Evidence-Based Medicine; Climbing a Mountain for a Better Decision-Making

Evidence-Based Medicine is a relatively new term used in medical sittings and Health Information Technology (HIT). It is a form of medicine that integrates practitioners’ expertise with the best available practical evidences to improve better patient care. Evidence-Based Medicine has increasingly been used and incorporated into daily medical practices to overcome the shortcomings in the conventional standard care. The purpose of this literature review is to highlight the importance of Evidence-Based Medicine and how it can act as a crucial tool in decision-making to empower the quality of medical services for better patient outcomes

Effect of Monosodium Glutamate on the Digestibility of Different Nutrients Using Standardized Static In vitro Digestion Model

Monosodium glutamate (MSG) is a flavor enhancer and food additive with a unique umami taste. Due to its widespread use in humans, this study focused on the cytotoxicity, anti-diabetic effect, and interaction with protein digestion by performing a standardized static in vitro digestion model and lipid digestion by estimating free fatty acids released from 0.5 g of olive oil during intestinal lipolysis. The study showed that monosodium glutamate has an apparent cytotoxic effect on the Caco-2 cell line in a dose-dependent manner. MSG glutamate also showed low inhibitory activity on alpha-glucosidase enzyme even at high concentrations (16.3 % at 1800 ppm). By performing simulated in vitro digestion to study the interaction between MSG and protein digestion, followed by MTT study, total protein determination, and pH drop method, all results concluded that MSG affected proteolysis. Finally, the impact of MSG on lipolysis was studied through a free fatty acid release test. The results of the study demonstrated that MSG harmed fat digestibility in a concentration-dependent manner. As a result, it is essential to conduct further studies, especially in vivo studies, to determine the potential negative effects of MSG on human health

Passive smoking in the etiology of non-syndromic orofacial clefts:a systematic review and meta-analysis

Background Studies have found a consistent positive association between maternal smoking and nonsyndromic orofacial clefts (NSOFC). However, no comprehensive assessment of the association between NSOFC and passive smoking has been undertaken. This systematic review and meta-analysis explores the relationship between maternal passive smoking and NSOFC, and compares the associations between passive and active smoking. Methods and Findings Search strategy, inclusion / exclusion criteria, and data extraction from studies reporting maternal passive smoking and NSOFC was implemented without language restrictions. Risks of bias in the identified studies were assessed and this information was used in sensitivity analyses to explain heterogeneity. Meta-analysis and meta-regression of the extracted data were performed. Egger's test was used to test for small study effects. Fourteen eligible articles were identified. Maternal passive smoking exposure was associated with a twofold increase in risk of NSOFC (odds ratio: 2.11, 95% confidence interval: 1.54-2.89); this was apparent for both cleft lip with and without palate (OR: 2.05, 95% CI: 1.27-3.3) and cleft palate (OR: 2.11, 95% CI: 1.23-3.62). There was substantial heterogeneity between studies. In the studies that provided data enabling crude and adjusted odd ratios to be compared, adjustment for potential confounders attenuated the magnitude of association to about a 1.5-fold increase in risk. Conclusion Overall, maternal passive smoking exposure results in a 1.5 fold increase in risk of NSOFC, similar to the magnitude of risk reported for active smoking, but there is marked heterogeneity between studies. This heterogeneity is not explained by differences in the distribution of cleft types, adjustment for covariates, broad geographic region, or study bias/quality. This thorough meta-analysis provides further evidence to minimize exposure to environmental tobacco smoke in policy making fora and in health promotion initiatives.</p

CYTOTOXIC AND ANTIOXIDANT ACTIVITIES OF SECONDARY METABOLITES FROM PULICARIA UNDULATA

Objective: To evaluate the in vitro cytotoxicity, antioxidant activities and structure-activity relationship of secondary metabolites isolated from Pulicaria undulata.Methods: The methylene chloride-methanol (1:1) extract of the air-dried aerial parts of Pulicaria undulata was fractionated and separated to obtain the isolated compounds by different chromatographic techniques. Structures of the isolated compounds were determined on the basis of the extensive spectroscopic analysis, including 1D and 2D NMR and compared with the literature data. The crude extract and the isolated compounds were evaluated for in vitro antioxidant activity using the 2,2 diphenyl dipicryl hydrazine (DPPH) method and cytotoxic assay using human breast cancer (MCF-7) and hepatoma (Hep G2) cell line.Results: Nine secondary metabolites were isolated from Pulicaria undulata in this study. Of which two terpenoidal compounds; 8-epi-ivalbin and 11β, 13-dihydro-4H-xanthalongin 4-O-β-D-glucopyranoside firstly isolated from the genus pulicaria and three flavonoids; eupatolitin, 6-methoxykaempferol, and patulitrin firstly isolated from P. undulata. 6-methoxykaempferol (IC50 2.3 µg/ml) showed the most potent antioxidant activity. The highest cytotoxic effect against MCF-7 and Hep G2 cells was obtained with eupatolitin (IC50 27.6 and 23.5 µg/ml) respectively. The structure-activity relationship was also examined and the findings presented here showed that 3, 5, 7, 4' and 3, 5, 4', 5'-hydroxy flavonoids were potent antioxidant and has cytotoxic activity.Conclusion: Pulicaria undulata is a promising medicinal plant, and our study tends to support the therapeutic value of this plant as antioxidant drug and in the treatment of cancer

Fibromyalgia in Rheumatoid Patients, Depression and Cognitive Dysfunction

Aim of the work: To correlate relation between depression, cognitive dysfunction and fibromyalgia (FM) in rheumatoid patients. Patients and methods: The study was done on 60 patients, in 2 groups, Group A: Active, and Group B inactive patients. 9 were FM and 51 patients without FM Depression was diagnosed based on PHQ 9 depression scale test Cognitive function was assessed by MOCA test. Results: Mean scale of depression in FM 16.78 ± 6.38 while in patients free of FM are 12.27 ± 5.39 with statistically significant p value. Mean scale of cognitive dysfunction in patient with FM was 23.33 ± 3.87 while in patients without are 22.9 ± 4.51 without statistically significant p value. Conclusions: There is statistically significant correlation between depression and fibromyalgia and no statistically significant correlation between cognitive function and fibromyalgia

<i>Garcinia cambogia</i> phenolics as potent anti-COVID-19 agents:phytochemical profiling, biological activities, and molecular docking

COVID-19 is a disease caused by the coronavirus SARS-CoV-2 and became a pandemic in a critically short time. Phenolic secondary metabolites attracted much attention from the pharmaceutical industries for their easily accessible natural sources and proven antiviral activity. In our mission, a metabolomics study of the Garcinia cambogia Roxb. fruit rind was performed using LC-HRESIMS to investigate its chemical profile, especially the polar aspects, followed by a detailed phytochemical analysis, which led to the isolation of eight known compounds. Using spectrometric techniques, the isolated compounds were identified as quercetin, amentoflavone, vitexin, rutin, naringin, catechin, p-coumaric, and gallic acids. The antiviral activities of the isolated compounds were investigated using two assays; the 3CL-Mpro enzyme showed that naringin had a potent effect with IC50 16.62 &mu;g/mL, followed by catechin and gallic acid (IC50 26.2, 30.35 &mu;g/mL, respectively), while the direct antiviral inhibition effect of naringin confirmed the potency with an EC50 of 0.0169 &mu;M. To show the molecular interaction, in situ molecular docking was carried out using a COVID-19 protease enzyme. Both biological effects and docking studies showed the hydrophobic interactions with Gln 189 or Glu 166, per the predicated binding pose of the isolated naringin

Dietary Supplementation of Nile Tilapia (Oreochromis niloticus) With Panax ginseng Essential Oil: Positive Impact on Animal Health and Productive Performance, and Mitigating Effects on Atrazine-Induced Toxicity

The present study assessed the impact of Panax ginseng essential oil (GEO) supplementation on physiological parameters related to productive performance and health status in Nile tilapia reared under standard conditions and exposed to a sub-lethal atrazine (ATZ) concentration. Fish were allocated into 6 groups: the control group was reared in clean water and fed with a commercial basal diet (CNT), two groups were fed with the basal diet supplemented with two different levels of GEO (GEO1 and GEO2, respectively), one group was intoxicated with 1/5 of ATZ 96-h lethal concentration 50 (1.39 mg/L) (ATZ group), and the remaining two groups were fed with the GEO-supplemented diets and concurrently exposed to 1.39 mg ATZ/L (GEO1+ATZ and GEO2+ATZ, respectively). The experiment lasted for 60 days. GEO supplementation exerted a significantly positive influence on fish growth, feed utilization, and hepatic antioxidant defense systems at both levels of supplementation. ATZ exposure significantly reduced fish survival rates and impaired fish growth and feed utilization, with the lowest final weights, weight gain, total feed intake, and the highest feed conversion ratio being recorded in the ATZ-intoxicated group. ATZ exposure caused significant changes in intestinal digestive enzyme activity (decreased lipase activity), hematological indices (decreased hemoglobin, packed cell volume, erythrocytes, and leukocytes), blood biochemical variables (decreased total proteins, albumin, globulins, and immunoglobulin M; increased total cholesterol, triglycerides, and cortisol), and hepatic oxidative/antioxidant indices (decreased glutathione level, superoxide dismutase and catalase enzyme activity and mRNA expression levels, and increased malondialdehyde content). Moreover, in the hepatic tissue of ATZ-intoxicated Nile tilapia, histopathological alterations and upregulated mRNA expression levels of stress- and apoptosis-related genes (Hsp70, caspase 3, and p53) were observed. GEO supplementation in ATZ-treated groups significantly attenuated the aforementioned negative effects, though some parameters did not reach the CNT values. These findings provide further and partly new evidence that sub-lethal ATZ toxicity induces reduced survivability, growth retardation, impaired digestive function, anemia, immunosuppression, hepatic oxidative stress damage, and overall increased stress level in Nile tilapia, and suggest that GEO supplementation may be useful for mitigating this toxicity and provide more general support to the productive performance and health status of this fish species

Naso-Maxillary extramedullary plasmacytoma: A case report

We report an early case of extramedullary, right maxillary sinus and nasal, plasmacytoma. The patient was a 27 years old female who presented with nasal bleeding and a nasal mass. Imaging studies showed opacities in the nasal cavity and the maxillary sinus but there was no bone involvement.&nbsp; A biopsy from the nasal mass showed a plasmacytoma. She was investigated to rule out systemic disease. The investigations included; serum electrophoresis, urine analysis for Bence Jones proteins, bone marrow aspirates study and radiological skeletal survey. The results of all investigations were negative. After complete excision of the tumour endoscopically the patient was treated with adjuvant radiotherapy. She remained well, without recurrence or spread of the tumour at 4 years follow up. CTscans pre and postoperatively as well as H&amp;E and Immunohistochemistry slides are presented. To our knowledge, this is the first case to be reported in Sudan.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp