Promising hepatoprotective agents from the natural sources: a study of scientific evidence

Abstract Background Natural bioactive components derived from plant secondary metabolites have been pronounced as valuable alternatives for anticipating and subsiding hepatotoxic effects and its chronic complications based on experimental verification. The focus of this review is to elucidate the commonly used modern medicine for the treatment of liver disease and how major phytoconstituents have been tested for hepatoprotective activity, mechanism of action of some promising agents from natural sources, and clinical trial data for treating in patients with different liver diseases by the aid of natural phytoconstituents. Main text The review shows fifteen major isolated phytoconstituents, their biological sources, chemical structures, utilized plant parts, type of extracts used, hepatoprotective assay method, and their possible mechanism of action on the hepatoprotection. Nine promising hepatoprotective leads from natural sources with their chemistry and hepatoprotective mechanism are mentioned briefly. The review further includes the recent clinical trial studies of some hepatoprotective leads and their clinical outcome with different liver disease patients. Scientific studies revealed that antioxidant properties are the central mechanism for the phytoconstituents to subside different disease pathways by upsurging antioxidant defense system of cells, scavenging free radicals, down surging lipid peroxidation, improving anti-inflammatory potential, and further protecting the hepatic cell injury. In this review, we summarize recent development of natural product-based hepatoprotective leads and their curative potential for various sort of liver diseases. Furthermore, the usefulness of hit and lead molecules from natural sources for significant clinical benefit to discover new drug molecule and downsizing the problems of medication and chemical-induced hepatotoxic effects is extrapolated. Conclusion Further research are encouraged to elucidate the pharmacological principle of these natural-based chemical agents which will stimulate future pharmaceutical development of therapeutically beneficial hepatoprotective regimens. </jats:sec

Anti-inflammatory, analgesic, and acute toxicity evaluation of Litchi chinensis seed extract in albino rat

Litchi chinensis is a edible fruits of soapberry family commonly known as lychee; is traditionally used for the treatment of inflammation, headache, and body pain. The present study investigated the toxicity, anti-inflammatory, and analgesic activity of the ethanolic crude extract of Litchi chinensis to support its traditional use in its folk medicine and to screen the phytochemical constituents. 70% ethanolic extract of seeds of Litchi chinensis (LCSE) was prepared and preliminary phytochemical screening was performed. Acute toxicity of LCSE was carried out based on OECD guidelines 423. In vivo anti-inflammatory and analgesic effect of the extract was evaluated using carrageenan-induced paw edema and hot plate methods in Wistar albino rat's model. Results revealed that LCSE contains phenols, tannins, flavonoids, saponins, steroids, and alkaloids. LD50 values were found to be higher than 5000 mg/kg body weight; no any sign of toxicity, behavior changes, moribund, and mortality were observed in LCSE treated animals. Oral administration of LCSE at the dose of 150, 300, and 600 mg/kg produced a significant (p&lt;0.05) dose-dependent inhibition in carrageenan-induced rat paw edema and hot plate. These results suggest that LCSE is non-toxic, and shows potent anti-inflammatory and analgesic activities over Wistar albino rats. These finding demonstrate that lychee seed extract acts as a good therapeutic candidate for the safe anti-inflammatory agents.</jats:p

A systematic review and meta-analysis on pharmacist-led interventions for the management of peptic ulcer disease.

Pharmacists are essential for developing pharmacotherapy plans, conducting clinical assessments, and overseeing drug monitoring. Their interventions help prevent medication errors and adverse drug events and enhance medication safety. This study aimed to systematically review pharmacist-led interventions for managing medication-related issues in patients receiving anti-ulcer treatments. A systematic review and meta-analysis was performed to explore four databases for studies published from 1904 up to June 2024. Nine studies were reviewed, including four retrospective, three case-control, one mixed-method, and one prospective pre-post study involving 34,099 participants. The average age of the patients was 61 years, and 50.23% were male. The study quality was high, with an average score of 6.22/7 on the modified Newcastle-Ottawa scale. All studies involved direct interactions between pharmacists and patients or physicians, and data were primarily collected from hospital electronic records. Pooled analysis demonstrated that pharmacist interventions significantly improved the rational use of anti-ulcer medications (OR: 4.5; 95% CI: 0.97 to 20.80; I2 =  89%, P =  0.05), as reported by studies. Pharmacist interventions have a significant impact on improving rational drug use, reducing costs and treatment duration, and enhancing appropriate medication use. These interventions also positively influenced medication adherence and the correction of irrational drug use

Antioxidant, Alpha-Amylase Inhibitory and Hypoglycemic Activity of Smallanthus sonchifolius Leaves from Nepal: An Integrated In Vitro, In Vivo, and In Silico Approach

In 2019, diabetes mellitus affected 9.3% of the global population and accounted for one in nine adult deaths. Plant-based antioxidants neutralize harmful free radicals, mitigate oxidative stress, and significantly prevent diabetes and its complications. This study evaluated the in vitro antioxidant, alpha-amylase inhibitory, in vivo oral hypoglycemic, and in silico antidiabetic potential of Smallanthus sonchifolius (S. sonchifolius) leaf extract. Mice (n = 25) were divided into five groups after a 16-h fast with access to water. The groups received distilled water (normal control), metformin (100 mg/kg, standard), or S. sonchifolius ethanolic extract at 100, 250, or 500 mg/kg to compare the antidiabetic potential of the extract with that of the control. Fasting blood glucose levels were measured in tail vein blood before the experiment and at 30, 60, and 120 min post-administration to evaluate the hypoglycemic activity of the extract and standard drug. The ethanolic extract exhibited dose-dependent alpha-amylase inhibition (IC50 value 0.136 mg/mL) and significant hypoglycemic effects, reducing blood glucose levels similar to those of the standard drugs voglibose and metformin. The maximum blood glucose reduction was 17.99% and 15.74% in the normal and glucose-loaded mice, respectively, at 500 mg/kg within 120 min. In silico analysis shows, polymatin B and chlorogenic acid demonstrating the highest binding affinity of −8.2 and −7.2 kcal/mol, respectively, in PPAR-γ (3G9E). Polymatin B and chlorogenic acid showed strong binding affinities of −7.3 and −7.5 kcal/mol, respectively, in alpha-amylase (4W93). These findings indicate that S. sonchifolius possesses significant hypoglycemic and antioxidant properties, suggesting its potential as an antidiabetic agent, warranting further clinical research

Assessing the Indicators of Good Pharmacy Practice in Community Pharmacies: A Cross-Sectional Study

To evaluate the extent to which pharmacies in Hetauda Sub-metropolitan City, Nepal adhere to the recommended practices outlined in the good pharmacy practice guidelines formulated by International Pharmaceutical Federation and draft developed by Nepal Pharmacy Council. Good Pharmacy Practice evaluates the safety, effectiveness, availability, and accessibility of medicines, ensuring their correct usage which is essential component of community pharmacies. Data was collected by visiting community pharmacies throughout Hetauda sub-metropolitan city. The questionnaire includes 38 questions under 9 sections: premises, personnel, quality policy, services, documentation, procurement, storage, prescription handling, and dispensing. Frequencies and percentages were used to represent all categorical variables, while mean ± standard deviation (SD) was used to represent continuous variables. To determine relationships between categorical data, the Pearson Chi-square test (χ²) was utilized with a significance level set at P  < .05. Using SPSS Version 23, the quantitative data were analyzed. The findings indicated an overall compliance rate of 56.21% with the GPP indicators. The lowest adherence was observed in relation to the quality policy (11.02%), whereas the highest was obtained on the procurement process (86.6%). With regard to the qualifications of the pharmacy in charge, only 16.3% of the pharmacies had a pharmacist holding a bachelor’s degree, while 32.6% employed an assistant pharmacist with a diploma degree. A significant association was found between the qualification of pharmacy in charge with availability of computer ( P  = .010), safe and effective procurement ( P  = .036), keeping narcotics drugs in lock and key system ( P  = .002) and maintaining records of narcotics ( P  = .020). Our findings reveal that community pharmacists in Hetauda Sub-metropolitan city, Nepal do not meet the standards set by International Pharmaceutical Federation and the Good Pharmacy Practice guidelines formulated by the Nepal Pharmacy Council

Drug therapy and cost analysis of urinary tract infections in a tertiary care teaching hospital in Nepal

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Urinary tract infection (UTI) is the most common infection caused by the presence and growth of pathogenic microorganisms within the human urinary system into the lower and upper genito-urinary tract. UTI continues to be major health problems in developing countries like Nepal.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective observational study was conducted from June 2019 to November 2019 in the outpatient and inpatient department of Manipal teaching hospital. The face-to-face interview was adopted in 137 UTI patients with the census sampling technique.  &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 137 patients (121 out-patients and 16 in-patients), 82 (59.85%) female, and 55 (40.15%) males were enrolled in which UTI was observed in more than half of the sample in the aged group of 25-54. &lt;em&gt;Escherichia coli&lt;/em&gt; was the most common uropathogens isolated whereas dysuria was the most common presenting symptom among the patients. Cefixime 200 mg followed by nitrofurantoin 100 mg was the most commonly prescribed medicine for UTI. Disodium hydrogen 1.40 g oral liquid, pantoprazole 40 mg tablet, and multivitamins were commonly prescribed supportive medications. The empirically prescribed average cost was Nepalese rupee (NRs.) 820.44 whereas the total definitive average cost was NRs. 305.54. The average cost of medical management for in-patients was NRs. 2316.55 including registration, urine analysis, investigation bed charge, and other consumable charges as well as discharge medicine cost.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; With lower cost, higher sensitivity, and high prescription, cefixime, and nitrofurantoin could be better drugs for the management of UTI among outpatient department (OPD) patients while ceftriaxone could be better for in-patients.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;</jats:p

Psychological Impact, Behavioral Changes and Perception of COVID-19 Pandemic on Health Science Students of Nepal

Background: COVID-19 has become a great public health concern in the world. In this unbridled situation, most of the educational institutes have been closed as a result. Education sector suffers the worst during this period as it fails to get the real priority of the government. Aim: This study aims to assess the psychological impact, behavioral changes, and perception of the COVID-19 pandemic on health science students of Nepal. Methods: A web based online questionnaire that includes General Anxiety Disorder (GAD-7) was used among 765 participants in between August and September 2020. A chi square test was used to test the association between variables. Results: The prevalence rate of moderate and severe anxiety was 16.1%. Surprisingly, participants with different ethnicity, study program, university affiliation, symptoms related to COVID-19, confirmed or suspected case, living status were associated with the anxiety level (p&lt;0.05). The majority of the participants were engaged in all recommended and avoidance behaviors. Majority of the participants have right perception about hand washing frequency, wearing face mask, avoid going out that can reduce the risk of catching COVID-19. Awareness of corrected hand hygiene practice was 20.4%. Conclusions: The awareness of correct hand washing practice is less optimal, increase anxiety levels and changes behavioral responses to COVID-19 have been dramatic during the rising phase of the outbreak. These findings will help the concerned authorities to make the necessary policies and strategies in order to improve the mental health of the participants.</jats:p

Knowledge, Attitude and Perception of Undergraduate Health Science Students towards Complementary and Alternative Medicine: A Cross-Sectional Study in Nepal

Introduction: Apparently, Complementary and Alternative Medicine (CAM) is a recognized medical practice that precisely makes use of multiple treatment therapies and techniques in the prevention and management of variety of human disorders. Having a glance at the future, health science students belonging to different universities would take the leadin hospitals and health centers thus this study aims to analyze the level of knowledge, attitude and perception of them towards CAM in Nepal, also aims at awaking students about CAM therapies, related side effects, risks and possible complications.&#x0D; Methods: A cross sectional descriptive study was organized by enlisting 385 undergraduate students, pharmacy(107) and non-pharmacy (278) which encompasses demographic characteristics, source of information, knowledge, attitudes and perception towards CAM.&#x0D; Results: Report indicated that predominance of students had good knowledge regarding homeopathy (Pharmacy:81.3%, NP:71.9%, P-value:0.044), herbalmedicine (Pharmacy:62.5%,NP:56.5%, P-value:0.008, acupuncture (Pharmacy:72.9%, Non-Pharmacy:62.2%, P-value:0.073), gingko (Pharmacy:52.3%, Non-Pharmacy:40.6%), ginseng (Pharmacy:52.3, Non-Pharmacy:34.9%, P-value:0.001). In spite employing non reliable origin of CAM information and their mindset that CAM is proceeded by quacks, the preponderance of students had positive attitudes and perception regarding CAM management. However, few non pharmacy students believe that CAM should be adapted by legislation (Pharmacy: 78.5%, Non-Pharmacy: 66.2%, P-value: 0.032), only few believe that CAM is a convenient appendage via traditional medication (Pharmacy: 84.1%, Non-Pharmacy: 70.5%, P-value: 0.018).&#x0D; Conclusion: Disregarding scanty knowledge in the matter of CAM, students possess forward-looking attitudes and opinion regarding CAM, also express eagerness to increase their knowledge about CAM.</jats:p

LC-MS profiling and cytotoxic activity of Angiopteris helferiana against HepG2 cell line: Molecular insight to investigate anticancer agent.

Liver cancer is one of the most prevalent malignant diseases in humans and the second leading cause of cancer-related mortality globally. Angiopteris helferiana was mentioned as a possible anticancer herb according to ethnomedicinal applications. However, the molecular docking and chemical profiling of the bioactive phytoconstituents accountable for the reported anticancer action still require research. The present study aims the phytochemical profiling and bioactivity evaluation of A. helferiana. The study design with in-vitro and in-silico technique of the LC-MS followed by a study of the ligand-protein interaction using the molecular docking method, and investigates the cytotoxic activity by MTT assay of A. helferiana bioactive compounds on HepG2 cell lines. LC-MS results detected seventeen phytoconstituents in A. helferiana extract belonging to variable chemical classes with most prevailing compounds such as Vicenin 1, Schafroside, Violanthin, Coumarin, Quercetin, Angiopterioside, and Corosolic acid. The finding concluded that Quercetin showed significant binding energy of -8.8 kcal/mol and then Schafroside also possesses the binding energy of -8.1 kcal/mol against the human PPAR-δ receptor (PDBID: 1I7G). The extract showed the moderate cytotoxic activity having IC50 value of 236.93 μg/mL. Our finding suggests that these bioactive compounds could be developed as promising anticancer agent, but further in-vivo study require to validate the finding along with isolation of individual phytoconstituents