The Effect of Ephedra Foeminea Extract as an Antimicrobial and Antifungal Agent

Drugs derived from natural sources play a significant role in the prevention and treatment of human diseases. In many developing countries, traditional medicine is an essential part of primary healthcare systems (Abdallah, 2011). Due to the emergence of drug-resistant bacteria, it is essential to investigate new drugs with lesser resistance especially ones that can be derived from natural resources like plants. Ephedra is likely one of the oldest medicinal plants that are still currently in use. Antimicrobial and antifungal activities of some ephedra species have been noticed in recent years (ZHANG Ben-Mei et al,2018). The aim of the study is to observe and understand the effects of E. foeminea extracts as antimicrobial and antifungal agents. It is an experimental study; four different types of bacteria including, Staphylococcus aureus, Pseudomonas aeruginosa, MRSA, and Escherichia coli as well as two different types of fungi including, Klebsiella pneumoniae and Candida albicans were used as test microorganisms. Maceration extraction technique (William P. Jones,2012) for the dried stem of E. foeminea will be used by methanol / water 90/10 for 2 days (Ali Parsaeimehr et el,2010). Three concentrations of the extract will be used on 30 plates for each type of microorganism in the laboratories of the University of Palestine. Antimicrobial activity will be tested by using plate methods in which a variable diameter of a growth inhibition zone in most types of bacteria will appear. The MIC values may also be evaluated using the broth serial dilution method according to standard methods (CLSI, 2012)

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570