Band 36, Heft 2-3

Nephropathy and nephrotoxicity are significant causes of renal impairment, with both conditions contributing to a substantial global healthcare burden. Nephropathy encompasses a range of kidney diseases, including glomerulonephritis, diabetic nephropathy, hypertensive nephropathy, and polycystic kidney disease, each with distinct pathophysiological mechanisms and clinical manifestations. Nephrotoxicity, often induced by environmental toxins or medications, can lead to acute kidney injury (AKI) or chronic kidney disease (CKD) if not properly managed. Understanding the underlying processes and risk factors for kidney damage is crucial to preventing and treating these conditions effectively. However, while considerable research exists on each of these topics, there remains a gap in integrated knowledge regarding the diverse pathophysiological pathways, the role of early detection, and the optimal management strategies for nephropathy and nephrotoxicity. While substantial research has been conducted on nephropathy and nephrotoxicity, there remains a year gap in fully understanding the diverse mechanisms of kidney damage across different etiologies and their long-term implications for renal health. This work aimed to fill this gap by synthesizing current research on the pathophysiology, clinical manifestations, and treatment approaches for both nephropathy and nephrotoxicity. Major findings highlight the importance of early detection through biomarkers, the need for vigilant monitoring of renal function, and the role of avoiding nephrotoxic agents in both medical and environmental contexts. The paper also emphasizes the critical role of individualized treatment approaches, including the careful use of medications to prevent drug-induced nephropathy.

Incretin-based medicines have considerably impacted the treatment of type 2 diabetes mellitus (T2DM), providing considerable advantages in glycemic regulation, weight control, and cardiovascular results. This narrative review examines progress in incretin medicines, encompassing glucagon-like peptide-1 (GLP-1) receptor agonists, dual-receptor, and triple-receptor agonists, while emphasizing their therapeutic advantages, obstacles, and prospective developments. The examined articles were sourced from databases including PubMed and Google Scholar, concentrating on publications predominantly from 2010 to 2024. Selective foundational papers released before this timeline were incorporated to furnish critical historical context about incretin processes and their discovery. Incretin-based medicines, despite their therapeutic efficacy, encounter hurdles including elevated treatment costs, patient compliance difficulties, and variability in response attributable to genetic and physiological variables. Moreover, there are still deficiencies in comprehending the long-term cardiovascular safety and cancer risks linked to these medicines. Emerging dual- and triple-receptor agonists demonstrate potential in overcoming the shortcomings of conventional GLP-1 receptor agonists, providing enhanced metabolic results and broader uses in intricate disease profiles. Future research must concentrate on economic obstacles, streamlined regimens, customized medicine, the integration of artificial intelligence, patient stratification, as well as the safety and efficacy of incretin-based medicines for holistic management of T2DM.

Point-of-care testing (POCT) refers to decentralized testing done using complex but compact, portable devices that can be done near the site at the patient’s bedside. These enable quick diagnosis and timely intervention because turnaround time (TAT) decreases with these devices. They can also be operated by non-medical personnel and patients with minimum expertise as these devices are easy to handle and interpret. This increases patient awareness regarding their diseases and benefits doctors in giving more patient-centered care. POCT devices require minimum setup and can be utilized even in remote places. The present review focuses on POCT devices employed specifically in clinical biochemistry, e.g., glucose, HbA1c, cardiac biomarkers, fertility tests, hematological analysis, electrolytes, enzymes, urine dipstick tests, etc. This introductory review delves into comprehending the fundamentals of POCT technologies, their guidelines, applications, advantages, and disadvantages. It covers a broad overview of the tests done and the samples required to process these tests. It also compares the pros and cons of POCT devices over centralized laboratory testing. The review also aims to emphasize the relevance of its use in today’s era, current trends regarding POCT in urban and rural setups, challenges faced in the field during its implementation, and the potential areas of improvement in the future. However, it is advisable to seek references for more detailed and critical information regarding all the specific topics given in this review article.

Introduction Male infertility is a critical global health issue, with environmental and occupational exposure to heavy metals, such as lead (Pb), cadmium (Cd), mercury (Hg), and arsenic (As), impacting male reproductive health. This scoping review aims to evaluate the effects of heavy metal exposure on semen parameters. Content This study adhered to the 2020 PRISMA framework. A broad literature search was performed on January 2025, using Embase, PUBMED, and Scopus. A comprehensive literature search was performed using PubMed, Embase, and Scopus on January 12, 2025, using a combination of Medical Subject terms and keywords. Summary Of the 1,709 identified studies, 21 met the inclusion criteria and were analyzed. Findings indicate that lead exposure negatively impacts sperm concentration, motility, and morphology, primarily through oxidative stress and enzymatic inhibition. Cadmium disrupts the blood-testis barrier and acrosomal function, leading to sperm abnormalities. Arsenic exposure is linked to oxidative stress, apoptosis, and impaired sperm motility. Outlook The cumulative evidence supports a strong association between heavy metal exposure and male infertility. This review underscores the need for stricter occupational safety regulations and environmental policies to mitigate heavy metal exposure.

Glucagon, a key hormone in glucose homeostasis, plays a central role in maintaining blood glucose levels through hepatic glycogenolysis and gluconeogenesis. Historically, glucagon secretion was believed to be primarily regulated by insulin via the “insulin switch-off” hypothesis, where reduced insulin levels triggered glucagon release. However, this view has been revisited as emerging evidence highlights the complexity of glucagon regulation. New studies demonstrate that glucose itself, along with amino acids and fatty acid oxidation, directly influences glucagon secretion, challenging the insulin-centric perspective. These findings reveal the metabolic versatility of pancreatic α-cells and their capacity to adapt to nutrient availability. Recent therapeutic innovations, such as glucagon receptor antagonists, dual GLP-1/glucagon receptor agonists, and modulators of hepatic glucagon signalling, offer promising strategies to mitigate hyperglycemia, improve energy balance, and address metabolic dysregulation. This review provides an in-depth analysis of glucagon’s role in health and disease, emphasizing its therapeutic potential in managing diabetes and related metabolic conditions.

This study aimed to review the efficacy of commonly used supplements on the health status and performance of football players. We searched several databases for relevant publications published in English up to June 2024 using keywords such as nutritional supplementation, performance, football, and football players. The available literature indicated that l -arginine supplements may improve cardiovascular function, ventilation, the serum level of lactate, and maximal oxygen consumption (VO 2 Max) of football players. Branched-chain amino acids (BCAAs) may improve multiple-choice reaction time. Creatine supplements improve jumping, sprinting, change of direction speed, and reduce fatigue. Among the vitamins, vitamin D improves the serum level of injury-related hormones such as cortisol and testosterone. B vitamins reduce the level of blood lactate in the recovery periods. Vitamin E and vitamin C may improve performance by decreasing oxidative stress and increasing the antioxidant capacity and oxygen delivery to exercising skeletal muscles. Iron supplementation improves endurance capacity. Further studies are warranted to confirm the effects of the supplements on football players, to identify the appropriate dosage of the supplements and also to determine their mechanism of action.

Objectives Heart failure is a cardiovascular disease with a high incidence in the world and Indonesia as well. This disease must get serious attention because it results in high mortality rates and has a broad and long-term impact on patients with heart failure. The high recurrence rate, rehospitalization, and patients’ poor quality of life are influenced, one of them, by the self-care behavior of patients, considering that heart failure is a progressive and chronic disease. In practice, implementation of self-care behaviors in people living with heart failure is poor. This study analyzes the factors influencing self-care for heart failure patients. Methods This is a cross-sectional study that involved 100 heart failure patients taken from August to October 2020. Self-care was measured using the Self-Care of Heart Failure Index (SCHFI) questionnaire. The chi-square statistical test determines the relationship between the factors that influence self-care. Results The results showed that there was a significant relationship between education (p 0.00), marital status (p 0.005), occupation (p 0.00), NYHA class (p 0.00), and patient age (p 0.01) with self-care maintenance. There was no relationship between gender (p 0.30), comorbidity (p 0.21), and duration of heart failure (p 0.11). Conlusions Education, marital status, occupation, NYHA class, and age significantly influence self-care in heart failure patients, while gender, comorbidity, and disease duration do not. Targeted interventions are needed to improve self-care and reduce rehospitalization.

Objectives A well-structured, regular, and programmed physical exercise regimen is believed to be an effective physiological modulator for preventing the dysfunction of myonectin and visfatin secretion. Therefore, this study aims to analyze the physiological regulation of moderate-intensity programmed exercise in improving myonectin and visfatin biomarkers in obese women. Methods The study involved 30 physically healthy obese women, nonathletes, selected based on predetermined criteria, who voluntarily agreed to participate. They were then divided into two groups: a control group (CRT; n=15) and a programmed exercise group (ART; n=15). The exercise program lasted for 8 weeks, with a frequency of 5 times per week at moderate intensity. Metabolic performance was analyzed using the myonectin and visfatin biomarkers with the Sandwich-ELISA method. Data analysis was conducted using parametric paired sample t-tests and independent sample t-tests at a 5 % significance level. Results The study results showed a significant increase in myonectin secretion and a decrease in visfatin secretion (p≤0.05) after 8 weeks of programmed exercise, demonstrated by an increase in myonectin of 97.85 pg/mL and a decrease in visfatin of 0.05 ng/mL. Conversely, in the control group, myonectin decreased by 3.04 pg/mL, and visfatin increased by 0.03 ng/mL. Conclusions These findings confirm that an 8-week programmed exercise regimen can improve the secretion of myonectin and visfatin biomarkers, thereby enhancing metabolic performance in obese women. Thus, myonectin and visfatin biomarkers induced by programmed exercise serve as modulators for enhancing metabolic performance in obese women.

Objectives To compare heart rate variability (HRV) among adult Hypertensive and Normotensive subjects in supine position. Methods It was an analytical cross sectional study conducted on two study groups. The cases (n=60) comprised of outpatients (males and females in the age group 20–50 yrs) attending the Medicine OPD of Medical Collage, Kolkata, who were newly diagnosed as cases of hypertension according to JNC seven criteria while the control group (n=50) comprised of age and sex-matched adult normotensive subjects, who were non-smokers, non-alcoholics and were not suffering from any major cardiac, neurological or chronic illnesses. HRV profiling through short-term (5 min) ECG recording of each subject was carried out in the supine position with the help of a digital ECG recording machine (RMS-Polyrite D), with a sampling rate of 256 Hz. From the data so collected, various HRV parameters – both time domain (SDNN, RMSSD, NN50 and pNN50) and frequency domain (VLF, LF and HF) were calculated. Analysis of these parameters revealed the pattern of autonomic influence (sympathetic or parasympathetic predominance) prevalent among the subjects of the study and control groups. Results An overall reduction of the time domain parameters SDNN and RMSSD (considered more as markers of sympathetic activity) and frequency domain parameters (total power, LF and HF, all expressed in ms 2 ), which are markers of parasympathetic activity, was noted among the hypertensive subjects. However, the reduction in frequency domain parameters was much more (highly significantly) than that of time domain parameters. Also, both age and hypertension had significant independent effects on HRV but their 3-way interaction was found to be statistically insignificant. Conclusions The findings of the study thus points towards an autonomic dysregulation (characterized by decreased vagal activity and increased sympathetic activity), as an underlying basis (i.e. an important factor, among others) for hypertension.

Objectives Male infertility affects 20–30 % of infertile couples worldwide, and varicocele being a common cause. The relationship between leptin, a hormone involved in energy homeostasis and reproduction, and male fertility parameters remains incompletely understood, particularly in the context of varicocele and obesity. Thus, the current study sought to assess the associations between seminal plasma leptin and other clinical and demographic data of infertile patients. Methods In this cross-sectional study, 90 men (29 with varicocele, 61 without) were evaluated from November 2023 to March 2024. Seminal plasma leptin levels were measured using ELISA. Study subjects were classified into three weight classifications using body mass index (BMI) measurements: normal weight, overweight, and obese. Semen analysis, reproductive hormones assessment, and correlation analyses were performed to examine relationships between leptin levels and various clinical parameters. Results Patients with varicocele demonstrated significantly higher seminal plasma leptin levels compared to those without (9.27 vs. 7.65 ng/mL, p<0.05), this association persisted following statistical adjustment for demographic and clinical variables. In addition, BMI was the strongest independent predictor of seminal plasma leptin levels (β=0.26, p<0.01). Interestingly, overweight individuals showed higher leptin levels than both normal weight and obese participants. A significant inverse relationship found between leptin concentrations and luteinizing hormone levels (ρ=−0.375, p<0.05), while a positive association was found with progressive motility of sperm (ρ=0.225, p<0.05). Conclusions Higher levels of leptin were found in seminal specimens of varicocele-diagnosed subjects and strongly correlate with BMI in this Middle Eastern population. These results together propose that leptin’s level in semen could be useful as a biological indicator for varicocele-associated male fertility issues.

Objectives The Sarno river basin (Italy) is a region characterized by significant environmental pollution, raising concerns about heavy metal exposure in residents. The PREVES-STOP Initiative aims to address these concerns. This study investigates the prevalence of detectable blood lead (Pb) and cadmium (Cd) in a cohort of adults from this area and examines associations with key health indicators. Methods This study analyzed data from 75 adults (aged 30–65) participating in the PREVES-STOP Initiative. Participants completed comprehensive questionnaires assessing demographics, medical history, lifestyle factors (smoking, physical activity), and psychometric measures (fatigue, anxiety/depression, sleep quality). Blood samples were analyzed for Pb and Cd using established methods, with detectable levels defined as≥2 μg/100 mL (Pb) and ≥0.5 μg/L (Cd). Results Detectable Pb (18.67 % of participants) was significantly associated with higher systolic blood pressure, hemoglobin, and MCH, and inversely correlated with HDL cholesterol. Poorer sleep quality was also associated with detectable Pb. Detectable Cd (28 % of participants) was significantly associated with higher systolic blood pressure, LDL cholesterol, neutrophil count, and with higher odds of having a history of autoimmune diseases. Multivariate regression models, adjusting for age, sex, smoking status, and BMI, were used to determine these associations. Conclusions This study demonstrates that even low-level exposure to Pb and Cd in the Sarno river basin is associated with adverse clinical outcomes. The PREVES-STOP Initiative provides a valuable framework for community-based health assessment and intervention in areas affected by environmental pollution.

Objectives High-risk pulmonary embolism (PE) is known as the presence of hemodynamic instability and has a high mortality rate, which necessitates immediate reperfusion treatment. According to current PE treatment guidelines, alteplase is the approved and preferred agent for systemic thrombolysis. Herein, we present the efficacy and safety of systemic thrombolysis with reteplase in patients with high-risk PE. Methods The present retrospective observational study includes 30 patients with high-risk acute PE undergoing systemic thrombolysis with reteplase. All patients were in obstructive shock. The thrombolytic regimen consisted of two bolus doses of 10 U reteplase, given 30 min apart, followed by intravenous heparin. Results All patients had elevated cardiac troponin levels. D-dimer levels were elevated in 28 (93.3 %) patients. Systolic blood pressure increased after thrombolysis with reteplase, and the dyspnea, tachypnea, and coughing improved in all patients. Mean SPO 2 was 83.6 ± 6.96 % before treatment, which had risen to 95.7 ± 1.29 % after thrombolysis (p=0.059). Right ventricular dilatation was seen in all patients at presentation, which improved by 96.6 % after treatment and systolic pulmonary artery pressure decreased significantly in all patients at discharge. None of the patients needed to repeat thrombolytic therapy. There were no major hemorrhagic complications or death after thrombolysis, while 5 (16.7 %) patients experienced minor self-limiting bleeding. Conclusions Reteplase, as two bolus injections of 10 U given 30 min apart, is an effective thrombolytic regimen in treating acute high-risk PE with a low risk of major hemorrhagic complications.

Objectives In this study, the comparative bioavailability of semaglutide following the administration of oral (PO) and subcutaneous (SC) doses in healthy subjects was evaluated. The pharmacokinetics of semaglutide of these formulations at lower doses (SC dose of 0.25 mg; PO dose of 3 mg) was examined by utilizing a sensitive bioanalytical method. Methods Twenty-two subjects were administered either 0.25 mg SC or 3 mg PO and blood samples were taken up to 504 h. The samples were assayed for semaglutide with an analytical range of 0.05–50 ng/mL. The pharmacokinetic parameters were estimated using a non-compartmental approach and were used to evaluate the comparative bioavailability of semaglutide. Results The pharmacokinetics of semaglutide was characterized following the administration of low subcutaneous and oral doses. The comparative bioavailability (PO relative to SC) was 0.66 % at the doses administered. Overall, the study drug was well tolerated, and no serious adverse events were reported. Conclusions The bioavailability of semaglutide following oral and subcutaneous administrations has been determined using a validated bioanalytical method. This method will enable more investigations into the pharmacokinetics of all formulations of semaglutide at lower doses, which will enable a better understanding of its’ disposition in healthy subjects and in patients.

Objectives The study focuses exclusively on the results of an arterial blood gas report, which reveal a phenomenal contradiction if one follows the physiological and physicochemical approaches as well as the standard base excess determination to interpret an acid–base disturbance. The aim of this article is not to fully describe a clinical case and make a differential diagnosis but to analyze the blood gas report data in detail and present the conclusions that result from the application of the different approaches that exist for the interpretation of acid–base disorders. Methods The results of an arterial blood gas report of a patient with severe lactic acidosis were cross-examined using the standard base excess method and the physiologic and physiochemical approaches. The causes of the contradiction are discussed with a commentary on the underlying pathophysiology. Results The study revealed the presence of a normal anion gap (even after correction for albumin levels), a slightly increased strong ion gap and a moderately decreased standard base excess in a patient with severe lactic acidosis. Conclusions This real-life case provides an opportunity to give a brief overview of the current methods for investigating acid–base disturbances in a practical way, emphasizing both the common background and the conceptual differences and similarities.

Objectives This manuscript reviews advancements in oral and maxillofacial surgery, encompassing minimally invasive techniques, innovations in implant dentistry, regenerative medicine, innovations in temporomandibular joint, and novel methodologies in salivary gland surgery. Methods A comprehensive analysis of recent developments in the field is presented, focusing on the integration of new technologies and biological therapies. Emphasis is placed on minimally invasive procedures, virtual surgical planning with CAD/CAM and 3D printing, implant design and placement innovations, and regenerative approaches. Results Minimally invasive procedures, often employing endoscopic or robotic assistance, reduce surgical morbidity and accelerate patient recovery. Virtual surgical planning and 3D printing enhance pre-surgical accuracy. Innovations in implant design, surface modification, and guided surgery improve prosthetic outcomes. Regenerative medicine and tissue engineering, including the use of growth factors and stem cells, offer new options for tissue restoration. In temporomandibular joint disorders, these strategies aim to improve function and reduce reliance on arthroplasty. The use of superficial dermal substitutes in salivary gland surgery reduces complications such as Frey syndrome. Conclusions These advancements reflect a paradigm shift in oral and maxillofacial surgery, enhancing patient care and expanding the field’s potential through precision, biologically based therapies, and less invasive approaches