Review on Pharmacological and Phytochemical Prospects of Traditional Medicinal Plant: Persicaria hydropiper (Smartweed).

Persicaria hydropiper (L.) Delarbre (family Polygonacea), commonly known as Polygonum hydropiper, is a popular medicinal plant used in traditional medicine. The plant is indigenous to the tropical northern hemisphere and temperate zone, including China, Bangladesh, India, and Japan. The plant is used in folk medicine for numerous ailments such as hemorrhoids, antifertility, diarrhea, and dyspepsia. Its medicinal usage in Unani, Ayurveda, Siddha, and other traditional medicine is well-recognized. So far, a wide range of active phytochemicals of this plant has been identified, such as flavonoids, sulphated flavonoids, terpenoids, anthraquinones, steroids, coumarin, simple phenolics, and others. Pharmacological data reported in the literature suggest that various parts of P. hydropiper exhibit antimicrobial, antioxidant, hypoglycemic, antidepressant, cardioprotective, hepatoprotective, anticancer, and antifertility effects. The present review aims to compile the coherently document research on the phytochemical, pharmacological, and biological activities of P. hydropiper from different parts of the globe.

Final year dental students' perception and practice of professionalism and ethical attitude in ten Sudanese dental schools: A cross-sectional survey.

INTRODUCTION: Professionalism and ethics are essential components of all dental schools. Therefore, this study aimed to assess the level of professionalism among Sudanese undergraduate dental students. MATERIALS AND METHODS: This descriptive cross-sectional study was conducted among 307 students in the final year undergraduate Dental Surgery Bachelor program with 155 public and 152 private university students. We collected data through a self-administrated, semistructured questionnaire. RESULTS: Although most of the students enrolled in dental schools due to their performance at higher school (P value 0.00), this has no significant effect on their attendance and academic performance afterward (P value 0.25). The perception of the students toward ethics teaching was generally positive in both public (77.34%) and private schools (78.77%). Ethics was represented in the curriculum of both private (51.7%) and public (48.3%) dental schools as perceived by their students. 95.43% and 94.00% of public and private students, respectively, would always or sometimes work in teams, and 98.02% and 94.04% of public and private students, respectively, would always or sometimes respect patients' preference (P value 0.01). A total of 95.33% of the dental students would consult or refer patients with unexpected situations. Only 26% of all students would treat infectious diseases themselves. CONCLUSION: About three-quarters of Sudanese dental students showed a satisfactory level of perception toward the importance of teaching dental ethics and professionalism. It was reflected in an excellent attitude for teamwork and respecting patients' choices. The demand for teaching professionalism course in every dental school will increase gradually, and family physicians with interest in medical education may play a pivotal role in teaching professionalism to dental students.

Vitamin D level and its determinants among Sudanese Women: Does it matter in a sunshine African Country?

BACKGROUND: Vitamin D deficiency is a worldwide concern. The aim of the current study was to determine the vitamin D level and its contributing factors in Sudanese women. METHODS: In this cross-sectional study, 251 Sudanese women attending Family Health Centers in Khartoum, Sudan were interviewed. Following the exclusion of confounding factors, samples from 190 women were analzsed. Serum 25 hydroxyvitamin D "25(OH) D" was quantified using competitive electrochemiluminescence immunoassay. RESULTS: Participants' age ranged from 18 to 85 years with a mean age (±SD) of 40.2 (±14.06) years. The mean (±SD) vitamin D level was 13.4 (±6.72) ng/ml, ranged 3.00-36.5 ng/ml and the median was 12.7 ng/mL. In total, 157 out of 190 (82.6%) had vitamin D serum levels below 20 ng/ml (deficient); of whom, 52 (27.4%) were in the age group 21-30 years (P value = 0.228). The correlation between vitamin D level and residence outside Khartoum, sun-exposed face and hands, and face and limbs in comparison with being completely covered were found to be statistically significant (p values 0.008, 0.023, and 0.036). CONCLUSION: This study displayed a high percentage (82.6%.) of vitamin D deficiency among women in Sudan, and this in part may indicate that sunshine alone cannot guarantee vitamin D sufficiency in the tropics. Family physicians in tropical countries should screen those with clinical presentations related to vitamin D deficiency.

Renal stone disease and obesity: what is important for urologists and nephrologists?

Currently, obesity has reached an epidemic stage and represents a challenge for health authorities across the globe. Certainly, with emergence of obesity epidemic, we started to see an increase in the prevalence of chronic kidney disease (CKD) and nephrolithiasis. Interestingly, epidemiologic studies have shown that the incident stone risk increases with body mass index (BMI), and no further increase in risk is noticed when the BMI > 30 kg/m(2). Furthermore, metabolic syndrome and diabetes are also associated with an increase in the incidence of renal stones disease. The shared links between these metabolic disorders are insulin resistance. Furthermore, insulin resistance is thought to alter renal acid-base metabolism, resulting in a lower urine pH and increased risk of uric acid stone disease. Obesity is also associated with excess nutritional intake of lithogenic substances such as refined sugars, low fluid intake, calcium, oxalate, and purine-rich foods. Obesity is also associated with an increase in incidence of urinary tract infection. Recent reports suggested that renal stone disease carries risk of myocardial infarction, progression of CKD, and diabetes. Alarmingly, orlistat (obesity medication) and bariatric surgery are associated with hyperoxaluria and associated stone formation and even oxalate nephropathy. Certainly, the many health risks of obesity, including nephrolithiasis, will add more burden on urologists and nephrologists. Shockwave lithotripsy, percutaneous nephrolithotomy, and ureteroscopy are all safe procedures in obese individuals. Further research is urgently needed to address the pathophysiology and management of obesity-induced renal stones disease.

Relationship between non-alcoholic fatty liver disease and kidney function: a communication between two organs that needs further exploration.

Non-alcoholic fatty liver disease (NAFLD) is now regarded as hepatic component of the metabolic syndrome. In addition, NAFLD has emerged as a growing public health problem worldwide and an important challenge for health authorities. NAFLD is associated with insulin resistance and hyperlipidaemia and this appears as the potential pathogenic role of NAFLD in the development and progression of chronic kidney disease (CKD). Interestingly, NAFLD and CKD may share common pathogenic mechanisms like obesity, abdominal obesity, insulin resistance, hyperlipidaemia, hypertension and inflammation. Importantly, the association between NAFLD and CKD is also being shown to be independent of obesity, hypertension, and other potentially confounding features of the metabolic syndrome, and it occurs both in patients without diabetes and in those with diabetes. How the liver communicates with kidney in individuals with NAFLD is not well known and indeed an urgent research is needed to further elucidate the complex and intertwined mechanisms that link NAFLD and CKD. One potential pathway for future exploration may be inflammatory mediators in NAFLD that may lead to deterioration in renal function. In addition, large clinical studies are needed to study the impact of NAFLD on the progression of CKD and in particular during dialysis and transplant and importantly how treatment of NAFLD and weight loss will have reversible potential benefit in improving renal function.

Ezetimibe as a potential treatment for dyslipidemia associated with chronic renal failure and renal transplant.

Individuals with chronic renal disease (CKD) are prone to have accelerated process of atherosclerosis. Importantly, cardiovascular disease is the main cause of morbidity and mortality in kidney transplant recipients. Recent studies suggest a potential benefit of the lipid lowering medica-tions in preventing cardiovascular events in the CKD and the transplant populations. In particular, statin was shown to be effective in reducing low density lipoprotein (LDL)-cholesterol. However, refractory dyslipidemia and difficulty in lowering LDL to target were reported with the CKD and the kidney transplant patients. The second United Kingdom Heart and Renal protection study (UK-HARP-II) showed that the addition of ezetimibe to simvastatin was safe and effective in treating dyslipidemia in CKD. Furthermore, the combination of ezetimibe and statin was also effective and safe in treating dyslipidemia in kidney transplant recipients. The Study of Heart and Renal Pro-tection (SHARP) trial will evaluate the effects of lowering LDL-C with ezetimibe 10 mg and simvastatin 20 mg daily versus placebo in 9,000 patients with chronic kidney disease. The current evidence suggests that the addition of ezetimibe to satin is effective and safe in treating dyslipidemia in the CKD and the kidney transplant patients. Future clinical trials are needed to determine whether ezetimibe will reduce cardiovascular risk in the CKD patients.

Terlipressin and hepatorenal syndrome: what is important for nephrologists and hepatologists.

Hepatorenal syndrome (HRS) is a reversible form of functional renal failure that occurs with advanced hepatic cirrhosis and liver failure. Despite mounting research in HRS, its etiology and medical therapy has not been resolved. HRS encompasses 2 distinct types. Type 1 is characterized by the rapid development of renal failure that occurs within 2 wk and involves a doubling of initial serum creatinine. Type 2 has a more insidious onset and is often associated with ascites. Animal studies have shown that both forms, in particular type 1 HRS, are often precipitated by bacterial infections and circulatory changes. The prognosis for HRS remains very poor. Type 1 and 2 both have an expected survival time of 2 wk and 6 mo, respectively. Progression of liver cirrhosis and the resultant portal hypertension leads to the pooling of blood in the splanchnic vascular bed. The ensuing hyperdynamic circulation causes an ineffective circulatory volume which subsequently activates neurohormonal systems. Primarily the sympathetic nervous system and the renin angiotensin system are activated, which, in the early stages of HRS, maintain adequate circulation. Both advanced cirrhosis and prolonged activation of neurohormonal mechanisms result in fatal complications. Locally produced nitric oxide may have the potential to induce a deleterious vasodilatory effect on the splanchnic circulation. Currently medical therapy is aimed at reducing splanchnic vasodilation to resolve the ineffective circulation and maintain good renal perfusion pressure. Terlipressin, a vasopressin analogue, has shown potential benefit in the treatment of HRS. It prolongs both survival time and has the ability to reverse HRS in the majority of patients. In this review we aim to focus on the pathogenesis of HRS and its treatment with terlipressin vs other drugs.