Evidence-based anti-viral and immunomodulatory potential of Black cumin (Nigella sativa L) in COVID-19 / Potencial antivírico e inmunomodulador en COVID-19 del comino negro (Nigella sativa L) basado en la evidencia

Currently, the whole world is facing a life-threatening novel coronavirus 2019 (COVID-19) pandemic. Natural products are well-known for their potential role against viral disease, and some anti-viral agents have been developed to combat these diseases. Herein, the authors investigated the possible effects of this Holy plant Nigella sativa L. (NS), against coronavirus, using evidence-based and mechanistic approaches to conclude the immune-boosting and alleviation of respiratory systemeffects of NS. The pharmacological studies established a prominent role in treating various respiratory, immune systems, cardiovascular, skin, and gastrointestinal disorders. Literature supported the significant anti-viral role and showed an inhibitory role for NS against MHV-A59 CoV (mouse-hepatitis virus­A59) infected Hela, i.e., HeLaCEACAM1a (HeLa-epithelial carcinoembryonic antigen-related cell adhesion molecule 1a) cell. NS is a safe herbal product or dietary supplement and could be an effective and affordable community adjuvant treatment for coronavirus in the current scenario.

Actualmente, el mundo entero se enfrenta a una pandemia del nuevo coronavirus 2019 (COVID-19) que amenaza la vida. Los productos naturales son bien conocidos por su papel potencial contra las enfermedades virales, y se han desarrollado algunos agentes antivirales para combatir estas enfermedades. En este documento, los autores investigaron los posibles efectos de esta planta sagrada Nigella sativa L. (NS), contra el coronavirus, utilizando enfoques mecanicistas y basados en la evidencia para concluir el refuerzo inmunológico y el alivio de los efectos del SN en el sistema respiratorio. Los estudios farmacológicos establecieron un papel destacado en el tratamiento de diversos trastornos respiratorios, del sistema inmunológico, cardiovasculares, cutáneos y gastrointestinales. La literatura apoyó el importante papel antivírico y mostró un papel inhibidor de NS contra células Hela infectadas con MHV-A59 CoV (virus de la hepatitis de ratón-A59), es decir, HeLaCEACAM1a (molécula de adhesión celular 1a relacionada con el antígeno carcinoembrionario epitelial de HeLa). NS es un producto a base de hierbas o un suplemento dietético seguro y podría ser un tratamiento adyuvante comunitario eficaz y asequible para el coronavirus en el escenario actual.

The dietary supplement of Ginkgo biloba: a comprehensive review of its potential interactions based on pre-clinical and clinical evidences / El suplemento dietético de Ginkgo biloba: una revisión exhaustiva de sus posibles interacciones basada en evidencias clínicas y preclínicas

This review present Gingko biloba (GB) interactions, based on clinical and pre-clinical presentations. Literature was retrieved using databases; ScienceDirect, PubMed, Google scholar, Web of Science, Scopus etc. 14/45 interactions were found with clinical presentations. More interactions (80%) were reported with drugs followed by herbs (11.1%), and nutraceuticals (6.7%) with major mechanisms of interaction observed as; inhibition of Cytochrome metabolizing enzymes (44.4%) and platelet-activating factor (PAF) i.e. 15.6%. Major clinical features were; increased bleeding (eye, parietal), hematomas (subdural), and seizures as well as increased blood pressure, priapism, loss of infection/antiviral failure, and coma. Drugs with major interactions belonged to anti-platelet/anti-coagulant and NSAIDs. Synergistic effects were observed for GB vs herbs (except cannabis which showed rhabdomyolysis), foods, and nutraceuticals (except pyridoxine where neurotoxicity was seen). GB use should be monitored and the patient may seek proper advice from a healthcare professional.

Esta revisión presenta las interacciones de Gingko biloba (GB), basadas en presentaciones clínicas y preclínicas. La literatura se recuperó utilizando bases de datos; ScienceDirect, PubMed, Google Scholar, Web of Science, Scopus, etc. Se encontraron 14/45 interacciones con presentaciones clínicas. Se informaron más interacciones (80%) con fármacos seguidos de hierbas (11,1%) y nutracéuticos (6,7%) con los principales mecanismos de interacción observados como; inhibición de las enzimas metabolizadoras del citocromo (44,4%) y factor activador de plaquetas (PAF), es decir, 15,6%. Las principales características clínicas fueron; aumento de sangrado (ojo, parietal), hematomas (subdural) y convulsiones, así como aumento de la presión arterial, priapismo, pérdida de infección / insuficiencia antiviral y coma. Los fármacos con interacciones importantes pertenecían a los antiplaquetarios/anticoagulantes y los AINE. Se observaron efectos sinérgicos para GB frente a hierbas (excepto cannabis que mostró rabdomiólisis), alimentos y nutracéuticos (excepto piridoxina donde se observó neurotoxicidad). Se debe controlar el uso de GB y el paciente puede buscar el asesoramiento adecuado de un profesional de la salud.

Ethnopharmacological treatment of Cough in Piran, Malakand, Pakistan / Tratamiento etnofarmacológico de la tos en Piran, Malakand, Pakistán

The current study was designed to investigate the traditional recipes used to treat cough in Tehsil Piran, Malakand, Pakistan. These recipes were explored and quantitively analyzed for the first time. A total of 30 species of the plants, 6 animal products and one salt were reported to be used by the community to treat cough. Punica granatum L. and Olea ferruginea Royle dominated with Use value (UV) of 0.84 and Origanum vulgare L. with least use value of 0.1. The frequency citation (FC) of the Papaver somniferum L. is higher (98) while the lowest one is Verbascum thapsus L. (0.13). The large number of traditional recipes used for cough in this area shows that primary health care is still amalgamated in this culture. In future studies, these recipes may be further exploited as a base for modern medicine.

Este estudio fue diseñado con el propósito de investigar las recetas tradicionales utilizadas para tratar la tos en Tehsil Piran, Malakand, Pakistán. Estas recetas fueron exploradas y analizadas cuantitativamente por primera vez. Se constata que la comunidad utilizó un total de 30 especies de plantas, 6 productos animales y una sal para tratar la tos. Punica granatum L. y Olea ferruginea Royle se destacaron con un valor de uso (UV) de 0.84 y Origanum vulgare L. con un valor de uso mínimo de 0.1. La cita de frecuencia (FC) del Papaver somniferum L. es más alta (98) mientras que la más baja es Verbascum thapsus L. (0.13). La gran cantidad de recetas tradicionales utilizadas para la tos en esta área muestra que la atención primaria de salud todavía está amalgamada en esta cultura. En futuros estudios, estas recetas pueden explotarse aún más como base para la medicina moderna.

Evaluation of smooth muscle relaxant potential of Bismarckia nobilis (Hildebr. & Wendl.) in diarrhea, hypertension and asthma by ex-vivo and in-vivo method / Evaluación del potencial relajante en músculo liso de Bismarckia nobilis (Hildebr. & Wendl.) en diarrea, hipertensión y asma por métodos ex vivo e in vivo

To explore the mechanistic basis behind smooth muscle relaxant prospective of Bismarckia nobilis in gastrointestinal, respiratory and cardiovascular ailments. The methanolic extract of B. nobilis and sub-fractions have been evaluated in vitro rabbit isolated tissues, in vivo castor oil-induced diarrhea in rats and charcoal meal activity in mice. The B. nobilis extract relaxed spontaneous and K+(80 mM)- induced contractions in rabbit isolated jejunum preparations, CCh (1 µM) and K+ (80 mM)-induced contractions in tracheal and bladder preparations, PE (1 µM) and K+ (80 mM)-induced concentrations in aorta preparations, likewise verapamil. Spasmolytic activity of dichloromethane fraction is stronger as compared to aqueous fraction. In vivo castor oil-induced diarrhea in rats and charcoal meal activity in mice further supported spasmolytic activity. B. nobilis extract possess anti-spasmodic, anti-diarrheal, airway relaxant and vasodilator activities possible mediated through calcium channel blocking mechanism, justifying therapeutic utility of B. nobilis in diarrhea, asthma and hypertension.

El objetivo de trabajo fue explorar el mecanismo de acción relacionado con el efecto relajante del músculo liso inducido por Bismarckia nobilis (B. nobilis) en enfermedades gastrointestinales, respiratorias y cardiovasculares. El extracto metanólico de B. nobilis y subfracciones fue evaluado in vitro en tejidos aislados de conejos. Además se evaluó diarrea in vivo inducida con aceite de ricino en ratas y la actividad de harina de carbón vegetal en ratones. El extracto de B. nobilis relajó tanto las contracciones espontáneas como las inducidas por K+(80 mM) en preparaciones de yeyuno aisladas de conejos, las contracciones inducidas por PE (1 µM) y K+(80 mM) inducidas en preparaciones de aorta; de manera similar a verapamilo. La actividad espasmolítica de la fracción de diclorometano es más potente en comparación con la fracción acuosa. La diarrea inducida in vivo por el aceite de ricino en ratas y la actividad de la harina de carbón vegetal en ratones apoyaron aún más la actividad espasmolítica. El extracto de B. nobilis posee actividades antiespasmódicas, antidiarreicas, relajantes de las vías respiratorias y vasodilatadoras, posibles a través del mecanismo de bloqueo de los canales de calcio, lo que justifica la utilidad terapéutica de B. nobilis en la diarrea, el asma y la hipertensión.

Study of erythrocytes as a novel drug carrier for the delivery of artemether

Resealed erythrocytes have been explored in various dimensions of drug delivery, owing to their high biocompatibility and inability to initiate immune response. The present research was designed to evaluate the drug delivery potential of erythrocytes by loading a hydrophobic anti-malarial drug, Artemether. Three different loading techniques were applied to achieve maximum optimized drug loading. A HPLC method was validated for drug quantification in erythrocytes. The relatively high loading was achieved using hypotonic treatment was 31.39% as compared to other two methods. These, drug loaded erythrocytes were characterized for membrane integrity via ESR showing higher ESR values for drug loaded cells as compared to normal cells. Moreover, microscopic evaluation was done to observe morphological changes in erythrocytes after successful loading which showed swollen cells with slight rough surface as compared to smooth surface of normal cells. Drug release was studied for 8 h which showed more than 80% release within 3-7 h from erythrocytes treated with different hypotonic methods. Overall, the study revealed a potential application of erythrocytes in delivery of hydrophobic drugs using hypotonic treatment as compared to other methods.

Mini-cex: an assessment tool for observed evaluation of medical postgraduate residents during their training program: an overview and recommendations for its implementation in cpsp residency program

The mini-CEX is a workplace-based assessment to assess professional performance of medical trainees. Proper reporting of the gap between desired and observed performance forms the basis and the incentive for the trainees to improve their skills. It plays a key role by combining learning with assessment There is an urgent need for including this form of assessment in our clinical training programs especially postgraduate residents training

Unmet Communication and Information Needs for Patients with IBD: Implications for Mobile Health Technology.

Aims: In order to develop an application that addresses the most significant challenges facing IBD patients, this qualitative study explored the major hurdles of living with IBD, the information needs of IBD patients, and how application technology may be used to improve quality of life. Methods: 15 IBD patients participated in two focus groups of 120 minutes each. Data collection was achieved by combining focus groups with surveys and direct observation of patients looking at a patient-engaged app (HealthPROMISE) screenshots. The survey elicited information on demographics, health literacy and quality of life through the Short IBD Questionnaire (SIBDQ). Results: The needs of IBD patients center around communication as it relates to both patient information needs and navigating the social impacts of IBD on patients’ lives: a) Communication Challenges regarding Information Needs: Patients cited a doctor-patient communication divide where there is a continued lack of goal setting when discussing treatments and a lack of objectivity in disease control. When objectively compared with the SIBDQ, nearly half of the patients in the focus groups wrongly estimated their IBD control. b) Communication Challenges regarding Social Impacts of IBD: Patients strongly felt that while IBD disrupts routines, adds significant stress, and contributes to a sense of isolation, the impact of these issues would be significantly alleviated through more conversation and better support. c) Implication for Mobile Health Solutions: Patients want a tool that improves tracking of symptoms, medication adherence and provides education. Physician feedback to patient input on an application is required for long-term sustainability. Conclusions: IBD patients need mobile health technologies that evaluate disease control and the goals of care. Patients feel an objective assessment of their disease control, goal setting and physician feedback will greatly enhance utilization of all mobile health applications.

Age and gender specific stroke risk factors in a teaching hospital in Khyber Pakhtunkhwa

To determine age and gender specific stroke risk factors in a teaching hospital in Khyber Pakhtunkhwa. A hospital based descriptive study was performed in medical units of Lady Reading Hospital, Peshawar, from July 2011 to March 2012. A total of 100 patients of 18 years and above and of both genders were included. Study patients with first-ever acute stroke were divided into three groups; Group A young adult [<40 years], Group B, middle-aged [40-60 years], and Group C elderly [>60 years]. In these 03 groups, stroke risk factors were compared. Patients were assessed for hypertension, ischemic heart disease, hyperlipidemia, atrial fibrillation, diabetes mellitus and smoking. SPSS version 18.0 was used for statistical analysis. A sample of 100 patients was taken comprising 68% males and 32% females. Study patients had a mean age of 63.44 +/- 13.849. There were 08 patients in Group A, 29 in Group B, and 63 patients in Group C. Overall, hy-pertension was found in [62%], followed by smoking [47%], coronary artery disease [33%], diabetes mellitus [28%], hyperlipidemia [24%] and atrial fibrillation [21%]. Pattern of distribution of stroke risk factors is age and gender specific. Majority were found to have hypertension. Hypertension, diabetes mellitus, atrial fibrillation and hyperlipidemia differ significantly among the 03 age groups. Smoking was significantly different in males and females

Common mullein, pharmacological and chemical aspects

Verbascum thapsus L. [Khardhag or Common mullein], a member of the family Scrophulariaceae, is a famous herb that is found all over Europe, in temperate Asia, in North America and is well-reputed due to its medicinal properties. This medicinal herb contains various chemical constituents like saponins, iridoid and phenylethanoid glycosides, flavonoids, vitamin C and minerals. It is famous in various communities worldwide for the treatment of various disorders of both humans and animals aliments. A number of pharmacological activities such as anti-inflammatory, antioxidant, anticancer, antimicrobial, antiviral, antihepatotoxic and anti-hyperlipidemic activity have been ascribed to this plant. The plant is used to treat tuberculosis also, earache and bronchitis. In the present paper botanical and ethnomedicinal description, pharmacological profile and phytochemistry of this herb is being discussed.

In Vitro Antimicrobial and Haemolytic Studies of Bambusa arundinaceae leaves.

Bambusa arundinacea locally known as Bans or bamboo, a perennial fastest growing plant. This plant is medicinally much famous. The biological activities of this plant were carried out by using standard procedures. The aim of this work was to investigate the in vitro antimicrobial and haemolytic activities of Bambusa arundinaceae leaves. The GC-MS analysis revealed that the major components determined in n-hexane extract were as n-Nonane (17.14%), 2,2,3-Trimethylbutane (5.85%), Tridecane (5.42%), and 3,4,5,6-Tetramethyloctane (5.32%). The disc diffusion and modified resazurin microtitre-plate assays were used to evaluate the inhibition zones (IZ) and minimum inhibitory concentration (MIC) of B. arundinaceae leaves extracts. The plant extracts showed considerable antimicrobial activity. The heamolytic activity against human blood erythrocytes (RBCs) was studied and the % lysis of RBCs was found to be in the range of 1.03 to 4.81. The results of the present study confirmed the considerable antimicrobial and haemolytic activities of the plant Bambusa arundinaceae.

Antibiotic sensitivity pattern of Salmonella serotypes in patients with enteric fever in a teaching hospital

To determine the sensitivity of salmonella serotypes to antibiotics in patients with enteric fever. This descriptive study was carried out in medical units of Lady Reading Hospital Peshawar from January 2008 to December 2011. Patients were included by consecutive sampling technique. Blood samples were collected from patients with clinically suspected enteric fever and were sent to hospital laboratory for culture and sensitivity[C/S]. Salmonella colonies were identified using standard biochemical tests including fermentation of glucose, negative urease reaction, lysine decarboxylase, negative indole test, H2S production, and fermentation of dulcitol. Serological confirmation tests included polyvalent antisera for flagellar and somatic antigens. Antibiotic susceptibility was checked by Kirby- Bauer disc diffusion method for 22 antibiotics. Blood cultures of 106[61%] patients out of 173 patients were positive for salmonella species. Salmonella Typhi was found in 54.7% while salmonella paratyphi A in 32.1% and B in 13.2%. The sensitivity of salmonella species for ceftriaxone and ceftazidime was found to be 100%, followed by imipenem[98.1%] and meropenem [96.2%]. The sensitivity of drugs like amoxicillin, chloramphenicol and co-trimaxazolewere 2.8%, 12.3% and 22.6% respectively. Regarding quinolones, most sensitive was moxifloxacin49.1%, followed by ciprofloxacin 48.1%. Salmonella typhi was fully sensitive to meropenum, ceftriaxoneand cetazidime while paratyphi A or B was fully sensitive to ceftriaxone, ceftazidime and imipenem. The sensitivity of salmonella species was very low to the first line agents such as amoxicillin, chloramphenicol and co-trimaxazole. Salmonella species were fully sensitive to third generation cephalosporins such as ceftriaxone and ceftazidime

Medical record documentation of patients admitted to a medical unit in a teaching hospital

To compare the standards of documentation with audit study 2005 and to determine that changes have been implemented. This descriptive audit study was conducted in the medical C unit of Lady Reading Hospital, Peshawar - Pakistan from 1[st] January 2010 31[st] December 2010. Out of 3684 patients admitted during the year2010. 200 case notes were randomly selected and subjected to re-audit. The clinical notes were broadly analysed for documentation of six parameters. Each parameter's documentation was to be graded as very good, good, average, poor or not documented. Personal bio-data was documented average in 195[97.5%] cases; History and examination were average in 98[49%] cases and good in 85[42.5%] cases; Investigations were documented good in 140[70%] and average in 13[6.5%] cases. Progress notes were good in130[65%]cases and treatment was documented good in194[97%]cases.In105[52.5%]charts, one or more of the six selected items were not documented at all. Progress notes were not written in 48[24%], investigations in35 [17.5%].diagnosis in16 [8%], history and examination in4[2%],bio-data in 2[1%]and treatment in1[0.5%] of the case notes. For comparison between audit 2005 and present audit 2010,the P value was 0.05. No change was made in the previous five years and no steps of improvement have been implemented

Frequency of hepatoma in hepatitis B and C positive cirrhotic patients

To find out the frequency of hepatoma in hepatitis B and C positive patients with liver cirrhosis. This descriptive study was conducted at Medical 'C' unit of Postgraduate Medical Institute Lady Reading Hospital Peshawar on patients admitted from January 2004 to June 2006. Seven hundred and forty patients who had hepatitis B and C positive liver cirrhosis were included in the study. Patients were interviewed according to the proforma after fulfilling the inclusion and exclusion criteria. Blood tests including liver function tests, coagulation profile and hepatitis B, C virus profile, ultrasound, serum alpha-fetoprotein level were done. Data was analyzed at the end of study. Out of 740 patients with liver cirrhosis, 52 [7.03%] patients had hepatoma. Mean age was 62.3 years. Male to female ratio was 6.4:1. Thirty two percent of the patients were Hepatitis B surface antigen positive while anti HCV antibody was found positive in 68% of the patients. Alpha-fetoprotein level was elevated in all the cases. Mean alpha-fetoprotein level was>653.82. Mean tumour size was 5.41cm. Tumour was unifocal in 48% of the patients while 52% of the cases had multifocal involvement. Right lobe was involved in 44%, left lobe in 6% while 50% of the patients had both lobes of the liver involved. This study demonstrates that hepatoma is more common in HCV related cirrhosis liver. It is a tumour of advanced age