Exploring the pharmacological and chemical aspects of pyrrolo-quinazoline derivatives in Adhatoda vasica.

Adhatoda or Justicia is one of the biggest and complex genera of the Acanthaceae family. Adhatoda vasica is commonly known as 'Adosa'. It is an ayurvedic medicine with a medicinal history of more than a thousand years in India. Traditionally, it is used to treat cough, asthma, phlegm, bleeding hemorrhoids, for both adults and youth. This plant possesses antiarthritis, antiseptic, antimicrobial, anti-tuberculosis, anti-inflammatory and abortifacient properties. Alkaloids are the major phytoconstituents present in the plant in the form of pyrrolo-quinazoline derivatives viz vasicine, vasicinone, vasicinol, adhatodine, adhatodinine, adhavasinone and anisotine etc. The asserted objectives are to conduct a systematic review on the phytochemistry, pharmacology and traditional uses of A. vasica, as well as highlighting the challenges found in the research. This will promote the utilization of A. vasica at extract level and further development of new drug leads based on the compounds isolated and used for treatment of various ailments. The present review covers the literature survey from 1888 to 2023. The relevant data has been collected from various peer-reviwed journals, and books via Sci-Finder, PubMed, Science Direct, Google Scholar, EBSCO, online electronic journals, SpringerLink and Wiley. This paper aims to present a systematic review of known traditional applications, pharmacological and chemical aspects in Adhatoda vasica.

Angiographic quantification of aortic regurgitation following myval octacor implantation; independent core lab adjudication.

BACKGROUND: The balloon expandable Myval transcatheter heart valve (THV) showed encouraging results regarding residual aortic regurgitation (AR) from multiple observational studies. The newly designed Myval Octacor has been introduced recently, aiming for a reduction in AR and improved performance. OBJECTIVES: The focus of this study is to report the incidence of AR using the validated quantitative Videodensitometry angiography technology (qLVOT-AR%) in the first in human use of the Myval Octacor THV system. METHODOLOGY: We report on the first in human use of the Myval Octacor THV system in 125 patients in 18 Indian centres. Independent retrospective analysis of the final aortograms following implantation of the Myval Octacor was performed using the CAAS-A-Valve software. AR is reported as a regurgitation fraction. The previously validated cutoff values have been used to identify ≥moderate AR (RF% >17%), mild (6% < RF% ≤17%), and none or trace AR (RF% ≤ 6%). RESULTS: Final aortogram was analysable for 103 patients (84.4%) among the 122 available aortograms. 64 (62%) patients, had tricuspid aortic valve (TAV), 38 (37%) with bicuspid AV (BAV), and one with unicuspid AV. The median absolute RF% was 2% [1, 6], moderate or more AR incidence was 1.9%, mild AR in 20.4%, and none or trace AR in 77.7%. The two cases with RF% >17% were in the BAV group. CONCLUSION: The initial results of Myval Octacor using quantitative angiography-derived regurgitation fraction demonstrated a favourable outcome regarding residual AR, possibly due to improved device design. Results must be confirmed in a larger randomised study, including other imaging modalities.

Safety and procedural outcomes of intravascular lithotripsy in calcified coronaries in Indian patients.

OBJECTIVE: Calcified coronaries still remain a major challenge for interventional cardiologist. This study aims to evaluate safety and efficacy of intravascular lithotripsy (IVL) in management of coronary artery calcification. METHODS: This was a retrospective single centre study regarding the utility of IVL in management of calcified coronaries. Patients with hemodynamically stable acute coronary syndrome or symptomatic chronic coronary syndrome (CCS) and calcified coronaries on angiography and who underwent IVL were enrolled. Intravascular imaging was performed wherever feasible. The primary endpoint was procedural success. In addition, data regarding procedural complications were collected. RESULTS: A total of 29 patients underwent IVL with a majority being males and having comorbidities such as hypertension and diabetes. A procedural success rate of 93.1% was achieved with no patient having >50% residual stenosis. IVL catheter was successfully delivered in all patients. The mean catheter diameter was 3.3 ± 0.4 mm and mean number of delivered pulses was 70.3 ± 16.4. The arteries most commonly intervened were the left main coronary and the left anterior descending artery. Intracoronary imaging revealed a significant increase in minimum luminal cross-sectional area (MLA) post IVL (pre-MLA: 5.1 ± 2.5 mm2; post-MLA: 10.7 ± 2.9 mm2; P<0.001). Two patients had in-hospital MACE in form of peri-procedural non Q-wave MI. No patient had arrhythmias, stent thrombosis, coronary perforation, or slow flow/no-reflow. Two patients had a rupture of IVL balloon while four had coronary artery dissection. CONCLUSIONS: IVL is a safe and highly effective modality with high procedural success rate in management of calcified coronaries.

Left atrial high-grade rhabdomyosarcoma; an unusual location.

A 63-year-old diabetic and hypertensive lady presented in New York Heart Association class III-IV dyspnea on exertion. Echocardiography showed a large mass attached to the anterior mitral leaflet and the base of the interatrial septum. After removal of the mass and excision of the anterior and posterior mitral leaflets, a bioprosthetic valve was deployed. The postoperative course was uneventful. Histopathology showed that the tumor was a high-grade rhabdomyosarcoma. Although it is a highly lethal tumor, surgical removal was indicated to relieve dyspnea, clarify the diagnosis, and improve short-term survival. Our patient survived for 8 months after surgical excision.

Facile Synthesis of Naphtha-quinoxaline Derivatives from ß-lapachone Using Graphene Oxide as Catalyst.

OBJECTIVE: To develop efficient method for the synthesis of naphtha-quinoxaline derivatives via the reaction of ß-lapachone with various 1,2-diamines. METHODS: A mixture of ß-lapachone (1mmol), 1,2-diamine (1mmol) and graphene oxide (20mg) in methanol (3mL) was heated at 60°C, under constant stirring for appropriate time. After completion of the reaction, the catalyst was filtered off, washed with ethyl acetate (3x3mL) and the combined filtrate was washed with H2O, dried (anhy. Na2SO4) and concentrated under vacuum. The residue was chromatographed over a column of silica gel eluting with a mixture of hexane and ethyl acetate in different ratios, to afford the desired product. All synthesized compounds were assigned with the help of analytical and 1H, 13C NMR, IR, and mass spectral studies. RESULTS: To establish the catalytic role of GO in the synthesis of naphtha-quinoxaline derivatives, the reaction of ß-lapachone with 3,4-diaminotoluene was selected as a model reaction. The catalytic activity of graphene oxide in comparison with other catalysts like acidic resin amberlyst-15 and solid acid catalyst like montmorillonite K-10 were studied. The reaction was also observed in various solvents such as water, acetonitrile, toluene, dichloromethane, ethanol and 1,4-dioxane using GO as a catalyst. Excellent yields were obtained at 60°C in methanol. The efficacy of the present protocol was investigated by the reaction of ß- lapachone with other 1,2-diamines. CONCLUSION: An attractive green metal free carbocatalyst Graphene Oxide (GO) has been successfully utilized for the expedient synthesis of naphtha-quinoxaline derivatives. GO showed high catalytic activity which is attested by the desired products being produced in shorter time. The main advantage of this method is the reusability of the catalyst which makes the procedure sustainable.