Purpose Hyperinflammation in severe COVID-19 infection increases the risk of respiratory failure and one of the cogent reasons of mortality associated with COVID-19. Baricitinib, a janus kinases inhibitor, can potentially suppress inflammatory cascades in severe COVID-19 pneumonia. Methods The objective of this study was to compare the clinical outcomes of high dose of baricitinib with its usual dose in patients with severe COVID-19 pneumonia. This prospective cohort study was conducted on 238 adult patients with severe COVID-19 pneumonia. Eight milligram and 4 mg of baricitinib was given orally to 122 patients in the high dose (HD) group and 116 patients the usual dose (UD) group, respectively daily for 14 days, and clinical outcomes were compared among the groups. Results Blood oxygen saturation level was stabilized (≥94% on room air) earlier in the HD group compared to the UD group [5 (IQR: 4–5)/8 (IQR: 6–9), P < 0.05]. Patients in the HD group required intensive care unit (ICU) and intubation supports more in the UD group than that in patients of the HD group [17.2%/9%, P < 0.05; 11.2%/4.1%, P > 0.05; N = 116/122, respectively]. The 30-day mortality and 60-day rehospitalization rate were higher in the UD group than the HD group [6%/3.3%, P < 0.01; 11.9%/7.6%, P > 0.05; N = 116/122, respectively]. Conclusion The daily high dose of baricitinib in severe COVID-19 results in early stabilization of the respiratory functions, declined requirements of critical care supports, reduced rehospitalization with mortality rate compared to its daily usual dose.

BackgroundUnderstanding injection practices is crucial for evidence-based development of intervention initiatives. This study explored the extent of injection use and injection safety practices in primary care hospitals in Bangladesh.MethodsThe study employed both quantitative and qualitative research methods. The methods used were - a retrospective audit of prescriptions (n = 4320), focus group discussions (six with 43 participants), in-depth interviews (n = 38) with a range service providers, and systematic observation of the activities of injection providers (n = 120), waste handlers (n = 48) and hospital facilities (n = 24). Quantitative and qualitative data were assessed with statistical and thematic analysis, respectively, and then combined.ResultsAs many as 78% of our study sample (n = 4230) received an injection. The most commonly prescribed injections (n = 3354) including antibiotics (78.3%), IV fluids (38.6%), analgesics/pain killers (29.4%), vitamins (26.7%), and anti-histamines (18.5%). Further, 43.7% (n = 1145) of the prescribed antibiotics (n = 2626) were given to treat diarrhea and 42.3% (n = 600) of IV fluids (n = 1295) were used to manage general weakness conditions. Nearly one-third (29.8%; n = 36/120) of injection providers reported needle-stick injuries in the last 6 months with highest incidences in Rajshahi division followed by Dhaka division. Disposal of injection needles, syringes and other materials was not done properly in 83.5% (n = 20/24) of the facilities. Health providers' safety concerns were not addressed properly; only 23% (n = 28/120) of the health providers and 4.2% (n = 2/48) of the waste handlers were fully immunized against Hepatitis B virus. Moreover, 73% (n = 87/120) of the injection providers and 90% (n = 43/48) of the waste handlers were not trained in injection safety practices and infection prevention. Qualitative data further confirmed that both providers and patients preferred injections, believing that they provide quick relief. The doctors' perceived injection use as their prescribing norm that enabled them to prove their professional credibility and to remain popular in a competitive health care market. Additionally, persistent pressure from hospital administration to use up injections before their expiry dates also influenced doctors to prescribe injections regardless of actual indications.ConclusionsAs far as the patients and providers' safety is concerned, this study demonstrated a need for further research exploring the dynamics of injection use and safety in Bangladesh. In a context where a high level of injection use and unsafe practices were reported, immediate prevention initiatives need to be operated through continued intervention efforts and health providers' training in primary care hospitals in Bangladesh.

BackgroundOleanolic acid (NZ-15), 7 α, 28-olean diol (NZ-38) and Stigmasterol (NZ-14) were isolated from the ethanolic extracts of the roots of Leea macrophylla (Family: Leeaceae) by using chromatographic analysis. This is the first report of isolation of these compounds from this plant. Their structures were constructed by spectroscopic analysis and by comparing the data with the published one. Subsequently the ethanolic extract was fractionated with two organic solvents and all the fractions were studied to evaluate their in vitro antioxidant property.MethodsThe ethanolic extract was fractionated with two organic solvents and all the fractions were studied to evaluate their in vitro antioxidant property by DPPH free radical scavenging assay, superoxide anion radical scavenging assay, nitric oxide radical scavenging assay, and reducing power assay.ResultsIn the DPPH free radical scavenging assay and superoxide radical scavenging assay, the ethyl acetate soluble fraction of ethanolic extract revealed the highest free radical scavenging activity with IC50 value of 2.65 and 155.62 μg/ml, respectively as compared to standard ascorbic acid (IC50 value of 5.8 and 99.66 μg/ml). Ethyl acetate fraction also possessed highest reducing power activity with an EC50 value of 15.27 μg/ml compared to ascorbic acid (EC50 0.91 μg/ml). On the other hand, the carbon tetrachloride fraction exhibited most significant NO scavenging activity with IC50 value of 277.8 μg/ml that was even higher than that of standard ascorbic acid (IC50 value 356.04 μg/ml). In addition, the total phenolic contents of these extract and fractions were evaluated using Folin-Ciocalteu reagent and varied from 7.93 to 50.21 mg/g dry weight expressed as gallic acid equivalents (GAE).ConclusionsThis study showed that different extracts of roots of L. macrophylla possess potential DPPH, superoxide, and NO free radical scavenging activities. The antioxidant activities of the plant extracts might be due to the presence of oleanolic acid, oleanolic acid derivative 7 α, 28-olean diol and stigmasterol.

The petroleum ether, ethyl acetate, and methanol extracts of Phyllanthus reticulatus Poir. (Euphorbiaceae) were chosen for pharmacological screening. In the acetic acid-induced writhing test, the ethyl acetate extract in doses of 150 and 300 mg=kg showed 51.23 and 65.12% inhibition of writhing, respectively. A significant elongation of tail-flick time was evident both in the ethyl acetate and the methanol extracts (42.38 and 60.49%) only at the 300 mg=kg dose level. In carrageenan-induced rat paw edema model, the methanol extract at the 300 mg=kg dose level showed 40.03% inhibition of edema at the end of 4 h. These results demonstrated that the extracts of P. reticulatus possess significant analgesic and anti-inflammatory properties.

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ABSTRACT:Andrographis paniculata (Burm. f.) Wall. ex Nees, commonly known as Kalmegh, is widely used as antimalarial drug in herbal and traditional systems. Andrographolide is the major triterpenoid present in the plant and responsible for its therapeutic activities. The identification and quantification of andrographolide were ascertained by various spectrophotometric and chromatographic analyses. The plant sample was extracted with methanol. The amorphous residue obtained from extraction was analyzed for identification of andrographolide by chemical method, TLC, UV-Vis, FT-IR and LCMS/MS analyses. The quantitative estimation of andrographolide content in plant sample was carried out by simple reversed phase HPLC method with C 18 column using a mixture of water and methanol (35:65) as mobile phase at a flow rate of 0.7 mL/min, and the estimated concentration level of andrographolide was found as 38.36±0.42 µg/mL in the solution of amorphous residue (50 µg/mL). After quantitative determination of andrographolide, standardization of its market preparations was accomplished using the same RP-HPLC method. The estimated % potencies of andrographolide compared to reference standard in six market preparations were found to be 97. 56, 98.37, 98.21, 95.60, 98.91 and 96.40.

RESUMO:As propriedades antinociceptiva, antiinflamatória e diurética dos extratos de P. barbatum (L.) Hara var. barbata, Polygonaceae, nas doses de 200 e 400 mg/kg de peso corpóreo foram avaliadas em modelos utilizando camundongos/ratos, respectivamente, o método de contorções induzidas por ácido acético, o teste de edema induzido por carragenina e o método de Lipschitz. No método de contorções induzidas por ácido acetic, todos os extratos apresentaram efeito nociceptivo dose dependente. O efeito nociceptivo mais potente foi observado com o extrato de éter de petróleo na dose de 400 mg/kg com uma inibição das contorções de 46,8% comparado com o controle positivo de aminopirina de 62,2%. O extrato de éter de petróleo na dose de 400 mg/kg também mostrou maior atividade antiinflammatoria após 2 h com 39,3% de inibição do edema de pata, e este efeito foi maior que o observado para o agente antiinflamatório convencional fenilbutazona (inibição máxima de 38,4% após 4 h). Todos os extratos aumentaram o volume de urina de maneira dose dependente e o extrato acetato de etila mostrou um nível de significância de diurese comparável ao agente diurético padrão, furosemida.Unitermos: Polygonum barbatum var. barbata, Polygonaceae, analgesic, antiinflammatório; diurético, modelo animal. ABSTRACT:The antinociceptive, anti-inflammatory and diuretic properties of the extracts of P. barbatum (L.) Hara var. barbata, Polygonaceae, at the doses of 200 and 400 mg/kg body weight, were evaluated in mice/rat models using, respectively, the acetic-acid-induced writhing method, the carrageenan-induced edema test and the Lipschitz method. In the acetic-acid-induced writhing test in mice, all extracts displayed a dose dependent analgesic effect. The most potent analgesic activity was observed with the petroleum ether extract at the dose of 400 mg/kg body weight with an inhibition of writhing response 46.8% compared to 62.2% for the positive control aminopyrine. Petroleum ether extract at the dose of 400 mg/kg body weight also displayed the highest levels of anti-inflammatory activity after 2 h with the 39.3% inhibition of paw edema, and this effect was better than the effect observed by the conventional anti-inflammatory agent phenylbutazone (maximum inhibition of 38.3% after 4 h). All extracts increased urine volume in a dose-dependent manner, and the ethyl acetate extract showed a significant level of diuresis comparable to that of the standard diuretic agent furosemide.Keywords: Polygonum barbatum var. barbata; Polygonaceae; antinociceptive; anti-inflammatory; diuretic; animal model. INTRODUCTIONPolygonum barbatum (L.) Hara var. barbata (family Polygonaceae), common name 'bekhanjabaj', is a perennial herb found widely in marshy and aquatic places, by the sides of the rivers, seasonally flooded roadsides ditches and small ponds throughout Bangladesh, India and Thailand, and also in many other countries in the south-east Asia (Balza et al., 1989; Kirtikar & Basu, 1999; GRIN Database, 2009 To our knowledge, no pharmacological screening has e...

Currently, viral infection is the most serious health issue which causing unexpected higher rate of death globally. Many viruses are not yet curable, such as corona virus-2 (SARS-CoV-2), human immunodeficiency virus (HIV), hepatitis virus, human papilloma virus and so others. Furthermore, the toxicities and ineffective responses to resistant strains of synthetic antiviral drugs have reinforced the search of effective and alternative treatment options, such as plant-derived antiviral drug molecules. Therefore, in the present review, an attempt has been taken to summarize the medicinal plants reported for exhibiting antiviral activities available in Bangladesh along with discussing the mechanistic insights into their bioactive components against three most hazardous viruses, namely SARS-CoV-2, HIV, and HBV. The review covers 46 medicinal plants with antiviral activity from 25 families. Among the reported 79 bioactive compounds having antiviral activities isolated from these plants, about 37 of them have been reported for significant activities against varieties of viruses. Hesperidin, apigenin, luteolin, seselin, 6-gingerol, humulene epoxide, quercetin, kaempferol, curcumin, and epigallocatechin-3-gallate (EGCG) have been reported to inhibit multiple molecular targets of SARS-CoV-2 viral replication in a number of in silico investigations. Besides, numerous in silico, in vitro, and in vivo bioassays have been demonstrated that EGCG, anolignan-A, and B, ajoene, curcumin, and oleanolic acid exhibit anti-HIV activity while piperine, ursolic acid, oleanolic acid, (+)-cycloolivil-4′-O-β-d-glucopyranoside, quercetin, EGCG, kaempferol, aloin, apigenin, rosmarinic acid, andrographolide, and hesperidin possess anti-HBV activity. Thus, the antiviral medicinal plants and the isolated bioactive compounds may be considered for further advanced investigations with the aim of the development of effective and affordable antiviral drugs.