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Comparison of three dual therapies for lowering blood pressure: a multi-country randomized clinical trial
(Lippincott Williams & Wilkins, 2025-05) Schutte, A. E.; Salam, A.; Cushman, W. C.; De Silva, H. A.; Di Tanna, G. L.; Grobbee, D.; Narkiewicz, K.; Ojji, D.; Poulter, N. R.; Schlaich, M. P.; Oparil, S.; Spiering, W.; Williams, B.; Wright, J. T. J.; Lakshman, P.; Ulawattage, W.; Hay, P.; Whelton, P.; Rodgers, A.
OBJECTIVE: Hypertension guidelines currently recommend initiating treatment with low-dose dual single pill combinations (SPCs) of blood pressure (BP) medications for most patients. However, randomized double-blind comparisons between dual SPCs are limited. As part of an evaluation of a low-dose triple SPC, we compared three dual SPCs, each containing two of telmisartan (T), amlodipine (A) or indapamide (I). DESIGN AND METHOD: This randomized, double-blind trial enrolled adults with hypertension receiving 0-3 BP medications from Australia, Czech Republic, New Zealand, Poland, Sri Lanka, United Kingdom and the USA. After a 4-week run-in switching existing BP medications to a triple SPC at T20 mg/A2.5 mg/I1.25 mg, participants were randomised to one of three dual SPCs (T20 mg/A2.5 mg, T20 mg/I1.25 mg, or A2.5 mg/I1.25 mg). After 6 weeks the doses were doubled, unless contraindicated. The primary efficacy outcome was change in home SBP from randomisation to week 12. The primary safety outcome was withdrawal of treatment due to adverse events. The trial was completed on 1 September 2023. RESULTS: Before run-in, participants (n=834) were on average on 1.6 BP medications and mean clinic BP was 142/85 mmHg. Following the active run-in mean home BP was 129/78 mmHg. 834 participants were randomised (mean age 59 years, 52% female). At week 12, mean home SBP of the TI, TA and AI groups were: 131 (95% CI: 130, 132), 134 (133, 135), and 133 (132, 134) mmHg, respectively, with TI superior to TA (3.1, 1.8-4.4, p<0.0001) and AI (2.1, 0.7-3.4, p=0.0027). Home BP control (<135/85 mmHg) at week 12 was 64%, 58% and 56% in the TI, TA and AI groups. Withdrawal of treatment due to adverse events occurred in 1.5%, 1.1% and 1.4%; symptomatic hypotension occurred in 4.0%, 1.8%, and 1.4% of TI, TA and AI groups (all comparisons at p>0.05). CONCLUSIONS: In this randomized, double-blind comparison of three dual SPCs, TI showed a greater home SBP lowering efficacy compared to TA or AI, with similar tolerability for all three SPCs. Although dual combinations of major drug classes are equally recommended in hypertension guidelines, these findings suggest superior efficacy of TI compared to TA and AI at these doses.
Statin Prescription for Primary Prevention of Cardiovascular Diseases in Patients without Hyperlipidemia: Experience from a Low-middle Income South Asian Country
(Bombay, 2025-05) Mettananda, C.; Janaka, K. C.; Herath, M.; Jayasinghe, K.; Manilgama, S. R.; Matthias, A. T.; Rasnayake, L.; Sannasuriya, N.; Sathischandra, H.; Suganthan, N.; Dey, J. K.; Kudrigikar, V.; Rao, S.; Mehta, S.
BACKGROUND: Prescription of statins in primary prevention of atherosclerotic cardiovascular disease (ASCVD) is not as firmly established as it is for secondary prevention, even in high-income countries. The World Health Organization (WHO) has set nine global targets for preventing and controlling noncommunicable diseases (NCDs), including a goal that, by 2025, 50% of eligible individuals receive drug therapy and counseling focused on managing cardiovascular disease. Data from countries classified as low- to middle-income countries (LMIC) show that only one in 10 eligible people is being treated with statins for primary prevention of cardiovascular disease. Statin utilization for primary prevention in patients with normal cholesterol levels could be even lower, but data from LMIC is lacking. OBJECTIVES: We aimed to study statin prescriptions for primary prevention of ASCVD among Sri Lankans without hyperlipidemia. METHODS: This was a cross-sectional study conducted in a hospital setting in eight selected medical clinics of secondary/tertiary care hospitals representing eight out of nine highly populated provinces of Sri Lanka from 15th December 2022 to 30th April 2023. Prescriptions of consecutive, consenting adults aged 40-75 years, without prior ACVD or hyperlipidemia but eligible for statin primary prevention according to the recommendations of the American Heart Association (AHA) guideline, were studied. Prescriptions were evaluated for rates and the intensity of statin prescription, stratified by their CVD risk. Data were gathered by interviewing patients using a questionnaire and reviewing medical records. RESULTS: We studied 800 patients eligible for statin primary prevention, with a mean age of 62 ± 8.3 years, of which 247 (30.9%) were men, and 566 (70.8%) had diabetes. According to the ASCVD score classification, 176 (22.0%) were at high risk (score >20%) and 624 (78%) were at moderate risk of cardiovascular (CV) events. Statins were prescribed to 659 (82.4%) patients, but only 12 (6.8%) high-risk patients received high-intensity statins, and 470 (75.3%) moderate-risk patients were on moderate-intensity statins. Moreover, 32 (18.2%) high-risk patients were not prescribed any statins. Overall, 482 (60.3%) patients were on guideline-recommended statin doses. CONCLUSION: In this research, the rate of statin prescription for primary prevention of ASCVD in Sri Lanka's healthcare system was found to be satisfactory, exceeding the WHO's target of 50% of eligible individuals receiving this drug therapy. However, >90% of patients at high risk of CVD were not on appropriate doses of statins. This highlights the need for improvement in individualizing treatment to administer the right dose of statin to the right patient.
Lipolytic microorganisms and their wide range of microbial extracellular lipases: Diverse biotechnological applications
(The Journal of Desk Research Review and Analysis, 2025) Dias, P. P. C. M.; Gunasinghe, Y. H. K. I. S.; Rathnayake, I. V. N.
Lipases are economically important, effective biocatalysts widely used in various industries. These enzymes can catalyse the hydrolysis of esters formed from glycerol and long-chain fatty acids. Lipases can be extracted from plant and animal sources, even though they can be synthesised via chemical processes. Currently, microbial enzymes are being used for industrial purposes. There are 150 industrial enzymes with hydrolytic action, including lipase, which is the third largest group of industrial enzymes. Microbial lipases are utilised as biocatalysts in various biotechnological applications due to their stability in organic solvents, broad substrate specificity without a cofactor, and higher enantioselectivity. Microbial lipases are more crucial in biotechnological applications due to their ease of production and environmentally sustainable production ability. Among them, extracellular microbial lipases play a crucial role in the enzyme production industry because of their ease of production and purification. The ability of microorganisms to adapt to extreme environmental conditions has been advantageous in industrial microbiology. The organisms in those environments utilise various substances as their primary energy source, so they possess specific enzymes that break down these energy sources. To utilise microbial lipases in industry, they must withstand harsh environments. The current review provides key information about the diversity of lipolytic microorganisms. These various microbial sources can be utilised to produce lipases, including different types of microbial lipases, their classification, general structure, catalytic activity, and their wide range of biotechnological applications. In addition to the enzyme, this review discusses lipolytic microorganisms, which can be applied to wastewater treatment.
Mining with Microbes: A Systematic Review of Bioleaching of Rare Earth Elements from Phosphate Rocks
(The Journal of Desk Research Review and Analysis, 2025) Samarasekere, P. W.; Vijayarathna, S. P.; Rathnayake, I. V. N.
Rare earth elements (REEs) play a key role in advanced materials and clean energy technologies. However, traditional methods for extracting REEs are often complex, costly, and harmful to the environment. This systematic review explores the potential of using phosphate-solubilising microorganisms as a more sustainable alternative for recovering REEs, particularly from phosphate-rich minerals such as apatite found in phosphate rock. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the review investigates existing research on microbial bioleaching of REEs using a range of microorganisms, including bacteria and fungi. It also compares important factors affecting the bioleaching process, including pH, temperature, media composition, pulp density, and particle size. The findings indicate that inconsistent data and varying parameters recorded in the studies make it difficult to establish clear correlations regarding the efficiency of bioleaching of REEs. The review highlights the need for further research to clarify the specific mechanisms behind microbial bioleaching and to understand better the roles of individual microorganisms involved in the process.
On Order Degree Problem for Moore Bound
(Axioms, 2025) Wijerathne, H. M. C.; Lanel, J.; Perera, K.; Wanigasekara, C.
The degree diameter problem is a quest to determine the largest graph in terms of vertices satisfying given degree and diameter constraints. The largest possible graphs that can exist and that are subject to degree and diameter constraints are called Moore graphs. Since Moore graphs are rare, researchers are eager to build graphs closer to Moore graphs. This paper discusses the possibility of constructing graphs closer to Moore graphs, keeping a fixed order and minimizing the number of vertex pairs that break the diameter constraint, and suggests a new general relative index that measures the closeness to optimality. Based on the proposed index, it is highlighted that some of the graphs constructed in this work are closer to Moore graphs than the existing best results in the degree diameter problem. Furthermore, a fitness landscape analysis is conducted to identify the nature and the difficulty of the problem. This new method can be considered a new approach to constructing graphs closer to Moore graphs.