Steroids from Diplazium esculentum: Antiplasmodial activity and molecular docking studies to investigate their binding modes.

Diplazium esculentum is an edible fern commonly consumed by the local community in Malaysia either as food or medicine. Isolation work on the ethyl acetate extract of the stem of D. esculentum resulted in the purification of two steroids, subsequently identified as stigmasterol (compound 1) and ergosterol5,8-endoperoxide (compound 2). Upon further testing, compound 2 displayed strong inhibitory activity against the Plasmodium falciparum 3D7 (chloroquine-sensitive) strain, with an IC50 of 4.27±1.15 µM, while compound 1 was inactive. In silico data revealed that compound 2 showed good binding affinity to P. falciparum-Sarco endoplasmic reticulum calcium-dependent ATPase (PfATP6); however, compound 1 did not show an antiplasmodial effect due to the lack of a peroxide moiety in the chemical structure. Our data suggested that the antiplasmodial activity of compound 2 from D. esculentum might be due to the inhibition of PfATP6, which resulted in both in vitro and in silico inhibitory properties.

The economic dimension of directing treated wastewater to the production of green fodder in Saudi Arabia.

This study aimed to identify the economic dimension of directing treated wastewater to the production of green fodder. To achieve its objectives, the study relied on economic equations, the method of using multiple criteria, and a scoring technique for prioritization. The study showed that green fodder is a crop that depletes water, as it consumes about 67.27% of the water used for agricultural purposes. In determining the priority of regions intending to use treated wastewater, the ranking put Riyadh region first, followed by the eastern region, the Qassim region, Hail, Makkah Al-Mukarramah, Tabuk, Asir, Al-Jawf, Jizan, Madinah, Najran, the northern borders, and Al-Baha, in this order. The area that can be cultivated with forage crops is estimated to be about 53.05 thousand hectares, with a production of 953.75 thousand tons. The cost of treating wastewater to make it usable amounts to 2126.22 million riyals, while the value of the benefits gained from its use is 2508.95 million riyals; thus, the Saudi agricultural economy achieves a net gain estimated at about 382.73 million riyals annually. Therefore, this study recommends the use of treated wastewater in the production of green fodder.

Cardiometabolic determinants of mortality in a geriatric population: is there a "reverse metabolic syndrome"?

AIMS: Diabetes or insulin resistance, overweight, arterial hypertension, and dyslipidaemia are recognized risk factors for cardiovascular (CV) disease. However, their predictive value and hierarchy in elderly subjects remain uncertain. METHODS: We investigated the impact of cardiometabolic risk factors on mortality in a prospective cohort study of 331 elderly high-risk subjects (mean age+/-SD: 85+/-7 years). RESULTS: Two-year total mortality was predicted by age, diabetes, low BMI, low diastolic blood pressure (DBP), low total and HDL cholesterol, and previous CV events. The effect of diabetes was explained by previous CV events. In non-diabetic subjects, mortality was predicted by high insulin sensitivity, determined by HOMA-IR and QUICKI indices. In multivariate analyses, the strongest mortality predictors were low BMI, low HDL cholesterol and previous myocardial infarction. Albumin, a marker of malnutrition, was associated with blood pressure, total and HDL cholesterol, and HOMA-IR. The inflammation marker CRP was associated with low total and HDL cholesterol, and high HOMA-IR. CONCLUSION: In very old patients, low BMI, low DBP, low total and HDL cholesterol, and high insulin sensitivity predict total mortality, indicating a "reverse metabolic syndrome" that is probably attributable to malnutrition and/or chronic disorders. These inverse associations limit the relevance of conventional risk factors. Previous CV events and HDL cholesterol remain strong predictors of mortality. Future studies should determine if and when the prevention and treatment of malnutrition in the elderly should be incorporated into conventional CV prevention.

Homocysteine levels and peripheral arterial occlusive disease: a prospective cohort study and review of the literature.

AIM: The aim of this study was to determine the prevalence of hyperhomocysteinemia in a population with peripheral vascular occlusive disease in Kuwait. METHODS: From November 2000 to May 2002, total serum homocysteine levels were measured in 172 consecutive patients admitted to the vascular surgery unit because of peripheral vascular arterial disease. A fluorescence polarization immunoassay was used for measuring total serum homocysteine levels. Serum homocysteine levels over 15 mol/L were considered as high. RESULTS: The mean ankle-brachial index was 0.59+/-0.2 and 0.55+/-0.2 for right and left legs, respectively. The mean serum homocysteine level was 14.9+/-4.7 mol/L (range, 4.2-50.0). High homocysteine levels were found in 70 out of 172 patients (40.7%). The prevalence of hyperhomocysteinemia was significant in patients with hypertension (P=0.03) and ischaemic heart disease (P=0.04). Binary logistic regression model showed that male gender, diabetes mellitus and hypertension were significant independent predictors for high levels of homocystinemia in peripheral vascular occlusive disease [adjusted odds ratio (OR) 2.90; 95% confidence interval (CI); 1.18-7.12; P=0.02]; [0.35 OR; 95% CI; 0.15-0.79; P=0.01] and [2.12 OR; 95% CI; 0.98-4.59; P=0.05], respectively. Diabetes was significant but appeared to protect for peripheral vascular occlusive disease in patients with high levels of serum homocysteine. CONCLUSION: Elevated homocysteinemia was found in 40.7% of patients suffering from peripheral vascular disease. In this cohort, male gender, diabetes and hypertension were found to be risk factors along with elevated homocysteine levels.

Use of the industrial yeast Candida utilis for cadmium sorption.

The sorption ability of Candida utilis biomass for cadmium ions with accumulating competence of dried cells and cells in alginate was compared. After an optimization of process conditions (pH 5.5, biomass concentration 1 g/L and c0 50 mg/L), the cadmium sorption capacity of dried yeast biomass was perceptibly higher than that of the other tested adsorbents. Considering the sorption of the dried yeast biomass equal to 100 %, the cells in alginate reached 86 % while native cells showed only 42 %.

Removal of copper ions from dilute solutions by Streptomyces noursei mycelium. Comparison with yeast biomass.

Sorption properties of Streptomyces noursei mycelium for copper ions were compared with the accumulation competence of dried and native yeast (Candida utilis) biomass. The copper sorption capacity of S. noursei after optimization was found to be higher than that of the two other adsorbents (dried yeast biomass 82 %, native Candida cells 48 % of the sorption capacity of the S. noursei mycelium).

Association between pulse pressure, carotid intima-media thickness and carotid and/or iliofemoral plaque in hypertensive patients.

Increased common carotid artery intima-media thickness (CCA-IMT) and carotid and/or iliofemoral (C/IF) plaque are frequent in subjects treated for hypertension, but their association with pulse pressure (PP) has rarely been studied. Using ultrasound techniques, CCA-IMT and C/IF plaques were studied in 323 hypertensive subjects, who were classified into four groups according to the adequacy of blood pressure (BP) control (systolic BP (SBP) <140 mmHg and diastolic BP (DBP) <90 mmHg) and PP (high or low). After adjustment for confounding variables, an increase in CCA-IMT was the only factor significantly and independently associated with high PP, irrespective of the effectiveness of blood pressure control and of antihypertensive drug treatment. CCA-IMT correlated with age, PP, waist-to-hip ratio, tobacco consumption, and heart rate. C/IF plaques correlated with age, tobacco consumption, diabetes mellitus, and dyslipidaemia. To conclude, even with SBP<140 mmHg and DBP<90 mmHg on treatment, hypertensive subjects may have increased CCA-IMT values and C/IF plaque. Four cardiovascular risk factors seem to be involved in these alterations, namely tobacco consumption, dyslipidaemia, diabetes and increased PP. Only the latter factor does not have a standardized effective treatment.

Successful treatment of recurrent celiac axis compression syndrome. A case report.

The celiac axis compression syndrome is characterized by the clinical triad, epigastric pain, weight loss and postprandial emesis. The aetiology is attributed to intermittent ischaemia of the foregut. The results of three different modalities of treatment, transluminal dilatation, surgical division of the median arcuate ligament, and bypass surgery in a patient with recurrent celiac artery compression syndrome are reviewed. A 62-year-old woman with a previous partial gastrectomy presented with postprandial abdominal pain and marked weight loss. Investigations for gastrointestinal tract pathology were all negative. Angiography revealed compression of the celiac axis and an angioplasty was unsuccessful. The patient underwent surgical division of the median arcuate ligament with complete relief of symptoms, which recurred four months later. Angiography demonstrated a restenosis of the celiac axis. An aorto-celiac artery bypass was done with complete and persistent relief of symptoms at four years follow-up. This is a rare syndrome, which requires predisposing anatomic factors. In this patient, a previous partial gastrectomy with gastrojejunostomy roux-en-y caused disconnection of the pancreatico-duodenal network. Scarring renders ineffective less invasive interventions. Bypass surgery is the treatment of choice and offers durable results.

Laparoscopic closure of perforated duodenal ulcer.

BACKGROUND: Medical treatment of peptic ulcer is highly successful, and the eradication of Helicobacter pylori (H. pylori) reduces ulcer recurrence. However, the incidence of perforated duodenal ulcer and its associated mortality have not been reduced by modern methods of therapy. Laparoscopic simple closure and omental plug by suturing, fibrin glue, and stapler have been successful. METHODS: Over a 1-year period (1996-97), 21 patients with perforated duodenal ulcer were operated on in our hospital by laparoscopic simple closure and omental patch. The mean age was 36.4 +/- 11.8 years (range, 18-61). Twenty patients were male (93.7%). The mean duration of pain was 9.1 +/- 11.7 hs (range, 2-48). Three patients had a previous history of duodenal ulcer (14.3%), and another three (14.3%) patients had a history of nonsteroidal antiinflammatory drug (NSAID) intake. Erect chest radiograph showed that 19 patients had air under the diaphragm (90.5%). Sixteen patients (76.2%) had frank pus in the abdomen, and five patients had a minimal peritoneal reaction (23.8%). RESULTS: The mean operative time was 71.6 +/- 24.6 mins (range, 40-120), and the mean hospital stay was 5.2 +/- 1.6 days (range, 3-9). The mean time to resume oral fluids was 3.1 +/- 0.8 days (range, 2-4). Only one patient was reoperated due to leakage identified by gastrographin swallow. CONCLUSIONS: This procedure is safe and efficient; however, further study of its long-term effectiveness and comparability to existing therapy is still needed.

Ruptured mycotic aneurysm of the popliteal artery. A case report and review of the literature.

We report a case of a ruptured mycotic popliteal artery aneurysm as a consequence of septic embolization from infective endocarditis. The clinical presentation and radiological findings are presented. The popliteal, tibio-peroneal, and the antero-tibial arteries were reconstructed using an in situ bifurcated saphenous vein graft. Follow-up at 24 months disclosed a patent repair with normal ankle-brachial index.

Successful treatment of threatening limb loss ischemia of the upper limb caused by ergotamine. A case report and review of the literature.

We report a case of ischemia limited to the upper limb caused by chronic use of ergotamine. The effect of this drug was not related to hypersensitivity or to the potentiating effects of other medications. The patient was successfully treated discontinuing ergotamine and administering an alpha-blocking agent for three months. A review of the literature of the vascular complications of ergotamine is presented.

Aortic pulse wave velocity, an independent marker of cardiovascular risk.

Aortic pulse wave velocity (PWV), a classical index of aortic stiffness, may be easily measured in humans using non invasive ultrasound methods of high reproducibility. Recent epidemiological studies have shown that, independently of confounding factors as age, blood pressure and cardiac mass, aortic PWV is a predictor of cardiovascular (CV) mortality in populations of hypertensive subjects, whether they have or not end-stage renal disease. Since aortic PWV is dominantly influenced by age, this finding may be of major importance for the evaluation of CV risk in geriatric populations.

D-amino-acid oxidase--an improved production of the enzyme by the yeast Trigonopsis variabilis in a laboratory fermentor.

The cultivation of the yeast Trigonopsis variabilis producing D-amino-acid oxidase (an enzyme participating in the transformation of cephalosporin C into 7-aminocephalosporanic acid for the production of beta-lactam antibiotics) was controlled by changes of dissolved oxygen tension and extended fermentation times. The production technology was optimized on a laboratory scale and scale-up parameters were identified.

[Structure and function of the arteries of very elderly people. The PROTEGER Study (Cardiovascular Prognosis and Therapeutic Optimization in Geriatrics)]. / Structure et fonction des artères des sujets très âgés-l'étude PROTEGER. (PRonostic cardio-vasculaire et Optimisation Thérapeutique En GERiatrie).

The purpose of PROTEGER, a multicenter prospective observational study, was to determine the contribution of hemodynamic, arterial, echocardiographic and biological parameters to the evaluation of individual cardiovascular risk in the elderly. The study included patients aged over 70 years hospitalized in geriatric units with overt cardiovascular disease. Cross sectional analysis of the first 194 subjects included in the study demonstrated a high rate of arterial alterations involving both structure and function. The principal alterations observed were: high pulse pressure despite normal mean systolic and diastolic pressures, frequent and diffuse arterial calcifications, reduced compliance and distensibility, increased thickness, diameter and incremental elastic modulus of the carotid and increased pulse wave velocity. Analysis of monitoring results in the PROTEGER study will demonstrate the role of hemodynamic measurements and arterial alterations in the prediction of cardiovascular risk in hospitalized elderly.