Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 Guidelines Reviewed.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) report is an essential resource for all clinicians who strive to provide optimal care to patients with chronic obstructive lung disease (COPD). The annual report of GOLD makes few revisions and updates besides including data from the preceding year. At an interval, GOLD comes up with a significant modification in its guidelines, which is generally a major overhaul of the pre-existing guidelines. According to the latest 2023 updates, published in November 2022, there have been significant advancements made in the field of COPD. These include the development of more precise definitions for COPD and its exacerbations, the introduction of a new set of parameters to measure exacerbation severity, and updating the COPD assessment tool. Additionally, revisions have been made to the initial and follow-up treatment guidelines. The report also simplifies the treatment algorithm and sheds light on new findings that suggest the use of pharmacological triple therapy can reduce mortality rates. Furthermore, the report includes discussions on inhaler device selection and adherence to COPD medications. These improvements demonstrate a continued effort to enhance COPD treatment and management. Although there are some areas that could benefit from more detailed guidance and explanation, such as the proper utilization of blood eosinophil counts for treatment decisions, and the establishment of treatment protocols post-hospitalization, the latest modifications to the GOLD recommendations will undoubtedly aid healthcare providers in addressing any gaps in patient care. We aim to highlight key changes in the GOLD 2023 report and present a viewpoint about their potential implications in a real-world clinical scenario.

Oxygen Requirement and Associated Risk Factors in Post-COVID-19 Patients Admitted to a Tertiary Care Center: A Cross-Sectional Study.

Background: COVID-19 commonly affects the lungs and may lead to mild to severe hypoxemia. The supplemental oxygen requirement gradually reduces with the improvement in lung pathology. However, a few patients may have exertional desaturation, and ongoing oxygen needs at the time of hospital discharge. The objective of this research was to study the requirement of oxygen therapy in the immediate post-COVID-19 period and its associated risk factors. Materials and Methods: An analytical cross-sectional study was conducted on the admitted post-COVID-19 patients who had recently tested real-time polymerase chain reaction (RT-PCR) negative in a tertiary care center from August 2021 to mid of October 2021. Nonprobability consecutive sampling was used, and the sample size was 108. The data were analyzed using the Statistical Package for the Social Sciences (IBM-SPSS), version 23. The mode of oxygen therapy (nasal cannula, face mask, reservoir mask, or mechanical ventilation) in the first two weeks of the study was presented appropriately in a table. The nonparametric statistical tests were applied to determine the association between the duration of post-COVID-19 oxygen therapy and several other risk factors such as age, gender, comorbidities, smoking status, exposure to firewood, COVID-19 vaccination, and severity of COVID-19. Results: 95 (87.96%) cases required oxygen therapy in their immediate post-COVID-19 period. The overall median duration of oxygen therapy was 6.00 (4.00-10.00) days. The nasal cannula was the most commonly used mode of oxygen supplement. The duration of oxygen therapy was significantly higher in patients aged more than 60 years (6.00 [5.00-11.00], p = 0.013), chronic obstructive pulmonary disease (10.00 [6.00-12.75], p = 0.006), history of chronic smoking (9.00 [5.50-13.00], p = 0.044), and severe COVID-19 infection (7.00 [5.00-10.50], p = 0.042). Conclusions: The proportion of patients requiring oxygen therapy in the immediate post-COVID-19 period was higher than that reported in other studies. In addition, old age (>60 years), chronic obstructive pulmonary disease, chronic smoking, and severe COVID-19 infection significantly increased the duration of oxygen therapy. So, these factors should be assessed while discharging patients from COVID-19 facilities, and oxygen supplementation should be planned for needy patients.

Progressive multifocal leukoencephalopathy in the background of chlorambucil treated chronic lymphocytic leukemia: a case report from Nepal.

Introduction: Progressive multifocal leukoencephalopathy is a rare manifestation in itself. Although many immunosuppressive states are associated with the disease, its occurrence in the setting of chronic lymphocytic leukaemia treated with chemotherapy is seldom reported to date. Case presentation: A 67-year-old woman with known chronic lymphocytic leukaemia who was previously receiving chlorambucil treatment was identified as having progressive multifocal leukoencephalopathy; her prognosis is currently good. Clinical discussion: Although a rare disease in an immunocompromised setting, progressive multifocal leukoencephalopathy often leads to a grave outcome. However, the authors describe a case with a good prognosis to date. Conclusion: Progressive multifocal leukoencephalopathy should be in differentials in immunocompromised patients with dementia. Given that the later prognosis of the disease is unpredictable, an earlier diagnosis would be better for immunological reconstitution.

Neuro-cryptococcosis in an immunocompetent individual with radiologically atypical findings: a case report and review of literature.

We present a case of a 29-year-old immunocompetent female without any known comorbidities with intermittent headache and vomiting who was ultimately diagnosed with cryptococcal meningitis (CM). Though her neuroimaging findings were atypical to those commonly found in CM, she was diagnosed with CM with a cryptococcal antigen test. However, in contrast to the good prognosis as stated in the literature, she died during her course stay at the hospital. Therefore, cryptococcosis should be taken as differentials, even in an immunocompetent individual presenting with features suggestive of meningitis, to prevent the worst clinical outcome.

Psychotic symptoms in a patient with Systemic Lupus Erythematosus: A diagnostic dilemma between lupus psychosis and steroid induced psychosis.

Introduction: Systemic Lupus Erythematosus (SLE) is a chronic auto-immune disorder with the involvement of multiple organ systems. It is more common in females. Case presentation: Here, we present a case of 12-year-old female, known case of SLE with lupus nephritis, presenting with neuropsychiatric symptoms. She was under steroids as well for a few weeks due to flare-up of symptoms prior to that. Due to this, there was a diagnostic dilemma between lupus psychosis and steroid induced psychosis. Clinical discussion: Approximately one third to half of the patients may have neurological involvement in Systemic Lupus Erythematosus. However, neuropsychiatric symptoms in them could be due to corticosteroids, which are frequently used in treatment. There are no definitive and easily available laboratory markers to distinguish these two aetiologies. Conclusions: Systemic Lupus Erythematosus patients, who are on steroids, with neuropsychiatric features should be assessed adequately. As there are no specific guideline and biomarkers to distinguish between these two, meticulous evaluation is necessary for appropriate management.

Estimation of sorption-desorption characteristics of biosorbent of Lantana camara leaves for removal of Pb (II) ions from wastewater.

This study points out the method regarding the removal of Pb (II) ions from water by treatment with Lantana camara leaves' biosorbent (LCLB). The sorption process was investigated by varying different parameters pH, contact time, adsorbent dose, initial metal ion concentration, and temperature. For a 5.00 g sorbent dose and a 45 min of the contact period, a Pb (II) ion solution with an initial metal ion concentration of 10 mg/L resulted in 90.7% maximum elimination at an optimum pH 6 and temperature 298 ± 1.5 K with LCLB. The adsorption process was spontaneous and exothermic. The maximum monolayer adsorption was 3.5 mg/g for Pb (II) sorption using LCLB. Adsorption of Pb (II) ions using LCLB (R2 > 0.999) followed the pseudo-second-order kinetics. The spectroscopic characterization was done by fourier transform infrared (FT-IR) analysis, while scanning electron microscope (SEM) images were captured for the morphological characterization. Desorption experiments revealed that hydrochloric acid has a strong potential as an eluent for Pb (II) ion desorption. The findings proposed that LCLB can be used as an effectual and cost-effective biosorbent for the expulsion of Pb (II) ions.

Ameliorating potential of curcumin and its analogue in central nervous system disorders and related conditions: A review of molecular pathways.

Curcumin, isolated from turmeric (Curcuma longa L.) is one of the broadly studied phytomolecule owing to its strong antioxidant and anti-inflammatory potential and has been considered a promising therapeutic candidate in a wide range of disorders. Considering, its low bioavailability, different curcumin analogs have been developed to afford desired pharmacokinetic profile and therapeutic outcome in varied pathological states. Several preclinical and clinical studies have indicated that curcumin ameliorates mitochondrial dysfunction, inflammation, oxidative stress apoptosis-mediated neural cell degeneration and could effectively be utilized in the treatment of different neurodegenerative diseases. Hence, in this review, we have summarized key findings of experimental and clinical studies conducted on curcumin and its analogues with special emphasis on molecular pathways, viz. NF-kB, Nrf2-ARE, glial activation, apoptosis, angiogenesis, SOCS/JAK/STAT, PI3K/Akt, ERK1/2 /MyD88 /p38 MAPK, JNK, iNOS/NO, and MMP pathways involved in imparting ameliorative effects in the therapy of neurodegenerative disorders and associated conditions.

Role of curcumin in ameliorating hypertension and associated conditions: a mechanistic insight.

Curcumin, belongs to the curcuminoid family, is a natural phenolic compound, presenting low bioavailability and pleiotropic activity. Since ancient times, curcumin has been in use as food spices and folk remedy to treat cough, cold, cuts and wounds, and skin diseases. Preclinical and clinical studies have indicated that curcumin acts a promising therapeutic agent in the management of a wide array of health issues, viz., hyperlipidemia, metabolic syndrome, anxiety, arthritis, cancer and inflammatory diseases. Owing to its enormous potential, recent research has been focused on the synthesis of curcumin and its analogues for the management of metabolic disorders. In the current scenario, hypertension is considered as a key risk factor due to its involvement in various pathogeneses. Mechanistically, curcumin and its analogues like hexahydrocurcumin, tetrahydrocurcumin, etc. have been reported to elicit anti-hypertensive effect through diverse signalling pathways, viz., pathway mediated by Nrf2-ARE, NF-kB, NO/cGMP/PDE5/MMPs, RAAS/ACE, HAT/HDAC, G0/G1/apoptosis, CYP3A4, UCP2/PARP, VEGF/STAT/AXL/tyrosine kinase and TGF-ß/Smad-mediated pathways. Thus, the present review has been aimed to highlight different molecular pathways involved in the amelioration of hypertension and associated conditions.

Antidepressant activity of Spathodea campanulata in mice and predictive affinity of spatheosides towards type A monoamine oxidase.

The antidepressant activity of Spathodea campanulata flowers was evaluated in mice and in silico. When tested at doses of 200 and 400 mg/kg, the methanol extract of S. campanulata (MESC) showed dose-dependent antidepressant activity in the force swim test (FST), tail suspension test (TST), lithium chloride-induced twitches test and the open field test. In FST and TST, animals treated with MESC demonstrated a significant decrease in the immobility period compared to the control group. The lithium chloride-induced head twitches were significantly reduced following administration of MESC. The latter, at the dose of 400 mg/kg, also significantly reduced locomotor activity. Following administration of MESC, changes in the levels of serum corticosterone, and of norepinephrine, dopamine, serotonin, 4-hydroxy-3-methoxyphenylglycol (MHPG), 4-dihydroxyphenylacetic acid (DOPAC), and 5-hydroxyindoleacetic acid (5-HIAA) were measured in different brain regions using HPLC. The presence of spatheoside A (m/z 541) and spatheoside B (m/z 559) in MESC was detected using HPLC/ESI-MS. These two iridoids demonstrated a high predictive binding affinity for the active site of the type A monoamine oxidase (MAO-A) enzyme with scores of 99.40 and 93.54, respectively.  These data suggest that S. campanulata flowers warrants further investigation as a source of novel templates for antidepressive drugs.

Curcumin: An Insight into Molecular Pathways Involved in Anticancer Activity.

Curcuma longa has been mentioned in the Indian system of medicine for the management of a wide range of diseases. C. longa and its metabolites like curcumin, ar-turmerone, methylcurcumin, demethoxy-curcumin, and bisdemethoxycurcumin have also been reported to be beneficial in various types of cancer. Curcumin elicits anticancer properties chiefly by triggering apoptotic pathways in cancer cells. The properties are facilitated through diverse signaling pathways viz. pathways mediated by NF-kB, WNT/ß-catenin pathway COX-2, LOX, STAT3, prostaglandin E2, phosphorylase kinase, VEGF, AKT, AP1, STAT3, PI3K, Akt, mTOR, ERK5, AP-1, TGF-b, PPARc, EBPa, NLRP3 inflammasome, p38MAPK, Nrf2, Notch-1, AMPK, TLR-4, etc. The present article highlights curcumin biosynthesis, phytochemistry and diverse molecular pathways involved in regulating several types of secondary messengers to exhibit anticancer activity in almost all the forms of cancer.

Formulation and Evaluation of Polyherbal Cream and Lotion for the Treatment of Psoriasis-Induced Secondary Infections.

BACKGROUND: Psoriasis is one of the most common skin diseases in humans and affects a major population worldwide. The aim of the present study is to evaluate the efficacy of selected polyherbal formulations against psoriasis-induced secondary infections. AIM: Psoriasis is one of the most common skin diseases in humans and affects a major population worldwide. The aim of the present study is to evaluate the efficacy of selected polyherbal formulations against psoriasis-induced secondary infections. METHODS: Samples were collected from the scalp, behind the ears, chest and back of the patients. The microscopic examination of fungal and bacterial growth was carried out with lactophenol cotton blue stain and gram stain, respectively. Volatile constituents of essential oils were identified by GC-MS analysis, in order to investigate the relation between chemical composition and biological activity. Nutrient agar media was used for antibacterial activity whereas Sabourauds dextrose agar media was used for antifungal activity. RESULTS: A total of 24 isolates were obtained from 2 patients of scalp psoriasis. Anti-oxidant activity of the samples was determined using DPPH radical scavenging method. In the present study, EOs showed a good antifungal action against Malassezia pachydermatis and other microbial strains. The GC-MS analysis revealed the presence of eugenol, linalool, citral, neral, limonene, terpenes, eucalyptol and thymol in the essential oils. The formulated retention lotion 1 (L4), 2 (L5), 3 (L6) and Cream 1 (C1) showed DPPH radical scavenging activity by 23.52%, 24.48%, 28% and 5.08%, respectively. CONCLUSION: The present study concluded that most of the formulated lotions and creams showed good antimicrobial activity and may be applied topically against scalp psoriasis.

Terpenoid compositions, and antioxidant and antimicrobial properties of the rhizome essential oils of different Hedychium species.

A phytochemical study of the rhizome essential oils of four different Hedychium species was performed by means of GC and GC/MS analyses. H. ellipticum mainly contained 1,8-cineole, sabinene, and terpin-4-ol, while H. aurantiacum possessed terpin-4-ol, para-cymene, and bornyl acetate as the major entities. Similarly, trans-meta-mentha-2,8-diene and linalool were noticed in H. coronarium. Three different collections (I-III) of H. spicatum showed amazing differences in the relative contents of their essential oils, 1,8-cineole and 10-epi-gamma-eudesmol being identified as markers for samples I and II, terpin-4-ol and sabinene being the major compounds in sample III. The rhizome essential oils of the above species were studied for their antioxidant activities by different methods, including their effect on the chelating properties of Fe(2+), DPPH radical-scavenging activity, and reducing power. Antimicrobial screenings of the oils by the paper-disc method were performed against Staphylococcus aureus, Shigella flexneri, Pasteurella multocida, Escherichia coli, and Salmonella enterica enterica, and the respective minimum-inhibitory-concentration (MIC) values were determined. The rhizome essential oils from all Hedychium species exhibited moderate-to-good Fe(2+) chelating activity. H. spicatum from collection site III showed a completely different DPPH radical-scavenging profile than the samples from the other collection sites.