NATURAL PRODUCTS TARGETING NITRIC OXIDE AS A THERAPEUTIC STRATEGY FOR TREATMENT OF HYPERTENSION: A REVIEW Hypertension remains a significant global health challenge, necessitating the exploration of novel therapeutic strategies. Nitric oxide (NO) signaling plays a pivotal role in blood pressure regulation, making it an attractive target for hypertension management. Natural products have garnered considerable attention for their potential to modulate NO signaling pathways and mitigate hypertension. This review provides a comprehensive overview of natural products targeting NO as a therapeutic strategy for hypertension treatment. We systematically examine the mechanisms by which natural compounds enhance NO bioavailability, promote vasodilation, and exert antihypertensive effects. Key natural products are evaluated for their efficacy in preclinical studies. Furthermore, we discuss the challenges and limitations associated with translating preclinical findings to clinical practice. Overall, this review highlights the promising role of natural products in modulating NO signaling pathways and offers insights into their potential as adjunctive therapies for hypertension management. Further research is warranted to elucidate the optimal dosing regimens, long-term effects, and potential drug interactions of natural compounds in diverse patient populations.

Stringent criteria have traditionally guided cervical clearance in trauma patients, particularly those who exhibit mid -line cervical pain or cannot undergo a reliable examination. This can sometimes result in extended periods of cervical immobilisation or necessitate the use of further imaging scans. In the absence of fractures, dislocation, or pathological subluxation on cervical computed tomography (CT) scan, cervical collar can be safely removed. We report a polytrauma case with altered consciousness, where bilateral facet fracture dislocation at the C5/C6 level was initially overlooked. CT scan of the spine revealed traumatic brain injury and lumbar vertebral fracture, and the collar was removed and proceeded with surgical stabilisation. The progress was complicated a pulmonary embolism and CT scan also identified the overlooked cervical injuries. A retrospective review of the initial scan revealed the presence of subtle signs of a small unilateral facet avulsion fragment. Our patient succumbed to his injuries. This discovery underscores the potential for pathologies to be missed with dire consequences. Our case illustrates the severe outcomes that can arise from overlooking a cervical spine injury, underscoring the importance of keeping cervical collars in place for high-risk patients until comprehensive imaging can be performed.

Objective: COVID-19 has gravely affected patients with psychiatric conditions. Potential interactions may occur between psychotropic medications and medications used in treatment of COVID-19. This study aimed to compare the online databases in terms of the quality of drug-drug interaction related information available on them. Methods: 216 drug interactions which included fifty-four psychotropic medication interactions with four COVID-19 drugs across six databases were analyzed by four authors independently. The overall grading of the databases was done on Likert scale independently by the authors using the parameters of ease of understanding for consumers and professionals, level of completeness, discussion on level of evidence and the number of available drugs, congruity with other databases and the mean score was tabulated. Results: Drugbank and Lexicomp had maximum discrepancy. The safety profile of Hydroxychloroquine was the best (eighteen moderate/severe psychotropic medication reactions) while Ritonavir has worst profile with thirty-nine medications. Drugbank had the highest SCOPE score (1.00) for completeness and covid19druginteractions.com had least (0.81). Overall, Liverpool© Drug Interaction Group and Lexicomp scored the highest (23/30 each) and were the best interaction checker software closely followed by Drugs.com (22/30). Medscape and WebMD were the poorest interaction checker databases. Conclusion There is significant variability in the available online databases. Liverpool © Drug Interaction Group and Lexicomp were the most reliable sources for healthcare workers whereas for patients, Drugs.com was the easiest to understand (as it segregates the needs of general consumers and professionals distinctly to explain the interaction).

Introduction: Diabetic Peripheral Neuropathy (DPN), the most common complication of Diabetes Mellitus (DM), is often under-diagnosed and inadequately treated. This study identified the proportion of undiagnosed DPN and its associated risk factors among patients with established type 2 DM (T2DM) in community health clinics in the Gombak district. Methods: A cross-sectional study was conducted in 2 community health clinics within the Gombak district between September and December 2017. Adults with T2DM were selected via systematic random sampling and screened using the Neuropathy Symptoms Score (NSS). Clinical records of participants’ foot examinations were reviewed to identify positive findings of DPN and compared with the NSS. Results: The study’s sample comprised 425 patients. Most had co-morbidities, including hypertension, dyslipidaemia and pre-existing DM-related complications. About two-thirds of them performed no daily foot inspection and had no proper footwear. The proportion of patients with positive NSS was 49.4%. However, only 0.2% were diagnosed with positive DPN in their clinical foot examination record. Conclusion Although a positive NSS was identified in 1 out of 2 patients with established DM, only 0.2% of patients had DPN on their examination records. Most patients had never done daily foot inspections and lacked proper footwear. A positive NSS was associated with uncontrolled diabetes and lower BMI. Proper screening and examination for patients, especially those with uncontrolled diabetes and low BMI, is crucial in identifying DPN to ensure that these diabetic patients receive better preventative care, especially proper foot care and strict diabetic control, to prevent DPN-related complications.
Diabetes ; Diabetic Neuropathies ; Malaysia

By 2050, it is predicted that six million hip fractures will occur each year of which the majority will happen in Asia. Malaysia is not spared from this predicted rise and its rate of increase will be one of the highest in this region. Much of this is driven by our unprecedented growth in the number of older people. Characteristics of individuals with hip fractures in Malaysia mirror what has been reported in other countries. They will be older multimorbid people who were already at risk of falls and fractures. Outcomes were poor with at least a quarter do not survive beyond 12 months and in those that do survive have limitation in their mobility and activities of daily living. Reviewing how these fractures are managed and incorporating new models of care, such as orthogeriatric care, could address these poor outcomes. Experts have warned of the devastating impact of hip fracture in Malaysia and that prompt action is urgently required. Despite that, there remains no national agenda to highlight the need to improve musculoskeletal health in the country

A 68-year-old female presented with a 1-month history of lower back pain with right-sided radiculopathy and numbness. She was diagnosed with lumbar spondylosis and treated conservatively with analgesia and physiotherapy. Imaging showed multiple susuk, a metal alloy, in the lower back region and other regions of the body. The patient had undergone traditional medicine consultation 10 years earlier when the susuk was inserted in the lower back as talisman. The practice of the insertion of susuk is popular in rural East Malaysia and Indonesia. These foreign bodies act as possible causes of chronic inflammation and granuloma formation. In addition, the localised heighten peril upon imaging. This report suggests that the insertion of multiple susuk as talisman carries risk to safety of patients when imaging, and this practice complicates the management of musculoskeletal disorders

The occurrence of a second primary cancer in a cancer survivor is well documented. It may be synchronous or metachronous. Incidence of metachronous cancer involving cervix is 0.82% to 1.33%. One such metachronous cancer is that of breast and cervix. We present a case of a woman who received tamoxifen for invasive ductal cancer of breast following a modified radical mastectomy and subsequently developed adenocarcinoma of cervix after six month of tamoxifen therapy. The role of tamoxifen in pathogenesis of cervical cancer and that of human papillomavirus infection in pathogenesis of both cancer of cervix and breast cancer has been well recognized. In our patient, the adenocarcinoma of cervix (rare occurrence) which is likely due to six month of tamoxifen therapy is a perplexing question. Women diagnosed and treated for breast cancer need to be followed up for development of other metachronous gynecological cancers.
Adenocarcinoma* ; Breast ; Breast Neoplasms* ; Cervix Uteri* ; Female ; Humans ; Incidence ; Mastectomy, Modified Radical ; Neoplasms, Second Primary ; Papillomavirus Infections ; Survivors ; Tamoxifen ; Uterine Cervical Neoplasms

OBJECTIVECalcium Glucarate (Cag), Ca salt of D-glucaric acid is a naturally occurring non-toxic compound present in fruits, vegetables and seeds of some plants, and suppress tumor growth in different models. Due to lack of knowledge about its mode of action its uses are limited in cancer chemotherapy thus the objective of the study was to study the mechanism of action of Cag on mouse skin tumorigenesis.

METHODSWe have estimated effect of Cag on DMBA induced mouse skin tumor development following complete carcinogenesis protocol. We measured, epidermal transglutaminase activity (TG), a marker of cell differentiation after DMBA and/or Cag treatment and [3H] thymidine incorporation into DNA as a marker for cell proliferation.

RESULTSTopical application of Cag suppressed the DMBA induced mouse skin tumor development. Topical application of Cag significantly modifies the critical events of proliferation and differentiation TG activity was found to be reduced after DMBA treatment. Reduction of the TG activity was dependent on the dose of DMBA and duration of DMBA exposure. Topical application of Cag significantly alleviated DMBA induced inhibition of TG. DMBA also caused stimulation of DNA synthesis in epidermis, which was inhibited by Cag.

CONCLUSIONCag inhibits DMBA induced mouse skin tumor development. Since stimulation of DNA synthesis reflects proliferation and induction of TG represents differentiation, the antitumorigenic effect of Cag is considered to be possibly due to stimulation of differentiation and suppression of proliferation.

9,10-Dimethyl-1,2-benzanthracene ; toxicity ; Administration, Topical ; Animals ; Anticarcinogenic Agents ; therapeutic use ; Carcinogens ; toxicity ; Cell Division ; drug effects ; DNA ; biosynthesis ; Enzyme Inhibitors ; toxicity ; Female ; Glucaric Acid ; therapeutic use ; Mice ; Skin Neoplasms ; chemically induced ; enzymology ; prevention & control ; Thymidine ; metabolism ; Transglutaminases ; metabolism