Insights into mechanisms underlying the gut and airways modulatory effects of Swertia chirata.

Swertia chirata is used in folk medicine for the treatment of constipation, colic, diarrhea, and asthma. This study was carried out in order to provide a pharmacological basis for its medicinal use in gastrointestinal and respiratory disorders. Crude extract of Swertia chirata (Sc.Cr) and its fractions were studied using rabbit isolated tissue preparations. In jejunum, Sc.Cr, which tested positive for alkaloids, flavonoids, saponins, tannins, and terpenes, caused stimulation at concentrations of 0.01-1.0 mg/mL, followed by a relaxant effect at higher concentrations. In the presence of atropine, the contractile effect was blocked and only relaxation occurred. Sc.Cr inhibited high K(+) (80 mM)-induced contractions at 0.01-10 mg/mL and shifted Ca(2+) concentration-response curves to the right, similar to that caused by verapamil. In trachea, Sc.Cr relaxed the carbachol (1 muM) and high K(+)-induced contractions, in a pattern similar to that of verapamil. Bioassay directed fractionation revealed the separation of spasmogenic and spasmolytic components in aqueous and organic fractions, respectively. The chloroform fraction exhibited a concentration-dependent (0.1-3.0 mg/mL) bronchodilator effect. These results indicate that Swertia chirata exhibits gut excitatory and inhibitory effects, mediated through cholinergic and Ca(2+) antagonist mechanisms, respectively, as well as bronchodilatation, via Ca(2+) channel blockade. Thus, this study provides a sound mechanistic background for the therapeutic application of Swertia chirata in gut motility disorders, such as constipation, colic, and diarrhea, and airways hyperactivity disease, such as asthma

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality