Ethnobotanical, ecological and health risk assessment of some selected wild medicinal plants collected along mafic and Ultra Mafic rocks of Northwest Pakistan.

The current study investigated wild plant resources and health risk assessment along with northern Pakistan's mafic and ultramafic regions. Ethnobotanical data was collected through field visits and semi-structured questionnaire surveys conducted from local inhabitants and healers. Six potentially toxic elements (PTEs) such as lead (Pb), cadmium (Cd), nickel (Ni), chromium (Cr), manganese (Mn), and zinc (Zn) were extracted with acids and analyzed using atomic absorption spectrophotometer (AAS, Perkin Elmer-7000) in nine selected wild medicinal plants. Contamination factor (CF), pollution load index (PLI), estimated daily intake (EDI), target hazard quotient (THQ), and hazard index (HI) were used to determine the health risk assessment of the studied medicinal plants. The results showed that the selected medicinal plants were used for the treatments of cough, joint swelling, cardiovascular disorders, toothaches, diabetes, and skin pimples by the local inhabitants due to their low-cost and easy accessibility. The concentrations of Pb (3.4-53 mg kg-1), Cd (0.03-0.39 mg kg-1), Ni (17.5-82 mg kg-1), Cr (29-315 mg kg-1), Mn (20-142 mg kg-1), and Zn (7.4-64 mg kg-1) in the studied medicinal plants were found above the safe limits (except Zn) set by WHO/FAO/USEPA (1984/2010). The Pb contamination factor was significantly (p < 0.05) higher in A. modesta (7.84) and D. viscosa (6.81), and Cd contamination factor was significantly higher in C. officinalis (26.67), followed by A. modesta (8.0) mg kg-1. Based on PTE concentrations, the studied plants are considered not suitable for human consumption purposes. Pollution load index values for A. modesta, A. barbadensis, A. caudatus, A. indica, C. procera (2.93), D. viscosa (2.79), and C. officinalis (2.83), R. hastatus (3.12), and Z. armatum were observed as 1.00, 2.80, 2.29, 2.29, 2.93, 2.79, 2.83, 3.12 and 2.19, respectively. Hazard index values were in order of R. hastatus (1.32 × 10-1) ˃ C. procera (1.21 × 10-1) ˃ D. viscosa (1.10 × 10-1) ˃ A. caudatus (9.11 × 10-2) ˃ A. barbadensis (8.66 × 10-2) ˃ Z. armatum (7.99 × 10-2) ˃ A. indica (6.87 × 10-2) ˃ A. modesta (5.6 × 10-2) ˃ C. officinalis (5.42 × 10-2). The health risk index values suggested that consumption of these plants individually or in combination would cause severe health problems in the consumers. Pearson's correlation results showed a significant correlation (p ≤ 0.001) between Zn and Mn in the studied medicinal plants. The current study suggests that wild medicinal plants should be adequately addressed for PTEs and other carcinogenic pollutants before their uses in the study area. Open dumping of mining waste should be banned and eco-friendly technology like organic amendments application should be used to mitigate PTEs in the study area.

Effect of amino acid fortified mulberry leaves on economic and biological traits of Bombyx mori L.

The demand for silk has been increasing day by day but the average silk production is not enough to meet its demand. In this study, we investigated the effect of amino acid supplemented mulberry feed on the biological and commercial traits of Bombyx mori L. (Lepidoptera; Bombycidae). The silkworm larvae at 5th instar stage were taken and fed with fresh and healthy mulberry leaves coated with Alanine, Glycine and Serine in fourteen different combinations. Results of the current study revealed that the average weight of silkworm larvae and the % ratio of silk gland to body weight on day 7 was significantly (P˂0.05) higher in the group fed with amino acid fortified leaves as compared to the control. The commercial traits of larvae fed with amino acid fortified leaves also improved significantly. The larvae fed with Alanine (1 %) treated mulberry leaves showed the maximum cocoon weight, cocoon length, cocoon width, cocoon shell ratio and fibroin content as compared to the control group. It is evident from the results that the amino acid (particularly alanine) coated mulberry leaves have a positive effect on the commercial and biological traits of Bombyx mori (L.).

In Vivo Efficacy, Toxicity Assessment, and Elemental Analysis of Traditionally Used Polyherbal Recipe for Diarrhea.

A polyherbal formulation consisting of Mentha piperita L., Camellia sinensis L. Kuntze, and Elettaria cardamomum (L.) Maton with a ratio of 10 : 5 : 2, respectively, was recommended for curing nausea, vomiting, and diarrhea. Experimental validation is crucial to affirm its therapeutic property leads toward the development of modified antidiarrheal agents. This research aimed to investigate the in vivo antidiarrheal efficacy of traditionally used polyherbal recipe in a castor oil-induced animal model. Moreover, the study also presents the elemental screening and in vivo toxicity of tested polyherbal recipe. Individual plant parts of the polyherbal recipe were mixed according to the traditional prescription ratio, and hydromethanolic extract was prepared by the cold maceration process. The antidiarrheal activity was assessed by castor oil induction method, charcoal meal test, and enteropooling procedure in Sprague-Dawley rats. Elemental analysis and in vivo subacute toxicity were carried out, followed by biochemical, hematological, and histopathological analyses. Polyherbal extract significantly delayed the diarrhea onset in a dose-dependent manner and showed marked inhibition at 200 and 400 mg/kg. Fecal weight was reduced significantly (p < 0.05) at 200 mg/kg (0.26 ± 0.25) in comparison with the control (1.63 ± 0.15). The diarrhea score was zero at a concentration of 200 and 400 mg/kg. Antienteropooling effect of the extract was greater than that of loperamide. Following subacute toxicity, all the treated rats were normal, survived, and showed no changes in behavior. There were no significant differences between values of blood parameters in both the control and extract-treated groups except a significant decrease in monocytes (control 8.4; polyherbal 2.2). Elemental analysis showed a slight increase in the amount of manganese (Mn, 8.076 ppm) as compared to the WHO recommended level (2 ppm). Traditionally used polyherbal recipe is effective and safe for combating diarrheal diseases. In vivo evidence supported the use, safety, and efficacy of the polyherbal recipe that has been used as an alternative medicine for diarrhea in the study area. Inhibition of castor oil-induced diarrhea and antisecretory effect of the studied polyherbal recipe makes it a potent antidiarrheal drug without no or limited toxic effects at the tested dose after further analysis.

The Impact of Signals Transmission on Patients' Choice through E-Consultation Websites: An Econometric Analysis of Secondary Datasets.

(1) Background: The COVID-19 pandemic has dramatically and rapidly changed the overall picture of healthcare in the way how doctors care for their patients. Due to the significant strain on hospitals and medical facilities, the popularity of web-based medical consultation has drawn the focus of researchers during the deadly coronavirus disease (COVID-19) in the United States. Healthcare organizations are now reacting to COVID-19 by rapidly adopting new tools and innovations such as e-consultation platforms, which refer to the delivery of healthcare services digitally or remotely using digital technology to treat patients. However, patients' utilization of different signal transmission mechanisms to seek medical advice through e-consultation websites has not been discussed during the pandemic. This paper examines the impact of different online signals (online reputation and online effort), offline signals (offline reputation) and disease risk on patients' physician selection choice for e-consultation during the COVID-19 crisis. (2) Methods: Drawing on signaling theory, a theoretical model was developed to explore the antecedents of patients' e-consultation choice toward a specific physician. The model was tested using 3-times panel data sets, covering 4231 physicians on Healthgrades and Vitals websites during the pandemic months of January, March and May 2020. (3) Results: The findings suggested that online reputation, online effort and disease risk were positively related to patients' online physician selection. The disease risk has also affected patients' e-consultation choice. A high-risk disease positively moderates the relationship between online reputation and patients' e-consultation choice, which means market signals (online reputation) are more influential than seller signals (offline reputation and online effort). Hence, market signals strengthened the effect in the case of high-risk disease. (4) Conclusions: The findings of this study provide practical suggestions for physicians, platform developers and policymakers in online environments to improve their service quality during the crisis. This article offers a practical guide on using emerging technology to provide virtual care during the pandemic. This study also provides implications for government officials and doctors on the potentials of consolidating virtual care solutions in the near future in order to contribute to the integration of emerging technology into healthcare.

Assessment of differences in morphological and physiological leaf lodging characteristics between two cultivars of Hippeastrum rutilum.

BACKGROUND: Environmental lodging stress, which is a result of numerous factors, is characterized by uncertainty. However, several studies related to lodging in cereal crops have reported that lodging in the Hippeastrum rutilum environment is very rare. Hippeastrum rutilum is a garden flower with high ornamental value and abundant germplasm resources. Under past cultivation practices, it was found that the plant types of 'Red Lion', with red flowers, and 'Apple Blossom', with pink flowers, are quite different. The leaves of 'Red Lion' are upright, while the leaves of 'Apple Blossom' show lodging, which seriously affects its ornamental value. The aims of this study were to compare the differences between the two varieties with leaf lodging and upright leaves according to morphological and physiological attributes. In this study, karyotype analysis and phenotypic morphological and physiological characteristics were compared to explore the differences between the two plant types. RESULTS: The karyotype analysis of the two cultivars showed that their chromosome types were both tetraploid plants. The results showed that the lignin content in the leaves of 'Red Lion' was high, the cross-sectional structure of the leaf vascular bundle was more stable, and the chlorophyll content was high. In addition, significantly less energy was transferred to the electron transport chain (ETR) during the photoreaction. Similarly, the results regarding the maximum photosynthetic rate (Fv/Fm), nonphotochemical quenching (NPQ) and effective quantum yield of photosystem II photochemistry (△F/Fm') all indicated that the photosynthetic capacity of "Red Lion" was greater than that of "Apple Blossom", which was affected by leaf lodging. The size of the leaves was significantly smaller, and the leaf sag angle, leaf width, and leaf tip angle presented significantly lower values in 'Red Lion' than in 'Apple Blossom', which exhibits leaf sag. The difference in these factors may be the reason for the different phenotypes of the two cultivars. CONCLUSION: The results of this study proved that lodging affects the photosynthetic capacity of Hippeastrum rutilum and revealed some indexes that might be related to leaf lodging, laying a theoretical foundation for cultivating and improving new varieties.

Exploring the impact of online information signals in leveraging the economic returns of physicians.

INTRODUCTION: With the growth in Internet technology, online rating websites encourage patients to contribute actively in rating their physicians. These rating sites provide more information for patients, such as electronic word of mouth (eWOM) and physician trustworthiness. Although several studies in e-commerce have investigated the role of eWOM and seller trustworthiness in the consumer purchase decision-making process and the price premium for products or services, studies on the role of different information sources that reflect the service quality and delivery process in choosing a competent physician remain scarce. This research develops a two-equation model to examine the effect of different signals, i.e., patient-generated signals (PGSs) and system-generated signals (SGSs), on patient choice, which is an important predictor of physicians' economic returns. METHODS: A secondary data econometric analysis and structural modeling using 2896 physicians' real data from a publicly available online physician rating site, i.e., Healthgrades.com, were conducted using a mixed-methods approach. A hybrid text mining approach was adopted to calculate the sentiment of each review. RESULTS: We find that both PGSs and SGSs have a significant impact on patient choice at different stages of health consultation. Furthermore, disease risk negatively moderates the association between PGSs and information search, while the impact of both signals on patient willingness to pay a price premium is positively moderated by the disease risk. CONCLUSION: Our study contributes to the unified framework of signaling theory and Maslow's hierarchy of needs theory by making a clear distinction between PGSs or SGSs and their influence on patient decision-making across different disease risks. Moreover, PGSs and SGSs are two essential factors for physicians to increase their income.

Rat-bites of an epidemic proportion in Peshawar vale; a GIS based approach in risk assessment.

Contemporary studies demonstrate that rodent bites do not occur frequently. However, a huge number of cases were reported from Peshawar vale, Pakistan during 2016. Two species, the local black rat Rattus rattus (Linnaeus, 1758) and the invasive brown rat Rattus norvegicus (Berkenhout, 1769) might be the suspected cause. Several studies indicated the invasion of brown rats into Pakistan presumably via port city of Karachi. In this study, we modeled geospatial distribution of rodent bites for risk assessment in the region. Bite cases reported to tertiary care lady reading hospital were monitored from January 1 to August 31, 2016. Among 1747 cases, statistically informative data (n = 1295) was used for analyses. MaxEnt algorithm was employed for geospatial modeling, taking into account various environmental variables (temperature, precipitation, humidity, and elevation) and anthropogenic factors (human population density, distance from roads, distance from water channels, and land use/land cover). MaxEnt results revealed that urban slums (84.5%) are at highest risk followed by croplands (10.9%) and shrublands (2.7%). Anthropogenic factors affecting incidence of rodent bites included host density (contribution: 34.7), distance from water channels (3.2), land use/land cover (2.8), and distance from roads (2). Most of the cases occurred within a radius of 0.3 km from roads and 5 km from water channels. Rodent bite incidence is currently at its peak in Peshawar vale. Factors significantly affecting rodents' bite activity and their distribution and dispersal include urbanization, distance from roads, and water channels. Further studies are needed to determine the impact of invasion by brown rat on bite incidence.

Trajectory of cause of death among brought dead neonates in tertiary care public facilities of Pakistan: A multicenter study.

BACKGROUND: Considering the fact that Pakistan is amongst the countries with very high neonatal mortality rates, we conducted a research study to determine the possible causes and characteristics of neonates presenting dead to the emergency department of tertiary public health care facilities of Pakistan using verbal autopsies. METHODS: A descriptive case series study was conducted in emergency department/pediatrics ward/neonatal ward/nursery unit of ten tertiary care public health facilities, situated in seven major cities of Pakistan from November, 2011 to June, 2013. Precoded verbal autopsy proforma was used to collect information regarding cause of death, family narratives and other associated risks accountable for pathway to mortality. RESULTS: We identified 431 neonates presenting dead to the emergency department (238 males and 193 females). Sepsis (26.7%), birth asphyxia (18.8%) and persistent pulmonary arrest (17.2%) were main primary causes of brought death. Around 72% brought dead neonates were referred from doctors/health care facilities and more than 28% caregivers mentioned that they were not informed about the diagnosis/ailment of their deceased newborn. CONCLUSIONS: Findings of our study suggest that infectious disease remains the main primary cause of neonatal mortality. Underweight in newborns (64%) was estimated as a leading associated risk. Delays in referrals to respective health care facility enlightened the concern of sub-standard prerequisites of neonatal care that could be one of the major contributing risk factor of high mortality rates.

Ethnogynaecological assessment of medicinal plants in Pashtun's tribal society.

The present study was designed to document detailed ethnogynaecological knowledge of selected remote regions of Pashtun's tribe in northwest Pakistan. Semistructured questionnaires were designed to collect ethnogynaecological and ethnographic data. Total of 51 medicinal plants belonging to 36 families were documented that were used by the women of studied regions for the treatment of 9 types of gynaecological complaints. Majority of the plants (19) were found used against menses followed by 11 plants each for gonorrhea and pregnancy. Bannu region has high number of gynaecological plants (22) followed by Karak (15). Women of the regions mostly used whole plants (33%) and leaves (31%) for various ethnomedicinal preparation of gynae. Fic results showed that all ailments in different areas scored high consensus ranges between 0.6 and 1.00. Majority of the female respondents (44%) were aged between 61 and 70 years, of which most were illiterate. Women in the remote regions of Pakistan have tremendous traditional knowledge in utilizing medicinal plants for their reproductive health. Plants with high Fic values should be cross-checked for their in vitro and in vivo validation. Young girls should be educated on the importance of ethnogynaecological practices to conserve this valuable knowledge.

Ethnopharmacological assessment of medicinal plants used against livestock infections by the people living around Indus River.

The present study was aimed to document detailed ethnopharmacological knowledge of medicinal plants against livestock infections of an unexplored remote region of Pakistan. Semistructured questionnaires were used for data collection. Total 43 plants belonging to 26 families were found to be used in ethnoveterinary practices. Seeds (29%) were found to be the most frequent plant part used followed by leaves (22%). Ethnoveterinary recipes were mostly prepared in the form of decoction and powdering. Informant consensus factor (Fic) results revealed high consensus for gastrointestinal (0.81), mastitis (0.82), and dermatological infections (0.80). Curcuma longa ranked first with highest fidelity level (FL) value (66%) followed by Trachyspermum ammi that ranked second (58%). Preference ranking (PR) results showed that Zingiber officinale, Punica granatum, Triticum aestivum, Gossypium hirsutum, and Withania coagulans were the most preferred species for the treatment of diarrhea. Direct matrix ranking (DMR) results showed that Morus alba, Melia azedarach, Withania coagulans, Cassia fistula, Azadirachta indica, and Tamarix aphylla were the multipurpose species of the region. We invite the attention of pharmacologists and chemists for further exploration of plants having high Fic, FL, and PR values in the present study. Conservation strategies should be adopted for the protection of multipurpose plant species.

Nutritional assessment and antioxidant activities of different varieties of Vigna radiata.

Three cultivars of Vigna radiata, namely, NM-92, NM-98, and NM-06, were analyzed for their proximate composition. The samples were also tested by HPLC for amino acid content. The data showed that all the varieties had same moisture level. The maximum ash content (4.29%) was present in NM-92, and crude fat (2.26%) was highest in NM-98 while NM-06 contained maximum amount of crude protein. About eighteen types of amino acids were detected in each of the three varieties. Acidic amino acids, that is, aspartic and glutamic acids, were in considerable amount ranged from 13 to 23% followed by leucine, isoleucine, alanine, valine, lysine, phenyl alanine, serine, and arginine which fell in the range of 3-8% of total protein. The maximum amount (13.00 and 22.80%) of aspartic and glutamic acids was present in NM-98. Similarly arginine (6.83%) and serine (5.45%) were also in highest amount in this variety. Leucine (7.46%) was maximum in NM-92 variety. NM-06 contained almost all the amino acids in lesser quantity except for few like threonine, proline, glycine, and alanine. It was concluded from the present study that varieties were of different nutritional value and HPLC was a sensitive method for amino acids determination. Antioxidant activities of all three varieties were also assayed and showed significant results.

Richness and cover of nontimber economic plants along altitude in temperate Himalayan forest-use types.

Pakistani Himalaya stretches over a wide range of altitudinal gradients and supports high diversity of medicinal plants that are an important source for rural livelihood. Altitudinal effects on ground vegetation have already been indicated but ground vegetation is also under severe threat of grazing and over collection. The present study investigated the effect of altitude on medicinal plants abundance in both old-growth and derived woodland forests. Each of the five line transects was selected in old-growth and derived woodland forests. Each line transect consisted of four plots distributed at four altitudinal levels (2200, 2300, 2400, and 2500 m asl). Species richness under derived woodland had shown strong negative correlation (r = -0.95) with altitude while it was found to be nonsignificant under old-growth. Cover of most of the species such as Veronica laxa (r = -0.95, P ≤ 0.05) had shown significant negative correlation with altitude under derived woodland. Cover abundance of some species like Valeriana jatamansi and Viola canescens has also shown significant negative correlation under old-growth forest. Derived woodland can decrease the cover abundance of valuable medicinal plants towards extension at higher altitudes. Thus, protection of the derived woodland could serve as a tool for the improvement of rural livelihood and ecological restoration.

Ethnobotanical assessment of plant resources of Banda Daud Shah, District Karak, Pakistan.

BACKGROUND: The Indigenous knowledge of plants is scientifically and culturally very significant. This paper elucidates the empirical findings of an ethnobotanical survey of Banda Daud Shah, District Karak, Pakistan. METHODS: Data collection was carried out from October 2011 to September 2012. Total twelve survey trips were made, three in each season. About 100 respondents were interviewed; most of them were aged people between 60-70 years. Interviews were conducted using structured questionnaire composed of variety of questions regarding ethnomedicinal uses of plants of the study area. Direct matrix ranking (DMR), informant citations and market survey of multipurpose plants were also carried out. RESULTS: The local community was using 58 plant species belonging to 52 genera and 34 families for different purposes. A total of 25 plant species were herbs followed by 18 shrubs. Leaf (45%) was the most commonly used plant part followed by the whole plants (23%). In total, 40 plant species were medicinally used to treat variety of diseases, of which highest number of species being used for gastro-intestinal problems (19 spp.), expectorant (3 spp.) and antipyretic (3 spp.). Beside medicinal values, 25 species were used for fuel and 18 for fodder purposes. Informant consensus showed that gastrointestinal and respiratory infections were ranked highest (FIC = 0.75) among all ailments. According to DMR output, Dalbergia sisso ranked first due to high multipurpose uses among all species and was found most threatened with higher market value. CONCLUSION: The investigated area is rural in nature and the inhabitants are highly dependent on the native plants for their health care needs and other requirements like fuel wood and fodder due to financial constraints and unavailability of resources. Medicinal plants for high ranked diseases may be phtyochemicaly and pharmacologically investigated to prove their efficacy. The local medicinal flora is facing overexploitation, overgrazing and improper way of collection. Proper conservation strategies such as controlled grazing, reforestation and rangeland management among many others may be adopted to promote the sustainable use of medicinal plants.