Herbal medications and natural products for patients with covid-19 and diabetes mellitus: Potentials and challenges

BACKGROUND

The presence of diabetes mellitus (DM) among COVID-19 patients is associated with increased hospitalization, morbidity, and mortality. Evidence has shown that hyperglycemia potentiates SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection and plays a central role in severe COVID-19 and diabetes comorbidity. In this review, we explore the therapeutic potentials of herbal medications and natural products in the management of COVID-19 and DM comorbidity and the challenges associated with the preexisting or concurrent use of these substances.

METHODS

Research papers that were published from January 2016 to December 2021 were retrieved from PubMed, ScienceDirect, and Google Scholar databases. Papers reporting clinical evidence of antidiabetic activities and any available evidence of the anti-COVID-19 potential of ten selected natural products were retrieved and analyzed for discussion in this review.

RESULTS

A total of 548 papers (73 clinical trials on the antidiabetic activities of the selected natural products and 475 research and review articles on their anti-COVID-19 potential) were retrieved from the literature search for further analysis. A total of 517 articles (reviews and less relevant research papers) were excluded. A cumulative sum of thirty-one (31) research papers (20 clinical trials and 10 others) met the criteria and have been discussed in this review.

CONCLUSION

The findings of this review suggest that phenolic compounds are the most promising phytochemicals in the management of COVID-19 and DM comorbidity. Curcumin and propolis have shown substantial evidence against COVID-19 and DM in humans and are thus, considered the best potential therapeutic options.

Population awareness of cardiovascular disease risk factors and health care seeking behavior in the UAE

OBJECTIVES

We aimed to determine the awareness, knowledge, and attitude of people residing in Dubai, United Arab Emirates, regarding cardiovascular disease (CVD) risk factors. Our aim was to further identify prospects to increase awareness of modifiable CVD risk factors and influence behavior.

METHODS

This observational study was conducted in Dubai: a global city in the United Arab Emirates. Participants were selected using simple randomization approach in primary health care centers, and a questionnaire was implemented based on literature review.

RESULTS

Out of 1020 individuals approached, 738 agreed to participate in the study (response rate of 72%).The majority of participants surveyed had good knowledge and attitude toward CVD (528, 71.5% and 445, 60% respectively); yet, poor/fair practice related to CVD risk factors (553, 75%). Predictive Margins of Knowledge Scores were significant for age (p<.01), academic level (p<.0001), and nationality (p<.0001) (Table 5). Participants aging 40-49, non-UAE subjects, and university/Postgraduate academic level scored better on the knowledge. Demographics predictor for practice score was highly significant for age (p=.0001) and BMI (p=.0001). Those aging ≥50 and obese participants scored higher on practice toward CVD risk factors. Knowledge score was significant predictor of practice and attitude toward CVD risk factors (p=.0001, p<.0001).

CONCLUSIONS

Although more than half of the current study participants had high knowledge and attitude toward CVD, their behaviors were not satisfactory. It is necessary to establish more effective educational interventions intended to promote positive health behaviors. Public health providers need to explain to the public that knowledge and proper actions regarding the reduction of risk factors are associated with reduced CVD and mortality.

Gut microbiome signatures distinguish type 2 diabetes mellitus from non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is closely associated with type 2 diabetes mellitus (T2D), and these two metabolic diseases demonstrate bidirectional influences. The identification of microbiome profiles that are specific to liver injury or impaired glucose metabolism may assist understanding of the role of the gut microbiota in the relationship between NAFLD and T2D. Here, we studied a biopsy-proven Asian NAFLD cohort (n = 329; 187 participants with NAFLD, 101 with NAFLD and T2D, and 41 with neither) and identified Enterobacter, Romboutsia, and Clostridium sensu stricto as the principal taxa associated with the severity of NAFLD and T2D, whereas Ruminococcus and Megamonas were specific to NAFLD. In particular, the taxa that were associated with both severe liver pathology and T2D were also significantly associated with markers of diabetes, such as fasting blood glucose and Hb1Ac. Enterotype analysis demonstrated that participants with NAFLD had a significantly higher proportion of Bacteroides and a lower proportion of Ruminococcus than a Korean healthy twin cohort (n = 756). However, T2D could not be clearly distinguished from NAFLD. Analysis of an independent T2D cohort (n = 185) permitted us to validate the T2D-specific bacterial signature identified in the NAFLD cohort. Functional inference analysis revealed that endotoxin biosynthesis pathways were significantly enriched in participants with NAFLD and T2D, compared with those with NAFLD alone. These findings may assist with the development of effective therapeutic approaches for metabolic diseases that are associated with specific bacterial signatures.

The local and circulating SOX9 as a potential biomarker for the diagnosis of primary bone cancer

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The SOX9 expression increased in tumor tissues and peripheral blood of malignant and benign bone tumors.

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The protein level of SOX9 is enhanced in malignant bone tumor tissues.

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SOX9 over-expression correlated with tumor severity, grade, invasion feature, poor response to therapy, and recurrence.

Purpose

The status of the local and circulating SOX9, a master regulator of the tumor fate, and its relevance to tumor types, severity, invasion feature, response to therapy, and chemotherapy treatment were surveyed in bone cancer in the current study.

Methods

The SOX9 expression level was evaluated in tissue and peripheral blood mononuclear cells from patients with different types of malignant and benign bone tumors also tumor margin tissues using Real-Time PCR. The protein level of SOX9 was assessed using immunohistochemistry and western blot analysis. Also, the correlations of the SOX9 expression level with the patient’s clinical and pathological features were considered.

Results

The remarkable overexpression of SOX9 was detected in bone tumors compared to tumor margin tissues (P < 0.0001). Malignant bone tumors revealed a higher expression of SOX9 compared to benign tumors (P < 0.0001) while osteosarcoma tumors showed higher expression levels compared to Ewing sarcoma, and chondrosarcoma. Overexpression of SOX9 was observed in high grade, metastatic, recurrent tumors also tumors with poor response to therapy. Besides, the patients under the chemotherapy treatment demonstrated higher levels of SOX9 compared to the rest of malignant tumors (P = 0.02). The simultaneous up-regulation of circulating SOX9 in the patients with bone cancer was observed compared to healthy individuals (P < 0.0001) accompanying with overexpression of SOX9 in malignant tumors compared to benign tumors (P < 0.0001). The circulating SOX9 expression was up-regulated in the patients with malignant bone tumors who receive chemotherapy treatment also patients with high grade, metastatic, recurrent tumors. The protein level of SOX9 was in line with our data on the SOX9 gene expression.

Conclusion

The simultaneous overexpression of local and circulating SOX9 in bone cancer besides its positive correlation with tumor severity, malignancy, size, and chemotherapy may deserve receiving more attention in bone cancer diagnosis and therapy.

Biopsy Proven Fibrosis in Non-Alcoholic Fatty Liver Disease: An Analysis of Risk Factors

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is emerging as an important cause of liver disease in India. NAFLD is characterized by hepatic steatosis in absence of a significant alcohol use or other known liver disease. Non-alcoholic steatohepatitis (NASH) is a progressive form of NAFLD which deserves particular attention because it is more prone for development of fibrosis. Liver biopsy is the gold standard for diagnosis of NASH by evaluating necroinflammatory activity and stages of fibrosis. The aim of the study was to analyze liver biopsy specimens and identify risk factors associated with fibrosis in patients of NAFLD in eastern coastal India.

METHODS

A total of 216 subjects with fatty liver in ultrasonography (USG) were selected for needle biopsy. Those NAFLD cases showing fibrosis in biopsy were analyzed for risk factors association.

RESULTS

Definite NASH was diagnosed in 50 (23.14%), borderline NASH in 66 (30.55%) and not NASH in 100 (46.39%) of cases. Those patients with fibrosis (22%) were taken as cases and those without fibrosis (78%) were taken as controls for risk factor analysis. Age > 40 [odds ratio (OR) 2.01 (1.09-4.04)], female gender [OR 2.74 (1.24-6.05)], body mass index (BMI) > 23 [OR 15.36 (4.59-51.37)] and moderate fatty change in USG [OR 1.89 (1.01-3.62)] were observed as risk factors for progression to fibrosis in NAFLD cases.

CONCLUSION

Older age, females, obesity and moderate fatty liver on USG are risk factors for development of fibrosis in patients with NAFLD. Patients with these risk factors should be selected for liver biopsy and to be kept for close follow-up.

Benign prostatic hyperplasia, metabolic syndrome and androgenic alopecia: Is there a possible relationship?

OBJECTIVE

To evaluate the incidence of benign prostatic hyperplasia (BPH) and metabolic syndrome in patients with androgenetic alopecia (AGA) in comparison with those with no AGA, as several previous studies have reported inconsistent results of an association between metabolic syndrome and BPH with AGA.

PATIENTS SUBJECTS AND METHODS

This cross-sectional study included 400 participants, divided into 300 patients diagnosed with AGA, with different grades according to Norwood-Hamilton classification, and 100 control subjects with no AGA. Criteria for diagnosis of metabolic syndrome according to Adult Treatment Panel-III criteria (waist circumference, blood pressure, fasting blood sugar, high-density lipoprotein and triglycerides), as well as criteria for diagnosis of BPH (prostatic volume, urine flow, and prostate-specific antigen) were assessed in all patients and compared with the control subjects.

RESULTS

There were significant differences between the AGA and no-AGA groups for the following variables: waist circumference, body mass index, fibrinogen level, fasting blood sugar, cholesterol, C-reactive protein, erythrocyte sedimentation rate, and glycosylated haemoglobin. There was a significant difference in number of patients with AGA manifesting criteria of metabolic syndrome (51% vs 28%), as well as BPH diagnostic criteria (36% vs 6.8%) compared with the control subjects. Both BPH and metabolic syndrome were shown to be significant independent variables associated with AGA.

CONCLUSIONS

Dermatologists, urologists, and primary care physicians should monitor patients with early onset AGA for the development of urinary symptoms, to permit an earlier diagnosis of BPH; and for metabolic syndrome symptoms, to permit early diagnosis of cardiovascular risk factors.

Arterial stiffness in metabolic syndrome

Arterial stiffness is increasingly recognized as an important determinant of cardiovascular risk and may be directly involved in the process of atherosclerosis. As atherosclerosis leads to increased arterial resistance and decrease the flow propagation speed within the arterial lumen, a similar decrease in aortic flow propagation with increased downstream resistance is detected, so aortic flow propagation velocity AVP was evaluated in many studies as a new parameter of aortic stiffness.

Aim

To measure arterial stiffness using the new parameter AVP and compare it to flow mediated dilatation FMD as a parameter of endothelial dysfunction in patients with metabolic syndrome MS.

Methods

AVP (assessed by transthoracic echocardiography) and FMD (assessed by brachial artery reactivity test) were measured in 100 patients with MS (Group 1) and were compared to 14 normal subjects (Group 2).

Results

Patients with MS had significantly lower values of AVP as compared to the normal subjects; 36 ± 5 cm/s vs 57 ± 5, p < 0.05, and lower FMD; 6% ± 1 vs 17 ± 3 p < 0.05 as well, there was significant correlations between AVP and FMD (r = 0.89, p < 0.001).

Conclusion

Transthoracic echocardiographic determination of AVP is a simple practical method and correlates well with FMD in patients with MS.

A Randomized Controlled Trial Comparing Efficacy of Pentoxifylline and Pioglitazone on Metabolic Factors and Liver Histology in Patients with Non-alcoholic Steatohepatitis

BACKGROUND AND AIMS

Non-alcoholic steatohepatitis (NASH) involves increased hepatic macrosteatosis due to increased insulin resistance and non-hepatic processes including oxidative stress, apoptosis, and increased pro-inflammatory cytokines. Present study compared the efficacy of pentoxifylline and pioglitazone therapy in improving the metabolic factors and liver histology in patients with NASH.

METHODS

Sixty consecutive biopsy proven NASH patients aged 18-70 years with ALT > 1.2 times the upper limit of normal were randomized to receive either pentoxifylline 1200 mg/day in three divided doses orally every day or pioglitazone (30 mg/day) daily for 6 months. All the patients were also instructed to reduce their calorie intake by 500 kcal/day as well as to perform modest exercise (brisk walking) regularly at least 5 days per week. Before and after treatment, liver function tests, serum insulin, C-peptide levels, TNF-α, adiponectin, leptin levels, HOMA-IR and hepatocyte injury and fibrosis scores on liver histology were assessed.

RESULTS

Both pentoxifylline and pioglitazone were effective in improving transaminases, insulin resistance (HOMA-IR) and adiponectin levels significantly. TNF-α levels improved with either of the drugs but did not achieve significant levels. Both the drugs improved the markers of acute liver injury. However, only steatosis improved significantly with either of the drugs. Patients treated with pioglitazone had significant improvement in lobular inflammation, portal inflammation and Brunts grade. Brunts grade improved significantly with pioglitazone as compared to pentoxifylline at the end of the therapy.

CONCLUSIONS

Pioglitazone shows better improvement in both metabolic factors and liver histology in patients with NASH compared to pentoxifylline.