PAKistan Study of prEmature coronary atHerosclerosis in young AdulTs (PAK-SEHAT): A prospective longitudinal study protocol investigating the prevalence, severity and determinants of atherosclerotic cardiovascular disease in the young adult Pakistani population

Introduction: Atherosclerotic cardiovascular disease (ASCVD) is a major cause of morbidity, mortality and health expenditures worldwide. Despite having higher ASCVD in the Pakistani population, data on subclinical coronary atherosclerosis in young Pakistanis remain scarce. The PAKistan Study of prEmature coronary atHerosclerosis in young AdulTs (PAK-SEHAT) aims to assess the prevalence, severity and determinants of subclinical coronary atherosclerosis among Pakistani men (35-60 years) and women (35-65 years) free of clinically symptomatic ASCVD and will assess 5-year rates of ASCVD events.Methods and analysis: PAK-SEHAT is an ongoing prospective cohort study with 2000 participants from all provinces of Pakistan who will be interviewed at the baseline along with phlebotomy, measurement of carotid intima-media thickness (CIMT) and coronary CT angiography (CCTA). Phlebotomy will be repeated at 2.5 years, whereas CIMT and CCTA will be repeated at 5 years. We will report the frequency of maximal coronary stenosis ≥50% and ≥70%, number of coronary vessels with plaque and the number of coronary segments affected per participant on CCTA. We will use Cox proportional hazards regression models to evaluate the association between baseline characteristics and incident ASCVD events during follow-up. These associations will be presented as HRs with 95% CIs.Ethics and dissemination: The study protocol was approved by the Tabba Heart Institute Institutional Review Board (THI/IRB/FQ/22-09-2021/016). All study procedures are consistent with the principles of the Declaration of Helsinki. Findings of the study will be disseminated via peer-reviewed publications and conference presentations.Trial registration number: NCT05156736

Multiple mechanisms of flaxseed: Effectiveness in inflammatory bowel disease

Materials and methods: Aqueous-methanolic crude extracts of Flaxseed (Fs.Cr) and Flaxseed oil were tested against 6% acetic acid- (AA-) induced colitis in BALB/c mice. Microscopic damage parameters of the hematoxylin and eosin-stained and periodic acid-Schiff-alcian blue-stained sections of the colon were scored to be assessed. Possible antispasmodic mechanism was studied on isolated rabbit jejunum, while antibacterial activity was assessed in vitro for microbes implicated in IBD.Results: In AA-induced colitis, Flaxseed oil was found to be more effective in reducing mortality and colonic ulcers than Fs.Cr at 500 mg/kg dose. Fs.Cr was more efficacious in increasing mucin content as compared to oil, exhibiting slightly greater anti-inflammatory effect (50% vs 35%) and reducing depth of lesion (55% vs 42.31%, respectively). Antispasmodic activity of Fs.Cr (0.03 and 0.1 mg/ml) was mediated by phosphodiesterase inhibitors (PDEI, possibly PDE-4 subtype) with a resultant increase in cAMP levels. Flaxseed oil PDEI activity was mild (1 and 3 mg/ml). Fs.Cr (0.1 and 0.3 mg/ml) was potent in exhibiting anticholinergic activity, similar to dicyclomine, whereas Flaxseed oil showed anticholinergic effect at 1 and 3 mg/ml. Flaxseed oil (9 and 14 µg/ml) was bactericidal against enteropathogenic E.coli (EPEC), enterotoxigenic E.coli (ETEC), and enteroaggregative E.coli (EAEC), whereas Fs.Cr exhibited bactericidal effect against EPEC at 100 µg/ml.Conclusions: Results of this study, taken together with previous studies, suggest that Flaxseed possesses anti-inflammatory, antibacterial, and antispasmodic action through multiple pathways and thus offers promising potential to be developed for IBD

Development and in-vitro Evaluation of Once Daily Tablet Dosage Form of Loxoprofen Sodium

Purpose: To formulate and characterize once daily controlled release tablet of loxoprofen sodium.Methods: Eudragit RS-100, hydroxylpropyl methylcellulose (HPMC) and pectin were used as release retarding polymers. All the formulations were prepared by direct compression method. Various precompression studies were carried out to determine Hausner’s ratio, Carr’s index, angle of repose, bulk density and tapped density Differential scanning calorimetry (DSC) studies and also post-compression studies to evaluate hardness, friability, weight variation, drug content, in-vitro drug release were conducted on the tablets. The drug release data were subjected to kinetic models, including zero order, first order, Hixon Crowell, Higuchi and Korsmeyer-Peppas.Results: Compressibility index (7.6 ± 1.32 - 12.5 ± 1.43%), Hausner’s ratio (1.08 ± 0.04 - 1.14 ± 0.03), angle of repose (27.78 ± 0.47 - 30.49 ± 0.46°), hardness (6.25 ± 0.27 - 7.21±0.21 kg/cm2), friability (0.14 ± 0.06 - 0.28 ± 0.0 %), weight variation (249.5 ± 2.09 - 251.35 ± 2.41 mg) and drug content  (97.30 ± 0.28 - 103.70 ± 0.31 %) were within generally accepted limits for the pre-and post-compression formulations, respectively. The tablets having the maximum amount of among the three polymers tested as matrix materials, HPMC, represented by F3 tablets, exerted better sustained release properties after 12 h. Release pattern was more of Fickian diffusion followed by Higuchi mechanism.Conclusion: The release of the loxoprofen sodium was optimized up to 12 h.Keywords: Loxoprofen, Sustained release, hydroxypropyl methylcelluose, Pectin, Eudragit, Matrix tablet

Application of glucose oxidase for the production of metal gluconates by fermentation

The present study deals with the application of glucose oxidase (GOX) for the production of metal gluconates by fermentation method. It provides a method for the conversion of glucose into gluconic acid and its derivatives using the enzyme glucose oxidase (GOX). Due to the presence of calcium carbonate in fermentation medium the gluconic acid is converted into calcium gluconate. Conditions like concentration of substrate, temperature, pH, fermentation period and different phosphate sources were optimized during fermentation. The maximum GOX activity was observed at 35°C (pH 5.5) after 44 h of incubation at 100 rpm. At the maximum enzyme activity, the percentage yield of gluconates are also maximum; both go side by side. Sulphuric and oxalic acids method were employed for the production of gluconic acid. Derivatives of gluconic acid that is, calcium lactate gluconate, sodium gluconate, potassium gluconate, zinc gluconate and copper gluconate were formed by using double displacement and direct methods. The direct method gave the better yield. The percentage yields were 73, 89.63, 81.93, 92.86 and 81.53%, respectively. Keywords: Glucose oxidase (GOX), metal gluconate, double displacement

A Short History of Evolution of Indigenous Plants and Medicine System

The importance of plants is well known to us. Life and its growth cannot be imagined without plants. Food for our survival is produced by plants and they also create a healthy and eco-friendly environment to live (Sazada et al., 2009).The use of various parts of different medicinal plants to cure specific ailments has been common from ancient times in India. The indigenous system of medicine namely Ayurvedic, Siddha and Unani have been in existence for many centuries. Apart from India, these systems are also prominent in Korea, China, Singapore, West Asia and many other countries. The knowledge of medicinal plants has been inherited traditionally therefore; the utilization of this knowledge has become important for human existence. In the old times, plants were used as remedies for the diseases. The oldest religious book of the World “Rigveda” provides information about the medicinal use of plant “Soma” as a medicinal agent by the Indo-Aryans, which was written between 4000 and 1600 B.C. (Bhattacharjee, 2004).The plant “Soma” is considered to have intoxicating characteristics. This plant is used for sacrificial objectives by Aryans and they also identified its juice as a stimulating beverage (Steiner, 1986). The Aryans also played a vital role in the presentation of therapeutical properties of other medicinal herbs and plants. The knowledge of Aryans about a large number of medicinal plants is demonstrated by the work of Charaka and Sushruta (Kirtikar, 1958).The ancient Indian literature is helpful in driving the current knowledge of using cinchona in malaria, digitalis, strophanthus and physostigma in heart diseases and of quassia as a bitter tonic. The indigenous system of medicine in the Indian sub-continent known as Ayurveda goes back to 700 B.C. and its systematization is attributed mostly to Charaka and Sushruta who have cited about 700 medicinal plants. The book “Sushruta Samhita” compiled in 1000 B.C. includes a comprehensive chapter on herbal therapeutics and contains remarkable information about the use of medicinal plants (Singh and Abrar, 1990)

Impact of Delayed Pain to Needle and Variable Door to Needle Time On In-Hospital Complications in Patients With ST-Elevation Myocardial Infarction Who Underwent Thrombolysis: A Single-Center Experience.

Background Myocardial infarction is a life-threatening event, and timely intervention is essential to improve patient outcomes and mortality. Previous studies have shown that the time to thrombolysis should be less than 30 minutes of the patient\u27s arrival at the emergency room. Pain-to-needle time is a time from onset of chest pain to the initiation of thrombolysis, and door-to-needle time is a time between arrival to the emergency room to initiation of thrombolytic treatment. Ideally, the target for door-to-needle time should be less than 30 minutes; however, it is unclear if the door-to-needle time has a significant impact on patients presenting later than three hours from the onset of pain. As many of the previous studies were conducted in first-world countries, with established emergency medical services (EMS) systems and pre-hospital ST-elevation myocardial infarction (STEMI) triages and protocols, the data is not completely generalizable to developing countries. We, therefore, looked for the impact of the shorter and longer door-to-needle times on patient outcomes who presented to the emergency room (ER) with delayed pain-to-needle times (more than three hours of pain onset). Objective To determine the impact of delayed pain-to-needle time (PNT) with variable door-to-needle time (DNT) on in-hospital complications (post-infarct angina, heart failure, left ventricular dysfunction, and death) in patients with ST-elevation myocardial infarction (STEMI) who underwent thrombolysis. Methods and results A total of 300 STEMI patients who underwent thrombolysis within 12 hours of symptoms onset were included, which were divided into two groups based on PNT. These groups were further divided into subgroups based on DNT. The primary outcome was in-hospital complications between the two groups and between subgroups within each group. The pain-to-needle time was ≤3 hours in 73 (24.3%) patients and \u3e3 hours in 227 (75.7%) patients. In-hospital complications were higher in group II with PNT \u3e3 hours (p3 hours), has a significant impact on in-hospital complications with no difference in mortality

Ectomycorrhizal Fungi as Biofertilizers in Forestry

Ectomycorrhiza (ECM) is an association of fungi with the roots of higher plants in which both the species are equally benefited and appears to be important for the survival of both parties, and no doubt this association offered extensive benefits in the restoration of forest and ecosystem soil aggregation and stabilization. The most important and vital role of ECM fungi, which is analyzed globally, is that they are best and environment friendly biofertilizers. ECM fungi considered as a biotechnological tool in forest management because their role in reforestation, bioremediation, control of soil pathogen, and restoration of ecosystem is reviewed extensively. ECM fungi not only increase the biomass of edible fruiting bodies but also improve soil structure, nutrient cycle, and also produce phytohormones, which increase the growth and survival of seedlings and enhance the photosynthetic rate of plants and also maintain their tolerance level against environmental stresses in forest nursery. Ectomycorrhizas also reduce fertilization expenses in an environment friendly manner. The importance of ECM fungi and mycorrhizal helper bacteria for the growth enhancement of the economically important trees and significantly important role in restoration of sites degraded by forestry operation

Healthcare Access Among Individuals of Asian Descent in the U.S.

Introduction. Some groups of Asian Americans, especially Asian Indians, experience higher rates of atherosclerotic cardiovascular disease (ASCVD) compared with other groups in the U.S. Barriers in accessing medical care partly may explain this higher risk as a result of delayed screening for cardiovascular risk factors and timely initiation of preventive treatment. Methods. Cross-sectional data were utilized from the 2006 to 2015 National Health Interview Survey (NHIS). Barriers to accessing medical care included no place to seek medical care when needed, no healthcare coverage, no care due to cost, delayed care due to cost, inability to afford medication, or not seeing a doctor in the past 12 months. Results. The study sample consisted of 18,150 Asian individuals, of whom 20.5% were Asian Indian, 20.5% were Chinese, 23.4% were Filipino, and 35.6% were classified as “Other Asians”. The mean (standard error) age was 43.8 (0.21) years and 53% were women. Among participants with history of hypertension, diabetes mellitus, or ASCVD (prevalence = 25%), Asian Indians were more likely to report delayed care due to cost (2.58 (1.14,5.85)), while Other Asians were more likely to report no care due to cost (2.43 (1.09,5.44)) or delayed care due to cost (2.35 (1.14,4.86)), compared with Chinese. Results among Filipinos were not statistically significant. Conclusions. Among Asians living in the U.S. with cardiovascular risk factors or ASCVD, Asian Indians and Other Asians are more likely to report delayed care or no care due to cost compared with Chinese