An Overview of Indian Novel Traditional Medicinal Plants with Anti-Diabetic Potentials

Diabetes mellitus is a global metabolic epidemic affecting essential biochemical activities in almost every age group. Indian literatures like Ayurveda have already mentioned herbal remediation for a number of human ailments. Among Indian traditional medicinal plants several potential anti-diabetic plants and herbs are being used as part of our diet since prehistoric time. India has a long list of native medicinal plants with confirmed blood sugar lowering property. Some of these have proved remarkable for cure of diabetes and its complications. The current paper is aimed at providing a review on clinical and experimental studies carried out on the most effective and commonly used hypoglycemic plants and herbs species from traditional Indian flora. This write-up includes hypoglycemic and anti-hyperglycemic activities of plants, active hypoglycemic compounds and constituents along with their available toxicity status.     

Clericuzio‐type poikiloderma with neutropenia in a patient from India

A 9‐year‐old boy presented for evaluation of variegated skin pigmentation. Palms and soles revealed honeycombed hyperpigmented hyperkeratosis. Irregular, firm, skin coloured nodules suggestive of cutaneous calcification were present on both elbows. Total leucocyte count and absolute neutrophil count were 3720/mm3 and 420/mm3 respectively. The neutropenia was not cyclical. Systematic analysis of the whole exome data revealed a homozygous mutation in USB1 gene; chr16:g.58043892TA>‐[1/1]. A final diagnosis of poikiloderma with neutropenia‐ Clericuzio type (PNC) was made. Naegeli Franceschetti Jadassohn, dermatopathia pigmentosa reticularis, PNC and dyskeratosis congenita, all can present with overlapping cutaneous manifestations. Subtle clinical details like thickened nails, hyperextensible joints, calcinosis cutis, characteristic facies and a preceding erythematopapular rash strongly favor the diagnosis of PNC. The index case highlights two novel findings: obliterated dermatoglyphics and mucin deposition (features not described hitherto in PNC).     

Aneurysms of the inferior vena cava

Two cases of saccular aneurysms of the infrarenal inferior vena cava (IVC) associated with retrohepatic IVC obstruction are described. Ultrasonographic, computerized tomographic and inferior venacavography findings in these cases are presented.     

Recent developments in the nanomaterial-catalyzed green synthesis of structurally diverse 1,4-dihydropyridines

1,4-Dihydropyridine (1,4-DHP), a privileged heterocyclic scaffold, has been extensively utilized in various biological and therapeutic applications. In this review article, we discussed the role of different nano-catalysts, nanoflakes, nanocomposites, and other green-supported nanomaterials in the synthesis of a biologically active and vital pharmaceutical precursor 1,4-DHP and its derivatives such as polyhydroquinoline, benzopyranopyridines, and dihydropyridine since 2015. It is evident that although the use of various tailored nanostructures under different conditions to optimize the synthesis of 1,4-DHP and its compounds has provided sustainable and efficient proposals, yet the development of greener practices in the synthesis of 1,4-DHPs, which can be applied to design new synthetic routes and sequences in process development, is a far-reaching task to be accomplished.

Single pot multicomponent approaches using different nanomaterials as green catalysts for synthesis of 1,4-dihydropyridine (1,4-DHP), a privileged heterocyclic scaffold with vital biological and therapeutic applications are reviewed.      

Original research: Risk stratifying gastric ulcers: development and validation of a scoring system

ObjectiveDebate is ongoing regarding the need for universal endoscopic follow-up to ensure gastric ulcer healing. We aimed to assess the value of follow-up oesophago-gastro-duodenoscopies (OGDs) for gastric ulcer healing and stratify patients according to risk of malignancy by developing a risk score.Design/methodAll patients in National Health Service (NHS) Lothian with an index OGD and a diagnosis of gastric ulcer between 1 January 2014 and 31 December 2018 were identified. Data were analysed with logistic regression to identify factors significantly associated with a diagnosis of cancer; a risk score was derived and externally validated.Results778 patients were identified and 60.3% (469/778) of patients had a follow-up OGD. 8.6% (66/778) of patients were diagnosed with cancer. No cases of cancer were found on follow-up OGD of a benign appearing ulcer with negative biopsies. Macroscopic suspicion of malignancy was present at index OGD in 100% (3/3) of those diagnosed with cancer on subsequent OGDs. Older age (p=0.014), increased ulcer size (p<0.001) and non-antral location (p=0.030) were significantly associated with malignancy. A risk score (area under the curve (AUC) 0.868, p<0.001, minimum score=0, maximum score=6) was derived from these variables. 78.0% of patients with malignant ulcers scored ≥3, only 15.8% with benign ulcers scored ≥3 (negative predictive value (NPV) 97.4%). External validation yielded an AUC of 0.862 (p<0.001) and NPV of 98.6%; 84.0% of those with malignant ulcers scored ≥3.ConclusionUlcers with a combination of macroscopically benign appearances, at least six negative biopsies and a low risk score do not necessarily need endoscopic follow-up.     

A comparative assessment of in vitro cytotoxic activity and phytochemical profiling of Andrographis nallamalayana J.L.Ellis and Andrographis paniculata (Burm. f.) Nees using UPLC-QTOF-MS/MS approach

Andrographis paniculata (Burm. f.) Nees and Andrographis nallamalayana J.L.Ellis have traditionally been used to treat various ailments such as mouth ulcers, intermittent fever, inflammation, snake bite. This study compares the comparative in vitro cytotoxic activity, and phytochemical profiling of methanol extract of A. nallamalayana (ANM) and A. paniculata (APM). UPLC-ESI-QTOF-MS/MS analysis has been performed. The cytotoxic activity of crude methanol extracts were evaluated against three different cancer cell lines (HCT 116, HepG2, and A549 cell line). Both plants'' extract exhibited significant cytotoxic activity against tested cell lines in a dose-dependent manner. IC₅₀ of ANM and APM in HCT 116 cell was 11.71 ± 2.48 μg ml⁻¹ and 45.32 ± 0.86 μg ml⁻¹ and in HepG2 cell line was 15.65 ± 2.25 μg ml⁻¹ and 60.32 ± 1.05 μg ml⁻¹ respectively. Cytotoxicity of these two extracts was comparatively similar in A549 cells. ANM induced cytotoxicity involved programmed cell death, externalisation of phosphatidylserine, ROS generation, up-regulation and down-regulation of major apoptotic markers. HRMS analysis of ANM and APM resulted in the identification of 59 and 42 compounds, respectively. Further, using the MS/MS fragmentation approach, 20 compounds, of which 18 compounds were identified for the first time from ANM, which belongs to phenolic acids, flavonoids, and their glycosides. Three known compounds, echioidinin, skullcapflavone I and 5,2′,6′-trihydroxy-7-methoxyflavone 2′-O-β-d-glucopyranoside, were isolated from A. nallamalayana and their crystal structures were reported for the first time. Subsequently, seven major compounds were identified in A. nallamalayana by direct comparison (retention time and UV-spectra) with authentic commercial standards and isolated compounds using HPLC-UV analysis. The cytotoxicity of phytochemicals from both the plants using in silico tools also justify their in vitro cytotoxic activity. It is the first report on the comparative characterisation of phytochemicals present in the methanolic extract of both the species of Andrographis, along with the cytotoxic activity of A. nallamalayana.

A comparative study of two Andrographis species have been done, and it was found that Andrographis nallamalayana J.L.Ellis is phytochemically and biologically different from Andrographis paniculata (Burm. f.) Nees.     

Outcomes of COVID-19 in Hematopoietic Stem Cell Transplant Recipients: Multicenter Retrospective Analysis

COVID-19, caused by the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), was declared a pandemic by the World Health Organization on March 9, 2020. Hematopoietic stem-cell transplantation (HSCT) recipients may be highly susceptible to infection and related pulmonary complications due to nascent immune systems or organ damage from treatment-related toxicities. Poor outcomes in such group of patients were linked to older age, steroid therapy at the time of COVID-19 infection, and COVID-19 infection within a year of HSCT. We studied a cohort of 28 hematopoietic stem cell transplant recipients (male 17, M:F ratio of 1.5) with COVID-19 infection from 1st June 2020, through 31st December 2020 for outcome. Fever was the most common symptom at the time of presentation in 22 (78.5%) patients. Mortality rate at Day 28 and Day 42 was found to be 4/28 (14.3%) and 7/28 (25%) respectively. Patients within one year of HSCT and severe infection had higher day 28 mortality (with p values = 0.038)". There was no relation of mortality with type of transplant.