Vitex trifolia: AN ETHNOBOTANICAL AND PHARMACOLOGICAL REVIEW

Objective: The perspective of this review is the list of activities carried out or studied along with description, habitat macro-microscopy, phytoconstituents, medicinal uses, clinical studies, and toxicology on the plant Vitex trifolia. Methods: A large number of the species of the Genus Vitex are widely employed in Indian traditional systems of medicine. A total of 270 plant species of genus Vitex have been identified worldwide. V. trifolia is used in Ayurveda and Unani. These species are rich source of secondary metabolites such as polyphenolic compounds, terpenoids, phytosterols, protein and amino acids, tannins, and saponins.Results: The results of various studies V. trifolia possess larvicidal, analgesic, anti-inflammatory, antimicrobial, antioxidant, hepatoprotective, antihistaminic, and antiasthmatic properties.Conclusion: The review on V. trifolia explains that there is a need for detailed study on its clinical relevance and safety of plant extracts

Distance and the pattern of intra-European trade

Given an undirected graph G = (V, E) and subset of terminals T ⊆ V, the element-connectivity κ ′ G (u, v) of two terminals u, v ∈ T is the maximum number of u-v paths that are pairwise disjoint in both edges and non-terminals V \ T (the paths need not be disjoint in terminals). Element-connectivity is more general than edge-connectivity and less general than vertex-connectivity. Hind and Oellermann [21] gave a graph reduction step that preserves the global element-connectivity of the graph. We show that this step also preserves local connectivity, that is, all the pairwise element-connectivities of the terminals. We give two applications of this reduction step to connectivity and network design problems. • Given a graph G and disjoint terminal sets T1, T2,..., Tm, we seek a maximum number of elementdisjoint Steiner forests where each forest connects each Ti. We prove that if each Ti is k element k connected then there exist Ω( log hlog m) element-disjoint Steiner forests, where h = | i Ti|. If G is planar (or more generally, has fixed genus), we show that there exist Ω(k) Steiner forests. Our proofs are constructive, giving poly-time algorithms to find these forests; these are the first non-trivial algorithms for packing element-disjoint Steiner Forests. • We give a very short and intuitive proof of a spider-decomposition theorem of Chuzhoy and Khanna [12] in the context of the single-sink k-vertex-connectivity problem; this yields a simple and alternative analysis of an O(k log n) approximation. Our results highlight the effectiveness of the element-connectivity reduction step; we believe it will find more applications in the future

Increased Incidence of Interatrial Block in Younger Adults with Cryptogenic Stroke and Patent Foramen Ovale

Background: Stroke is often unexplained in younger adults, although it is often associated with a patent foramen ovale (PFO). The reason for the association is not fully explained, and mechanisms other than paradoxical embolism may be involved. Young stroke patients with PFO have more atrial vulnerability than those without PFO. It is plausible that stretching of the interatrial septum may disrupt the interatrial conduction pathways causing interatrial block (IAB). IAB is associated with atrial fibrillation, dysfunctional left atria and stroke. Methods: Electrocardiogram (ECG) characteristics of prospectively recruited young patients (≤55 years of age) with unexplained stroke (TOAST and A-S-C-O) were compared with control data. All stroke cases underwent bubble contrast transthoracic and transoesophageal echography. IAB was defined as a P-wave duration of ≧110 ms. ECG data were converted to electronic format and analysed in a blind manner. Results: Fifty-five patients and 23 datasets were analysed. Patients with unexplained stroke had longer P-wave duration (p = 0.013) and a greater prevalence of IAB (p = 0.02) than healthy controls. Case status was an independent predictor of P-wave duration in a significant multivariate model. There was a significant increase in the proportion of cases with a PFO with IAB compared with cases without PFO and with controls (p = 0.005). Conclusions: Young patients with unexplained stroke, particularly those with PFO, exhibit abnormal atrial electrical characteristics suggesting atrial arrhythmia or atrial dysfunction as a possible mechanism of stroke

Effects of oral lycopene supplementation on vascular function in patients with cardiovascular disease and healthy volunteers: a randomised controlled trial.

AIMS: The mechanisms by which a 'Mediterranean diet' reduces cardiovascular disease (CVD) burden remain poorly understood. Lycopene is a potent antioxidant found in such diets with evidence suggesting beneficial effects. We wished to investigate the effects of lycopene on the vasculature in CVD patients and separately, in healthy volunteers (HV). METHODS AND RESULTS: We randomised 36 statin treated CVD patients and 36 healthy volunteers in a 2∶1 treatment allocation ratio to either 7 mg lycopene or placebo daily for 2 months in a double-blind trial. Forearm responses to intra-arterial infusions of acetylcholine (endothelium-dependent vasodilatation; EDV), sodium nitroprusside (endothelium-independent vasodilatation; EIDV), and NG-monomethyl-L-arginine (basal nitric oxide (NO) synthase activity) were measured using venous plethysmography. A range of vascular and biochemical secondary endpoints were also explored. EDV in CVD patients post-lycopene improved by 53% (95% CI: +9% to +93%, P = 0.03 vs. placebo) without changes to EIDV, or basal NO responses. HVs did not show changes in EDV after lycopene treatment. Blood pressure, arterial stiffness, lipids and hsCRP levels were unchanged for lycopene vs. placebo treatment groups in the CVD arm as well as the HV arm. At baseline, CVD patients had impaired EDV compared with HV (30% lower; 95% CI: -45% to -10%, P = 0.008), despite lower LDL cholesterol (1.2 mmol/L lower, 95% CI: -1.6 to -0.9 mmol/L, P<0.001). Post-therapy EDV responses for lycopene-treated CVD patients were similar to HVs at baseline (2% lower, 95% CI: -30% to +30%, P = 0.85), also suggesting lycopene improved endothelial function. CONCLUSIONS: Lycopene supplementation improves endothelial function in CVD patients on optimal secondary prevention, but not in HVs. TRIAL REGISTRATION: ClinicalTrials.gov NCT01100385

A study of knowledge, attitude and practice on use of antibiotics and its resistance among the doctors and interns at urban tertiary care hospital: an interventional study

Background: Infections due to resistant micro-organisms considerably increase the mortality rate, treatment cost, disease spread and duration of illness. The development of antibiotic resistance (AMR) is increasing steadily increasing over the last 10-15 years, which is a real threat to disease management. Many studies states that about 20-50% of antibiotic use unnecessary so decreasing the use of antibiotics is the first step to curb the AMR.Methods: A questionnaire based prospective interventional study among the doctors. Systemic random sampling was applied. The pre tested structured questionnaire was used. Data’s were summarised in the excel sheet, analysed by proportions, percentages and other statistical methods like Student t test, Fisher test and Chi square test were used to check the association. The p>0.05 was considered as significant.Results: Out of 200 doctors, preliminary screening of 170 was included in the study and finally 156 participants were actively selected for analysis of results. Out of 156 participants, 55.1% were MBBS Intern and 44.9% were doctors. High significance (p=0.0001) were found between pre and post knowledge, attitude and practice of doctors.Conclusions: Further modes of studies have to perform to identify the determinants of attitude behaviour and motivation that lead people to use and misuse antibiotics. For effective outcome many more qualitative and quantitative studies are required. In addition, health care system should follow proper regulation and prescription policy as well as controls for prescription of antibiotic drugs

Tetrahydrobiopterin Supplementation Improves Endothelial Function But Does Not Alter Aortic Stiffness in Patients With Rheumatoid Arthritis.

BACKGROUND: Rheumatoid arthritis is a systemic inflammatory condition associated with increased cardiovascular risk that may be due to underlying endothelial dysfunction and subsequent aortic stiffening. We hypothesized that supplementation with tetrahydrobiopterin (BH4) would recouple endothelial nitric oxide synthase and thus improve endothelial function and consequently reduce aortic stiffness. METHODS AND RESULTS: We conducted 2 randomized, double-blinded, placebo-controlled crossover studies examining 2 separate regimens: an acute regimen, with a single dose of BH4 400 mg versus placebo (n=18), and a short-term regimen, composed of a 1-week treatment with BH4 400 mg once daily versus placebo (n=15). Flow-mediated dilatation and aortic pulse wave velocity were studied 4 times, before and after each treatment phase. Acute BH4 supplementation led to an improvement of flow-mediated dilatation, whereas placebo had no effect (mean±SD of effect difference 2.56±4.79%; P=0.03). Similarly, 1-week treatment with BH4 improved endothelial function, but there was no change with placebo (mean±SD of effect difference 3.50±5.05%; P=0.02). There was no change in aortic pulse wave velocity following acute or short-term BH4 supplementation or placebo (mean±SD of effect difference: acute 0.09±0.67 m/s, P=0.6; short-term 0.03±1.46 m/s, P=0.9). CONCLUSION: Both acute and short-term supplementation with oral BH4 improved endothelial function but not aortic stiffness. This result suggests that BH4 supplementation may be beneficial for patients with rheumatoid arthritis by improving endothelial dysfunction and potentially reducing risk of cardiovascular disease. There appears to be no causal relationship between endothelial function and aortic stiffness, suggesting that they occur in parallel, although they may share common risk factors such as inflammation.KMMP and IBW were funded by British Heart Foundation. IBW, JC and NS received funding from the Comprehensive Local Research Network and IBW and JC from the National Institute for Health Research: Cambridge Biomedical Research Centre.This is the final version of the article. It first appeared from Wiley Blackwell via http://dx.doi.org/10.1161/JAHA.115.00276

Risk assessment for hospital admission in patients with COPD; a multi-centre UK prospective observational study.

In chronic obstructive pulmonary disease (COPD), acute exacerbation of COPD requiring hospital admission is associated with mortality and healthcare costs. The ERICA study assessed multiple clinical measures in people with COPD, including the short physical performance battery (SPPB), a simple test of physical function with 3 components (gait speed, balance and sit-to-stand). We tested the hypothesis that SPPB score would relate to risk of hospital admissions and length of hospital stay. Data were analysed from 714 of the total 729 participants (434 men and 280 women) with COPD. Data from this prospective observational longitudinal study were obtained from 4 secondary and 1 tertiary centres from England, Scotland, and Wales. The main outcome measures were to estimate the risk of hospitalisation with acute exacerbation of COPD (AECOPD and length of hospital stay derived from hospital episode statistics (HES). In total, 291 of 714 individuals experienced 762 hospitalised AECOPD during five-year follow up. Poorer performance of SPPB was associated with both higher rate (IRR 1.08 per 1 point decrease, 95% CI 1.01 to 1.14) and increased length of stay (IRR 1.18 per 1 point decrease, 95% CI 1.10 to 1.27) for hospitalised AECOPD. For the individual sit-to-stand component of the SPPB, the association was even stronger (IRR 1.14, 95% CI 1.02 to 1.26 for rate and IRR 1.32, 95% CI 1.16 to 1.49 for length of stay for hospitalised AECOPD). The SPPB, and in particular the sit-to-stand component can both evaluate the risk of H-AECOPD and length of hospital stay in COPD. The SPPB can aid in clinical decision making and when prioritising healthcare resources

On the complexity of strongly connected components in directed hypergraphs

We study the complexity of some algorithmic problems on directed hypergraphs and their strongly connected components (SCCs). The main contribution is an almost linear time algorithm computing the terminal strongly connected components (i.e. SCCs which do not reach any components but themselves). "Almost linear" here means that the complexity of the algorithm is linear in the size of the hypergraph up to a factor alpha(n), where alpha is the inverse of Ackermann function, and n is the number of vertices. Our motivation to study this problem arises from a recent application of directed hypergraphs to computational tropical geometry. We also discuss the problem of computing all SCCs. We establish a superlinear lower bound on the size of the transitive reduction of the reachability relation in directed hypergraphs, showing that it is combinatorially more complex than in directed graphs. Besides, we prove a linear time reduction from the well-studied problem of finding all minimal sets among a given family to the problem of computing the SCCs. Only subquadratic time algorithms are known for the former problem. These results strongly suggest that the problem of computing the SCCs is harder in directed hypergraphs than in directed graphs.Comment: v1: 32 pages, 7 figures; v2: revised version, 34 pages, 7 figure

Diagnosis of patients with heart failure with preserved ejection fraction in primary care : Cohort study

Aims Heart failure with preserved ejection fraction (HFpEF) accounts for half of all heart failure (HF), but low awareness and diagnostic challenges hinder identification in primary care. Our aims were to evaluate the recruitment and diagnostic strategy in the Optimise HFpEF cohort and compare with recent recommendations for diagnosing HFpEF. Methods and results Patients were recruited from 30 primary care practices in two regions in England using an electronic screening algorithm and two secondary care sites. Baseline assessment collected clinical and patient-reported data and diagnosis by history, assessment, and trans-thoracic echocardiogram (TTE). A retrospective evaluation compared study diagnosis with H2FPEF score and HFA-PEFF diagnostic algorithm. A total of 152 patients (86% primary care, mean age 78.5, 40% female) were enrolled; 93 (61%) had HFpEF confirmed. Most participants had clinical features of HFpEF, but those with confirmed HFpEF were more likely female, obese, functionally impaired, and symptomatic. Some echocardiographic findings were diagnostic for HFpEF, but no difference in natriuretic peptide levels were observed. The H2FPEF and HFA-PEFF scores were not significantly different by group, although confirmed HFpEF cases were more likely to have scores indicating high probability of HFpEF. Conclusions Patients with HFpEF in primary care are difficult to identify, and greater awareness of the condition, with clear diagnostic pathways and specialist support, are needed. Use of diagnostic algorithms and scores can provide systematic approaches to diagnosis but may be challenging to apply in older multi-morbid patients. Where diagnostic uncertainty remains, pragmatic decisions are needed regarding the value of additional testing versus management of presumptive HFpEF