Efficacy of Habb-e-Asab in diabetic peripheral neuropathy: a randomized placebo control study

Objectives Diabetic peripheral neuropathy (DPN) is a common diabetes complication. The prevalence of neuropathy is 55% for type 1 and 66% for type 2 diabetes. In Unani medicine neuropathy is known as Khidr (numbness). It is treated with drugs possessing hypoglycemic and analgesic properties, etc. Habb-e-Asab, a polyherbal Unani formulation used for the treatment of Waja-ul-Asab (neuralgia) is routinely used for its indications in neurological pain in Unani medicine. The aim of this study to investigate the efficacy of Habb-e-Asab in diabetic peripheral neuropathy. Methods Thirty patients with DPN were randomly assigned to test (n=20) and control (n=10) groups in a randomized single-blind placebo control study. For 45 days, the test group was given 250 mg Habb-e-Asab twice a day and the control group 250 mg placebo twice a day. The subjective parameters Pain in feet, burning in feet, and tingling in feet was assessed by the arbitrary scale and VAS fortnightly and objective parameters MNSI, and VPT was assessed in pre–post-treatment. Results The research drug revealed highly statistically significant with p<0.001 on VAS score and MNSI whereas VPT is significant with p<0.01 on few points. But control group exhibits no significant effect in any of the parameters. No adverse effects had been reported in either group. Conclusions Our finding indicated that the Habb-e-Asab for 45 days improved and reduced the severity of DPN in a patient with diabetes (CTRI/2018/02/011725).

Modern gold standard of cardiac output measurement – A simplified bedside measurement of individual oxygen uptake in the cath lab

Objectives Cardiac output (CO) measurements employing the direct Fick principle represent the gold standard in right-sided heart catheterization (RHC). The current widespread approach in hemodynamic workup however uses the indirect Fick principle with assumed values for oxygen uptake (VO2) leading to incorrect CO values in up to 25% of patients. We have tested a contemporary breath-by-breath gas analyzer that allows precise real-time measurements of VO2 with appropriate time and effort to serve the direct Fick principle. Methods By means of a small and mobile metabolic cart assembled with widely used components of a standard spiroergometer, we performed bedside measurements of individual VO2. In 33 unselected, consecutive patients with various indications for RHC we compared CO values derived from indirect vs. direct Fick calculations. Results In 28 of the 33 patients, VO2 measurements were completed with a plausible dataset within a median of 3.2 (interquartile range 2.8–6.2) min. In nine of the 28 patients, CO values based on measured VO2 values differed by more than 20% from CO calculations based on assumed VO2 values with value deviations scattering over a broad range in both directions (maximally +52% to minimally −46%). Conclusions The bedside measurement of VO2 for gold standard CO determination is technically feasible within a few min and can thus be easily included in any RHC protocol. As modern therapy for numerus indications demand a precise upfront measurement of hemodynamics, our method might help to correctly identify patients for costly therapies.

Hydroxychloroquine pre-exposure prophylaxis provides no protection against COVID-19 among health care workers: a cross-sectional study in a tertiary care hospital in North India

Objectives The use of Hydroxychloroquine (HCQ) prophylaxis has been recommended by the National task force constituted by the Indian Council of Medical Research (ICMR) for the prevention of corona virus disease 2019 (COVID-19) among healthcare workers (HCWs). However, this recommendation was based essentially on the preclinical data and limited clinical experience. The aim of this study was to evaluate the efficacy and safety of HCQ as a pre-exposure prophylaxis for COVID-19 infection among Indian HCWs. Methods A cross-sectional study was conducted among HCWs of a tertiary care hospital in north India. The HCQ prophylaxis was initiated among 996 HCWs and they were followed up to 8 weeks for conversion to COVID-19 positive status and any adverse drug reaction (ADR). Results About 10.3% of the study participants were tested positive for COVID-19 which was comparable to the positivity rate among HCWs not taking HCQ prophylaxis (9.7%). Conclusions HCQ was well tolerated at a weekly dose of 400 mg for 8 weeks but provided no additional benefit in prevention of COVID-19 among HCWs.

Diabetic wound healing approaches: an update

Diabetic wounds are of profound clinical importance. Despite immense efforts directed towards its management, it results in the development of amputations, following a diagnosis of diabetic foot. With a better understanding of the complexities of the microbalance involved in the healing process, researchers have developed advanced methods for the management of wounds as well as diagnostic tools (especially, for wound infections) to be delivered to clinics sooner. In this review, we address the newer developments that hope to drive the transition from bench to bedside in the coming decade.

Antibody-dependent enhancement of virus infection and disease: implications in COVID-19

Antibody-dependent enhancement (ADE) can be seen in a variety of viruses. It has a deleterious impact on antibody treatment of viral infection. This effect was first discovered in the dengue virus, and it has since been discovered in the coronavirus. Over 213 million people have been affected by the rapid spread of the newly emerging coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19). The new coronavirus offers a significant threat and has sparked widespread concern. ADE in dengue virus and other viruses are discussed with possible effect on COVID-19 treatment and vaccine development will need to consider this phenomenon to ensure it is mitigated and avoided altogether. In these case scenarios, the role of ADE and its clinical consequences remains to be explored for this newly detected virus.

Anti-atherosclerotic activity of aqueous extract of Ipomoea batatas (L.) leaves in high-fat diet-induced atherosclerosis model rats

Objectives Cardiovascular diseases, especially atherosclerosis, are the leading cause of human mortality in Indonesia. Ipomoea batatas (L.) is a food plant used in Indonesian traditional medicine to treat cardiovascular diseases and related conditions. We assessed the anti-atherosclerotic activity of the aqueous extract of I. batatas leaves in a rat model of high-fat diet-induced atherosclerosis and its mechanism. Methods The presence of amino acid content in the I. batatas L. purple variant was determined by liquid chromatography high-resolution mass spectrometry (LC-HRMS). Thirty male Wistar rats were divided into five groups (n=6/group), i.e., standard diet group (SD), high-fat diet group (HF), and HF plus I. batatas L. extracts orally (625; 1,250; or 2,500 mg/kg) groups. The numbers of macrophages and aortic wall thickness were analyzed histologically. Immunohistochemical analyses were performed to assess foam cells-oxidized low-density lipoprotein (oxLDL), endothelial nitric oxide synthase (eNOS), and vascular endothelial growth factor (VEGF) expression in the aorta. Results LC-HRMS analysis showed nine amino acid content were identified from I. batatas L. In vivo study revealed that oral administration of I. batatas L. leaf extract alleviated foam cells-oxLDL formation and aortic wall thickness caused by high-fat diet atherosclerosis rats. Further, I. batatas L. leaf extract promoted the number of macrophages and modulated VEGF and eNOS expression in the aorta. Conclusions I. batatas L. leaf extract shows a positive anti-atherosclerosis effect. Furthermore, the mechanism may promote the macrophages, eNOS, VEGF expressions, and inhibition of foam cells-oxLDL formation and aortic wall thickness with the best dosage at 2,500 mg/kg. This could represent a novel approach to prevent cardiovascular diseases.

Monocyte chemoattractant protein-1 levels are associated with major depressive disorder

Objectives Major depressive disorder (MDD) is a distressing condition characterized by persistent low mood, loss of interest in daily activities. Researchers consider several biological, psycho-social, and genetic factors are involved in depression. The present study aimed to investigate the serum levels of monocyte chemoattractant protein-1 (MCP-1) in MDD patients to explore its role in depression. Methods This case-control study recruited 114 MDD patients and 106 healthy controls (HCs) matched by age and gender. A specialized psychiatrist diagnosed the cases and evaluated the controls based on the diagnostic and statistical manual for mental disorders, 5th edition. We quantified serum MCP-1 levels using commercially available enzyme-linked immune sorbent assay kits. Also, we applied the Hamilton depression rating scale (Ham-D) to measure the severity of depression. Results We observed the decreased levels of serum MCP-1 in MDD patients compared to HCs. Also, we obtained a significant negative correlation between serum MCP-1 levels and Ham-D scores. Moreover, female MDD patients with higher Ham-D scores exhibited lower serum MCP-1 levels. The receiver operating characteristic analysis demonstrated the good diagnostic value of MCP-1 with the area under the curve at 0.837. Conclusions The depression-related alteration of serum MCP-1 may be more complicated than the current assumption and depends on the characteristics of the individual patients. Our study suggests that the serum MCP-1 levels might involve in the pathophysiology and mechanism of MDD. The present findings, along with the diagnostic evaluation, might be used to evaluate depressive patients.

A review of the mechanisms of anti-cancer activities of some medicinal plants–biochemical perspectives

Cancer is a disease resulting in unbridled growth of cells due to dysregulation in the balance of cell populations. Various management procedures in handling cases of cancer are not without their adverse side effects on the normal cells. Medicinal plants/herbs have been in use in the management of various ailments, including cancer, for a long time. Medicinal plants have been credited with wide safety margins, cost effectiveness, availability and diverse activities. This study reviewed various mechanisms of anti-cancer activities of some medicinal plants from a biochemical perspective. The mechanisms of anti-cancer activities of plant compounds addressed in this article include induction of apoptosis, anti-angiogenic effects, anti-metastasis, inhibition of cell cycle, inhibition of DNA destruction and effects on key enzymes, cytotoxic and anti-oxidant effects. The anti-cancer activities of some of the plants involve more than one mechanism.

Alpha2-antiplasmin deficiency affects depression and anxiety-like behavior and apoptosis induced by stress in mice

Objectives Depression is a psychiatric disorder that affects about 10% of the world’s population and is accompanied by anxiety. Depression and anxiety are often caused by various stresses. However, the etiology of depression and anxiety remains unknown. It has been reported that alpha2-antiplasmin (α2AP) not only inhibits plasmin but also has various functions such as cytokine production and cell growth. This study aimed to determine the roles of α2AP on the stress-induced depression and anxiety. Methods We investigated the mild repeated restraint stress-induced depressive and anxiety-like behavior in the α2AP+/+ and α2AP−/− mice using the social interaction test (SIT), sucrose preference test (SPT), and elevated plus maze (EPM). Results The stresses such as the mild repeated restraint stress suppressed α2AP expression in the hippocampus of mice, and the treatment of fluoxetine (selective serotonin reuptake inhibitor [SSRI]) recovered the stress-caused α2AP suppression. We also showed that α2AP deficiency promoted the mild restraint stress-stimulated depression-like behavior such as social withdrawal and apathy and apoptosis in mice. In contrast, α2AP deficiency attenuated the mild restraint stress induced the anxiety-like behavior in mice. Conclusions α2AP affects the pathogenesis of depression and anxiety induced by stress.

Effect of ascorbic acid supplementation on pulmonary functions in healthy adults: a randomized controlled pilot study

Objectives The fact that oxidative stress plays an important role in the pathogenesis of various pulmonary diseases is supported by the beneficial effect of antioxidants. It is also well known that an altered oxidant-antioxidant balance after the age of 35 years increases the susceptibility to develop obstructive lung diseases later in life. Given this, the present study was designed to evaluate the effect of antioxidant supplementation on lung functions in healthy adults after the age of 35 years. Methods Persons of age ≥35 years (n=45) were randomized into three arms (each comprising 15 participants) to receive either no intervention (NI arm), ascorbic acid 250 mg daily (AA250 arm), or ascorbic acid 500 mg daily (AA500 arm) for 6 weeks. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, and peak expiratory flow (PEF) were measured at baseline and 6 weeks. Persons of age group (20–30 years) were also enrolled in the study to compare their lung functions and cardiovascular parameters at baseline with those ≥35 years of age. All the adverse events experienced by participants were recorded. Results Baseline pulmonary functions were found to be comparable among the three study arms and compared to ≥35 years age group, these parameters were found to be better in the younger age group (20–30 years). Most of the pulmonary functions were comparable among the three study arms at 6 weeks. A significant improvement in PEF and % predicted PEF was noted in AA250 arm when compared to baseline values (p=0.049 and 0.026, respectively) and in participants with normal pulmonary functions when compared to those with reduced functions at baseline (p=0.059 and p=0.037). Conclusions Although ascorbic acid did not affect most of the pulmonary functions in healthy adults, it improved PEF and % predicted PEF at a daily dose of 250 mg. In this regard, it was found effective in individuals with normal pulmonary indices at baseline.