Comparative account of vitamin C contents, antioxidant properties and iron contents of minor fruits in Sri Lanka

Sri Lanka is a habitat of diverse fruit varieties; nevertheless 95% of them are underutilized by people due to unawareness of their nutritional values and health aspects, and hence become ‘minor fruits’. This study was aimed on revealing vitamin C, iron and antioxidant contents of 29 varieties of minor fruits (MFs) with the comparison of the same with three best commonly consumable fruits (CFs), namely Carica papaya, Mangifera indica and Psidium guajava. Ascorbic acid (Asc), dehydroascorbic acid (DAsc), vitamin C (TC), phenolic (TP), flavonoid (TF), iron (Fe) contents and antioxidant capacities (AOCs) of fruits were determined using standard methods. The results of mean Asc, DAsc, TC, TP, TF and Fe contents in 100 gm of MFs ranged from 3.1 to 121.5 mg, 1.2 to 70.7 mg, 6.6 to 136.1 mg, 24.9 to 1613.3 mg Gallic acid equivalent, 6.2 to 228.0 mg Quercetin equivalents and 0.2 to 4.9 mg respectively. DPPH and Ferric Reducing Antioxidant Power (FRAP) assays were used for AOCs and variation of IC50 values in a DPPH assay was 1.2 to 245.4 mg/ml whereas FRAP values ranged from 9.6 to 486.7 ?mol FeSO4/gm. Among the studied minor fruits, Melastoma malabathricum (Maha bovitiya/ Malabar melastome) is found as the best respect to all considered parameters. As a conclusion, it can be stated that, the Sri Lankan minor fruits are good alternatives to the common fruits as they are recognized as good source of vitamin C, iron and higher content of antioxidants. As an outcome, Sri Lankan minor fruits can be promoted as alternatives to common fruits and as source of revenue for national economy

Phytochemistry and medicinal properties of Psidium guajava L. leaves: A review

Psidium guajava L. (Myrtaceae), also known as guava, is a medicinal tree native to tropical America that has been introduced and is widely available in many countries. Almost all plant parts of P. guajava have a long history of being used to treat a variety of ailments, in addition to applications as foods. Guava leaves are used as both medicine and food purposes, and there are numerous scientific reports on their medicinal uses, chemical composition and pharmacological properties. Cancer, blood pressure, diarrhea, bowel irregularities, diabetes, cough, cold, constipation, dysentery, scurvy, weight loss, improves skins tonicity are some of the diseases treated with guava leaves. Polyphenols, flavonoids, saponins, tannins, terpenoids, glycosides, flavones, cardiac glycosides, cardenolides, phlobatanins, steroids and other classes of bioactive compounds have been identified from the leaves. The primary chemical constituents of guava leaves are phenolic compounds, iso-flavonoids, gallic acid, catechin, quercetin, epicathechin, rutin, naringenin, kaempferol, caryophyllene oxide, p-selinene etc. Several studies have demonstrated its pharmacological activities including antioxidant, antimicrobial, antidiabetic, antitumor, anticancer, antidiarrheal, healing, cytotoxic, hepatoprotective, anti-inflammatory, antimalarial/ anti-plasmodial, dental plaque, antiglycative and many more. This review is aimed on compiling all the literature reported on pharmacological activities and phytochemical compositions of guava leaves as a support to the scientific community for further studies and to provide scientific data to validate its traditional uses

Development and validation of a reference marker for identification of aerobic and anaerobic bacteria associated with diabetes chronic wound ulcers using PCR denaturing gradient gel electrophoresis

Introduction: Diabetes chronic wounds consist with a diverse microbial community and unculturablespecies may be highly prevalent.Objectives: This study aimed to establish a bacterial reference marker consisting of a group ofchronic wound related bacteria, using polymerase chain reaction-denaturing gradient gelelectrophoresis (PCR-DGGE) for profiling of bacteria in diabetes chronic wound infections.Methods: DNA was extracted from the known wound bacterial strains. PCR–DGGE was performedusing eubacterial specific primers targeting V2-V3 region of 16S rDNA. DGGE was performed usinga 30-55% denaturing gradient. Migration position of each organism was detected on DGGE gel andimportant organisms were selected. Equal volume from PCR products of each selected organism wasmixed, diluted with gel loading dye in 1:1.5 ratio and used for all DGGE gels. The ladder was thensubjected to species identification of fifteen tissue debridement specimens obtained from diabeteschronic wound ulcers. The identification efficacy was tested by sequencing.Results: DNA of bacterial pathogens which showed different migration distances on the gel werecombined and used as a reference panel. This bacterial ladder consisted of eleven different bacterialspecies including Bacteroides sp., S. aureus, Acineto bacter sp., P. aeruginosa, Streptococcus Group Aand Group B sp., E. faecalis, Providencia sp., Veillonella sp., E .coli and Enterobacter sp. Accordingto the reference panel, Pseudomonas species were abundant. Further the results were confirmed bysequencing.Conclusion: Reference marker allows comparative analysis of DGGE patterns and can be used as atool for presumptive identification of polymicrobial microbiota in chronic wound infections

Real world hospital costs following stress echocardiography in the UK: a costing study from the EVAREST/BSE-NSTEP multi-entre study

Background: Stress echocardiography is widely used to detect coronary artery disease, but little evidence on downstream hospital costs in real-world practice is available. We examined how stress echocardiography accuracy and downstream hospital costs vary across NHS hospitals and identifed key factors that afect costs to help inform future clinical planning and guidelines. Methods: Data on 7636 patients recruited from 31 NHS hospitals within the UK between 2014 and 2020 as part of EVAREST/BSE-NSTEP clinical study, were used. Data included all diagnostic tests, procedures, and hospital admissions for 12 months after a stress echocardiogram and were costed using the NHS national unit costs. A decision tree was built to illustrate the clinical pathway and estimate average downstream hospital costs. Multi-level regression analysis was performed to identify variation in accuracy and costs at both patient, procedural, and hospital level. Linear regression and extrapolation were used to estimate annual hospital cost-savings associated with increasing predictive accuracy at hospital and national level. Results: Stress echocardiography accuracy varied with patient, hospital and operator characteristics. Hypertension, presence of wall motion abnormalities and higher number of hospital cardiology outpatient attendances annually reduced accuracy, adjusted odds ratio of 0.78 (95% CI 0.65 to 0.93), 0.27 (95% CI 0.15 to 0.48), 0.99 (95% CI 0.98 to 0.99) respectively, whereas a prior myocardial infarction, angiotensin receptor blocker medication, and greater operator experience increased accuracy, adjusted odds ratio of 1.77 (95% CI 1.34 to 2.33), 1.64 (95% CI 1.22 to 2.22), and 1.06 (95% CI 1.02 to 1.09) respectively. Average downstream costs were £646 per patient (SD 1796) with signifcant variation across hospitals. The average downstream costs between the 31 hospitals varied from £384–1730 per patient. False positive and false negative tests were associated with average downstream costs of £1446 (SD £601) and £4192 (SD 3332) respectively, driven by increased non-elective hospital admissions, adjusted odds ratio 2.48 (95% CI 1.08 to 5.66), 21.06 (95% CI 10.41 to 42.59) respectively. We estimated that an increase in accuracy by 1 percentage point could save the NHS in the UK £3.2 million annually. Conclusion: This study provides real-world evidence of downstream costs associated with stress echocardiography practice in the UK and estimates how improvements in accuracy could impact healthcare expenditure in the NHS. A real-world downstream costing approach could be adopted more widely in evaluation of imaging tests and interventions to refect actual value for money and support realistic planning

A Practitioner’s Toolkit for Insulin Motivation in Adults with Type 1 and Type 2 Diabetes Mellitus: Evidence-Based Recommendations from an International Expert Panel

Aim To develop an evidence-based expert group opinion on the role of insulin motivation to overcome insulin distress during different stages of insulin therapy and to propose a practitioner’s toolkit for insulin motivation in the management of diabetes mellitus (DM). Background Insulin distress, an emotional response of the patient to the suggested use of insulin, acts as a major barrier to insulin therapy in the management of DM. Addressing patient-, physician- and drug-related factors is important to overcome insulin distress. Strengthening of communication between physicians and patients with diabetes and enhancing the patients' coping skills are prerequisites to create a sense of comfort with the use of insulin. Insulin motivation is key to achieving targeted goals in diabetes care. A group of endocrinologists came together at an international meeting held in India to develop tool kits that would aid a practitioner in implementing insulin motivation strategies at different stages of the journey through insulin therapy, including pre-initiation, initiation, titration and intensification. During the meeting, emphasis was placed on the challenges and limitations faced by both physicians and patients with diabetes during each stage of the journey through insulinization. Review Results After review of evidence and discussions, the expert group provided recommendations on strategies for improved insulin acceptance, empowering behavior change in patients with DM, approaches for motivating patients to initiate and maintain insulin therapy and best practices for insulin motivation at the pre-initiation, initiation, titration and intensification stages of insulin therapy. Conclusions In the management of DM, bringing in positive behavioral change by motivating the patient to improve treatment adherence helps overcome insulin distress and achieve treatment goals

Real world hospital costs following stress echocardiography in the UK: a costing study from the EVAREST/BSE-NSTEP multi-centre study

Background: Stress echocardiography is widely used to detect coronary artery disease, but little evidence on downstream hospital costs in real-world practice is available. We examined how stress echocardiography accuracy and downstream hospital costs vary across NHS hospitals and identified key factors that affect costs to help inform future clinical planning and guidelines. Methods: Data on 7636 patients recruited from 31 NHS hospitals within the UK between 2014 and 2020 as part of EVAREST/BSE-NSTEP clinical study, were used. Data included all diagnostic tests, procedures, and hospital admissions for 12 months after a stress echocardiogram and were costed using the NHS national unit costs. A decision tree was built to illustrate the clinical pathway and estimate average downstream hospital costs. Multi-level regression analysis was performed to identify variation in accuracy and costs at both patient, procedural, and hospital level. Linear regression and extrapolation were used to estimate annual hospital cost-savings associated with increasing predictive accuracy at hospital and national level. Results: Stress echocardiography accuracy varied with patient, hospital and operator characteristics. Hypertension, presence of wall motion abnormalities and higher number of hospital cardiology outpatient attendances annually reduced accuracy, adjusted odds ratio of 0.78 (95% CI 0.65 to 0.93), 0.27 (95% CI 0.15 to 0.48), 0.99 (95% CI 0.98 to 0.99) respectively, whereas a prior myocardial infarction, angiotensin receptor blocker medication, and greater operator experience increased accuracy, adjusted odds ratio of 1.77 (95% CI 1.34 to 2.33), 1.64 (95% CI 1.22 to 2.22), and 1.06 (95% CI 1.02 to 1.09) respectively. Average downstream costs were £646 per patient (SD 1796) with significant variation across hospitals. The average downstream costs between the 31 hospitals varied from £384–1730 per patient. False positive and false negative tests were associated with average downstream costs of £1446 (SD £601) and £4192 (SD 3332) respectively, driven by increased non-elective hospital admissions, adjusted odds ratio 2.48 (95% CI 1.08 to 5.66), 21.06 (95% CI 10.41 to 42.59) respectively. We estimated that an increase in accuracy by 1 percentage point could save the NHS in the UK £3.2 million annually. Conclusion: This study provides real-world evidence of downstream costs associated with stress echocardiography practice in the UK and estimates how improvements in accuracy could impact healthcare expenditure in the NHS. A real-world downstream costing approach could be adopted more widely in evaluation of imaging tests and interventions to reflect actual value for money and support realistic planning

Microbial transformation of sesquitepenoid ketone, (+) Nootkatone by Macrophomia phaseolina

Microbial transformation is an effective tool for the structural modification of bioactive natural and synthetic compounds leading to synthesis of more potent derivatives. Its application in asymmetric synthesis is increasing due to its versatility and ease. This article presents biotransformation of sesquiterpenoid ketone, (+)-Nootkatone (1) by M. phaseolina, a plant pathogenic fungus. The transformation afforded four main compounds. They were determined to be 1:6 stereoisomeric mixture of 11,12-dihydroxy- 11,12-dihydronootkatone (2, 3), 13-hydroxynootkaone (4) and 12-hydroxy-11,12- dihydronootkatone (5) with the help of EI-MS, HR-FAB-MS(pos), HR-FAB-MS (neg), 1H-NMR, 13CNMR, COSY-450, NOESY, HMBC, HMQC spectral analyses. The compound 4 was firstchandana- amarasingha-samayawardana-avifauna-Bundala-1.1-28.07 identified as Nootkatone metabolites in this study. Further, the parental compound (1) and the transformed products 4 and 5 were found to be present significant antiprotozoal activity

Total Vitamin C, Ascorbic Acid, Dehydroascorbic Acid, Antioxidant Properties, and Iron Content of Underutilized and Commonly Consumed Fruits in Sri Lanka

Sri Lanka is rich in a wide diversity of fruits, but many are underutilized by the people in Sri Lanka despite their nutritional value. This is mainly due to little awareness of the palatability of many fruits and hence low popularity in the market. The present study aimed at providing comparative data on the main biochemical and nutritional parameters of thirty-seven (37) species of fruits grown in Sri Lanka, including 22 underutilized fruits and 15 commonly consumed fruits. The main parameters of the comparison were the contents of ascorbic acid (AA), total vitamin C (TVC), total phenolic content (TPC), total flavonoid content (TFC), total iron (Fe), and antioxidant capacities (ACs). The mean AA, TVC, TPC, TFC, and Fe contents in 100 g of fresh edible portions of fruits ranged from 2.0 to 185.0 mg, 8.1 to 529.6 mg, 12.9 to 2701.7 mg gallic acid equivalent, 0.2 to 117.5 mg quercetin equivalents, and 0.1 to 1.1 mg, respectively. The IC50 values in a DPPH assay varied between 0.8 to 1856.7 mg/mL and FRAP values in a FRAP assay ranged from 4.2 to 2070 μmol FeSO4/g in the studied fruits. Fruits were ranked based on the levels of the abovementioned biochemical properties. Using this ranking, 12 of the top 15 fruits were underutilized. Phyllanthus emblica (Indian gooseberry) is at the top of these underutilized fruits, and Psidium guajava (guava) is the best among commonly consumed fruits. These results indicate that underutilized fruits in Sri Lanka can be recommended as high quality and low-cost alternatives for securing nutritional requirements. Hence, underutilized fruits can be promoted as healthy additional fruits in Sri Lanka