Background and objectivesMany aspects of CKD management rely heavily on patient self-care, including medication and dietary adherence, self-monitoring of BP, and daily physical activity. Growing evidence suggests that incorporating smartphone-based applications can support self-care in CKD and chronic disease more generally.Design, setting, participants, & measurementsWe identified applications targeting patients with CKD by conducting a search of the US Apple App Store (iOS) and Google Play Store (Android) using the following four phrases: “kidney disease,” “renal,” “dialysis,” and “kidney transplant.” We considered the first 50 applications for each search term on each application store. We adapted a previously described framework for assessment of mobile health applications to account for kidney disease–specific content areas and evaluated applications on their types of patient engagement, quality, usability, and safety. Engagement and quality were assessed by both a patient and a nephrologist, usability was assessed by a patient, and safety was assessed by a nephrologist. Overall, two patients with CKD and three nephrologists performed the evaluations. We examined pairwise correlations between patient, nephrologist, and consumer ratings of application quality.ResultsOur search strategy identified 174 unique applications on Android and 165 unique applications on iOS. After excluding applications that were not related to kidney disease, were not patient facing, or were last updated before 2014, 12 Android-only applications, 11 iOS-only applications, and five dual-platform applications remained. Patient and nephrologist application quality ratings, assessed by the net promoter score, were not correlated (r=0.36; P=0.06). Consumer ratings on the application stores did not correlate with patient ratings of application quality (r=0.34; P=0.18).ConclusionsOnly a small subset of CKD applications was highly rated by both patients and nephrologists. Patients’ impressions of application quality are not directly linked to consumer application ratings or nephrologist impressions.

Background: Clinical registries provide physicians with a means for making data-driven decisions but few opportunities exist for patients to interact with registry data to help make decisions.

Aims: To evaluate clinical validation, safety assessment and efficacy of Siddha line of treatment in COVID-19 patients. Presentation of the Case: Open labelled, interventional, prospective cohort study conducted in Covid ward, Kokila Siddha Hospital and Research Centre, Madurai between June and Aug 2021. Among 22 registered in the trial 5 (22.72%) developed breathing difficulty, treated with oxygen support, 10 (45.5%) were male, 12 (54.5%) were female. At the time of admission, maximum 9 (40.9 %) had fever, followed by dry cough 18 (81.8%), dyspnea 8 (36.4%), malaise 16 (72.7%), anorexia 8 (36.4%), headache 4 (18.2%), Type-2DM 5 (23%), and 2 (9%) had hypertension as comorbidity. Hematology, LFT, RFT, D-Dimer, PTT, CRP were taken before and after 5 days of treatment. Discussion: The mean hospital stay was 7 days and discharged on a minimum of 4th day and a maximum of 16th day. The mean hospital stay for hypoxic patients was 10 days. Paired sample test analysis has been carried out to find a significant difference in the counts of lymphocytes, ESR, CRP and PTT after the administration of the intervention. Conclusion: The medications chosen according to the pathology of Kaba suram and administered starting on first day of admission, depending on the stage and severity of the infection. Patients were provided with appropriate food, exercise, therapy in conjunction with medications and found the patient's condition has not deteriorated further. It is reasonable to conclude that the treatment of COVID-19 with selective Siddha medications stopped the disease progress more critical.

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Background: Wound healing is impaired in diabetes due to dysregulated inflammation. Previous studies by our group and others have demonstrated that inflammatory mediators are significantly increased in diabetic wounds, however, the mechanisms behind this hyper-inflammatory response remain largely unknown. As there is known to be high levels of endotoxin in type 2 diabetic (T2D) wounds, we aimed to assess the role of high fat diet (HFD) on Toll-Like Receptor 4 (TLR4) expression. We hypothesized that HFD/T2D would alter histone methylation, leading to increased receptor expression and enhanced inflammation. Methods: C57/BL6 mice were subjected to either normal or HFD for 12-16 weeks to induce the diet-induced obese (DIO) model of physiologic T2D. 4mm hindlimb wounds were created and healing was monitored daily using NIH ImageJ software. Bone marrow-derived macrophages (BMDM) were cultured and TLR4 expression measured by qPCR. Myeloid TLR4 protein expression was assessed in peripheral blood and wound cell isolates by analytical flow cytometry. Macrophages (NK1.1-/Ly6G-/CD11b+) were isolated using magnetic sorting and inflammatory cytokine expression determined with qPCR and bioplex. Chromatin Immunoprecipitation (ChIP) analysis at the NF-kB binding site on the TLR4 promoter was performed using antibodies to trimethylated Histone 3 Lysine 4 (H3K4me3). (N=~5 mice per group for all studies). Results: DIO mice demonstrated significantly delayed wound healing as compared to littermate controls and BMDM isolated from these mice revealed increased TLR4 gene expression. Correspondingly, peripheral blood and wound monocyte/macrophages showed increased TLR4 receptor levels by flow cytometry. ChIP analysis at the TLR4 promoter revealed significantly increased H3K4me3, a gene activating mark, in the HFD BMDM. Finally, macrophage wound isolates from DIO mice had elevated levels of inflammatory gene expression and cytokines. Conclusion: Enhanced H3K4me3 at the TLR4 promoter in diabetic macrophages may increase receptor expression and contribute to the hyper-inflammatory response seen in T2D. Further mechanistic studies are needed in order to examine the role of TLR4 in wound healing.