Chronic Disease prevention and management

BACKGROUND: Survivors of childhood cancer report poor health-related quality of life (HRQOL). Modifiable lifestyle factors such as nutrition and physical activity represent opportunities for interventions to improve HRQOL. METHODS: The authors examined the association between modifiable lifestyle factors and HRQOL among 2480 adult survivors of childhood cancer in the St. Jude Lifetime Cohort Study. Dietary intake, physical activity, cigarette smoking, and alcohol consumption were assessed through questionnaires. Weight and height were measured in the clinic. HRQOL was evaluated using the Medical Outcome Study 36-Item Short Form Survey. The physical component summary (PCS), mental component summary (MCS), and 8 domain scores of HRQOL were calculated. Multivariable linear regression models were used to estimate regression coefficients () associated with HRQOL differences. RESULTS: Being physically active (PCS = 3.10; and MCS = 1.48) was associated with higher HRQOL whereas current cigarette smoking (PCS = -2.30; and MCS = -6.49) and obesity (body mass index 30 kg/m 2 ) (PCS = -3.29; and MCS = -1.61) were associated with lower HRQOL in both the physical and mental domains. Better diet (Healthy Eating Index-2015) was associated with higher physical HRQOL (PCS = 1.79). Moderate alcohol consumption was associated with higher physical (PCS = 1.14) but lower mental (MCS = -1.13) HRQOL (all P <.05). Adherence to multiple healthy lifestyle factors demonstrated a linear trend with high scores in both physical and mental HRQOL (highest vs lowest adherence: PCS = 7.60; and MCS = 5.76 [P for trend, <.0001]). CONCLUSIONS: The association between healthy lifestyle factors and HRQOL is cumulative, underscoring the importance of promoting multiple healthy lifestyles to enhance HRQOL in long-term survivors of childhood cancer. Cancer 2018;00:1-7.

The sequence similarities the between SARS-CoV-2 and SARS-CoV, indicates that SARS-CoV-2 utilizes ACE-2 as a cellular entry receptor. SARS-CoV-2 could utilize ACE-2 from humans. ACE inhibitors are designed to prevent the conversion of angiotensin I to angiotensin II, and ACE2 further converts angiotensin 2 to angiotensin 1-7, acting as a counterbalance for the proinflammatory angiotensin 2. When the virus occupies all the ACE2 receptors on host cells, there is more angiotensin 2 free-flowing in the system to activate the RAS pathway, which leads to Covid-19 complications. If the conversion of angiotensin 1 to angiotensin 2 is blocked by ACE inhibitors, the Covid-19 complications will be prevented. Considering this point, the Enalpril drug used as antihypertensive was hypothesized to act as repurposing drug in the treatment of SARS-CoV-2.

At the core of preventing and managing conflicts of interest are a set of principles that underlie the functioning of a democratic state and service of its citizens. Thus, principles such as transparency and impartiality in decision-making, the integrity of officials and keeping in mind the best interest of potential public during the decisionmaking, public confidence and increase his confidence in the government, form the basis of identifying policies and management of conflicts of interess or civil servants. Albanian law to prevent conflicts of interest is a law in its entirety, permeated by a spirit of somewhat stringent restrictions on civil servants. Such limitations have been given as the need to secure a decision as fair and impartial in the public interest, and the current state of the low level of public trust and confidence in the integrity of government institutions.

At the core of preventing and managing conflicts of interest are a set of principles that underlie the functioning of a democratic state and service of its citizens. Thus, principles such as transparency and impartiality in decision-making, the integrity of officials and keeping in mind the best interest of potential public during the decision-making, public confidence and increase his confidence in the government, form the basis of identifying policies and management of conflicts of interess or civil servants. Albanian law to prevent conflicts of interest is a law in its entirety, permeated by a spirit of somewhat stringent restrictions on civil servants. Such limitations have been given as the need to secure a decision as fair and impartial in the public interest, and the current state of the low level of public trust and confidence in the integrity of government institutions. The policy followed for identifying and managing conflicts of interest can be analyzed by doing, at first...

Este artículo presenta los principales resultados de la implementación de un programa educativo para laprevención y manejo de la violencia en las escuelas públicas por parte de los maestros de primero y segundociclo, el programa fue impartido por la Escuela de Enfermería de la Universidad de Costa Rica, con un total de 40horas de enero a febrero del 2011. Se utilizó diversas estrategias de enseñanza basadas en las necesidadeseducativas de este grupo de profesores, las cuales se mostraron en un estudio previo y la aplicación de unaevaluación de necesidades. Con la asistencia de 33 profesores, 32 mujeres y un hombre. Del total de participantes,30 completaron el programa. Los principales resultados son los siguientes: los participantes lograron adquirir,construir o mejorar sus conocimientos sobre la prevención y tratamiento de la violencia escolar, y tambiénaprendieron diversas técnicas o estrategias para la prevención y control de la violencia en las escuelas. Seconcluye que el éxito ...

BACKGROUND Female sex workers (FSWs) have high rates of both unintended pregnancy and HIV, but few health promotion interventions address their contraceptive needs or other sexual and reproductive health and rights (SRHR) concerns. A broader approach integrates contraceptive promotion with HIV and STI prevention and management, alcohol awareness, gender-based violence and rights, and healthcare utilization. The WHISPER mobile phone intervention uses a participatory development approach and behaviour change theory to address these high-priority concerns of FSWs in Mombasa, Kenya. OBJECTIVE This paper aims to describe the development and content of the WHISPER intervention, its theoretical framework and key content domains, and; explore workshop participants’ responses to the proposed intervention, particularly with regards to message content and behavior change constructs. METHODS The research team worked closely with FSWs in two phases of intervention development. First, we drafted ...

Several milk/whey derived peptides possess high in vitro angiotensin I-converting enzyme (ACE) inhibitory activity. However, in some cases, poor correlation between the in vitro ACE inhibitory activity and the in vivo antihypertensive activity has been observed. The aim of this study is to gain insight into the structure-activity relationship of peptide sequences present in whey/milk protein hydrolysates with high ACE inhibitory activity, which could lead to a better understanding and prediction of their in vivo antihypertensive activity. The potential interactions between peptides produced from whey proteins, previously reported as high ACE inhibitors such as IPP, LIVTQ, IIAE, LVYPFP, and human ACE were assessed using a molecular docking approach. The results show that peptides IIAE, LIVTQ, and LVYPFP formed strong H bonds with the amino acids Gln 259, His 331, and Thr 358 in the active site of the human ACE. Interestingly, the same residues were found to form strong hydrogen bonds with the ACE inhibitory drug Sampatrilat. Furthermore, peptides IIAE and LVYPFP interacted with the amino acid residues Gln 259 and His 331, respectively, also in common with other ACE-inhibitory drugs such as Captopril, Lisinopril and Elanapril. Additionally, IIAE interacted with the amino acid residue Asp 140 in common with Lisinopril, and LIVTQ interacted with Ala 332 in common with both Lisinopril and Elanapril. The peptides produced naturally from whey by enzymatic hydrolysis interacted with residues of the human ACE in common with potent ACE-inhibitory drugs which suggests that these natural peptides may be potent ACE inhibitors.

The renin-angiotensin system (RAS) is a key regulator of blood pressure and hypertension. Angiotensin-converting enzyme 2 (ACE2) and angiotensin-converting enzyme I (ACE) are two main components of the RAS that play a major role in blood pressure homeostasis. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses ACE2 as a receptor to enter cells. Despite some controversies, numerous studies have reported a significant association between the use of ACE inhibitors and reduced risk of COVID-19. In our previous studies, we produced and identified peptide sequences present in whey hydrolysates exhibiting high ACE inhibitory activity. Therefore, the aim of this work is to obtain an improved understanding of the function of these natural peptides as RAS inhibitors and investigate their potential therapeutic role in the COVID-19 pandemic. The molecular interactions between peptides IPP, LIVTQ, IIAE, LVYPFP, and human ACE2 were assessed by employing a molecular docking approach. The results show that natural whey-derived peptides have a dual inhibitory action against both ACE and ACE2. This dual activity distinguishes these ACE inhibitory peptides from synthetic drugs, such as Captopril and Lisinopril which were not shown to inhibit ACE2 activity, and may represent a potential strategy in the treatment of COVID-19.

In the early months of the coronavirus disease 2019 (COVID-19) pandemic, a hypothesis emerged suggesting that pharmacologic inhibitors of the renin-angiotensin system (RAS) may increase COVID-19 severity. This hypothesis was based on the role of angiotensin-converting enzyme 2 (ACE2), a counterregulatory component of the RAS, as the binding site for severe acute respiratory syndrome coronavirus

Este artículo presenta los principales resultados de la implementación de un programa educativo para laprevención y manejo de la violencia en las escuelas públicas por parte de los maestros de primero y segundociclo, el programa fue impartido por la Escuela de Enfermería de la Universidad de Costa Rica, con un total de 40horas de enero a febrero del 2011. Se utilizó diversas estrategias de enseñanza basadas en las necesidadeseducativas de este grupo de profesores, las cuales se mostraron en un estudio previo y la aplicación de unaevaluación de necesidades. Con la asistencia de 33 profesores, 32 mujeres y un hombre. Del total de participantes,30 completaron el programa. Los principales resultados son los siguientes: los participantes lograron adquirir,construir o mejorar sus conocimientos sobre la prevención y tratamiento de la violencia escolar, y tambiénaprendieron diversas técnicas o estrategias para la prevención y control de la violencia en las escuelas. Seconcluye que el éxito ...

Este artículo presenta los principales resultados de la implementación de un programa educativo para laprevención y manejo de la violencia en las escuelas públicas por parte de los maestros de primero y segundociclo, el programa fue impartido por la Escuela de Enfermería de la Universidad de Costa Rica, con un total de 40horas de enero a febrero del 2011. Se utilizó diversas estrategias de enseñanza basadas en las necesidadeseducativas de este grupo de profesores, las cuales se mostraron en un estudio previo y la aplicación de unaevaluación de necesidades. Con la asistencia de 33 profesores, 32 mujeres y un hombre. Del total de participantes,30 completaron el programa. Los principales resultados son los siguientes: los participantes lograron adquirir,construir o mejorar sus conocimientos sobre la prevención y tratamiento de la violencia escolar, y tambiénaprendieron diversas técnicas o estrategias para la prevención y control de la violencia en las escuelas. Seconcluye que el éxito ...

SummaryExtensive in vitro and, to a more limited extent, animal research have demonstrated the health potential of a wide set of egg protein hydrolysates; however, well‐designed human intervention studies are scarce. Health claim assessment, however, sets high standards for characterisation of the bioactive peptides, investigation of the mode‐of‐action and convincing human intervention studies. In this review, we discuss the state‐of‐the‐art and knowledge gaps related to egg‐derived peptide bioavailability and bioactivity. In addition, we will formulate recommendations for appropriate design of future human intervention trials with egg‐derived peptides.

Angiotensin converting enzyme 2 (ACE2) is the cellular entry point for severe acute respiratory syndrome coronavirus (SARS-CoV-2) - the cause of COVID-19 disease. It has been hypothesized that use of renin-angiotensin system (RAS) inhibiting medications in patients with hypertension, increases the expression of ACE2 and thereby increases the risk of COVID-19 infection and severe outcomes or death. However, the effect of RAS-inhibition on ACE2 expression in human tissues of key relevance to blood pressure regulation and COVID-19 infection has not previously been reported. We examined how hypertension, its major metabolic co-phenotypes and antihypertensive medications relate to ACE2 renal expression using information from up to 436 patients whose kidney transcriptomes were characterised by RNA-sequencing. We further validated some of the key observations in other human tissues and/or a controlled experimental model. Our data reveal increasing expression of ACE2 with age in both human ...

Diabetes mellitus and hypertension are common comorbidities, as hypertension is reported to be twice as frequent in diabetic patients as people who are non- diabetics. In diabetic condition, the risk and progression of cardiac disease, peripheral vascular disease, stroke, retinopathy, and nephropathy is greatly increased in the presence of hypertension. Persistent increase in blood pressure termed hypertension, can be either primary hypertension (essential hypertension) or secondary hypertension in nature. Primary or essential hypertension is characterized by elevated blood pressure caused by inherited factors which are characteristic of essential hypertension whereas identifiable causes such as chronic kidney diseases, endocrine disorders, constriction of the kidney arteries, or the use of drugs are among the etiology of secondary hypertension. Diabetes causes hyperinsulinemia which increases the risk of hypertension. This condition increases the amount of sodium that the body abso...

The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), represents a public health crisis of major proportions. Advanced age, male gender, and the presence of comorbidities have emerged as risk factors for severe illness or death from COVID-19 in observation studies. Hypertension is one of the most common comorbidities in patients with COVID-19. Indeed, hypertension has been shown to be associated with increased risk for mortality, acute respiratory distress syndrome, need for intensive care unit admission, and disease progression in COVID-19 patients. However, up to the present time, the precise mechanisms of how hypertension may lead to the more severe manifestations of disease in patients with COVID-19 remains unknown. This review aims to present the biological plausibility linking hypertension and higher risk for COVID-19 severity. Emphasis is given to the role of the renin-angiotensin system and its inhibitors, given the crucial role that this system plays in both viral transmissibility and the pathophysiology of arterial hypertension. We also describe the importance of the immune system, which is dysregulated in hypertension and SARS-CoV-2 infection, and the potential involvement of the multifunctional enzyme dipeptidyl peptidase 4 (DPP4), that, in addition to the angiotensin-converting enzyme 2 (ACE2), may contribute to the SARS-CoV-2 entrance into target cells. The role of hemodynamic changes in hypertension that might aggravate myocardial injury in the setting of COVID-19, including endothelial dysfunction, arterial stiffness, and left ventricle hypertrophy, are also discussed.

Review Article Inhibitors of α-glucosidase and Angiotensin-converting Enzyme in the Treatment of Type 2 Diabetes and its Complications: A Review on in Silico Approach Background: The use of pharmacological agents to synergistically target key enzymes associated with carbohydrate digestion (α-glucosidase) and the hypertension-related angiotensin-converting enzyme (ACE) are critical strategies for the management of type 2 diabetes (T2D) and its end-stage complications. Furthermore, aside from their blood pressure-lowering effect, ACE inhibitors (ACEIs) are important therapeutic agents for preventing diabetic complications, highlighting their synergistic renoprotective and antihypertensive effects in diabetic patients who are normotensive and hypertensive. Objectives: We reviewed the safety and potent activity of phytochemicals discovered based on molecular docking and dynamics in recent years that could be used to treat T2D. Methods: We surveyed recently in silico drug discovery findings on α-glucosidase and ACE retrieved from the PubMed database. Computational in silico ADMET meta-analysis was performed on 57 compounds that could potentially inhibit α-glucosidase or ACE. Results: The review highlighted the fact that most hit compounds of α-glucosidase and ACE involving the use of molecular docking and molecular dynamics techniques are competitive and peptide inhibitors, respectively. Moreover, we found that most authors do not consider absorption distribution metabolism excretion toxicity (ADMET) studies on drug candidates, which is important in determining the safety profile of potent leads. Hence, we performed in silico ADMET meta-analysis of the reported compounds and found some inhibitors with an excellent pharmacological profile. Conclusion: We propose that further studies be conducted on these promising leads to demonstrate their efficacy and safety in the treatment of T2D.

Angiotensin-converting enzyme (ACE) is the primary enzyme that converts angiotensin I (Ang I) to angiotensin II (Ang II) in the renin-angiotensin system (RAS). However, chymase hydrates Ang I to Ang II independently of ACE in some kidney diseases, and it may play an important role. The present study investigated whether chymase played a crucial role in aristolochic acid I (AAI)-induced nephropathy. C57BL/6 mice were treated with AAI via intraperitoneal injection for an accumulated AAI dosage of 45 mg/kg body weight (BW) (15 mg/kg BW per day for 3 days). The animals were sacrificed after acute kidney injury development, and blood, urine and kidneys were harvested for biochemical and molecular assays. Mice exhibited increased serum creatinine, BUN and urinary protein after the AAI challenge. Significant infiltrating inflammatory cells and tubular atrophy were observed in the kidneys, and high immunocytokine levels were detected. Renal RAS-related enzyme activities were measured, and a significantly increased chymase activity and slightly decreased ACE activity were observed in the AAI-treated mice. The renal Ang II level reflected the altered profile of RAS enzymes and was significantly increased in AAI-treated mice. Treatment of AAIinduced nephropathic mice with an ACE inhibitor (ACEI) or chymase inhibitor (CI; chymostatin) reduced renal Ang II levels. The combination of ACEI and CI (ACEI+CI) treatment significantly reversed the AAI-induced changes of Ang II levels and kidney inflammation and injuries. AAI treatment significantly increased renal p-MEK without increasing p-STAT3 and p-Smad3 levels, and p-MEK/p-ERK1/2 signalling pathway was significantly activated. CI

COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has reached pandemic proportions with negative impacts on global health, the world economy and human society. The clinical picture of COVID-19, and the fact that Angiotensin converting enzyme 2 (ACE2) is a receptor of SARS-CoV-2, suggests that SARS-CoV-2 infection induces an imbalance in the renin-angiotensin system (RAS). We review clinical strategies that are attempting to rebalance the RAS in COVID-19 patients by using ACE inhibitors, angiotensin receptor blockers, or agonists of angiotensin-II receptor type 2 or Mas receptor (MasR). We also propose that the new MasR activator BIO101, a pharmaceutical grade formulation of 20-hydroxyecdysone that has anti-inflammatory, anti-fibrotic and cardioprotective properties, could restore RAS balance and improve the health of COVID-19 patients who have severe pneumonia.

An inverse relationship between body mass index (BMI) and vitamin D status has been described. 12,13,14 Wortsman et al. 15 have shown that both obese and normal weight persons' skin Background: A strong relationship exists between hypertension and body weight. Research has linked both higher blood pressure and body weight with lower vitamin D status. Objective: This study assessed the vitamin D status of a low-income, urban, black community in South Africa, to examine whether serum levels of 25-hydroxy vitamin D [25(OH)D] are associated with hypertension and body mass index (BMI). Methods: Data collected from 339 adults (25-64 years) from the Assuring Health for All in the Free State (AHA-FS) study were analysed. Variables measured include serum 25(OH)D, blood pressure, weight and height to determine BMI, and HIV status. Results: Mean 25(OH)D level was 38.4 ± 11.2 ng/mL for the group; 43.5 ± 11.8 ng/mL and 37.0 ± 10.6 ng/mL for males and females, respectively. Approximately 40% of the participants were HIV-positive and 63.4% hypertensive. Based on BMI, 11.8% were underweight, 33.0% normal weight, 23.0% overweight and 32.1% obese. HIV status showed no correlation with 25(OH)D levels when controlling for BMI. Poor inverse relationships were found between BMI and 25(OH)D (p = 0.01), and between mean arterial blood pressure and 25(OH)D (p = 0.05). When controlling for BMI, no correlation was found between 25(OH)D and the prevalence of hypertension or mean arterial blood pressure. Conclusion: Approximately 96% of participants had an adequate vitamin D status, which could be attributed to latitude, sunny conditions and expected high levels of sun exposure because of living conditions. Results confirmed a poor inverse relationship between vitamin D status and hypertension, which seems to be dependent on BMI.

An inverse relationship between body mass index (BMI) and vitamin D status has been described. 12,13,14 Wortsman et al. 15 have shown that both obese and normal weight persons' skin Background: A strong relationship exists between hypertension and body weight. Research has linked both higher blood pressure and body weight with lower vitamin D status. Objective: This study assessed the vitamin D status of a low-income, urban, black community in South Africa, to examine whether serum levels of 25-hydroxy vitamin D [25(OH)D] are associated with hypertension and body mass index (BMI). Methods: Data collected from 339 adults (25-64 years) from the Assuring Health for All in the Free State (AHA-FS) study were analysed. Variables measured include serum 25(OH)D, blood pressure, weight and height to determine BMI, and HIV status. Results: Mean 25(OH)D level was 38.4 ± 11.2 ng/mL for the group; 43.5 ± 11.8 ng/mL and 37.0 ± 10.6 ng/mL for males and females, respectively. Approximately 40% of the participants were HIV-positive and 63.4% hypertensive. Based on BMI, 11.8% were underweight, 33.0% normal weight, 23.0% overweight and 32.1% obese. HIV status showed no correlation with 25(OH)D levels when controlling for BMI. Poor inverse relationships were found between BMI and 25(OH)D (p = 0.01), and between mean arterial blood pressure and 25(OH)D (p = 0.05). When controlling for BMI, no correlation was found between 25(OH)D and the prevalence of hypertension or mean arterial blood pressure. Conclusion: Approximately 96% of participants had an adequate vitamin D status, which could be attributed to latitude, sunny conditions and expected high levels of sun exposure because of living conditions. Results confirmed a poor inverse relationship between vitamin D status and hypertension, which seems to be dependent on BMI.

Angiotensin-converting enzyme 2 (ACE2) is the receptor for COVID-19 (SARs-CoV-2). ACE2 protects the lung and heart from acute respiratory distress syndrome (ARDS) and acute myocarditis and arrhythmias, because it breaks down Angiotensin II, which has inflammatory effects in the lung and heart as well as in the kidney. When SARS-CoV-2 binds to ACE2, it suppresses it, so this protective action of ACE2 is lost. Death from COVID-19 is due to ARDS and also heart failure and acute cardiac injury. Drugs that prevent the inflammatory actions of Angiotensin II (i.e., Angiotensin receptor blockers, ARBs) prevent acute lung injury caused by SARS-CoV. Clinical trials are underway to test the risks and benefits of ARBs and angiotensin-converting enzyme inhibitors (ACEIs) in COVID-19 patients requiring hospitalization. Other potential treatments are also discussed.

Angiotensin converting enzyme 2 (ACE2) is the cellular entry point for severe acute respiratory syndrome coronavirus (SARS-CoV-2) - the cause of COVID-19 disease. It has been hypothesized that use of renin-angiotensin system (RAS) inhibiting medications in patients with hypertension, increases the expression of ACE2 and thereby increases the risk of COVID-19 infection and severe outcomes or death. However, the effect of RAS-inhibition on ACE2 expression in human tissues of key relevance to blood pressure regulation and COVID-19 infection has not previously been reported. We examined how hypertension, its major metabolic co-phenotypes and antihypertensive medications relate to ACE2 renal expression using information from up to 436 patients whose kidney transcriptomes were characterised by RNA-sequencing. We further validated some of the key observations in other human tissues and/or a controlled experimental model. Our data reveal increasing expression of ACE2 with age in both human ...

The novel coronavirus (CoV) severe acute respiratory syndrome (SARS)-CoV-2 outbreak began at the end of 2019 in Wuhan, China, and has spread to over 200 countries. Many comorbidities have shown to be associated with the severity of the viral infection with hypertension being one of the highest rated comorbidities since loss of the ACE2 receptor due to SARS-Cov-2 infection can lead to increased blood pressure. The effects and clinical characteristics associated with the use of beta-blockers, angiotensin receptor blockers (ARB), and calcium-channel blockers (CCB) shows not to affect the outcome of covid-19, except in angiotensin converting enzyme inhibitor (ACEI) which may have negative outcomes on covid-19 infected patients. Many comorbidities have shown to be associated with the severity of the viral infection.

Objective: Our aim was to determine the effectiveness, feasibility, and necessary cultural adaptations of evidence-based interventions directed at tobacco use, unhealthy diet, and physical inactivity in adults and children in three different sectors: workplace, neighborhood and schools. Materials and Methods: We conducted in Sousse, Tunisia an interventional study through a quasiexperimental design (pre-post with intervention and control groups) to prevent non communicable disease risk factors. The intervention group included different settings and pre and post assessment concerned independent groups (schools with 1929 and 2170 participants, workplaces with 914 and 1098 participants and community with 940 and 1001 participants respectively at pre and post assessment). It was located in the delegation of Sousse Jawhara and Sousse Erriadh. The control group with similar settings (schools with 2074 and 2105 participants, workplaces with 861 and 1015 and community with 940 and 976 participants respectively at pre and post assessment) was located in the delegation of Msaken from the region of Sousse. Results: Tobacco use decreased among neighborhood (26.2% to 23.2%, p = 0.13) workplace (39.2% to 37.5%, p = 0.43) and schools (5.7% to 4.8%, p = 0.19) participants. In control group, it increased significantly in * Corresponding author. J. Maatoug et al. 322 schools and neighborhood. Participants who consumed five fruits and vegetables daily increased significantly in all settings in intervention group (from 30% to 33.2% in schools, 47.5% to 52.1% in workplace and 39.4% to 58.4% in neighborhood). However in control group it increased only in schools and neighborhood. An improvement in physical activity practice was seen both in intervention and control group among adults participants but not in schools. Conclusion: The "Together in Health" project for the prevention of risk factors for NCD is an example of a loco-regional initiative. Such initiatives can only be beneficial with a structure organized by the government.

It is predictable that the renin–angiotensin–aldosterone and kinin–kallikrein systems are dysregulated in COVID-19 (COV) patients because SARS-CoV-2 requires ACE2 to cause an infection. This study aimed to assess the serum levels of des-arg(9)-bradykinin (DABK) and angiotensin 1–7 (ang-(1–7)) in patients with COV who had the above-mentioned cardiovascular disease risk factors. In a cross-sectional study, 69 COV patients were selected among patients referred to the main referral center for these patients, in Kerman, Iran, and 73 matched control (non-COV) individuals among individuals who participated in the KERCARD cohort study. Serum levels of DABK and ang-(1–7) were measured by ELISA in the groups of CTL (healthy), HTN, DM, OB, COV, COV + HTN, COV + DM, and COV + OB. Ang-(1–7) levels were lower in the COV + HTN group compared to the HTN group. DABK levels were higher in the COV, HTN, and OB groups and in DM + COV subjects compared to their corresponding control group. The levels of...

Cereals have phytochemical compounds that can diminish the incidence of chronic diseases such as hypertension. The angiotensin-converting enzyme 2 (ACE2) participates in the modulation of blood pressure and is the principal receptor of the virus SARS-CoV-2. The inhibitors of the angiotensin-converting enzyme (ACE) and the block receptors of angiotensin II regulate the expression of ACE2; thus, they could be useful in the treatment of patients infected with SARS-CoV-2. The inferior peptides from 1 to 3 kDa and the hydrophobic amino acids are the best candidates to inhibit ACE, and these compounds are present in rice, corn, wheat, oats, sorghum, and barley. In addition, the vitamins C and E, phenolic acids, and flavonoids present in cereals show a reduction in the oxidative stress involved in the pathogenesis of hypertension. The influence of ACE on hypertension and COVID-19 has turned into a primary point of control and treatment from the nutritional perspective. The objective of thi...

Hypertension is a serious risk factor for various diseases. Therefore, lowering and preventing high blood pressure is a significant issue. Blockage of the renin-angiotensin-aldosterone system (RAAS), which controls blood pressure, is important to reduce blood pressure and consequently reduce symptoms of heart failure. This blockage can be carried out by angiotensin-converting enzyme (ACE) and angiotensin II receptor blockers (ARBs). The phenylalanyltyrosine (H-Phe-Tyr-OH, Phe-Tyr, L-Phe-L-Tyr, L-phenylalanyl-L-tyrosine) dipeptide examined in this study is an important structure that shows blood pressure lowering properties. For this reason, the potential of the peptide to be an ACE inhibitor or ARB was investigated. The molecular activity of the Phe-Tyr dipeptide was compared with antihypertensive drugs using theoretical calculations. Molecular docking method, one of these theoretical methods, has a considerable process in illuminating biochemical processes by investigating the inte...

Pathogens in our environment can act as agents capable of inflicting severe human diseases. Among them, the SARS-CoV-2 virus has recently plagued the globe and paralyzed the functioning of ordinary human life. The virus enters the cell through the angiotensin-converting enzyme-2 (ACE-2) receptor, an integral part of the renin-angiotensin system (RAAS). Reports on hypertension and its relation to the modulation of the RAAS are generating interest in the scientific community. This short review focuses on the SARS-CoV-2 infection's direct and indirect effects on our body through modulation of the RAAS axis. A patient having severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, which causes COVID-19 relates to hypertension as a pre-existing disease or develops it in a post-COVID scenario. Several studies on how SARS-CoV-2 modulates the RAAS axis indicate that it alters our body's physiological balance. This review seeks to establish a hypothesis on the mechanical dependency of SARS-CoV-2 and RAAS modulation in the human body. This study intends to impart ideas on drug development and designing by targeting the modulation of the RAAS axis to inactivate the pathogenicity of the SARS-CoV-2 virus. A systematic hypothesis can severely attenuate the pathogenicity of the dreadful viruses of the future.

The novel coronavirus (CoV) severe acute respiratory syndrome (SARS)-CoV-2 outbreak began at the end of 2019 in Wuhan, China, and has spread to over 200 countries. Many comorbidities have shown to be associated with the severity of the viral infection wit h hypertension being one of the highest rated comorbidities since loss of the ACE2 receptor due to SARS-Cov-2 infection can lead to increased blood pressure. The effects and clinical characteristics associated with the use of beta-blockers, angiotensin receptor blockers (ARB), and calcium-channel blockers (CCB) shows not to affect the outcome of covid-19, except in angiotensin converting enzyme inhibitor (ACEI) which may have negative outcomes on covid-19 infected patients. Many comorbidities have shown to be associated with the severity of the viral infection.

The severe acute respiratory syndrome (SARS-COV) are well known viruses from the family of Coronaviridae which in past caused outbreaks that led to various detrimental effect on world in many aspects. In the year 2019 when the new strain of coronavirus family (SARS-COV2) which is now known as COVID-19 (corona virus disease and 19 refer to the year it was first recognized) outbreak occurred in Wuhan affected the globe seriously. The health system got into a big challenge as this new strain of coronavirus spread much rapidly and caused much more mortality than the previous ones. The mortality was higher in those population which had comorbid conditions such as cardiovascular disease, lung disorders, chronic illnesses, diabetic patients and at the same time affected by COVID-19. Various regimes were selected but still proper and effective management is not available for such patients as these patients are already on multiple drugs. Among those chronic illnesses diabetic patients were found be highly susceptible to COVID-19. High disease mortality and worse outcomes in patients with diabetes urges that Diabetes appropriate management and better selection of drugs is crucial for the better outcomes in diabetic patients as most of the patients are treated for hypertension, hyperglycaemia and ongoing other chronic illnesses which could lead to worse case scenarios.

COVID-19 is one of the most relevant pathologies in recent months, becoming one of the most deadly pandemics that the world has faced; Since the detection of the first cases in Wuhan (China) until today, the evolution of those infected has been a bit unpredictable, although without a doubt comorbidities such as Diabetes Mellitus (DM) and Arterial Hypertension (HTN) have been an essential link in fatality of clinical evolutions and the main cause of transfer to intensive care units. A bibliographic analysis was carried out, using the Scielo, Scopus, EBSCO and Google Academic databases, where information was obtained from twenty-two bibliographic references in order to determine the influence of arterial hypertension and diabetes as risk factors in the evolution of patients with covid 19. Patients diagnosed with COVID-19 who have hypertension and diabetes as a personal medical history are more likely to develop complications during the course of the disease and even die. The control and isolation of these patients is of special importance, taking into account the risk posed by presenting these pathologies. The research work carried out in Cuba maintains the control and knowledge of the health personnel of the state of vulnerable patients.

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Background: Corona virus disease 2019 (COVID-19) is respiratory disorder, which is major public health concern. The incidence of COVID-19 is increasing day by day with multiple variants. The infection spread in more than 213 countries with more than 219 million cases reported and 4.5 million deaths recorded till date. The fatality rate of COVID is 4.1% in china, 12.8% in Italy, 10.2% in Spain, 3.9% in USA, 2.3% in Germany, 1.09% in India and 2% in Pakistan. Objectives: The purpose of this study to assess the percentage of hypertensive people who got the COVID 19. Methodology: Patients with confirmed COVID positive, admitted in hospital or home quarantined from different areas of Punjab province between November 2020 and April 2021 and willing to fill the questionnaire were included in the study. Hospitalized patients were admitted with specific presentation of acute respiratory distress and SARS COV-2 positive. Qualitative data collection was done through questionnaire. Only 200 tru...

The present paper relates to the medical and surgical device that occludes piercing site or insertion site around implant device and prevents infection and leakage. The principle object of the present invention is to provide a mechanical barrier comprising the top layer, the outer layer and the bottom layer wherein the outer layer of said device is connected to the top layer and the bottom layer as the supporting structure, wherein top layer comprises the inlet orifice for the entry of the external fixation pin wherein the outer layer comprises the grip formation region, supporting web structure and the radially extending region. The inlet orifice allows the external fixation pin to enter into the mechanical barrier. The radially extending region of the outer layer is connected with the supporting web structure and the bottom layer, which will constitute to the strength and stability of the mechanical barrier. The bottom layer of the mechanical barrier comprises the outlet orifice, gel cavity layer, wound contact layer and the protective layer wherein the composite gel housing is located at the bottom of the device wherein outlet orifice is located inside the composite gel cavity region.

COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has reached pandemic proportions with negative impacts on global health, the world economy and human society. The clinical picture of COVID-19, and the fact that Angiotensin converting enzyme 2 (ACE2) is a receptor of SARS-CoV-2, suggests that SARS-CoV-2 infection induces an imbalance in the renin-angiotensin system (RAS). We review clinical strategies that are attempting to rebalance the RAS in COVID-19 patients by using ACE inhibitors, angiotensin receptor blockers, or agonists of angiotensin-II receptor type 2 or Mas receptor (MasR). We also propose that the new MasR activator BIO101, a pharmaceutical grade formulation of 20-hydroxyecdysone that has anti-inflammatory, anti-fibrotic and cardioprotective properties, could restore RAS balance and improve the health of COVID-19 patients who have severe pneumonia.

Aim: The renal lesions–including severe acute kidney injury–are severe outcomes in severe acute respiratory syndrome coronavirus 2 infections. There are no reports regarding the influence of the nutritional status on the severity and progress of these lesions. Ageing is also an important risk factor. Methods: In the present study we compared the influence of overweight and undernutrition on the levels of renal angiotensin converting enzymes 1 and 2 (ACE and ACE2), which were evaluated by Western blotting. Since the renin-angiotensin-aldosterone system (RAAS) has been implicated in the progress of kidney failure during coronavirus disease 2019, the influence of Angiotensin-(3-4) [Ang-(3-4)] was investigated. Ang-(3-4) is the shortest angiotensin-derived peptide, which is considered the physiological antagonist of several Ang II effects. Results: Both overweight and undernutrition downregulate the levels of ACE2 without influence on the levels of ACE in proximal tubules from kidney ra...

Growing interest in hypertension—one of the main factors characterizing the cardiometabolic syndrome (CMS)—and anti-hypertensive drugs raised from the emergence of a new coronavirus, SARS-CoV-2, responsible for the COVID19 pandemic. The virus SARS-CoV-2 employs the Angiotensin-converting enzyme 2 (ACE2), a component of the RAAS (Renin-Angiotensin-Aldosterone System) system, as a receptor for entry into the cells. Several classes of synthetic drugs are available for hypertension, rarely associated with severe or mild adverse effects. New natural compounds, such as peptides, might be useful to treat some hypertensive patients. The main feature of ACE inhibitory peptides is the location of the hydrophobic residue, usually Proline, at the C-terminus. Some already known bioactive peptides derived from marine resources have potential ACE inhibitory activity and can be considered therapeutic agents to treat hypertension. Peptides isolated from marine vertebrates, invertebrates, seaweeds, o...

It has been a year since the coronavirus disease 2019 (COVID-19) was declared pandemic and wreak havoc worldwide. Despite meticulous research has been done in this period, there are still much to be learn from this novel coronavirus. Globally, observational studies have seen that majority of the patients with COVID-19 have preexisting hypertension. This raises the question about the possible relationship between COVID-19 and hypertension. This review summarizes the current understanding of the link between hypertension and COVID-19 and its underlying mechanisms.

Bioactive peptides are present in most soy products and eggs and have essential protective functions. Infection is a core feature of innate immunity that affects blood pressure and the glucose level, and ageing can be delayed by killing senescent cells. Food also encrypts bioactive peptides and protein sequences produced through proteolysis or food processing. Unique food protein fragments can improve human health and avoid metabolic diseases, inflammation, hypertension, obesity, and diabetes mellitus. This review focuses on drug targets and fundamental mechanisms of bioactive peptides on metabolic syndromes, namely obesity and type 2 diabetes, to provide new ideas and knowledge on the ability of bioactive peptide to control metabolic syndromes.

Background: Hypertension, as the comorbidity accompanying COVID-19, is related to angiotensin-converting enzyme 2 receptor (ACE-2R) and endothelial dysregulation which have an important role in blood pressure regulation. Other anti-hypertensive agents are believed to trigger the hyperinflammation process. We aimed to figure out the association between the use of anti-hypertensive drugs and the disease progression of COVID-19 patients.   Methods: This study is an observational cohort study among COVID-19 adult patients from moderate to critically ill admitted to Universitas Airlangga Hospital (UAH) Surabaya with history of hypertension and receiving anti-hypertensive drugs.   Results: Patients receiving beta blockers only had a longer length of stay than angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ACEI/ARB) or calcium channel blockers alone (17, 13.36, and 13.73 respectively), had the higher rate of intensive care unit (ICU) admission than ACEi...

The presentation of COVID-19, caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2), has largely been asymptomatic or mild in youngsters and the pediatric age group. The elderly population, however, have been at a much higher risk of severe disease wtih grave complications and even death. Furthermore, obseity, cardiovascular ailments and diabetes mellitus have also been implicated in severe disease outcomes. It has been found that a dysregulation of the renin-angiotensin system (RAS) plays a key role in the initiation of lung damage after SARS-CoV-2 infection, and RAS inhibitors may reestablish the equilibrium between the “classic RAS” arm and its counter regulatory arm, here defined as “anti-RAS,” of which ACE2 is the keystone. Till now, there has been paucity of solid evidence to either recommend or discontinue usage of ACEI/ARB medications in hypertensive patients in the midst of menace posed by COVID-19. Hence, we tried to summarize and simplify the myths and ...

To the Editor Dear Sir. We read with great interest the recently published article in this journal by Singh A.K et al. [1], regarding the controversies surrounding the use of RASB (Renin-angiotensin system blockers) among hypertensive patients in the COVID-19 (coronavirus 2019) era. Though we agree with the authors on most parts of the review, we have few concerns regarding the rationale and mechanisms for benefit of RASB in COVID-19 (section 3.5 b). We agree with one of the proposed mechanism that involves an increase in the soluble form of ACE-2 (Angiotensin-converting enzyme-2), which acts as an interceptor by binding to SARS-CoV-2 (Severe acute respiratory syndrome coronavirus-2) and does not allow the virus to bind to the membrane bound ACE-2 receptor, thereby inhibiting viral entry inside the cell [1e3]. However, we do not agree with the other proposed mechanism whereby authors have suggested that "RAS blockers increase angiotensin II, which is a substrate for ACE-2.

Since December 2019, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused a global pandemic named coronavirus disease-19 (COVID-19) and resulted in a worldwide economic crisis. Utilizing the spike-like protein on its surface, the SARS-CoV-2 binds to the receptor angiotensin-converting enzyme 2 (ACE2), which highly expresses on the surface of many cell types. Given the crucial role of ACE2 in the renin-angiotensin system, its engagement by SARS-CoV-2 could potentially result in endothelial cell perturbation. This is supported by the observation that one of the most common consequences of COVID-19 infection is endothelial dysfunction and subsequent vascular damage. Furthermore, endothelial dysfunction is the shared denominator among previous comorbidities, including hypertension, kidney disease, cardiovascular diseases, etc., which are associated with an increased risk of severe disease and mortality in COVID-19 patients. Several vaccines and therapeutics have been developed and suggested for COVID-19 therapy. The present review summarizes the relationship between ACE2 and endothelial dysfunction and COVID-19, also reviews the most common comorbidities associated with COVID-19, and finally reviews several categories of potential therapies against COVID-19.

The severe acute respiratory syndrome (SARS-COV) are well known viruses from the family of Coronaviridae which in past caused outbreaks that led to various detrimental effect on world in many aspects. In the year 2019 when the new strain of coronavirus family (SARS-COV2) which is now known as COVID-19 (corona virus disease and 19 refer to the year it was first recognized) outbreak occurred in Wuhan affected the globe seriously. The health system got into a big challenge as this new strain of coronavirus spread much rapidly and caused much more mortality than the previous ones. The mortality was higher in those population which had comorbid conditions such as cardiovascular disease, lung disorders, chronic illnesses, diabetic patients and at the same time affected by COVID-19. Various regimes were selected but still proper and effective management is not available for such patients as these patients are already on multiple drugs. Among those chronic illnesses diabetic patients were found be highly susceptible to COVID-19. High disease mortality and worse outcomes in patients with diabetes urges that Diabetes appropriate management and better selection of drugs is crucial for the better outcomes in diabetic patients as most of the patients are treated for hypertension, hyperglycaemia and ongoing other chronic illnesses which could lead to worse case scenarios.

Angiotensin-converting enzyme I (ACE I) is a zinc-containing metallopeptidase involved in the renin-angiotensin system (RAAS) that helps in the regulation of hypertension and maintains fluid balance otherwise, which results in cardiovascular diseases (CVDs). One of the leading reasons of global deaths is due to CVDs. RAAS also plays a central role in maintaining homeostasis of the CV system. The commercial drugs available to treat CVDs possess several fatal side effects. Hence, phytochemicals like peptides having plant-based origin should be explored and utilized as alternative therapies. Soybean is an important leguminous crop that simultaneously possesses medicinal properties. Soybean extracts are used in many drug formulations for treating diabetes and other disorders and ailments. Soy proteins and its edible products such as tofu have shown potential inhibitory activity against ACE. Thus, this review briefly describes various soy proteins and products that can be used to inhibit...