Biological and phytochemical investigations of extracts from Pterocarpus erinaceus Poir (Fabaceae) root barks

Background: Pterocarpus erinaceus Poir. belonging to Fabacae familly is used as medicinal plant in Burkina Faso’s folk medicine. Roots of P. erinaceus are used to treat ulcer, stomach ache and inflammatory diseases. The objective of the present study was to carry out phytochemical composition of methanol (MeOH) and dichloromethane (DCM) extracts from Pterocarpus erinaceus roots, to isolate pure compounds, and to evaluate their pharmacological activities.Methods: Chromatographic fractionation led to the isolation of active components of the extracts. The structures were established by NMR analysis and comparison with data from literature. The anti-inflammatory activity was evaluated using croton oil-induced edema of mice ear as well as the effect of extracts against lipoxygenase and lipid peroxidation was evaluated. 2,2-diphenyl-1-picrylhydrazyl (DPPH) and Cupric-reducing antioxidant capacity (CUPRAC) methods were used to evaluate the antioxidant activity of the extracts.Results: Friedelin (1), 3α-hydroxyfriedelan-2-one (2), α-sophoradiol (3) and stigmasterol (4) were isolated from DCM extract and maltol-6-O-apiofuranoside-glucopyranoside (5) isolated from MeOH. DCM extract and friedelin, 3α-hydroxyfriedelan-2-one, α- sophoradiol showed a significant anti-inflammatory effect against ear edema. Friedelin (1), α-sophoradiol (3) and maltol-6-O-apiofuranoside-glucopyranoside (5) exhibited lipoxygenase inhibition. MeOH extract (100 μg/mL) inhibited lipoxygenase and lipid peroxidation activities at 45.1 ± 3% and 30.7 ± 0.5% respectively. MeOH extract, ethyl acetate fraction and butanol fraction exhibited antioxidant property with both two methods used.Conclusion: The results suggested that the extracts and compounds from roots of Pterocarpus erinaceus possessed local antiinflammatory effect, antioxidant properties and inhibitor effect against lipoxygenase and lipid peroxidation activities.Keywords: Pterocarpus erinaceus, triterpenes, anti-inflammatory, antioxidant, lipoxygenas

BIOLOGICAL AND PHYTOCHEMICAL INVESTIGATIONS OF EXTRACTS FROM PTEROCARPUS ERINACEUS POIR (FABACEAE) ROOT BARKS

Background: Pterocarpus erinaceus Poir. belonging to Fabacae familly is used as medicinal plant in Burkina Faso’s folk medicine. Roots of P. erinaceus are used to treat ulcer, stomach ache and inflammatory diseases. The objective of the present study was to carry out phytochemical composition of methanol (MeOH) and dichloromethane (DCM) extracts from Pterocarpus erinaceus roots, to isolate pure compounds, and to evaluate their pharmacological activities. Methods: Chromatographic fractionation led to the isolation of active components of the extracts. The structures were established by NMR analysis and comparison with data from literature. The anti-inflammatory activity was evaluated using croton oil-induced edema of mice ear as well as the effect of extracts against lipoxygenase and lipid peroxidation was evaluated. 2,2-diphenyl-1-picrylhydrazyl (DPPH) and Cupric-reducing antioxidant capacity (CUPRAC) methods were used to evaluate the antioxidant activity of the extracts. Results: Friedelin (1), 3α-hydroxyfriedelan-2-one (2), α-sophoradiol (3) and stigmasterol (4) were isolated from DCM extract and maltol-6-O-apiofuranoside-glucopyranoside (5) isolated from MeOH. DCM extract and friedelin, 3α-hydroxyfriedelan-2-one, α- sophoradiol showed a significant anti-inflammatory effect against ear edema. Friedelin (1), α-sophoradiol (3) and maltol-6-Oapiofuranoside- glucopyranoside (5) exhibited lipoxygenase inhibition. MeOH extract (100 μg/mL) inhibited lipoxygenase and lipid peroxidation activities at 45.1 ± 3% and 30.7 ± 0.5% respectively. MeOH extract, ethyl acetate fraction and butanol fraction exhibited antioxidant property with both two methods used. Conclusion: The results suggested that the extracts and compounds from roots of Pterocarpus erinaceus possessed local antiinflammatory effect, antioxidant properties and inhibitor effect against lipoxygenase and lipid peroxidation activities

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Métabolites secondaires isolés de deux plantes néo-calédoniennes, Calophyllum Caledonicum Vieill. et Garcinia Vieillardii P. (étude chimique et valorisation biologique)

L'étude phytochimique de deux Clusiaceae néo-calédoniennes : Calophyllum caledonicum et Garcinia vieillardii a permis d'isoler et de caractériser 40 composés issus du métabolisme secondaire. Parmi ceux-ci, une majorité de xanthones et d'acides dérivés de la chromanone ont été identifiés. Huit de ces produits naturels sont originaux. Diverses évaluations biologiques menées sur les extraits bruts et les composés purifiés - propriétés antifongiques, antiprotéases, anti-VIH, antipaludiques, antileishmaniennes et/ou antiradicalaires - ont par ailleurs conduit à la mise en évidence de propriétés significatives de ces derniers. Une activité antileishmanienne intéressante a ainsi été décelée dans le cas de la pancixanthone B et de la 1,6-dihydroxyxanthone, isolées des écorces de G. vieillardii. Certains acides chromanes de C. caledonicum présentent quant à eux des activités inhibitrice et découplante de la chaîne respiratoire de mitochondries isolées de graines de pois.A phytochemical study of two neocaledonian Clusiaceae : Calophyllum caledonicum and Garcinia vieillardii led to the isolation and the structural identification of 40 secondary metabolites. This compounds mainly belong to the xanthones or the chromanes acids series. Among them, a majority of xanthones and some acids derived from chromanone were identified. Eight of those natural compounds present an original structure. The biological activities of either the crude extracts or the pure compounds have been evaluated - antifungal, antiproteasic, anti-HIV, antimalarial, antileishmanial and/or antioxidant - and showed significant results. Indeed, Pancixanthone B and 1,6-dihydroxyxanthone isolated from the stem bark of G. vieillardii showed a leishmanicidal activity towards the growth of promastigotes as well as amastigotes, while some acids isolated from C. caledonicum exhibit an inhibitory and decoupling activity of the respiratory chain of mitochondria isolated from pea seeds.ANGERS-BU Médecine-Pharmacie (490072105) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

Traitements homéopathiques et conseil officinal à la femme enceinte du début de la grossesse jusqu'au retour de couche (illustration par la mise en place de deux questionnaires à l'officine)

LYON1-BU Santé (693882101) / SudocSudocFranceF

Actinorhizal symbiosis, a review

International audienc