoV-2 infection.

Potential long-term effects of SARS-CoV-2 infection on the pulmonary vasculature: Multilayered cross-talks in the setting of coinfections and comorbidities

The Coronavirus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and its sublineages pose a new challenge to healthcare systems worldwide due to its ability to efficiently spread in immunized populations and its resistance to currently available therapies. COVID-19, although targeting primarily the respiratory system, is also now well established that later affects every organ in the body. Most importantly, despite the available therapy and vaccine-elicited protection, the long-term consequences of viral infection in breakthrough and asymptomatic individuals are areas of concern. In the past two years, investigators accumulated evidence on how the virus triggers our immune system and the molecular signals involved in the cross-talk between immune cells and structural cells in the pulmonary vasculature to drive pathological lung complications such as endothelial dysfunction and thrombosis. In the review, we emphasize recent updates on the pathophysiological inflammatory and immune responses associated with SARS-CoV-2 infection and their potential long-term consequences that may consequently lead to the development of pulmonary vascular diseases.

Increased advanced glycation end product specific fluorescence in repeatedly heated used cooking oil

Repeated heating of cooking oils is known to cause their degradation and generation of toxins. Dietary Advanced glycation end products (dAGEs) are formed when the foods are cooked in dry heat at very high temperatures. dAGEs are believed to contribute significantly to total pool of AGEs in body. In this study, cooking oil samples used for frying snacks were collected from 102 shops. AGEs were extracted using Aqueous-TCA-chloroform method. Fluorescent AGE levels were determined using a fluorescence spectrophotometer and compared with AGEs in corresponding fresh oil samples collected from same shops. Palm oil was most commonly (62.5%) used for cooking. Most of the samples were subjected to several rounds of heating (1-6). AGE specific fluorescence (ASF) in used oil (range = 8.5-745.11) samples was found to be significantly higher in 88/102 as compared to the corresponding fresh oil samples. Treatment with inhibitors like lime concentrate and vitamin C decreased ASF (10/14 and 10/11 samples respectively) of the used oils. The results suggest that cooking oil subjected to repeated heating can contribute to increase in fluorescent AGEs in diet. Simple practices like liberal use of common household substances like lime concentrate may help to reduce these in fried food.

A study of promotional advertisements of drugs in a medical journal: an ethics perspective

The study assessed 54 advertisements of 145 different drugs, published over one year (from December 2011 to November 2012) in an Indian medical journal, circulated widely mainly among general practitioners (GPs). The ethical guidelines of the World Health Organization (WHO) and Organisation of Pharmaceutical Producers of India (OPPI) for medicinal drug promotion were applied. The brand name was mentioned in all advertisements (100% compliance both with the WHO and OPPI criteria) and the names of the active ingredients were also mentioned in 128 (90.14%) advertisements. However, major adverse drug reactions were mentioned in only two advertisements (1.37%); precautions, contraindications and warnings in only two (1.37%); and major interactions in only one (0.68%). Only three advertisements (2.06%) were well substantiated with references. To ensure the ethical promotionof drugs among GPs, journals must introduce compulsory review and appraisal of promotional advertisements by a dedicated review board, including at least one member trained in pharmacology and one representative from the medical division of a pharmaceutical company.

Interaction of charged particles with localized electrostatic waves in a magnetized plasma

Charged particle interaction with localized wave packets in a magnetic field is formulated using the canonical perturbation theory and the Lie transform theory. An electrostatic wave packet characterized by a wide range of group and phase velocities as well as spatial extent along and across the magnetic field is considered. The averaged changes in the momentum along the magnetic field, the angular momentum, and the guiding center position for an ensemble of particles due to their interaction with the wave packet are determined analytically. Both resonant and ponderomotive effects are included. For the case of a Gaussian wave packet, closed-form expressions include the dependency of the ensemble averaged particle momenta and guiding center position variations on wave packet parameters and particle initial conditions. These expressions elucidate the physics of the interaction which is markedly different from the well known case of particle interaction with plane waves and are relevant to a variety of applications ranging from space and astrophysical plasmas to laboratory and fusion plasmas, as well as accelerators and microwave devices.

Kinetic theory for distribution functions of wave-particle interactions in plasmas

The evolution of a charged particle distribution function under the influence of coherent electromagnetic waves in a plasma is determined from kinetic theory. For coherent waves, the dynamical phase space of particles is an inhomogeneous mix of chaotic and regular orbits. The persistence of long time correlations between the particle motion and the phase of the waves invalidates any simplifying Markovian or statistical assumptions--the basis for usual quasilinear theories. The generalized formalism in this Letter leads to a hierarchy of evolution equations for the reduced distribution function. The evolution operators, in contrast to the quasilinear theories, are time dependent and nonsingular and include the rich phase space dynamics of particles interacting with coherent waves.

Transient dynamics of charged particles interacting with localized waves of continuous spectra

A modified canonical perturbation method is employed for analyzing the charged particle dynamics as they interact with localized waves with continuous spectrum. In contrast with periodic Hamiltonian models, where the method has already been applied in a multitude of respective systems, the system in hand is inherently aperiodic. The localized waves have the form of amplitude modulated electrostatic fields, ranging from ordinary wave packets to ultrashort pulses. The analytically obtained approximate invariants of the motion contain rich information for the structure of the phase space and the respective distribution functions.

Controlled optimization of mode conversion from electron Bernstein waves to extraordinary mode in magnetized plasma

In the CDX-U spherical torus, agreement between radiation temperature and Thomson scattering electron temperature profiles indicates approximately 100% conversion of thermally emitted electron Bernstein waves to the X mode. This has been achieved by controlling the electron density scale length (L(n)) in the conversion region with a local limiter outside the last closed flux surface, shortening L(n) to the theoretically required value for optimal conversion. From symmetry of the conversion process, prospects for efficient coupling in heating and current drive scenarios are strongly supported.

Seip-lawrence Syndrome (Three Cases in a Family)

A, rare episode of Seip-Lawrence syndrome manifesting in all three case siblings of consanpinous parents is reported. Two children we're male and one female. They exhibited low intelligence,' gaunt facies, depressed bridge of nose, large low-sct ears, thick lips and protruberant abdomen. Skin was showing hypermelanosis, hypertrichosis, absence of subcutaneous fat and acan nigricaFNx01s with' very prominent perianal rUgO6itiS In addition, the first child was short statured having hypertrophic Clitoris, hepatomcoy, left ventricular hypertro hy, hyperglycaemia and glycossuria- without ketoacidosis. The second child was, having enlargement of penis, left ventricular hypertrophy,,hepatospienomegaly and abnormal GTT. The third and the youngest child was having only cutaneous changes and no viscoromegaly or biochemical abnormality. Nou Of these patients were having gigantism and advanced bone age.