Del Mar College

Abstract The misnamed De administrando imperio is a historically enriched guide to foreign relations. It was presented by Constantine Porphyrogenitus to his 14-year-old son Romanos in 952. It is an odd work—ramshackle, untidy, but with a coherent core. This core originated as a handbook of diplomacy commissioned by his father, Leo VI, to complement his Tactics. It was narrowly focused on actual and potential allies and clients in four arenas of active diplomacy—Italy, the Balkans, the Ukrainian steppes, and Transcaucasia. It was unfinished at Leo’s death. Constantine took it over in the 930s and 940s, updating each of its four constituent dossiers, introducing new material (glosses, additional background history, miscellaneous information only tangentially connected with diplomacy, and a handy guide to northern diplomacy), and prefacing it with advice to Romanos and a prayer for his success.

Background: Chronic kidney disease(CKD) is a growing global health challenge, with hypertension being a leading cause of renal dysfunction across populations. A major yet underrecognized complication of hypertensive CKD (HTN-CKD) is anemia, which not only worsens renal outcomes but also amplifies cardiovascular risk through mechanisms like left ventricular hypertrophy and myocardial strain. Understanding its burden is critical, as anemia in this setting accelerates disease progression and contributes significantly to cardiovascular morbidity and mortality. Method: We estimated the global and regional burden of anemia attributable to HTN-CKD in 204 countries and its terriotories from 1990-2021 using standardized Global Burden of Disease Study 2021. Estimates of prevalence and years lived with disability(YLDs) were generated using DisMod-MR 2.1, a Bayesian meta-regression tool that integrates data from population-based surveys, cohort studies, hospital records, and vital registration systems. Age-standardized rates were calculated to facilitate comparisons across time and regions, and annualized percentage changes(APCs) were computed using log-linear regression. Results: Between 1990 and 2021, the global prevalence of anemia attributable to HTN-CKD more than doubled, rising from 2.6 million(95% UI: 2.4–2.9 million) to 5.6 million(5.2–6.1 million), with an APC of +2.46%. Correspondingly, YLDs increased from 74,819 (49,512–106,554) to 138,672 (92,028–198,889), reflecting an APC of +2.01%. The highest regional increase in prevalence was observed in South Asia (APC: +3.16%), followed by Latin America and the Caribbean (+2.94%), Sub-Saharan Africa (+2.80%), and North Africa and the Middle East (+2.71%). The greatest rise in age-standardized prevalence rate was seen in Fiji (APC: +0.80%), followed by the United States (APC: +0.74%), signaling a growing concern even in high-resource settings like the USA. Among adults aged 70 years and above in middle and low-middle SDI regions, both prevalence and YLDs showed annualized increases exceeding 2%, whereas younger age groups in high SDI regions exhibited stable or declining trends. Conclusion: The global burden of anemia due to HTN-CKD has escalated, with the sharpest increases concentrated in low- and middle-income regions where hypertension detection and management remain suboptimal. The burden is especially pronounced among older adults and men, accentuating widening disparities by age, sex, and socioeconomic status.

Heart failure (HF) is a growing global health concern, and cirrhosis is an increasingly recognized non-cardiac contributor through mechanisms like volume overload, systemic inflammation, and cirrhotic cardiomyopathy. As the global prevalence of liver disease rises, especially from nonalcoholic fatty liver disease (NAFLD), alcohol use, and viral hepatitis, understanding the burden of HF due to cirrhosis is essential. We estimated the non-fatal burden of HF attributable to cirrhosis across five etiologies—NAFLD, alcohol use, hepatitis C, hepatitis B, and other causes—in 204 countries and territories from 1990 to 2021 using data from the Global Burden of Disease Study 2021. Non-fatal burden was estimated by applying standardized severity distributions and disability weights to the prevalence of each cause to quantify impairment. Age-standardized prevalence rates (ASPRs) and annualized percentage changes (APCs) were calculated by SDI, age, and sex. Future prevalence to 2050 was projected using a log-linear regression model. Between 1990 and 2021, total prevalence counts rose substantially across all cirrhosis subtypes. NAFLD-related HF increased from 9,202 (95% UI: 6,417–12,641) to 30,092 (20,452–42,009); alcohol-related from 35,701 (27,666–45,427) to 82,258 (61,635–108,803); hepatitis C from 47,484 (37,044–60,873) to 92,079 (70,272–120,432); hepatitis B from 59,974 (47,824–74,529) to 112,111 (87,717–142,335); and other causes from 99,977 (77,246–129,309) to 133,311 (102,461–169,414). The highest ASPR increase was seen in low SDI regions (APC: 2.49%), followed by high SDI (2.24%), middle (1.73%), high-middle (1.67%), and low-middle SDI (1.60%) regions. In 2021, children aged 5–9 years exhibited the highest burden within the under-20 group (26,749 cases), while adults aged 65–69 years had the peak burden among older individuals (51,379 cases). Females showed a marginally higher annual growth in total prevalence (APC: 0.79%) and ASPR (0.04%) compared to males (0.78% and 0.01%, respectively). Projections estimate the prevalence of heart failure due to cirrhosis will increase to 788,332 cases globally by 2050. HF attributable to cirrhosis is a growing global health concern with rising prevalence across all etiologies, disproportionately impacting low-SDI regions and older adults. The projected surge by 2050 underscores an urgent need for integrated liver-cardiac care, early detection, and policy interventions targeting modifiable liver disease risk factors.

Background: Stroke is a major global health threat, with high systolic blood pressure (HSBP) as its leading modifiable risk factor. G20 nations—home to over 60% of the world’s population—face a growing burden driven by demographic shifts and uneven health policies. Despite their resources, comparative assessments of HSBP-attributable stroke trends across G20 countries remain scarce. Methods: Using the GBD 2021 analytical framework, we estimated the stroke burden attributable to HSBP in G20 countries from 1990-2021, stratified by age, sex, year, and location. Age-standardized mortality rates (ASMR), disability adjusted life years (DALYs) (ASDALR), years lived with disability (YLDs) (ASYLDsR), and counts were analyzed, and temporal trends were quantified using estimated annual percentage change (APC). Result: From 1990 to 2021, stroke deaths attributable to HSBP in G20 countries rose from 2.0 million (95% UI: 1.5–2.5) to 3.0 million (2.2–3.8), DALYs increased from 46.2 million (34.7–57.3) to 64.4 million (48.1–80.0), and YLDs doubled from 3.0 million (2.0–4.1) to 6.2 million (4.1–8.5). Age-standardized rates showed modest annual percentage declines: ASMR by 0.4%, ASDALR by 0.37%, and ASYLDR by 0.04%. Nationally, South Africa recorded the highest rise in ASMR (APC: +0.54%), followed by Indonesia (+0.33%), while most countries showed a downward trend. For ASYLDR, China reported the steepest increase (APC: +1.11%), followed by Indonesia (+0.025%), whereas the U.S. experienced a notable decline (−0.55%). By age, the highest unadjusted death rate in 2021 occurred in individuals aged ≥55 years [251 (186–315) per 100,000], compared to 8.47 (5.99–10.78) in those aged 20–54. Sex-wise, males experienced a greater burden increase than females from 1990–2021: deaths rose by 65% vs 29%, DALYs by 54% vs 25%, and YLDs by 118% vs 96%. Conclusion: In 2021, G20 countries accounted for 72.41% of global stroke deaths attributable to HSBP, while within the G20, 57.84% of all stroke deaths were attributed to HSBP. Despite overall declines in age-standardized rates, the rising absolute burden of stroke attributable to HSBP—particularly among males, older adults, and emerging G20 economies—highlights the urgent need for targeted hypertension control strategies and equitable stroke prevention efforts.

Abstract Background Pharmacists' role in providing favorable patient outcomes has been established in previous literature. However, the impact of pharmacists in treating patients with mental illness needs further investigation. Patients diagnosed with mental illnesses face multiple challenges that affect their quality and longevity of life compared to the general population with similar age groups. Previous studies confirmed that drug related problems (DRPs) play a major role in these patients due to several factors, such as medication errors and drug interactions. The purpose of this review is to investigate the impact of pharmacist‐led initiatives in safe medication use for mental health populations. Methods This narrative review examines the extent and nature of the literature on pharmacist‐led interventions related to medication safety with mental health conditions. The PubMed, Embase, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched from January 2000 until September 2023. A manual search of relevant citations was also conducted. The inclusion criteria included full‐text studies written in English and published within the above date range. Studies exploring pharmacist‐led interventions in any practice setting for patients with mental illnesses were included. Pharmacist‐led interventions as part of an interdisciplinary team were excluded. Results A total of 13 studies were included, collectively involving 4488 patients and 51 pharmacists. The most described interventions included DRPs, medication adherence, and appropriate prescribing. Pharmacist‐led interventions were presented in various aspects, including medication therapy management, long‐acting antipsychotic medication administration, and DRPs resolution through clinical interventions as transition of care. Conclusion The variation in healthcare settings and regulatory environments influenced the effectiveness of pharmacist‐led interventions. Pharmacists can depict DRP, prevent rehospitalizations, and assess any serious drug interactions that prevent harm and consequently have cost saving outcomes. This review highlights the need for more research, to quantify the impact of pharmacists in improving medication safety for mental health patients.

Glycosylation is one of the major post‐translational modifications (PTMs) in proteins, with significant effects on protein folding, conformation, stability, and activity. Glycosylation is particularly important for therapeutic protein drugs, such as monoclonal antibodies (mAbs), as it can profoundly impact their pharmacological properties, stability, and safety. Therefore, understanding the inherent heterogeneity of mAb glycoforms is an integral part of their manufacturing processes and quality control.Most marketed mAbs belong to the immunoglobulin G1 (IgG1), IgG2, or IgG4 subclass, carrying N‐glycosylation at the conserved asparagine position 297 (Asn‐297) in the CH2 domain of the Fc region. N‐glycosylation is critical for the Fc receptor binding and consequently affects key antibody effector functions such as antibody‐dependent cell‐mediated cytotoxicity (ADCC). However, assessing ADCC activity using a cell‐based assay remains a complicated, time‐consuming, and expensive task for laboratories.Here, we present a novel workflow leveraging FcγR‐IIIA biology to identify N‐glycan compositions and how to chromatographically determine changes in glycosylation in a time and cost‐effective manner. The TSKgel® FcR‐IIIA analytical and semi‐preparative columns separate mAbs into multiple subsets based on their affinity to the FcγR‐IIIA ligand. Utilizing an increasingly acidic pH gradient, mAb glycoforms are eluted from the column in an order that correlates to their ADCC activity. The analytical TSKgel FcR‐IIIA‐NPR column provides rapid assessment of a mAb's glycoform distribution, whereas the semipreparative TSKgel FcR‐IIIA‐5PW column enables collection of the peaks for more complex orthogonal released N‐glycan analyses and N‐glycosylation profiling using peptide mapping technique.With several mAbs containing various glycosylation patterns, we directly correlated the N‐glycan nature, structure, content, and elution profile on the FcR‐IIIA columns. Furthermore, we present a direct correlation between higher ADCC activity and binding affinity on the FcR‐IIIA columns, indicating that the complexity of the mAb glycosylation pattern is reflected in the observed FcR‐IIIA elution profile. Finally, employing both qualitative and quantitative assessments, we quantified the impact of individual N‐glycan structure and composition on mAb binding to the FcR ligand, providing an additional dimension to our understanding of the FcR‐IIIA columns.This in‐depth correlation analysis provides improved tools to predict, understand, and analyze changes in FcR‐IIIA elution profiles and how changes in the N‐glycan composition influence them. Altogether, this study describes a new framework for utilizing the TSKgel FcR‐IIIA columns for glycosylation profiling, providing a powerful way to simultaneously capture, profile, and characterize the glycosylation state of a given mAb of interest in a comprehensive manner.

Tracheomegaly is a medical condition where the tracheal diameter is greater than the upper limits of normal. Tracheomegaly can be classified as primary or secondary. Primary tracheomegaly is usually congenital. Secondary tracheomegaly can be due to multiple causes, including connective tissue disease, infections, autoimmune diseases like sarcoidosis, and prolonged mechanical ventilation. Here, we describe the first reported case of tracheomegaly secondary to coronavirus disease 2019 (COVID-19) pneumonia and COVID-induced interstitial lung disease (ILD). While many cases of tracheomegaly are asymptomatic, patients can have symptoms like cough, dyspnea, hemoptysis, or even respiratory failure. Tracheomegaly is associated with a higher risk of recurrent lower respiratory tract infections, chronic cough, bronchiectasis, and tracheobronchomalacia. Early recognition of COVID-19-induced tracheomegaly can help initial early management and reduce the incidence of infections.

Fractures of the distal radius are the most common fractures. Much has been written about this topic, but still many questions remain, including major controversies regarding outcome and optimal treatment. Closed reduction and plaster cast is the most common treatment for fractures of the distal radius. If an unacceptable re-displacement occurs, re-reduction and surgical fixation may be necessary.Objective: To determine the radiological outcome of distal radius fractures undergoing closed reduction and cast splint.Materials and Methods: This descriptive Cross sectional study was conducted in the Department of orthopaedics, Hayatabad medical complex, Peshawar from Nov 2013 to Nov 2014 , a total of 105 patients presenting with distal radius fractures were included in the study through a consecutive sampling technique and were subjected to closed reduction & cast splinting and radiological outcome were recorded.Results: The mean age was 31.62 ± 7.62 years of which 66.7% were male and 33.3% were females. After closed reduction & cast splinting, radial shortening was observed in 20% of cases, dorsal angulations was observed in 13.3% and radial angulations was observed in 6.7% of cases.Conclusion: Worse radiological outcomes are not uncommon after closed reduction & cast splinting. More research is required to generate recommendations for the therapy to reduce the burden of these worse radiological outcomes.

Obstructive sleep apnea (OSA) remains a prominent disease state characterized as the recurrent collapse of the upper airway while sleeping and is estimated to plague 936 million adults globally. Although the initial clinical presentation of OSA appears harmless, it increases the risk of cardiovascular diseases such as heart failure, stroke, and hypertension; metabolic disorders; and an overall decrease in quality of life, in addition to increasing mortality. Current treatment of OSA includes lifestyle changes, behavioral modification, mandibular advancement devices, surgical treatment, and continuous positive airway pressure, which remains the gold standard. It is crucial to identify OSA early on and initiate treatment to mitigate the adverse health risks it imposes. This review will discuss the pathophysiology, epidemiology, management strategies, and medical treatment of OSA.