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Effects of the aqueous extracts of rhodamnia cinerea on metabolic indices and sorbitol-related complications in type 2 diabetic rats

Mustapha Umar Imam, Sasikala M. Chinnappan, Maznah Ismail

Sains Malaysiana, 2017;46:589-595.

There is growing interest in the use of plant bioresources for managing type 2 diabetes. In this study, Rhodamnia cinerea, which is used traditionally to manage diseases in Malaysia, was explored for its antidiabetic effects. Type 2 diabetic rats were managed for 4 weeks using aqueous extract of R. cinerea or quercetin. Weights and fasting glucose were measured weekly, while serum lipid profiles, insulin, antioxidant status, urea, creatinine and liver enzymes were assayed at the end. Sorbitol contents, antioxidant capacities and aldose reductase activities of the kidney, lens and sciatic nerve were also assessed. The results showed that the aqueous extract of R. Cinerea mainly contained Myricitrin and it reduced glycemia (p>0.05), lipid profiles (p<0.05), F2-isoprostanes (p<0.05) and overall metabolic condition of type 2 diabetic rats. R. cinerea also attenuated sorbitol contents of the nerve (p<0.05) and kidney (p<0.05), partly through regulating the activity of aldose reductase (p<0.05 for nerve) and sorbitol dehydrogenase (p<0.05 for kidney) in comparison with diabetic untreated group. Quercetin is a known aldose reductase inhibitor and can improve several metabolic indices related to Type 2 diabetes. In this study, the results of R. cinerea were comparable to or better than those of quercetin, suggesting that R. cinerea extract can be a good candidate for managing Type 2 diabetes and its complications related to sorbitol accumulation.
Fulltext Needs of family members of critically ill patients in a critical care unit at Universiti Kebangsaan Malaysia Medical Centre

Zainah, M., Sasikala, M., Nurfarieza, M.A., Ho, S.E.

Medicine & Health, 2016;11(1):11-21.
MyJurnal

Fulfillment of the family needs for the critically ill patient in Critical Care Unit
should be met by healthcare providers to improve patient’s quality of life. The
purpose of this study was to identify the needs of family members of critically ill
patients in a Critical Care Unit. A cross-sectional study was conducted on 109
family members of patient hospitalized at the Intensive Care Unit and Coronary
Care Units of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). The
modified Critical Care Family Needs Inventory (CCFNI) comprised of 5 domains of
family member’s needs: Information, Proximity, Assurance, Comfort and Support.
The findings showed that assurance and information needs were the highest with
(3.77 ± 0.306); (3.62 ± 0.379), proximity need (3.60 ± 0.415), support need (3.57
± 0.477) and comfort need (3.55 ± 0.586), respectively. There was significant
relationship between respondent’s relationship with family needs of proximity
(p = 0.013). This study indicated that there were significant association between
respondent’s monthly income and family needs of comfort and support, (p = 0.033)
and (p = 0.004). There was also significant association between the gender with
comfort need (p = 0.013). In this study, it was observed that information, proximity,
assurance, comfort and support were opinioned as their requirements during
hospitalization. Hence, it assists in coping while being admitted to Intensive Care
Unit and Coronary Care Unit of UKMMC. An educational package and updating
patient’s information should be emphasized to enhance the family needs of critically
ill patient in the critical care settings.
Fulltext Efficacy of Labisia pumila and Eurycoma longifolia standardised extracts on hot flushes, quality of life, hormone and lipid profile of peri-menopausal and menopausal women: a randomised, placebo-controlled study

Chinnappan SM, George A, Evans M, Anthony J

Food Nutr Res, 2020;64.
PMID: 33061884 DOI: 10.29219/fnr.v64.3665

Background: Interest in herbal medicines and non-hormonal therapies for the treatment of menopausal symptoms has increased since the publication of adverse effects of estrogen replacement therapy. Vasomotor symptoms are the most characteristic and notable symptoms of menopause.
Objective: To investigate the changes in the frequency and severity of hot flush and associated vasomotor symptoms experienced by peri-menopausal and menopausal women supplemented with the herbal formulation (Nu-femme™) comprising Labisia pumila (SLP+®) and Eurycoma longifolia (Physta®) or placebo.
Design: Randomised, double-blind, placebo-controlled, 24-week study enrolled 119 healthy women aged 41-55 years experiencing peri-menopausal or menopausal symptoms and supplemented with Nu-femme™ or placebo. The primary endpoint was comparative changes between treatment groups in the change in the frequency and severity of hot flushes. The secondary objectives were to assess the changes in the frequency and severity of joint pain, Menopause Rating Scale (MRS) and Menopause-Specific Quality of Life (MENQOL) questionnaire domain scores. Concentrations of serum hormone, lipid profile, bone markers, sleep quality and vitality were also studied as secondary objectives.
Results: At week 12, significant (P < 0.01) improvements in hot flush symptoms were observed in Nu-femme™ and placebo groups. Even though there was no significant difference between groups, higher percentage of improvement, 65%, was seen in Nu-femme™ compared to 60% in placebo. Significant improvements (P < 0.001) in MRS and MENQOL scores at weeks 12 and 24 were observed in both groups, respectively. Luteinising hormone and follicle-stimulating hormone levels were significantly reduced (P < 0.05) at weeks 12 and 24, respectively, compared to baseline in the Nu-femme™ group, with no significant changes observed in the placebo group. There were significant (P < 0.05) reductions in serum low-density lipid and triglycerides levels at week 12 in Nu-femme™ group, but no changes seen in placebo group. At the end of week 24, changes in haematology and clinical chemistry parameters remained within normal clinical ranges in both groups.
Conclusion: Herbal formulation consists of L. pumila and E. longifolia (Nu-femme™) may support reduction in hot flushes and improvements in hormone and lipid profile in healthy peri-menopausal and menopausal women.
Fulltext Effect of Eurycoma longifolia standardised aqueous root extract-Physta® on testosterone levels and quality of life in ageing male subjects: a randomised, double-blind, placebo-controlled multicentre study

Chinnappan SM, George A, Pandey P, Narke G, Choudhary YK

Food Nutr Res, 2021;65.
PMID: 34262417 DOI: 10.29219/fnr.v65.5647

Background: Low testosterone levels cause physiological changes that compromise the quality of life in ageing men. A standardised water extract from the root of Eurycoma longifolia (EL), known as Physta®, is known to increase testosterone levels.
Objective: To evaluate the safety and efficacy of Physta® in improving the testosterone levels and quality of life in ageing male subjects.
Design: This randomised, double-blind, placebo-controlled study enrolled 105 male subjects aged 50-70 years with a testosterone level <300 ng/dL, BMI ≥ 18 and ≤30.0 kg/m2. The subjects were given either Physta® 100 mg, 200 mg or placebo daily for 12 weeks. The primary endpoints were changes in serum total and free testosterone levels. The secondary endpoints included changes in the level of sex hormone-binding globulin (SHBG), dihydroepiandrosterone (DHEA), glycated haemoglobin (HbA1c), insulin-like growth factor-1 (IGF-1), thyroid function tests (T3, T4, TSH and Free T3) and cortisol. Changes in Ageing Male Symptoms (AMS) score, Fatigue Severity Scale (FSS) score and muscle strength are other secondary endpoints. The safety of the intervention products was measured by complete blood count, lipid profile, liver and renal function tests.
Results: There was a significant increase in the total testosterone levels at week 12 (P < 0.05) in the Physta® 100 mg group and at weeks 4 (P < 0.05), 8 (P < 0.01) and 12 (P < 0.001) in the Physta® 200 mg group compared to placebo. No significant between-group differences in free testosterone levels were observed but a significant within-group increase occurred at weeks 4 (P < 0.01), 8 (P < 0.001) and 12 (P < 0.001) in the Physta®100 mg group and at weeks 2 (P < 0.01), 4 (P < 0.01), 8 (P < 0.001) and 12 (P < 0.001) in the Physta® 200 mg group. The AMS and FSS showed significant reduction (P < 0.001) in total scores at all time-points within- and between-group in both Physta® groups. DHEA levels significantly increased (P < 0.05) within-group in both Physta® groups from week 2 onwards. Cortisol levels significantly (P < 0.01) decreased in the Physta® 200 mg group, while muscle strength significantly (P < 0.001) increased in both Physta® groups at week 12 in the within-group comparison. There were no significant changes in SHBG. No safety related clinically relevant changes were observed.
Conclusion: Supplementation of Physta® at 200 mg was able to increase the serum total testosterone, reduce fatigue and improve the quality of life in ageing men within 2 weeks' time.
Trial registration: This clinical study has been registered in ctri.nic.in (CTRI/2019/03/017959).
Fulltext Aqueous leaf extract of Clinacanthus nutans improved metabolic indices and sorbitol-related complications in type II diabetic rats (T2D)

Umar Imam M, Ismail M, George A, Chinnappan SM, Yusof A

Food Sci Nutr, 2019 Apr;7(4):1482-1493.
PMID: 31024722 DOI: 10.1002/fsn3.988

Clinacanthus nutans (Burm. f.) Lindau (C. nutans) has been reported to lower blood glucose level; however, evidence on its efficacy in lowering diabetic complications is limited. The antidiabetic properties of C. nutans aqueous leaf extract on serum metabolic indices, sorbitol production, and aldose reductase enzyme activities in the kidneys, lens, and sciatic nerve of type II diabetic (T2D) rats were evaluated. All rats except normal control rats were fed with a high-fat diet for 8 weeks to induce obesity and subsequently injected with 35 mg/kg streptozotocin to induce type II diabetes. Aqueous leaf extract of C. nutans (100 and 200 mg kg-1 day-1) and quercetin (10 mg kg-1 day-1) were fed orally for 4 weeks. Diabetic rats administered with C. nutans at 100, 200 mg kg-1 day-1 and quercetin had significantly (p
Fulltext Nephroprotective Effect of Herbal Extract Eurycoma longifolia on Paracetamol-Induced Nephrotoxicity in Rats

Chinnappan SM, George A, Thaggikuppe P, Choudhary Y, Choudhary VK, Ramani Y, et al.

Evid Based Complement Alternat Med, 2019;2019:4916519.
PMID: 31214269 DOI: 10.1155/2019/4916519

Paracetamol (PCM) is a well-known drug widely used for its analgesic and antipyretic properties. PCM is generally considered as safe but overdose of PCM can cause nephrotoxicity. Traditionally, herbs have been used for the treatment of drug or toxin-induced renal disorders and numerous medicinal plants were tested for nephroprotection effect in PCM-induced nephrotoxicity model. The aim of the present study was to evaluate the protective effect of the herbal extract Eurycoma longifolia (EL) against PCM-induced nephrotoxicity rat model. Forty Wistar rats were randomly divided into five groups of eight rats each: control (vehicle 10 ml/kg), PCM alone (200 mg/kg PCM), EL 100 (EL 100 mg/kg+200 mg/kg PCM), EL 200 (EL 200 mg/kg+200 mg/kg PCM), and EL 400 (EL 400 mg/kg+200 mg/kg PCM). All animals from control group received vehicle daily and animals from groups PCM alone, EL 100, EL 200, and EL 400 received repeated dose of PCM and the assigned treatment of EL daily for a period of 14 days. On the 15th day, serum creatinine, blood urea nitrogen, protein, and albumin were measured in blood and creatinine clearance was measured in urine collected over 24 hours. Kidney sections of all experimental groups underwent histopathological analysis. There was a significant (p<0.05) increase in serum creatinine and blood urea levels in the PCM alone group compared to the treatment groups due to nephrotoxicity. In the treatment groups, there was a dose-dependent protection against PCM-induced changes observed in serum total protein, albumin, urea, and creatinine. Significant (p<0.05) drop was seen in serum creatinine and blood urea content in EL 200 and EL 400 groups. Creatinine clearance significantly increased for EL 200 (p<0.01) and EL 400 (p < 0.001) groups. Serum total protein and serum albumin content were significantly increased (p<0.05) in EL 200 and EL 400 groups compared to PCM alone group. Histopathological examination (H&E staining) of the rat kidneys revealed severe degeneration in the PCM alone group, while there was evidence of significant dose-dependent protection in the treatment groups against PCM-induced changes. The serum and urine biochemical results and histopathology analysis of the kidney indicate the nephroprotective potential of EL extract against PCM-induced nephrotoxicity.
Fulltext Corrigendum to "Nephroprotective Effect of Herbal Extract Eurycoma longifolia on Paracetamol-Induced Nephrotoxicity in Rats"

Chinnappan SM, George A, Thaggikuppe Krishnamurthy P, Choudhary Y, Choudhary VK, Ramani Y, et al.

Evid Based Complement Alternat Med, 2019 07 21;2019:9186747.
PMID: 31428177 DOI: 10.1155/2019/9186747

[This corrects the article DOI: 10.1155/2019/4916519.].
Fulltext Effects of Eurycoma longifolia Jack standardised water extract (Physta) on well-being of perimenopausal and postmenopausal women: protocol for a randomised, double-blinded, placebo-controlled, parallel group study

Muniandy S, Yahya HM, Shahar S, Kamisan Atan I, Mahdy ZA, Rajab NF, et al.

BMJ Open, 2023 Nov 01;13(11):e073323.
PMID: 37914304 DOI: 10.1136/bmjopen-2023-073323

INTRODUCTION: Eurycoma longifolia Jack (EL), profoundly recognised as 'Tongkat Ali', is a medicinal herb originating from Southeast Asia. It is commonly used in traditional 'antiageing' treatments to address decreased energy, mood, libido and hormonal imbalances. While the benefits of EL have been extensively studied among the male population, less attention has been given to its effects on women. Menopause can impact the overall well-being of middle-aged women and incorporation of herbal supplements can aid them in managing the menopausal symptoms.
METHODS AND ANALYSIS: This 12-week randomised double-blind, placebo-controlled, parallel-group study aims to evaluate the efficacy of the standardised water extract of EL known as Physta in increasing the quality of life of perimenopausal and postmenopausal women. The study involves 150 women aged 40-55 years who score more than 61 on the Menopause-Specific Quality of Life (MENQOL) assessment. These participants will be randomised into three groups, receiving Physta at either 50 mg or 100 mg or a placebo. The outcomes measures include mood state, quality of life, fatigue, sleep quality, sexual function and pain score assessed using Profile of Mood State, MENQOL, Chalder Fatigue Scale, Pittsburgh Sleep Quality Index, Female Sexual Function Index and the Brief Pain Inventory questionnaires, respectively. The secondary outcome of the study includes full blood analysis, urine analysis, female reproductive hormone profiling, inflammatory and oxidative stress biomarkers analysis.
ETHICS AND DISSEMINATION: The research protocol of the study was reviewed and approved by the Research Ethics Committee of Universiti Kebangsaan Malaysia (UKM/PPI/111/8/JEP-2021-898). The findings will be disseminated to participants, healthcare professionals and researchers via conference presentations and peer-reviewed publications.
TRIAL REGISTRATION NUMBER: ACTRN12622001341718.