Assessing the hypolipidemic and gastro-liver protective activity of herbal combination with emphasis on PPI amid selected multiple antihypertensive drug combination in experimental animal models.

OBJECTIVE: Peptic ulcer (PU) and hypertension are chronic diseases affecting up to 10% and 30% of the adult population worldwide. Most of these patients will require treatment with a combination of antihypertensive medicines, which have adverse effects on the body's different organs. This study specifically focused on antihypertensive multi-drug induced PU disease and disturbance of liver function. MATERIALS AND METHODS: During a 14-day oral administration of antihypertensive drugs, Cilnidipine (1 mg/kg), Rosuvastatin (1 mg/kg), Bisoprolol (0.52 mg/kg), and Clopidogrel (7.81 mg/kg) were observed for their effects on the stomach lining and liver function in Wister albino rats. This study aimed to assess the potential of an herbal combination of (BO) + (BA) + (ZO) 0.26 mg/kg body weight (b.w.) Powder and water mixture on the ulcer, lipid profile, and liver function for 14 days in the treatment of the indomethacin-induced gastric ulcers in rats at doses of 30 mg/kg b.w. for three days. Esomeprazole (20 mg/kg b.w.) is used as a standard reference to evaluate antiulcer activity in rat models. The experiment suggests that the gastroprotective effect of the herbal combination can be attributed to its reducing effect on the peptic and the Serum Glutamic Pyruvic Transaminase (SGPT) levels and within the normal range of 34.67 ± 0.88 IU/L. RESULTS: The results for Total Cholesterol (TC), Triglyceride (TG), High-density lipoprotein (HDL) and Low-density lipoprotein (LDL) of the herbal combination were 52 ± 9.81495 (mg/dl), 70 ± 12.12435 (mg/dl), 23.33 ± 6.06446 (mg/dl), 14.5 ± 1.32790 (mg/dl), respectively, where the standard group (atorvastatin) 5 mg/kg TC, TG, HDL and LDL were 69.77 ± 9.92 (mg/dl), 47.7 ± 10.35 (mg/dl), 33.43 ± 5.70 (mg/dl), 26.8 ± 3.70 (mg/dl), and control group total cholesterol, triglyceride, HDL and LDL were 68.67 ± 2.20 (mg/dl), 124.07 ± 2.94 (mg/dl), 49.14 ± 1.05 (mg/dl), 54.11 ± 1.15 (mg/dl). CONCLUSIONS: CThis investigation reported that antihypertensive drugs did not produce gastrointestinal (GI) toxicity, and the morphological structure of the organ was not changed. So, it could be concluded that the herbal combination used in this experiment has a promising role in controlling lipid profile, liver function, and antiulcer effects. Moreover, multiple drug therapy for hypertension does not cause any harm to the stomach. Further investigations might be carried out on a larger scale to make these statements more valid.

Detection of Enterobacteriaceae in cerebrospinal fluid fluid of neonates with meningitis from tertiary care hospitals.

OBJECTIVE: This study aimed to determine the bacteriological profile of childhood acute bacterial meningitis in Pakistan. PATIENTS AND METHODS: The study included a total of 100 children aged between 1 month and 5 years, who were admitted with a diagnosis of meningitis based on clinical findings and positive cerebrospinal fluid (CSF) tests. Out of the 100 CSF samples collected, 21 isolates were confirmed to contain Enterobacteriaceae. The most prevalent Enterobacteriaceae species were Pseudomonas (n=8, 38.09%), Klebsiella (n=4, 19.04%), E. coli (n=4, 19.04%), and Acinetobacter (n=4, 19.04%), while Citrobacter (n=1, 4.76%) was less common. Antibiotic susceptibility patterns were analyzed for these isolates. RESULTS: Pseudomonas (n=8) exhibited 25% resistance to cefepime and 38% resistance to imipenem. Klebsiella (n=4) showed 75% resistance to imipenem. Acinetobacter (n=4) demonstrated 50% resistance to imipenem, along with varying resistance to cefepime, amikacin, ciprofloxacin, and gentamicin. E. coli (n=4) showed 0% resistance to imipenem and amikacin. However, Citrobacter (n=1) showed 0% resistance to ciprofloxacin, aztreonam, gentamicin, amikacin, levofloxacin, and cefepime. Acute bacterial meningitis primarily affects children under 1 year of age. CONCLUSIONS: CSF culture revealed that Gram-negative bacteria, specifically Pseudomonas spp., were the predominant pathogens in this family based on Pakistani data.

Lactiplantibacillus plantarum and Saussurea costus as Therapeutic Agents against a Diabetic Rat Model-Approaches to Investigate Pharmacophore Modeling of Human IkB Kinase and Molecular Interaction with Dehydrocostus Lactone of Saussurea costus.

Lactic acid bacteria is well-known as a vital strategy to alleviate or prevent diabetes. Similarly, the plant Saussurea costus (Falc) Lipsch is a preventive power against diabetes. Here, we aimed to determine whether lactic acid bacteria or Saussurea costus is more effective in treating a diabetic rat model in a comparative study manner. An in vivo experiment was conducted to test the therapeutic activity of Lactiplantibacillus plantarum (MW719476.1) and S. costus plants against an alloxan-induced diabetic rat model. Molecular, biochemical, and histological analyses were investigated to evaluate the therapeutic characteristics of different treatments. The high dose of S. costus revealed the best downregulated expression for the IKBKB, IKBKG, NfkB1, IL-17A, IL-6, IL-17F, IL-1ß, TNF-α, TRAF6, and MAPK genes compared to Lactiplantibacillus plantarum and the control groups. The downregulation of IKBKB by S. costus could be attributed to dehydrocostus lactone as an active compound with proposed antidiabetic activity. So, we performed another pharmacophore modeling analysis to test the possible interaction between human IkB kinase beta protein and dehydrocostus lactone as an antidiabetic drug. Molecular docking and MD simulation data confirmed the interaction between human IkB kinase beta protein and dehydrocostus lactone as a possible drug. The target genes are important in regulating type 2 diabetes mellitus signaling, lipid and atherosclerosis signaling, NF-κB signaling, and IL-17 signaling pathways. In conclusion, the S. costus plant could be a promising source of novel therapeutic agents for treating diabetes and its complications. Dehydrocostus lactone caused the ameliorative effect of S. costus by its interaction with human IkB kinase beta protein. Further, future studies could be conducted to find the clinical efficacy of dehydrocostus lactone.

Gastroprotective Effects of Spirulina platensis, Golden Kiwifruit Flesh, and Golden Kiwifruit Peel Extracts Individually or in Combination against Indomethacin-Induced Gastric Ulcer in Rats.

This study was conducted to investigate the therapeutic effect of hydro-alcoholic extract of Spirulina platensis (SP), golden kiwifruit (Actinidia chinensis) flesh (KF), and golden kiwifruit peel (KP) individually or in combination (SFP) on indomethacin-induced gastric ulcer in rats. Negative control rats (GI) were orally administered distilled water in parallel with other treatments. The positive control rat group (GII) was administered 30 mg kg-1 indomethacin to induce gastric ulcers. The KF and KF extracts were used individually or together with SP in treating indomethacin-induced gastric ulcerated rat groups. Gastric ulcerated rat's groups GIII, GIV, GV, GVI, and GVII were orally administered at 30 mg kg-1 rat body weight as total phenolic content (TPC) equivalent from SP, KF, KP, SPF extracts, and Lansoprazole (30 mg kg-1, as reference drug) daily up to 14 days, respectively. The relevant biochemical parameters, antioxidant biomarkers, and histopathological examination were examined. Remarkably, treating rats with SP, KF, KP, and SFP extracts markedly reduced gastric juice and stomach volume expansion induced by indomethacin. The SP significantly retrieved the pH of gastric juice to a regular rate compared to GI. The ulcer index (UI) was significantly attenuated by SP, KF, KP, and SFP administration. The protection index percentage (PI %) was 80.79, 54.51, 66.08, 75.74, and 74.86% in GIII, GIV, GV, GVI, and GVII, respectively. The gastric mucin content was significantly better attenuated by 95.7 in GIII compared to its content in GI. Lansoprazole increased mucin content by 80.3%, which was considerably lower than SP and SFP. SP, KF, KP, SFP, and Lansoprazole improved the reform of gastric mucosal-increased secreted mucus by 95.6, 61.3, 64.8, 103.1, and 80.2% in GIII, GIV, GV, GVI, and GVII, respectively. Interestingly, SFP efficiently increased vit. B12 level by 46.0% compared to other treatments. While Lansoprazole administrating did not significantly attenuate vit. B12 level. The SP and SFP improved iron and Hemoglobin (HB) levels depending on treatment. SP, KF, KP, and SFP significantly decreased the malondialdehyde (MDA) and increased reduced glutathione (GSH) as well as superoxide dismutase (SOD) levels in blood and stomach tissues. The most potent effect was observed with SP, and SFP was even better than Lansoprazole. Histopathologically, treating rats with SP extract showed a marked reduction of gastric damage and severity changes induced by indomethacin. KP was much better than KF in lessening gastric histopathological damages caused by indomethacin. SFP significantly alleviates gastric histopathological alterations. The lansoprazole-treated group (GVII) greatly relieved the gastric histopathological changes and recorded mild focal necrosis and desquamation of the mucosa in addition to mild oedema in the serosal layer. In conclusion, the presented results proved the antiulcer potential of SP and A. chinensis extracts against an indomethacin-induced gastric ulcer in rats, which may be due to their antioxidant and anti-inflammation efficiency. Thus, these data suggested that SP, KF, KP, and SFP extracts as natural and safe alternatives have a gastroprotective potential against indomethacin-induced gastric ulceration. The antioxidative and anti-inflammatory properties are probable mechanisms.

Painful Diabetic Peripheral Neuropathy among Saudi Diabetic Patients is Common but Under-recognized: Multicenter Cross-sectional study at primary health care setting.

OBJECTIVE: The aim of this study was to assess the prevalence of painful diabetic peripheral neuropathy (PDPN) and its associated risk factors in patients with type 2 diabetes mellitus attending primary health care (PHC) in Saudi Arabia. MATERIALS AND METHODS: A multicenter, cross-sectional study evaluated 242 type 2 diabetics who attended the National Guard PHC clinics in Riyadh. Trained physicians obtained the relevant data and medical history and assessed PDPN using the Michigan Neuropathy Screening Instrument. RESULTS: About 35% of patients with type-2 diabetes in this study had painful diabetic peripheral neuropathy. High risk hemoglobin level and poor compliance with treatment were associated with increased odds of PDPN (Odds ratio [OR] =3.121, 95% confidence interval [CI] 1.154-8.444, OR = 3.546, 95% CI 1.531-8.214, respectively). It is noted that only in one patient with PDPN, was their PDPN recognized by physicians. Furthermore, none of our study participants was taking medication to control the pain. CONCLUSIONS: One-third of Saudi Arabia's Type 2 diabetes patients have PDPN. PHC physicians treating diabetes should be more aware of the importance of screening for PDPN and the treatment plan.

Prevalence and risk factors of gastroparesis-related symptoms among patients with type 2 diabetes.

BACKGROUND: The prevalence of gastroparesis in type 2 diabetes mellitus (T2DM) vary widely. Our aim is to estimate the prevalence of clinical symptoms of gastroparesis among patients with type 2 diabetes mellitus and explore the relationship between gastroparesis and other risk factors. METHODS: A cross-sectional study evaluating 147 type 2 diabetics using the Gastroparesis Cardinal Symptoms Index (GCSI). A GCSI Total Score ≥ 1.90 were chosen as having definite symptoms of gastroparesis. All patients completed a demographic questionnaire and interviewed to complete the. Demographic Data, disease duration, Medication, comorbidities, recent blood glucose and HbA1C were collected and investigated. RESULTS: The prevalence of clinical symptoms of gastroparesis among type 2 diabetics was 10.8%. Clinical symptoms of gastroparesis were significantly correlated to HbA1c (p=0.001), blood glucose (p= 0.003), duration of diabetes (p= 0.02) and comorbidities (p=0.009). The most common symptoms were bloating, stomach fullness and early satiety (63.94%, 55.1% and 48.3% respectively). In logistic regression analysis, female gender emerged as significant independent predictors of the presence of at least one symptom. CONCLUSIONS: The prevalence of clinical symptoms of gastroparesis observed in the Saudi patientsdiagnosedwithtype2 diabetes was 10.8% and is independently associated with poor controlled diabetes, hyperglycemia, and long duration of diabetes and history of Co-morbid conditions.

Depression and anxiety among parents and caregivers of autistic spectral disorder children.

OBJECTIVE: To evaluate the presence of depression and anxiety in parents/caregivers of autistic spectral disorder (ASD) children, and to identify associated factors. METHODS: In this retrospective cohort study carried out between July and December 2011, parents/caregivers of at least one child diagnosed with an ASD (cases group), were recruited through the Saudi Charitable Society of Autism Families and the Autism Clinic in the Pediatric out-patient clinic in King Fahad National Guard Hospital, King Abdulaziz Medical City (KAMC), Riyadh, Kingdom of Saudi Arabia. The parents/caregivers of a normally developed child (control group) were recruited from the Well Child Clinic at King Abdulaziz Medical City, Riyadh. We used a self-reported questionnaire containing questions on demographic data, as well as the Arabic version of the hospital anxiety and depression scale. RESULTS: The study included 100 parents/caregivers, 50 cases and 50 controls. More than 50% of the control group was in the age group 26-30 years (56%), while 42% of cases were in the age group 31-35 years. Time lapsed since autism diagnosis was over 3 years in one-third of cases. Twenty-two percent of cases, and only 2% of control parents/caregivers had a history of psychiatric problems (p=0.002). Both the mean depression score, and the mean anxiety score was significantly higher among cases when compared with controls, p<0.001. CONCLUSION: Autism is associated with burden and stress for parents/caregivers of the affected child. The demands placed by the disability contribute to a higher overall incidence of depression and anxiety among parents/caregivers.

Mesenteric panniculitis. Imaging of a rare cause of chronic abdominal pain.

We report a case of mesenteric panniculitis. This rare and poorly-known disease is characterized by a nonspecific inflammatory process involving the adipose tissue of the mesentery. This case illustrates its computerized tomographic and magnetic resonance imaging features and the value of imaging in differentiating it from other mesenteric diseases and thus, avoiding unnecessary surgery.