Therapeutic role of Ricinus communis L. and its bioactive compounds in disease prevention and treatment

Ricinus communis L. (R. communis), commonly known as castor oil plant, is used as a traditional natural remedy or folkloric herb for the control and treatment of a wide range of diseases around the globe. Various studies have revealed the presence of diverse phytochemicals such as alkaloids, flavonoids, terpenes, saponins, phenolic compounds such as kaempferol, gallic acid, ricin, rutin, lupeol, ricinoleic acid, pinene, thujone and gentisic acid. These phytochemicals have been responsible for pharmacological and therapeutic effects, including anticancer, antimicrobial, insecticidal, antioxidant, anti-diabetic, antinociceptive, anti-inflammatory, bone regenerative, analgesic, and anticonvulsant activity. R. communis harbours phytochemicals which have been shown to target peroxisome proliferator activated receptor (PPAR), nuclear factor NF- κ -B, cytochrome p450, P38 mitogen-activated protein kinases kinase (p38 MAPK), tumor protein P53, B-cell lymphoma-extra-large (Bcl-xL) and vascular endothelial growth factor receptor-2 (VEGFR-2). Considering its wide variety of phytochemicals, its pharmacological activity and the subsequent clinical trials, R. communis could be a good candidate for discovering novel complementary drugs. Further experimental and advanced clinical studies are required to explore the pharmaceutical, beneficial therapeutic and safety prospects of R. communis with its phytochemicals as a herbal and complementary medicine for combating various diseases and disorders.

Use of glycated hemoglobin in the diagnosis of diabetes mellitus and pre-diabetes and role of fasting plasma glucose, oral glucose tolerance test

A highly standardized screening test for newly diagnosis diabetes and pre-diabetes is necessary. The study goal was to clarify the power and efficacy of glycated hemoglobin [HbA1c] in the diagnosis of diabetes and pre-diabetes by comparing against the other American Diabetes Association [ADA] diagnostic criteria of fasting plasma glucose [FPG] and oral glucose tolerance test [OGTT]. This is a retrospective study. A total of 27,001 individuals attended to the internal medicine outpatient clinic between 2006 and 2010 years were screened. All diabetic patients and those using drugs associated with the development of diabetes were excluded. The results of FPG, OGTT and A1c for 1814 individual were analyzed and all grouped as diabetic patients, glucose intolerant [pre-diabetes] patients and non-diabetic patients according to new ADA criteria for the diagnosis of diabetes. The prevalence of newly diagnosed diabetes was 69.6% and 54% by using HbA1c alone, 64.2% and 28.2% with 2-h OGTT alone and 43.2% and 60.3%, respectively with FPG alone. Differences between FPG versus 2-h OGTT, FPG versus A1c and OGTT versus A1c were statistically significant [P < 0.0001, P < 0.0001 and P = 0.02, respectively]. Diagnostic sensitivity of all diabetic criteria was 69.6% for A1c; Nearly, 64.2% for OGTT and only 43.1% for FPG respectively. In terms of diagnostic ratio of glucose intolerance; difference between HbA1C and OGTT was statistically significant [P < 0.0001]. As a screening tool for newly diagnosed diabetes and pre-diabetes, the HbA1C level performed better than FPG and 2-h OGTT in this general Saudi population. High diagnostic power of A1C may contribute to the decrease in the number of undiagnosed patients

Mortality in necrotizing fasciitis

The objective of this study was to determine the mortality rate in patients presenting with Necrotizing Fasciitis. This prospective study was conducted at ward 26, JPMC Karachi over a period of two years from March 2001 to Feb 2003. All patients above the age of 12 years diagnosed to be having Necrotizing Fasciitis and admitted through the Accident and emergency department were included in this study. After resuscitation, the patients underwent the emergency exploration and aggressive surgical debridement. Post-operatively, the patients were managed in isolated section of the ward. The patients requiring grafting were referred to plastic surgery unit. The patients were followed up in outpatients department for about two years. Over all, 25 male and 5 female patients fulfilled the inclusion criteria and were included in this study. The common clinical manifestations include redness, swelling, discharging abscess, pain, fever, skin necrosis and foul smelling discharge etc. The most common predisposing factor was Diabetes mellitus whereas the most commonly involved site was perineum. All patients underwent aggressive and extensive surgical debridements. The common additional procedures included Skin grafting, Secondary suturing, Cystostomy and Orchidectomy. Bacteroides and E. coli were the main micro-organisms isolated in this study. Bacteroides was the most common microorganism isolated among the eight patients who died. Necrotizing Fasciitis is a potentially life threatening emergency condition and carries the mortality rate of about 26.6%. The major contributing factors to increase the mortality missed initially diagnosed, old age, diabetes mellitus truncal involvement and late presentation. Anorectal involvement of disease carry worse prognosis. Hyperbaric oxygen therapy and proper use of unprocessed honey reduced the mortality rate