Prediction of atherosclerotic cardiovascular risk in early childhood.

Atherosclerotic lesions are present even in very young individuals and therefore, risk stratification for cardiovascular (CV) disease should be implemented in childhood to promote early prevention strategies. In this review we critically appraise clinical, biochemical and genetic biomarkers available for pediatric clinical practice, which might be integrated to build effective algorithms to identify children at risk of future CV events. The first critical issue is to characterize in children aged 2-5 years, those CV risk factors/clinical conditions associated with dramatically accelerated atherosclerosis. Presence of clinical conditions such as obesity, diabetes mellitus, Kawasaki disease, etc., or positive family history for premature CV disease should be evaluated. Subsequently, a complete lipid profile and Lipoprotein(a) determination are recommended for children with increased baseline CV risk. Individuals with altered lipid profile could then undergo genetic testing for monogenic dyslipidemias to identify children with high CV genetic risk, who will be directed to appropriate therapeutic options. In perspective, calculation of a polygenic risk score, based on the analysis of several common single-nucleotide polymorphisms, could be integrated for better risk assessment. We here emphasize the importance of a "holistic" strategy integrating biochemical, anamnestic and genetic data to stratify CV risk in early childhood.

Digital Cognitive Training for Children with Attention Deficit Hyperactivity Disorder.

The present article used a pilot study to determine the effectiveness of digital cognitive mindfulness training developed based on dialectical behavioral therapy (DBT) in reducing attention deficit hyperactivity disorder (ADHD) symptoms in children. The sample consisted of 90 children (8-10 years old) diagnosed with ADHD. The participants were randomized into two groups: an experimental group (n = 45) and a control group (n = 45). Results were assessed at three time points: before, after the study, and one month after the end of the study. Regarding ADHD symptoms, the ANCOVA results showed that there were no statistically significant differences between the study groups for inattention and hyperactivity/impulsivity after testing. One month after completion of the program, there was a significant alleviation in symptoms of inattention, executive functioning, learning problems, aggression, and peer relationships. Hyperactivity was the only variable that showed a decrease both post-test and during follow-up. These results suggest that a DBT-based mindfulness program is a promising method of reducing ADHD symptoms in children.

Protective Properties of Spheroidal Taxifolin Form in Streptozotocin-Induced Diabetic Rats.

One of the key factors in the pathogenesis of diabetes and its complications is oxidative stress. To inhibit this process, antioxidants may be helpful. Herein, we focused on the protective properties of taxifolin spheroidal form (TS) in the streptozotocin rat model of diabetes mellitus. After 4 weeks of treatment with TS, the fasting blood glucose level of the diabetic animals decreased by 12% compared with the level right after the injection of streptozotocin. While the feed intake in the untreated diabetic rats increased by 5.3% compared with the healthy group, the TS-treated group showed a pronounced 15.3% decrease. Therapeutic administration of TS has a protective effect on the pancreas and the liver against the cytotoxic action of streptozotocin. The plasma antioxidant capacity of all diabetic groups appeared to be approximately 15% lower than in healthy rats with no significant difference between the TS-treated and untreated diabetic animals. Apparently, this can be attributed to taxifolin and plasma proteins binding. These data demonstrate the potential of TS in antidiabetic therapy.

Variation in Phenolic Compounds, Antioxidant and Antibacterial Activities of Extracts from Different Plant Organs of Meadowsweet (Filipendula ulmaria (L.) Maxim.).

Meadowsweet (Filipendula ulmaria (L.) Maxim.) has been widely used in the treatment of various diseases. The pharmacological properties of meadowsweet are derived from the presence of phenolic compounds of a diverse structure in sufficiently large quantities. The purpose of this study was to examine the vertical distribution of individual groups of phenolic compounds (total phenolics, flavonoids, hydroxycinnamic acids, catechins, proanthocyanidins, and tannins) and individual phenolic compounds in meadowsweet and to determine the antioxidant and antibacterial activity of extracts from various meadowsweet organs. It was found that the leaves, flowers, fruits, and roots of meadowsweet are characterized by a high total phenolics content (up to 65 mg g-1). A high content of flavonoids was determined in the upper leaves and flowers (117-167 mg g-1), with high contents of hydroxycinnamic acids in the upper leaves, flowers, and fruits (6.4-7.8 mg g-1); high contents of catechins and proanthocyanidins in the roots (45.1 and 3.4 mg g-1, respectively); and high tannin content in the fruits (38.3 mg g-1). Analysis of extracts by high-performance liquid chromatography (HPLC) showed that the qualitative and quantitative composition of individual phenolic compounds in various parts of the meadowsweet varied greatly. Among the flavonoids identified in meadowsweet, quercetin derivatives dominate, namely quercetin 3-O-rutinoside, quercetin 3-ß-d-glucoside, and quercetin 4'-O-glucoside. Quercetin 4'-O-glucoside (spiraeoside) was found only in the flowers and fruits. Catechin was identified in the leaves and roots of meadowsweet. The distribution of phenolic acids across the plant was also uneven. In the upper leaves, a higher content of chlorogenic acid was determined, and in the lower leaves, a higher content of ellagic acid determined. In flowers and fruits, a higher contents of gallic, caftaric, ellagic, and salicylic acids were noted. Ellagic and salicylic acids were also dominant among phenolic acids in the roots. Based on the results of the analysis of antioxidant activity in terms of the ability to utilize the radicals of 2,2-diphenyl-1-picrylhydrazine (DPPH) and 2,2'-azino-bis(3-ethylbenzthiazolino-6-sulfonic acid) (ABTS) and in terms of iron-reducing ability (FRAP), the upper leaves, flowers, and fruits of meadowsweet can be considered plant raw materials suitable to obtain extracts with high antioxidant activity. Extracts of plant fruits and flowers also showed high antibacterial activity against the bacteria Bacillus subtilis and Pseudomonas aeruginosa.

Dietary supplements for improving nitric-oxide synthesis.

Nitric oxide (NO) is an essential component of the human body, involved in blood vessel dilation, stimulation of hormone release, signaling and regulation of neurotransmission. Nitric oxide is synthesized by nitric-oxide-synthase-dependent and -independent pathways. Nitric oxide supplementation improves cardiac health, enhances performance during exercise, reduces high blood pressure during pregnancy, reduces erectile dysfunction and improves healing processes and respiratory response. Nitric-oxide-associated benefits are mostly apparent in untrained or moderately trained individuals. L-arginine and L-citrulline supplementation contributes to nitric oxide levels because L-arginine is directly involved in NO synthesis, whereas L-citrulline acts as an L-arginine precursor that is further converted to NO by a reaction catalyzed by NO synthase. L-arginine supplements increase respiratory response and enhance performance during exercise, while L-citrulline with malate and other molecules increase working capacity. Various studies involving beetroot juice have reported a significant increase in plasma nitrite levels, regarded as markers of NO, after intake of beetroot juice. Although NO supplementation may have mild to moderate side-effects, using smaller or divided doses could avoid some of these side-effects. Since nitric oxide supplementation may worsen certain health conditions and may interfere with certain medicines, it should only be taken under medical supervision.

Dietary supplements for the management of COVID-19 symptoms.

SARS-CoV-2, the etiological agent of COVID-19, caused a pandemic in 2020, which is only recently slowing down. The symptoms of COVID-19 range from cough to fever and pneumonia and may persist beyond the active state of the infection, in a condition called post-COVID syndrome. The aim of this paper is to review the relationship between COVID-19 and nutrition and to discuss to most up-to-date dietary supplements proposed for COVID-19 treatment and prevention. Nutrition and nutritional dysregulations, such as obesity and malnutrition, are prominent risk factors for severe COVID-19. These factors exert anti-inflammatory and proinflammatory effects on the immune system, thus exacerbating or reducing the immunological response against the virus. As for the nutritional habits, the Western diet induces a chronic inflammatory state, whereas the Mediterranean diet exerts anti-inflammatory effects and has been proposed for ameliorating COVID-19 evolution and symptoms. Several vaccines have been researched and commercialized for COVID-19 prevention, whereas several drugs, although clinically tested, have not shown promising effects. To compensate for the lack of treatment, several supplements have been recommended for preventing or ameliorating COVID-19 symptoms. Thus, it is critical to review the dietary supplements proposed for COVID-19 treatment. Supplements containing α-cyclodextrin and hydroxytyrosol exhibited promising effects in several clinical trials and reduced the severity of the outcomes and the duration of the infection. Moreover, a supplement containing hydroxytyrosol, acetyl L-carnitine, and vitamins B, C, and D improved the symptoms of patients with post-COVID syndrome.

Ethnobotanical study of medicinal plants utilized in the management of candidiasis in Northern Uganda.

BACKGROUND: The emergence of resistant Candida species to antifungal drugs has led to resurgence in herbal usage globally. However, little is known about anti-candida plants. This study explored ethnomedicinal plants as treatment option for candidiasis in Pader, Northern Uganda. METHODS: A cross-sectional survey of potential anti-candida plants was conducted using questionnaires, focus group discussions and field observations in March 2022. Sixty-three respondents were selected by snowball technique. The frequencies of respondents/responses were analyzed, associations of respondents' socio-demographics with indigenous knowledge of herbal usage established by Chi-square (χ2) test using SPSS 27. Informant Consensus Factor was computed to establish level of agreement on herbal usage, and thematic analysis done for focus group discussions. RESULTS: Candidiasis is still common and troublesome in Pader. All herbalist had equal chances of receiving and treating candidiasis patients irrespective of herbalist's gender, age, education level, occupation, marital status and religion (p > 0.05). About 39.7% of herbalists received candidiasis patients weekly (p < 0.01). All herbalists had knowledge on candidiasis. Death (56.8%) and discomfort (36.8%) were the major health risks of oropharyngeal candidiasis (OPC) and vulvovaginal candidiasis (VVC), respectively. A total of 32 potential anti-candida plant species in 18 families were identified. Families of Fabaceae (9 species) and Asteraceae (5 species) had most plant species. Trees (50.0%) and herbs (43.8%) were the dominant life forms. The commonest plants by frequency of mention were: Momordica foetida (26), Sansevieria dawei (20), Khaya anthotheca (15), Piliostigma thonningii (10), Clerodendrum umbellatum (7), Hallea rubrostipulata (5) and unidentified plant, 'Agaba/daa layata' in Acholi dialect (5). Plant parts mainly used were roots (56.3%) and stem barks (15.6%) harvested majorly by cutting (46.9%) and uprooting (12.5%). Most respondents (females, 95%) preferred herbal to western medication (p < 0.01) due to its perceived effectiveness. There was high consensus among herbalists on herbal remedies for OPC and VVC (FIC = 0.9). CONCLUSIONS:  Pader communities have diverse indigenous knowledge on candidiasis and prefer herbal medicines to orthodox treatment for candidiasis. However, the herbalists use unsustainable harvesting techniques like uprooting whole plants and cutting main roots. Hence, the need to document such indigenous knowledge before being lost for community usage and scientific validation.

Medically important bacteria isolated from commercial herbal medicines in Kampala city indicate the need to enhance safety frameworks.

The high global bacterial infection burden has created need to investigate the neglected potential drivers of pathogenic bacteria, to inform disease prevention. Kampala is facing a proliferation of herbalists, selling herbal medicine (HM), of largely unregulated microbiological quality. We evaluated the bacterial contamination burden in HM sold in Kampala, to support evidence-based redress. The total viable loads (TVL), total coliform counts (TCC), E. coli counts, and prevalence of selected bacterial strains in 140 HM were examined using conventional culture, following the guidelines of World Health Organization (WHO), and Uganda National Drug Authority (NDA). Data were analyzed using D'Agostino-Pearson test, frequencies, proportions, Chi-square, and Mann-Whitney U test with STATA version-15.0. Fifty (35.7%), fifty-nine (42.1%), and twelve (8.6%) HM were unsafe for human use because they exceeded WHO's permissible limits for TVL, TCC, and E. coli counts respectively. Solids had significantly higher mean TVL than liquids. Violation of NDA's guidelines was significantly associated with high TVL. Fifty-nine bacteria, viz., Klebsiella pneumoniae (n = 34; 57.6%), Escherichia. coli (12; 20.3%), Staphylococcus aureus (7; 11.9%), Klebsiella oxytoca (3; 5.1%), Bacillus cereus, Pseudomonas aeruginosa, and Enterobacter spp. (1; 1.7% each), were isolated from 45 (32.1%) samples. These bacteria can cause severe clinical diseases, and promote deterioration of HM potency.

Whey Protein, L-Leucine and Vitamin D Supplementation for Preserving Lean Mass during a Low-Calorie Diet in Sarcopenic Obese Women.

In sarcopenic obese subjects it is essential to reduce body weight and preserve lean mass, in order to avoid a worsening of muscle function. Several studies have shown that leucine supplementation can be useful to improve skeletal muscle mass in sarcopenic patients. The aim of our study was to evaluate the effectiveness of a short-term low-calorie diet (LCD) combined with supplementation with whey protein and leucine on weight loss, lean mass and muscle strength in sarcopenic, obese, hyperinsulinemic and post-menopausal women. Sixteen females with a mean age of 60 years (range: 50-70 years), BMI 37.6 kg/m2 (range: 31.7-44.1 Kg/m2), HOMA-index ≥ 2.5 (range: 2.9-12) were assigned to an LCD regimen (1000 kcal/day) with supplementation of 18 g whey proteins which 4.1 g of leucine for 45 days. Anthropometric indexes, blood and urine chemistry, body composition by DEXA, muscle strength by handgrip test and Short Physical Performance Battery (SPPB) were assessed at baseline and at the end of the treatment. A significant reduction in BMI (37.6 vs. 35.7 Kg/m2), waist circumference (107 vs. 102.4 cm), HOMA index (4.8 vs. 2.3) and fasting insulin (17.4 vs. 10.4 µIU/mL) was observed in all patients. Women preserved total lean body mass (55 vs. 5%) and significantly improved their muscle strength, as measured by handgrip (15.3 vs. 20.1 Kg), and their muscle function, as measured by SPPB (7.5 vs. 8.9). A significant increase in BUN was also observed (36.1 vs. 46.3). We conclude that LCD with adequate protein intake and supplementation with whey protein and leucine should be promoted to maintain muscle mass and improve muscle strength in post-menopausal women with sarcopenic obesity.

Effect of salicylic acid on phenolic compounds, antioxidant and antihyperglycemic activity of Lamiaceae plants grown in a temperate climate.

BACKGROUND: The Lamiaceae family, one of the most important herbaceous and shrub plant families, includes a wide variety of plants with biological and medicinal uses. This study aimed to conduct a comparative analysis of phenolic compounds content and biological activity of extracts from eight species of Lamiaceae plants, cultivated in a temperate climate, and to study the effect of the foliar salicylic acid application on these parameters. METHODS: Lamiaceae plants (Lavandula angustifolia, Salvia officinalis, Hyssopus officinalis, Agastache foeniculum, Thymus serpyllum, Mentha × piperita, Origanum vulgare, Monarda didyma) cultivated on field experimental sites. Plants were sprayed with salicylic acid at a concentration of 1 mM. The untreated with salicylic acid plants were used as control. RESULTS: The highest contents of hydroxycinnamic acids and flavonoids in control plants were observed in the Agastache foeniculum (6.4 ± 0.6 mg g-1 and 6.5 ± 0.4 mg g-1 respectively). The highest content of phenolic compounds was found in Monarda didyma (13.8 ± 0.7 mg g-1). Among the control plants, Agastache foeniculum, Hyssopus officinalis, and Mentha × piperita were characterized by the highest antioxidant activity. All the studied extracts had the ability to inhibit α-amylase and α-glucosidase. Significant positive correlations were revealed between the antioxidant activity and the contents of hydroxycinnamic acids, total phenolic compounds, and flavonoids. A high degree of correlation was found between the α-amylase inhibitory activity and the content of hydroxycinnamic acids (r = 0.72, p ≤ 0.05), as well as between the α-glucosidase inhibitory activity and the content of flavonoids (r = 0.83, p ≤ 0.05) and hydroxycinnamic acids (r = 0.81, p ≤ 0.05). The foliar treatment with salicylic acid led to an increase in the contents of hydroxycinnamic acids (in 6 species), flavonoids (in 2 species), total phenolic compounds (in 7 species), antioxidant activity (in 5 species), as well as in α-amylase (in 4 species) and α-glucosidase (in 5 species) inhibitory activity compared to the control plants. Lavandula angustifolia was the most susceptible to foliar treatment with salicylic acid. In this plant species, a significant increase in all studied biochemical parameters was noted. CONCLUSIONS: The results obtained on the stimulating effects of salicylic acid can be used to increase the nutritional and pharmacological value of plants of the Lamiaceae family cultivated in temperate climates.

Antibiotic-resistance in medically important bacteria isolated from commercial herbal medicines in Africa from 2000 to 2021: a systematic review and meta-analysis.

BACKGROUND: Antimicrobial resistance is swiftly increasing all over the world. In Africa, it manifests more in pathogenic bacteria in form of antibiotic resistance (ABR). On this continent, bacterial contamination of commonly used herbal medicine (HM) is on the increase, but information about antimicrobial resistance in these contaminants is limited due to fragmented studies. Here, we analyzed research that characterized ABR in pathogenic bacteria isolated from HM in Africa since 2000; to generate a comprehensive understanding of the drug-resistant bacterial contamination burden in this region. METHODS: The study was conducted according to standards of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). We searched for articles from 12 databases. These were: PubMed, Science Direct, Scifinder scholar, Google scholar, HerbMed, Medline, EMBASE, Cochrane Library, International Pharmaceutical Abstracts, Commonwealth Agricultural Bureau Abstracts, African Journal Online, and Biological Abstracts. Prevalence and ABR traits of bacterial isolates, Cochran's Q test, and the I2 statistic for heterogeneity were evaluated using MedCalcs software. A random-effects model was used to determine the pooled prevalence of ABR traits. The potential sources of heterogeneity were examined through sensitivity analysis, subgroup analysis, and meta-regression at a 95% level of significance. FINDINGS: Eighteen studies met our inclusion criteria. The pooled prevalence of bacterial resistance to at least one conventional drug was 86.51% (95% CI = 61.247-99.357%). The studies were highly heterogeneous (I2 = 99.17%; p < 0.0001), with no evidence of publication bias. The most prevalent multidrug-resistant species was Escherichia coli (24.0%). The most highly resisted drug was Ceftazidime with a pooled prevalence of 95.10% (95% CI = 78.51-99.87%), while the drug-class was 3rd generation cephalosporins; 91.64% (95% CI = 78.64-96.73%). None of the eligible studies tested isolates for Carbapenem resistance. Extended Spectrum ß-lactamase genes were detected in 89 (37.2%) isolates, mostly Salmonella spp., Proteus vulgaris, and K. pneumonia. Resistance plasmids were found in 6 (5.8%) isolates; the heaviest plasmid weighed 23,130 Kilobases, and Proteus vulgaris harbored the majority (n = 5; 83.3%). CONCLUSIONS: Herbal medicines in Africa harbor bacterial contaminants which are highly resistant to conventional medicines. This points to a potential treatment failure when these contaminants are involved in diseases causation. More research on this subject is recommended, to fill the evidence gaps and support the formation of collaborative quality control mechanisms for the herbal medicine industry in Africa.

Herbal medicine used for the treatment of diarrhea and cough in Kampala city, Uganda.

BACKGROUND: Globally, diarrheal and respiratory diseases are among the main causes of mortality and morbidity. In Uganda, cities are facing proliferation of trade in herbal medicines (HM), including those for diarrhea and/or cough. Information on the economic, and the ethnopharmacological aspects of these HM is scarce, deterring the sector from achieving optimal capacity to support national development. We profiled the anti-diarrhea and/or anti-cough HM, and the basic economic aspects of HM trade in Kampala city, to support ethnopharmacological knowledge conservation and strategic planning. METHODS: A cross-sectional survey was conducted on 65 herbalists using semi-structured questionnaires. This was supplemented by an observational survey using a high-resolution digital camera. Data were collected following the guidelines for research on HM, established by Uganda National Drug Authority, and World Health organization. RESULTS: Eighty-four plant species from 41 families were documented. Fabaceae and Myricaceae had the highest number of species (9, 10.7% each). Citrus limon (L.) Osbeck was the most commonly cited for cough, with a relative frequency of citation (RFC) of 1.00, and its relative medical importance was not significantly different from the other top 5 species except for Azadirachta indica A.Juss (RFC = 0.87). Entada abyssinica A. Rich (RFC = 0.97) was the most cited for diarrhea. Trees (34, 40.5%) were mostly used, and mainly harvested from wild habitats (55.2%) in 20 districts across Uganda. These HM were mainly sold as powders and concoctions, in markets, shops, pharmacies, and roadside or mobile stalls. The highest prices were Uganda Shillings (UGX) 48,000 ($13.15)/kg for Allium sativum L, and UGX 16,000 ($4.38)/kg for C. limon. All participants used HM trade as a sole source of basic needs; majority (60.0%) earned net monthly profit of UGX. 730,000 ($200) ≤ 1,460,000 ($400). The main hindrances to HM trade were the; disruptions caused by the COVID-19 pandemic (n = 65, 100%), and the scarcity of medicinal plants (58, 89.2%). CONCLUSION: There is a rich diversity of medicinal plant species traded in Kampala to treat diarrhea and cough. The HM trade significantly contributes to the livelihoods of the traders in Kampala, as well as the different actors along the HM value chain throughout the country.

Iontophoresis of treprostinil promotes wound healing in a murine model of scleroderma-related ulcers.

OBJECTIVE: Systemic sclerosis (SSc) is a rare, chronic disease characterized by fibrosis, vascular alterations and digital ulcerations. Few drugs have shown efficacy to enhance wound healing of existing SSc-related ulcers. Local delivery of treprostinil, a prostacyclin analogue, may improve wound healing. The present work aimed first at developing a mouse model of SSc-related ulcerations and second at assessing the effect of iontophoresis of treprostinil on wound healing. METHODS: We used two murine models of SSc: chemically induced with HOCl, and urokinase-type plasminogen activator receptor (uPAR)-deficient. Excisional wounding was performed on the dorsal midline with a biopsy punch. Animals were randomized into three groups: treated with electrostimulation alone, with treprostinil iontophoresis or untreated. We assessed wound healing over time, as well as skin microvascular reactivity, inflammation, microvessel density and collagen distribution, before wounding and after re-epithelialization. RESULTS: uPAR-/- mice, but not HOCl-treated mice, showed impaired wound healing and decreased microvascular reactivity compared with their controls. Treprostinil iontophoresis improved wound healing and microvascular density and decreased inflammation in uPAR-/- mice, while electro-stimulation did not. However, treprostinil had no effect on microvascular reactivity and collagen distribution. CONCLUSION: This study suggests that excisional wounds in uPAR-/- mice are a relevant model of SSc-related ulcers. In addition, treprostinil iontophoresis enhances wound healing in this model. Further work in now needed to show whether this effect translates in humans.

Formulation development of anti-rheumatoid gel of Saraca asoca (Roxb. ) De Wilde hydroalcoholic extract containing eucalyptus oil and peppermint oil as penetration enhancer

Abstract In the present research investigation, various concentrations of hydro-alcoholic extract of Saraca asoca (Roxb.) De Wilde (family: Caesalpinaceae) dried bark and carbopol polymer at different temperature ranges were optimized for the preparation of gel formulation. Natural penetration enhancers, v.i.z., eucalyptus oil and peppermint oil were incorporated separately in the extract based gel formulations to study the rate of drug permeation across egg membrane, using franz diffusion cell. In vitro anti-arthritis potential of the formulations was also studied using inhibition of albumin denaturation, antiproteinase activity and membrane stabilization method. As per the results of current study, it is established that S. asoca dried bark hydroalcoholic extract based gel prepared using peppermint oil as penetration enhancer exhibited good permeation rate of 8.48% at the end of 3 h. The percentage inhibition of proteins by antiproteinase method at concentration of 50 µg/ml was 50.01±1.00% which was close to 53.92±0.99% as shown by the standard drug, Diclofenac. Also, the percent protein inhibition determined using membrane stabilization method was found to be 49.70±1.00%, however, it was 63.32±0.94% for the standard drug, Diclofenac. Hence, it is concluded that peppermint oil may act as a good candidate for the preparation of potent anti-rheumatic gel preparations.

Ethnobotanical survey of medicinal plant species used by communities around Mabira and Mpanga Central Forest Reserves, Uganda.

BACKGROUND: Medicinal plants form an integral part of many health care systems in Uganda. This study aimed at documenting the therapeutic importance of plant species used in primary health care among communities living adjacent to Mabira and Mpanga forest reserves in Central Uganda. METHODS: An ethnobotanical study was conducted between April and June 2018 in 7 villages adjacent to Mpanga and 6 villages adjacent to Mabira central forest reserves. Information was obtained from 28 respondents identified using snowball and purposive sampling techniques and interviewed using semi-structured questionnaires. Descriptive statistics were used to present the data. The quantitative analysis of data was done using fidelity level, informant consensus factor, and percent respondent knowledge indices. RESULTS: A total of 136 medicinal plants were recorded. The plant species classified into 55 families were grouped under 14 medical categories with the highest number of plant species being used for digestive disorders (44%), followed by respiratory (38%) and dermatological disorders (36%). Hoslundia opposita Vahl was mentioned by 71% of the respondents for treating 22 disease conditions. Plant Family Fabaceae was the most represented with 16 species. Informant consensus agreement was high (0.7) for respiratory disorders. The fidelity level was 100% for Bidens pilosa L. and Callistemon citrinus Skeels for treating wounds and cough, respectively. Plant remedies were mainly prepared by decoction (31%) and administered orally (36%). A large number of plants (61%) were harvested from wild habitats. Herbs (50%) and leaves (50%) contributed the highest percentage of plant biological forms and parts used in remedy preparation. CONCLUSION: This study recorded plant species with the potential to treat a wide range of illnesses. This is reflected in the high diversity of the recorded species used for medicinal purposes. Pharmacological studies on the plants with high percentage use values and fidelity levels are needed to validate their uses in the management of the said therapeutic applications. Further research on the isolation and characterization of the plant active compounds could lead to the discovery of new potential drugs.

Antibacterial, antioxidant, and sun protection potential of selected ethno medicinal plants used for skin infections in Uganda.

BACKGROUND: Rural populations in Uganda rely heavily on medicinal plants for the treatment of bacterial skin infections. However, the efficacy of these medicinal plants for their pharmacological action is not known. The study aimed at evaluating the antibacterial, antioxidant, and sun protection potential of Spermacoce princeae, Psorospermum febrifugum, Plectranthus caespitosus, and Erlangea tomentosa extracts. METHODS: The plant samples were extracted by maceration sequentially using hexane, dichloromethane, ethyl acetate, methanol, and distilled water. Antibacterial activity of each extract was carried out using an agar well diffusion assay against Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Klebsiella pneumonie, Streptococcus pyogenes, and Salmonella typhi. Acute dermal toxicity of the aqueous extract of S. princeae and P. febrifugum, and E. tomentosa was assessed in young adult healthy Wistar albino rats at a dose of 8000 and 10,000 mg/kg body weight. The antioxidant activity of each extract was carried out using a 1,1-diphenyl-2-picryl-hydrazyl (DPPH) radical scavenging assay. The sun protection factor was determined using Shimadzu UltraViolet-Visible double beam spectrophotometer between 290 and 320 nm. RESULTS: The plant extracts showed good antibacterial activity against the tested bacterial strains with minimum inhibitory concentration (MIC) ranging between 3.12 and 12.5 mg/ml. There was no significant change in the levels of creatinine, alanine aminotransferase, and aspartate aminotransferase in the rats even at a higher dose of 10,000 mg/kg, which was related to the results of biochemical analysis of the blood samples from the treated and control groups. The aqueous and methanol extracts of S. princeae showed potential antioxidant properties, with half maximal inhibitory concentration (IC50) values of 59.82 and 61.20 µg/ml respectively. The organic and aqueous extracts of P. caespitosus showed high levels of protection against Ultraviolet light with sun protection potential values ranging between 30.67 and 37.84. CONCLUSIONS: The study demonstrated that the selected medicinal plants possessed good antibacterial, antioxidant, and sun protection properties. Therefore, the plants are alternative sources of antibacterial, antioxidant, and sun protection agents in managing bacterial skin infections.

In situ synthesis of silver or selenium nanoparticles on cationized cellulose fabrics for antimicrobial application.

In this study, we developed a method to prepare inorganic nanoparticles in situ on the surface of cationized cellulose using a rapid microwave-assisted synthesis. Selenium nanoparticles (SeNPs) were employed as a novel type of antimicrobial agent and, using the same method, silver nanoparticles (AgNPs) were also prepared. The results demonstrated that both SeNPs and AgNPs of about 100 nm in size were generated on the cationized cellulose fabrics. The antibacterial tests revealed that the presence of SeNPs clearly improved the antibacterial performance of cationized cellulose in a similar way as AgNPs. The functionalised fabrics demonstrated strong antibacterial activity when assessed using the challenge test method, even after repeated washing. Microscopic investigations revealed that the bacterial cells were visually damaged through contact with the functionalised fabrics. Furthermore, the functionalised fabrics showed low cytotoxicity towards human cells when tested in vitro using an indirect contact method. In conclusion, this study provides a new approach to prepare cationic cellulose fabrics functionalised with Se or Ag nanoparticles, which exhibit excellent antimicrobial performance, low cytotoxicity and good laundry durability. We have demonstrated that SeNPs can be a good alternative to AgNPs and the functionalised fabrics have great potential to serve as an anti-infective material.

Prevalence and dynamics of clinically significant bacterial contaminants in herbal medicines sold in East Africa from 2000 to 2020: a systematic review and meta-analysis.

BACKGROUND: Infectious diseases remain a leading cause of mortality and morbidity around the world, and those caused by bacteria are common in the East African region. In this region, trade and consumption of herbal medicine has been expanding in the recent decades. Herbal medicines may be contaminated with pathogenic bacteria; however, there is limited information due to fragmented studies in East Africa. In this meta-analysis, we critically analyzed original research related to the incidence of pathogenic bacterial contaminants of HM in the East African region since 2000. The aim was to create a comprehensive understanding of the extent and dynamics of bacterial contamination in HM, to guide future research and concerted public health protection in the region. METHODOLOGY: The study was conducted according to the standards of the Preferred Reporting Items for Systematic Reviews and Meta-analyses. We searched and evaluated published articles from eleven electronic databases (Google Scholar, PubMed, HerbMed, MEDLINE, Science Direct, Scifinder Scholar, Cochrane Library, International Pharmaceutical Abstracts, EMBASE, Biological Abstracts and Commonwealth Agricultural Bureau Abstracts). Prevalences of different bacterial species, Cochran's Q test, and the I2 statistic for heterogeneity were evaluated using a software called MedCalcs. Random and fixed effects models were used to determine the pooled prevalence of clinically significant bacteria from studies which were included in this meta-analysis. The potential sources of heterogeneity were examined through sensitivity analysis, sub-group analysis, and meta-regression at 95% level of significance. RESULTS: Fourteen studies met our inclusion criteria. Overall, the studies were highly heterogeneous (I2 = 98.48%) and there was no evidence of publication bias. Escherichia coli was the most prevalent contaminant. Salmonella spp. and Shigella spp. were the most frequently reported primary pathogens with pooled prevalence of 10.4% and 6.3%, respectively. Our findings are in tandem with recent systematic reviews conducted in Europe and Asia, but are in discrepancy with the reviews recently conducted in southern Africa. CONCLUSION AND RECOMMENDATIONS: The East African herbal medicine industry poses considerable health risks to communities through dissemination of clinically significant bacteria. Presence of enteric bacterial contaminants indicates possible fecal pollution of herbal medicine region-wide. Adequate research pertaining to microbial safety of herbal medicine in the East African countries remains highly desired. The latter will enable establishment of strong, region-wide herbal safety mechanisms in order to support comprehensive public health protection in East Africa.

Scale-up integrated care for diabetes and hypertension in Cambodia, Slovenia and Belgium (SCUBY): a study design for a quasi-experimental multiple case study.

Health systems worldwide struggle to manage the growing burden of type 2 diabetes and hypertension. Many patients receive suboptimal care, especially those most vulnerable. An evidence-based Integrated Care Package (ICP) with primary care-based diagnosis, treatment, education and self-management support and collaboration, leads to better health outcomes, but there is little knowledge of how to scale-up. The Scale-up integrated care for diabetes and hypertension project (SCUBY) aims to address this problem by roadmaps for scaling-up ICP in different types of health systems: a developing health system in a lower middle-income country (Cambodia); a centrally steered health system in a high-income country (Slovenia); and a publicly funded highly privatised health-care health system in a high-income country (Belgium). In a quasi-experimental multi-case design, country-specific scale-up strategies are developed, implemented and evaluated. A three-dimensional framework assesses scale-up along three axes: (1) increase in population coverage; (2) expansion of the ICP package; and (3) integration into the health system. The study includes a formative, intervention and evaluation phase. The intervention entails the development and implementation of an improved scale-up strategy through a roadmap with a minimum dataset to monitor proximal and distal outcomes. The SCUBY project is expected to result in three different roadmaps, tailored to the specific health system and country context, to progress scale-up of the ICP along three dimensions. These roadmaps can be adapted to other health systems with similar typology. Implementation is expected to increase the number of well-controlled patients with type 2 diabetes and hypertension in Cambodia, to reduce inequities in care and increase patient empowerment in Belgium and Slovenia.

Baseline HOMA IR and Circulating FGF21 Levels Predict NAFLD Improvement in Patients Undergoing a Low Carbohydrate Dietary Intervention for Weight Loss: A Prospective Observational Pilot Study.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a major cause of liver disease. Very low-calorie ketogenic diets (VLCKD) represent a feasible treatment as they induce profound weight loss and insulin resistance (IR) improvement. Despite the recognized benefits on NAFLD deriving from pharmacological administration of fibroblast growth factor 21 (FGF21), whose endogenous counterpart is a marker of liver injury, little is known about its physiology in humans. AIM: To identify predictors of NAFLD improvement as reflected by the reduction of the non-invasive screening tool hepatic steatosis index (HSI) in obese patients undergoing a weight loss program. METHODS: Sixty-five obese patients underwent a 90-day dietary program consisting of a VLCKD followed by a hypocaloric low carbohydrate diet (LCD). Anthropometric parameters, body composition, and blood and urine chemistry were assessed. RESULTS: Unlike most parameters improving mainly during the VLCKD, the deepest HSI change was observed after the LCD (p = 0.02 and p < 0.0001, respectively). Baseline HOMA-IR and serum FGF21 were found to be positive (R = 0.414, p = 0009) and negative (R = 0.364, p = 0.04) independent predictors of HSI reduction, respectively. CONCLUSIONS: We suggest that patients with IR and NAFLD derive greater benefit from a VLCKD, and we propose a possible role of human FGF21 in mediating NAFLD amelioration following nutritional manipulation.