Checkpoint Inhibitor-Related Capillary Leak Syndrome (CLS)

Immune checkpoint inhibitors (ICIs) are now being widely used for the treatment of various malignancies, but they have a distinctive set of side effects due to the overactivation of the immune system, which is important to recognize. Capillary leak syndrome (CLS) is a rare but potentially life-threatening side effect of ICIs that causes a significant increase in the permeability of capillaries, leading to the leakage of plasma-containing proteins from these small vessels. This condition results in several clinical features, including edema, hypotension, hypoalbuminemia, and hemoconcentration. Timely recognition and discontinuation of the offending immunotherapy can optimize outcomes. Treatment is focused on supportive care and prompt initiation of immunosuppressants, such as steroids.

Modelling the GDP of KSA using linear and non-linear NNAR and hybrid stochastic time series models

BACKGROUND

Gross domestic product (GDP) serves as a crucial economic indicator for measuring a country's economic growth, exhibiting both linear and non-linear trends. This study aims to analyze and propose an efficient and accurate time series approach for modeling and forecasting the GDP annual growth rate (%) of Saudi Arabia, a key financial indicator of the country.

METHODOLOGY

Stochastic linear and non-linear time series modeling, along with hybrid approaches, are employed and their results are compared. Initially, conventional linear and nonlinear methods such as ARIMA, Exponential smoothing, TBATS, and NNAR are applied. Subsequently, hybrid models combining these individual time series approaches are utilized. Model diagnostics, including mean absolute error (MAE), root mean square error (RMSE), and mean absolute percentage error (MAPE), are employed as criteria for model selection to identify the best-performing model.

RESULTS

The findings demonstrated that the neural network autoregressive (NNAR) model, as a non-linear approach, outperformed all other models, exhibiting the lowest values of MAE, RMSE and MAPE. The NNAR(5,3) projected the GDP of 1.3% which is close to the projection of IMF benchmark (1.9) for the year 2023.

CONCLUSION

The selected model can be employed by economists and policymakers to formulate appropriate policies and plans. This quantitative study provides policymakers with a basis for monitoring fluctuations in GDP growth from 2022 to 2029 and ensuring the sustained progression of GDP beyond 2029. Additionally, this study serves as a guide for researchers to test these approaches in different economic dynamics.

A novel comparative study of NNAR approach with linear stochastic time series models in predicting tennis player's performance

BACKGROUND

Prediction models have gained immense importance in various fields for decision-making purposes. In the context of tennis, relying solely on the probability of winning a single match may not be sufficient for predicting a player's future performance or ranking. The performance of a tennis player is influenced by the timing of their matches throughout the year, necessitating the incorporation of time as a crucial factor. This study aims to focus on prediction models for performance indicators that can assist both tennis players and sports analysts in forecasting player standings in future matches.

METHODOLOGY

To predict player performance, this study employs a dynamic technique that analyzes the structure of performance using both linear and nonlinear time series models. A novel approach has been taken, comparing the performance of the non-linear Neural Network Auto-Regressive (NNAR) model with conventional stochastic linear and nonlinear models such as Auto-Regressive Integrated Moving Average (ARIMA), Exponential Smoothing (ETS), and TBATS (Trigonometric Seasonal Decomposition Time Series).

RESULTS

The study finds that the NNAR model outperforms all other competing models based on lower values of Root Mean Squared Error (RMSE), Mean Absolute Error (MAE), and Mean Absolute Percentage Error (MAPE). This superiority in performance metrics suggests that the NNAR model is the most appropriate approach for predicting player performance in tennis. Additionally, the prediction results obtained from the NNAR model demonstrate narrow 95% Confidence Intervals, indicating higher accuracy and reliability in the forecasts.

CONCLUSION

In conclusion, this study highlights the significance of incorporating time as a factor when predicting player performance in tennis. It emphasizes the potential benefits of using the NNAR model for forecasting future player standings in matches. The findings suggest that the NNAR model is a recommended approach compared to conventional models like ARIMA, ETS, and TBATS. By considering time as a crucial factor and employing the NNAR model, both tennis players and sports analysts can make more accurate predictions about player performance.

Incidence and characteristics of ligamentous knee injuries accompanying a femur shaft fracture and their association with injury mechanism and fracture characteristics: A prospective-observational study in a low-middle-income country

Objective

This study aims to elaborate the incidence, types, and characteristics of ligamentous knee injuries accompanying femoral-shaft fractures and their association with demographic data, fracture characteristics, and injury mechanism.

Methods

This multi-center-prospective-observational study examined patients in the Shaheed Mohtarma Benazir Bhutto Institute of Trauma and Civil Hospital orthopedic wards. Using the consecutive sampling technique, 146 patients with femoral-shaft fractures were recruited, and scrutinized to determine the presence of ligamentous knee injury, through an evaluation form encompassing patients' demographic data, fracture characteristics, knee examinations, and confirmed through magnetic resonance imaging. Knee injuries were detected intra-operatively under regional/general anesthesia and post-operatively utilizing diagnostic maneuvers (varus/valgus stress, Lachman, anterior/posterior drawer, external rotation recurvatum, and McMurray tests) by 2-3 surgeons and confirmed through magnetic resonance imaging. Magnetic resonance imaging was exclusively employed in suspected false positive/negative cases, and when a titanium implant was utilized, that is, 131 cases (89.7%). Chi-square test was used to assess the relationship between incidence and type of ligamentous knee injury with demographic data, injury mechanism, and fracture characteristics.

Results

Among the 146 patients with femoral-shaft fractures, 78% and 22% were males and females, with 37% experiencing associated ligamentous knee injury. Medial collateral ligament and anterior cruciate ligament were the commonest types of ligamentous injuries accompanying femoral-shaft fractures, at 44% and 33%. The Chi-square revealed a statistically significant association between the incidence of ligamentous knee injury accompanying femoral-shaft fracture with demographic data, injury mechanism, and fracture characteristics (p-value < 0.05), and was noted to be higher among males (55.6%), participants aged 18-25 years (66.7%), involved in a road traffic accident (88.9%), resulting in a complex (77.8%) and close fracture (88.9%). A similar association was seen between medial collateral ligament and anterior cruciate ligament injuries with age, injury mechanism, and fracture characteristics (p-value < 0.05).

Conclusion

Our study revealed the unaddressed fact that Pakistan has a significant incidence of ligamentous knee injuries accompanying femoral-shaft fractures. These insights can empower clinicians/surgeons to understand and manage this condition effectively.

Relationship between gaming disorder across various dimensions among PUBG players: a machine learning-based cross-sectional study

Background

PlayerUnknown's battlegrounds (PUBG), a widely played multiplayer online game, has sparked interest and concern regarding its impact on players. This study explored the relationship between factors such as cultivation level, motivation, religious engagement, gaming disorder, and addiction among PUBG players.

Methods

This study employed a convenience sampling technique to select a sample of 500 PUBG players. An Artificial Neural Network (ANN) model was used to identify the primary factors contributing to the level of cultivation.

Results

Male participants exhibited a higher level of cultivation than their female counterparts did. According to the ANN model, gaming disorder exhibited the greatest normalized importance, with a value of 100%. This was followed by the religious level, which had a normalized importance of 54.6%. Additionally, motivation level and gaming addiction demonstrated normalized importance values of 47.6 and 44.4%, respectively. This study revealed a statistically significant correlation between engaging in PUBG and the cultivation effect observed among respondents.

Conclusion

This study highlights several noteworthy factors, including gaming disorder, religious affiliation, motivation level, and gaming addiction. These factors offer valuable insights into understanding gaming behavior and devising effective interventions.

A longitudinal prospective study of septoplasty impact on headache and allergic rhinitis in patients with septal deviation

OBJECTIVE

To measure the severity of allergic rhinitis (AR) and different types of headaches in patients with septal deviation before and after septoplasty.

METHODS

This multicentre, prospective, longitudinal, observational study enrolled patients with deviated nasal septum, nasal symptoms and headaches associated with persistent AR lasting at least 2 months without resolution. The nasal obstruction evaluation (NOSE) scale, immunoglobulin-E (Ig-E) levels and visual analogue scale (VAS) for headache pain severity were evaluated before and after septoplasty using Wilcoxon signed-rank test.

RESULTS

A total of 196 patients were enrolled in the study (102 males; 94 females). A total of 134 patients (68%) were diagnosed with severe AR and 166 (85%) experienced headaches with AR. The majority (100 of 166 patients; 60%) had sinusoidal headaches, while 25% (42 of 166 patients) reported a combination of sinusoidal headache and migraine and 14% (24 of 166 patients) experienced migraines. A comparison of preoperative and postoperative Ig-E levels, NOSE and VAS scores demonstrated that septoplasty significantly improved AR symptoms and headaches. Although there were significant improvements in headaches overall post-septoplasty, only the sinusoidal components improved, while migraine remained unaffected.

CONCLUSION

Septoplasty improved AR and sinusoidal headaches in patients with septal deviation, but migraines remained unaffected.

Impact of trans-anal versus laparoscopic total mesorectal excision on the surgical and pathologic outcomes of patients with rectal cancer: meta-analysis of randomized controlled trials

BACKGROUND

Despite its profound impact on the oncologic outcomes of rectal cancer, the most optimal surgical approach to total mesorectal excision (TME) has not been identified yet. All previous meta-analyses on this subject have been based on observational studies. This meta-analysis was conducted to assess the surgical and oncologic outcomes of laparoscopic TME (LaTME) compared to trans-anal TME (TaTME), utilizing only randomized controlled trials.

DESIGN

Systematic review and meta-analysis of randomized controlled trials.

METHODS

We searched electronic databases (MEDLINE, Cochrane CENTRAL, Clinicaltials.gov) from 2010 onwards, for all published clinical trials comparing TaTME to LaTME. Results are presented as risk ratios, with 95% CI, and pooled using the random effects model.

RESULTS

A total of 1691 patients, from 6 eligible randomized controlled trials, were included for analysis. Analyzed data showed no significant difference in morbidity (RR: 0.85, p = 0.15), mortality (RR: 0.50, p = 0.44), conversion to open (RR: 0.40, p = 0.07), or anastomotic leakage (RR: 0.73, p = 0.10) between TaTME and LaTME. There was also no difference in the rate of positive distal resection margin (DRM) (RR: 0.55, p = 0.10) or positive circumferential resection margin (CRM) (RR: 0.67, p = 0.30). Patients undergoing TaTME were more likely to have a complete TME (RR: 1.06, p = 0.002) and shorter hospital stays (RR: - 0.97, p < 0.00001).

CONCLUSIONS

Patients undergoing TaTME for rectal cancer were more likely to have a complete TME when compared to LaTME, though this did not translate into improved distal or circumferential resection margin. Additionally, TaTME and LaTME had similar surgical outcomes except for shorter length of stay with TaTME.

The Virtual Face of Colon and Rectal Surgery Training in the USA: An In-Depth Evaluation and Analysis of Fellowship Programs Website Content

BACKGROUND

With an ever-evolving digital and virtual world hastened by the COVID-19 pandemic, prospective colon and rectal surgery fellowship applicants must rely on online sources of information, such as websites, rather than in-person visits to fellowship programs. This study analyzes and evaluates the content and accuracy of colon and rectal surgery fellowship program websites.

METHODS

The Fellowship and Residency Electronic and Interactive Database website provides a complete collection of colon and rectal surgery fellowship websites based in the USA. The accessibility of the websites was verified via Google search, and relevant content for the applicants was evaluated based on 50-point criteria.

RESULTS

Analysis of 60 fellowship program websites was conducted, out of which only a fifth (20%) were kept up to date. Twenty-seven (45%) websites fulfilled 50% of the 50-point criteria. The most and least included data points were program overview (69%) and residential/housing information (24%). Most websites contained basic information relevant to international applicants but lacked crucial information such as visa sponsorship (12%) and city information (23%).

CONCLUSION

An informative and easily accessible website is essential for prospective applicants to choose the best program for their career goals and academic needs. This study highlighted multiple areas for potential improvement in the colon and rectal surgery program websites. Individual colon and rectal surgery programs may benefit and attract more candidates to their programs through a fully optimized website design and content.

An autoregressive distributed lag approach for estimating the nexus between CO2 emissions and economic determinants in Pakistan

Carbon dioxide (CO2) emissions have become a critical aspect of the economic and sustainable development indicators of every country. In Pakistan, where there is a substantial increase in the population, industrialization, and demand for electricity production from different resources, the fear of an increase in CO2 emissions cannot be ignored. This study explores the link that betwixt CO2 emissions with different significant economic indicators in Pakistan from 1960 to 2018 using the autoregressive distributed lag (ARDL) modelling technique. We implemented the covariance proportion, coefficient of determination, the Durbin Watson D statistics, analysis of variance (ANOVA), variance inflating factor (VIF), the Breusch-Pagan test, the Theil's inequality, the root mean quare error (RMSE), the mean absolute percentage error (MAPE), and the mean absolute error (MAE) for the diagnostics, efficiency, and validity of our model. Our results showed a significant association between increased CO2 emissions and increased electricity production from oil, gas, and other sources. An increase in electricity production from coal resources was seen to have resulted in a decrease in CO2 emissions. We observed that an increase in the gross domestic product (GDP) and population growth significantly contributed to the increased CO2 emissions. The increment in CO2 emissions resulting from industrial growth was not significant. The increment in CO2 emissions in the contemporary year is significantly associated with the preceding year's increase. The rate of increase was very alarming, a sign that no serious efforts have been channelled in this regard to reduce this phenomenon. We call for policy dialogue to devise energy-saving and CO2 emission reduction strategies to minimize the impact of climate change on industrialization, population growth, and GDP growth without deterring economic and human growth. Electricity production from different sources with no or minimal CO2 emissions should be adopted. We also recommend rigorous tree planting nationwide to help reduce the concentration of CO2 in the atmosphere as well as environmental pollution.

Abstract 4004: Targeting drug-resistant acute myeloid leukemia (AML) cells using novel casein kinase II (CK2) inhibitor

Introduction: Protein Kinase CK2 level and activity are high in Acute Myeloid Leukemia (AML) stem cells. Genetic inhibition of CK2 promotes apoptosis and shows synergistic cytotoxic activity with cytotoxic therapy. Here we report the anti-leukemia efficacy of a novel and potent small molecule inhibitor of CK2, BMS-135, in AML mouse models.

Methods: AML cell lines (n=8) and primary AML cells (n=3) representing various AML genetic subtypes (MLL rearranged, FLT3-ITD, TP53 mutation) were tested in vitro. Cells were treated with serial dilution of BMS-135 for 24 to 48hrs, and cell viability was measured using calorimetric cell viability (WST) assay. Similarly, treated cells were analyzed for cell cycle distribution, apoptosis, and colony formation. We measured the mRNA and protein levels of known CK2 targets. RNA sequencing and gene expression analysis was done to evaluate gene expression changes following treatment with BMS-135. Cell line-derived xenograft and patient-derived xenograft of AML were treated with BMS-135 at a dose of 7.5mg/kg oral gavage twice daily for 21 days or vehicle.

Results: Combined in vitro and in vivo experiments establish the efficacy of BMS-135. Cytotoxicity at inhibitory concentrations of 30-800nM, G0-G1 cell cycle arrest, increased apoptosis, and poor colony formation following treatment were noted consistently in all cells. Single-drug treatment with BMS-135 achieved 50-80% leukemia inhibition and significantly prolonged survival in treated mice after 3 weeks of therapy. Following in vivo treatment with BMS-135, we confirmed the inhibition of known CK2 targets (AKT, PI3K, Bcl-xL) in the bone marrow and spleen AML cells. No significant myelosuppression or organ toxicity was noted in tumor-bearing mice following 3 weeks of treatment when compared to vehicle-treated mice. BMS-135 shows synergistic cytotoxic activity with daunorubicin and cytarabine.

Conclusions: Selective inhibitor of CK2 is well tolerated and shows superior in vivo efficacy and target inhibition in a series of AML cells and xenografts. BMS-135 works synergistically with cytotoxic agents like daunorubicin and cytarabine. These results support further pre-clinical characterization and clinical development of BMS-135 for treating AML in combination with cytotoxic therapy.

Citation Format: Koby Duke, Katherine Mercer, Rajesh Rajaiah, Muhammad Daniyal, Yi Qiu, Ashok Purandare, Yasin Uzun, Lijun Zhang, Morgann Klink, Chandrika Gowda. Targeting drug-resistant acute myeloid leukemia (AML) cells using novel casein kinase II (CK2) inhibitor. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4004.

Ovarian Carcinosarcoma and Response to Immunotherapy

Ovarian carcinosarcoma (OCS) is an uncommon and highly aggressive subtype of ovarian cancer. This form of cancer is characterized by limited treatment options and a poor prognosis. In this report, we present a case study of a 64-year-old female diagnosed with stage III OCS, who underwent debulking surgery and adjuvant chemotherapy, followed by immunotherapy, with encouraging outcomes. Despite the availability of diverse chemotherapy options, the prognosis for patients with OCS remains grim. However, the present case study of a 64-year-old female with OCS illustrates the promising outcomes achieved with immunotherapy. Additionally, this case highlights the significance of microsatellite instability testing in guiding treatment decisions for ovarian cancers of this nature.

A hybrid forecasting technique for infection and death from the mpox virus

Objectives

The rising of new cases and death counts from the mpox virus (MPV) is alarming. In order to mitigate the impact of the MPV it is essential to have information of the virus's future position using more precise time series and stochastic models. In this present study, a hybrid forecasting system has been developed for new cases and death counts for MPV infection using the world daily cumulative confirmed and death series.

Methods

The original cumulative series was decomposed into new two subseries, such as a trend component and a stochastic series using the Hodrick-Prescott filter. To assess the efficacy of the proposed models, a comparative analysis with several widely recognized benchmark models, including auto-regressive (AR) model, auto-regressive moving average (ARMA) model, non-parametric auto-regressive (NPAR) model and artificial neural network (ANN), was performed.

Results

The introduction of two novel hybrid models, HPF 1 1 and HPF 3 4 , which demonstrated superior performance compared to all other models, as evidenced by their remarkable results in key performance indicators such as root mean square error (RMSE), mean absolute error (MAE) and mean absolute percentage error (MAPE), is a significant advancement in disease prediction.

Conclusion

The new models developed can be implemented in forecasting other diseases in the future. To address the current situation effectively, governments and stakeholders must implement significant changes to ensure strict adherence to standard operating procedures (SOPs) by the public. Given the anticipated continuation of increasing trends in the coming days, these measures are essential for mitigating the impact of the outbreak.

Analysis of adolescents' perception and awareness level for Sexual and Reproductive Health Rights in Pakistan

Background

Awareness of rights is a precondition to establishing rule of law in society. Sexual and Reproductive Health and Rights (SRHR) are closely knitted in the human rights framework as they overlap with other human rights such as the right to health and life. However, awareness about these rights remains a challenge. Considering the importance of these rights this study has measured the awareness of adolescents about SRHR in Bahawalpur (Division) of Pakistan.

Methodology

We conducted a cross-sectional study in the Divison of Bahawalpur, Pakistan from October 2019 to December 2019. The study included a sample size of 500 respondents which included 250 young females of age 15-19 and 250 their parents (mother). The reasoning behind including only females in this study was the increased vulnerability and greater impact of SRHR in their life compared to males. The age range 15-19 was primarily selected as females this age will better understand and respond to the questionnaire compared to females in their early adolescent years. The quantitative research was conducted using two-stage cluster sampling. Detailed structured questionnaires were distributed among the respondents to obtain their points of view on the awareness of SRHR. The population was divided into multi-clusters with 25 households comprising 250 households for the division of Bahawalpur. The information was also gathered from the doctors and the teachers through interviews. The data were analyzed using SPSS version 21.

Results

The study explored the knowledge and understanding of adolescent SRHR thereby highlighting the key restrictions in Bahawalpur, Pakistan, which prohibit adolescents from gaining access to SRHR and exercising it. There is a significant portion of adolescents who strongly agreed with the importance and awareness level and think they should be more aware of information regarding SRHR. However, they are of the view that they are less independent in practicing them.

Conclusion

The study found a low level of awareness about SRHR among young female and their parents in Bahawalpur, Pakistan. It is a need of time and responsibility of the local government of the Bahawalpur region to devise clear and proper policies which give access to these rights. This can be done by including the information on these rights in the course curriculum and teachers keeping in view the cultural and regional restrictions that guide the young female about SRHR.

Public knowledge, attitudes, and practices towards herbal medicines; a cross-sectional study in Western Saudi Arabia

BACKGROUND

Herbal medicines, derived from medicinal plants, are among the most popular alternative remedies around the globe. In Saudi Arabia, herbal medicines are extensively used by public as part of the culture as well as religious norms. Therefore, this study aimed to evaluate knowledge, attitudes, and practices regarding herbal medicines among the general population in Saudi Arabia.

METHODS

A descriptive cross-sectional survey study was conducted on the general population of Jeddah city with the help of a validated and self-administered questionnaire. Sample size was calculated to be 450 with subjects between 20 and 60 years of either gender. Descriptive and inferential statistical analysis was performed using SPSS.

RESULTS

Results of our data showed that 173 (42.2%) of the total participants used herbal medicines, however, significant association was found between female gender and the usage of herbal medicines (p < 0.001). Approximately, more than half (56.0%) of the respondents agreed that herbal medicines could be used to promote health and treat illnesses, and 45% respondents agreed that herbal medicines are safe. 153 (37.4%) of the participants opined that herbal medicines could be taken with conventional or allopathic medicine. The data also showed a significant (p < 0.05) association between knowledge about the source of herbal medicine and gender where females were found to have more knowledge compared to males. Moreover, a significantly higher number of chronic disease patients were using herbal medicines compared to individuals with no medical problems (p < 0.001). Strikingly, majority (n = 204; 49.9%) of the respondents used herbal medicines as a first choice when sick, while a good number (n = 172; 42.1%) of respondents did not consult doctors before taking herbal medicines.

CONCLUSION

The use of herbal medicines is common among the general population of Jeddah. Although most of the participants believed that the herbal medicines are safe and do not require consultation, there is a dire need to increase awareness as well as to establish effective strategies to evaluate the safety, efficacy and quality of the herbal medicines for propitious consequences of this commonly used entity in the local society.

Modeling and Forecasting Monkeypox Cases Using Stochastic Models

BACKGROUND

Monkeypox virus is gaining attention due to its severity and spread among people. This study sheds light on the modeling and forecasting of new monkeypox cases. Knowledge about the future situation of the virus using a more accurate time series and stochastic models is required for future actions and plans to cope with the challenge.

METHODS

We conduct a side-by-side comparison of the machine learning approach with the traditional time series model. The multilayer perceptron model (MLP), a machine learning technique, and the Box-Jenkins methodology, also known as the ARIMA model, are used for classical modeling. Both methods are applied to the Monkeypox cumulative data set and compared using different model selection criteria such as root mean square error, mean square error, mean absolute error, and mean absolute percentage error.

RESULTS

With a root mean square error of 150.78, the monkeypox series follows the ARIMA (7,1,7) model among the other potential models. Comparatively, we use the multilayer perceptron (MLP) model, which employs the sigmoid activation function and has a different number of hidden neurons in a single hidden layer. The root mean square error of the MLP model, which uses a single input and ten hidden neurons, is 54.40, significantly lower than that of the ARIMA model. The actual confirmed cases versus estimated or fitted plots also demonstrate that the multilayer perceptron model has a better fit for the monkeypox data than the ARIMA model.

CONCLUSIONS AND RECOMMENDATION

When it comes to predicting monkeypox, the machine learning method outperforms the traditional time series. A better match can be achieved in future studies by applying the extreme learning machine model (ELM), support vector machine (SVM), and some other methods with various activation functions. It is thus concluded that the selected data provide a real picture of the virus. If the situations remain the same, governments and other stockholders should ensure the follow-up of Standard Operating Procedures (SOPs) among the masses, as the trends will continue rising in the upcoming 10 days. However, governments should take some serious interventions to cope with the virus.

LIMITATION

In the ARIMA models selected for forecasting, we did not incorporate the effect of covariates such as the effect of net migration of monkeypox virus patients, government interventions, etc.

Association of increased pain intensity, daytime sleepiness, poor sleep quality, and quality of life with mobile phone overuse in patients with migraine: A multicenter, cross-sectional comparative study

BACKGROUND

The number of regular smartphone users has increased dramatically worldwide. Headaches, followed by sleep difficulties, forgetfulness, dizziness, and other ailments, are among the most prevalent complaints among smartphone users during or after use. In addition, migraine is a debilitating disease and is the world's second leading cause of disability. Hence, we performed this study to determine how smartphone overuse influenced migraine patients' level of disability, pain intensity, sleep quality, and overall quality of life.

METHODS

In this observational study, the patients were divided into two groups high mobile phone use group (HMPUG) and the low mobile phone user group (LMPUG) using the Mobile Phone Problematic Use Scale. We assessed, for each group, patients' level of disability, pain intensity, sleep quality, daytime sleepiness, and quality of life through the Migraine Disability Assessment Scale, Visual Analogue Scale, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and 24-h Migraine Quality of Life Questionnaire, respectively.

RESULTS

Our study showed that the respondents' average age was  27.59 (9.79) years. The average number of family members was 5.98 (2.3251). A total of 65.8% (n = 263) of the 400 participants were female, while 34.3 % (n = 137) were male. Greater pain intensity, poor sleep quality, and reduced medication effectivity were found in HMPUG compared to LMPUG (p < .05). However, increased duration of migraine and medication intake was reported in the LMPUG (p < .05).

CONCLUSION

We observed that smartphone overuse could worsen pain, sleep, and reduce treatment efficacy in individuals with migraine. Therefore, controlled smartphone use is recommended to avoid worsening symptoms.

Therapeutic potential of herbal medicine for the management of hyperlipidemia: latest updates

Hyperlipidemia, the most common form of dyslipidemia, is the main source of cardiovascular disorders, characterized by elevated level of total cholesterol (TC), triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) with high-density lipoprotein cholesterol (HDL-C) in peripheral blood. It is caused by a defect in lipid metabolism in the surface of Apoprotein C-II or a defect in lipoprotein lipase activity as well as reported in genetic, dietary and environmental factors. Several electronic databases were investigated as information sources, including Google Scholar, PubMed, Web of Science, Scopus, ScienceDirect, SpringerLink, Semantic Scholar, MEDLINE and CNKI Scholar. The current review focused on the risk factors of dyslipidemia, synthetic medication with their side effects and different types of medicinal plants having significant potential for the management of hyperlipidemia. The management of hyperlipidemia mostly involves a constant decrease in lipid level using different remedial drugs like statin, fibrate, bile acid sequestrates and niacin. However, this extensive review suggested that the consequences of these drugs are arguable, due to their numerous adverse effects. The selected parts of herb plants are used intact or their extracts containing active phytoconstituents to regulate the lipids in blood level. It was also noted that the Chinese herbal medicine and combination therapy is promising for the lowering of hyperlipidemia. This review intends to provide a scientific base for future endeavors, such as in-depth biological and chemical investigations into previously researched topics.

Biomimetic Hybrid Membrane-Coated Xuetongsu Assisted with Laser Irradiation for Efficient Rheumatoid Arthritis Therapy

Rheumatoid arthritis (RA) is a systemic autoimmune disease underlying a cascade of chronic inflammatory processes. Over the past decades, the response rate of effective RA treatments has remained scarce despite numerous advancements in the current therapeutic interventions, owing largely to the associated off-target adverse events and poor accumulation in the inflamed joints. Recently, there is a high interest in the development of targeted drug delivery system by using nanotechnology, as it can provide a handle to improve the therapy efficacy of RA. Here, multifunctional HA@RFM@PB@SE nanoparticles (HRPS NPs) are developed by loading schisanlactone E (SE, also called with xuetongsu), an anti-RA compound isolated from Tujia ethnomedicine xuetong, into Prussian blue nanoparticles (PB NPs) and further camouflage of RBC-RAFLS hybrid membrane with HA modification onto PB@SE NPs (PS NPs). We demonstrated that the modification of RFM makes PB NPs ideal decoys for targeting inflammatory mediators of arthritis due to the homing effects of the parental cells. Moreover, the encapsulation of RFM on the PB@SE NPs extended the blood circulation time and improved its targeting ability, which accordingly achieved optimal accumulation of SE in arthritic rat paws. In vitro and in vivo assay demonstrated the outstanding performance of HRPS NPs for synergistic chemo-/photothermal therapy of RA without side effects to healthy tissues. Molecular mechanism exploration indicated that the ultrastrong inhibition of synovial hyperplasia and bone destruction was partly via suppressing NF-κB signaling pathway and the expression of matrix metalloproteinases. In summary, the nanodrug delivery system showed controllable release behavior, targeted accumulation at arthritic sites and systemic regulation of immunity, hence improved therapeutic efficacy and clinical outcomes of the disease without attenuating safety.

Herbal Medicine for the Management of Laxative Activity

Constipation is one of the most common and prevalent chronic gastrointestinal conditions across the globe that is treated or managed through various methods. Laxatives are used for the treatment or management of chronic/acute constipation. But due to the adverse effects associated with these laxatives, herbal foods should be considered as alternative therapies for constipation. In this review, the laxative potential of plant-based medicines used for constipation were discussed. Constipation may be caused by various factors such as lifestyle, particular food habits, pregnancy and even due to some medication. Chronic constipation is responsible for different health issues. Pharmacological and non-pharmacological paradigms are applied for the treatment or management of constipation. In the pharmacological way of treatment, medicinal plants have a key role, because of their fibrous nature. Numerous plants such as Prunus persica (Rosaceae), Cyamopsis tetragonolobus (Leguminosae), Citrus sinensis (Rutaceae), Planta goovata (Plantaginaceae), Rheum emodi (Polygonaceae), Cassia auriculata (Caesalpinacea), Ricinus communis (Euphorbiaceae), Croton tiglium (Euphorbiaceae), Aloe barbadensis (Liliaceae), Mareya micrantha (Euphorbiaceae), Euphorbia thymifolia (Euphorbiaceae), Cascara sagrada (Rhamnaceae), Cassia angustifolia (Fabaceae) have laxative activity. Medicinal plants possess a significant laxative potential and support their folklore therefore, further, well-designed clinical-based studies are required to prove and improve the efficacy of herbal medicine for constipation. The present review showed that herbs laxative effect in various in-vivo/ in-vitro models.

Anti-gastric cancer activity and mechanism of natural compound "Heilaohulignan C" isolated from Kadsura coccinea

In this research, we analyzed the antitumor activity of one new compound Heilaohulignan C (B-6) on the human gastric carcinoma cells. MTT, cell migration, Calcein AM/Propidium Iodide (PI), and flow cytometry in BGC-823 cell line (gastric tumor). Western blot was utilized to distinguish the protein level. Xenografts nude mice were used for in vivo anticancer analysis. H&E staining and laboratory investigation was accomplished for toxicity study. MTT test demonstrated the cytotoxicity of BGC-823 cells, Calcein AM/Propidium Iodide (PI) examine indicated increment dead cells proportion with a high dose of B-6, Flow cytometry (FACS) measure showed that B-6 influenced gastric cancer cells by initiating apoptosis. Western blot analysis confirmed that (B-6) decrease the level of Bcl-2 and increase the level of p53, Bax, and cleaved Caspase-3, this confirms that the B-6 doing the apoptosis through caspase and cytochrome C apoptotic pathways. Also, B-6 particularly decline the tumor volume and tumor size in the xenograft mice. H&E staining additionally supports that B-6 does not have any toxic impact on the normal tissues. This research supports that B-6 have pharmacological activity against gastric cancer, by p53 and mitochondrial dependent apoptotic pathway, and have no toxicity on normal tissues.

Adrenal Mass Hemorrhage Clinically Mimicking a Pheochromocytoma

Background: A pheochromocytoma is diagnosed clinically using correlation of clinical, imaging, and laboratory studies. We report the case of an adrenal mass hemorrhage that presented with significantly elevated urine metanephrines mimicking a pheochromocytoma.

Clinical Case: A 59-year-old healthy woman presented to the ED with chest pain, left flank and upper quadrant pain associated with diaphoresis and palpitations. Vital signs were significant for a pulse of 92 bpm, and a BP of 213/88 mm Hg. Physical exam revealed tenderness to palpation on the left upper quadrant and left costovertebral angle. Laboratory tests were significant for an elevated D-dimer (2,449 ng/mL, reference range 215–499 ng/mL). CT abdomen with IV contrast showed a 3.5 x 2.9 cm round mass abutting the lateral limb of the left adrenal gland with surrounding fat stranding with suspicion of inflammation or hemorrhage. 24-hour urine metanephrines showed elevated metanephrine (7,227 mcg/24hr; reference range &lt;400 mcg/24 hr) and normetanephrine (1,209 mcg/24hr; reference range 900 mcg/24 hr). In the setting of up trending cardiac enzymes and inferior-lateral ST segment depression, a cardiac catheterization was performed which was unrevealing. She was discharged from the hospital and referred to endocrinology. On that visit, ~ 1 month after the patient was admitted to the hospital, plasma metanephrines were ordered which showed mildly elevated plasma metanephrine (0.83 nmol/L; reference range &lt;0.5 nmol/L) and normetanephrine (1.2 nmol/L; reference ranges &lt;0.9 nmol/L). An MRI abdomen with and without contrast revealed a 2.7 x 2.2 x 1.8 cm nodule arising from the lateral limb, with loss of signal on in-phase images suggestive of blood products. Plasma metanephrines and MRI findings ruled out the diagnosis of a pheochromocytoma.

Conclusion: To our knowledge, few cases of an adrenal mass hemorrhage clinically mimicking a pheochromocytoma have been reported. Although the inpatient clinical presentation of our patient was consistent with this, the outpatient plasma metanephrines and MRI were not. An adrenal adenoma hemorrhage should be considered as a potential differential diagnosis for elevated metanephrines, which can clinically mimick a pheochromocytoma.

References: (1)Sekos K, Short T, Ing SW. Adrenal hemorrhage due to hypercoagulable state mimicking pheochromocytoma. Journal of Clinical and Translational Endocrinology: Case Report. 8. 9–12. 2018.(2)Wordsworth S, Thomas B, Agarwal N, Hoddell K, Davies S. Elevated urinary cathecholamines and adrenal haemorrhage mimicking phaechromocytoma. BMJ Case Reports. 2010.

Zootherapy as traditional therapeutic strategy in the Cholistan desert of Bahawalpur-Pakistan

The use of traditional medicines has tremendously increased over the past few decades. Approximately 80% of the world's population relies on traditional medicines for their primary healthcare needs because of their cost effectiveness and efficiency with no or minimal side effects. Zootherapy refers to the use of medicines that are prepared or derived from animals or from their products. The current study documented the folk knowledge related to the practice of various animal-derived products and ethnozoological based drugs used as medicines by the residents of the Cholistan desert of Bahawalpur (Pakistan). In this regard 46 knowledgeable and reliable elderly people, hakims and spiritual healers ranging from 35-60 years of age having knowledge related to zootherapy were included in the current study. A field survey from February 2006 to November 2007 was conducted by interviewing the selected respondents through a structured questionnaire. They provided knowledge regarding the use of animals and their derived products in traditional medicine. The zootherapeutic knowledge was based on both domestic animals as well as wild animals. A total of 20 animal species were included in the study, among which nine animals were domestic while 11 were wild animals. Among selected animals, nine were mammals, four birds, four reptiles and three insects. It was reported that camel was the most commonly used (n = 32 respondents) among mammals while Pigeon (n = 39 respondents), Spiny-tailed lizard (n = 41 respondents) and Indian honey bee (n = 27 respondents) among birds, reptiles and insects, respectively, have significant use for the treatment of different diseases. Based on this communication we could recommend that this type of abandoned knowledge should be considered for the management and conservation of faunistic resources. However, the advantageous role of animals and their products was reported but more extensive research is required to explore the bioactive constituents in the raw material of these animals responsible for their beneficial effects.

Development, Characterization and Stability Evaluation of Topical Gel Loaded With Ethosomes Containing Achillea millefolium L. Extract

Background: Delivering plant extract at high loading with intact antioxidants and efficient skin permeation always remains a challenge. To address this, we prepared a stable gel formulation containing nanoethosomes loaded with Achillea millefolium L. (AM) extract for topical drug delivery.

Method: The AM extract was tested at first for phytochemical analysis, antioxidant activity, total phenolic and flavonoid content, and FTIR examination. The nanoethosomes containing AM extract were synthesized and characterized by size, surface charge, and morphology, and entrapment efficiency (EE) was determined. The optimized nanoethosomes were then incorporated to develop a topical gel formulation and subjected to skin for permeation, pH, viscosity, and organoleptic evaluation for up to three months.

Results: The AM ethanolic extract demonstrated 88% free radical scavenging activity and notable phenolic and flavonoid contents of up to 123 mg GAE/g and 42 mg QE/g, respectively. The optimized nanoethosomes encapsulated with AM extract (240 nm) were spherical in shape, with −31.1 mV of surface charge, and showed considerable entrapment efficiency (90%). Furthermore, the selected topical gel remained stable during the study period. The Exvivo permeation study of ethosomal gel showed the highest release percentage of 79.8%.

Conclusion: The study concludes that topical gel loaded with nanoethosomes containing AM extract is an encouraging approach for topical drug delivery.

Advancement of Natural Compounds as Anti- Rheumatoid Arthritis Agents: Focus on Their Mechanism of Actions

Rheumatoid arthritis (RA) is a chronic inflammatory disease categorized by infiltration of inflammatory cells, synovial hyperplasia, pannus formation and bone destruction, leading to disability worldwide. Despite the presence of the commercial availability of anti-RA agent on the market, the application of these drugs is limited due to its side effects. Anti-rheumatic drugs are more effective and safer being investigated by many researchers, especially, natural products with anti-RA have been identified and the underlying molecular mechanisms of action of novel and known compounds have been reported. In this review, we intend to provide a comprehensive view and updated on naturally occurring compounds known and novel that has the effect of anti-RA, and then classify them according to their molecular mechanisms of action in regulating the anti-RA lane main. The safety of compounds from natural plants and western medicine has also been briefly compared. In addition, the clinical trials with anti-RA compounds isolated from natural plants in RA were also summarized in this manuscript.

Anti-anxiety properties of selected medicinal plants

Exploration of new drugs targeting anxiety treatment is a major concern worldwide. Medicinal plants are being used as a potential source of novel drugs for anxiety disorders. The objective of this review is to provide information about the healing outcomes of anxiety treatment with natural products. Valeriana officinalis, Citrus aurantium, Commelina benghalensis, Achyranthes aspera, Mimosa pudica, Achillea millefolium, Nymphaea alba, Leonurus cardiac, Camellia sinensis, Turnera aphrodisiaca, Crataegus oxyacantha and Piper methysticum showed promising effects on anxiety in animal models. In clinical studies, passion flower, kava, valerian, St John's wort, and ashwagandha showed the most positive results. More studies are needed for the exploration of the anti-anxiety of medicinal plants. In drugs derived from natural sources have explored many components that are playing an essential role in curing anxiety disorders and associated complications.

Hybrid-cell membrane-coated nanocomplex-loaded chikusetsusaponin IVa methyl ester for a combinational therapy against breast cancer assisted by Ce6

Hybrid-cell membrane coating nanocomplexes loading chikusetsusaponin IVa methyl ester for combinational therapy against breast cancer assisted with Ce6.

Clinical Decision Unit, an extension of emergency department: An experience and advantage in a tertiary care centre

Objective

To evaluate the clinical decision unit of a tertiary care health facility and to see the disease pattern. .

Methodology

The cross-sectional retrospective study was conducted at the Department of Emergency Medicine, Aga Khan University Hospital, Karachi, from September to October 2011, and comprised data of patients admitted to the clinical decision unit from January to December 2010. The protocols were developed for 7 diseases: acute coronary syndrome, ureteric colic, abdominal pain, bronchial asthma, gastroenteritis with dehydration, headache, and minor head injury. Data-collection proforma recorded demographics, dates of admission, presenting complaints at triage, diagnosis at admission, final disposition and bounce back of the patients. Data was analysed using Microsoft Excel 2007.

RESULTS

Of the 1515 patients whose data was analysed, 824(54%) were males. The overall age ranged from newborns to 93 years. Further, 904(60%) patients had presented to the triage counter as P3 category. Acute gastroenteritis was the most common complaint 240(15.84%). Of the total, 1311(87%) were sent home from the clinical decision unit; 39(2.8%) of them bounced back with the same complaint. Overall, 2(0.2%) adult patients expired.

CONCLUSIONS

The unit evaluated had a productive initial year. Acute gastroenteritis was the most common protocol in use, but other protocols should also be developed to address local needs.

Is it safe to consume traditional medicinal plants during pregnancy?

The popularity of natural medicine is growing worldwide. Unlike conventional licensed medicines, herbal medicine practices are usually not supported by effectiveness, efficacy, or safety studies, which raise concerns about potential risks involved in their usage, particularly in high-risk patients such as pregnant women where teratogenicity is a concern. Despite a lack of science-based evidence, the use of herbal products for the management of pregnancy-associated challenges is common, due to the common notion that they are free of toxic effects and adverse reactions because they are "natural." The lack of concern about utilizing herbal remedies during pregnancy is strengthened by the lack of regulation in most countries for their marketing. However, plant-based remedies are not free of adverse reactions. Medicinal plants and herbal remedies contain substances that can be toxic to the human body and the fetus. Potential effects of indiscriminate use of medicinal plants are embryotoxicity, teratogenic, and abortifacient effects. Some plant constituents can cross the placenta and reach the fetus. Phytochemicals and their metabolites are known to induce stimulation of uterine contraction and hormone imbalance that could result in abortion. The alterations to the hormonal profile can affect conception, induce teratogenic activity, and halt the pregnancy or produce a congenital malformation. Due to the wide range of modes of action of phytochemicals, some medicinal plants may be safe to use during certain trimesters of pregnancy and harmful at other stages. This manuscript reviews available scientific information concerning potential health hazards associated with the consumption of herbal medicines during pregnancy, highlighting those herbs that should be avoided due to their potential abortifacient and/or teratogenic activity. We focused on plants that were tested by preclinical studies, and studies of these plants are summarized. Common therapeutic use of these herbs, estimated effects, toxicological effects, and animal studies of these plants is summarized. The literature reviewed suggests that consumption of the following medicinal plants should be avoided during pregnancy: Abrus precatorius, Achyranthes aspera, Ailanthus excelsa, Aloe vera, Aristolochia indica, Areca catechu, Bambusa vulgaris, Cassia occidentalis, Cicer arietinum, Cimicifuga racemose, Dolichandrone falcate, Ginkgo biloba, Hydrastis canadensis, Indigofera trifoliate, Lavandula latifolia, Maytenus ilicifolia, Momordica cymbalaria, Moringa oleifera, Musa rosacea, Oxalis corniculate, Phytolacca dodecandra, Plumeria rubra, Ricinus communis, Ruta graveolens, Stachys lavandulifolia, Senna alata, Trigonella foenum-graecum, Vitus agnus-castus, and Valeriana officinalis.

Predictive modeling of COVID-19 death cases in Pakistan

BACKGROUND

The world is presently facing the challenges posed by COVID-19 (2019-nCoV), especially in the public health sector, and these challenges are dangerous to both health and life. The disease results in an acute respiratory infection that may result in pain and death. In Pakistan, the disease curve shows a vertical trend by almost 256K established cases of the diseases and 6035 documented death cases till August 5, 2020.

OBJECTIVE

The primary purpose of this study is to provide the statistical model to predict the trend of COVID-19 death cases in Pakistan. The age and gender of COVID-19 victims were represented using a descriptive study.

METHOD

ology: Three regression models, which include Linear, logarithmic, and quadratic, were employed in this study for the modelling of COVID-19 death cases in Pakistan. These three models were compared based on R2, Adjusted R2, AIC, and BIC criterions. The data utilized for the modelling was obtained from the National Institute of Health of Pakistan from February 26, 2020 to August 5, 2020.

CONCLUSION

The finding deduced after the prediction modelling is that the rate of mortality would decrease by the end of October. The total number of deaths will reach its maximum point; then, it will gradually decrease. This indicates that the curve of total deaths will continue to be flat, i.e., it will shift to be constant, which is also the upper bound of the underlying function of absolute death.

Flavonoid glycosides from the rhizomes of Pronephrium penangianum

Six flavonoid glycosides jixueqisus A-F, together with nine known flavonoids, were isolated from the rhizomes of the fern Pronephrium penangianum. Among them, two red pigments jixueqisus A and B possess the same rare 6,8-dimethyl-2-phenyl-7H-1-benzopyran-7-one skeleton (a long conjugated system). Jixueqisu Cwas a dihydrochalcone glycoside, jixueqisu D was a chalcone glycoside, jixueqisu E was an aurone glycoside, and jixueqisu F was a flavonone glycoside. Interestingly, jixueqisus D-F, (2S)-5,2',5'-trihydroxy-7-methoxyflavanone and 5,2',5'-trihydroxy-7-methoxyflavone possessed a 2,5-dihydroxy substituted benzene ring (B-ring). Their structures were elucidated by various spectroscopic and chemical methods. Furthermore, the plausible biosynthetic pathways of jixueqisus A-F were discussed, respectively. All isolated compounds were evaluated for their activities against the proliferation of MCF-7, HepG-2, HCT-116 and BGC-823 tumor cell lines, four known flavane-4-ol glycosides, abacopterins A and C, eruberin B and triphyllin A, exhibited moderate activities to various cell lines.

The flower head of Chrysanthemum morifolium Ramat. (Juhua): A paradigm of flowers serving as Chinese dietary herbal medicine

ETHNOPHARMACOLOGICAL RELEVANCE

Dietary herbal medicines are widely used for the prevention and treatment of a variety of diseases due to their pharmacological activities in China. Juhua (the flower head of Chrysanthemum morifolium Ramat.), the most representative flower-derived one, which is mainly used for the treatment of respiratory and cardiovascular diseases, shows significant activities, such as antimicrobial, anti-inflammatory, and anticancer, and, neuroprotective, as well as effects on the cardiovascular system.

AIMS OF THIS REVIEW

This review aims to provide an overview of the crucial roles of flowers in Chinese dietary herbal medicine, and the pharmaceutical research progress of Juhua (the paradigm of dietary herbal medicine derived from the flower) including its applications in Traditional Chinese medicine and diet, cultivars, phytochemistry, quality control, pharmacology, and toxicity, along with chrysanthemum breeding and biotechnology.

METHOD

The information associated with Chinese dietary herbal medicine, flower-derived medicine, dietary flower, and pharmaceutical research of Juhua, was collected from government reports, classic books of Traditional Chinese medicine, the thesis of doctors of philosophy and maters, and database including Pubmed, Scifinder, Web of Science, Google Scholar, China National Knowledge Internet; and others.

RESULT

All flower-originated crude medicines recorded in Chinese pharmacopeia and their applications were summarized for the first time in this paper. The edible history and development of flowers in China, the theory of Chinese dietary herbal medicines, as well as flowers serving as dietary herbal medicines, were discussed. Moreover, applications in Traditional Chinese medicine and diet, cultivars, phytochemistry, quality control, pharmacology, and safety evaluation of Juhua, together with chrysanthemum breeding and biotechnology, were summarized in this paper.

CONCLUSION

The theory of dietary herbal medicines, which are an important part of the Traditional Chinese medicine system, has a history of thousands of years. Many herbal flowers, serving as dietary herbal medicines, contribute significantly to the prevention and treatment of a variety of diseases for Chinese people. To better benefit human health, more effective supervision practice for dietary herbal medicines is needed. Although various investigations on Juhua have been done, there is a lack of analytical methods for discrimination of cultivar flowers and identification of authenticity. Research on the major compounds with bioactivities, especially those related to its clinical application or healthcare function, as well as their possible mechanize, need be strengthened. More safety evaluation of Juhua should be carried out. The research limitations Juhua is facing exist in all dietary herbal medicine.

Sodium-Glucose Cotransporter-2 (SGLT-2) Inhibitors: Benefits in Diabetics With Cardiovascular Disease

Optimal blood glucose control helps reduce the development of the complications of type II diabetes mellitus (T2DM). T2DM patients usually are at increased risk of cardiovascular (CV) events and mortality. Therapies and strategies to treat diabetes and its related CV outcomes still need more investigation to find the best management options for this population. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have several benefits over multiple organ systems of the human body. However, the comparative effectiveness of this drug class is still not well-established. Our review aims to assess SGLT-2 inhibitors' effects on the CV complications that occur because of uncontrolled diabetes.

A comprehensive literature search was conducted on PubMed and PubMed Central to find the relevant studies that were done from 2016 through 2020 to gather data for this review article. Those studies include reviews, randomized clinical trials, systematic reviews, and meta-analyses.

Studies used in this article found an associated decrease in CV complications and mortality in patients with T2DM who received treatment with SGLT-2 inhibitors compared to the placebo group. These drugs have shown significant efficacy and safety outcomes in diabetic patients with heart disease, as they are glycosuric and diuretics, both of which are characteristics that could provide benefits to this population.

SGLT-2 inhibitors appear to reduce the risk of cardiovascular events and mortality, suggesting that the benefits of these drugs seen in people with diabetes may apply to a broad population in the real world. We recommend further studies should confirm the immense clinical benefits with SGLT-2 inhibitors in patients with T2DM.

DNAzyme and rGO based fluorescence assay for Fpg activity analysis, drug screening, and bacterial imaging

Due to the significant role of formamidopyrimidine DNA glycosylase (Fpg) in physiological processes and DNA oxidative damage-related diseases, it is essential to establish sensitive methods for monitoring the Fpg activity in vitro and in vivo so as to illustrate its concrete role in these events. In this work, a sensitive, simple and reliable fluorescence assay was developed by taking the advantages of DNAzyme assisted cascade signal amplification and ultra-high fluorescence quenching efficiency of reduced graphene oxide (rGO). This detection system consisted of DNAzyme, rGO and fluorescence probe allows the activity of Fpg to be detected in a linear range from 0 to 80 U/mL with a detection limit of 0.66 U/mL. With the help of this method, 11 natural compounds were screened, and 7 compounds were identified as activators of Fpg. More importantly, the developed assay was used to monitor the activity of Fpg through fluorescence imaging in living Escherichia coli for the first time. The imaging results visually demonstrated the dynamic activation effect of natural compound Ginsenoside Re on the Fpg of Escherichia coli. In summary, these results indicated that this DNAzyme and rGO based fluorescence assay provides a potent strategy for Fpg quantitative assay in vitro and real-time monitoring in living bacteria, which holds great potential for applying on biological study and Fpg-targeted drug screening.

Prevalence, risk factors, challenges, and the currently available diagnostic tools for the determination of helminths infections in human

Soil transmitted helminthes (STH) are among the major public health issues in tropical and sub-tropical countries infecting more than 2 billion humans worldwide. STH causes considerable morbidity in children, affecting their cognitive development and physical growth. Endemic areas with poor sanitation and limited access to good quality water supply have the highest burden of STH infection. Various approaches to reduce and control the worm infections include the intermittent deworming of children with anti-helminthic drugs. Individual patient management and population based studies can only be successful upon using the diagnostic techniques with high accuracy. The lack of reliable tools for the provision of correct diagnostic results about the status and intensity of infection is a major challenge, as these factors varies considerably in areas of low infection intensities. The techniques currently available for the diagnosis of parasitic infections show limited specificity and sensitivity and as such several techniques in combination are normally used in diagnosing the variety of parasite species infection. This review article was planned to study the prevalence, risk factors, and the available diagnostic techniques for soil and water transmitted helminthes infections in humans. This article also discussed the challenges in diagnosis, treatment, and management of worm infections particularly helminthes. The articles available online on important portals like google scholar, PubMed, Digital Libraries, PakMediNet, Science direct, and the Directory of Open Access Journals (DOAJ) were searched for inclusion of the data in this review study. Duplicate studies and irrelevant reports describing the general aspects of parasite infections were excluded. This review study provides a comprehensive report on the prevalence, accurate diagnostic, and chemotherapeutic protocols to reduce the burden of worms infections. WHO suggests the chemotherapy for worm infections as feasible and cost effective strategy in schools due to the lack of proper policy for the prevention of intestinal worms.

Vicia plants-A comprehensive review on chemical composition and phytopharmacology

The plants belonging to the genus Vicia are of great interest as a source of many bioactive compounds and micronutrients. A snapshot of their cultivation, habitat, main components, from which essential oils can be obtained, is given. The traditional medicinal uses of Vicia plants are also reported, as well as the wide spectrum of the main biological activities attributed to Vicia plants is discussed regarding potential health beneficial properties, in particular anti-Parkinson, anticholinesterase, antidepressant, anticonvulsant, antimicrobial, cytotoxic, antioxidant, antiinflammatory and antinociceptive, antidiabetic, antihemolytic, anticoagulant, estrogenic, diuretic, antihypoxic activities.

Comprehensive Review on Graphene Oxide for Use in Drug Delivery System

Motivated by the accomplishment of carbon nanotubes (CNTs), graphene and graphene oxide (GO) has been widely investigated in the previous studies as an innovative medication nanocarrier for the loading of a variety of therapeutics as well as anti-cancer medications, poor dissolvable medications, antibiotics, antibodies, peptides, DNA, RNA and genes. Graphene provides the ultra-high drug-loading efficiency due to the wide surface area. Graphene and graphene oxide have been widely investigated for biomedical applications due to their exceptional qualities: twodimensional planar structure, wide surface area, chemical and mechanical constancy, sublime conductivity and excellent biocompatibility. Due to these unique qualities, GO applications provide advanced drug transports frameworks and transports of a broad range of therapeutics. In this review, we discussed the latest advances and improvements in the uses of graphene and GO for drug transport and nanomedicine. Initially, we have described what is graphene and graphene oxide. After that, we discussed the qualities of GO as a drug carrier, utilization of GO in drug transport applications, targeted drug transport, transport of anticancer medications, chemical control medicine releasee, co-transport of different medications, comparison of GO with CNTs, nano-graphene for drug transport and at last, we have discussed the graphene toxicity. Finally, we draw a conclusion of current expansion and the potential outlook for the future.

Clinical outcome of paediatric patients with traumatic brain injury (TBI) receiving 3% hypertonic saline (HTS) in the emergency room of a tertiary care hospital

OBJECTIVE

To determine the clinical outcome and mean length of hospital stay of paediatric patients with severe blunt traumatic head injury (THI) receiving 3% hypertonic saline (HTS) in the Emergency Department (ED).

Methodology

This case series study was conducted at the Department of Emergency Medicine, Aga Khan University Hospital, Karachi, from 2014 to 2015 via chart review of 105 patients. Detailed history and clinical examination of all paediatric patients aged 2-16 years was recorded which included moderate to severe head injury as classified by the Glasgow Coma Scale (GCS) by the Brain Trauma Foundation. As per routine care after admission of such a patient, for resuscitation 3% HTS was administered. GCS was recorded at 6 hours and at the time of discharge.

RESULTS

Of the 105 patients, 76 (72.4%) were male and 29 (27.6%) were female, and the mean age was 61.6+45.9 months. Traumatic brain injury (TBI) was found moderate in 60 (57.1%) cases and severe in 45 (42.9%) of our patients as per the GCS. Six hours after resuscitation with 3% hypertonic saline, 45 (43%) patients normalised as per GCS, 39 (37%) patients had moderate TBI and 21 (20%) had severe TBI. Forty five patients had a hospital stay of 2-3 days. The GCS improved after resuscitation with 3% hypertonic saline in emergency department, with a mean length of stay of 4.6+3.9 and 12.6+10.7 days in moderate and severe head injury respectively with a P value of <0.001, and was normal in 94 (89.5%) patients at the time of discharge.

CONCLUSIONS

Paediatric patients with TBI receiving 3% hypertonic saline results in improved GCS and a decrease in the length of hospital stay.

Progress and prospects in the management of bacterial infections and developments in Phytotherapeutic modalities

The advent of antibiotics revolutionized medical care resulting in significantly reduced mortality and morbidity caused by infectious diseases. However, excessive use of antibiotics has led to the development of antibiotic resistance and indeed, the incidence of multidrug-resistant pathogens is considered as a major disadvantage in medication strategy, which has led the scholar's attention towards innovative antibiotic sources in recent years. Medicinal plants contain a variety of secondary metabolites with a wide range of therapeutic potential against the resistant microbes. Therefore, the aim of this review is to explore the antibacterial potential of traditional herbal medicine against bacterial infections. More than 200 published research articles reporting the therapeutic potential of medicinal plants against drug-resistant microbial infections were searched using different databases such as Google Scholar, Science Direct, PubMed and the Directory of Open Access Journals (DOAJ), etc., with various keywords like medicinal plants having antibacterial activities, antimicrobial potentials, phytotherapy of bacterial infection, etc. Articles were selected related to the efficacious herbs easily available to local populations addressing common pathogens. Various plants such as Artocarpus communis, Rheum emodi, Gentiana lutea L., Cassia fistula L., Rosemarinus officinalis, Argemone maxicana L, Hydrastis canadensis, Citrus aurantifolia, Cymbopogon citrates, Carica papaya, Euphorbia hirta, etc, were found to have significant antibacterial activities. Although herbal preparations have promising potential in the treatment of multidrug-resistant bacterial infection, still more research is required to isolate phytoconstituents, their mechanism of action as well as to find their impacts on the human body.

Development of a nanodrug-delivery system camouflaged by erythrocyte membranes for the chemo/phototherapy of cancer

Aim: Development of a new drug-delivery system using a compound derived from Pronephrium penangianum (J5) for the treatment of cervical cancer. Materials & methods: The delivery system was developed using Prussian blue nanoparticles, camouflaged by red blood cell membrane and with folic acid surface modifications. Results: Our results showed the successful development of a nanodrug-delivery system, which increases the half-life and immune evasion ability of the drug. The mechanism of this system was through suppressing B-cell lymphoma 2 and increasing B-cell lymphoma 2-associated X protein and the cleaved caspase level. An in vivo study also confirmed good antitumor activity without any side effects to normal tissue. Conclusion: This drug-delivery system provides a good alternative for the treatment of cervical cancer using J5.

Xuetonglactones A-F: Highly Oxidized Lanostane and Cycloartane Triterpenoids From Kadsura heteroclita Roxb. Craib

Xuetonglactones A–F (1–6), six unreported highly oxidized lanostane- and cycloartane-type triterpenoids along with 22 known scaffolds (7–28) were isolated from the stems of Kadsura heteroclita (Roxb.) Craib. Compared with previous congeners, xuetonglactone A (1), possesses an unprecedented 20,21-α-epoxide, and xuetonglactone D (4) features an unusual 19-α-hydroperoxyl moiety. The structures and the absolute configurations of the compounds were established by extensive one- and two-dimensional NMR, and electronic circular dichroism (ECD) spectroscopic analysis, with those of 1 and 5 confirmed by single-crystal X-ray diffraction technique. Compounds 1 and 2 exhibited inhibition of iNOS activity in LPS-induced macrophages with IC₅₀ values of 22.0, and 17.0 μg/mL, respectively. While compounds 6, 7, 8, and 24 showed potent cytotoxic activities against human cervical cancer cell lines (HeLa) with the IC₅₀ values of 4.0, 5.8, 5.0, and 6.4 μM, and against human gastric cancer cells (BGC 823) with the IC₅₀ values of 2.0, 5.0, 2.5, and 2.0 μM, respectively. Moreover, plausible biogenetic pathways of (1–6) were also proposed.

Awareness and current knowledge of epilepsy

Epilepsy is a severe neural disorder that affects approximately fifty million individuals globally. Despite the fact that for most of the people with epilepsy, convulsions are better controlled by current accessible antiepileptic medicines, yet there are more than 30% of individuals affected with medically intractable epilepsy and around 30-40% of all patients with epilepsy affected by many adverse reactions and convulsion resistance to the present antiepileptic drugs. Consequently, various scientists attempt to develop new strategies to treat epilepsy, for instance, to find out novel antiepileptic ingredients from traditional medicines. This work aims to present a complete summary of natural medicines prescribed as antiepileptic agents all over the world by ethnic groups and different tribes. We undertook an extensive bibliographic analysis by searching peer reviewed papers and classical textbooks and further consulting well accepted worldwide scientific databases. We carried out PubMed, EMbase and CENTRAL searches by means of terms such as "antiepileptic" and "anti-convulsant" activity of plants. Medicinal plants have been prescribed to treat epilepsy and have been recognized as antiepileptic medicines. In this review, a variety of herbs have been reviewed for thorough studies such as Cuminum cyminum, Butea monosperma, Solanum americanum, Anacyclus pyrethrum, Leonotis leonurus, Elaeocarpus ganitrus and Angelica archangelica. This paper shows that it was high time experimental studies are increased to obtain novel potential active principles from medicinal plants. Plant extracts and their chemical constituents should be further evaluated to clarify their mechanisms of action. This paper provides a solid base upon which to further investigate the clinical efficacy of medicinal plants that are both currently prescribed by physicians as traditional antiepileptic agents, but also could be effective as an antiepileptic drug with further research and study.

Endogenous Cys-Assisted GSH@AgNCs-rGO Nanoprobe for Real-Time Monitoring of Dynamic Change in GSH Levels Regulated by Natural Drug

Glutathione (GSH) levels are closely related to the homeostasis of redox state which directly affects human disease occurrence by regulating cell apoptosis. Hence, real-time monitoring of dynamic changes in intracellular GSH levels is urgently needed for disease early diagnosis and evaluation of therapy efficiency. In this study, an endogenous cysteine (Cys)-assisted detection system based on GSH@AgNCs and reduced graphene oxide (rGO) with high sensitivity and specificity was developed for GSH detection. Compared with GSH, GSH@AgNCs with weaker affinity and bonding force was quite easier to extrude from the rGO surface when competing against GSH, leading to the obvious change in fluorescence signal. This phenomenon was termed as "a crowding out effect". Furthermore, the presence of Cys can improve GSH assay sensitivity by enhancing the quenching efficiency of rGO on the GSH@AgNCs. In vitro assay indicated that the efficiency of fluorescence recovery was positively related with GSH concentration in the range from 0 to 10 mM. In addition, the method was employed for real-time monitoring of the dynamic changes in GSH levels regulated by natural drugs. The imaging results showed that the natural compound 3 (C3) can downregulate GSH levels in HepG2 cells, which was accompanied by reactive oxygen species (ROS) release and apoptosis induction. Finally, the method was used to monitor the change of GSH levels in serum samples with chronic hepatitis B (CHB) infection. The results demonstrated that the occurrence and development of CHB may be positively correlated with GSH levels to some extent. Overall, the above results demonstrate the potential application of this new nanosystem in anticancer natural drug screening and clinical assay regarding GSH levels.

Chemical constituents, experimental and clinical pharmacology of Rosa damascena: a literature review

CONTEXT

Rosa damascena Mill. is prescribed for the management of chest and abdominal pain, constipation, digestive disorders, menstrual bleeding and liver ailments.

OBJECTIVE

The current review compiles up to date and complete information of whole plant of R. damascena with particular emphasis on its numerous scientifically proved pharmacological effects, traditional and folk medicinal uses.

KEY FINDING

The data on the pharmacological effects of R. damascena were collected from various databases such as PubMed, Wiley Online Library, Elsevier and Web of Science using the keywords like phytoconstituents, pharmacology, medicinal uses and biological activity of R. damascene. Rosa damascena has a wide spectrum of bio-pharmacological activity like antidepressant, hypoglycaemic, anti-inflammatory, analgesic, antioxidant and antimicrobial. The main ingredients of R. damascena essential oil responsible for pharmacological activity are geraniol and citronellol. Its uses have been widely accepted in traditional system of medicines for the management of numerous diseases of human beings in different dosage forms.

SUMMARY

Rosa damascena has a significant place in traditional system of medicine. It is cost-effective and an important plant with curative application in contemporary medicine. Further studies on the characterization of chemical constituents and scientific basis of pharmacological activity of R. damascena should be carried out to evaluate its impact on traditional system of medicines. Large-scale preclinical and clinical trials will be beneficial in investigating the mechanism of the therapeutic potential of R. damascene to explore its uses in pharmaceutical industries.

Awareness and Current Therapeutics of Asthma

Introduction:

Asthma is a serious allergic disorder of the respiratory system. It affects about 300 million people worldwide. This has a great burden on medical treatment. Several medicines are available, but they have many serious side effects. Therefore, there is a need to search for a new therapeutic agent with no or minimal side effects while most economical for patients. In folk medicine, antiasthmatics herbal medicine has been used and showed potential therapeutic antiasthmatic efficacy due to the presence of potential bioactive compounds.

Methods:

Different databases were searched (ie, Embase, PubMed, CBM, AMED, and CINAHL). We have reviewed the published data of the last 20 years. We used MeSH terms “asthma” herbal treatment of asthma, allopathic treatment of asthma, and treatment strategies for asthma. The traditional medicine was compared with modern medicine and the same pharmacotherapies alone or with placebo. The methodology was evaluated by using the GRADE summary of Finding tables and Cochrane Risk of Bias Tool.

Results:

There have been some clear-cut indications toward the recognition of further molecular and cellular mechanisms of asthma. Most of them recommend a further target for treatment. The novel procedures, biologics, and pharmaceuticals are evaluated. Both allopathic and herbal treatments of asthma are effective. Due to none or lesser side effects, herbal medicines are safer than conventional medicine.

Conclusion:

The preliminary documentation of the plants discussed in the review show the presence of several secondary metabolites that are responsible for the management of asthma and its relevant complications. Further research studies are needed to identify the bioactive compounds from these plants that have potential efficacy to cure asthma, and clinically based studies are needed to search for a complete cure for this disease.

Hexose monophosphate shunt, the role of its metabolites and associated disorders: A review

The hexose monophosphate (HMP) shunt acts as an essential component of cellular metabolism in maintaining carbon homeostasis. The HMP shunt comprises two phases viz. oxidative and nonoxidative, which provide different intermediates for the synthesis of biomolecules like nucleotides, DNA, RNA, amino acids, and so forth; reducing molecules for anabolism and detoxifying the reactive oxygen species during oxidative stress. The HMP shunt is significantly important in the liver, adipose tissue, erythrocytes, adrenal glands, lactating mammary glands and testes. We have researched the articles related to the HMP pathway, its metabolites and disorders related to its metabolic abnormalities. The literature for this paper was taken typically from a personal database, the Cochrane database of systemic reviews, PubMed publications, biochemistry textbooks, and electronic journals uptil date on the hexose monophosphate shunt. The HMP shunt is a tightly controlled metabolic pathway, which is also interconnected with other metabolic pathways in the body like glycolysis, gluconeogenesis, and glucuronic acid depending upon the metabolic needs of the body and depending upon the biochemical demand. The HMP shunt plays a significant role in NADPH₂ formation and in pentose sugars that are biosynthetic precursors of nucleic acids and amino acids. Cells can be protected from highly reactive oxygen species by NADPH ₂ . Deficiency in the hexose monophosphate pathway is linked to numerous disorders. Furthermore, it was also reported that this metabolic pathway could act as a therapeutic target to treat different types of cancers, so treatments at the molecular level could be planned by limiting the synthesis of biomolecules required for proliferating cells provided by the HMP shunt, hence, more experiments still could be carried out to find additional discoveries.

Two new alkaloids isolated from traditional Chinese medicine Binglang the fruit of Areca catechu

Binglang, the fruit of Areca catechu L, has a long history as an important Chinese herbal medicine. Two new alkaloids (1 and 2), along with forty-one known compounds (3-43) were isolated from the dried fruit of Areca catechu L. The structures were elucidated on basis of the IR, UV, MS and 1D, 2D NMR spectroscopic data. Compounds 26 and 33 showed weak cytotoxicity against human gastric cancer cell line (BGC-823) with IC₅₀ of 15.91 μM and 20.13 μM, respectively.