Journal articles on the topic 'Diabetes – Alternative treatment – Popular works'

Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemia due to unhealthy dietary patterns, sedentary lifestyle behavior, and obesity. Among the two types of diabetes, type 2 is the most common in the world and the drugs used to treat hyperglycemia in type 2 DM cause adverse side effects. Hence, it is important to search for an effective natural anti-diabetic treatment to combat hyperglycemia and its complications in diabetic patients. Among the different herbal plants, pumpkin is very popular in terms of reducing blood glucose levels. Pumpkin is a popular vegetable cultivated all over the world and a rich source of bioactive compounds including phenolic compounds, unsaturated fatty acids, vitamin E and carotenoids. Currently, considerable attention is given to the seeds, leaves, and flesh of pumpkins due to their nutritional value and health benefits. However, this article focuses on the potency of pumpkin seeds and leaves to treat hyperglycemia.

Despite advances in the medical world, obesity remains a major worldwide health hazard .The majority of chronic diseases like diabetes is largely related to obesity which is usually a product of an unhealthy lifestyle and poor dietary habits. The ketogenic diet has become an increasingly popular approach for both weight loss and as an alternative diet for type 2 diabetes mellitus (T2DM). In addition, this diet has a positive effect on body weight, blood glucose level, glycosylated hemoglobin and plasma lipid profile. This review focuses on the therapeutic effectiveness of using LCKD for the treatment of type 2 diabetes.

Background: Complementary and Alternative Medicine (CAM) is a popular practice among Saudis. CAM refers to drugs and medical procedures that doctors do not typically employ. Objective: The study’s goal was to determine the prevalence of CAM and the most prevalent form used among patients with diabetes in Al Ahsa, Saudi Arabia. Methods: This cross-sectional study enrolled individuals with diabetes mellitus (DM) in Al Ahsa, Saudi Arabia. Online questionnaires were employed between March to July 2023 to collect data on sociodemographic characteristics, information about diabetes, knowledge and use of CAM, and the different types of herbal supplements used. Results: Of the 386 patients, 54.1% were males, 45.9% were aged between 46 and 60 years old, and 45.9% had heard of CAM. The most popular CAM treatment for diabetes was biologically based, and the most common reason for using CAM was its accessibility (27.1%). The majority (82.1%) of diabetic patients reported using CAM as a treatment. Independent predictors of CAM use were diabetes complications, having heard of CAM, and social media. Conclusion: CAM use has a high prevalence in the treatment of diabetes. Independent predictors of CAM use were a shorter disease duration, diabetes complications, having heard of CAM, and social media. To avoid negative and unnecessary side effects, patients must be informed about CAM use.

The results indicate that OGB alone or together with Metformin works significantly faster in lowering glucose and to a healthy level without side effects when compared to clinical findings with current pharmaceutical treatment options, which take 3 months to 6 months to show clinically meaningful results. OGB’s speed of action also suggests that it works more holistically to address the various cellular disease onset mechanisms at the same time. The learning’s also suggest that the select polyphenols and magnesium in OGB may safely and more effectively supplement and or potentially replace T2DM pharmaceutical medications.

Type 2 diabetes mellitus (T2DM) occurs in 95% of the diabetic populations. Management of T2DM is a challenge. Traditional Chinese medicines (TCM) are usually served as adjuvants used to improve diabetic syndromes in combination of routine antidiabetic drugs. For single-herb prescriptions, Ginseng, Bitter melon, Golden Thread, Fenugreek, Garlic, and Cinnamon might have antidiabetic effects in T2DM patients. Among 30 antidiabetic formulas approved by the State Food and Drugs Administrator of China, top 10 of the most frequently prescribed herbs are Membranous Milkvetch Root, Rehmannia Root, Mongolian Snakegourd Root, Ginseng, Chinese Magnoliavine Fruit, Kudzuvine Root, Dwarf Lilyturf Tuber, Common Anemarrhena Rhizome, Barbary Wolfberry Fruit, and India Bread, which mainly guided by the theory of TCM. Their action mechanisms are related to improve insulin sensitivity, stimulate insulin secretion, protect pancreatic islets, and even inhibit intake of intestinal carbohydrates. However, it is very difficult to determine antihyperglycemic components of TCM. Nevertheless, TCM are becoming popular complementary and alternative medicine in treatment of syndromes of T2DM. In the future, it requires further validation of phytochemical, pharmacological, and clinical natures of TCM in T2DM in the future studies, especially for those herbs with a high prescription frequency.

Diabetes mellitus is one of the most dangerous metabolic diseases. The incidence of this disease continues to increase and is often associated with severe complications. Plants and natural plant products with a healing effect have been successfully used in the treatment of many disease entities since the beginning of the history of herbalism and medicine. At present, great emphasis is placed on the biodiversity of crops and the replacement of the monoculture production system of popular temperate climate plants, such as apple, pear, plum, and vine, with alternative fruit species. Very promising fruit plants are Cornelian cherry (Cornus mas); mulberry (Morus alba); bird cherry (Prunus padus); sour cherry (Prunus cerasus); plants of the genus Amelanchier, Sorbus, and Crategus; medlar (Mespilus germanica); quince (Cydonia oblonga); plants of the genus Vaccinium; and wild roses. When promoting the cultivation of alternative fruit-bearing plants, it is worth emphasizing their beneficial effects on health. This systematic review indicates that the antidiabetic effect of various parts of fruit plants is attributed to the presence of polyphenols, especially anthocyanins, which have different mechanisms of antidiabetic action and can be used in the treatment of diabetes and various complications associated with this disease.

Currently Fitofarmaka therapy is popular among the people because it is considered as a treatment that has few side effects, cheap, and easy to obtain one of which is by conjoined pumpkin therapy. In Patients with Type II Diabetes Mellitus in the Work Area of ​​Cempaka Health Center, Banjarmasin. This type of research is Quasy-experiment with Pre-Test and Post-Test Non Equivalent Control Group design, the sampling technique is purposive sampling. Data analysis uses Paired Sample T-Test and Independent Sample Sample T-Test with a significance limit α = 0.05. Conjuring boiled pumpkin for 7 days in the intervention group was obtained. For patients with type II Diabetes mellitus, they can choose an alternative treatment besides pharmacological therapy, namely by using Siam Pumpkin which is processed by boiling.

Despite access to conventional medical therapies, the use of complementary medicine is increasing in many communities. The present study aimed to evaluate the popular knowledge of medicinal plants used to treat diabetes and its co-morbidities, in four rural communities in the municipality of Vitória de Santo Antão, in the Brazilian State of Pernambuco. The relative importance of a particular medicinal plant was calculated based on the percentage of mentions (IR%). The similarity between the communities was quantified using the Sørensen index (Ss).Interviews were conducted with 141 patients, of these, 83 reported use of medicinal plants as an alternative treatment. Overall there were 186 mentions, covering 61 ethnospecies. In relation to IR%, Mentha × villosa presented the highest value.Knowing the factors that influence selection of medicinal plants sheds light on the mechanisms through which patterns of use develop and this may help to preserve this knowledge.

It has been estimated that up to one-third of patients with diabetes mellitus use some form of complementary and alternative medicine. Momordica charantia (bitter melon) is a popular fruit used for the treatment of diabetes and related conditions amongst the indigenous populations of Asia, South America, India and East Africa. Abundant pre-clinical studies have documented the anti-diabetic and hypoglycaemic effects of M. charantia through various postulated mechanisms. However, clinical trial data with human subjects are limited and flawed by poor study design and low statistical power. The present article reviews the clinical data regarding the anti-diabetic potentials of M. charantia and calls for better-designed clinical trials to further elucidate its possible therapeutic effects.

Background and Objectives. Human beings have used natural products as one of the pharmaceutical sources to improve human health for thousands of years. Phytochemical constituents distributed in different parts of medicinal plants cause therapeutic effects on treatment of acute and chronic diseases. Over the years, traditional Persian medicine has become popular over Iran and some countries globally as a source of alternative therapies of kidney diseases and renal dysfunctions. Iranian herbal medicine consists of natural compounds with complex active ingredients that causes valuable effects. Despite performing research works on traditional Persian medicine in the treatment of kidney disorders, there is still a need to investigate on chemical components and biological molecules of medicinal plants. Methods. This review was focused on studying the various secondary metabolites in model plants of Iranian herbal medicine known as treatment of kidney diseases in traditional Persian medicine textbooks including Makhzan-ol-Advieh, The Canon of Medicine, and Taghvim al-Abdan fi Tadbir al-Ensan. Results. Secondary metabolites of 94 medical plants belonging to 42 families were reported with their scientific and family name. Conclusion. Although herbal medicines are gaining rapid popularity among people and the pharmaceutical industry, the understandings of the phytochemical and therapeutic properties of medicinal plant are important for developing effective nephroprotective medicines. Therefore, the relationship between traditional uses and biological properties should be clearly verified through further studies.

Gestational Diabetes Mellitus (GDM) is a hyperglycemia condition with onset in the second or third trimester of pregnancy. Currently, the first-line prevention and management of GDM are lifestyle modifications that must be implemented throughout pregnancy, even before pregnancy. When lifestyle management is unable to maintain normoglycemia in pregnancy, treatment therapy such as insulin and/or oral antidiabetic drugs is needed. Insulin as a first-choice therapy still has drawbacks, including its high price, potential weight gain, hypoglycemia, and uncomfortable route of administration. Herbal therapy using plant extracts and bioactive compounds with antidiabetic effects has become a concern as preventive, alternative, and complementary therapy. This article will provide information about GDM and the potential of herbal plants that can be used in the treatment of GDM. This review will focus on recent herbal remedies derived from various types of medicinal plants that have been validated through scientific evaluation as promising treatments for GDM. Data was collected through Google Scholar using the keywords "herbs and gestational diabetes mellitus". The references were articles with publication years from 2019 to 2023, written in English, original research, and free full-text articles that were relevant. 6,970 works of literature met the keywords "herbs and gestational diabetes mellitus". Then we selected 15 articles that were most relevant. The bioactive compounds found in plants may be used in the future to complement current treatment strategies for GDM. This review has demonstrated that herbal plants can reduce blood glucose levels in GDM. Additionally, unsaturated fatty acids have also shown the potential for lowering blood glucose levels in GDM. These findings have beneficial effects in regulating glucose metabolism, reducing inflammation, and protecting against oxidative damage associated with GDM.

Myrtus communis L (Myrtaceae) is one of the popular drugs being used in the Unani system of phytomedicine since ancient Greece period. From time immemorial, different parts of this plant and essential oil have been used for a variety of purposes such as cosmetics (hair fall control), flavoring of food and drinks as well as extensive therapeutic purposes. Ethnobotanical information revealed that M communis L has been a folkloric repute for the treatment of several diseases like gastric ulcer, diarrhea, dysentery, cancer, rheumatism, hemorrhage, deep sinuses, leucorrhoea, hemorrhoid, inflammation, dyspepsia, anxiety, insomnia, diabetes, hypertension, pulmonary disorders, and skin diseases. Moreover, ethnopharmacological studies revealed that the plant is endowed with extensive pharmacological activities, including antimicrobial, antidiarrheal, antidiabetic, antispasmodic, vasodilator, antiulcer, antioxidant, anticancer, anxiolytic, sedative-hypnotic, and anti-inflammatory activities, among others. The plant has been known to contain phenolic acids, tannins, flavonoids, glycosides, and terpenes. The myrtle oil was also found to be rich in a variety of bioactive monoterpenes and sesquiterpenes with their derivatives. Most of these studies validate the aforementioned traditional claims of this medicinal plant. Further studies are needed to unravel other pharmacological activities of this plant in the long run.

Over the last four decades, the escalation in diabetes and obesity rates has become epidemic all over the world. Diabesity describes the strong link between T2D and obesity. It correlates deeper with the elevated risks of developing cardiovascular disease hypertension, stroke, and several malignancies. Therapeutic usage of medicinal plants and natural products in the treatment of diabetes and obesity has long been known to physicians of Greco-Arab and Islamic medicine. Improved versions of their abundant medicinal plant-based formulations are at present some of the most popular herbal treatments used. Preclinical and clinical data about medicinal plants along with their bioactive constituents are now available, justifying the traditionally known therapeutic uses of products derived from them for the prevention and cure of obesity-related T2D and other health problems. The aim of this review is to systematize published scientific data dealing with the efficiency of active ingredients or extracts from Middle Eastern medicinal plants and diet in the management of diabesity and its complications. Google Scholar, MEDLINE, and PubMed were searched for publications describing the medicinal plants and diet used in the management of T2D, obesity, and their complications. The used keywords were “medicinal plants” or “herbals” in combination with “obesity,” “diabetes,” “diabetes,” or nephropathy. More than 130 medicinal plants were identified to target diabesity and its complications. The antidiabetic and anti-obesity effects and action mechanisms of these plants are discussed here. These include the regulation of appetite, thermogenesis, lipid absorption, and lipolysis; pancreatic lipase activity and adipogenesis; glucose absorption in the intestine, insulin secretion, glucose transporters, gluconeogenesis, and epigenetic mechanisms.

Abstract Progesterone signaling and its proper regulation is important for reproductive function. When progesterone signaling is dysregulated, gynecological diseases can occur, for example endometriosis, uterine fibroids, and endometrial cancer. While these diseases are treated with progestin therapy, progestins can bind to multiple steroid receptors, exerting side effects of weight gain, immunosuppression, cardiovascular disease, and stroke. Discovering an alternative progestin that is selective for the progesterone receptor (PR) is ideal. One potential source of such an alternative is botanical dietary supplements, which have become increasingly popular among consumers with sales reaching $9.6 billion in 2019. Although botanical supplements are popular, the chemical structures and biological action of botanical supplements would benefit from deeper scientific investigation. Studies of Trifolium pratense L. (red clover), primarily used for the treatment of menopausal symptoms, identified phytoestrogen compounds as the chemicals that mitigate those symptoms. Interestingly, irilone, identified from red clover, potentiated progesterone signaling via a progesterone response element luciferase (PRE/Luc) assay. Potentiation is when a compound has no activity by itself but when combined with another molecule, i.e. progesterone, that compound enhances PR activity. Prior to irilone, a natural compound with the ability to potentiate progesterone signaling had not been previously reported. The purpose of this study was to determine the mechanism of action of irilone. We hypothesized that irilone was potentiating PR by blocking PR degradation and by altering PR post-translational modifications. Irilone was found to potentiate 5 nM P4 using a PRE-luciferase assay in both T47D and Ishikawa PR expressing cells. Since PR is a downstream target gene of ER, we investigated if irilone also had ER activity. Irilone increased expression of an ERE-luciferase reporter gene. Next, we investigated if irilone could stabilize PR degradation and if irilone altered PR phosphorylation via western blot. Irilone was found to increase PR protein levels, but when ER was blocked, this was mitigated. In the presence of P4, irilone did not increase phosphorylation of serine 294 on PR. Future studies will determine if irilone is altering sumoylation of PR, and if irilone can potentiate PR signaling in vivo. Determining how irilone is potentiating progesterone will help us understand PR biology and could be an effective treatment for gynecological diseases by enhancing endogenous progesterone action.

In the current years, a lot of research works have been continued in the quest to find a desired drug delivery system within the human body. Among different drug delivery systems, nanobots have become much popular due to its capability to perform different tasks like actuating, sensing, signaling, information processing and intelligence at nanoscale dimension. A nanobot is a robotic machine that can be programmed to diagnose, monitor and treat various vital diseases. It works at cellular level with minimum side effects and thus substitute the conventional treatment procedures. The major limitations of nanobots are proper designing and manufacturing process. In spite of its expensive manufacturing set up, they are pre-eminent for medical applications, such as nanobots like respirocytes, microbivores and clottocytes have been designed to act as artificial substitutes of blood. This article describes the use of nanobots in different fields of medical science like diagnosis and treatment of cancer, diabetes, aneurysm, tetanus, HIV, skin disease, gout as well as in the field of dentistry, surgery and treating many other diseases. It also represents the recent research which has been applied in vivo to different animals. Scientists hope that nanobots will act on molecular level, protect the biological system and thus ensure a better and longer life. Bangladesh Pharmaceutical Journal 22(1): 99-108, 2019

Context. Modified Chaihu Shugan powder (MCSP) is a popular traditional Chinese herbal formula for functional dyspepsia, which is revised from Chaihu Shugan San and recorded in a medical classic works of China. However, its role and effect in treating functional dyspepsia have not been well established.Objective. To assess the effect and safety of modified Chaihu Shugan powder for functional dyspepsia.Methods. We searched the published and unpublished studies up to August 2012. Only RCTs of modified Chaihu Shugan powder with or without prokinetic drugs versus prokinetic drugs in the patients diagnosed with functional dyspepsia were included.Results. Twenty-two clinical trials involving 1998 participants were included. There were evidences that modified Chaihu Shugan powder (RR = 1.20, 95%, CI 1.14 to 1.27) and modified Chaihu Shugan powder plus prokinetic drugs (RR = 1.18, 95%, CI 1.11 to 1.25) were significantly better treatment options than prokinetic drugs alone in improving symptoms. No serious adverse events were described in the included trials.Conclusions. This meta-analysis showed that modified Chaihu Shugan powder alone or in combination with prokinetic drugs might be more effective than prokinetic drugs alone. However, with poor methodological quality, all the included trials were at high risk of bias. Further large-scale high-quality trials are required for assessment.

Context: Diabetes mellitus is considered one of the scourges of the third millennium in the world for several years. Aims: To evaluate, identify and preserve the experiences gained over the centuries. It is about therapeutic use of medicinal plants exploited for the treatment of diabetes, and to clarify its toxicities, in order to sensitize the population of the High Atlas Central (HAC) of Morocco not only on the risk but also the benefit of the use of phytotherapy. Methods: The surveys ethnopharmacological were conducted 834 the interviewees, using semi-structured survey, by application of quantitative indices such as Consensus index (CI %), Use value (UVi), family UV (FUV), relative frequency of citation (RFC), plant part value (PPV), and informant consensus factor (ICF) to assess the exact value of medicinal plants (MP). Results: We found that 144 medicinal plants in 121 genera and 52 plant families were traditionally used to treat diabetes, of which seven species were endemic to the study area, and 32 were being cited first ever to treating diabetes. In addition, we collected toxicological information on 99 antidiabetic plants, of which 41 species showed no toxic activity and 43 were toxic and sometimes lethal in high doses. The Ranunculaceae family showed the highest use value (FUV =0.139). Leaves were the most used plant parts (PPV =0.282) and infusion was the dominant method of preparation. The frequently used species were Olea europaea L. (UVi =0.172), Salvia officinalis L. (UVi =0.156) and Euphorbia resinifera Berg (UVi =0.150). Conclusions: These results are a rich source of information. They contribute to the knowledge of the antidiabetic medicinal flora of our study area, and to the preservation of the local popular know-how of the word that tends to disappear. They may also represent a database that consists of purifying and identifying the characterization of active compounds of herbal extracts with antidiabetic activity.

Abstract Hericium erinaceus is a very popular edible and medicinal mushroom used for the treatment of enervation and gastrointestinal diseases in Eastern Asia. Chemical investigation on the fruiting body of Hericium erinaceus led to the isolation of 4 new (1 – 4) and 10 known meroterpenoids (5 – 14). The structures of new compounds were determined via analysis of NMR and MS data in combination with chemical derivatization. The inhibitory activities of 1 – 14 against α-glucosidase were evaluated using p-nitrophenyl-α-D-glucopyranoside, sucrose, or maltose as substrate. Compounds 6, 9, 11 – 13 were demonstrated to show the α-glucosidase inhibitory activities. This work confirms the potential of H. erinaceus in the treatment of diabetes.

Acanthus ilicifolius Linn. (Acanthaceae) is a popular mangrove ethnomedicinal plant that cures several ailments, including asthma, diabetes, cancer, and many others. Our experiment was aimed at evaluating the anti-atherogenic effect of A. ilicifolius (leaf and stem) on a high-fat diet-induced atherogenic rat model. Atherosclerosis was developed in 12 weeks. Treatment with the standard drug (3 mg/kg b.w./day, p.o. of Simvastatin), separate doses of methanolic and ethanolic extracts of A. ilicifolius leaf (250 and 500 mg/kg b.w./day, p.o.), and stem (200 and 400 mg/kg b.w./day, p.o.) was subsequently conducted for additional 15 days. The anti-atherogenic effect was evaluated by estimating the change in body weight, systolic blood pressure, and lipid profile. Histopathology of aorta, liver, and kidney of atherogenic models was done for further evaluation. The antioxidant effect of different extracts was performed via DPPH (2,2-diphenyl-1-picrylhydrazyl) assay using ascorbic acid as standard. The anticoagulant effect was determined after 15 days of treatment with the same doses of the plant extracts and the standard Warfarin (2 mg/kg b.w./day, p.o.). When compared with atherogenic control, treatment with A. ilicifolius significantly reduced ( p < 0.01) body weight, systolic blood pressure, and serum lipid levels while it elevated HDL (high-density lipoprotein) level in a dose-dependent manner. Moreover, bleeding and clotting time was significantly decreased ( p < 0.01) under the treatment of plant extracts. The histopathological data showed considerable improvement in tissue morphology after treatment. Our study evidenced that the alcoholic extracts of A. ilicifolius leaf and stem have anti-atherogenic properties and may be recommended as a potential herbal remedy for preventing cardiovascular diseases.

Atopic dermatitis (AD) is a relapsing and remitting chronic inflammatory skin disease for which a variety of etiological factors are involved. Treatment strategies should be multifaceted and have few side effects. In this respect, acupuncture has become increasingly popular as a safe, consistently effective, and drug-free therapy that treats multiple AD symptoms. We aim to not only verify the effectiveness of acupuncture but also suggest patient-specific response determinants and a new underlying mechanism implicating the gut-brain axis. We have designed a randomized, participant-blinded, sham-controlled clinical trial for 60 mild to moderate AD patients. In a previous study, we observed that the clinical skin symptoms of AD were closely associated with gastrointestinal (GI) symptoms. From these findings, we developed an intervention with six acupuncture points: three for AD symptoms and three for GI symptoms. Also, since high responders and low responders to the acupuncture treatment could be identified in the previous study, we now aim to explore response-determining factors, with a particular focus on GI symptoms. Therefore, we will precisely evaluate not only AD symptoms using the SCORAD, EASI, and DLQI tools, but also GI symptoms using the GSRS, TDS, BSFS, and AR tools and abdominal examination. AD develops in association with complicated pathophysiological factors, such as skin barrier function, genetic susceptibility, and immunological factors. Moreover, the underlying mechanism by which acupuncture treatment works has not been clearly elucidated. We, therefore, will conduct a simultaneous cross-sectional study with a sample of 40 healthy individuals, wherein potential indicators, such as fMRI, gut microbiota, and serum TARC and ATX, will be investigated to determine the gut-brain axis-associated mechanism of acupuncture. We expect that the results of this study could provide important clinical evidence for the effects of acupuncture and help elucidate the therapeutic mechanisms that underlie acupuncture’s efficacy in AD treatment. This trial is registered with https://clinicaltrials.gov/ct2/show/KCT0005422 (Trial registration: Korean Clinical Trial Registry (http://cris.nih.go.kr; registration number: KCT0005422); date of registration: September 23, 2020).

Urinary tract infection (UTI) is the second most popular infection in the geriatric community, and the first popular is urine and fecal incontinence. Because of the effects of immunological aging, elderly are more susceptible to bacterial microorganisms and viral infections. The disease ranges from relatively harmless cystitis to potentially fatal pyelonephritis. This article aims to discuss the epidemiology, diagnosis, risk factors, progress of the disease, causative microorganisms, and guidelines for drug management of UTIs in geriatric patients. This study was performed following the PRISMA checklist. PubMed (2016-2022), Biological Sciences (ProQuest) (2012-2022), and ScienceDirect were used to locate English-language literature (2018-2022). We extracted data to assess the epidemiology, diagnosis, risk factors, causative microorganisms, and treatment management of UTIs in geriatric patients. This systematic review encompassed 11 observational studies including a total of 945,908 elderly patients and were published between 2012 and 2022. The prevalence varies across the studies. Urinary catheterization, gender, polypharmacy, comorbidities especially diabetes mellites older age, dementia, older age, vaginitis, previous history of UTI, bedridden state, and antimicrobial use were the independent risk factors. E. coli was the most found causative agent. Antibiotics were given specifically for UTIs. Despite the high rate of risk factors and prevalence of UTIs in the geriatric, treatment options are minimal. There is no evidence to support the use of antibiotics for long-term UTI prevention. However, alternative prophylaxis methods for patients with recurring infections must be developed. Although further studies are required to properly understand the clinical features and treatment modalities in elderly patients within the community or under institutional care.

Eggplant is an agronomically important non-tuberous solanaceous crop grown primarily for its large oval fruit. In popular medicine, eggplant is indicated for the treatment of several diseases, including diabetes, arthritis, asthma and bronchitis. Eggplant is susceptible to a number of diseases and pests capable of causing serious crop losses. This problem has been addressed by hybridizing eggplant with wild resistant Solanum species, which present a wide genetic diversity and are source of useful agronomic traits. The application of in vitro methodologies to eggplant has resulted in considerable success. Eggplant tissues present a high morphogenetic potential that is useful for developmental studies as well as for establishing biotechnological approaches to produce improved varieties, such as embryo rescue, in vitro selection, somatic hybridization and genetic transformation. Taken together, these characteristics also make eggplant a complete model for studies on different areas of plant science, including control of gene expression and assessment of genetic stability of somaclones derived from different morphogenetic processes. In the present study, important factors that affect the efficiency of in vitro regeneration through organogenesis and embryogenesis as well as genetic transformation are analyzed. The potential of this species as a model plant for studying various aspects of plant genetics and physiology is also discussed.

Parts of Ceiba pentandra are wildly used in Africa to treat diabetes and previous works have demonstrated their in vivo antidiabetic effects on type 1 diabetes models. In addition, it has been recently shown that the decoction and the methanol extract from the stem bark of C. pentandra potentiate in vitro, the peripheral glucose consumption by the liver and skeletal muscle slices. But nothing is known about its effect on type II diabetes, especially on insulin resistance condition. We investigated herein the antihyperglycemic, insulin-sensitizing potential, and cardioprotective effects of the dried decoction from the stem bark of Ceiba pentandra (DCP) in dexamethasone-induced insulin resistant rats. DCP phytochemical analysis using LC-MS showed the presence of many compounds, including 8-formyl-7-hydroxy-5-isopropyl-2-methoxy-3-methyl-1,4-naphthaquinone, 2,4,6-trimethoxyphenol, and vavain. Wistar rats were given intramuscularly (i.m.) dexamethasone (1 mg/kg/day) alone or concomitantly with oral doses of DCP (75 or 150 mg/kg/day) or metformin (40 mg/kg/day) for 9 days. Parameters such as body weight, glycemia, oral glucose tolerance, plasma triglycerides and cholesterol, blood pressure, and heart rate were evaluated. Moreover, cardiac, hepatic and aortic antioxidants (reduced glutathione, catalase, and superoxide dismutase), malondialdehyde level, and nitric oxide content were determined. DCP decreased glycemia by up to 34% and corrected the impairment of glucose tolerance induced by dexamethasone but has no significant effect on blood pressure and heart rate. DCP reduced the total plasma cholesterol and triglycerides as compared to animals treated only with dexamethasone. DCP also increased catalase, glutathione, and NO levels impaired by dexamethasone, without any effect on SOD and malondialdehyde. In conclusion, the decoction of the stem bark of Ceiba pentandra has insulin sensitive effects as demonstrated by the improvement of glucose tolerance, oxidative status, and plasma lipid profile. This extract may therefore be a good candidate for the treatment of type II diabetes.

Tea is one of the most popular and widely consumed beverages worldwide, and possesses numerous potential health benefits. Herbal teas are well-known to contain an abundance of polyphenol antioxidants and other ingredients, thereby implicating protection and treatment against various ailments, and maintaining overall health in humans, although their mechanisms of action have not yet been fully identified. Autophagy is a conserved mechanism present in organisms that maintains basal cellular homeostasis and is essential in mediating the pathogenesis of several diseases, including cancer, type II diabetes, obesity, and Alzheimer’s disease. The increasing prevalence of these diseases, which could be attributed to the imbalance in the level of autophagy, presents a considerable challenge in the healthcare industry. Natural medicine stands as an effective, safe, and economical alternative in balancing autophagy and maintaining homeostasis. Tea is a part of the diet for many people, and it could mediate autophagy as well. Here, we aim to provide an updated overview of popular herbal teas’ health-promoting and disease healing properties and in-depth information on their relation to autophagy and its related signaling molecules. The present review sheds more light on the significance of herbal teas in regulating autophagy, thereby improving overall health.

Abstract: Retinal lesions that impair vision are a typical symptom of diabetic retinopathy, result of diabetes mellitus. Blindness may develop if it is not detected in time. Tragically, there is no known cure for DR, and therapy only works to stop vision loss. DR diagnosis and treatment can significantly lower risk of eyesight loss. Contrary to computer-aided methods, physical examination in case of DR visual image acquisition through optometrists is time-, effort-, and premium and prone to error. Deep learning recently emerged as popular techniques in boosting expertise in number of fields, including that of the analysis and categorization of medical picture data.. Convolutional neural networks are an extremely effective depths classification algorithm that is increasingly being employed in the medical imaging analysis. In order to complete this study, the most recent national methods for classifying and recognizing DR retinal fundus pictures using deep learning methodologies were examined. Additionally, the retinal fundus retina statistics that are accessible on DR were assessed. Also presented are a number of challenging issues that demand additional researches

Fungi, and their spores, are responsible for the spoilage of several foods and plants and are susceptible to contamination with mycotoxins, which have associated health hazards. In this context, proper methodologies for inactivating such fungi and controlling mycotoxin production are critical. High-pressure processing (HPP) has recently become popular as a nonthermal alternative to conventional thermal pasteurization processes. Even though HPP can effectively eliminate some fungal spores, some species, such as those from the genera Byssochlamys, Talaromyces, and Aspergillus, are quite resistant to this treatment. Additionally, high pressure can also be used as a cold extraction technique for bioactive compounds from medicinal plants and other matrices (termed high pressure-assisted extraction, HPE). With this method, safe use for food, cosmetic, and pharmaceutical applications is guaranteed. This method simultaneously works (depending on the applied pressure level) as an extraction technique and induces the pasteurization effect on the extracts. This encyclopedia entry aims to highlight the effects of nonthermal HPP on fungal spores, the prevalence of mycotoxins in plant materials and how high pressure can be used as an extraction technique to produce high-value cold pasteurized extracts with biological activity.

Microbial products have been used for the treatment of different diseases for many centuries. The serratiopeptidase enzyme provides a new hope for COVID-19-infected patients. Nowadays, anti-inflammatory drugs are easy to obtain at minimal expenditure from microbial sources. Serratia sp. is identified as one of the most efficient bacteria produced from serratiopeptidase. Screening for new and efficient bacterial strains from different sources has been of interest in recent years. Serratiopeptidase remains the most well-known anti-inflammatory drug of choice. Serratiopeptidase is a cheaper and safer anti-inflammatory drug alternative to NSAIDs. The multifaceted properties of serratiopeptidase may lead towards arthritis, diabetes, cancer and thrombolytic treatments. Existing serratiopeptidase treatments in combination with antibiotics are popular in the treatment of postoperative swelling. Although an exclusive number of serratiopeptidase-producing strains have been derived, there is an urge for new recombinant strains to enhance the production of the enzyme. This review explores the properties of serratiopeptidase, different therapeutic aspects, industrial production, and various analytical techniques used in enzyme recovery. In addition, the review highlights the therapeutic and clinical aspects of the serratiopeptidase enzyme to combat COVID-19-induced respiratory syndrome.

A polyherbal drug composed of leaves of Murraya koenigii L. Spreng, cloves of Allium sativum L., fruits of Garcinia quaesita Pierre, and seeds of Piper nigrum L. is a popular drug which has been used by indigenous practitioners in Sri Lanka for the treatment of diabetes mellitus and dyslipidemia. The acute toxicity assessment was conducted, following a single oral dose of 0.25–2.0 g/kg in healthy rats, and rats were observed up to 14 days. The hot water extract (1.0 g/kg) and the water : acetone extract (0.5, 1.0, and 1.5 g/kg) were administered to Wistar rats for 28 days in the subchronic study. Hypoglycemic and antihyperglycemic activities (dose response studies) of cold water, hot water, and water : acetone extracts of the polyherbal mixture were evaluated at the doses of 0.5, 1.0, and 1.5 g/kg in healthy and streptozotocin-induced diabetic rats (70 mg/kg, ip), respectively. Acute toxicity study showed that the polyherbal drug did not cause any change in animals throughout the experimental period of 14 days. The administration of the hot water extract and the water : acetone extract of the polyherbal drug for 28 days did not produce changes in the selected biochemical and hematological parameters in Wistar rats (p > 0.05). The histological assessment corroborated the biochemical findings with no significant treatment-related changes in the kidney and liver. The treatment of polyherbal drug significantly lowered the serum glucose concentration compared to the diabetic control rats (p < 0.05) while it did not lead to a severe reduction of glucose concentration in healthy rats. The hot water and water : acetone extracts of the polyherbal drug showed a statistically significant improvement on total area under the glucose tolerance curve in diabetic rats (p < 0.05), reflecting dose-dependent antihyperglycemic effects of the drug. Based on the results, we conclude that the aforementioned antidiabetic polyherbal remedy is free of toxic/adverse effects at the equivalent human therapeutic dose in healthy Wistar rats and would be a safe therapeutic agent for long-term treatments.

Natural products, including organisms (plants, animals, or microorganisms) have been shown to possess health benefits for animals and humans. According to the estimation of the World Health Organization, in developing countries, 80% of the population has still depended on traditional medicines or folk medicines which are mostly prepared from the plant for prevention or treatment diseases. Traditional medicine from plant extracts has proved to be more affordable, clinically effective and relatively less adverse effects than modern drugs. Literature shows that the attention on the application of phytochemical constituents of medicinal plants in the pharmaceutical industry has increased significantly. Plant-derived secondary metabolites are small molecules or macromolecules biosynthesized in plants including steroids, alkaloids, phenolic, lignans, carbohydrates and glycosides, etc. that possess a diversity of biological properties beneficial to humans, such as their antiallergic, anticancer, antimicrobial, anti-inflammatory, antidiabetic and antioxidant activities Diabetes mellitus is a chronic disease result of metabolic disorders in pancreas β-cells that have hyperglycemia. Hyperglycemia can be caused by a deficiency of insulin production by pancreatic (Type 1 diabetes mellitus) or insufficiency of insulin production in the face of insulin resistance (Type 2 diabetes mellitus). The current medications of diabetes mellitus focus on controlling and lowering blood glucose levels in the vessel to a normal level. However, most modern drugs have many side effects causing some serious medical problems during a period of treating. Therefore, traditional medicines have been used for a long time and play an important role as alternative medicines. Moreover, during the past few years, some of the new bioactive drugs isolated from plants showed antidiabetic activity with more efficacy than oral hypoglycemic agents used in clinical therapy. Traditional medicine performed a good clinical practice and is showing a bright future in the therapy of diabetes mellitus. World Health Organization has pointed out this prevention of diabetes and its complications is not only a major challenge for the future, but essential if health for all is to be attained. Therefore, this paper briefly reviews active compounds, and pharmacological effects of some popular plants which have been widely used in diabetic treatment. Morphological data from V-herb database of each species was also included for plant identification.

The Coronavirus pandemic caused by the novel SARS-CoV-2 has significantly impacted human health and the economy, especially in countries struggling with financial resources for medical testing and treatment, such as Brazil’s case, the third most affected country by the pandemic. In this scenario, machine learning techniques have been heavily employed to analyze different types of medical data, and aid decision making, offering a low-cost alternative. Due to the urgency to fight the pandemic, a massive amount of works are applying machine learning approaches to clinical data, including complete blood count (CBC) tests, which are among the most widely available medical tests. In this work, we review the most employed machine learning classifiers for CBC data, together with popular sampling methods to deal with the class imbalance. Additionally, we describe and critically analyze three publicly available Brazilian COVID-19 CBC datasets and evaluate the performance of eight classifiers and five sampling techniques on the selected datasets. Our work provides a panorama of which classifier and sampling methods provide the best results for different relevant metrics and discuss their impact on future analyses. The metrics and algorithms are introduced in a way to aid newcomers to the field. Finally, the panorama discussed here can significantly benefit the comparison of the results of new ML algorithms.

Diabetic retinopathy (DR) is a medical condition caused by diabetes. The development of retinopathy significantly depends on how long a person has had diabetes. Initially, there may be no symptoms or just a slight vision problem due to impairment of the retinal blood vessels. Later, it may lead to blindness. Recognizing the early clinical signs of DR is very important for intervening in and effectively treating DR. Thus, regular eye check-ups are necessary to direct the person to a doctor for a comprehensive ocular examination and treatment as soon as possible to avoid permanent vision loss. Nevertheless, due to limited resources, it is not feasible for screening. As a result, emerging technologies, such as artificial intelligence, for the automatic detection and classification of DR are alternative screening methodologies and thereby make the system cost-effective. People have been working on artificial-intelligence-based technologies to detect and analyze DR in recent years. This study aimed to investigate different machine learning styles that are chosen for diagnosing retinopathy. Thus, a bibliometric analysis was systematically done to discover different machine learning styles for detecting diabetic retinopathy. The data were exported from popular databases, namely, Web of Science (WoS) and Scopus. These data were analyzed using Biblioshiny and VOSviewer in terms of publications, top countries, sources, subject area, top authors, trend topics, co-occurrences, thematic evolution, factorial map, citation analysis, etc., which form the base for researchers to identify the research gaps in diabetic retinopathy detection and classification.

Diabetes mellitus is a metabolic disease characterized by chronic hyperglycemia caused by defects in insulin secretion, insulin reactions, or both. More than one third of diabetic patients have complications in the form of diabetic ulcers, and half are infected, and 15% of these infections require limb amputation. High cost expenditure and risks of microbial resistance to antibiotics also adds the complexity of the problem. The purpose of this literature review is to offer Nano-Oxy, using oxygen in nanoparticle size, as an alternative diabetic ulcer treatment. Literature searching was conducted through online search method. Oxygen therapy has been widely used to treat diabetic ulcers, including hyperbaric oxygen therapy (HOT) and topical oxygen therapy (TOT). Both of them have good results on diabetic ulcer therapy. Oxygen can act as an antimicrobial agent through the activation mechanism of neutrophils and macrophages which play a role in phagocytosis process and ROS regeneration. Nano-Oxy has advantages than the previous therapy, such as it does not cause barotrauma, oxygen poisoning, and low risk of burning. The mechanism of how Nano-Oxy works is similar with the Micro-nanobubbles (MNBs) concept. The negatively charged surface of MNBs can prevent them from aggregating, attracts particles, and help remove debris. MNBs also generate free radicals while shrinking in water, which contribute to its antibacterial effect. In addition, Nano-oxygen technology can be applied externally, but still have effect on the intended target cells. Therefore, Nano-oxygen can be used as a diabetic ulcer therapy to replace the role of antibiotics.

The use of Traditional Arabic Medicine (TAM) for various diseases has been popular but scarcely studied in Syria. In the present study, we carried out ethnobotanical and ethnopharmacological research on the plants traditionally used to cure various diseases in northern Syria. The information was collected from the city and villages of the Aleppo governorate “Mohaafazah” in the north of Syria, collecting data directly on the basis of a detailed survey of inhabitants and herbalists. In this survey, we found that hundreds of plant species are still in use in TAM for the treatment of various diseases. We selected the most common 100 species, used in the treatment of more than 25 diseases. Among these plants, 53 are used for treating gastrointestinal disorders, 38 for respiratory system diseases, including asthma, bronchitis and cough, 34 for skin diseases, 21 for diabetes, 17 for kidney and urinary disorders, 16 for cardiac disorders, 14 for infertility and sexual impotency, 13 for treating liver diseases, 13 for several types of cancer, 9 for enhancing breast milk excretion, 8 for weight loss, 5 for reducing cholesterol, and three for weight gain. Plants were collected and identified: scientific Latin names, local names, the used parts of the plant, the herbal preparations and the local medical uses are described. Scientific literature concerning the activity of the investigated species is also reported and discussed according to their traditional uses.

Cassava is a type of crop popular in Asian countries. It can be easily cultivated and grows to a mature plant in 9 months. Considering its availability, this work studied activated carbon based on cassava stem. Ofloxacin was chosen as the adsorbate, simulating the wastewater from the pharmaceutical industry. Cassava stem was ground into particles and heated to the activated state, 787 °C. The cassava-stem-activated carbon was further treated with the surface modifier, namely sodium hydroxide and zinc chloride, to study the improvement in ofloxacin adsorption. Prepared adsorbents were characterised using the SEM, FT-IR, XRD, DSC and TGA methods before being evaluated through batch adsorption, thermodynamic, and kinetic studies. The surface area analysis indicates that treatment of the activated carbon with NaOH and ZnCl2 increases the surface area due to the removal of organic content by the chemicals. Better ofloxacin adsorption of all activated carbon samples can be obtained with solutions at pH 8. An endothermic reaction was predicted, shown by higher ofloxacin adsorption at a higher temperature, supported by a positive value of ΔH° in the thermodynamic studies. The negative values of ΔG° revealed that adsorptions were spontaneous. The higher R2 values indicate that the adsorption process follows the pseudo-second-order equation of kinetic study. The maximum adsorption capacities are 42.37, 62.11, 62.89 and 58.82 mg/g for raw cassava stem (RC), cassava-stem-activated carbon (AC), NaOH-modified cassava-stem-activated carbon (NAC), and ZnCl2 modified cassava-stem-activated carbon (ZAC). The adsorption capacity is good compared to previous works by other researchers, making it a possible alternative material for the pharmaceutical industry’s wastewater treatment.

Rhodiola crenulata, a popular folk medicine for anti-altitude sickness in Tibet, has been shown to have protective effects against high glucose (HG)-induced endothelial cell dysfunction in human umbilical vein endothelial cells (HUVECs). However, its mechanisms of action are unclear. Here, we aimed to examine the effects and the mechanisms of action of Rhodiola crenulata extract (RCE) on matrix metalloproteinases (MMPs) and inflammatory responses under HG conditions. HUVECs were pretreated with RCE or untreated and then exposed to 33[Formula: see text]mM glucose medium for 24[Formula: see text]h. The levels of oxidative stress markers, MMPs, endogenous tissue inhibitors of MMPs (TIMPs), and adhesion molecules were determined. Zymography assays were also carried out. We found that RCE significantly decreased HG-induced increases in reactive oxygen species (ROS) and activation of MAPK and NF-[Formula: see text]B pathways. In addition, RCE not only significantly reduced the expression and activities of MMPs but also upregulated TIMP protein levels. Consistently, HG-induced activation of the toll-like receptor 4 (TLR4)/myeloid differentiation primary response protein (MyD88) signaling pathway, intracellular adhesion molecule-1 (ICAM-1), vascular adhesion molecule-1 (VCAM-1), and high mobility group box 1 (HMGB1) as well as endothelial cell apoptosis was inhibited by RCE treatment. RCE exerts protective effects on endothelial cells against HG insult, partially by suppressing the HMGB1/TLR4 axis. These findings indicate that Rhodiola crenulata may be a potential therapeutic agent for diabetes-associated vascular diseases.

Momordica charantia is a popular vegetable associated with effective complementary and alternative diabetes management in some parts of the world. However, the molecular mechanism is less commonly investigated. In this study, we investigated the association between a major cucurbitane triterpenoid isolated from M. charantia, 3β,7β,25-trihydroxycucurbita-5,23(E)-dien-19-al (THCB) and peroxisome proliferator activated receptor gamma (PPARγ) activation and its related activities using cell culture and molecular biology techniques. In this study, we report on both M. charantia fruit crude extract and THCB in driving the luciferase activity of Peroxisome Proliferator Response Element, associated with PPARγ activation. Other than that, THCB also induced adipocyte differentiation at far less intensity as compared to the full agonist rosiglitazone. In conjunction, THCB treatment on adipocytes also resulted in upregulation of PPAR gamma target genes expression; AP2, adiponectin, LPL and CD34 at a lower magnitude compared to rosiglitazone’s induction. THCB also induced glucose uptake into muscle cells and the mechanism is via Glut4 translocation to the cell membrane. In conclusion, THCB acts as one of the many components in M. charantia to induce hypoglycaemic effect by acting as PPARγ ligand and inducing glucose uptake activity in the muscles by means of Glut4 translocation.

Abstract Electronic nicotine delivery systems or electronic cigarettes (e-cigarettes) are becoming exceptionally popular in the world as an alternative to conventional nicotine cigarettes, both among smokers and people who have never smoked. Nicotine can induce lipolysis in adipose tissue, leading to increased serum free fatty acids (FFAs). Increased levels of FFAs are one of the key elements in generating a pro-inflammatory response and lead to ectopic lipid accumulation, lipotoxicity, mitochondrial dysfunction, and DNA damage. Our laboratory has shown that e-cigarettes induce cardiac dysfunction associated with oxidative stress and inflammatory phenotype. We investigated the effects of acipimox, an antihyperlipidemic drug that blocks lipolysis, on e-cigarettes-induced cardiac dysfunction and its associated inflammatory signals and oxidative stress. C57BL/6J wild type mice on high fat diet were exposed to saline, e-cigarette with nicotine (2.4%), e-cigarette (2.4%) plus acipimox for 12 weeks. Fractional shortening and ejection fraction was decreased in mice exposed to e-cigarette (2.4%) compared with saline and acipimox. Therefore, acipimox normalized the e-cigarette-induced cardiac dysfunction. Transcriptomic evaluation with Gene Set Enrichment Analysis revealed that e-cigarette treated mice had genes enriched in the G2/M DNA damage checkpoint pathways. These transcriptomic changes were normalized by acipimox. Mice exposed to e-cigarettes had increased circulating levels of M-CSF, IL-6, and FFAs, which were decreased by acipimox. Mice exposed to e-cigarette (2.4%) had increased cardiac Heme oxygenase 1, a marker of oxidative stress. Additionally, treatment with e-cigarette (2.4%) increased the apurinic/apyrimidinic sites. This marker of oxidative DNA damage was normalized by acipimox. Understanding the consequences of e-cigarette use on the cardiovascular system is directly relevant to developing policies related to e-cigarette use. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Tangzhiqing (TZQ), a Chinese herbal medicine, has been widely used to treat diabetes mellitus in China. TZQ works as a potential α-glucosidase inhibitor to reduce the absorption of glucose from dietary carbohydrates. The main aim of this study was to investigate the postprandial glucose-lowering effect of TZQ on the common carbohydrates in healthy humans. Meanwhile, the possible types of the inhibited α-glucosidase enzymes were predicted in this study. Glucose, sucrose, maltose, maltodextrin, and starch were chosen as investigated carbohydrates. The baseline incremental area under the curve (IAUC) and glycemic index (GI) values of the investigated carbohydrates were evaluated. Then, thirty-six subjects were randomly assigned to three groups to assess postprandial hypoglycemic effects of 3-, 6-, and 9-tablet TZQ. The subjects in each group were randomized to eight subgroups. An eight-period, eight-sequence, crossover design was performed to investigate the postprandial glucose-lowering effect of TZQ after drinking each carbohydrate. A significant decrease was observed on the postprandial glucose IAUCs (279.41 ± 111.31 vs. 203.86 ± 61.08) and GIs (124.91 ± 48.54 vs. 91.69 ± 27.47) of maltose after oral administration of 6-tablet TZQ, as well as IAUCs (145.05 ± 55.01 vs. 110.23 ± 57.03) and GIs (84.87 ± 33.40 vs. 65.50 ± 33.89) of sucrose after administration of 3-tablet TZQ. The glucose IAUCs (109.15 ± 55.92 vs. 57.68 ± 46.09) and GIs (49.09 ± 25.15 vs. 25.94 ± 20.73) of starch statistically reduced following the administration of 6-tablet TZQ. The lowering postprandial blood glucose effect of TZQ did not increase proportionally with increasing doses in humans. There were no significant changes in the glucose-lowering effect of glucose and maltodextrin after the administration of 3-, 6-, or 9-tablet TZQ, respectively. TZQ is a potential treatment for postprandial hyperglycemia, which can probably make α-glucosidases inhibit maltase, sucrase, and α-amylase in the digestive organs.

Anxiety is a mental disorder of high prevalence, being a topic of attention since the earliest historical records. In Brazil, it affects all life aspects of 9.3% of the population. Conventional treatments, which are most effective, can have adverse effects. Therefore, there is a significant increase in demand for alternative therapies which are less "aggressive" and cheaper, like phytotherapy. Among the numerous plants indicated for the treatment of anxiety, it is worth highlighting Citrus aurantium popularly known as "bitter orange" or "sour orange". Studies show the influence of its essential oils and plant extracts on the central nervous system, especially in the control of anxiety and depression. Although the use of plants, as a form of disease treatment and prevention, is an ancient practice, their indications are often based especially on popular knowledge. Thus, scientific evidence and studies are needed to ensure safety and efficacy in the use of plant species. Thus, the purpose of this study is to investigate the mechanism of action of Citrus aurantium in anxiety disorders. A bibliographical revision was carried out in health scientific databases using the descriptors “Citrus aurantium”, individually and, combined with the following descriptors “anxiety”, “central nervous system”, “mental disorders” and “mechanism of action”. Articles searched based on titles, abstracts, and year of publication (2010-2020), and those that did not address the anxiolytic effect of the species and/or its mechanism of action were excluded. We found 151 articles and considered for the review 16 articles that met the inclusion criteria. Although there are few works that study and prove the anxiolytic effect of Citrus aurantium, the vast majority of them only mention possible mechanisms of action. Analyzing the results reviewed, it was possible to observe that Citrus aurantium acts positively on anxiety, probably, as suggests the studies, through serotonergic pathway.

Anxiety is a mental disorder of high prevalence, being a topic of attention since the earliest historical records. In Brazil, it affects all life aspects of 9.3% of the population. Conventional treatments, which are most effective, can have adverse effects. Therefore, there is a significant increase in demand for alternative therapies which are less "aggressive" and cheaper, like phytotherapy. Among the numerous plants indicated for the treatment of anxiety, it is worth highlighting Citrus aurantium popularly known as "bitter orange" or "sour orange". Studies show the influence of its essential oils and plant extracts on the central nervous system, especially in the control of anxiety and depression. Although the use of plants, as a form of disease treatment and prevention, is an ancient practice, their indications are often based especially on popular knowledge. Thus, scientific evidence and studies are needed to ensure safety and efficacy in the use of plant species. Thus, the purpose of this study is to investigate the mechanism of action of Citrus aurantium in anxiety disorders. A bibliographical revision was carried out in health scientific databases using the descriptors “Citrus aurantium”, individually and, combined with the following descriptors “anxiety”, “central nervous system”, “mental disorders” and “mechanism of action”. Articles searched based on titles, abstracts, and year of publication (2010-2020), and those that did not address the anxiolytic effect of the species and/or its mechanism of action were excluded. We found 151 articles and considered for the review 16 articles that met the inclusion criteria. Although there are few works that study and prove the anxiolytic effect of Citrus aurantium, the vast majority of them only mention possible mechanisms of action. Analyzing the results reviewed, it was possible to observe that Citrus aurantium acts positively on anxiety, probably, as suggests the studies, through serotonergic pathway.

Natural products have been the center of attraction ever since they were discovered. Among them, plant-based natural products were popular as analgesics, anti-inflammatory, antidiabetic, and cosmetics and possess widespread biotechnological applications. The use of plant products as cosmetics and therapeutics is deep-rooted in Nepalese society. Although there are few ethnobotanical studies conducted, extensive research of these valuable medicinal plants has not been a priority due to the limitation of technology and infrastructure. Here, we selected 4 traditionally used medicinal plants to examine their bioactive properties and their enzyme inhibition potential. α-Glucosidase and α-amylase inhibitory activities were investigated using an in vitro model followed up by antioxidant and antimicrobial activities. The present study shows that ethyl acetate fraction of Melastoma melabathrium (IC50 9.1 ± 0.3 µg/mL) and water fraction Acacia catechu (IC50 9.0 ± 0.6 µg/mL) exhibit strong α-glucosidase inhibition. Likewise, the highest α-amylase inhibition was shown by crude extracts of Ficus religiosa (IC50 29.2 ± 1.2 µg/mL) and ethyl acetate fractions of Shorea robusta (IC50 69.3 ± 1.1 µg/mL), and the highest radical scavenging activity was shown by F. religiosa with an IC50 67.4 ± 0.6 µg/mL. Furthermore, to identify the metabolites within the fractions, we employed high-resolution mass spectrometry (LC-HRMS) and annotated 17 known metabolites which justify our assumption on activity. Of 4 medicinal plants examined, ethyl acetate fraction of S. robusta, ethyl acetate fraction of M. melabathrium, and water or ethyl acetate fraction of A. catechu extracts illustrated the best activities. With our study, we set up a foundation that provides authentic evidence to the community for use of these traditional plants. The annotated metabolites in this study support earlier experimental evidence towards the inhibition of enzymes. Further study is necessary to explore the clinical efficacy of these secondary molecules, which might be alternatives for the treatment of diabetes and pathogens.

For more than a century, Cannabis was considered a narcotic and has been banned by lawmakers all over the world. In recent years, interest in this plant has increased due to its therapeutic potential, in addition to a very interesting chemical composition, characterized by the presence of an atypical family of molecules known as phytocannabinoids. With this emerging interest, it is very important to take stock of what research has been conducted so far on the chemistry and biology of Cannabis sativa. The aim of this review is to describe the traditional uses, chemical composition and biological activities of different parts of this plant, as well as the molecular docking studies. Information was collected from electronic databases, namely SciFinder, ScienceDirect, PubMed and Web of Science. Cannabis is mainly popular for its recreational use, but it is also traditionally used as remedy for the treatment of several diseases, including diabetes, digestive, circulatory, genital, nervous, urinary, skin and respiratory diseases. These biological proprieties are mainly due to the presence of bioactive metabolites represented by more than 550 different molecules. Molecular docking simulations proved the presence of affinities between Cannabis compounds and several enzymes responsible for anti-inflammatory, antidiabetic, antiepileptic and anticancer activities. Several biological activities have been evaluated on the metabolites of Cannabis sativa, and these works have shown the presence of antioxidant, antibacterial, anticoagulant, antifungal, anti-aflatoxigenic, insecticidal, anti-inflammatory, anticancer, neuroprotective and dermocosmetic activities. This paper presents the up-to-date reported investigations and opens many reflections and further research perspectives.

Individuals seek complementary and alternative medicine (CAM) for a variety of health conditions, and yoga is a popular CAM modality. Over the past few decades, yoga has become incorporated into hundreds of healthcare facilities, most commonly in large university medical centers. While research has shown yoga to be effective in reducing symptoms and improving outcomes in chronic health conditions, most patients seek yoga therapy on their own, as few primary care practitioners have incorporated yoga therapy into their practices. The purpose of this article is to describe the efforts of the Casey Health Institute to incorporate yoga therapy into their primary care integrative medicine center. At Casey Health, a full-time Clinical Yoga Specialist works alongside the physicians, nurses, and CAM providers in delivering care to a wide variety of patients. The majority of referrals to yoga therapy have been for pain-related musculoskeletal conditions, as well as hypertension, headaches, anxiety, depression, and sleep disturbances. Most patients attend weekly 60-minute individual sessions, and the Clinical Yoga Specialist stays in touch with the patient between appointments via telephone and email. T h e Clinical Yoga Specialist has become an integral part of Casey Health, participating in collaborative medical appointments in which two CAM practitioners provide simultaneous treatments to a patient. She also participates in the clinic's ongoing weight loss program. The Clinical Yoga Specialist spends one morning each week “floating” in the clinic, when she is on-call to the practitioners to assist in treatment and/or to introduce a yoga therapy experience to the patients. These brief interventions introduce the patients to the therapeutic benefits of yoga, while simultaneously demonstrating yoga's effectiveness to the healthcare providers. Casey Health has developed a unique teacher training program whose faculty includes senior Iyengar yoga teachers as well as physicians and CAM practitioners. Casey Health is incorporating clinical outcomes into their electronic medical record that can be used internally to assess comparable effectiveness and cost effectiveness of the different treatment modalities such as yoga therapy, providing evidence that eventually may lead to yoga therapy becoming an accepted treatment that is eligible for insurance reimbursement.

Purpose Jambolan has be used as a diabetes-treatment aid, and it has become quite popular; studies have been carried out over the years on this fruit because it presents high activity against superoxide anion and hydroxyl radicals due to the bioactive compounds that may play an important role against oxidative stress. No studies have been reported on the effects of pasteurization on the bioactive compounds of jambolan tropical juice. The paper aims to discuss these issues. Design/methodology/approach For evaluation of the effects of pasteurization on jambolan juice bioactive compounds, a complete compound and rotational experimental design was carried out by varying temperature (80–90°C) and time (45–75 s). The bioactive compounds (total phenolic, total anthocyanin and antioxidant activity) and the enzymatic activity of enzymes (enzymatic browning) were assessed. Findings The study of bioactive compounds in the pasteurized juice of jambolan, showed that the total phenolics (TP) and ABTS antioxidant activity presented statistical significance (p<0.05). The action of enzymes causing enzymatic browning was only observed in the standard sample. The optimization of the pasteurization process with the maximum bioactive compound retention was 91.65°C for 69.45 s. The optimal point found is in agreement with studies on thermal treatment that recommend using short times at high temperatures for better retention of food constituents. Originality/value The incidence of chronic diseases in humans has increased significantly over the years, some bioactive phytochemicals present in fruits may help against these diseases, so the production of tropical jambolana juices can help to nourish and regulate the consumer health. Therefore, studying the maintenance of bioactive compounds present in this product could be an alternative for the production of healthier foods.

Perioperative infusion support of surgical patients is the main and non-alternative element of treatment. At the same time, the tactics of infusion therapy continues to be the subject of study. Ideas about the optimal quantitative and qualitative composition of the fluid transfused to patients are being revised as ideas about the pathogenesis of critical conditions evolve. The basis of pathogenetic analysis of compensatory hemodynamic capabilities, as a point of application of infusion treatment, previously consisted mainly of invasive monitoring techniques, replaced in recent years by the control of routine parameters with proven high correlation with invasive ones. In current studies devoted to the problems of infusion correction of hemodynamic abnormalities, the most discussed issues are the applicability of isotonic and balanced polyionic crystalloids, less often colloidal solutions in various clinical situations, and the results of such studies do not always allow to unambiguously determine the choice of infusion media, and sometimes simply incomparable. Some researchers advocate the use of isotonic crystalloids, some works prove the best effectiveness of balanced salt solutions. With the volumes of treatment corresponding to the perioperative period, in most studies there are no differences in the effectiveness of the main composite groups of crystalloids at all. We see the reason for this in the peculiarities of randomization methods, when statistical limitations do not allow us to avoid discrete data analysis: their comparative grouping occurs according to the principle of selecting a target parameter, and all the others are classified as auxiliary or secondary. It seems to us that the involvement of arrays of data obtained in real clinical practice as a result of a combination of local theoretical and empirical ideas about corrective treatment regimens correlated with their effectiveness could smooth out the inconsistency of the results of such studies, especially since clinicians have a sample with a volemic load at their disposal, allowing them to predict the hemodynamic reaction of the patient's body to infusion and a set of routine parameters for more fine-tuning of therapy. In anesthesiological and resuscitation practice, there is an opinion of the currently popular empirical-evidence plan that balanced salt solutions are preferable to isotonic solutions with a higher degree of severity of patients, but this opinion is not a priori and requires additional research to verify the choice.

Background: Reishi (Ganoderma lucidum) is a well-known and popular edible mushroom eaten as vegetables all over the world. It has been used as alternative medicine for long years in China, Korea, Japan, Malaysia, and in eastern Russia. It is reported to exhibit a number of medicinal properties including antitumor, antioxidant, immunomodulating, anti-inflammatory, hepatoprotective, and hypoglycemic activities due to the presence of bioactive polysaccharide. Glucocorticoids, prescribed for the treatment of arthritis to protect inflammation and reduce pain, can induce hyperglycemia or aggravate the hyperglycemic condition reaching to very high glucose levels in diabetic patients. However, no report has been published for its activity on glucocorticoid-induced diabetes. Objective: To investigate the effect of Ganoderma lucidum on alloxan- and glucocorticoid- induced diabetes in Long-Evans rats. Methods: Alloxan monohydrate (150 mg/kg) was intraperitoneally administered to Long-Evans rats as a single dose. The same volume of normal saline was injected to control rats. Three days after alloxan injection, rats with plasma glucose levels higher than 12 mmoL /L were considered as diabetic and they were included in the study. Reishi mushroom was collected from the Mushroom Development Institute, Ministry of Agriculture, Savar, Dhaka, Bangladesh, where it was identified by a Taxonomist. Petroleum ether extract (PEE) Methanol extract (ME) were prepared by maceration and distillation techniques. The extracts were orally administered once in a day at doses of 200, 400, 600 and 800 mg/kg, respectively for 7 days. Metformin (150 mg/kg) was orally administered as a standard antidiabetic drug. Glucose levels were measured at 0 and 7th days of treatment. The rats were allowed to rest for 1 week without treatment. The animals were again injected with dexamethasone (2 mg/kg) through intra-muscular route for 3 days and glucose levels were monitored regularly. Rats were then further treated with PEE and ME and metformin for another 7 days and glucose levels were determined at 0 and 7th days of treatment. Results: The PEE and ME of Reishi mushroom dose-dependently reduced the plasma glucose levels in alloxan-and steroid-induced fasting diabetic rats. The maximum reduction of fasting plasma glucose levels observed by PEE (800 mg/kg) and ME (800 mg/kg) were 55.57% and 36.01% in alloxan-induced and 51.41% and 32.02% in steroid-induced diabetic rats, respectively. Whereas, metformin (150 mg/kg) resulted in the diminution of fasting blood glucose levels by 60.02 and 51.12% in the alloxan- induced and steroid-induced diabetic rats, respectively. Both the PEE (800 mg/kg) and ME (800 mg/kg) significantly augmented plasma insulin levels (***P < 0.001 and **P < 0.01) and reduced HbA1c (**P < 0.01 and *P < 0.05) in alloxan-and steroid-induced diabetic rats. Besides, treatment of diabetic rats with PEE (800 mg/kg) and ME (800 mg/kg) controlled the 2-h post prandial elevated glucose levels in blood plasma. The same dose of the extracts also significantly reduced the levels of total cholesterol (TC) (***P < 0.001 and ***P < 0.01), triglyceride (TG) (***P < 0.001 and **P < 0.01) and low-density lipoprotein-cholesterol (LDL-c) (***P < 0.001 and ***P < 0.001), as well as increased the level of high density lipoprotein cholesterol (HDL-c) (**P < 0.01 and **P < 0.01, respectively). Conclusion: Our study demonstrated that edible mushrooms-Reishi has antihyperglycemic, insulin-sensitivity, and hyperlipidaemic activity against both alloxan- and corticosteroid-induced diabetes rats. The bioactive chemicals responsible for those activities are most probably the polysaccharides available in the mushroom. Thus, usage of Reishi mushrooms as vegetables or as extract will be beneficial for the management of diabetes.Keywords: Antihyperglycemic, antidiabetic, insulin-sensitizer, anti-hyperlipidemic, Gano mushroom, Reishi mushroom, Ganoderma lucidum, alloxan-induced diabetes, Steroid induced diabetes, Glycated haemolgobin (HbA1c), Oral glucose tolerance test (OGTT), Hyperlipidemia

Purpose. Bone trauma is a clinical condition that afflicts the majority of the world’s population. For the management of bone trauma, the underlying mechanisms of the drugs effective for bone healing are deemed necessary. Achyranthis bidentatae Radix (ABR) is a popular alternative medicine recommended in the treatment of bone trauma and injury, yet its mechanism of action persists to be vague. This study was conducted for the evaluation of the mode of action of ABR through network pharmacology in treating bone trauma. Methods. An extensive survey of published works led to the development of a drug-target database, after which multiple protein targets for bone trauma were discerned. The protein-protein interaction network was developed by utilizing the STITCH database and gene ontology (GO) enrichment analysis using Cytoscape and ClueGO. Moreover, docking studies were performed for revealing the affinity of various ingredients with IL6. Results. The extensive literature survey yielded the presence of 176 components in ABR, and 151 potential targets were acquired. Scrutinization of these targets revealed that 21 potential targets were found to be associated with bone trauma. Out of which, some remarkable targets such as IL6, MAPK14, MAPK8, SRC, PTGS2, and MMP2 were observed to be associated in the functional interaction of ABR. According to docking results, several ingredients of ABR such as Baicalien, Copistine, Epiberberine, Kaempferol, and Palmatine have the lowest docking scores (range between -6 and -7). Conclusions. The results of the study elucidated that ABR can positively be utilized for the management of bone trauma, which can be mediated by multiple molecular mechanisms such as ERBB2 signaling pathway, positive regulation of oxidoreductase activity, JNK cascade pathway, multicellular organism metabolic process, T cell costimulation, and the positive regulation of MAPK activity. The findings also suggest that several ingredients of ABR such as Baicalien, Copistine, Epiberberine, Kaempferol, and Palmatine have good affinity with IL6, suggesting the promising potential of ABR in treating bone trauma, likely through IL6.

Madam, Tirzepatide, also known as Mounjaro, has become increasingly popular among diabetic patients due to its potential to aid in weight loss. However, with the growing demand for this medication for its weight-loss benefits, there are apprehensions that it may soon become scarce. Tirzepatide, a dual Glucagon-like peptide (GLP-1) and Glucose-dependent insulinotropic polypeptide (GIP) receptor agonistis an injectable synthetic peptide with glucose-lowering effects.(1) It stimulates first- and second-phase insulin secretion, and reduce glucagon levels. Since its approval by the FDA in late 2021, Tirzepatide has become increasingly popular among diabetic patients as it has reported a mean decrease of 1.53% in patients' HbA1C levels in the first 40 weeks of use, which is higher than other drugs available in the market(1,2). Many patients also reported significant weight loss after starting the medication, which has led to increased demand for the drug. While this drug is yet to be approved by FDA for weight loss, it is expected that it will be approved for weight loss by mid of 2023. Despite that, some doctors already e off-label as a weight loss drug in people not suffering from Diabetes(3). This can lead to an increased demand for the drug as seen earlier in the case of Ozempic (semaglutide) in 2022 leading to an acute shortage (4). Pharmacies are already reporting low supplies of Tirzepatide, and some patients are facing trouble in getting their prescriptions filled(5). For diabetic patients who are relying on Tirzepatide to manage their blood glucose levels and promote weight loss, this shortage could have serious consequences. Patients who are unable to acquire the drug may be forced to switch to other medications or try alternative treatments, which may not be as effective. In conclusion, the recent surge in demand for Tirzepatide has led to concerns about a potential shortage of the medication. While the drug has shown promise in helping diabetic patients improve glycemic control and promote weight loss, patients need to have access to the medication when they need it. To help mitigate the shortage of Tirzepatide, some experts are calling for increased production of the drug and improved distribution channels to ensure that patients can continue to benefit from this promising treatment option.

Abstract: Diabetes is a metabolic disorder where the pancreas does not produce enough insulin so that the blood glucose concentration (hyperglycemia) increases. There are 415 million people with diabetes globally and it is estimated that by 2040 it will be 642 million. Noodles are instant foods that are popular with the public, generally made from wheat flour with a high glycemic index of 85. Jackfruit seeds contain flavonoids that play a role in increasing the activity of antioxidant enzymes that can reduce blood sugar levels. Rice bran contains high fiber capable of controlling blood sugar levels. This study aims to develop noodles with the addition of jackfruit seed flour and rice bran as an alternative food for diabetics. This study uses research and development methods with a procedural model. The organoleptic test has 4 test parameters, namely color, aroma, texture, and taste. There are trained and untrained panelists. The formulation studied consisted of one control formulation (F0) and three treatment formulations with the addition of jackfruit seed flour and rice bran, namely F1:F2:F3 with the percentage addition of jackfruit seed flour 10 percent:20 percent:30 percent and rice bran flour 5 percent in all formulations. The results of the organoleptic test showed that there was no significant difference between the aroma and taste parameters with p-value greater than 0.05, while the color and texture parameters showed a significant effect with p-value less than 0.05. The highest scoring scores are found in F0 and F1 with a somewhat favorable range scale. The best nutritional content is found in F3. Abstrak: Diabetes adalah penyakit gangguan metabolik pankreas tidak memproduksi cukup insulin sehingga konsentrasi glukosa darah (hiperglikemia) meningkat. Penderita diabetes secara global sebanyak 415 juta orang dan diperkirakan tahun 2040 menjadi 642 juta. Mi merupakan makanan instan yang digemari masyarakat, umumnya berbahan tepung terigu dengan indeks glikemik tinggi yaitu 85. Biji nangka memiliki kandungan flavonoid berperan meningkatkan aktivitas enzim antioksidan yang mampu menurunkan kadar gula darah. Bekatul mengandung serat tinggi mampu mengontrol kadar gula darah. Penelitian ini bertujuan melakukan pengembangan mi penambahan tepung biji nangka dan bekatul sebagai alternatif pangan penderita diabetes. Penelitian ini menggunakan metode penelitian dan pengembangan dengan model prosedural. Uji organoleptik memiliki 4 parameter uji yaitu warna, aroma, tekstur, dan rasa. Terdapat panelis terlatih dan tidak terlatih. Formulasi yang diteliti terdiri atas satu formulasi kontrol (F0) dan tiga formulasi perlakuan dengan penambahan tepung biji nangka dan bekatul yaitu F1:F2:F3 dengan persentase penambahan tepung biji nangka 10 persen:20 persen:30 persen dan tepung bekatul 5 persen pada semua formulasi. Hasil uji organoleptik diketahui parameter aroma dan rasa tidak adanya perbedaan yang bermakna dengan p-value lebih dari 0,05, sedangkan parameter warna dan tekstur menunjukkan adanya pengaruh yang nyata dengan p-value kurang dari 0,05. Skor penilaian tertinggi terdapat pada F0 dan F1 dengan skala range agak suka. Kandungan gizi terbaik terdapat pada F3.

Background and Aims: Dukan diet, a popular diet with high content of protein and carbohydrate and fat restriction has been widely used for weight loss. We aimed to compare the effects of the Dukan diet with traditional low-calorie diet in nutritional, laboratory and vascular parameters in obese subjects. Methods and Results: Obese subjects classes I or II of both genders, aging 19 to 65 years were allocated into two groups: Traditional low-calorie diet (n=17) and Dukan Diet (n=17). Anthropometric, laboratory and vascular evaluations were performed at baseline, 3, 6 and 12 months. Body composition was evaluated by bioelectric impedance and endothelial function by flow-mediated dilation of the brachial artery, at same times. After 12 months, it was verified that Dukan diet was more effective (p<0.05) than traditional diet for: weight loss (-10.6 vs -2.9 kg), body mass index (-3.7 vs -1.1 kg/m2), waist circumference (-11.2 vs -2.1 cm), fat (-5.7 vs -2.0 kg) and lean mass (-4.8 vs 0.8 kg) and basal metabolic rate (-152 vs -28 cal). In Dukan diet group, improvement (p<0.05 vs baseline) was observed in triglyceride levels (172.40 to 111.90 mg/dL) and insulin resistance, based on HOMA-IR index (4.98 to 3.26). The glomerular filtration rate decreased in this group after 3 months (132.50 to 113.80 mL/min) and no changes in flow-mediated dilation were observed throughout the study with both diets. Conclusion: Dukan diet was more effective than traditional diet for weight loss and laboratory parameters and without changes in endothelial function, in the 12-months follow-up of obese subjects. Introduction Low-carbohydrate diets have been one of the most recently used dietary therapies in patients with diabetes and obesity in clinical studies(1). Among them, in addition to carbohydrate restriction, fat restriction and high protein concentration, as in the Diet Dukan, has been widely used by the general population, aiming at weight loss. The Dukan diet is designed to reduce carbohydrate and fat intake in the first phase of the diet, with exclusive intake of protein, followed by another Three phases, with progressive and slow reintroduction of other nutrients such as fiber, carbohydrates and fats. In recent years, there has been increasing interest in the effectiveness of very low carbohydrate diets, called ketogenic diets, in the effectiveness of weight loss in order to combat obesity and cardiovascular disease risk(2). In this diet, ketone bodies are formed and they are used as an alternative energy source in the absence of glucose. Ketogenic diet promotes weight loss reducing appetite, increasing satiety and thermogenesis, due to the high protein consumption(3) affect hormones that control appetite, such as ghrelin and leptin(4) reduces lipogenesis and increases lipolysis(5,6) and gluconeogenesis(7). Replacing carbohydrates by proteins in the diet have been the aim of several studies but with inconsistent results. High protein intake has positive effects on weight loss, acting on satiety, body composition, lipid profile and glucose homeostasis. Furthermore, it increases thermogenesis, energy expenditure(8) and the elevation in the amino acid level in the plasma acts on the satiety center, decreasing appetite, since amino acids also stimulate insulin secretion resulting in decreased or maintained blood glucose levels(9). Few studies have been published with Dukan diet. Freeman et al. were the first to publish an article with the Dukan Diet in 2014, describing adverse effects in one patient undergoing this diet(10). Nouvenne et al. reviewed studies about the influence of popular diets on kidney stone formation risk. In this article, the authors suggest that in the Dukan diet, due to the high consumption of animal protein, urinary calcium can increase and the citrate urinary excretion can decrease, increasing the risk of kidney stone formation(11). In 2015, Wyka et al. evaluated dietary consumption in women adopting the Dukan-diet, based on the menu consumed in each of 4 phases of diet. They observed weight loss of around 15 kg after 8 to 10 weeks of diet and higher intake of proteins, mainly of animal origin, high consumption of potassium, iron and vitamins A, D and B2 and reduced consumption of carbohydrates, vitamin C and folates. They suggest that this diet may be harmful to health if adopted for a long time, developing of kidney and liver disease, osteoporosis and cardiovascular disease(12). Considering that the Dukan Diet is widely disseminated and it is used by the population in general for weight loss and few scientific studies are found in the literature, we propose to evaluate the nutritional, laboratory parameters related to cardiovascular disease, comparing this diet with traditional hypocaloric diet in obese individuals. Methods Study design This study was a clinical trial with nutritional intervention, for one year. Patients were recruited from the Lipids, Atherosclerosis and Vascular Biology Division of the Universidade Federal de São Paulo (UNIFESP). The study conforms to the ethical guidelines and approval was obtained from the ethics committee and it was registered in the Brazilian Registry of Clinical Trials. All participants provided written informed consent and received no monetary incentive. A total of 40 subjects were initially recruited and the participants were followed up clinically by a cardiologist and nutritionist during the 12-month period with monthly visits. Of the 40 participants who started the study, 34 completed the 12-month follow-up, whose data are presented in this study. The inclusion criteria were: both genders, aging 19-65 years old, obesity grade I or II (body mass index between 30 kg/m² and 39.9 kg/m²), stable body weight in the previous 3 months and desire to lose weight. The main exclusion criteria were: patients in primary or secondary prevention of coronary heart disease with low-density lipoprotein cholesterol (LDL-C) levels greater than 190 mg/dL and triglycerides greater than 400 mg/dL; diabetes mellitus; untreated hypothyroidism; psychiatric and hepatic disease; chronic renal failure; cardiac and respiratory insufficiency; systemic infections; use of antidepressants, corticoids, diuretics and diabetes medications; bariatric surgery, cancer and failure to accept the conditions necessary to conduct the research. Two groups were constituted: Traditional low-calorie diet (TD): n=17, 14 females and 3 males, 45±11 years old, 90±11 Kg body weight and body mass index (BMI) 34±2Kg/m2; High protein/Low carbohydrate diet-Dukan Diet (DD): n=17, 10 females and 7 males, 38±11 years old, 95±9 Kg of body weight and BMI 34±2 Kg/m2. The TD group received orientations according to the Food Guideline for the Brazilian Population, with 1 500–1 800 calories/day. They were stimulated to improve healthy eating habits increasing the consumption of natural foods without preservatives, such as vegetables and fruits rich in fiber and antioxidants. Daily consumption of fruits and vegetables at meals was recommended; carry out the fractionation of the meals throughout the day, avoiding prolonged fasting. Hydration and regular physical activity were recommended, according to healthier life habits(13). The DD group followed the high-protein/low-carbohydrate diet as proposed by Dukan Diet, available at https://www.dietadukan.com.br and received an illustrated book about this diet(14). This diet is structured in four phases: two for weight loss (1st and 2nd phases) and two for weight maintenance (3rd and 4th phases): 1st stage - Attack: For 5 consecutive days, it is allowed to consume only proteins with lean meats, eggs, light cheese and milk, 1.5 tablespoons of oat bran per day and light physical activity for 20 minutes. 2nd stage - Cruise: This phase is maintained until the desired weight loss. The vegetables are introduced alternating with the pure protein day (first stage). It is recommended 2 tablespoons of oat bran per day and light physical activity for 30 minutes. 3rd phase - Consolidation: The time of this phase is equivalent to 10 days per kg of lost weight. In this stage carbohydrates and lipids are introduced by a controlled and moderate way, being divided in two parts: in the first part, corresponding to half of the period to be followed, is allowed: 1 fruit, 2 slices of bread (50 g) or 1 spoon of farinaceous per day and 1 gala dinner per week. In the second part, it is allowed 2 fruits, 4 slices of bread (100 g) or 2 spoons of farinaceous per day and 2 gala dinners per week. This phase has one rule: make one day of the week with pure protein (first stage) and it is recommended 2.5 tablespoons of oat bran per day and light physical activity for 35 minutes. 4th phase - Stabilization: In this phase, three rules must to be followed: one day a week it should follow up the pure protein diet, the daily consumption of 3 tablespoons of oat bran and at least 40 minutes of daily walking. From this phase, the participants followed up the low calorie diet. The adherence of the participants was monitored by the interview with the nutritionist and qualitative evaluation of ketone bodies in the urine, using Labtest UriAction 10 reagent strips. At baseline, 3, 6 and 12 months, the following evaluations were performed: nutritional assessment determining anthropometry, blood samples were collected for laboratory tests. Endothelial function was evaluated in fasting and 2-hours post prandial situations. In the periods between the predetermined visits, the participants were followed up by the nutritionist monthly and by telephone contact whenever requested and with medical attention whenever necessary. Nutritional evaluation Nutritional assessment was performed by anthropometric determinations of weight, height, BMI, abdominal circumference and bioelectric impedance (BIA). BIA was carried out using the Biodynamics Model 450 TBW® apparatus, with portable plethysmograph and patients were instructed according to the manufacturer's instruction(15). Laboratory parameters Peripheral blood samples were collected for dosages of total cholesterol and fractions, triglycerides, glucoses, insulin, iron, ferritin, ALT, AST, urea, creatinine, hemoglobin and hematocrit. Biochemical parameters were determined through the automated colorimetric enzymatic method in Cobas Mira® (Roche, Switzerland) and LDL-c was estimated by the Friedewald equation. Serum insulin concentration was determined by immunofluorometry and the insulin resistance calculated by the HOMA-IR – Homeostasis Model Assessment Insulin Resistance, and values ≥ 2.5 values were considered as presence of insulin resistance(16). Glomerular Filtration Rate (GFR) was estimated by the Cockroft-Gault equation adapted to obese patients(17). Endothelial function Endothelial function was assessed by Endothelial-dependent flow-mediated dilation (FMD) of the brachial artery(18), using an ultrasound system (Sonos5500; Hewlett-Packard-Phillips, Palo Alto, CA), equipped with vascular software for two-dimensional imaging, color and spectral Doppler ultrasound modes, internal electrocardiogram monitor and linear-array transducer with a frequency range from 7.5 to 12.0 MHz. FMD evaluation was performed in two stages: fasted at least 6 hours and 2 hours after the consumption of a small meal, according to each diet. These meals were consisted of 374.04 calories, 36g proteins, 16g carbohydrates and 18g lipids in the DD and in TD, it was composed by 361.20 calories, 24g of protein, 41g of carbohydrates and 11g of lipids. Statistical Analysis The variables were expressed as mean and standard deviation. The distribution of the date normality was analyzed by the Kolmogorov-Smirmov (KS) test. When they did not present normal distribution, a logarithm [log(Y)] transformation was performed prior to analysis. The comparison between the variables of two groups was performed using Student's t-test for independent numerical variables and Fisher's exact test for categorical variables. Comparisons between more than two groups were performed by analysis of variance (ANOVA) for repeated measures, followed by the Tukey test, if differences were found. For the sample power calculation, the Statistical Software, Statistica Ultimate Academic, version 12.7, Concurrent Network was used. Values of p ≤ 0.05 were considered for statistical significance and analysis was performed using the software [GraphPadPrism 4.0 (GraphPad Software, San Diego, CA, USA)]. Results Participants’ characteristics At the beginning of the study, the groups were matched for age, gender, weight and BMI. At 3 months, all participants of DD group (100%) were in phase 2; at 6 months, 13 participants (76.4%) were in phase 3 and 4 (23.5%) in phase 2; and at 12 months, all (100%) were already in phase 4. The TD group followed the same recommendation during the 12 months. The qualitative evaluation of the presence of ketone bodies in the urine of the DD group participants, which were still in phase 2, was positive in 94% at 3rd month and 80% at the 6th month. The following adverse effects have been reported during the course of the study: weakness, fatigue, dizziness, lack of concentration, irritability, constipation, ketone breath and social life impairment. These symptoms were of low intensity and transient, especially in the early stages of the DD diet. These adverse effects were not causes for withdrawal from the study. Anthropometry The changes in body weight, BMI, waist abdominal circumference and BMR were more effective in DD than TD group during all follow-up evaluations. The changes after 12 months in relation to baseline of the anthropometric parameters in the DD and DT groups respectively were: Weight loss (-10.6 Kg, p<0.0001 and – 2.9 Kg, p<0.0001), BMI (-3.7 Kg/m2, p<0.0001 and -1.1 Kg/m2, p<0.0001), waist abdominal circumference (-11.2 cm, p<0.0001 and -2.1 cm, p=0.0008) and BMR (-152 cal, p<0.0001 and -28 cal, p=0.0198). After 12 months, the participants of DD group reached the overweight level but the TD group was still within the obesity range. Reductions were observed in both groups, in fat mass (-5.7 Kg, p<0.0001 and -2.0 Kg, p<0.0001), and in lean mass (-4.8 Kg, p<0.0001 and -0.8 Kg, p=0.0196, in DD and DT group, respectively). Laboratory parameters and endothelial function In TD group, there was only hematocrit reduction after 6 months (p=0.0103) and glucose level after 3 months (p=0.0021) compared to baseline. In DD group, laboratory alterations occurred in relation to hemoglobin, hematocrit, triglycerides, insulin, HOMA-IR and GFR. It was observed an improvement in the triglycerides levels (172.40 ± 62.36 mg/dL and 111.90 ± 43.22 mg/dL, p=0.0001) and insulin resistance determined by HOMA-IR at all times of study (4.98 ± 3.03 and 3.26 ± 2.03, p=0.0008) at baseline and 12 months, respectively. GFR was reduced only after 3 months (132.50 ± 31.13 and 113.80 ± 24.25 mL/min, p=0.0063) in the DD group. No differences were observed in endothelial function in the two study groups, in both fasting and postprandial. Discussion This study demonstrated higher weight loss in the Dukan diet group, compared to the traditional low calorie diet. The effect of weight loss in the DD group was persistent and remained until 6th month, but in 12 months it was observed a gain around 3.41 ± 0.21 Kg. The DD is performed in phases, with severe restriction until the 3rd phase and at about the 6th month; carbohydrates and a gala meal are reintroduced, promoting a weight gain. Sacks et al. observed that regardless of the nutritional composition of the diet, obese participants that had a weight loss, after 12 months of treatment, they can gain weight, but with a reduction of approximately 11.4% of the initial weight(19). We observed that participants of TD group also presented significant weight reduction, suggesting the effectiveness of the close follow up with nutritionist and physician. Abdominal circumference is an indirect parameter of fat mass corresponding to visceral fat that is associated with a higher risk for cardiovascular diseases. In our data, we observed a reduction in waist circumference in both groups after 12 months. Moreno et al. comparing ketogenic diet with standard diet in a group of obese patients found an important reduction in abdominal circumference with partial recovery after 24 months(20). Although DEXA Scan is considered the gold standard for body composition determination, BIA is a non-invasive and relatively inexpensive method and widely used(21). A significant reduction in the relative values of body fat was observed at 3 and 6 months in the DD group and only after 3 months in the TD. Increase in percent of lean mass was observed in the DD group at 3 and 6 months, but this increase does not represent a gain of lean mass, since the relative increase is a result of the reduction of body weight, promoting a relative increase in the values of lean mass. The loss of lean mass in the DD group may be due to the low caloric intake of the diet, as Chaston et al. (2007) pointed out that diet with low-calorie diet promote marked weight loss, but there is a decline in lean mass resulting from this process(22) . In our study, in spite of consuming a large amount of protein, this nutrient alone is not enough to promote the maintenance of lean mass and exercise stimulation is still necessary, which did not happen in this study, since the participants were all sedentary. In obese individuals, weight gain after marked loss is common, with reduction in basal metabolic rate(23). Several studies have observed this phenomenon during rapid weight loss(24) and diets with low carbohydrate intake are among the factors that influence metabolic adaptation. Some studies suggest that low amounts of carbohydrate (<45%) decrease the basal metabolic rate during and after weight loss. This type of diet can promote fat mass loss and preservation of lean mass during weight loss, reducing the basal metabolic rate. Reduction in BMR was observed in both groups, but in the DD group, the reduction occurred at all times in relation to baseline whereas in TD group the reduction was greater only after 6 months of intervention. Improvement in insulin resistance and triglycerides were observed only in the DD group. Individuals with insulin resistance have greater difficulty to metabolize carbohydrates, diverting a greater amount of dietary carbohydrates to the liver, where much of it is converted to fat (lipogenesis), rather than being oxidized in energy in the skeletal muscle. For this reason, very low carbohydrate diets applied in obese individuals, in addition to leading to weight loss also improves glycemic and lipid control. The effects of the very prolonged ketogenic diet are still poorly investigated and for this reason this diet should only be used for a limited period (from 3 weeks to a few months) to stimulate fat loss, improve metabolism, and then adjusting a transition to a normal diet(25). No changes in levels of total cholesterol, HDL-c and LDL-c were observed in any group. However, only in the DD group there was a significant reduction in TG level. In general, diets with reduced carbohydrates and high levels of proteins and fats increase LDL-c and TG levels showing beneficial effects of the ketogenic diet on cardiovascular risk factors. Most studies show that reducing carbohydrates can bring significant benefits in reducing total cholesterol, increases in HDL-c and reduction of triglycerides in the blood. HMG-CoA reductase, a key enzyme in the synthesis of endogenous cholesterol is activated by insulin, so that a reduction in blood glucose and hence insulin levels, leads to lower cholesterol synthesis. Thus, a reduction in dietary carbohydrate associated with adequate cholesterol consumption leads to inhibition of cholesterol biosynthesis(26). When insulin is elevated, lipolysis is reduced and lipogenesis is increased, resulting in overproduction of VLDL containing TG, formation of small and dense LDL particles and reduction of HDL. Low concentrations of glucose and insulin also reduce the expression of the carbohydrate-sensitive response element binding protein (ChREBP) transcription factor, and expression of the binding protein of the sterol regulatory element (SREBP-1c), responsible for the synthesis of fatty acids, as well as their incorporation into triglycerides and phospholipids, activating the main lipogenic enzymes, reducing hepatic lipogenesis and VLDL production(27). When we evaluated the GFR, a reduction only in DD group was observed at 3 months of intervention, but still in normal reference levels. Our results did not show significant changes in serum creatinine levels, but GFR decrease in DD group. Carbohydrate-restricted diets have higher amounts of protein may affect glomerular filtration leading to progressive loss of renal function(28). In the study conducted by Brinkworfh et al. (2010), renal function was evaluated in 68 obese individuals without renal dysfunction who consumed two similar hypocaloric diets for one year, one with carbohydrate reduction and another with high carbohydrate content, and observed that creatinine serum levels and the GFR did not change in any of the dietary groups(29). In general, endothelial function improves after weight loss in obese individuals(30). However, associations between changes in endothelial function with anthropometric and biochemical parameters are still controversial(31). We observed that the endothelial function did not present a significant difference in the two study groups, both in fasting and in the 2 hours postprandial. Volek et al. (2009) observed that low-carbohydrate diet improves postprandial vascular function compared to a low-fat diet in overweight individuals with moderate hypertriglyceridemia(32). Low-carbohydrate diets, may improve vascular function in individuals with metabolic adaptations(32) and carbohydrate-restricted diets may induce benefits in endothelial function in the presence of insulin resistance, since impaired insulin action may be related to endothelial dysfunction. In our study, the meal offered for postprandial evaluation was not high in fat, but correspond to the diet proposed in each group. According to Nicholls et al. (2006), a single carbohydrate-restricted meal does not alter endothelial function(33) and this may be the reason we did not observe a change in endothelial function in the DD group in this study. Conclusion Comparing the nutritional and laboratory effects of traditional and hyper-protein diets with carbohydrate reduction, we can conclude that Dukan diet was more effective than traditional diet for weight loss, as well as for laboratory parameters and without changes in endothelial function, in the 12-months follow-up of obese subjects. Conflict of interest No conflict of interest. Acknowledgement Patricia Naomi Sakae had a scholarship from CAPES – Brazil. References Gogebakan O.; Kohl A.; Osterhoff MA.; van Baak MA.; Jebb SA.; Papadaki A.; et al. Effects of weight loss and long-term weight maintenance with diets varying in protein and glycemic index on cardiovascular risk factors: the diet, obesity, and genes (DiOGenes) study: a randomized, controlled trial. Circulation. 2011, 124(25), 2829-2838. Merino J.; Kones R.; Ferre R.; Plana N.; Girona J.; Aragones G.; et al. Low-carbohydrate, high-protein, high-fat diet alters small peripheral artery reactivity in metabolic syndrome patients. Clin Investig Arterioscler. 2014, 26(2), 58-65. Krieger JW.; Sitren HS.; Daniels MJ.; Langkamp-Henken B. Effects of variation in protein and carbohydrate intake on body mass and composition during energy restriction: a meta-regression 1. Am J Clin Nutr. 2006, 83(2), 260-274. Samaha FF.; Iqbal N.; Seshadri P.; Chicano KL.; Daily DA.; McGrory J.; et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med. 2003, 348(21), 2074-2081. Paoli A.; Rubini A.; Volek JS.; Grimaldi KA. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr. 2013, 67(8), 789-796. Nordmann AJ.; Nordmann A.; Briel M.; Keller U.; Yancy WS, Jr.; Brehm BJ.; et al. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006, 166(3), 285-293. Veech RL. The therapeutic implications of ketone bodies: the effects of ketone bodies in pathological conditions: ketosis, ketogenic diet, redox states, insulin resistance, and mitochondrial metabolism. Prostaglandins Leukot Essent Fatty Acids. 2004, 70(3), 309-319. Feinman RD.; Fine EJ. Nonequilibrium thermodynamics and energy efficiency in weight loss diets. Theor Biol Med Model. 2007, 4, 27. Veldhorst MA.; Westerterp-Plantenga MS.; Westerterp KR. Gluconeogenesis and energy expenditure after a high-protein, carbohydrate-free diet. Am J Clin Nutr. 2009, 90(3), 519-526. Freeman TF.; Willis B.; Krywko DM. Acute intractable vomiting and severe ketoacidosis secondary to the Dukan Diet(c). J Emerg Med. 2014, 47(4), e109-112. Nouvenne A.; Ticinesi A.; Morelli I.; Guida L.; Borghi L.; Meschi T. Fad diets and their effect on urinary stone formation. Transl Androl Urol. 2014, 3(3), 303-12. Wyka J.; Malczyk E.; Misiarz M.; Zolotenka-Synowiec M.; Calyniuk B.; Baczynska S. Assessment of food intakes for women adopting the high protein Dukan diet. Rocz Panstw Zakl Hig. 2015, 66(2), 137-42. Ministério da Saúde. Guia alimentar para a população brasileira: Promovendo a alimentação saudável. Brasília; 2006. Dukan P. O Método Dukan Ilustrado 1a edição ed. Rio de Janeiro; 2013. Heyward V Stolarczyk L. Métodos de dobras cutâneas. In: Heyward VV.; Stolarczyk LM. Avaliação da composição corporal aplicada. São Paulo; 2000. Sakae PN.; Ihara SS.; Ribeiro DA.; de Carvalho L.; Parise ER. Insulin resistance is associated with DNA damage in peripheral blood cells in non-diabetic patients with genotype 1 chronic hepatitis C. Free Radic Res. 2013, 47(9), 750-756. Salazar DE.; Corcoran GB. Predicting creatinine clearance and renal drug clearance in obese patients from estimated fat-free body mass. Am J Med. 1988, 84(6), 1053-1060. Fonseca HA.; Fonseca FA.; Monteiro AM.; Bianco HT.; Boschcov P.; Brandao SA.; et al. Obesity modulates the immune response to oxidized LDL in hypertensive patients. Cell Biochem Biophys. 2013, 67(3), 1451-1460. Sacks FM.; Bray GA.; Carey VJ.; Smith SR.; Ryan DH.; Anton SD.; et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009, 360(9), 859-873. Moreno B.; Crujeiras AB.; Bellido D.; Sajoux I.; Casanueva FF. Obesity treatment by very low-calorie-ketogenic diet at two years: reduction in visceral fat and on the burden of disease. Endocrine. 2016, 54(3), 681-690. Matthie JR. Bioimpedance measurements of human body composition: critical analysis and outlook. Expert Rev Med Devices. 2008, 5(2), 239-261. Chaston TB.; Dixon JB.; O'Brien PE. Changes in fat-free mass during significant weight loss: a systematic review. Int J Obes (Lond). 2007, 31(5), 743-50. Muller MJ.; Bosy-Westphal A. Adaptive thermogenesis with weight loss in humans. Obesity (Silver Spring). 2013, 21(2), 218-228. Camps SG.; Verhoef SP.; Westerterp KR. Weight loss, weight maintenance, and adaptive thermogenesis. Am J Clin Nutr. 2013, 97(5), 990-994. Paoli A.; Bianco A.; Grimaldi KA.; Lodi A.; Bosco G. Long term successful weight loss with a combination biphasic ketogenic Mediterranean diet and Mediterranean diet maintenance protocol. Nutrients. 2013, 5(12), 5205-5217. Paoli A. Ketogenic diet for obesity: friend or foe? Int J Environ Res Public Health. 2014, 11(2), 2092-2107. Volek JS.; Fernandez ML.; Feinman RD.; Phinney SD. Dietary carbohydrate restriction induces a unique metabolic state positively affecting atherogenic dyslipidemia, fatty acid partitioning, and metabolic syndrome. Prog Lipid Res. 2008, 47(5), 307-318. Crowe TC. Safety of low-carbohydrate diets. Obes Rev. 2005, 6(3), 235-245. Brinkworth GD.; Buckley JD.; Noakes M.; Clifton PM. Renal function following long-term weight loss in individuals with abdominal obesity on a very-low-carbohydrate diet vs high-carbohydrate diet. J Am Diet Assoc. 2010, 110(4), 633-638. Mavri A.; Poredos P.; Suran D.; Gaborit B.; Juhan-Vague I. Effect of diet-induced weight loss on endothelial dysfunction: early improvement after the first week of dieting. Heart Vessels. 2011, 26(1), 31-38. Hamdy O.; Ledbury S.; Mullooly C.; Jarema C.; Porter S.; Ovalle K.; et al. Lifestyle modification improves endothelial function in obese subjects with the insulin resistance syndrome. Diabetes Care. 2003, 26(7), 2119-2125. Volek JS.; Ballard KD.; Silvestre R.; Judelson DA.; Quann EE.; Forsythe CE.; et al. Effects of dietary carbohydrate restriction versus low-fat diet on flow-mediated dilation. Metabolism. 2009, 58(12), 1769-1777. Nicholls SJ.; Lundman P.; Harmer JA.; Cutri B.; Griffiths KA.; Rye KA.; et al. Consumption of saturated fat impairs the anti-inflammatory properties of high-density lipoproteins and endothelial function. J Am Coll Cardiol. 2006, 48(4), 715-720.