Biochemical characterization of bioinspired nanosuspensions from Swertia chirayita extract and their therapeutic effects through nanotechnology approach

Swertia chirayita is used as a traditional medicinal plant due to its pharmacological activities, including antioxidant, antidiabetic, antimicrobial, and cytotoxic. This study was aimed to evaluate the therapeutic efficacy of newly synthesized nanosuspensions from Swertia chirayita through nanotechnology for enhanced bioactivities. Biochemical characterization was carried out through spectroscopic analyses of HPLC and FTIR. Results revealed that extract contained higher TPCs (569.6 ± 7.8 mg GAE/100 g)) and TFCs (368.5 ± 9.39 mg CE/100 g) than S. chirayita nanosuspension, TPCs (500.6 ± 7.8 500.6 ± 7.8 mg GAE/100 g) and TFCs (229.5± 3.85 mg CE/100 g). Antioxidant activity was evaluated through DPPH scavenging assay, and nanosuspension exhibited a lower DPPH free radical scavenging potential (06 ±3.61) than extract (28.9± 3.85). Anti-dabetic potential was assessed throughα-amylase inhibition and anti-glycation assays. Extract showed higher (41.4%) antiglycation potential than 35.85% nanosuspension and 19.5% α-amylase inhibitory potential than 5% nanosuspension. Biofilm inhibition activity against E. coli was higher in nanosuspension (69.12%) than extract (62.08%). The extract showed high cytotoxicity potential (51.86%) than nanosuspension (33.63%). These nanosuspensions possessed enhanced bioactivities for therapeutic applications could be explored further for the development of new drugs.

THE ROLE OF DISTAL LOCKING IN INTRAMEDULLARY NAILS FOR HIP FRACTURE FIXATION: A REVIEW OF CURRENT LITERATURE

Traditionally, it was believed that both proximal and distal locking are essential for achieving stability during intra-medullary fixation for extra-capsular hip fractures. However, recent literature has presented varying perspectives on the necessity of distal locking. Distal locking plays a significant role in managing hip fractures with uncertainties regarding longitudinal and rotational stability. This includes cases of comminuted intertrochanteric fractures with subtrochanteric extension, reverse oblique and high oblique fractures, broad medullary canals, comminution of the lateral wall, diaphyseal fractures, and large posteromedial fragments extending below the level of the lesser trochanter. In stable pertrochanteric fractures, with the lag screw passing through the lateral cortex of the distal fragment, may not require a distal locking screw. Distal locking has been associated with potential complications, including irritation of the fascia lata, prolonged operation time, increased radiation exposure, greater blood loss, implant loosening, secondary femoral stress fractures, and damage to the femoral artery. Thus, although distal locking is of doubtful significance in stable pertrochanteric fractures it is essential in unstable fracture patterns.

CURRENT CONCEPTS IN THE MANAGEMENT OF BOXER'S FRACTURE

Fractures of the metacarpal particularly the 5th metacarpal is quite common among all hand fractures and has a high incidence in male adult population. Proper management of these fractures plays a key role in rehabilitation and early return to work thus reducing the economic burden. Treatment of these injuries depends on the type of injury: whether it is a closed/open fracture, degree of angulation at the fracture site and also mal-rotation and shortening of the finger. Non-operative management is suitable for fractures which are closed, non-displaced and without angulation or rotation. Open fractures, fractures with angulation and/or mal-rotation and fractures with neuro-vascular injury are more suitable for operative management. The acceptable angulation for conservative management for most studies is 70 degrees. Buddy strapping with a Futura splint provides good functional results. In fractures requiring operative intervention, K-wire fixation is a minimally invasive method of fixation, which in most cases has good functional results. Plate and screw fixation, however, is preferred for cases with significant comminution or multiple metacarpal fractures.

Ethnomedicinal uses of plants for various diseases in the remote areas of Changa Manga Forest, Pakistan

Abstract This study aims at reporting the indigenous knowledge of the medicinal flora from the inhabitants of surroundings of the World’s largest artificial planted forest “Changa Manga”, Pakistan. Data were collected by direct interviews and group meetings from 81 inhabitants including 32 local healers having information regarding the use of indigenous medicinal plants over a period of one year. Different statistical tools were applied to analyze the data including Frequency citation (FC), Relative frequency citation (RFC), Use Value, Factor of informants consensus and fidelity level. This study reported 73 plant species belonging to 37 plant families and 46 genera. The majority of plant species belong to compositae family. The most commonly used medicinal plants were P. hysterophorus L., P. dactylifera L., S. indicum L, P. harmala L., P. emblica L., and A. indica A.Juss. The greatest number of species was used to cure gastrointestinal disorders. The highest fidelity level (68.18%) was of E. helioscopia to cure gastrointestinal disorders. Maximum fresh uses (17) were reported by C. dactylon (L.) Pars. While the highest number of species reporting fresh uses in similar number was 13. In this study, five novel plants are being reported for the first time in Pakistan for their ethnomedicinal worth. Our data reflect unique usage of the medicinal plants in the study area. The statistical tools used in the study proved useful in pointing the most important and disease category specific plants. High use value plant and the new reported medicinal plants might prove an important source of the isolation of pharmacologically active compounds.

An Insight into Biochemical Characterization and Explorations of Antioxidant, Antibacterial, Cytotoxic, and Antidiabetic Activities by Trachyspermum ammi Nanosuspensions

BACKGROUND

Trachyspermum ammi is a frequently utilized traditional medicinal plant renowned for its pharmacological attributes, particularly in the realm of treating infectious diseases. This current study aims to comprehensively assess the in vitro properties of freshly prepared nanosuspensions derived from Trachyspermum ammi extracts, with a focus on their cost-effective potential in various areas, including antioxidant, antibacterial, cytotoxic, and antidiabetic activities.

METHODS

Biochemical characterization of T. ammi nanosuspensions by high-performance liquid chromatography (HPLC) and Fourier-transform infrared spectroscopy (FTIR) analyses.

RESULTS

HPLC analysis revealed the presence of kaempferol and sinapic acid in various amounts at 11.5 ppm and 12.3 ppm, respectively. FTIR analysis of T. ammi powder revealed the presence of alcohols and amines. The assessment of antioxidant activity was conducted using a DPPH scavenging assay, indicating that the nanosuspensions exhibited their highest free radical scavenging activity, reaching 14.9%. Nanosuspensions showed 3.75 ± 3.529.5% biofilm inhibition activity against Escherichia coli. The antidiabetic activity was accessed through antiglycation and α- amylase inhibition assays, while nanosuspension showed the maximum inhibition activity at 25.35 ± 0.912133% and 34.6 ± 1.3675%. Hemolytic activity was also evaluated, and T. ammi nanosuspension showed 22.73 ± 1.539% hemolysis.

CONCLUSIONS

This nanotechnology approach has established a foundation to produce plant-based nanosuspensions, offering a promising avenue for the biopharmaceutical production of herbal nanomedicines. These nanosuspensions have the potential to enhance bioavailability and can serve as a viable alternative to synthetic formulations.

Unlocking integrated waste biorefinery approach by predicting calorific value of waste biomass

The current study analyzed the high heating values (HHVs) of various waste biomass materials intending to the effective management and more sustainable consumption of waste as clean energy source. Various biomass waste samples including date leaves, date branches, coconut leaves, grass, cooked macaroni, salad, fruit and vegetable peels, vegetable scraps, cooked food waste, paper waste, tea waste, and cardboard were characterized for proximate analysis. The results revealed that all the waste biomass were rich in organic matter (OM). The total OM for all waste biomass ranged from 79.39% to 98.17%. Likewise, the results showed that all the waste biomass resulted in lower ash content and high fixed carbon content associated with high fuel quality. Based on proximate analysis, various empirical equations (HHV=28.296-0.2887(A)-656.2/VM, HHV=18.297-0.4128(A)+35.8/FC and HHV=22.3418-0.1136(FC)-0.3983(A)) have been tested to predict HHVs. It was observed that the heterogeneous nature of various biomass waste considerably affects the HHVs and hence has different fuel characteristics. Similarly, the HHVs of waste biomass were also determined experimentally using the bomb calorimeter, and it was observed that among all the selected waste biomass, the highest HHVs (21.19 MJ kg-1) resulted in cooked food waste followed by cooked macaroni (20.25 MJ kg-1). The comparison revealed that experimental HHVs for the selected waste biomass were slightly deviated from the predicted HHVs. Based on HHVs, various thermochemical and biochemical technologies were critically overviewed to assess the suitability of waste biomass to energy products. It has been emphasized that valorizing waste-to-energy technologies provides the dual benefits of sustainable management and production of cleaner energy to reduce fossil fuels dependency. However, the key bottleneck in commercializing waste-to-energy systems requires proper waste collection, sorting, and continuous feedstock supply. Moreover, related stakeholders should be involved in designing and executing the decision-making process to facilitate the global recognition of waste biorefinery concept.

Hippocampus shapes cortical sensory output and novelty coding through a direct feedback circuit

To extract behaviorally relevant information from our surroundings, our brains constantly integrate and compare incoming sensory information with those stored as memories. Cortico-hippocampal interactions could mediate such interplay between sensory processing and memory recall1-4 but this remains to be demonstrated. Recent work parsing entorhinal cortex-to-hippocampus circuitry show its role in episodic memory formation5-7 and spatial navigation8. However, the organization and function of the hippocampus-to-cortex back-projection circuit remains uncharted. We combined circuit mapping, physiology and behavior with optogenetic manipulations, and computational modeling to reveal how hippocampal feedback modulates cortical sensory activity and behavioral output. Here we show a new direct hippocampal projection to entorhinal cortex layer 2/3, the very layer that projects multisensory input to the hippocampus. Our finding challenges the canonical cortico-hippocampal circuit model where hippocampal feedback only reaches entorhinal cortex layer 2/3 indirectly via layer 5. This direct hippocampal input integrates with cortical sensory inputs in layer 2/3 neurons to drive their plasticity and spike output, and provides an important novelty signal during behavior for coding objects and their locations. Through the sensory-memory feedback loop, hippocampus can update real-time cortical sensory processing, efficiently and iteratively, thereby imparting the salient context for adaptive learned behaviors with new experiences.

Biochemical, structural characterization and in-vitro evaluation of antioxidant, antibacterial, cytotoxic, and antidiabetic activities of nanosuspensions of Cinnamomum zeylanicum bark extract

Cinnamomum zeylanicum is a traditional medicinal plant known for its anti-inflammatory, antidiabetic, antimicrobial, anticancer, and antioxidant properties. Its therapeutic efficacy using nanosuspensions is still unclear for treating infectious diseases. This study was designed to evaluate the bioactivities, biochemical characterization, and bioavailability of freshly prepared nanosuspensions of C. zeylanicum. Structural and biochemical characterization of C. zeylanicum and its biological activities, such as antioxidants, antimicrobials, antiglycation, α-amylase inhibition, and cytotoxicity was performed using Fourier-transform infrared (FTIR) spectroscopy and High-Performance Liquid Chromatography (HPLC). C. zeylanicum extract and nanosuspensions showed TPCs values of 341.88 and 39.51 mg GAE/100 g while showing TFCs as 429.19 and 239.26 mg CE/100g, respectively. DPPH inhibition potential of C. zeylanicum extract and nanosuspension was 27.3% and 10.6%, respectively. Biofilm inhibition activity revealed that bark extract and nanosuspension showed excessive growth restraint against Escherichia coli, reaching 67.11% and 66.09%, respectively. The α-amylase inhibition assay of extract and nanosuspension was 39.3% and 6.3%, while the antiglycation activity of nanosuspension and extract was 42.14% and 53.76%, respectively. Extracts and nanosuspensions showed maximum hemolysis at 54.78% and 19.89%, respectively. Results indicated that nanosuspensions possessed antidiabetic, antimicrobial, anticancer, and antioxidant properties. Further study, however, is needed to assess the clinical studies for the therapeutic use of nanosuspensions.

Comparative Study of Antioxidant, Antidiabetic, Cytotoxic Potentials, and Phytochemicals of Fenugreek (Trigonella foenum-graecum) and Ginger (Zingiber officinale)

Trigonella foenum-graecum and Zingiber officinale are used as traditional medicinal plants for the treatment of infectious and inflammatory diseases. However, a comparative analysis and bioactivities of T. foenum-graecum and Z. officinale lack some necessary information for therapeutic purposes. This study was designed to evaluate the biochemical characterizations and biological efficacy of T. foenum-graecum and Z. officinale as antioxidant, antidiabetic, antiamnesic, and cytotoxic agents. Antioxidant activity was determined by DPPH free radical scavenging assay. Antidiabetic potentials were evaluated by glycation, alpha-amylase, and acetylcholinesterase inhibition assays. We performed biochemical characterization through analyses of high-performance liquid chromatography (HPLC) and FTIR (Fourier transform infrared spectroscopy). Results revealed that total phenolic contents (TPCs) (g GAE/100 g) of T. foenum-graecum and Z. officinale were 5.74 ± 0.81 g and 6.15 ± 0.06 g, respectively, and total flavonoid contents (TFCs) varied from 1.51 ± 0.58 g CE/100 g to 17.54 ± 0.58. DPPH scavenging potentials of T. foenum-graecum and Z. officinale extract were 50.27% and 88.82%, respectively. Antiglycation potentials of T. foenum-graecum and Z. officinale showed a maximum activity at 16–29% and 96%. Alpha-amylase and alpha-glucosidase inhibition ranged from 9.43–24.95 and 10.52–27.89 and 54.97%, respectively. All the test samples of T. foenum-graecum and Z. officinale showed acetylcholinesterase inhibition potential at 0.37–46.88%. HPLC analysis of T. foenum-graecum revealed the presence of quercetin, gallic acid, caffeic acid, vanillic acid, syringic acid, and cumeric acid, while Z. officinale revealed the quercetin, gallic acid, vanillic acid, benzoic acid, chlorogenic acid, p.Coumaric acid, ferulic acid, and cinnamic acid. FTIR analysis revealed the presence of aldehydes, ketones, aromatic compounds, amines, and carbonyl groups in T. foenum-graecum, while alcohol, alkane, alkene, ketone, amine, and ether are bioactives present in the methanolic extract of Z. officinale. It was concluded that a comparative analysis of T. foenum-graecum and Z. officinale showed that Z. officinale showed higher therapeutic effects.

The role of mitochondria and mitophagy in cell senescence

Mitochondrial malfunction and cell senescence have been defined as the hallmarks of aging. Cell senescence leads to the loss of health allied with aging. While deciphering the complex association between mitochondria and cellular senescence, it is observed that senescence has a two-faced nature being beneficial and hazardous. This duality of cellular senescence is associated with circumstantial aspects. During the process of cellular senescence, dysfunctional mitochondria are accumulated, the efficiency of the oxidative phosphorylation process declines along with the enhanced synthesis of reactive oxygen species. It is suggested that reduction in the negative consequences of senescence throughout old age might be accomplished by targeting the mitochondria as all roads lead towards mitochondria. It is unclear how perturbation of mitophagy in senescence results in the accumulation of mitochondria, impairment of mitochondrial biogenesis and onset of diseases. Understanding this complex interplay will bring about a long yet healthy lifespan. But definitely casual and specific players contribute in the initiation and conservation of the cell senescence. Variations in metabolism, quality control and dynamics of mitochondria are observed during cell aging process. Several On-target and Off-target mechanisms can also cause side effects in cellular senescence. Translational research of these mechanisms may lead to effective clinical interventions. This chapter reviews the role of mitochondria, homeostatic mechanisms and mitophagy as drivers and effectors of cell senescence along with multiple signalling pathways that lead to the initiation, maintenance, induction and suppression of cellular aging process during health and disease.

Nanotechnology approach for exploring the enhanced bioactivities, biochemical characterisation and phytochemistry of freshly prepared Mentha arvensis L. nanosuspensions

INTRODUCTION

Mentha arvensis L. is the most valuable medicinal plant that possesses anti-inflammatory, hepatoprotective, antimicrobial, and antioxidant properties. There are few studies available in the literature about M. arvensis L nanoparticles, but their nanosuspensions-based information remains unclear and needs further study.

OBJECTIVE

This study was designed to explore the nanotechnology approach for biochemical characterisation, enhanced bioactivities, and photochemistry of freshly prepared M. arvensis L. nanosuspensions.

METHODOLOGY

Nanosuspensions of M. arvensis L. leaves were prepared by following the nanoprecipitation method. In this study, we performed structural and biochemical characterisation through analyses of Fourier-transform infrared (FTIR) spectroscopy, high-performance liquid chromatography (HPLC), phase contrast microscopy and enhanced bioactivities; antioxidant, alpha-amylase inhibition, glycation inhibition and cytotoxicity assays.

RESULTS

FTIR analysis revealed the presence of phenols, amines hydroxyl, carboxylic acid, alkenes, alkenes and alkynes. HPLC analysis revealed the presence of chlorogenic acid, a principal phenolic component. Biofilm inhibition activity revealed that the growth formation of Escherichia coli inhibited up to 62.4% and 53.35% by leaves extract and nanosuspension, respectively. However, the growth of Staphylococcus aureus was not inhibited by nanosuspension and extract. Nanosuspension and extract exhibited 155.92 mg, 108.11 mg gallic acids per 100 g of dry weight total phenolic content and 233.44 mg, 163.933 mg catechin per 100 g of dried weight total flavonoid content in extract and nanosuspension, respectively. Antioxidant activity revealed the scavenging potential of nanosuspensions and extract was 41.01% and 12.07%, respectively. Alpha-amylase inhibiting activity of nanosuspension and extract was 36% and 33%, while, the antiglycation potential of nanosuspension and extract were 41.68% and 35.18%, respectively. Nanosuspensions and extract showed maximum hemolytic activity at 12.91% and 17.18%, respectively.

CONCLUSION

These cost-effective nanoformulations could serve as a platform for therapeutic purposes in controlling the high risk of infectious diseases and designing efficient plant nanosuspensions by discovering novel bioactive compounds in an adequate manner.

Malignant Dural Solitary Fibrous Tumor; An Exceedingly Rare Entity

Introduction/Objective

A solitary fibrous tumor (SFT) is an extremely rare mesenchymal neoplasm, accounting for <1% of all primary CNS tumors. Most SFT is dural-based and occurs predominantly in the fourth to sixth decade of life. Here, we present a case of a dural solitary fibrous tumor.

Methods/Case Report

A 28-year-old male presented with intermittent throbbing headache, nausea, and vomiting. Imaging revealed a large, well-circumscribed left parafalcine, dural-based multilobulated, solid, and cystic mass. The patient underwent craniotomy with mass resection. Preliminary intraoperative findings were of a spindle cell neoplasm. Histopathologic examination showed hypercellular neoplasm composed of the spindle to ovoid cells with a high nuclear to cytoplasmic ratio and limited intervening stroma arranged in a haphazard pattern with prominent branching staghorn vasculature. Focal areas of necrosis and mitotic counts of 8/10 high power field were also seen. The lesional cells showed focal cytoplasmic CD34 expression and strong STAT6 nuclear expression. Finally, a diagnosis of SFT, haemangiopericytoma phenotype classified as grade 3, was made.

Results (if a Case Study enter NA)

NA

Conclusion

Most SFTs are considered clinically benign (grade 1 tumors) with favorable outcomes after complete resection. However, haemangiopericytoma phenotype with hypercellularity, necrosis, and elevated mitotic count (> 4/10 HPF) is known to have an increased risk of local recurrence and rare metastasis, requiring patients to receive adjuvant radiotherapy after resection for longer progression-free survival. Therefore, it is vital to be aware of this entity for optimal management and more active systemic surveillance in patients with high-grade SFT tumors. Our patient is currently doing well post-adjuvant radiotherapy and is under active annual surveillance.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Enzyme Inhibitory and Mutagenicity Guided Investigation of Selected Medicinal Plants in Different Solvents

Abstract. Plants have developed the foundation of traditional systems of medicine that have been in existence for thousands of years due to the presence of vital bioactive constitutes. Aside from antioxidant, antimicrobial, hypoglycemic, anticarcinogenic and numerous activities of natural products, limited recognition regarding diverse therapeutic attributes of medicinal plants such as Momordica charantia, Syzygium cumini, Zingiber officinale and Parthenium hysterophorus exist. The current study was designed to explore the enzyme inhibitory (alpha glucosidase and acetylcholinesterase) and cytotoxicity capacities of solvent fractions of these indigenous plants. All the samples had inhibitory effects on alpha glucosidase, but methanolic fractionations of each plant exhibited greater inhibitory efficacy against enzyme action compared to other fractionations. Except for the methanolic extract of Parthenium hysterophorus (33.25 ± 0.43), all other studied plants, viz. Zingiber officinale (50.33 ± 0.99), S. cumini (73.91 ± 1.05) and Momordica charantia (72.30 ± 1.17) indicated more than 50% alpha glucosidase inhibitory potentials. Acetylcholinesterase inhibitions (percentage inhibition) by different fractions of P. hysterophorus, Z. officinale, S. cumini and M. charantia were in the range of 0.23 ± 0.14 to 11.40 ± 0.26, 13.04 ± 0.11 to 44.05 ± 0.76, 4.21 ± 0.15 to 71.55 ± 0.80 and 1.03 ± 0.09 to 50.12 ± 0.82 respectively. Among all studied plants, Momordica charantia, Syzygium cumini, and Zingiber officinale were non-mutagenic. Although slight variation in bioactivities was observed, all the botanical extracts are excellent sources of bioactive constituents with the potential to inhibit alpha glucosidase and acetylcholinesterase. Further research in this regard is warranted involving bioassay-guided assessment.   Resumen. Las plantas han desarrollado la base de los sistemas tradicionales de medicina que existen desde hace miles de años debido a la presencia de constituyentes bioactivos vitales. Además de las numerosas actividades antioxidantes, antimicrobianas, hipoglucemiantes, anticancerígenas y de los productos naturales, existe un reconocimiento limitado con respecto a los diversos atributos terapéuticos de las plantas medicinales como Momordica charantia, Syzygium cumini, Zingiber officinale y Parthenium hysterophorus. El estudio actual fue diseñado para explorar las capacidades inhibidoras de enzimas (alfa glucosidasa y acetilcolinesterasa) y citotóxicas de las fracciones solventes de estas plantas autóctonas. Todas las muestras tuvieron efectos inhibidores sobre la alfa glucosidasa, pero los fraccionamientos metanólicos de cada planta exhibieron una mayor eficacia inhibidora contra la acción enzimática en comparación con otros fraccionamientos. A excepción del extracto metanólico de Parthenium hysterophorus (33,25 ± 0,43), todas las demás plantas estudiadas, a saber. Zingiber officinale (50,33 ± 0,99), S. cumini (73,91 ± 1,05) y Momordica charantia (72,30 ± 1,17) indicaron más del 50 % de potenciales inhibidores de la alfa glucosidasa. Las inhibiciones de acetilcolinesterasa (porcentaje de inhibición) por diferentes fracciones de P. hysterophorus, Z. officinale, S. cumini y M. charantia estuvieron en el rango de 0,23 ± 0,14 a 11,40 ± 0,26, 13,04 ± 0,11 a 44,05 ± 0,76, 4,21 ± 0,15 a 71,55 ± 0,80 y 1,03 ± 0,09 a 50,12 ± 0,82 respectivamente. Entre todas las plantas estudiadas, Momordica charantia, Syzygium cumini y Zingiber officinale no fueron mutagénicas. Aunque se observó una ligera variación en las bioactividades, todos los extractos botánicos son excelentes fuentes de constituyentes bioactivos con el potencial de inhibir la alfa glucosidasa y la acetilcolinesterasa. Se justifica una mayor investigación a este respecto que involucre una evaluación guiada por bioensayo.

In vitro and in vivo study of inhibitory potentials of α-glucosidase and acetylcholinesterase and biochemical profiling of M. charantia in alloxan-induced diabetic rat models

OBJECTIVES

Diabetes mellitus is a multifactorial chronic disease that affects the human population and it is the third most common cause of death worldwide. Momordica charantia is used as popular folk medicine and its action against diabetes mellitus remains unclear. We investigated the inhibitory potentials of α-glucosidase, acetylcholinesterase, and biochemical profiling of M. charantia in alloxan-induced diabetic rat models.

METHODS

An In vivo study was carried out by using twenty male albino Wistar rats randomly divided into five groups each comprising four rats. Diabetes mellitus was induced by single intraperitoneal administration of 80 mg/kg body weight of alloxan and treatment with plant extract was conducted for a period of thirty days to check their impact on body weight and differentblood values. Biochemical profiling and characterization were performed by in vitro assays and HPLC, and FTIR. Histopathologic effects of M. charantia were examined through automated image analysis. Results were analyzed through Tukey's test, a complete randomized design and two factorial designs under CRD.

RESULTS

Methanolic extract demonstrated potent alpha-glucosidase (72.30 ± 1.17%) and acetylcholinesterase (50.12 ± 0.82%) inhibitory activities. HPLC analysis confirmed the existence of vital flavonoids, antioxidants, and saponins. FTIR revealed the presence of hydroxyl groups, esters, alkanes, alkenes, alkynes, ketones, alcohols, amines and carboxylic acids as major functional groups. Results of in vivo study demonstrated that co-administration of alloxan and methanolic extract of M. charantia significantly improved the levels of fasting blood glucose, glycated hemoglobin and insulin in diabetic rats.

CONCLUSION

M. charantia can be recommended as a therapeutic adjunct for diabetic patients as it can provide favorable remedial action in the context of the diabetes continuum of metabolic syndrome.

Isolation and In Silico Characterization of Defensin Genes from Some Indigenous Plant Species of Pakistan

Aims: Damage of crop plants due to pathogenic attacks, postharvest crops spoilage and lethal effects of chemical pesticides has enforced scientists to find some potential natural alternative. Plants produce different types of antimicrobial peptides including defensins in response to biotic and abiotic stresses. Defensins are small cysteine rich, cationic peptide with 40-45 amino acid residues with a variety of biological activities. Hence defensins have pharmaceutical and agricultural significance especially wide range of antifungal activities. Methodology: Nine plant species viz Brassica napus, Brassica nigra, Conyza bonariensis, Alhagi marorum, Sonchus arvensis, Brassica compestris, Eruca sativa, Cirsium arvensis and Brassica juncea were selected for the study. Four set of primers were applied on extracted genomic DNAs and four amplified genes were isolated from different plants species by PCR. The amplified genes were cloned via pTZ57R/T in E.coli. The cloned fragments were sequenced and characterized by different bioinformatics tool such as coding length and peptide sequence, site of cell aggregation, peptide physico-chemical properties, antimicrobial properties and gene expression pattern. Result: The amplified products from B. napus, B. nigra, B. compestris, E. sativa and B. juncea were about 330 bp in length and showed upto 85% nucleotide homology to the reported defensins. Deduced amino acid sequence from Bn-Def, Es-Def Bj-Def and Bc- Def showed the conserved defensin domain. These sequences were also characterized for different characteristic like charged amino acids, pI value, shelflife and stability.  Sonchus arvensis didn’t give any specific product by prescribed set of primers. However the products from Alhagi marorum was about 770 bp and B. napus was of 270 bp but both give homology below 30%. Conclusion: This study showed that in silico characterization of deduced antimicrobial peptides from different plant species has depicted these as an effective alternative to communal therapeutics. However, further work is needed to verify defensins specific activity at protein level.

Nanotechnology Approach for Exploring the Enhanced Bioactivities and Biochemical Characterization of Freshly Prepared Nigella sativa L. Nanosuspensions and Their Phytochemical Profile

Nigella sativa is one of the most commonly used medicinal plants as it exhibits several pharmacological activities such as antioxidant, antibacterial, anticancer, antidiabetic, and hemolytic. The purpose of this study was to apply the nanotechnology approach for exploring the enhanced bioactivities of freshly prepared Nigella sativa L. nanosuspensions and the phytochemical profile of N. sativa seed ethanolic extract. In this study, we performed the biochemical characterization of Nigella sativa L. ethanolic extract through High-performance liquid chromatography (HPLC), Fourier-transform infrared spectroscopy (FT-IR), and Gas chromatography (GC), and bioactivities in terms of antioxidant, antidiabetic, antibacterial, and hemolytic activities of nanosuspension and extract were competitively studied. The results revealed that the nanosuspension of N. sativa seeds showed higher total phenolic (478.63 ± 5.00 mg GAE/100 g) and total flavonoid contents (192.23 ± 1.390 mg CE/100 g) than the ethanolic seed extract. The antioxidant activity was performed using the DPPH scavenging assay, and nanosuspension showed higher potential (16.74 ± 1.88%) than the extract. The antidiabetic activity was performed using antiglycation and α-amylase inhibition assays, nanosuspension showed higher antidiabetic potential [antiglycation (58 ± 0.912%)] and [bacterial α-amylase inhibition (18.0 ± 1.3675%)], respectively. Nanosuspension showed higher biofilm inhibition activity against Escherichia coli (66.44 ± 3.529%) than the extract (44.96 ± 2.238%) and ciprofloxacin (59.39 ± 3.013%). Hemolytic activity was performed and nanosuspension showed higher hemolytic activity than the extract as 7.8 ± 0.1% and 6.5 ± 0.3%, respectively. The study showed that nanosuspension had enhanced the bioavailability of bioactive plant compounds as compared to the ethanolic extract. Therefore, nanosuspension of N. sativa seed extract showed higher biochemical activities as compared to the ethanolic extract. This nanotechnology approach can be used as a platform for the development of combination protocols for the characterization of liquid state nanosuspensions in an adequate manner and also for therapeutic applications.

Ultrasound Assisted Extraction and Characterization of Bioactives From Verbascum thapsus Roots to Evaluate Their Antioxidant and Medicinal Potential

Worldwide, Verbascum thapsus is used for the treatment of various ailments owing to the presence of bioactives of therapeutic potential. Current study was planned to extract bioactives from V thapsus roots using methanol and water as solvents under stimulated effect of ultrasonic waves and characterize them to evaluate their potential benefits. Proximate analysis explored the presence of significant contents of protein, fats, fiber, organic and inorganic minerals. Fourier transform infrared spectra and high-performance liquid chromatography chromatogram indicated the presence of different phytochemicals having antioxidant potential as evidenced by total phenolic contents, total flavonoids content and 2,2-diphenyl-1-picrylhydrazyl activity of both extracts. Both extracts displayed excellent antimicrobial potential against Staphylococcus aureus (S aureus) and Fusarium Solani (F solani). Aqueous and methanolic extracts exhibited higher inhibition of biofilm made by Bacillus subtilis (B subtilis) as 55.09 and 61.58%, respectively in comparison to biofilm of Escherichia coli ( E coli) as 48.11 and 36.51%, respectively. Methanol extract exhibited anti-amylase activity (IC50 5.26 ± .31 μg/mL) with an inhibition rate of 68.11% whereas IC50 of aqueous extract was 6.59 ± .53 μg/mL with an inhibition rate of 63.53%. Inhibitory potential against α-glucosidase (IC50 3.70 ± .94 ppm) was demonstrated by methanol extract in comparison to aqueous extract (IC50 7.58 ± .15). The study concluded that V thapsus roots have significant medicinal potential due to the presence of variety of bioactive molecules and can be used in pharmaceutical preparations.

Exopolysaccharides production from marine Bacillus strains and their antioxidant and bio-flocculant capacities

Microbial exopolysaccharides (EPS) have gained high scientific concern due to their exceptional physicochemical features and high industrial applicability. Owing to their biotechnological importance, the present study was designed to screen and isolate the EPS-producing Bacillus strains based on their growth potential on specific media and colony morphologies. The bacterial isolates Bacillus subtilis Bs1-01, Bacillus licheniformis Bl1-02, and Bacillus brevis Bb1-04 showed excellent EPS production due to their shortened lag phase and abundant biomass production. Shake-flask fermentation valued the maximum production yield of 50.19 ± 1.14 g/L by Bl1-02 after 72 h incubation (about 3.40 times higher than that of Bacillus thuringiensis Bt1-05). The basic component analysis revealed the improved amount of total carbohydrate, reducing sugar ends, and protein contents by Bl1-02 strain. Structural characteristics and functional groups of the EPS characterized by Fourier transform infrared spectroscopy demonstrated that all EPS were in close agreement to each other due to the presence of similar chemical bonds and functional groups. EPS from Bl1-02 strain showed stronger and more stable bio-emulsifying and hygroscopicity activities (12.23%). The crude EPS exhibited potent antioxidant properties which were examined against reducing potential (H₂O₂ scavenging) and total antioxidant tests. Among bio-flocculation activities of EPS at different concentrations, Bs1-01 strain produced EPS at a concentration of 60 mg/mL was observed to show the maximum value of 79.20%. In conclusion, the EPS from marine Bacillus strains showed excellent functional properties suggesting potential industrial applications that demand separate investigations.

Comparative Analysis of Nutritional and Antioxidant Characteristics of Different Pakistani and Exotic Almonds

Health boosting potential of almonds is attributed to its antioxidant potential and rich nutritional profile containing a blend of multifarious nutrients and phytochemicals. These traits considerably vary amongst different genotypes and varieties. Hence, current research was planned to explore the basic nutritional composition and antioxidant potential of four different almond genotypes i.e. Patasa & Talwar (Pakistani) and Abdul Wahidi & Katha (Afghani). Amongst, Talwar and Abdul Wahidi showed better nutritional profile followed by Patasa and Katha. Proximate analysis revealed higher quantities of oil in Talwar and Abdul Wahidi i.e. 51.12±0.97 and 50.64±0.86%, respectively. Katha contained higher ash contents. Likewise, Abdul Wahidi and Talwar were also high in fiber content as 13.11±0.39 and 12.45±0.37, correspondingly. Substantial amount of protein was quantified in Abdul Wahidi. Talwar almonds were proved as a good source of potassium and magnesium, 14.02±1.12 mg/g and 3.10±0.24 mg/g, respectively. Likewise, Abdul Wahidi contained higher amount of phosphorous, 9.17±1.10 mg/g. However, Patasa were high in calcium. High performance liquid chromatography (HPLC) based quantification showed that vitamin-E (α-tocopherol) was highest in Patasa trailed by Abdul Wahidi and Talwar. However, Katha almonds were low in vitamin-E. In vitro analysis exhibited Talwar and Abdul Wahidi with the highest flavonoids contents. Whereas, Patasa and Abdul Wahidi almonds had promising amounts of total phenolics. Antioxidant assays (DPPH and ABTS) explicated better radical scavenging activity by Talwar and Abdul Wahidi almonds whilst Katha almonds showed better performance for FRAP assay.

Placental Mesenchymal Dysplasia, An Exceedingly Rare Entity and Challenging Diagnosis

Introduction/Objective

Placental mesenchymal dysplasia (PMD) is an extremely rare entity with an incidence of only 0.02/1000 deliveries.

Methods/Case Report

We present a case of a 26 year-old female Gravida 3, Para 1 with intrauterine pregnancy at 37 weeks of gestation. Fetal ultrasound showed mildly cystic upper portion of the placenta. The noninvasive prenatal testing was negative for triploidy. A viable healthy female infant was delivered with no maternal complications.

On gross examination, placenta was heavy with approximately 25% incomplete cotyledons. Placental maternal surface showed, spongiform cut surfaces admixed with multiple cystic structures ranging in size from 0.5 to 1.5 cm and markedly dilated blood vessels.

Histopathologic examination revealed markedly enlarged villi, mesenchymal hyperplasia, and hyper vascularity of small vessels. No trophoblast proliferation was identified. Subsequently, the diagnosis of PMD was made.

Results (if a Case Study enter NA)

NA

Conclusion

PMD is a rare anomaly which is characterized by placentomegaly and grape like vesicles resembling molar pregnancy. Etiologies include imbalance of paternal and maternal alleles, androgenetic and bi-parental mosaicism, and Beckwith Weidman Syndrome (BWS). Differential diagnosis includes partial molar pregnancy, complete mole with co-existing normal fetus, hemangioma, subchorionic hematoma, confined placental mosaicism and hydropic complications. Histologic features, ancillary studies including immunohistochemistry and genetic testing are helpful in differentiating PMD. PMD is an underdiagnosed entity with increased risk of premature delivery and intrauterine fetal death. It is pertinent for the clinicians to be aware of this entity for optimal patient management.

Duodenal Duplication Cyst in adult male; An Extremely Rare Entity and a Diagnostic Pitfall leading to Whipple procedure

Introduction/Objective

Whipple procedure is a complex, invasive operation and has high morbidity and mortality. It is the most commonly indicated treatment for treating malignant tumors, however, it can be also used for benign entities as well including biliary stricture, chronic pancreatitis, choledochal cyst, inflammatory pseudotumour, and duodenal angiodysplasia.

Methods/Case Report

We report a case of a 50-year-old man who presented with symptoms of gastric outlet obstruction. Esophagogastroduodenoscopy and CT scan showed an obstruction at the level of the second part of the duodenum with proximal dilation. Subsequently, a Whipple procedure was performed based on high clinical suspicion of duodenal cancer. Gross examination revealed a unilocular thick walled cyst (4.2 cm) in the duodenum. Histopathologic examination showed a cyst lined by duodenal mucosa with thick smooth muscle wall and focal ectopic gastric tissue. This was finally diagnosed as a duodenal cyst consistent with duplication cyst.

Results (if a Case Study enter NA)

NA

Conclusion

Duplication cysts are rare congenital abnormality predominantly diagnosed in infancy and childhood. They are most commonly located in the distal ileum, followed by the esophagus and ileocecal region, and are extremely rare in duodenum. Differential diagnosis includes choledochocele, pancreatic pseudocyst, and cystic tumors of the pancreas, mesenteric cysts, and duodenal diverticulums. Treatment options include total excision, cystojejunostomy, and endoscopic marsupialization but occasionally may lead to more invasive measures such as the Whipple procedure. Although duodenal duplication cysts can have variable clinical presentation and radiological findings, making preoperative diagnosis very challenging, it is still pertinent to be aware of this entity for the optimal patient care.

Rhabdomyosarcoma in Ovary- Pathologist’s Diagnostic Dilemma

Introduction/Objective

Rhabdomyosarcoma is the most common pediatric soft tissue sarcoma. However, rhabdomyosarcoma in the ovary is exceptionally unusual and presents a diagnostic challenge. We report one such case and its clinical and pathological perspective.

Methods/Case Report

16-year-old female presented with an enlarging pelvic mass, abdominal distension, and pain. Imaging revealed a heterogeneous left ovarian mass, right axillary lymphadenopathy, and right-hand soft tissue mass. CA-125 was 1833.0 U/ml. Patient underwent left salphingo-oophorectomy, omentectomy, peritoneal and mesenteric biopsy for ovarian staging, incidental appendectomy, and right axillary lymph node excision with suspicion of ovarian epithelial tumor. Pathological evaluation revealed a 16-cm intact ovary with multiple solid and cystic nodules with areas of hemorrhage and necrosis. Microscopic examination of ovarian tumor showed a high-grade malignant tumor consisting of sheets of small round blue cells with severe cytologic atypia, increased mitoses, and features suggestive of rhabdoid morphology. The other specimens were positive for metastases. The tumor cells were immunopositive for Myogenin and MyoD1 while immunonegative for Cytokeratin AE1/AE3, SF-1, PLAP, SALL4, MelanA, and S-100. INI-1 and BRG-1 demonstrated intact nuclear expression. FISH testing identified rearrangement of the FOX01 gene at 13q14. Based on these findings, diagnosis of alveolar rhabdomyosarcoma was rendered. Currently, the patient is receiving rhabdomyosarcoma chemotherapy treatment and has responded well.

Results (if a Case Study enter NA)

NA

Conclusion

In cases with complex and urgent clinical presentation, where the existence of a primary tumor is unknown and where symptoms attributable to primary ovarian tumor dominate the clinical picture, rhabdomyosarcoma is rarely proposed in the differential diagnoses of small round blue cell tumors of the ovary. At present, the right-hand mass is under evaluation; thus, the true nature of the ovarian mass, primary or metastatic is unknown. Our case illustrates the importance of exact diagnoses, as treatment of rhabdomyosarcoma, is different from other ovarian tumors.

Probing the Comparative Bioefficacy of Allium sativum L. Bulb through Different Solvents

Abstract. Allium sativum (garlic), an aromatic bulbous plant is one of the most vital and oldest authenticated herbs which has been utilized from ancient times as a traditional medicine. A. sativum has cardioprotective, antimicrobial, anti-inflammatory, antidiabetic, antioxidant and anticancer properties due to a large range of phenolic compounds and sulfur containing compounds. The current study was conducted to assess the antioxidant chemistry, and numerous bioactivities of A. sativum bulbs extracts in different solvents. Ethanol fraction was the most active antioxidant and showed maximum total phenolic content (16.18 g GAE/100 g), total flavonoid content (95.04 g CE/100 g) and free radical scavenging activity (75.50 %). Methanol (4 %) fraction exhibited maximum antiglycation activity. Aqueous, n-hexane and ethyl acetate fractions exhibited maximal (52 %, 24 % and 38 %) inhibitions of alpha-amylase, alpha-glucosidase and acetylcholinesterase respectively. In an antimicrobial assay, ethanol (59.05 %) and chloroform (72.92 %) fractions showed maximum inhibition of Pasturella multocida and Staphylococcus aureus strains respectively. n-butanol and n-hexane fractions showed maximum (31 %) antihemolytic activity and (20 %) thrombolytic activities respectively. A. sativum bulb extracts and fractions have noteworthy bio-efficacies that holds promise to be used as a source of natural drug to cure various disorders.   Resumen. Allium sativum (ajo), una planta bulbosa aromática, es una de las hierbas autenticadas más vitales y antiguas que se han utilizado desde la antigüedad como medicina tradicional. A. sativum tiene propiedades cardioprotectoras, antimicrobianas, anti-inflamatorias, anti-diabéticas, anti-oxidantes y anti-cancerígenas debido a una amplia gama de compuestos fenólicos y compuestos que contienen azufre. El estudio actual se llevó a cabo para evaluar la química antioxidante y numerosas bioactividades de extractos de rizoma de A. sativum en diferentes disolventes. La fracción de etanol tuvo la mayor actividad antioxidante y mostró un contenido fenólico total máximo (16.18 g GAE / 100 g), contenido total de flavonoides (95.04 g CE / 100 g) y actividad captadora de radicales libres (75.50 %). La fracción de metanol (4 %) exhibió la mayor actividad de antiglicación. Las fracciones acuosa, de n-hexano y de acetato de etilo inhibieron la actividad de alfa-amilasa, alfa-glucosidasa y acetilcolinesterasa, en 52 %, 24 % y 38 % respectivamente. En el ensayo antimicrobiano, las fracciones de etanol (59.05 %) y cloroformo (72.92 %) mostraron una inhibición máxima de las cepas de Pasturella multocida y Staphylococcus aureus, respectivamente. Las fracciones de n-butanol y n-hexano mostraron actividad anti-hemolítica (31 %) y trombolítica (20 %) respectivamente. Los extractos y fracciones de rizoma de A. sativum tienen bioeficacia notable con potencial de ser utilizadas como una fuente de fármaco natural para curar diversos trastornos.

Closing the Osteoporotic-Fracture Care Gap for Frail Older Persons

Aim To implement standardised fracture risk assessment in the frail older person. Methods Frail older patients underwent opportunistic screening for fracture risk. Roadblocks to standardised assessment were identified. An Integrated Care Team for older persons (ICT) trained in fracture risk assessment using FRAX. Clinical assessment was via a locally agreed algorithm. Data was entered onto Excel. The SQUIRE guidelines for quality improvement programmes were used to report the results. Results Of 96 patients opportunistically screened, the average age was 84 years. FRAX was completed for 19% (n=18). 89% (n=16) met the pharmacotherapy threshold. Nine were recommended pharmacotherapy. Of sixteen patients recommended for DXA, just 31% (n=5) were booked. Following implementation of a quality improvement project, 100 patients were assessed, and average age was 80 years. FRAX was completed for 62% (n=63) and 95% (n=60) required pharmacotherapy. 24% (n=14) had untreated prior fracture. All had pharmacotherapy prescribed. 59% (n=59) required DXA scanning. 70% (n=41) had DXA ordered. Conclusion ICT ownership increased FRAX assessment 3-fold and point of contact prescribing to 100%.

Traditional knowledge about medicinal plant in the remote areas of Wari Tehsil, Dir Upper, Pakistan

Traditional medicine is cheaper and easily available to local people, to care for most frequent diseases in the Northern parts of Pakistan. Our study aimed at inventorying medicine from local plants, documenting their uses, and assessing their market value in 2015-2018 during spring, summer, and winter seasons. A total of 15 trips were made, 5 in each season. Semi-structured interviews with 165 inhabitant's age range between 20-80 years were conducted, analyzed the data is analyzed using Relative frequency of citation(RFC), Use Value(UV), Fidelity Level(FL), Informants consensus factor(ICF), and Jaccard index(JI) to find the most frequent and well-known used species in the area. A total of 86 species belonging to 39 vascular plant families, 33 genera were documented as medicinally important. Family Asteraceae was observed as the dominant family among all the families with 10 species, the leaf was the most used parts and decoction 36% was the most preferred preparation type. Herb was the predominant life form (67%). The maximum UV (0.92) was demonstrated by J. adhatoda L. species, while A. sativum L. shows maximum RFC (0.58), the highest ICF value represented by diarrhea and dermatitis 0.92, and high FL value is recorded 100%. According to our collections, wild species were 45%, invasive species were 38% and cultivated 17% recorded, dicots species were recorded more 81%. Seven 7 medicinal species is being economically important and export to the local and international market of the world, whereas P. integrima L. species were the most exported species according to the local dealers. The investigated area is rural and the local people depend on the area's plants for their health needs, and other uses like a vegetable, fuelwood, fodder, etc. The current result of RFC, UV, ICF, FL, and JI shows that medicinal flora needs to be pharmacologically and phytochemically investigated to prove their efficacy. The documentation of medicinal knowledge is important to preserve this precious old knowledge before it is lost forever, due to technological and environmental changes in the world.

Association analysis of vitamin D receptor gene polymorphisms in North England population with Type 2 diabetes mellitus

Background

Numerous diabetes susceptibility loci, include a region consisting vitamin D receptor gene found in chromosome 12q, have been known using genome wide screens.

Aim

The aim of present study is to probe the relationship between polymorphism of vitamin D receptor gene (single nucleotide polymorphisms) and type 2 diabetes mellitus (T2DM). Five hundred T2DM patients and 200 healthy subjects with normal HbA1c (≤ 5.0 %), fasting blood sugar (≤ 120 mg/dL) and random blood sugar (≤ 140 mg/dL) were enrolled.

Metholodgy

The genotypes were found by polymerase chain reaction restriction fragment length polymorphism and DNA sequencing.

Results

revealed that no considerable differences in frequencies of genotype and allele of the Bsm I and Fok I polymorphisms between healthy and patients in the North England (For Fok I: OR = 1.11, 95% CI: 0.72–1.12; for Bsm I: OR = 1.35, 95% CI: 0.79–1.98).

Conclusion

It is recommended that both following polymorphisms of vitamin D receptor gene may not considerably add to the progression of T2DM in the North England.

Primary Conjunctival Kaposi Sarcoma; A Rare And Unheard Entity

Introduction/Objective

Kaposi’s sarcoma (KS) is the most common malignant vascular tumor in human immunodeficiency virus (HIV) patients caused by human herpesvirus 8. It can affect the vascular endothelium of any part of the body however ocular KS as an initial manifestation has been reported only in 3 cases so far. It affects the vascular endothelium of the lacrimal gland, eyelids, orbit, palpebral and bulbar conjunctiva. It presents as a violaceous fleshy nodular mass.

Methods

A 23-year-old male with a past medical history of HIV presented with bilateral eye erythema and significant upper and lower lid edema. The patient was initially admitted for facial swelling which led to a conjunctival biopsy and a diagnosis of KS was made and doxorubicin along with chemotherapy was started. Four months later after the initiation of chemotherapy, the patient experienced worsening of facial swelling, and an area on the left side of his face got very firm. His physical examination was positive for a fever, drooling, facial swelling with trouble swallowing, and change of voice along with shortness of breath.

Results

CT of the orbit revealed symmetric enhancement swelling of the preseptal periorbital soft tissues which was thought to be nonspecific and a differential diagnosis included lymphedema, acute sinusitis, and orbital cellulitis was considered. A chest x-ray revealed bilateral pleural effusions and CT head revealed diffuse scalp and facial cutaneous and subcutaneous edema. Lab findings were significant for a low CD4: CD8 ratio. Cytological examination of the pleural fluid revealed predominantly blood, reactive mesothelial cells, macrophages, neutrophils, and lymphocytes, and appropriately controlled immunostain was positive for ERG and HHV8 with a possibility that Kaposi’s sarcoma cannot be completely excluded. Unfortunately, the patient passed away during the same time of pleural fluid analysis.

Autopsy findings revealed multiple metastatic foci in the mediastinal soft tissue, within the right land left lung, scalp soft tissue, retroperitoneal soft tissue, and hilar lymph node which were positive for CD34, CD31, and HHV8 and consistent with metastatic KS.

Conclusion

Thus, it is important to keep in mind that isolated conjunctival KP with later on systemic metastasis is rare with conjunctiva being an unusual site for the initial presentation, and a possibility of primary conjunctival KS should be considered in HIV positive patients.

A predictive model for Covid-19 spread - with application to eight US states and how to end the pandemic

A compartmental model is proposed to predict the coronavirus 2019 (Covid-19) spread. It considers: detected and undetected infected populations, social sequestration, release from sequestration, plus reinfection. This model, consisting of seven coupled equations, has eight coefficients which are evaluated by fitting data for eight US states that make up 43% of the US population. The evolution of Covid-19 is fairly similar among the states: variations in contact and undetected recovery rates remain below 5%; however, variations are larger in recovery rate, death rate, reinfection rate, sequestration adherence and release rate from sequestration. Projections based on the current situation indicate that Covid-19 will become endemic. If lockdowns had been kept in place, the number of deaths would most likely have been significantly lower in states that opened up. Additionally, we predict that decreasing contact rate by 10%, or increasing testing by approximately 15%, or doubling lockdown compliance (from the current ~15% to ~30%) will eradicate infections in Texas within a year. Extending our fits for all of the US states, we predict about 11 million total infections (including undetected), and 8 million cumulative confirmed cases by 1 November 2020.

SAT0189 SAMPLE SIZES AND RECRUITMENT RATES ARE DECREASING WHILE PLACEBO RESPONSE RATES ARE INCREASING IN CLINICAL TRIALS FOR SYSTEMIC LUPUS ERYTHEMATOSUS - A MANDATE FOR NEW STRATEGIES

Background:

Randomized controlled trials in Systemic Lupus (SLE) have shown disappointing results for decades. Key challenges may include the heterogenous population coupled with high placebo response rates.

Objectives:

To evaluate trends in SLE study metrics over time and explore associations between primary endpoint failure and response in placebo/standard of care arms.

Methods:

Data from Phase II or III trials which enrolled ≥ 100 patients with SLE and reported SRI-4 and/or BICLA responses after a minimum of 24 weeks were included in the analysis. Sample size, recruitment rates, regional patient distributions, and results in placebo arms (at 24-36 weeks or 48-52 weeks) were examined according to the start date of each study in order to determine trends over time. Placebo group SRI-4 response rates in studies that met their primary endpoint were compared with those that did not.

Results:

Twenty-seven (14 phase II and 13 phase III) studies met the search criteria. Eleven of them met their primary endpoints. The study start dates ranged from Dec 2006 to Jan 2017. Mean/median total subject numbers were 461/349. Mean/median placebo subjects’ age at baseline were 39.9/39.2 and SLEDAI: 10.6/10.6. Mean/median placebo SRI-4 responses at Week 24-36 were 47.2%/45.8% and 42.8%/43% at Week 48-52. For BICLA, the rates were 40.3%/37.2% at Week 24-36 and 33.2%/33.5% at Week 48-52.

As expected, lower placebo response was found in trials that met primary endpoints vs studies that did not (p=0.005). Total subject numbers and recruitment rates decreased over time while placebo SRI-4 response rates increased overall (Figure). However, there has been a greater range of placebo responses in more recent trials. Similar trends were observed in BICLA responses at Week 24-36 and 48-52, and in a corticosteroid reduction endpoint (percent of patients with reduction in steroid dose by ≥25% and to ≤7.5 mg/day prednisone/equivalent) at Week 48-52. Enrollment of patients from North America decreased while proportions of Eastern Europeans increased over time (Figure).

Conclusion:

High placebo response rates pose a continuing challenge in SLE studies and are associated with primary endpoint failures.

Clinical trial metrics have been changing over time, with declining size and recruitment rates, possibly due to competition from increasing numbers of studies.

These trends should be considered while designing and conducting future trials. Attention to site training and data quality may be particularly important to control high placebo rates, especially as trial sizes decrease.

Figure.

Disclosure of Interests:

Ewa Olech Grant/research support from: BMS, Consultant of: Abbvie, Amgen, Remegen, Employee of: IQVIA, Speakers bureau: Abbvie, Amgen, Merck, Pfizer, UCB, Eduard van Rijen Employee of: IQVIA, Faizi Hussain Employee of: IQVIA, Gregory Dennis Employee of: IQVIA, Ali Ashrafzadeh Employee of: IQVIA, Joan T Merrill Grant/research support from: Xencor, Bristol Myers Squibb, Glaxo Smith Kline, Consultant of: Xencor, Abbvie, UCB, Glaxo Smith Kline, EMD Serono, Astellas, Remegen, Celgene/Bristol Myers Squibb, Exagen, Astra Zeneca, Amgen, Jannsen, Servier, ILTOO, Daitchi Sankyo, Lilly, Paid instructor for: Abbvie, Bristol Myers Squibb

Aging - Oxidative stress, antioxidants and computational modeling

Aging is a degenerative, biological, time-dependent, universally conserved process thus designed as one of the highest known risk factors for morbidity and mortality. Every individual has its own aging mechanisms as both environmental conditions (75%) and genetics (25%) account for aging. Several theories have been proposed until now but not even a single theory solves this mystery. There are still some queries un-answered to the scientific community regarding mechanisms behind aging. However, oxidative stress theory (OST) is considered one of the famous theories that sees mitochondria as one of the leading organelles which largely contribute to the aging process. Many reactive oxygen species (ROS) are produced endogenously and exogenously that are associated with aging. But the mitochondrial ROS contribute largely to the aging process as mitochondrial dysfunction due to oxidative stress is considered one of the contributors toward aging. Although ROS is known to damage cell machinery, new evidence suggests their role in signal transduction to regulate biological and physiological processes. Moreover, besides mitochondria, other important cell organelles such as peroxisome and endoplasmic reticulum also produce ROS that contribute to aging. However, nature has provided humans with free radical scavengers called antioxidants that protect from harmful effects of ROS. Future predictions regarding aging, biochemical mechanisms involved, biomarkers internal and external factors can be easily done with machine learning algorithms and other computational models. This review explains important aspects of aging, the contribution of ROS producing organelles in aging, importance of antioxidants fighting against ROS, different computational models developed to understand the complexities of the aging.

Vitamin D receptor FokI polymorphism in a Pakistani population with type 2 diabetes mellitus

Present research was undertaken with the aim to assess the association of VDR gene FokI polymorphism with T2DM in local population. The study comprised of 100 T2DM patients (DG) and 50 normal individuals (CG) groups. Demographic parameters; age, gender, BMI and blood pressure were recorded. Fasting glucose (FG), HbA1c, vitamin D, liver function parameters, renal function parameters and lipid profile were measured. Significantly higher (P<0.05) BMI (34.6±11.3 vs. 24.9±4.0kg/m2), sBP (141±16 vs. 124±14mm Hg), dBP (81±8 vs. 76±7mm Hg), FG (145±5.54 mg/dL vs. 80±3.55mg/dL, HbA1c (7.43±0.69 % vs. 4.85±0.33%) were evident in DG as compared to CG. Prominent reduction (P<0.05) in vitamin D levels (13.69±1.85mg/dL) manifested in case subjects than that of control subjects (22.36±2.34mg/dL) as a negative correlation existed between HbA1c and vitamin D. Compared to control participants, substantially different FokI allele distribution was observed in T2DM patients. Current study s also showed no significant link between FokI genotype and the biochemical parameters. Present study endorsed the fact that diabetic patients have hypovitaminosis D and variable VDR polymorphisms. However, confirmational studies are indecisive and warrants further research.

Developing antimicrobial calcium alginate fibres from neem and papaya leaves extract

OBJECTIVE

The aim of this study was to evaluate an alternative approach to developing antimicrobial alginate fibres using plant extracts, such as those from neem and papaya leaves.

METHOD

Aqueous leaves extract from neem, papaya and their hybrid combinations were used as solvent to develop sodium alginate fibres. Sodium alginate polymer containing these extracts was extruded in a calcium chloride (CaCl₂) bath to develop neem (NE), papaya (PE) and their hybrid combinations-based calcium alginate fibres (H-1 to H-5). The surface morphology, spectra, liquid absorption, tensile strength and antimicrobial activity of these developed fibres were measured.

RESULTS

NE fibre showed greater tensile strength than PE. The liquid absorption property of all developed fibres decreased, but showed antibacterial properties against Staphylococcus aureus and reduced bacterial growth up to 85% when compared with pure calcium alginate fibre.

CONCLUSION

Neem, papaya and hybrid extract-based calcium alginate fibres have the potential to be used as wound dressings.

Study of selected therapeutic potentials of Momordica charantia fruit

M. charantia extract partitioned in different solvents was assessed for antioxidant (2, 2-diphenyl l-picrylhydrazyl), total phenolic contents (TPC), total flavonoid contents (TFC), antiglycation, alpha amylase and acetylcholinesterase inhibitory activities along with cytotoxic, thrombolytic and antibiofilm potentials. Most effective antioxidant fraction was n-hexane with TPC and TFC, highest in n-butanol and ethanol fractions, respectively. Ethyl acetate fraction showed maximum glycation and alpha amylase inhibitions and optimum acetylcholinesterase inhibition was by ethanol fraction. Fractions exhibited significant hemolytic and thrombolytic efficacies and bacterial growth restraint. The present research reveals some medicinal potency of M. charantia.

Assessing universality of DNA barcoding in geographically isolated selected desert medicinal species of Fabaceae and Poaceae

In pursuit of developing fast and accurate species-level molecular identification methods, we tested six DNA barcodes, namely ITS2, matK, rbcLa, ITS2+matK, ITS2+rbcLa, matK+rbcLa and ITS2+matK+rbcLa, for their capacity to identify frequently consumed but geographically isolated medicinal species of Fabaceae and Poaceae indigenous to the desert of Cholistan. Data were analysed by BLASTn sequence similarity, pairwise sequence divergence in TAXONDNA, and phylogenetic (neighbour-joining and maximum-likelihood trees) methods. Comparison of six barcode regions showed that ITS2 has the highest number of variable sites (209/360) for tested Fabaceae and (106/365) Poaceae species, the highest species-level identification (40%) in BLASTn procedure, distinct DNA barcoding gap, 100% correct species identification in BM and BCM functions of TAXONDNA, and clear cladding pattern with high nodal support in phylogenetic trees in both families. ITS2+matK+rbcLa followed ITS2 in its species-level identification capacity. The study was concluded with advocating the DNA barcoding as an effective tool for species identification and ITS2 as the best barcode region in identifying medicinal species of Fabaceae and Poaceae. Current research has practical implementation potential in the fields of pharmaco-vigilance, trade of medicinal plants and biodiversity conservation.