In vitro and In vivo Determination of Biological Activities of Bitter Gourd (Momordica charantia L.) Peel, Flesh and Seeds.

Momordica charantia L. has been remained a well-known medicinal vegetable used traditionally. However, which part is most effective against which disorder, has been remained undiscovered yet. The objective of this study was to examine the antimicrobial, antihyperlipidemic and antihyperglycemic activities of peel, flesh, and seeds of bitter gourd, through in vitro and in vivo assays. Ethanolic extracts from powders of three fractions of bitter gourd were assessed for antimicrobial potential against bacterial and fungal strains, whereas, powders of these fractions were used to determine antihyperlipidemic and antihyperglycemic activity, in alloxan induced diabetic rats. Our results showed that BSE exhibited better antimicrobial activity against Bacillus cereus, whereas BFE exhibited better against Escherichia coli. Blood glucose was significantly lowered by all three powders in a dose dependent manner, when fed to diabetic rats, with the highest decrease by BSP, which reduced the glucose level from 296.20 ± 2.00 mg/dl to 123.10 ± 0.80 mg/dl, at 15 mg dose, after 28 days trial. Elevated levels of TC (101.18 ± 0.65 mg/dl), TG (83.69 ± 0.61 mg/dl) and LDL-C (25.90 ± 0.09 mg/dl) in positive control rats were lowered down in well manners by BSP at 15 mg dose, to 86.30 ± 0.53, 67.70 ± 0.53 and 19.32 ± 0.06 mg/dl, respectively. As compared to BFP and BPP, BSP showed significant involvement in antibacterial, antihyperglycemic, and antihyperlipidemic actions. Along with the edible flesh, peels and seeds, which are usually discarded as waste, could also be utilized for development of pharma foods capable of promoting health.

Physiological and biochemical variations of naturally ripened mango (Mangifera Indica L.) with synthetic calcium carbide and ethylene.

To meet the increasing consumer demands for fruits, the implementation of artificial ripening techniques using synthetic chemicals has become increasingly commonplace among less ethical fruit production companies in today's global market. The objective of present work was to establish a difference in the physiological and biochemical and profiles of naturally ripened mangoes vs. those ripened by application of synthetic calcium carbide and ethylene. The application of calcium carbide at 10 g/kg mangoes resulted early ripening in 2 days, with a 3-day shelf life, as compared with 5 and 6 days, for mangoes ripened by ethylene and naturally, respectively. Higher levels of calcium carbide reduced moisture, fiber, protein and carbohydrates content and increased the ash content of mangoes, as compared to higher levels of ethylene, whereas in naturally ripened mangoes the content percentages were 80.21, 3.57, 3.05 6.27 and 4.74, respectively. Artificial ripening resulted in significant loss of ascorbic, citric and malic acid, as values were recorded 35.94, 2.12 and 0.63 mg/g, respectively, in mangoes ripened with 10 g/kg of calcium carbide. However, in naturally ripened mangoes the amounts of these acids were recorded significantly (p < 0.05) high as 52.29, 3.76 and 1.37 mg/g, respectively. There was an increase in total soluble solids (TSS) and reducing sugars, and a decrease in titratable acidity in calcium carbide (10 g/kg) treated mangoes. Elemental analyses revealed high levels of minerals in naturally ripened mangoes, with significant values of iron (0.45 mg/100 g), zinc (0.24 mg/100 g) and copper (0.17 mg/100 g). The organoleptic quality of the fruit decreased significantly (p < 0.05) as a result of the use of calcium carbide. Although use of artificial ripening techniques provides speedy ripening of mangoes, there are obvious limitations. Consequently, natural ripening should be promoted in order to have safer and more nutritious mangoes.

Food Application of Orange Seed Powder through Incorporation in Wheat Flour to Boost Vitamin and Mineral Profiles of Formulated Biscuits.

The significance of conducting research for its application has been noted as a result of the rising global food production and waste generation. As a result, there is increasing interest in fruits and vegetable seeds that contain bioactive chemicals, such as those that are obtained from orange seeds. In the current work, orange seed powder replaced wheat flour at 0, 2.5, 5, 7.5, and 10% levels, to observe changes in physicochemical features of developed biscuits. Proximate analysis of orange seed powder and wheat flour revealed that orange seed powder has high fat, fiber, protein, and ash contents as compared to wheat flour, whereas moisture contents in wheat flour were high. In developed biscuits, the highest values (percentage) of ash (9.68 ± 0.04), fiber (6.79 ± 0.12), protein (10.42 ± 0.25), and fat (36.90 ± 0.55) were found in biscuits developed with 10% orange seed powder. Orange seed powder was a comparatively good source of both macro and micro minerals, as compared to wheat flour. High contents of selenium (5.32 ± 0.03), iron (2.12 ± 0.05), zinc (3.88 ± 0.12), and manganese (2.25 ± 0.04) mg/100 g, present in orange seed powder, were the prominent findings of this research work, as wheat flours were observed to be deficient in these trace minerals. Contents of calcium, magnesium, potassium, zinc, manganese, zinc, and selenium in control biscuits were found 20.51 ± 0.08, 17.29 ± 0.04, 46.12 ± 0.05, 1.06 ± 0.01, 1.97 ± 0.01, 0.12 ± 0.01, and 0.11 ± 0.01 mg/100 g, respectively, and replacement of wheat flour with 10% orange seed powder increased values of these minerals to 103.90 ± 0.35, 44.35 ± 0.50, 71.29 ± 0.32, 2.59 ± 0.4, 2.75 ± 0.02, 1.31 ± 0.01, and 2.02 ± 0.05 mg/100 g, respectively. Vitamins E and K, which were not detected in wheat flour, were present in orange powder in high amount, whereas B group vitamins, which were also present in wheat flour, were observed in significantly high quantities in orange seed powder. Increment in vitamin A, D, E, K, and B complexes was significant as a result of orange seed powder supplementation, except for vitamins B1 and B2, which were slightly decreased. Sensory evaluation revealed that a 5% replacement of orange seed powder provided good quality biscuits with acceptable colour, flavor, taste, texture, and overall acceptability. Orange seed powder could prove an important ingredient in the baking industry with the potential of promoting the nutritional value of foods.

Long-term testosterone undecanoate replacement therapy: Impact of ethnicity.

BACKGROUND: Testosterone replacement therapy (TRT) is indicated for symptomatic male hypogonadism. However, the safety and efficacy profiles across different ethnicities for long-term TRT remain unclear. OBJECTIVE: To measure the impact of ethnicity on various biochemical parameters following testosterone undecanoate (TU) replacement. METHOD: A retrospective analysis of 50 male patients treated with TU from 2006 to 2017 in a large secondary care centre was performed. Changes in total testosterone, PSA, haematocrit, haemoglobin, total cholesterol and low-density lipoprotein (LDL) over eight years of treatment were analysed. Wilcoxon rank sum test was used to assess differences in these parameters between Caucasians and South Asians. RESULTS: Thirty-one Caucasians (age: median (IQR) 55.0 years (49.0-68.0); total duration of follow-up 6.1 years (2.9-9.3)) and 19 South Asians (age: median (IQR) 52.0 years (38.0-69.0); duration of follow-up 6.5 years (1.3-8.4)) were treated with TU during the study period. There was no significant difference in total testosterone levels between the two ethnicities. We noted a higher free and bioavailable testosterone in South Asians than Caucasians, albeit within their reference range. PSA was higher in Caucasians than South Asians at two and eight years of TU therapy. After one year of TRT, haematocrit was higher in South Asians than Caucasians at one year, whereas LDL and total cholesterol were significantly higher in Caucasians than South Asians. CONCLUSIONS: Caucasians have a tendency towards increased PSA, total cholesterol and LDL compared with South Asians with TU replacement therapy. There is a higher increment of haematocrit in South Asians following one year of TU replacement therapy. All biochemical changes following TRT were within the respective reference ranges suggesting no apparent risk of prostate cancer and venous thromboembolism.

Myocardial Infarction with non-obstructed coronaries - atypical presentation of pheochromocytoma.

SUMMARY: Although pheochromocytoma classically presents with headaches, palpitations and paroxysmal hypertension, atypical presentations such as cardiomyopathy, stroke and subarachnoid haemorrhage have been infrequently documented. We present in this case report, an uncommon presentation of pheochromocytoma with myocardial infarction with normal coronary arteries (MINOCA). A 79-year-old woman presented with central crushing chest pain radiating to left arm associated with headache, palpitations, sweating and difficulty in breathing. For 2 years, she experienced brief episodes of headache, tinnitus, dizziness, palpitations, and sweating that spontaneously resolved. Clinical examination was unremarkable except for high blood pressure (210/105 mmHg). Her electrocardiogram showed T wave inversions from V1 to V6 and elevated troponins (774 ng/L at baseline and 932 ng/L 3 h from baseline (normal <16 ng/L) in keeping with a diagnosis of non-ST elevated myocardial infarction. Coronary angiography showed normal coronary arteries. Patient was hence treated as myocardial infarction with normal coronaries (MINOCA). Despite appropriate treatment for MINOCA, she continued to experience episodic headaches, palpitations, dizziness and erratic blood pressures (particularly severe hypertension shortly after beta-blocker administration). Further investigations revealed raised urine noradrenaline of 4724 nmol/24 h (<554 nmol/24 h) and urine adrenaline of 92863 nmol/24 h (<77 nmol/24 h). Computerised tomography demonstrated a well-defined rounded mass in right adrenal gland morphological of pheochromocytoma. She underwent laparoscopic right adrenalectomy with histology confirming pheochromocytoma. This case highlights the importance of thorough investigation for the underlying cause for MINOCA. In patients with unexplained erratic blood pressure control, pheochromocytoma should be considered as a differential diagnosis. LEARNING POINTS: Pheochromocytoma is rare tumour that often presents with non-specific symptoms. It is important to investigate underlying cause of MINOCA. Thorough history is the key to diagnosis.

Adrenal insufficiency from steroid-containing complementary therapy: importance of detailed history

Summary: A 62-year-old Asian British female presented with increasing tiredness. She had multiple co-morbidities and was prescribed steroid inhalers for asthma. She had also received short courses of oral prednisolone for acute asthma exacerbations in the last 2 years. Unfortunately, the frequency and dose of steroids for asthma was unclear from history. Her type 2 diabetes mellitus (DM) control had deteriorated over a short period of time (HbA1c: 48­85 mmol/mol). Blood tests revealed undetectable cortisol and ACTH (<28 mmol/L, <5.0 ng/L). Renin, electrolytes and thyroid function were within normal limits. A diagnosis of secondary adrenal insufficiency, likely due to long-term steroid inhaler and recurrent short courses of oral steroids for asthma exacerbations was made. Patient was commenced on hydrocortisone 10 mg, 5 mg and 5 mg regimen. Steroid inhaler was discontinued following consultation with respiratory physicians. Despite discontinuation of inhaled steroids, patient continued not to mount a response to Synacthen®. Upon further detailed history, patient admitted taking a 'herbal' preparation for chronic osteoarthritic knee pain. Toxicology analysis showed presence of dexamethasone, ciprofloxacin, paracetamol, diclofenac, ibuprofen and cimetidine in the herbal medication. Patient was advised to discontinue her herbal preparation. We believe the cause of secondary adrenal insufficiency in our patient was the herbal remedy containing dexamethasone, explaining persistent adrenal suppression despite discontinuation of all prescribed steroids, further possibly contributing to obesity, hypertension and suboptimal control of DM. In conclusion, a comprehensive drug history including herbal and over-the-counter preparations should be elucidated. Investigation for the presence of steroids in these preparations should be considered when patients persist to have secondary adrenal insufficiency despite discontinuation of prescribed steroid medications. Learning Points: The likelihood of complementary and alternative medicines (CAMs) in medication-induced secondary adrenal insufficiency should be considered in any patient presenting with potential symptoms of adrenal insufficiency. If the contents of CAM preparation cannot be ascertained, toxicology screening should be considered. Patients should be advised to stop taking CAM preparation when it contains steroids and hydrocortisone replacement therapy commenced, with periodic reassessment of adrenal function, and then if indicated weaned accordingly. Patients should be informed about the contents of CAM therapies, so they can make a truly informed choice regarding the risks and benefits. This case also highlights a need to increase regulatory processes over CAM therapies, given their propensity to contain a number of undisclosed medications and potent steroids.