Scripta Medica is a peer-reviewed and open access journal available in the online and printed form. It covers all fields of medicine, dental medicine, pharmacy and health sciences. Scripta Medica is being published quarterly, by the end of each quarter. The journal has the International Advisory Board with memebers from all over the world.
Faculty of Medicine, University of Banja Luka
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Phytochemical Heterocycles in Depression Management: A Sustainable Strategy
According to WHO, depression is raising globally and expected as global burden by 2030. After COVID-19, drastic incline led to 17 % of total world population that suffered from well-known mental disorder depression and around 140,000 suicides annually attributed to depression. Owing to the diverse adverse effects associated with marketed antidepressants, research has increasingly shifted towards traditional herbal medicines for curing the both physical and emotional symptoms associated with depression. In recent years, natural products, particularly plant-derived secondary metabolites have with heterocyclic backbones, has become promising candidates for depression therapy. This review explores the medicinal potential of various plant-based compounds, including indole alkaloid, pyridine alkaloid, saponins, polyphenols. The secondary metabolites of these plants have demonstrated markable antidepressant-like effects in preclinical studies by modulating neurotransmitter system, reducing inflammation and promoting neurogenesis. For instance, compounds such as psychollatine and mitragynine (indole alkaloid), saikosaponin (saponins) and polyphenolic compounds like crocin and curcumin have resultant biological activity. Herbal remedies like St John’s Wort (Hypericum perforatum), saffron, turmeric and ginseng have been used from centuries for mood regulation. By combining traditional knowledge with modern scientific researches, researchers can utilise the nature’s therapeutic power to innovate safer and effective treatments for depression. However, further investigation is necessary to elucidate the accurate mechanism of these compounds through which they exert their effect, optimise dosing, quality control and rigorous clinical trials. Ultimately, by combining the best of both traditional medicine and modern science- there can be revolution in the treatment of depression and lives of countless individuals can be improved.
Case Series of Burkholderia Pseudomallei Infections in Critically Ill Patients: Unveiling Key Challenges
Melioidosis remains a diagnostic challenge in tropical regions due to its broad clinical spectrum. This series presents seven diabetic individuals from an endemic area with diverse forms of the disease, including pulmonary, visceral, soft tissue and lymph node involvement. Laboratory confirmation was achieved through culture and nested polymerase chain reaction (PCR). Most patients improved with appropriate intravenous therapy followed by oral antibiotics; one experienced recurrence. The varied presentations often resemble other endemic infections, delaying diagnosis. Prompt clinical recognition and early use of molecular tools are vital for initiating targeted treatment and improving outcomes in vulnerable populations.
Antifungal Interventions and Clinical Outcomes: A Review
Fungal infections pose a significant risk to public health since they are linked to high rates of illness and death, particularly in immunocompromised individuals. Therapy is difficult because there are few antifungal drugs available and many of them are harmful. Fungi have also evolved defence mechanisms to fight these drugs. This article overlooks at antifungal drugs that are currently on the market, discusses resistance mechanisms and investigates new treatment-enhancing strategies. Combinations of antifungal drugs can increase effectiveness and reduce toxicity. New drug formulations, including nanoparticles are being studied to improve dispersion and reduce adverse effects. Furthermore, commercially marketed prescriptions may become more effective if their chemical makeup is changed. Additionally, novel drugs are being tested more rapidly and precisely using mini-host animal models. These creative methods could expedite the process and enhance patient outcomes. This study notes multiple challenges, such as patient peculiarities, intricate drug interactions and pathogen diversity, while also emphasising the advancements in antifungal therapy. Enhancing efficacy and reducing toxicity requires advancements in diagnosis, treatment and medicine. More studies on emerging fungal infections and antibiotic resistance are needed.
A Narrative Review on Preclinical/Clinical Trials on Aducanumab
The most widespread type of dementia, Alzheimer's disease (AD), is predicted to triple in global prevalence by 2050. AD has a substantial societal and economic impact across the world, negatively affecting both patients and their caregivers, as the disorder has few therapeutic alternatives. Aducanumab was the first monoclonal antibody approved in 2021 for the treatment of mild AD. Representing the first AD drug approval in 20 years and based on the concept of targeting amyloid-β (Aβ) as an immunisation treatment for AD, Aducanumab was demonstrated to reduce Aβ plaque formation in animal models and humans. This was used as a proxy of efficacy in AD clinical trials to slow disease progression and reduce cognitive decline in AD. Culminating from the Aβ hypothesis of AD that has dominated the focus of AD drug development since its inception, Aducanumab, for many, represents validation of the hypothesis and promise for the future. This review examines the antibody research, preclinical and clinical studies, that underpin the development of aducanumab as an AD medication. No single drug is generally likely to cure a complex, progressive and heterogeneous degenerative disorder, but it may act as a stepping stone towards greater understanding and potentially more effective treatment options. Time will ultimately tell in the case of aducanumab as to whether it is a small or large step in the correct or incorrect direction to unravel the mystery of this complex disorder and provide a worthwhile treatment.
Co-Crystals for Drug Design: A Logical Approach for Modifying Physicochemical Properties of Drugs
Drug design plays a critical role in the pharmaceutical industry, addressing the limitations of many compounds with medicinal properties that cannot serve as an effective active pharmaceutical ingredient. Extensive research has been conducted to overcome this challenge, with co-crystals emerging as a promising solution. In drug design, APIs often face challenges such as low solubility, poor mechanical properties, or degradation risks. Since the discovery of co-crystals, their potential applications have expanded significantly. Initially recognised as simple solubility modifiers, recent research emphasises their diverse uses, including flavour masking and the enhancement of mechanical properties. With the commercialisation of co-crystal-based drugs, research has shifted from their potential applications to optimise production methods. This article reviews key production methods, including solvent evaporation and hot-melt extrusion, which enable scalable and ecologically sustainable co-crystal synthesis. Addressing poor physicochemical properties, especially low bioavailability, remains a persistent challenge in pharmaceutical development. Co-crystals present an innovative and efficient solution. An active pharmaceutical ingredient (API) and a co-former are joined by non-covalent interactions to form co-crystals, which are crystalline solids. These structures maintain the natural pharmacological efficacy of pharmaceuticals while improving their physicochemical characteristics, such as stability and solubility. They provide a systematic and rational approach to improve API properties because their design follows well-established crystal engineering principles. This review emphasises the increasing interest in co-crystals and their importance in crystal preparation methods. Co-crystallisation has improved the stability, dissolution rate and solubility of active pharmaceutical ingredients. Although, there are challenges related to scalability, innovative solutions are necessary to ensure consistent and cost-effective production. With ongoing research and advancements in scalable manufacturing, co-crystals are poised to revolutionise pharmaceutical development by overcoming bioavailability challenges and enhancing therapeutic outcomes.
Effect of Deuterated Aspirin Treatment of Obese Iraqi Patients With Blood Hyperviscosity Syndrome
Background/Aim: Hyperviscosity syndrome (HVS) is a predictor of blood flow resistance and blood viscosity, density, or thickness. A number of factors that influence blood viscosity have been identified. This study aimed to compare the effects of the deuterated aspirin (aspirin-D) to standard aspirin (aspirin-H) on the prothrombin time (PT) and the normalised international ratio (INR) in obese HVS patients and healthy individuals of normal weight. Haematocrit (HCT) was the primary determinant of blood viscosity and flow resistance. Methods: The study included 120 Iraqi individuals, aged between 21 and 55 years, divided into 2 groups, 60 patients in an obese HVS group and 60 in a healthy weight control group. Total complete blood count, haemoglobin (Hb), the effects of aspirin-H and aspirin-D on blood viscosity were evaluated by measuring HCT, red blood cell (RBC), PT and INR. Results: Patients aged 31–41 years with a body mass index (BMI) of 30–39.9 kg/m² constituted the largest proportion of the HVS group (41.66 %), while the same age group represented the highest percentage among healthy controls (40 %). Patients with HVS showed highly significant increases (p < 0.001) in anthropometric and haematological parameters, including BMI, Hb, HCT and RBC, along with a significant reduction in PT and INR compared to controls. Aspirin treatment, particularly deuterated aspirin, significantly increased PT and INR values, indicating improved anticoagulant activity. Conclusion: Aspirin-D was superior to standard aspirin-H in reducing blood viscosity and delaying clotting time in both HVS patients and healthy subjects.
Emerging Trends in Pharmacological Strategies for Targeting Neuroinflammation in Depression
The article discusses evolving pharmacological strategies for addressing the neuroinflammation in depression, highlighting its role in major depressive disorder. Neuroinflammation is linked to neurotransmitter imbalances, hypothalamic-pituitary- adrenal axis dysregulation and impaired neurogenesis. Key treatments explored include anti-inflammatory agents such as N-acetylcysteine, toll-like receptor (TLR) inhibitors and cytokine blockers like anti-interleukin-6 and tumour necrosis factor alpha (TNF-α) agents. Glutamate modulation, antioxidants and omega-3 fatty acids are also examined for their therapeutic efficacy. The article emphasises the need for combination therapies and novel approaches like ketamine and microbiome-targeted treatments to combat inflammation-related depression. Despite significant progress, further research is needed to fully understand the mechanisms and optimise therapeutic strategies.
Allocation of Stem Cell Alterations in Spermatogenesis of Male Rats Affected by Zymafluor and Detection of Reverse Effect of Vitamin E on Testis Histology Using Immunohistochemical Techniques
Background/Aim: Zymafluor is a proven protective agent against dental caries and it is a naturally occurring agent present in water and soil. Aim of this study was to analyse the detrimental effect of sodium fluoride and opposing effect of vitamin E on spermatogenesis on testicular tissue of male rats using stem cell markers (aldehydes dehydrogenase 1A1 - ALDH1A1 and NANOG). Methods: Four groups of male rats (10 rats in each) were used in this study as follow: group C regarded as a control group received normal saline, group F received sodium fluoride (Zymafluor) once daily, group FE received vitamin E followed by sodium fluoride and group E received vitamin E. The experiment was carried out for 28 days. After this period, the rats were sacrificed and the tissue of testis was processed for immunohistochemistry to stain with ALDH1A1 and NANOG stem cell biomarkers. Results: A decrease in the expression of both ALDH1A1 and NANOG stem cell markers in group F was highly observed and statistically significant. The expression was improved in spermatic cells of group FE for both markers. Normally strong intensity of markers was observed in group E. The spermatogenesis was diminished in F group according to Jonhson score and improved in group FE, while group C and E displayed normal Johnson score for spermatogenesis. Conclusion: Sodium fluoride had a toxic effect on testis affecting spermatogenesis and decreasing quality and quantity of mature sperm, but the administration of vitamin E reversed the toxic effect of sodium fluoride, acting as an antidot. ALDH1A1 and NANOG appeared as markers of stem cell expressed in spermatogenic niche and spermatocytes and affected by many chemicals destroying these cells such as sodium fluoride.
Determinants of Health-Related Quality of Life in Mothers of Children With Autism Spectrum Disorder in Bangladesh
Background/Aim: Autism spectrum disorder (ASD) has a significant impact on the quality of life of children with this disorder as well as their mothers. ASD prevalence in Bangladesh has been estimated to be 0.15-0.8 %, but the health-related quality of life (HRQoL) of mothers having children with ASD has not been studied. This study aimed to estimate the HRQoL of these mothers and the main determinants that affect it. Methods: This study adopted a cross-sectional design using the SF-scale among 160 mothers who were selected through two stage sampling technique (stratified random and purposive sampling) attending at 16 service centres for persons with disabilities from January to June 2023. Results: The mean age of the participants was 32.78 years and they were mostly married (95 %), were Muslims (84.4 %) and only had primary education (29.4 %). The average monthly family income was 17,781 Bangladeshi Taka (BDT). The total HRQoL was significantly low (37.70 ±18.27). The physical component score (40.32 ± 21.36) and the mental component score (35.08 ± 15.17) revealed that there were severe deficits. The findings also suggest that the maternal age, less education, less income, family structure, children age and child-behaviour issues were all significant predictors of poorer HRQoL (p < 0.05). Conclusions: This paper thus concludes that the HRQoL of the mothers of children with ASD in Bangladesh is critically impaired, due to the effect of socio-economic, family and child related factors.
Anticancer Activity of Opuntia Cochenillifera Extract Against Triple-Negative Breast Cancer Cells via Apoptosis Induction and Bioinformatics-Based Target Prediction
Background/Aim: Breast cancer remains one of the most commonly diagnosed cancers among women worldwide and is a significant public health concern. Aim of this study was to investigate the in vitro anticancer activity of Opuntia cochenillifera ethanolic extract (EOC) against triple‑negative breast cancer (TNBC) cells and to predict potential molecular targets involved in its mechanism of action through bioinformatics analysis. Methods: Fresh O cochenillifera leaves were extracted by ethanol maceration. Phytochemical constituents were analysed using qualitative screening, thin‑layer chromatography (TLC), UV–Vis spectrophotometry and Fourier transform infrared (FTIR) spectroscopy. Cytotoxicity against MDA‑MB‑231 TNBC cells was determined via MTT assay and morphological assessment. Apoptosis induction was quantified by Annexin V–FITC/PI flow cytometry. Potential molecular targets were identified through integrated bioinformatics platforms, including STITCH, SEA, SwissTargetPrediction, STRING and Cytoscape, followed by pathway enrichment analysis. Results: Phytochemical analysis revealed the presence of alkaloids, flavonoids, phenolics, saponins and steroids, with flavonoids as predominant constituents (68 mg/g extract). FTIR spectra confirmed hydroxyl, aliphatic, aromatic and carbonyl functional groups consistent with phenolic and flavonoid structures. EOC exhibited dose‑dependent cytotoxicity against MDA‑MB‑231 cells, with an IC₅₀ of 270.63 µg/mL, accompanied by morphological and flow‑cytometric evidence of apoptosis. Network pharmacology analysis identified 34 apoptosis‑related target genes, including six hub genes (CDKN1A/p21, TP53, MAPK1, MAPK3, AKT1 and FOXO3), associated with TP53‑p21 signalling, MAPK cascades and mitochondrial stress‑induced apoptosis pathways. Conclusion: O cochenillifera ethanolic extract demonstrated significant cytotoxic and pro‑apoptotic effects in TNBC cells, potentially mediated through TP53‑p21 and MAPK pathway modulation. These findings suggest that O cochenillifera is a promising candidate for further investigation as a natural adjuvant therapeutic agent for triple‑negative breast cancer.
Prevalence and Associated Factors of Depression in Women in the Last Trimester of Pregnancy: A Cross-Sectional Study in a Southern Province of Vietnam
Background/Aim: Depression during pregnancy is a significant public health issue, particularly in the third trimester when women experience various physical and emotional changes. This study aimed to investigate the prevalence of depression and anxiety among women in the final trimester of pregnancy, as well as the associated factors. Methods: A cross-sectional descriptive study was conducted involving pregnant women in their last three months of pregnancy who attended regular prenatal check-ups at the prenatal clinic of Phuong Chau International Hospital in Can Tho. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for depressive symptoms. Results: The present study found a prevalence of depression of 14.3 %. Symptoms of depression were significantly associated with a history of previous miscarriage (p = 0.004), a history of abortion (p < 0.001), treatment for vulvovaginitis (p = 0.002) and satisfaction with the marital relationship (p = 0.003). Conclusion: This study identified factors associated with depressive symptoms in pregnant women during their third trimester. Absence of previous miscarriage, absence of abortion history, no treatment for vulvovaginitis and marital satisfaction were associated with lower odds of depressive symptoms.
The Effect of Gingival Inflammation on Salivary Cytochrome P450 Enzymes in Children: A Case-Control Study
Background/Aim: Gingival inflammation in children involves characteristic changes of the salivary composition that reflect not only weakened local defence factors but also increased defensive reflexes. This study aimed to compare the salivary parameters cytochrome concentration, density and flow rate between children with gingival inflammation and clinically healthy gingiva. Methods: A total of 86 children were included and divided into two groups: 41 with gingival inflammation and 45 with healthy gingiva, which was gender matched for age. Unstimulated saliva was collected and cytochrome concentration, salivary density and flow rate were measured. Results: Participants with gingival inflammation had significantly lower mean salivary cytochrome concentration and density but showed increased salivary flow rate compared to healthy controls. These differences were found in both sexes, being more marked in boys with respect to the age increase of flow rate. Correlation studies showed a strong negative correlation between salivary density and flow rate in both groups. These results indicate that there is a unique biochemical signature for gingival inflammation in children, which includes lower cytochrome and density, accompanied by an increase in flow rate. Conclusion: In children, gingival inflammation was associated with reduced salivary CYP450 and density and increased flow rate in saliva, suggesting a unique biochemistry of oral disease.
Emerging Biomaterial Strategies for Giant Cell Arteritis: Challenges and Future Outlook
Giant cell arteritis (GCA) is a common vasculitis of the big arteries that affects people as they get older and it usually results in potentially serious problems like vision loss and stroke. Steroids remain the cornerstone of GCA treatment, although long-term steroid use is associated with significant adverse effects and a high chance of recurrence. This review will look at biomaterials as a new treatment technique that could help improve GCA management through focused therapy, reduced systemic side effects and facilitated vascular restoration. A comprehensive evaluation of current breakthroughs in biomaterial-based GCA techniques was carried out, with an emphasis on nanoparticles, hydrogels and tissue-engineered scaffolds. The literature was reviewed to determine their therapeutic efficacy, biocompatibility and potential for clinical use. Biomaterials such as nanoparticles and hydrogels have showed promise in controlled drug delivery, allowing for focused treatment at sick artery sites while lowering systemic steroid exposure. Tissue-engineered scaffolds have shown promise for vascular repair and regeneration, at least more effectively than standard methods of treating an injured vessel. However, many problems exist, including maintaining long-term biocompatibility, stability and avoiding immunological responses. Although early preclinical studies have produced encouraging results, clinical translation is still in its infancy. Emerging biomaterials will be a potential area in GCA care, offering new opportunities for treatment efficacy enhancement while reducing side effects. Advanced research in the areas of biocompatibility and immune response challenges should be conducted to ease these promising tactics into clinical practice as a new hope for people suffering from this debilitating condition.
Unveiling the Therapeutic Potential of Ipomoea Batatas Lam: A Journey From Preclinical Research to Clinical Applications
Ipomoea batatas Lam, commonly known as sweet potato, has garnered recognition for its significant therapeutic potential, which can be largely ascribed to its abundant array of bioactive secondary metabolites. Among these phytoconstituents, flavonoids, anthocyanins, carotenoids and terpenoids have been shown to possess notable pharmacological properties through preclinical investigations. Evidence from in vitro studies utilising cell culture models indicates that these compounds exhibit robust antioxidant and anticancer activities, with anthocyanins in particular being reported to inhibit the proliferation of cancer cells. Furthermore, in vivo experiments substantiate the diverse therapeutic efficacy of Ipomoea batatas, revealing its anti-obesity, hypoglycaemic, hepatoprotective and anti-arthritic properties. Advancements in the understanding of these therapeutic attributes have facilitated the progression of extracts from Ipomoea batatas to clinical evaluation with subsequent assessment of safety, toxicity, pharmacokinetics and benefit-risk ratios. The transition from preclinical research to clinical validation accentuates its relevance in the realm of metabolic health, especially in combating obesity, liver dysfunction and diabetes. The successful completion of Phase III clinical trials has resulted in the introduction of plant-based antidiabetic formulations into the market, thereby reinforcing the pharmacological significance of this plant. Nevertheless, despite these promising developments, the complex interactions between the phytoconstituents and their corresponding therapeutic effects warrant further investigation. Continued research in this domain is essential, as it promises not only to enrich the understanding of the medicinal properties of Ipomoea batatas but also to reveal innovative therapeutic applications. Such endeavours will likely establish Ipomoea batatas as an esteemed natural resource within contemporary medicine.
COVID-19 Vaccine Safety in Adults: A Narrative Review of Adverse Reactions in ASEAN Countries
The spread of the SARS-CoV-2 virus, known as the COVID-19 virus, which causes the coronavirus disease 2019 known as “COVID-19”, has led to a rapid response from governments around the world. In response to the significant threat it presents to global health, comprehensive strategies have been implemented to mitigate worldwide transmission and reduce mortality rate. Association of South East Asian Nations (ASEAN) countries have also taken steps to encourage people to get vaccinated. The use of vaccines from many global pharmaceutical companies has led to the collection of reports on adverse drug reactions to monitor and evaluate the use of pharmaceutical products after administrated. This study aimed to evaluate the adverse drug reactions of COVID-19 vaccines administered in ASEAN countries through a narrative review of relevant scientific literature. A narrative review was conducted using PubMed and ScienceDirect databases to identify original, open-access studies published between 2020 and 2025. Eligible articles involved adults aged 18–59 years and reported adverse events following COVID-19 vaccination in ASEAN countries. Nine studies met the inclusion criteria and were qualitatively analysed. Six vaccines were evaluated: Ad26.COV2.S (Johnson &Johnson), AZD1222 (AstraZeneca), BNT162b2 (Pfizer-BioNTech), CoronaVac (Sinovac), Sputnik V and mRNA-1273 (Moderna). The most adverse drug reactions reported included injection site pain, fever, headache, fatigue and muscle pain, respectively, based on the severity of side effects. Current evidence confirms that COVID-19 vaccines used in Southeast Asian demonstrated favourable safety and tolerability profiles among adults, consistent with global pharmacovigilance data. These findings support continued vaccination programs and highlight the importance of strengthening regional pharmacovigilance systems and harmonised AEFI reporting to sustain public confidence in immunisation efforts across ASEAN.
Global Research Trends and Risk Factors for Loneliness in Older Adults
Loneliness was defined as an unpleasant feeling for a person when there is a gap between expectations of desired social connection with actual number of social relationships owned, both in terms of quantity or especially the quality. This research was systematic literature review with bibliometric analysis employs a two-phase quantitative approach. In the first phase, scientific publications were collected from two databases, there is Scopus and Web of Science (WoS). The analysis and visualization show that loneliness among older adults is an increasingly prominent topic in global research, especially since the COVID-19 pandemic. This research reveals that loneliness was closely linked to multidimensionality and was receiving attention from various fields, including neuroscience, behavioral health and geriatric care. The main themes of this research include psychological and cognitive factors, social isolation, and geriatric vulnerability. Although the topic of loneliness among the elderly is gaining high attention in global academic interest, there was still a gap in innovative research, which calls for a multidisciplinary approach, especially in the discussion of risk factors for loneliness among the elderly. Some of the potential topics for further research are the relationship of loneliness among the elderly with socioeconomic factors, technology and digitalization, elderly care, religion and culture, and the direct relationship of loneliness with biomedical risks in geriatric clinical conditions such as atrial fibrillation, cognitive impairment, osteoporosis, and fall risk. These topics will open up great opportunities for researchers to contribute to and develop the advancement of this issue.
Gunshot wounds remain one of the most complex types of combat injuries. A gunshot wound is a dynamic system in which the initial mechanical destruction of tissue is only the starting point of a complex and multi-level process. Subsequently, the wound site steadily transforms and the volume of non-viable tissue increases, spreading beyond the wound channel area. This review examines the pathogenesis of a gunshot wound, which is a chain of cause-and-effect changes in which each link is formed as a direct consequence of previous disturbances. The pathophysiological events that contribute to the chronic wound process are identified, which cannot be interrupted by natural mechanisms.
Ubiquitously Occurring Perfluoroalkyl and Polyfluoroalkyl Substances: An Overview of Food and Environmental Contamination and Implications for Human Health
Perfluoroalkyl and polyfluoroalkyl substances (PFAS), commonly known as ‘forever chemicals’, are synthetic, anthropogenic compounds widely used in food packaging, processing equipment and nonstick surfaces. Their strong carbon–fluorine bonds make them highly persistent in the environment and within living organisms, including humans. This review focuses on the chemical structures of PFAS, their similarity to fatty acids, environmental contamination pathways, their entry into the food chain and water systems, their biological behaviour and their adverse health effects. Our observations suggest that the harmful effects of PFAS pollutants may be even more far-reaching, as they may jeopardise the function of the cardiorespiratory, neurological and reproductive systems in humans. PFAS analogues exhibit exceptionally long biological half-lives in humans with 2.7 to 5.1 years for perfluorooctanoic acid (PFOA), 3.4 to 5.7 years for perfluorooctane sulfonate (PFOS) and 2.8 to 8.5 years for perfluorohexane sulfonate (PFHxS), often persisting in blood and tissues for several years after exposure has ceased. This prolonged retention allows PFAS to accumulate over time, increasing the likelihood of chronic exposure and long-term health consequences even at low environmental concentrations. Evidence-based regulations by food and environmental regulatory agencies, along with projections of the impacts of regulatory intervention, are needed to protect public health.
Pathophysiological Pathways Linking Diabetes to Cardiac Hypertrophy: From Insulin Resistance to Personalised Cardioprotection
Diabetes and cardiac hypertrophy are closely interconnected, sharing overlapping metabolic and cardiovascular pathways. This review aimed to investigate the underlying mechanisms that drive this relationship and to evaluate current diagnostic and therapeutic strategies with the goal of improving clinical outcomes. An extensive review of recent literature was undertaken to explore how factors such as insulin resistance, hyperglycaemia, inflammation, oxidative stress and lipotoxicity contribute to cardiac remodelling and functional decline. Developments in diagnostic modalities, including advanced imaging techniques and emerging biomarkers, were examined alongside both lifestyle interventions and pharmacological treatments. Diabetes is a significant contributor to the progression of cardiac hypertrophy, primarily through metabolic dysregulation and persistent low-grade inflammation. The importance of early detection—using sophisticated imaging tools and biomarker profiling—has become increasingly evident for timely and effective intervention. Therapeutic agents such as metformin, sodium glucose cotransporter-2 inhibitors (SGLT2) and glucagon like peptide-1 receptor agonist (GLP-1) have demonstrated beneficial effects in reducing cardiovascular complications in individuals with diabetes. Moreover, novel approaches, including chronotherapy and personalised medicine, are gaining traction as potential means to enhance treatment efficacy and patient outcomes. The robust association between diabetes and cardiac hypertrophy underscores the necessity for a more integrated and nuanced approach to diagnosis and management. Combining early detection with targeted pharmacotherapy and personalised care strategies offers a promising route to addressing this complex clinical challenge. Continued research is essential to refine these approaches and to optimise long-term outcomes for affected patients.
Pharmacovigilance and Adverse Drug Reactions in Type 2 Diabetes Mellitus: Insights from a Tertiary Care Hospital in Central India
Background: Type 2 Diabetes Mellitus is a chronic condition that frequently necessitates prolonged pharmacological treatment and is frequently complicated by polypharmacy and comorbid conditions. These components elevate the likelihood of adverse drug reactions that demand active pharmacovigilance to enhance drug safety and patient adherence. Methods: A prospective observational study was carried out over duration of 12 months at a tertiary care teaching hospital located in Central India. A total of 964 adults diagnosed with type 2 diabetics were enrolled. Data on demographics, comorbidities, and drug prescriptions were recorded. ADRs were identified through clinical evaluation and assessed for causality, severity, and preventability. Chi-square tests and logistic regression were utilized for statistical evaluation. Results: Among 964 patients (mean age 46.9 ± 12.4 years), the highest prevalence was observed in the 41–50 age group (32.6%). ADRs were reported in 231 patients (23.96%). Hypoglycemia (notably with sulfonylureas, p < 0.01) and gastrointestinal disturbances (mainly with metformin) were the most common ADRs. The Naranjo assessment categorized 62.3% of ADRs as probable, with 89.1% classified as mild-to-moderate in severity. According to Schumock and Thornton criteria, 54.5% of ADRs were preventable. Logistic regression revealed polypharmacy (OR = 2.73, p < 0.01) and kidney dysfunction (OR = 2.21, p < 0.01) as significant predictors of ADRs. Conclusion: This research underscores a significant prevalence of ADRs in patients with T2DM, with many being preventable. Sulfonylureas and metformin were frequently implicated. Strengthening pharmacovigilance practices and promoting rational drug use are necessary for improving patient safety and therapeutic results in diabetes management.
Role of Lung Ultrasound in Determining the Endpoint of Fluid Therapy in Patients With Septic Shock
Background/Aim: Fluid resuscitation in septic shock is essential, but determining the optimal volume remains challenging. This research aimed to evaluate the role of lung ultrasound (LUS) in assessment of endpoint of fluid therapy in septic shock. Methods: This prospective observational research comprised 60 adults with septic shock admitted to critical care unit between May 2024 and December 2025. Fluid responsiveness was assessed by left ventricular outflow tract velocity–time integral (LVOT VTI) variation during passive leg raise; ≥ 10 % increase defined responders. LUS was performed using simplified, quantitative eight zone and qualitative eight zone protocols. Echocardiographic evaluation of left ventricular systolic and diastolic function, along with inferior vena cava collapsibility index (IVCCI), was also performed. Results: Thirty-five patients (58.3 %) were fluid responders and 25 (41.7 %) non-responders. Non-responders exhibited lower IVCCI and higher prevalence of diastolic dysfunction, particularly grades II–III. The simplified LUS score (cut-off ≥ 11) showed excellent discrimination of fluid unresponsiveness [AUC 0.913 (95 % CI 0.844 – 0.983)]. The quantitative 8-zone score (cut-off ≥ 4) had good performance [AUC 0.834 (95 % CI 0.732 – 0.942)], while the qualitative protocol had the highest specificity for discriminating fluid unresponsiveness (sensitivity 76 %, specificity 85.5 %). Combining LUS with echocardiography improved identification of patients unlikely to benefit from further fluid. Conclusion: LUS, particularly the simplified protocol, may serve as a bedside tool to predict fluid unresponsiveness and guide resuscitation endpoints in septic shock. Combined with echocardiography, it supports a multimodal, individualised approach that minimises overload risk.
The Development of Polyclonal Antibody Against Glucose-6-Phosphate Dehydrogenase (G6PD) for G6PD Deficiency Newborn Screening in Indonesia
Background/Aim: Glucose-6-phosphate dehydrogenase (G6PD) deficiency, an enzymatic disorder affecting carbohydrate metabolism, is a common cause of haemolytic anaemia and jaundice in newborns. Despite the proven benefits of G6PD screening, Indonesia faces significant challenges in implementing nationwide programs. Standard screening via dried blood spot (DBS) samples has limitations, prompting the need for improved diagnostic methods. This study aimed to develop a more sensitive and accessible screening method by creating polyclonal antibodies against G6PD. Methods: G6PD protein was isolated from newborn cord blood and confirmed using western blot analysis. The rabbits were immunised with purified G6PD antigen. The polyclonal antibody with the highest titre was purified by SAS method. Results: Western blotting confirmed the presence of G6PD at approximately 56 kDa in the isolated protein fraction. Immunised rabbits showed a significant increase in antibody titre compared with the control group. This research successfully isolated G6PD and produced polyclonal antibodies against it. However, further work is required to fully characterise the antibody and evaluate its suitability for G6PD deficiency screening. This antibody development holds promise for creating a dipstick kit for G6PD deficiency screening, thus overcoming the limitations of the DBS method. Colloidal gold-based immunochromatographic strips could be a suitable platform for such a kit due to their ease of use and rapid results. Conclusion: Presented findings constitute a solid foundation for introducing a novel immunochemical reagent and developing a rapidly scalable protocol for producing G6PD-specific antibodies.
The Phytochemical Screening of Ethanolic Extract of Kopasanda (Chromolaena Odorata (L) RM King and H Rob) Leaves and Its Anti-Hyperglycaemic Activity in the Mouse Model Of Hyperglycaemia
Background/Aim: Hyperglycaemia is a defining feature of diabetes mellitus, a chronic metabolic disorder. Complications of diabetes mellitus may include vascular issues both macrovascular and microvascular as well as nervous system abnormalities or neuropathy. The herb “Kopasanda” (Chromolaena odorata (L)) has been shown to reduce blood glucose levels. This study aimed to investigate the antihyperglycaemic potential of ethanol-extracted Kopasanda leaves in male mice induced with oral glucose. Phytochemical screening was conducted to confirm the presence of bioactive constituents by identifying secondary metabolites. Methods: The test animals were randomly divided into five groups. Three groups were administered ethanol extract of C odorata leaves at doses of 5, 10 and 20 mg/kg body weight (bw) orally. The positive control group received glibenclamide (0.013 mg/kg bw), while the negative control group was given a 0.5 % w/v CMC solution at a dose of 2.5 mL/kg body weight orally. Results: Administration of the ethanol leaf extract at a dose of 5 mg/kg bw resulted in a significant 55.21 % reduction in blood glucose levels. A 38.24 % decrease was observed in the group receiving 10 mg/kg bw while a notable reduction was also recorded at the 20 mg/kg. These findings were statistically significant compared to the negative control (p < 0.05). Conclusion: Phytochemical analysis confirmed the presence of alkaloids, flavonoids, saponins and tannins in the ethanol extract of C odorata L leaves. The extract demonstrated notable antihyperglycaemic effects.
Phytochemical Profiling and Antioxidant Assessment of Indian Cymbalaria Muralis Extracts
Background/aim: Cymbalaria muralis (ivy-leaved toadflax) is a small creeping plant native to Europe, South Africa and some regions of India. Indian Cymbalaria muralis is recognised as a plant of traditional importance, but scientific literature available for its pharmacological activities as well as its bioactive constituents is very limited, hence this plant draws more attention for research. Aim of this study was to access phytochemical profile and potential antioxidative potential. Methods: Phytochemical profiling of Indian Cymbalaria muralis methanolic (CMME) and aqueous extract (CMAE) was carried using gas chromatography-mass spectrometry (GC-MS) and liquid chromatography–tandem mass spectrometry (LC-MS/MS) techniques and LC-MS/MS techniques. In addition to determining total phenolic content (TPC) and total flavonoid content (TFC), antioxidant activity of both extracts was evaluated using DPPH radical scavenging method. Results: The GC-MS spectrum of CMME and CMAE showed a presence of 52 compounds (86 peaks) and 8 compounds (11 peaks) respectively with majority of compounds corresponding to fatty acids or lipids. LC-MS/MS studies further confirmed the presence of some anticipated compounds, namely apigenin, luteolin, chrysoeriol 7-glucosides, 7-glucuronides, apigenin 7-O-glucoside, chrysoeriol 7-rutinosides, diosmin, catapol, linarin, glucosyringic, 8-epimuraloside and 8-epiloganic acid with discovery of 3 novel metabolites namely harpagide, aucubin and actinidine. The total phenolic content (TPC) was found to be 91.33 ± 0.67 mg/g (CMME) and 68.75 ± 0.65 mg/g (CMAE), total flavonoid content (TFC) in CMME and CMMA was 30.16 ± 0.15 mg/g and 10.04 ± 0.17 mg/g respectively. In DPPH radical scavenging activity, CMME was found as better antioxidant (IC50-40.82 g/mL) in comparison to CMAE (IC50-75.20 g/mL). Conclusion: The Indian Cymbalaria muralis exhibited remarkable antioxidant activity and rich phytochemical profile.
The Silent Crisis: Economic Burden of Diagnosis for Genetic Diseases in Low- and Middle-Income Countries (LMICs)
Genetic disorders, although secondary to infectious and non-communicable diseases in the global health priority agenda, are an important drain, albeit ill-defined, on the economies of low- and middle-income countries (LMICs) and on their health resources. The economic costs of diagnosing a genetic disorder in these settings, both direct and indirect, are detailed in the narrative review. Direct costs include the significant expense of advanced molecular diagnosis, inadequate infrastructure and dependence on expensive foreign services, which are largely financed through catastrophic, out-of-pocket payments. Indirect costs include the prolonged and expensive “diagnostic odyssey,” the loss of productivity in patients and patients’ relatives and the costs to society of misdiagnosis and avoidable disability. This emergency can be addressed by investing in strategic local diagnostic capacity, task-shifting and innovative finance models to enable equal access to genomic medicine and to break the vicious cycle of health-related poverty in LMICs.
Post-Polypectomy Syndrome (PPS): A Case Report
A 51-year-old female with unremarkable medical history developed right iliac fossa pain and fever one day post-<span style="mso-style-textoutline-type: none; mso-style-textoutline-outlinestyle-dpiwidth: 0pt; mso-style-textoutline-outlinestyle-linecap: flat; mso-style-textoutline-outlinestyle-join: round; mso-style-textoutline-outlinestyle-pctmiterlimit: 0%; mso-style-textoutline-outlinestyle-dash: solid; mso-style-textoutline-outlinestyle-align: center; mso-style-textoutline-outlinestyle-compound: simple; mso-bidi-font-weight: bold;">polypectomy procedure. Management involved hospital admission for monitoring, supportive care with intravenous fluids and “nothing by mouth (NPO)”, broad-spectrum intravenous antibiotics and analgesia. The case here points the critical importance of post-polypectomy syndrome (PPS) occurring after cold endoscopic mucosal resection (EMR). Clinicians should consider PPS in patients admitted with fever, abdominal pain and raised inflammatory markers within a week of polypectomy, regardless of the technique used. Prompt CT imaging is crucial for accurate diagnosis and to exclude perforation.
Retrieval of Migrated Guidewire Extending From Right Ventricular Apex to the Inferior Vena Cava via Pigtail-Assisted Snaring
Intravascular embolisation of foreign bodies (FB) is a rare, serious complication that may occur during central venous line insertion. A 39-year-old male in a critical condition presented to casualty department with a through-and-through chest gunshot wound. Chest X-ray showed left haemothorax; an urgent chest tube was introduced and central venous access was introduced via the right femoral vein. The guided wire used in the procedure was unintentionally pushed to reach the right ventricular apex. Echocardiography confirmed FB location. Once stabilised, the patient was referred to Iraqi Centre of Cardiac Diseases, where transcatheter retrieval was performed. To stabilise the FB, a 6F pigtail catheter was used to create a U-shaped loop in the guided wire body, coupled with successful snaring. By strategic planning and effective teamwork, retrieval of FB was safely accomplished using a standard catheterisation tool from a high-risk anatomical site without complication.
Global Research Trends on Herbal Medicine for Hypertension: A Bibliometric and Visual Analysis from 1979 to 2025
Hypertension is a major risk factor for cardiovascular disease globally. Despite widespread availability of conventional treatments, blood pressure control rates remain low globally. Herbal medicine is an alternative or complementary medicine that is gaining increasing attention. Scientific analysis is needed to understand the dynamics of global research on this topic. This study uses a data-driven bibliometric approach from Scopus, covering publications from 1979 to 2025. The analysis was conducted using Biblioshiny and VOSviewer software to evaluate publications, collaborations and keyword trends. A total of 2,954 documents were analysed with an annual growth rate of publications of 9.74 % and an average of 31.38 citations per document. China, the United States and India were the countries with the highest contributions in terms of both publications and citations. Institutions such as the China Academy of Chinese Medical Sciences and China Medical University emerged as the most active research centres. Plants such as Allium sativum, Hibiscus sabdariffa and Olea europaea were the main focus of research. Keyword clusters indicated two major focuses: clinical and pharmacological aspects. International collaboration was still relatively low (17.81 %) but showed potential for growth. Research on herbal medicine for hypertension shows steady growth and multidisciplinary approaches.
Background: Amniotic band disease (ABD) is a rare condition, generally associated with three types of anomalies: malformations, deformities and amputations. Several theories have been put forward, the extrinsic theory being the most widely adopted. The aim of the study was to clarify the pathophysiology of the disease, to propose a new classification and to precise the therapeutic indication through a radio-clinical description of seventy-five amniotic bands in ten patients. Methods: This was a descriptive radio-clinical and surgical study of 75 amniotic bands in amniotic disease. The clinical features were used to describe the type of amniotic band: deep (impeding vascular circulation, compressing soft tissues and bone) or superficial cutaneous with a good prognosis. The shape of the band was described as semicircular, circular, heliocoidal or complex figure of two linked circles shaping the number 8 flat/bended. There were 5 mild constrictions without lymphedema, 28 moderate (constrictions without lymphedema in 7 cases and severe constrictions with lymphedema in 21 cases) and 41 amputations (one leg and 40 fingers and toes). Surgical treatment involved 16 deep constrictions and three feet. Results: Resection of the amniotic bridges gave an acceptable cosmetic result, but lymphedema persisted. Surgery on both feet enabled walking with plantigrade support. However, the Ponseti technique was used on a child with a severe and complex heliocoid constriction. He developed ischaemia, requiring immediate removal of the cast. Digital separation of the fingers restored a functional hand in particular the pauci-digital pincer, but the aesthetics were judged insufficient by the parents. Conclusions: Based on presented findings, amniotic limb disease should be classified into three types: ‘Type A’ with a good prognosis, ‘Type B’ subdivided into six sub-types and “Type C’ defined by circular or complex constriction. The classification provides a therapeutic orientation. Depending on the type of the constriction band of the disease, different strategies can be envisaged: therapeutic abstention, cosmetic surgery or emergency limb salvage surgery.
Personalised Anaesthesia, Arterial Blood Gases and Tissue Hypoxia: Modulating Postoperative Regeneration and Healing
The fundamental limiting factor of major surgery is the body's ability to regenerate and heal tissue after it has been operated on, but this process must take its own course. Recent evidence is available to show that the method of anaesthesia employed during operative procedures and in particular the maintenance of arterial blood gases (ABG), may have a significant influence on regenerative processes by altering, as the case may be, the degree of hypoxia present within tissues. This narrative review addresses the issue of an individualised plan of anaesthesia, aiming to maintain a constant and progressive improvement in oxygen tension (PaO2) and carbon dioxide tension (PaCO2), as well as their impact on cellular repair processes. The view taken is that the best results cannot be attained by a rigid generalised state of normoxia, but by individualising the treatment by the means of the arterial blood gas results to achieve ends which will have a bearing upon such factors as hypoxia-inducible factor 1-alpha (HIF1α), which refers to a factor evidenced in the regulation of angiogenesis, collagen synthesis and the processes of wound healing. We are considering important clinical experiments and data, taking into account oxygenation strategies, ventilation policies and methods of checking that support individual arterial blood gas aims with the goal of improving the quality of recovery and outcomes beyond the operative phases.