Anthraquinone Derivatives as an Immune Booster and their Therapeutic Option Against COVID-19

Anthraquinone derivatives are identified for their immune-boosting, anti-inflammatory, and anti-viral efficacy. Hence, the present study aimed to investigate the reported anthraquinone derivatives as immune booster molecules in COVID-19 infection and evaluate their binding affinity with three reported targets of novel coronavirus i.e. 3C-like protease, papain-like protease, and spike protein. The reported anthraquinone derivatives were retrieved from an open-source database and filtered based on a positive druglikeness score. Compounds with positive druglikeness scores were predicted for their targets using DIGEP-Pred and the interaction among modulated proteins was evaluated using STRING. Further, the associated pathways were recorded concerning the Kyoto Encyclopedia of Genes and Genomes pathway database. Finally, the docking was performed using autodock4 to identify the binding efficacy of anthraquinone derivatives with 3C-like protease, papain-like protease, and spike protein. After docking the pose of ligand scoring minimum binding energy was chosen to visualize the ligand-protein interaction. Among 101 bioactives, 36 scored positive druglikeness score and regulated multiple pathways concerned with immune modulation and (non-) infectious diseases. Similarly, docking study revealed torososide B to possess the highest binding affinity with papain-like protease and 3C-like protease and 1,3,6-trihydroxy-2-methyl-9,10-anthraquinone-3-O-(6'-O-acetyl)-β-D-xylopyranosyl-(1 → 2)-β-D-glucopyranoside with spike protein.

Withanolides from Withania somnifera as an immunity booster and their therapeutic options against COVID-19

Traditionally, Withania somnifera is widely used as an immune booster, anti-viral, and for multiple medicinal purposes. The present study investigated the withanolides as an immune booster and anti-viral agents against the coronavirus-19. Withanolides from Withania somnifera were retrieved from the open-source database, their targets were predicted using DIGEP-Pred, and the protein-protein interaction was evaluated. The drug-likeness score and intestinal absorptivity of each compound were also predicted. The network of compounds, proteins, and modulated pathways was constructed using Cytoscape, and docking was performed using autodock4.0, and selected protein-ligand complexes were subjected to 100 ns Molecular Dynamics simulations. The molecular dynamics trajectories were subjected to free energy calculation by the MM-GBSA method. Withanolide_Q was predicted to modulate the highest number of proteins, showed human intestinal absorption, and was predicted for the highest drug-likeness score. Similarly, combined network interaction identified Withanolide_Q to target the highest number of proteins; RAC1 was majorly targeted, and fluid shear stress and atherosclerosis associated pathway were chiefly regulated. Similarly, Withanolide_D and Withanolide_G were predicted to have a better binding affinity with PLpro, Withanolide_M with 3CLpro, and Withanolide_M with spike protein based on binding energy and number of hydrogen bond interactions. MD studies suggested Withanoside_I with the highest binding free energy (ΔG_bind-31.56 kcal/mol) as the most promising inhibitor. Among multiple withanolides from W. somnifera, Withanolide_D, Withanolide_G, Withanolide_M, and Withanolide_Q were predicted as the lead hits based on drug-likeness score, modulated proteins, and docking score to boost the immune system and inhibit the COVID-19 infection, which could primarily act against COVID-19. HighlightsWithanolides are immunity boosters.Withanolides are a group of bio-actives with potential anti-viral properties.Withanolide_G, Withanolide_I, and Withanolide_M from Withania somnifera showed the highest binding affinity with PLpro, 3CLpro, and spike protein, respectively.Withanolides from Withania somnifera holds promising anti-viral efficacy against COVID-19.Communicated by Vsevolod Makeev.

Network pharmacology of AYUSH recommended immune-boosting medicinal plants against COVID-19

The Ministry of AYUSH recommended the use of a decoction of the mixture of Ocimum tenuiflorum, Cinnamomum verum, Piper nigrum, Zingiber officinale, and Vitis vinifera as a preventive measure by boosting the immunity against the severity of infection caused by a novel coronavirus (COVID-19). The present study aimed to identify the probable modulated pathways by the combined action of AYUSH recommended herbal tea and golden milk formulation as an immune booster against COVID-19. Reported phytoconstituents of all the medicinal plants were retrieved from the ChEBI database, and their targets were predicted using DIGEP-Pred. STRING database and Cytoscape were used to predict the protein–protein interaction and construct the network, respectively. Likewise, MolSoft and admet SAR2.0 were used to predict the druglikeness score and ADMET profile of phytoconstituents. The study identified the modulation of HIF-1, p53, PI3K-Akt, MAPK, cAMP, Ras, Wnt, NF-kappa B, IL-17, TNF, and cGMP-PKG signaling pathways to boost the immune system. Further, multiple pathways were also identified which are involved in the regulation of pathogenesis of the multiple infections and non-infectious diseases due to the lower immune system. Results indicated that the recommended herbal formulation not only modulated the pathways involved in boosting the immunity but also modulated the multiple pathways that are contributing to the progression of multiple disease pathogenesis which would add the beneficial effect in the co-morbid patients of hypertension and diabetes. The study provides the scientific documentation of the role of the Ayurvedic formulation to combat COVID-19.

Combination of system biology to probe the anti-viral activity of andrographolide and its derivative against COVID-19

The present study aimed to investigate the binding affinity of andrographolide and its derivative i.e., 14-deoxy-11,12-didehydroandrographolide with targets related to COVID-19 and their probable role in regulating multiple pathways in COVID-19 infection. SMILES of both compounds were retrieved from the PubChem database and predicted for probably regulated proteins. The predicted proteins were queried in STRING to evaluate the protein-protein interaction, and modulated pathways were identified concerning the KEGG database. Drug-likeness and ADMET profile of each compound was evaluated using MolSoft and admetSAR 2.0, respectively. Molecular docking was carried using Autodock 4.0. Andrographolide and its derivative were predicted to have a high binding affinity with papain-like protease, coronavirus main proteinase, and spike protein. Molecular dynamics simulation studies were performed for each complex which suggested the strong binding affinities of both compounds with targets. Network pharmacology analysis revealed that both compounds modulated the immune system by regulating chemokine signaling, Rap1 signaling, cytokine-cytokine receptor interaction, MAPK signaling, NF-kappa B signaling, RAS signaling, p53 signaling, HIF-1 signaling, and natural killer cell-mediated cytotoxicity. The study suggests strong interaction of andrographolide and 14-deoxy-11,12-didehydroandrographolide against COVID-19 associated target proteins and exhibited different immunoregulatory pathways.

Urolithiasis: a tribal scenario

Urolithiasis is quite prevalent in Satpura belt of Central India. Forty five children with urolithiasis were studied in Jawahar Medical Foundations Hospital, Dhule, Maharashtra over a period of three years. The mean age was 7.1 +/- 3.2 (range 18 months-15 years). The chief presenting complaints were dysuria and lower abdominal pain. The physical, laboratory and radiographic findings were evaluated. Calculi were located in the bladder (80%), urethra (9%), kidney (6.6%) and ureter (4.4%). Calculi were mainly composed of calcium oxalate (65.7%) and calcium phosphate (34.3%). The predominant urinary tract stones in the tribal Satpura belt are bladder stones and may be related to poor nutrition, low socioeconomic status and consumption of bajra (millet) as staple food as found in this region (93.5%).

Gene ontology enrichment analysis of α-amylase inhibitors from Duranta repens in diabetes mellitus

Background

Although α-amylase is the choice of target to manage postprandial hyperglycemia, inhibitors of this enzyme may get absorbed into the systemic circulation and modulate proteins involved in the pathogenesis of diabetes mellitus. Hence, the present study aimed to identify α-amylase inhibitors from Duranta repens via in silico and in vitro and predict their role in the modulation of multiple pathways involved in diabetes mellitus.

Methods

α-amylase inhibitory activity of hydroalcoholic extract/fractions (s) and pure compounds from D. repens was performed using in vitro enzyme inhibitory assay. Multiple open-source databases and published literature were used to retrieve reported phytoconstituents present in D. repens and their targets. The network was constructed between α-amylase inhibitors, modulated proteins, and expressed pathways. Further, hit molecules were also confirmed for their potency to inhibit α-amylase using in silico molecular docking and in vitro enzyme inhibitory assay. The glucose uptake assay was performed to assess the effect of hydrolcoholic extract/fraction(s) using rat hemidiaphragm.

Results

Fraction rich in flavonoids showed the highest α-amylase inhibitory activity with a IC₅₀ of 644.29 ± 4.36 µg/ml compared to other fractions. PI3K-Akt signaling pathway and p53 signaling pathway were predicted to be primarily modulated in the compound-protein-pathway network. Similarly, scutellarein was predicted as lead hit based on α-amylase inhibitory action, binding affinity, and regulated pathways. Further, α-amylase inhibitors were also predicted to modulate the pathways involved in diabetes complications like AGE-RAGE and FoxO signaling pathway. Fraction rich in flavonoids showed the highest glucose uptake in rat hemidiaphragm with an effective concentration of 534.73 ± 0.79 µg/ml.

Conclusions

The α-amylase inhibitors from D. repens may not be limited within the gastrointestinal tract to inhibit α-amylase but may get absorbed into the systemic circulation and modulate multiple pathways involved in the pathogenesis of diabetes mellitus to produce synergistic/additive effect.

System biology-based investigation of Silymarin to trace hepatoprotective effect

Silymarin is used as a hepatoprotective agent since ancient times which could be via its potent anti-oxidant effect. However, the mode of silymarin for the hepatoprotective effect has not been established with the targets involved in hepatic cirrhosis. The present study investigated the multiple interactions of the flavonolignans from Silybum marianum with targets involved in hepatic cirrhosis using a series of system biology approaches. Chemo-informative tools and databases i.e. DIGEP-Pred and DisGeNET were used to predict the targets of flavonolignans and proteins involved in liver cirrhosis respectively. Further, STRING was used to enrich the protein-protein interaction for the flavonolignans-modulated targets. Similarly, molecular docking was performed using AutoDock Vina. Additionally, molecular dynamics simulation and MM-PBSA calculations were carried out for the lead-hit complexes by GROMACS. Thirteen flavonolignans were identified from S. marianum, in which silymonin exhibited the highest drug-likeness score i.e. 1.09. Similarly, CTNNB1 was found to be regulated by the 12 different flavonolignans and was majorly expressed within the compound(s)-protein(s)-pathway(s) network. Further, silymonin had the highest binding affinity; binding energy -9.2 kcal/mol with the CTNNB1 and formed very stable hydrogen bond interactions with Arg332, Ser336, Lys371, and Arg475 throughout 100 ns molecular dynamic production run. The binding free energy of CTNNB1-silymonin complex was found to be -15.83 ± 2.71 kcal/mol. The hepatoprotective property of S. marianum may be due to the presence of silymonin and silychristin; this could majorly modulate CTNNB1, HMOX1, and CASP8 in combination with other flavonolignans. Our findings further suggest designing the in-vitro and in-vivo studies to validate the interaction of flavonolignans with identified targets to strengthen present findings of S. marianum as a hepatoprotective..

A study of epidural pressures in infants

BACKGROUND

The pressures exerted on fragile structures in the infant during epidural injections have never been studied previously.

METHODS

We measured the pressure changes in the epidural space of 20 infants during injection of local anaesthetic solutions. The pressures developed during passage of the epidural needle through the ligaments of spine and in the epidural space during the injection of 1 ml at two rates of injection, over 1 and 2 min and the residual pressure 1 and 2 min after each injection were studied.

RESULTS

The mean pressure while the needle was being advanced through the ligamentum flavum was 69.14 +/- 36.95 mmHg. The epidural pressure after needle had just penetrated the ligament without eliciting the loss of resistance was 1 +/- 9.759 mmHg. A distinct pulsatile waveform identical to the pulse waveform was observed as soon as the epidural space was entered. The pressure rise varied according to the rate of injection. The pressures were 27.79 mmHg when the rate of injection was 1 ml.min(-1), with a residual pressure after 1 min of 12 +/- 5.53 mmHg and 10.14 +/- 5.53 mmHg after 2 min of injection. When the rate of injection was 1 ml.2 min(-1), the pressures were 15.66 +/- 9.48 mmHg with a residual pressure after 1 min of 14.79 +/- 5.15 mmHg and 12.93 +/- 5.46 mmHg after 2 min of injection.

CONCLUSIONS

The residual pressures seem to vary more with the volume injected than the rate of injection or the pressures developed during the injection. The relationship between the rate of injection and pressures is significant when compared with adults where the pressures have been measured after an injection rate of 1 ml.s(-1) and 1 ml.5 s(-1). This is a very fast rate compared with our rates of injection of 1 ml over 1 and 2 min. Based on the findings of this study, we recommend a rate of 1 ml.2 min(-1) in infants. In neonates, a slower rate of injection would be preferable.

Tunnelling of caudal epidural catheters in infants

The working conditions in the developing world necessitate the development of many adaptations and improvizations of accepted anaesthetic techniques to improve patient care. Subcutaneous tunnelling of caudally placed epidural catheters is one such improvization to prevent the soiling of the catheter by urine and faeces. This study compares the duration of retention of catheter in a group with tunnelled catheters with an untunnelled group. The absence of a catheter emerging through skin at the site of catheter insertion hastens healing thus prolonging the retention of catheter in the tunnelled group and soiling ceases to be a major problem.

Newborn healthcare in urban India

The rapid population growth in urban India has outpaced the municipal capacity to build essential infrastructures that make life in cities safe and healthy. Local and national governments alike are grappling with the challenges of urbanization with thousands migrating from villages to cities. Thus, urbanization in India has been accompanied by a concentration of poverty and urban public healthcare has emerged as one of the most pressing priorities facing our country. Newborn mortality rates in urban settings are lower than rural areas, early neonatal deaths account for greater proportion than late neonatal deaths. The available evidence suggests that socio-economic inequalities and poor environment pose major challenges for newborn health. Moreover, fragmented and weak public health system, multiplicity of actors and limited capacity of public health planning further constrain the delivery of quality and affordable health care service. Though healthcare is concentrated in urban areas, delay in deciding to seek health care, reaching a source of it and receiving appropriate care affects the health outcomes disproportionately. However, a few city initiatives and innovations piloted in different states and cities have brought forth the evidences of effectiveness of different strategies. Recently launched National Urban Health Mission (NUHM) provides an opportunity for strategic thinking and actions to improve newborn health outcomes in India. There is also an opportunity for coalescence of activities around National Health Mission (NHM) and Reproductive, Maternal, Newborn and Child Health+Adolescent (RMNCH+A) strategy to develop feasible and workable models in different urban settings. Concomitant operational research needs to be carried out so that the obstacles, approaches and response to the program can be understood.

Upper lid orbicularis oculi muscle strip and sequential brow suspension with autologous fascia lata is beneficial for selected patients with essential blepharospasm

PURPOSE

Severe cases of blepharospasm resistant to botulinum toxin represent a challenging clinical problem. Over the last 10 years, we have adopted a staged surgical management of these cases with an initial upper lid orbicularis myectomy (combined with myectomy of procerus and corrugator supercilius as appropriate) and then 4-6 months later a brow suspension with autologous fascia lata. The aim of this study was to assess the outcome of this staged surgical approach.

MATERIALS AND METHODS

A questionnaire was sent to all patients who had undergone the procedure and the clinical records reviewed.

RESULTS

Fourteen patients had undergone the procedure of which 13 were alive. They were sent a questionnaire and 10 of them responded. All had both procedures. Eight of the 10 reported great benefit from the surgery, one some benefit, and one was worse off. All patients still required botulinum toxin injections after the surgery.

CONCLUSIONS

Majority, but not all, of the patients in our series greatly benefitted from this staged surgical approach.

Reversal of insulin resistance by Ficus benghalensis bark in fructose-induced insulin-resistant rats

ETHNOPHARMACOLOGICAL RELEVANCE

Bark of Ficus benghalensis L. (family: Moraceae), commonly known as Banyan is recorded as Nyagrodha in Ayurvedic Pharmacopeia of India to manage burning sensation, obesity, diabetes, bleeding disorders, thirst, skin diseases, wounds, and dysmenorrhoea. However, the effect of F. benghalensis bark over glycolysis, gluconeogenesis, and appetite regulation in insulin-resistant pathogenesis has not been reported yet.

AIM OF THE STUDY

The present study aimed to investigate the effect of hydroalcoholic extract of F. benghalensis bark in gluconeogenesis, glycolysis, and appetite regulation in fructose-induced insulin resistance in experimental rats.

MATERIALS AND METHODS

Male Wister rats were supplemented with fructose in drinking water (10% w/v for 42 days and 20% w/v for next 12 days; a total of 54 days); insulin resistance was confirmed via the elevated area under the curve of the glucose during oral glucose tolerance test after 54 days and was subjected with extract treatment for next 30 days. After 30 days of treatment, animals were fasted to perform oral glucose and insulin tolerance test to estimate glucose and insulin levels. The blood sample was collected for biochemical estimation and the liver homogenate was prepared to estimate hepatic enzymes and enzymatic and non-enzymatic anti-oxidant biomarkers followed by histopathological evaluation. Also, glycogen content was quantified in gastrocnemius muscle and liver homogenates. Further, reported bioactives from the F. benghalensis were retrieved from the ChEBI database and docked against hexokinase, phosphofructokinase, glucose-6-phosphatase, lactate dehydrogenase, and fructose-1,6-biphosphatase to identify the probable lead hits against the enzymes involved in gluconeogenesis.

RESULTS

Treatment with the F. benghalensis bark extract significantly increased the body weight and food intake and significantly decreased fructose supplemented water intake. Further, treatment with extract significantly increased the exogenous glucose clearance and well responded to the exogenous insulin. Further, extract treatment improved lipid metabolism, ameliorated plasma leptin, and multiple enzymatic and non-enzymatic antioxidant biomarkers. Likewise, it also improved gluconeogenesis mediated pathogenesis of non-alcoholic fatty liver injury. Additionally, molecular docking also identified mucusisoflavone A and B as lead hits in downregulating gluconeogenesis.

CONCLUSION

Hydroalcoholic extract of F. benghalensis bark may prevent insulin resistance by downregulating gluconeogenesis and improving the appetite in fructose-induced insulin-resistant rats.

Glibenclamide antagonizes the inhibitory effect of morphine on gall bladder emptying

Egg yolk-induced gall-bladder emptying in mice was used to investigate the effect of glibenclamide and minoxidil (ATP-dependent K(+)-channel modulators) on biliary tract effects of morphine. The inhibitory effect of morphine (1-4 mg kg-1, i.p.) on egg yolk-induced gall-bladder emptying was completely blocked by pretreatment with naloxone (2 mg kg-1, i.p.) or glibenclamide (0.65 mg kg-1, i.p.) whereas, pretreatment with minoxidil (0.65 mg kg-1, i.p.) did not modify the inhibitory effect of morphine on gall-bladder emptying. Our results suggest that biliary-tract actions of morphine are mediated through glibenclamide-sensitive K+ channels similar to those involved in the analgesic action of morphine.

Complications of anaesthesia and surgery for laryngotracheo-oesophageal cleft

Laryngotracheo-oesophageal cleft presents great difficulty in airway management. Tracheostomy and/or bilateral endobronchial intubation to secure the airway and a feeding gastrostomy are essential to sustain life until major definitive surgery can be planned. We describe the anaesthesia for these emergency life saving procedures in a 1.1-kg, 2-day-old neonate of 29 weeks gestation with apnoeic spells. Endoscopy to diagnose the extent of cleft, probable tracheostomy and gastrostomy were planned. Oesophagoscopy and bronchoscopy revealed a grade 3-4 cleft. Inadequate spontaneous ventilation during these procedures necessitated positive pressure ventilation. This resulted in a gaseous distension of an intact stomach which could be decompressed into the oesophagus. After the bronchoscopy, the use of a 3-mm tracheal tube without a Murphy's eye minimized the distension during gastrostomy. There was an accidental extubation after gastrostomy. Emergency reintubation with a 4-mm tracheal tube with a Murphy's eye resulted in gastric distension which led to tension pneumoperitoneum with a disappearance of PECO2. Misdiagnosis of this as loss of airway led to repeated intubations and extubation until the pneumoperitoneum was suspected and decompressed. After this setback, the baby's condition deteriorated over the next few hours ending fatally. The problems and suggestions to avoid these complications are discussed.

Effect of Moringa oleifera bark extracts on dexamethasone-induced insulin resistance in rats

BACKGROUND

Experimental study has revealed the antidiabetic potentials of ethanolic extract of the bark of Moringa oleifera Lam., (Moringaceae), a multipurpose tree of south Asia.

OBJECTIVE

To investigate the effects of alcoholic and petroleum ether extracts of Moringa oleifera bark on acute and chronic insulin resistance induced by dexamethasone in rats.

MATERIALS AND METHODS

Dexamethasone (dexa) was administered for 11 days (1 mg/kg, s. c., once daily) and single dose (1 mg/kg, i. p.) to induce chronic and acute insulin resistance respectively. 2 doses each of alcoholic (AE125 and AE250 mg/kg) and petroleum ether extracts (PEE30 and PEE60 mg/kg) and single dose each of alcoholic (AE250 mg/kg) and petroleum ether extract (PEE 60 mg/kg) of Moringa oleifera bark were tested in chronic and acute studies. At the end of the studies fasting plasma glucose, triglyceride levels and oral glucose tolerance were measured.

RESULTS

In chronic study, treatment of rats with AE125 and AE250 prevented dexamethasone-induced hypertriglyceridemia and oral glucose intolerance but not fasting hyperglycemia, whereas both PEE30 and PEE60 had no effects on any of these parameters measured except that significant reduction of triglyceride level was observed in PEE60 treated rats. Oral glucose intolerance induced by single dose administration of dexamethasone was prevented by AE250 but not by PEE60. In normal rats AE250 treatment improved the glucose tolerance, where as PEE60 had no effect on this parameter.

CONCLUSION

The present study indicates that AE of Moringa oleifera prevents dexamethasone-induced insulin resistance in peripheral tissues.

An unusual cause of tracheal stenosis

PURPOSE

To report a large chronic tracheal foreign body, causing tracheal stenosis in an 11-yr-old girl.

CLINICAL FEATURES

The history was suggestive of obstructive airways disease with secondary bronchiectasis. Physical findings were crepitations and rhonchi all over the chest. Blood gases were normal. Chest X-ray showed bronchiectasis and a ventilation perfusion scan identified a tracheo-esophageal fistula. During anesthesia to confirm this, intubation and ventilation were difficult because of tracheal stenosis. The hypoventilation resulted in severe hypercarbia and acidosis. A subsequent CT scan showed a stenosis of 2 mm diameter and 1 cm length in the middle third of trachea, bronchiectasis, and an air filled pocket between the trachea and esophagus. PFT showed a severe obstruction. Antitubercular treatment which was started on the presumptive diagnosis of tuberculous stenosis and tracheoesophageal fistula caused a delay with deterioration of patient from intermittent dyspnea to orthopnea with severe hypecarbia and acidosis. The anesthetic management of the tracheal reconstruction was difficult due to her moribund condition even after medical treatment, the short length of the trachea above the obstruction, its severity and lack of resources for alternative techniques. A large foreign body was found lying obliquely in the trachea dividing it into an anterior narrow airway mimicking a stenosed trachea, and a wider posterior blind passage.

CONCLUSION

The anesthetic consequences were peculiar to the unexpected etiology of the stenosis and poor general condition of the patient. Minor details like the tracheal tube bevel and ventilatory pattern became vitally important.

Cyperus rotundus L. reverses the olanzapine-induced weight gain and metabolic changes-outcomes from network and experimental pharmacology

Cyperus rotundus L. is used to treat multiple clinical conditions like inflammation, diarrhea, pyrosis, and metabolic disorders including diabetes and obesity. The present study aimed to predict the interaction of reported bioactives from Cyperus rotundus against obesity via network pharmacology and to evaluate the efficacy of hydroalcoholic extract of Cyperus rotundus against the olanzapine-induced weight gain and metabolic disturbances in experimental animals. Reported phytochemicals of Cyperus rotundus were retrieved from the open-source database(s) and published literature and their targets were predicted using SwissTargetPrediction, enriched in STRING, and bioactives-proteins-pathways network was constructed using Cytoscape. Further, the hydroalcoholic extract of Cyperus rotundus (100, 200, and 400 mg/kg/day, p.o.) was co-administered with olanzapine (2 mg/kg, i.p.) for 21 days in Sprague Dawley rats. During treatment, body weight and food intake were recorded; after the successful completion of 21 days of treatment, animals were fasted to perform oral glucose and insulin tolerance tests. Further, the animals were euthanized; blood and abdominal fat were collected for lipid profiling and histopathological examination respectively. Herein, network pharmacology predicted neuroactive ligand-receptor interaction as a primarily modulated pathway and protein tyrosine phosphatase 1b as a majorly triggered protein via the combined action of bioactives. Further, Cyperus rotundus significantly reversed weight gain, cumulative food intake, ameliorated the lipid and glucose metabolism, and promoted energy expenditure.

Dental management of PHACE syndrome under general anesthesia

PHACE syndrome was first described by Dr. Ilonia Frieden and colleagues in 1996. It is an under-recognized rather than a very rare condition among patients with large facial hemangiomas. It is challenging as it has significant neurological, vascular and airway implications. Vascular malformations compromising cerebral blood flow predispose the patient to strokes and seizures. Subglottic hemangiomas, if present, could bleed during intubation. Meticulous neurological monitoring is mandatory in those undergoing repair of the great vessels. We describe the perioperative management of a child with PHACE syndrome subjected to dental treatment under general anesthesia.

The marijuana-schizophrenia multifaceted nexus: Connections and conundrums towards neurophysiology

Delta-9-tetrahydrocannabinol, a component of marijuana, interacts with cannabinoid receptors in brain involved in memory, cognition, and emotional control. However, marijuana use and schizophrenia development is a complicated and contentious topic. As a result, more investigation is needed to understand this relationship. Through the functional enrichment analysis, we report the delta-9-tetrahydrocannabinol to manipulate the homeostatic biological process and molecular function of different macromolecules. Additionally, using molecular docking and subsequent processing for molecular simulations, we assessed the binding ability of delta-9-tetrahydrocannabinol with the estrogen-related protein, dopamine receptor 5, and hyaluronidase. It was found that delta-9-tetrahydrocannabinol may have an impact on the brain's endocannabinoid system and may trigger the schizophrenia progression in vulnerable people. Delta-9-tetrahydrocannabinol may interfere with the biological function of 18 proteins linked to schizophrenia and disrupt the synaptic transmission (dopamine, glutamine, and gamma-aminobutyric acid). It was discovered that it may affect lipid homeostasis, which is closely related to membrane integrity and synaptic plasticity. The negative control of cellular and metabolic processes, fatty acids binding /activity, and the manipulated endocannabinoid system (targeting cannabinoid receptors) were also concerned with delta-9-tetrahydrocannabinol. Hence, this may alter neurotransmitter signaling involved in memory, cognition, and emotional control, showing its direct impact on brain physiological processes. This may be one of the risk factors for schizophrenia development which is also closely tied to some other variables such as frequency, genetic vulnerability, dosage, and individual susceptibility.