Bougainvillea glabra (choisy): A comprehensive review on botany, traditional uses, phytochemistry, pharmacology and toxicity.

ETHNOPHARMACOLOGICAL RELEVANCE: Bougainvillea glabra (Choisy). (Family: Nyctinaginacea) is a valuable ornamental plant with culinary uses and also utilized in traditional medicine for treating common ailments. It is traditionally employed against several diseases such as diarrhoea, hypotension, intestinal disorders, stomachache, nausea, inflammation-related ailments, and in pain management. Though widely validated via in vitro and in vivo models, to date no endeavour has been made to compile in a single review the traditional, phytochemistry and pharmacological properties of B. glabra. AIMS: To provide an up-to-date, authoritative review with respect to the traditional uses, chemical composition, in vitro and in vivo pharmacological properties, and toxicological estimations accomplished either utilizing the crude extracts or, wherever applicable, the bioactive compounds isolated from B. glabra. Besides, a critical evaluation of the published literature has been undertaken with regards to the current biochemical and toxicological data. MATERIALS AND METHODS: Key databases per se, Ovid, Pubmed, Science Direct, Scopus, and Google scholar amongst others were probed for a systematic search using keywords to retrieve relevant publications on this plant. A total of 52 articles were included for the review depending on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: The studies conducted on either crude extracts, solvent fractions or isolated pure compounds from B. glabra had reported a varied range of biological effects comprising antibacterial, antifungal, antidiabetic, cytotoxic, analgesic, antipyretic, anti-inflammatory, and antioxidant activities. Phytochemical analysis of different parts of B. glabra unveiled 105 phytochemicals, belonging to phenolic, flavonoid, betacyanin, terpenoid, glycoside and essential oils classes of secondary metabolites. CONCLUSION: Most of the pharmacological activities of crude extracts from this plant have been reported. A very few studies have reported the isolation of compounds responsible for observed biological potential of this plant. Moreover, the toxicity studies of this plant still need to be explored comprehensively to ensure its safety parameters. Additional investigations are recommended to transmute the ethnopharmacological claims of this plant species in folklore medicines into scientific rationale-based information.

Correlation of acidosis-adjusted potassium level and cardiovascular outcomes in diabetic ketoacidosis: a systematic review.

BACKGROUND: During the progress and resolution of a diabetic ketoacidosis (DKA) episode, potassium levels are significantly affected by the extent of acidosis. However, none of the current guidelines take into account acidosis during resuscitation of potassium level in DKA management, which may increase the risk of cardiovascular adverse events. OBJECTIVE: To assess literature regarding the adjustment of potassium level using pH to calculate pH-adjusted corrected potassium level, and to observe the relationship of cardiovascular outcomes with reported potassium level and pH-adjusted corrected potassium in DKA. METHODOLOGY: Seven databases were searched from inception to January 2018 for studies which had reported people with diabetes developing diabetic ketoacidosis, in relation to prevalence or incidence, fluid resuscitation or potassium supplementation treatment, treatment or cardiovascular outcomes, and experimentation with DKA management or insulin. Quality of studies was evaluated using Cochrane Risk of Bias and Newcastle Ottawa Scale. RESULTS: Forty-seven studies were included in qualitative synthesis out of a total of 10,292 retrieved studies. Forty-one studies discussed the potassium level and blood pH at the time of admission, ten studies discussed cardiovascular outcomes, and only four studies concurrently discussed potassium level, pH, and cardiovascular outcomes. Only two studies were graded as good on the Newcastle Ottawa Scale. The reported potassium level was well within normal range (5.8 mmol/L), whereas pH rendered patients to be moderately acidotic (7.13). Surprisingly, none of the included studies mentioned pH-adjusted corrected potassium level and, hence, this was calculated later. Although mean corrected potassium was within the normal range (3.56 mmol/L), 13 studies had corrected potassium below 3.5 mmol/L and five had it below 3.0 mmol/L. Nevertheless, with the exception of one study, none discussed cardiovascular outcomes in the context of potassium or pH-adjusted potassium level. CONCLUSION: The evidence surrounding cardiovascular outcomes during DKA episodes in light of a pH-adjusted corrected potassium level is scarce. A prospective observational, or preferably, an experimental study in this regard will ensure we can modify and enhance safety of existing DKA treatment protocols.