Randomised trial of indwelling pleural catheters for refractory transudative pleural effusions.

OBJECTIVE: Refractory symptomatic transudative pleural effusions are an indication for pleural drainage. There has been supportive observational evidence for the use of indwelling pleural catheters (IPCs) for transudative effusions, but no randomised trials. We aimed to investigate the effect of IPCs on breathlessness in patients with transudative pleural effusions when compared with standard care. METHODS: A multicentre randomised controlled trial, in which patients with transudative pleural effusions were randomly assigned to either an IPC (intervention) or therapeutic thoracentesis (TT; standard care). The primary outcome was mean daily breathlessness score over 12 weeks from randomisation. RESULTS: 220 patients were screened from April 2015 to August 2019 across 13 centres, with 33 randomised to intervention (IPC) and 35 to standard care (TT). Underlying aetiology was heart failure in 46 patients, liver failure in 16 and renal failure in six. In primary outcome analysis, the mean±sd breathlessness score over the 12-week study period was 39.7±29.4 mm in the IPC group and 45.0±26.1 mm in the TT group (p=0.67). Secondary outcomes analysis demonstrated that mean±sd drainage was 17 412±17 936 mL and 2901±2416 mL in the IPC and TT groups, respectively. A greater proportion of patients had at least one adverse event in the IPC group (p=0.04). CONCLUSION: We found no significant difference in breathlessness over 12 weeks between IPCs or TT. TT is associated with fewer complications and IPCs reduced the number of invasive pleural procedures required. Patient preference and circumstances should be considered in selecting the intervention in this cohort.

Outpatient Talc Administration by Indwelling Pleural Catheter for Malignant Effusion.

BACKGROUND: Malignant pleural effusion affects more than 750,000 persons each year across Europe and the United States. Pleurodesis with the administration of talc in hospitalized patients is the most common treatment, but indwelling pleural catheters placed for drainage offer an ambulatory alternative. We examined whether talc administered through an indwelling pleural catheter was more effective at inducing pleurodesis than the use of an indwelling pleural catheter alone. METHODS: Over a period of 4 years, we recruited patients with malignant pleural effusion at 18 centers in the United Kingdom. After the insertion of an indwelling pleural catheter, patients underwent drainage regularly on an outpatient basis. If there was no evidence of substantial lung entrapment (nonexpandable lung, in which lung expansion and pleural apposition are not possible because of visceral fibrosis or bronchial obstruction) at 10 days, patients were randomly assigned to receive either 4 g of talc slurry or placebo through the indwelling pleural catheter on an outpatient basis. Talc or placebo was administered on a single-blind basis. Follow-up lasted for 70 days. The primary outcome was successful pleurodesis at day 35 after randomization. RESULTS: The target of 154 patients undergoing randomization was reached after 584 patients were approached. At day 35, a total of 30 of 69 patients (43%) in the talc group had successful pleurodesis, as compared with 16 of 70 (23%) in the placebo group (hazard ratio, 2.20; 95% confidence interval, 1.23 to 3.92; P=0.008). No significant between-group differences in effusion size and complexity, number of inpatient days, mortality, or number of adverse events were identified. No significant excess of blockages of the indwelling pleural catheter was noted in the talc group. CONCLUSIONS: Among patients without substantial lung entrapment, the outpatient administration of talc through an indwelling pleural catheter for the treatment of malignant pleural effusion resulted in a significantly higher chance of pleurodesis at 35 days than an indwelling catheter alone, with no deleterious effects. (Funded by Becton Dickinson; EudraCT number, 2012-000599-40 .).

ANTIOXIDANT, ANTIBACTERIAL AND GUT MODULATING ACTIVITIES OF KALANCHOE LACINIATA.

Kalanchoe laciniata (L.) DC. (Crassulaceae) is a widely distributed plant in Africa and Asia. Traditionally, various communities use this plant for the treatment of a variety of ailments such as gut prob- lems, allergic conditions and wounds. The current study was designed to explore the antibacterial, antioxidant and gut modulating activities of K. laciniata in order to provide scientific rationale for its traditional uses. Phytochemical compounds were assessed through screening 70% crude methanolic extract of K. laciniata. Its gut modulatory activity was evaluated by in vitro tissue experiments on rabbit jejunum which yielded maximal spasmogenic response of 28.4 ± 4.6% (n = 4) at 3 mg/mL, while spasmolytic response was recorded with EC50 value of 3.2 mg/mL (2.8-3.5, 95% CI, n = 5). In antibacterial assays crude extract was found effective against Stapllococcus aurus and Bacillus subtilis, with MIC value of 5 and 2.5 mg/mL, respectively. The testing of the methanolic crude extract for antioxidants resulted in total phenolic contents of 27.8 ± 1.8 mg GAE/g DW and 22.7 ± 2.1 mg AAE/g DW total antioxidant activity. It also scavenged 17.3 ± 3.0% of DPPH free radical when compared with quercitin.

Dermatological and cosmeceutical benefits of Glycine max (soybean) and its active components.

Glycine max, known as the soybean or soya bean, is a species of legume native to East Asia. Soya beans contain many functional components including phenolic acids, flavonoids, isoflavonoids (quercetin, genistein, and daidzein), small proteins (Bowman-Birk inhibitor, soybean trypsin inhibitor) tannins, and proanthocyanidins. Soybean seeds extract and fresh soymilk fractions have been reported to possess the cosmeceutical and dermatological benefits such as anti-inflammatory, collagen stimulating effect, potent anti-oxidant scavenging peroxyl radicals, skin lightening effect and protection against UV radiation. Thus, present review attempts to give a short overview on dermatological and cosmeceutical studies of soybean and its bioactive compounds.

Long COVID-19 Syndrome: Insights From a Major Tertiary Center in the UK on Who Is at Greater Risk.

INTRODUCTION: The COVID-19 pandemic triggered the unprecedented 'long COVID' crisis, with persistent symptoms beyond two months post-infection. This study explores the nexus between long COVID symptoms, patient demographics such as age, gender, and smoking, and clinical factors like vaccination, disease severity, and comorbidities. METHODS: A retrospective analysis of records was conducted between September 2021 and December 2022. The analysis covered adults with confirmed COVID-19 diagnoses. Data encompassed demographics, medical history, vaccination, disease severity, hospitalization, treatments, and post-COVID symptoms, analyzed using logistic regression. RESULTS: Among 289 participants, the average age was 51.51 years. Around 62.6% were females, and 93% received the COVID-19 vaccination, i.e., primarily the mRNA vaccine (48.4%) and the adenovirus vector-based vaccine (34.8%). Reinfections occurred in 11.76% of cases. Disease severity varied, with 75% having mild, 15% having moderate, and 10% having severe infections. Hospitalization rates were significant (25.6%), including 10.7% requiring intensive care. Thirteen distinct post-COVID symptoms were reported. Fatigue, shortness of breath upon exertion, and brain fog emerged as the most prevalent symptoms. Notably, females exhibited higher symptom prevalence. Significant correlations were established between higher BMI and smoking with augmented symptomatology. Conversely, a link between booster doses and symptom reduction was discerned. Using multinomial regression analysis, gender and smoking were identified as predictors of post-COVID-19 symptoms. CONCLUSION: The study underscores obesity, smoking, and the female gender's impact on long COVID symptoms; boosters show promise in alleviation. Respiratory pathology might underlie persistent symptoms in cases with radiological abnormalities and abnormal spirometry. Findings contribute to risk stratification, intervention strategies, and further research.

ANTIBACTERIAL AND ANTIOXIDANT POTENTIAL OF STEM BARK EXTRACT OF BOMBAX CEIBA COLLECTED LOCALLY FROM SOUTH PUNJAB AREA OF PAKISTAN.

BACKGROUND: Ethnic medication systems have been used extensively by humans since their origin. Now a day, in the developing countries these systems are being used due to their effectiveness and affordability. Especially inhabitants of rural areas still rely on these systems as first line of treatment against diseased conditions. Till now, majority of medicines is derived from the natural origin particularly plants owing to their little side effects and cost effectiveness. MATERIALS AND METHODS: In the present work, we evaluated antibacterial and antioxidant activity of methanolic extract of Bombax ceiba stem bark. Total phenolic and flavonoid contents were also assessed in the extract. The antioxidant capacity was determined by DPPH, Nitric Oxide scavenging and reducing power activity. For antibacterial activity, Gram-negative (Escherichia coli, Pseudomonas aeruginosa and Salmonella typhi) and Gram-positive bacteria (Bacillus subtilis, Staphylococcus aureus) were used. RESULTS: Phenolic content was 133.21±1.56 µg GAE/mg of extract while Flavonoid content was 997.93±2.14 µg QE/mg. Plant extract demonstrated strong antiradical activity with EC50 18.78 ± 0.69 and 23.62 ± 1.99fg/ml for Nitric Oxide and DPPH assay respectively while EC50 in case of reducing power activity was 139.4 ± 0.98µg/ml. Plant extract displayed inhibitory effect against microbial growth with S. typhi as the most resistant strain and Staphylococcus aureus the most sensitive one. CONCLUSION: This study revealed that Bombax ceiba of local origin has broad spectrum antibacterial activity and it can also provide defense against oxidative stress.

An overview of dermatological and cosmeceutical benefits of Diospyros kaki and its phytoconstituents

Abstract Diospyros kaki L.f. belonging to family Ebenaceae, commonly known as persimmon is used as a medicinal plant in Chinese traditional medicine since many years for different ailments including cosmetics and dermatologic applications. Traditionally this plant is used to treat different skin conditions including pimples, skin eruptions and eczema. Present interest has been focused toward use of natural bioactive compounds in various curative and beautifying applications in dermatological and cosmeceutical disciplines. The objective of this article is to present cumulative data on potential use of D. kaki for its possible role in dermatologic and cosmetic applications. Scientific data has revealed an excellent position of D. kaki in both dermatology and cosmetic discipline making it a valuable choice in respective field. Active principles from different plant parts have shown to possess anti-inflammatory, antiallergic, photo-protective, and anti-wrinkle effects with appreciable activities against tyrosinase, elastase, and collagenase enzymes. Promising antioxidant activity and skin whitening potential, augmented by reduction in sebum contents, and reduction in size and number of skin pores make it a suitable choice as cosmetic ingredient. Data has been summarized and presented on available molecular mechanism that can contribute toward phytoconstituents usage in cosmetics and dermatology mediated by different cellular pathways. Crude extracts and some of phytochemical obtained from this plant such as isoquercitrin and hyperin have better reported activities than well-known cosmetic ingredients viz., arbutin, kojic acid and hydroquinone with possibility of having no side effects. Photo protection against degenerative effects of UVA, UVB and gamma radiation can help skin to fight well against oxidative stress and reactive oxygen species. Further investigation need to be directed toward human subjects for evaluation of these reported activities for obtaining optimum commercial and industrial benefits from this valuable plant.