Evaluating anthelmintic, anti-platelet, and anti-coagulant activities, and identifying the bioactive phytochemicals of Amaranthus blitum L.

BACKGROUND: Highlighting affordable alternative crops that are rich in bioactive phytoconstituents is essential for advancing nutrition and ensuring food security. Amaranthus blitum L. (AB) stands out as one such crop with a traditional history of being used to treat intestinal disorders, roundworm infections, and hemorrhage. This study aimed to evaluate the anthelmintic and hematologic activities across various extracts of AB and investigate the phytoconstituents responsible for these activities. METHODS: In vitro anthelmintic activity against Trichinella spiralis was evaluated in terms of larval viability reduction. The anti-platelet activities were assessed based on the inhibitory effect against induced platelet aggregation. Further, effects on the extrinsic pathway, the intrinsic pathway, and the ultimate common stage of blood coagulation, were monitored through measuring blood coagulation parameters: prothrombin time (PT), activated partial thromboplastin time (aPTT), and thrombin time (TT), respectively. The structures of isolated compounds were elucidated by spectroscopic analysis. RESULTS: Interestingly, a previously undescribed compound (19), N-(cis-p-coumaroyl)-ʟ-tryptophan, was isolated and identified along with 21 known compounds. Significant in vitro larvicidal activities were demonstrated by the investigated AB extracts at 1 mg/mL. Among tested compounds, compound 18 (rutin) displayed the highest larvicidal activity. Moreover, compounds 19 and 20 (N-(trans-p-coumaroyl)-ʟ-tryptophan) induced complete larval death within 48 h. The crude extract exhibited the minimal platelet aggregation of 43.42 ± 11.69%, compared with 76.22 ± 14.34% in the control plasma. Additionally, the crude extract and two compounds 19 and 20 significantly inhibited the extrinsic coagulation pathway. CONCLUSIONS: These findings extend awareness about the nutritional value of AB as a food, with thrombosis-preventing capabilities and introducing a promising source for new anthelmintic and anticoagulant agents.

Phytochemical profiling of three Amaranthus species using LC-MS/MS metabolomic approach and chemometric tools.

Several Amaranthus vegetables (Amaranthaceae) have been recognized as valuable sources of minerals, vitamins, proteins, and phytonutrients, with health-promoting characteristics. In this study, three edible Amaranthus species, namely A. hybridus (AH), A. blitum (AB), and A. caudatus (AC), were chemically characterized using non-targeted liquid chromatography-tandem mass spectrometry (LC-MS/MS) technique. Further, multivariate chemometric analyses were conducted, including principal component analysis (PCA) and correlation-covariance plot (C-C plot). As a result, forty-one diverse compounds were identified, which varied in distribution and abundance across the investigated species. Amino acids and flavonoid glycosides were the most prevalent metabolites. Other identified compounds comprised nucleoside, chlorogenic acids, hydroxy cinnamoyl amides, and triterpenoid saponins. The most discriminant metabolites were flavonoid glycosides and hydroxy cinnamoyl amides, giving each species a chemotaxonomic identity. Advancing the chemotaxonomy of Amaranthaceae, adenosine nucleoside and N-coumaroyl-ʟ-tryptophan were first reported from this family. Isorhamnetin and tricin glycosides were uniquely identified in AC, offering useful chemotaxonomic markers for this species. Notably, AB and AH profiles shared most metabolites, yet with varying abundance. These include adenosine, nicotiflorin, dicaffeoylquinic acids, and N-trans-feruloyl-4-O-methyldopamine. However, N-coumaroyl-ʟ-tryptophan and kaempferol dirhamnoside were exclusively found in AB, separating it from AH. In conclusion, the applied analytical techniques established molecular fingerprints for the included species, identified specific biomarkers, and investigated their interconnections.

Evaluation of optimum diabetes care on glycemic control of patients with gestational diabetes during Ramadan fasting.

AIMS: There is limited evidence that evaluates the impact of fasting during Ramadan in pregnant women. We explored the safety of fasting in Gestational Diabetes Mellitus (GDM) in Ramadan, while understating the glycemic variability. METHODS: 25 patients with GDM who choose to fast, were enrolled and provided optimum care that included Ramadan focused education and FreeStyle LibreFlashContinuous Glucose Monitoring(FSL-CGM) was utilized for 2-4 weeks assessment period of non-Ramadan days plus 2-3 weeks during Ramadan and medication adjustment. RESULTS: The average glucose improved significantly, while time in target and percent above target numerically improved during Ramadan compared to pre-Ramadan. There was significant increment on the number of hypoglycemic events in Ramadan. The average lowest blood glucose reading reduced significantly by 14 mg/dL with average duration of hypoglycemic events increased significantly by 38.5 min. CONCLUSION: Our study reinforces the importance of structured education before Ramadan to deliver optimal care for the management of diabetes. Strikingly FSL-CGM demonstrated that hypoglycemia is significantly increased during Ramadan Fasting. There was effective reflection of hyperglycemic spikes, immediately post Iftar. The results corroborated with the earlier studies for higher frequency of hypoglycemia during Ramadan fasting, under similar standards of care in high-risk patients with diabetes.

Use of flash glucose monitoring system in assessing safety of the SGLT2 inhibitors during Ramadan fasting in high risk insulin treated patients with type 2 diabetes.

BACKGROUND: The risks of hypoglycemia, dehydration and kidney injury may theoretically be aggravated by people with type 2 diabetes treated with Insulin and SGLT2 inhibitors during Ramadan. Data on safety and efficacy of SGLT2-I in people with type 2 diabetes treated with insulin is scanty. We aimed to assess the impact of SGLT2 inhibitors during Ramadan in high-risk patients with type 2 diabetes treated with insulin, on hypoglycemia, glycemic control and kidney function. METHODS: This is a prospective interventional study on high-risk diabetes patients who insisted on fasting. All patients were treated with insulin ±â€¯SGLT2I. All patients received a FGMS and Ramadan focused education. All patients attended clinic before and post Ramadan where they were advised on treatment modification as well as biometric and biochemical measurements. RESULTS: 95 patients enrolled in the study and 49 of them were on SGLT2i. There was a no significant change in creatinine in both groups. FGMS showed an improvement in the sensor-calculated HbA1c from 7.3 ±â€¯1.5 to 6.8 ±â€¯1.1 and from 8 ±â€¯1.6 to 7.7 ±â€¯1.5 in the SGLT2 group and the non-SGT2i groups, respectively. The hypoglycemia was predominantly reported during Ramadan between 12:00 to 18:00 h, while in pre-Ramadan readings was during 2400-0600 and 1200-1800 slots. CONCLUSIONS: This is the first study that assesses the use of SGLT2i along with insulin during Ramadan, using FGMS in high-risk patients with type 2 diabetes under optimal care. There was minimal interruption of fasting, significant improvement in glycemic control, and no significant change in the kidney function after Ramadan.

The use of Free Style Libre Continues Glucose Monitoring (FSL-CGM) to monitor the impact of Ramadan fasting on glycemic changes and kidney function in high-risk patients with diabetes and chronic kidney disease stage 3 under optimal diabetes care.

AIM: To understand the risk of hypoglycaemia during Ramadan fasting by use of CGM, as well as to observe the Glycemic control and renal functions in patients with diabetes and chronic kidney disease stage 3 (CKD-3). METHOD: A prospective interventional study conducted in the Dubai Hospital, a tertiary care centre in the United Arab Emirates, during the month of Ramadan 1437 AH (Hijri), which corresponded to June 6th till July 5th, 2016. 25 patients with type 2 diabetes and stage 3 chronic kidney disease (CKD stage 3) were included in the study, who intended to fast during Ramadan. The aim was to observe the serum glucose level through 24 h FreeStyle Libre flash continuous glucose monitor (FSL-CGM). Most patients had three sensors during the study, covering an average three weeks during Ramadan and three weeks outside Ramadan (Sha'ban and shawal). We also monitored the change in, BP, HBA1c, kidney functions and BMI before and after Ramadan. RESULTS: This study included 25 adults with a mean age of 60 (±14 years). Fasting Ramadan did not result in any significant change in biophysical and biochemical profile of these patients. Data from FSL-CGM showed significantly longer duration (101.9 ±â€¯119.1 Vs. 45.9 ±â€¯47.6 min, p < 0.033) and more frequent hypoglycemic episodes (4.4 ±â€¯4.7 Vs. 2.3 ±â€¯3.0, p < 0.047) during Ramadan compared tonon-Ramadan respectively. The mean blood glucose readings were also significantly lower (70.7 ±â€¯29.3 Vs.93.7 ±â€¯57.9 mg/dl p < 0.011) during Ramadan compared to non -fasting period. The renal function mean ±â€¯SD (serum creatinine 1.48 ±â€¯0.37, 1.44 ±â€¯0.37 and eGFR, 49.0 ±â€¯18.4, 48.9 ±â€¯17.5 p 0.9) showed no significant change due to fasting. CONCLUSION: In patients with diabetes and CKD-stage 3 Ramadan fasting under close supervision and optimal diabetes care, was not associated with worsening of HBA1c and renal function. Patients had significantly more frequent and prolonged hypoglycemic episodes during Ramadan.

Assessment of risk of fasting during Ramadan under optimal diabetes care, in high-risk patients with diabetes and coronary heart disease through the use of FreeStyle Libre flash continuous glucose monitor (FSL-CGMS).

AIM: Most of Muslims patients with diabetes and Coronary Heart Disease (CHD) elect to fast in Ramadan, but the actual risk in this subset of patients with diabetes is largely unknown. We aimed to understand the safety of fasting in CHD patients with diabetes insisting on fasting Ramadan under optimal care. We also monitored the change in biophysical and biochemical parameters of these patients before and after Ramadan. We conducted this prospective study in a tertiary care hospital in Dubai during Ramadan 2016, (June 6th till July 5th). PATIENTS AND METHODS: 21 Patients with T2DM with stable known CHD during the three months prior to study and insisted on fasting despite advice against it were recruited for the study. All patients received continuous glucose monitoring with free style libre monitoring device (FSL-CGM) during and outside Ramadan period. We recorded DM or CVD-related emergency visit or hospitalisation, change in BMI, systolic and diastolic BP, lipids profile, e-GFR, HBA1c, and frequency of hypoglycemia during Ramadan fasting and not -fasting period. RESULTS: This is first study using CGM in CHD patients with diabetes who observe fast in Ramadan. Patients had a significantly higher incidence (3.2 ±â€¯2.8 vs 1.1 ±â€¯1.6 episodes, p = 0.033) and prolonged duration of hypoglycemia (117.8 ±â€¯87.2, 49.1 ±â€¯59.1 min p 0.022) during fasting compared to non-fasting respectively. No significant alteration was seen in BMI, SBP and DBP, lipid profile and renal function. There is a significant improvement in HBA1c during Ramadan. CONCLUSION: We could not associate any adverse cardiovascular effects with fasting Ramadan in patients with stable CHD under optimal diabetes care. FSL-CGMS data showed higher frequency of hypoglycemia during Ramadan fasting. Studies with larger sample size are needed for further validation of these findings.

The role of optimum diabetes care in form of Ramadan focused diabetes education, flash glucose monitoring system and pre-Ramadan dose adjustments in the safety of Ramadan fasting in high risk patients with diabetes.

BACKGROUND: Physiology of intermittent and prolonged fasting is known from healthy subjects. Evidence on high and very high-risk groups is lacking. The anticipated risks include hypoglycemia, hyperglycemia, dehydration and thrombosis. Education, pre-Ramadan doses adjustment, and glucose monitoring devices (Optimum diabetes care in Ramadan) is expected to lower this risk. AIMS: We aimed to assess the value of optimum care in diabetes management during Ramadan on the metabolic parameters of high risk patients with diabetes. Moreover, we wanted to assess and understand the safety of fasting in this group. METHODS: This is a prospective interventional study. Patient with high-risk diabetes who insisted on fasting. High risk patients defined as any one with type 1 or type 2 diabetes on insulin, Gestational diabetes, stage 3 kidney disease, and having history of ischemic heart disease. All patients received a Freestyle Libre continuous glucose monitoring device, and was offered to attend the clinic at any time during the study, this collectively defined as optimum diabetes care during Ramadan. Biometric (Weight, height, Blood pressure) and biochemical (Glycosylated hemoglobin A, Lipids profile, creatinine, and estimated glomerular filtration rate) were reported within 4-6 weeks before and after Ramadan. RESULTS: Total of 169 patients were. Majority were females 54.4% (n = 92). There was a remarkable improvement in glycemic control from 7.6 + 1.2 to 7.3 + 1.2 percent (p = 0.00). Serum creatinine showed a negligible change at the end of the study from 0.81 + 0.3 to 0.82 + 0.2 mg/dl). Only total cholesterol worsened significantly (p = 0.02).

Glycemic and lipids control in patients with diabetes and cardiovascular or renal diseases across all the government health sectors in the Emirate of Dubai, United Arab Emirates.

The guidelines suggest setting the glycemic and lipid targets according to the stage of the disease and other co -existing complications in the patients with diabetes. AIMS: We aimed to evaluate the HbA1c and lipids level in patients with high risk diabetes from 2012-2016, attending different level of care in Dubai health authority. MATERIALS AND METHODS: This is a retrospective analysis of the electronic medical records of all patients who attended the Dubai Health authority between 2012-2016. All patients with an ICD code of any type of diabetes in addition to cardiovascular or renal diseases were. Patients were categorized based on their HbA1c into control of<7.5, 7.5 - 8, and >8%. While lipids were categorized as f LDL < 70 mg/dl, and the Non-HDL <100 mg/dl. RESULTS: Out of total number of 26647 patients diagnosed with diabetes, 2015 patients did fit the criteria of this study. The desired mean of HbA1c of <7.5% achieved by 21.76% and 28.94% in T1DM and T2DM, respectively. The LDL of < 70 mg/dl was achieved by 27.8% of the patients. CONCLUSION: In patients with diabetes and multiple complications, the glycemic and lipids control is suboptimal. However, the pattern showed numerical improvement over the years.

Efficacy of bariatric surgery in improving metabolic outcomes in patients with diabetes. A 24-month follow-up study from a single center in the UAE.

BACKGROUND: Owing to its impact on weight loss, remission of diabetes mellitus and metabolic syndrome, bariatric surgery has offered hope for grossly obese individuals. In recent years, obesity has increased in the UAE and the use of bariatric surgery has increased in-line with this trend. However, data regarding bariatric surgery outcomes in diabetic Emirati people is scarce. OBJECTIVE: To evaluate the effect of bariatric surgery in patients with diabetes mellitus. METHODS: This is a retrospective analysis of diabetic patients treated with bariatric surgery with a minimal follow-up of 1 year and extended for some patients (21) to 2 years follow up. A total of 80 patients underwent bariatric surgery. Two surgical procedures were used; laparoscopic sleeve gastrectomy (n=53) or mini-gastric bypass between January 1, 2015, and July 20, 2017. RESULTS: Mean baseline weight was 119.2±31.2 kg, this has significantly dropped to 100.1±23.1, 91.2±22.3, 82.3±17.5, and 81.3±15.3 kg at 3, 6, 12, and 24 months respectively, and this change was statistically significant P<0.001 at each time point. Mean baseline HbA1c was 8.6% ± 2.3% and this dropped significantly to 6.5±1.7, 5.9±1.2, 5.6±0.8, and 5.4±0.7 at 3, 6, 12, and 24 months respectively (P<0.000). In 49 (61.3%) we considered fatty liver based on ultrasound features either with or without elevation in alanine aminotransferase (ALT). We noticed a significant decrease in ALT at 3, 6, and 12 months after surgery. Furthermore, 11 patients (22.4%) showed sonographic features of improvement in fatty liver in addition to normalization of ALT. CONCLUSIONS: Bariatric surgery was effective over a follow-up period of 2 years in achieving significant weight loss as well as resulting in improvements in glycemic control, blood pressure, and fatty liver.

Safety of Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2-I) During the Month of Ramadan in Muslim Patients with Type 2 Diabetes.

OBJECTIVES: Sodium-glucose cotransporter 2 inhibitors (SGLT2-I) are a new class of antidiabetic drugs that might increase the risk of dehydration and hypoglycemia, particularly during the month of Ramadan in which Muslims abstain from eating and drinking for 14-16 hours daily. We aimed to provide real-life evidence about the safety of SGLT2-I during Ramadan. METHODS: All patients over the age of 18 years on SGLT2-I before Ramadan 2016 who would be fasting during Ramadan were included. Demographic data, detailed medical history including comorbidities and medication profile, and laboratory results were collected before and after Ramadan. We also conducted a phone interview to evaluate the frequency and severity of hypoglycemia and dehydration. RESULTS: Of the total of 417 patients, 113 (27.0%) experienced hypoglycemic events, and 93 of these (82.3%) checked their blood glucose using a glucometer. Confirmed hypoglycemia (< 70 mg/dL) was observed in 78 (83.8%). The hypoglycemic events were significantly more frequent in the SGLT2-I plus insulin-treated group than in those treated with SGLT2-I plus oral hypoglycemic agents group (p < 0.001). Confirmed hypoglycemic events were more frequent in those using SGLT2-I plus intensive insulin compared to those using SGLT2-I plus basal insulin (p = 0.020). Symptoms of dehydration were seen in 9.3% (n = 39) of the total population. We observed statistically significant reductions in glycated hemoglobin and weight by the end of Ramadan (p < 0.001). There were no significant changes in lipid profile and creatinine levels by the end of the study. CONCLUSIONS: The use of insulin in combination with SGLT2-I increases the risk of hypoglycemia during Ramadan. Hypoglycemic events were mild and did not require hospital admission. However, careful monitoring during prolonged fasting is warranted. No significant harmful effects on renal function result from treatment with SGLT2-I during Ramadan.

Efficacy and Safety of SGLT2 Inhibitors in Reducing Glycated Hemoglobin and Weight in Emirati Patients With Type 2 Diabetes.

BACKGROUND: SGLT2 inhibitors are a new class of drugs that act by inhibiting glucose reabsorption in the proximal renal tubules. Many trials have demonstrated their effectiveness in reducing glycated hemoglobin (HbA1c) and weight, but they have never been examined in Arab or Emirati populations. METHODS: We assessed the efficacy of SGLT2 inhibitors in reducing HbA1c and weight in our population and specifically in an Emirati cohort. We also assessed the effect on fasting blood glucose, blood pressure, lipid profile, serum creatinine, and side effects. RESULTS: The total number of patients was 307. The baseline HbA1c in the Emirati cohort was 8.9±1.7%, which dropped significantly to 8±1.5% at 6 months (P = 0.0001). At 1 year, the mean HbA1c was 8±1.4%, which was significantly different from baseline (P = 0.0001). However, the change in mean HbA1c from 6 months (8±1.5%) to 1 year (8±1.4%) was not statistically significant (P = 0.88). A similar highly significant change was observed when comparing weights at baseline and 6 months in the Emirati population (85.7 ± 17.8 kg vs. 84 ± 17.2 kg, P = 0.0001). Total cholesterol dropped significantly at 6 months (P = 0.008), as did low-density lipoprotein (LDL) (P = 0.005). CONCLUSIONS: The use of SGLT2 inhibitors is associated with significant reductions in HbA1c and weight. Unlike all previous trials, the inhibitors significantly reduced total cholesterol and LDL. Larger trials are needed to reassess their effects on lipid parameters.

Comparative Evaluation of Anthelmintic Activity of Edible and Ornamental Pomegranate Ethanolic Extracts against Schistosoma mansoni.

Due to the development of praziquantel (PZQ) schistosomes resistant strains, the discovery of new antischistosomal agents is of high priority in research. This work reported the in vitro and in vivo effects of the edible and ornamental pomegranate extracts against Schistosoma mansoni. Leaves and stem bark ethanolic extracts of both dried pomegranates were prepared at 100, 300, and 500 µg/mL for in vitro and 600 and 800 mg/kg for in vivo. Adult worms Schistosoma mansoni in RPMI-1640 medium for in vitro and S. mansoni infected mice for in vivo tests were obtained from Theodor Bilharz Research Institute, Cairo, Egypt. In vitro activity was manifested by significant coupled worms separation, reduction of motor activity, lethality, and ultrastructural tegumental alterations in adult worms. In vivo activity was manifested revealed by significant reduction of hepatic granulomas number and diameter, decreased number of bilharzial eggs in liver tissues, lowered liver inflammatory infiltration, decreased hepatic fibrosis, and inducible nitric oxide synthase (iNOS) expression. Ethanolic stem bark extract of edible pomegranate exhibited highest antischistosomal activities both in vitro and in vivo. Therefore, pomegranate showed a good potential to be used as a promising new candidate for the development of new schistosomicidal agents.

Exenatide's effect in reducing weight and glycosylated hemoglobin level in an Arab population with type 2 diabetes.

OBJECTIVES: To determine whether exenatide is effective in reducing weight and glycosylated hemoglobin level (HbA1c), and to investigate its efficacy in improving lipid profile, blood pressure, and creatinine levels in the Arab population. METHODS: This study was conducted at the Endocrine Unit, Dubai Hospital, Dubai, United Arab Emirates. We retrospectively collected data from patients with type 2 diabetes started on exenatide between November 2011 and February 2012. Data included demographics, clinical, laboratory results, and medications used. A general linear model adjusted by baseline characteristics (weight, HbA1C, age, use of statins, and duration of diabetes) was used to assess changes between baseline and end of trial in HbA1C, weight, low density lipoprotein cholesterol, total cholesterol, triglycerides, creatinine, and blood pressure. RESULTS: After 6 months of treatment with exenatide, the HbA1c decreased by 0.47% (95% confidence level [CI]: -0.01 - 0.95) (p=0.055). Weight reduction was highly significant; 5.6 kg (95% CI: 3.34 - 7.85) (p<0.001). Those reductions remained significant after adjustment for confounding factors. CONCLUSION: This study showed that weight reduction was highly significant with exenatide. The borderline significance in HbA1c reduction can be attributed to the small sample size. 

Antiparasitic antioxidant phenylpropanoids and iridoid glycosides from Tecoma mollis.

A radical scavenging guided phytochemical study on the stem bark of Tecoma mollis afforded seven active phenylpropanoid glycosides (1-7), including a new one (4), and one iridoid (8). The structures of the isolated compounds were elucidated on the basis of spectroscopic evidences and correlated with known compounds. Compounds (1-7) displayed promising antioxidant activity (DPPH assay) in relation to ascorbic acid (positive control). The antimicrobial activity for compounds (1-8) was evaluated against five bacterial and five fungal strains. The isolated compounds exhibited nonselective weak to moderate antimicrobial activity. The highest antileishmanial activity against Leishmania donovani was observed for compound (7) with an IC50 value of 6.71 µg/ml, using pentamidine and amphotericin B as drug controls. Compound (5) exhibited moderate antimalarial activity (45% inhibition) against chloroquine sensitive (D6) clones of Plasmodium falciparum.

Prevalence of Candida colonization in preterm newborns and VLBW in neonatal intensive care unit: role of maternal colonization as a risk factor in transmission of disease.

UNLABELLED: Candida species are important nosocomial pathogens in the newborn population, particularly among the premature very low birth weight (VLBW) infants in neonatal intensive care units (NICU). Candida colonization in neonates and subsequent dissemination result in a plenty of morbidity and mortality risks. This work aims to determine the prevalence of Candida species colonization in preterms and VLBW newborns in NICU in Al-Hasa, Kingdom of Saudi Arabia, and detect the relation of maternal colonization as a risk factor for transmitting the disease. SUBJECTS AND METHODS: One hundred two preterms were included; 70 delivered vaginally (index cases) and 32 delivered by cesarean section (control group). Several swabs from oral, umbilical and anus were taken at birth, at third day and 1 week after birth. High vaginal swabs were also taken from the mother before labor. RESULTS: Candida colonization was detected in 12.8% of index cases. Most of them (88.8%) were detected at the third day after birth. The initial site of colonization was the anus (88.8%) in comparison with oral cavity (66.6%) and the umbilicus (55%). Vaginal delivery and prolonged duration of premature rupture of membranes were significantly positively correlated to neonatal colonization (p < 0.02 and p = 0.02, respectively). The lowest birth weight, gestational age and uses of invasive techniques have the highest significant risk for colonization after birth (p < 0.04, p = 0.03 and p = 0.03, respectively). Candida albicans was the most common species detected (77.7% of the cases). The preterm's colonization species were all identical to their mother vaginal colonization species. Invasive candidiasis was detected in 22.2% of colonized preterm. CONCLUSION: Candida colonization has a considerable prevalence among the preterms in our NICU. Besides vaginal delivery, low birth weight and low gestational age could be considered as risk factors for colonization. Early screening of the mothers with preterm labor for Candida and proper management help to avoid colonization with subsequent risk of invasive Candidiasis.