Comparative effectiveness and safety of novel antidiabetic agents in the management of obstructive sleep apnea: a systematic review, meta-analysis, and network meta-analysis.

Evaluation of the electronic consultation tool between primary care pharmacists and general practitioner for resolving potentially inappropriate prescriptions and drug-related problems

Design, synthesis, and antidiabetic evaluation of triazolopyrimidine thioacetamides as potent and selective α-glucosidase inhibitors.

Background: Metabolic syndrome (MetS) is a multifactorial clinical entity characterized by a cluster of conditions—including central obesity, insulin resistance, dyslipidemia, and hypertension—that significantly increase the risk of cardiovascular disease and type 2 diabetes. Its prevalence is rising globally, with substantial implications for healthcare systems. Objective: This review aims to describe the clinical and epidemiological characteristics of metabolic syndrome in the adult population and to analyze the currently available diagnostic criteria and therapeutic strategies. Methods: A narrative review of the recent scientific literature was conducted, including studies published from 2015 to 2025 in databases such as PubMed, Scopus, and Web of Science. Diagnostic criteria from major health organizations (ATP III, IDF, WHO) were reviewed, as well as therapeutic approaches including lifestyle interventions, pharmacological treatments, and emerging therapies. Results: Metabolic syndrome affects approximately 20–30% of the adult population worldwide, with variations by age, sex, ethnicity, and socioeconomic status. The most widely used diagnostic criteria include central obesity measured by waist circumference, triglyceride and HDL cholesterol levels, blood pressure, and fasting glucose. Treatment focuses primarily on weight reduction through diet and physical activity, control of individual components with medications, and management of underlying insulin resistance. New therapies targeting the gut microbiome and novel antidiabetic agents (e.g., GLP-1 receptor agonists, SGLT2 inhibitors) show promise. Conclusion: Metabolic syndrome remains a major public health challenge. Early identification and a multidisciplinary approach to treatment are essential to reduce the risk of long-term complications. Future research should focus on personalized therapeutic strategies and prevention programs adapted to different populations.

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder requiring combination therapy for optimal control. Dapagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, offers added metabolic and cardiovascular benefits with other oral antidiabetic agents. This study aimed to assess healthcare professionals’ (HCPs) real-world experience with dapagliflozin-based regimens in Indian patients with T2DM, focusing on glycaemic outcomes, metabolic benefits, and safety. Methods: This multicentre, questionnaire-based study was conducted among 104 HCPs, including endocrinologists, diabetologists, and general physicians across India. The structured 17-item questionnaire assessed patient demographics, comorbidities, dietary compliance, glycaemic control, HbA1c reduction with various combination therapies, weight changes, adverse events, and treatment adjustments based on the last 10 patients managed by each HCP. Descriptive analysis was performed, and outcomes were expressed as percentages. Results: Most HCPs (63.46%) reported that their patients were older than 55 years, and 60.58% had diabetes for more than three years. Chronic kidney disease (40.38%) and dyslipidaemia (31.73%) were the most common comorbidities. Nearly half of the HCPs (48.08%) reported an HbA1c reduction of 1.25%-1.5% with dapagliflozin (10 mg) and vildagliptin (100 mg). The triple combination of dapagliflozin, vildagliptin, and metformin showed similar efficacy. Most HCPs (77.88%) reported no significant side effects, with minimal discontinuations (72.12%) and infrequent hypoglycaemic episodes. Additionally, 66.35% observed weight reduction in 6-10 patients receiving dapagliflozin-based therapy. Conclusion: Dapagliflozin-based combinations are well tolerated and effective for glycaemic control and metabolic improvement in Indian T2DM patients. Vildagliptin and metformin combinations were preferred for those with high HbA1c and cardiovascular risk. These findings support the safety and utility of dapagliflozin regimens, though larger studies are needed for validation.

Evogliptin, a dipeptidyl peptidase-4 inhibitor with a glucose-dependent mechanism of action, is widely used as a monotherapy or in combination with other agents. However, observational studies in routine clinical settings remain limited. This study aimed to evaluate the effectiveness and safety of evogliptin in combination with other antidiabetic agents frequently used in clinical practice. This study was conducted in 51 hospitals in South Korea. We evaluated evogliptin in three groups: the evogliptin add-on, evogliptin-switching, and initial combination groups. The primary endpoint was the change in haemoglobin A1c (HbA1c) levels (%) from baseline to 12 weeks. The change in HbA1c (%) levels from baseline to 24 weeks was a secondary endpoint in the extended study. Proportions of patients achieving the HbA1c target, changes in fasting and postprandial glucose levels, and safety endpoints were also evaluated. Between-group comparisons were performed between the add-on and initial combination groups. In the 1596 patients of the effectiveness set, the mean changes in HbA1c levels at 12 weeks were -0.8% ± 1.2%, -0.3% ± 0.8% and -1.9% ± 1.4% for the evogliptin add-on, evogliptin-switching and initial combination groups, respectively. Among the 1920 patients in the safety set, 23 experienced adverse drug reactions, and there was no significant difference among the three groups. Evogliptin reduces blood glucose levels and is well-tolerated when used as an add-on, as a switch from other dipeptidyl peptidase 4 inhibitors, or as part of an initial combination therapy in patients with type 2 diabetes mellitus.

Background/Objectives: This study aimed to evaluate the antidiabetic potential of five extracts/sub-extracts and five known cycloartane saponins [astragalosides (AST) I, II, III, IV, and cyclocanthoside E] from Astragalus noeanus (AN), using four specific diabetes-related molecular targets. Methods: Four diabetes-associated in vitro and in silico targets—protein tyrosine phosphatase 1B (PTP1B), dipeptidyl peptidase IV (DPP IV), α-amylase, and advanced glycation end-products (AGEs)—were employed to obtain comprehensive antidiabetic activity profiles. Additionally, the antioxidant and prebiotic capacities of the extracts/sub-extracts were assessed in vitro. A cycloartane saponin was isolated and structurally characterized. Quantitative analyses of total flavonoids, total saponins, and high-performance thin-layer chromatography (HPTLC) were performed to profile the chemical constituents of the plant material. Results: Among the extracts/sub-extracts, the aqueous extract (ANW) exhibited the highest inhibitory effects against all four diabetes-related targets, with inhibition percentages ranging from 83.70% to 93.49%. The methanol extract (ANM) demonstrated significant prebiotic activity comparable to standard controls on two Lactobacillus strains. The chloroform extract (ANC) showed the highest flavonoid content and exhibited the strongest antioxidant activity across all assays. ANM yielded the highest saponin content (3250 mg escin equivalent/g). HPTLC quantification revealed that AST IV was the predominant saponin in ANM (14.28 μg/mg) after cyclocanthoside E (117.27 ± 6.71 μg/mg). Among the saponins, AST IV displayed the most potent inhibition in diabetes-related enzyme assays, surpassing reference drugs acarbose and vildagliptin at equivalent concentrations. AST III also demonstrated considerable activity, ranking just below AST IV. Molecular docking studies identified AST II and AST III as the most promising ligands, exhibiting superior binding affinities and stronger hydrogen bonding and hydrophobic interactions with target proteins. Cyclocanthoside E was isolated from A. noeanus and evaluated for its antidiabetic effects for the first time, with its structure confirmed by NMR and LC-HRMS analyses. Conclusions: This study highlights Astragalus noeanus as a promising source for safe and effective antidiabetic agents. The potent activity of the aqueous extract, along with AST IV and AST III, warrants further investigation through clinical trials to validate their therapeutic potential in diabetes management.

Background: Despite metformin being the established first-line pharmacotherapy for type 2 diabetes mellitus, many patients require additional antidiabetic agents to achieve glycemic targets. The comparative effectiveness of second-line oral antidiabetic drug classes in real-world clinical settings requires further evaluation. Methods: A prospective observational study was conducted involving 180 patients with inadequately controlled type 2 diabetes on metformin monotherapy, who were prescribed either sulfonylurea (n=60), DPP-4 inhibitor (n=60), or SGLT-2 inhibitor (n=60) as add-on therapy. Glycemic parameters, body weight, and adverse events were assessed at baseline and after 24 weeks of treatment. Results: All three drug classes significantly reduced HbA1c from baseline. The SGLT-2 inhibitor group demonstrated the greatest HbA1c reduction (-1.18 ± 0.42%), followed by sulfonylurea (-1.08 ± 0.48%) and DPP-4 inhibitor (-0.86 ± 0.38%) groups (p=0.001). Significant weight reduction occurred with SGLT-2 inhibitors (-2.84 ± 1.42 kg; p<0.001), while weight gain was observed with sulfonylureas (+1.62 ± 1.18 kg; p<0.001). Hypoglycemia incidence was highest with sulfonylureas (18.3% vs. 3.3% DPP-4 inhibitors vs. 5.0% SGLT-2 inhibitors; p=0.006). Conclusion: SGLT-2 inhibitors and sulfonylureas provide superior glycemic efficacy compared to DPP-4 inhibitors when added to metformin, with SGLT-2 inhibitors offering additional weight reduction benefits and lower hypoglycemia risk.

Carvacrol from Moringa oleifera as a potential antidiabetic agent using integrated in-silico approach inhibiting TCF7L2.

An excessive activation of the tryptophan-kynurenine (TRP-KYN) pathway, frequently observed in metabolic and inflammatory disorders, leads to disturbances in the balance between neurotoxic and neuroprotective metabolites. These alterations may contribute to neuronal dysfunction and cognitive impairment, highlighting the importance of modulating this pathway in the context of neuroprotection. Metformin, apart from the AMPK activation and its broad anti-inflammatory actions, has been indicated as a drug capable of influencing the synthesis of TRP metabolites, including the neuroprotective kynurenic acid (KYNA), whereas the effects of sitagliptin in this regard are not known. Here, the effects of sub-chronic metformin or sitagliptin treatment on the brain levels of kynurenines and on functional alterations within the TRP-KYN pathway were evaluated in vivo, in adult non-diabetic Wistar male rats. A 5-day treatment with metformin decreased cortical TRP and KYNA, hippocampal KYN, and cerebellar levels of all studied kynurenines, whereas in the striatum, KYNA level increased. In contrast, sitagliptin did not alter the formation of kynurenines in the examined structures. However, both of the tested drugs had a significant impact on TRP/L-KYN or L-KYN/KYNA ratios in different parts of the brain. These findings indicate a prominent region-specific effect of metformin on brain kynurenines. In conclusion, commonly used antidiabetic agents differ in their impact on central TRP metabolism, which may have significant implications for understanding their potential neuroprotective effects and role in cognitive impairment.

Liver transplantation is an effective method for treating end-stage liver failure and certain liver cancers. Survival after this procedure is associated with the development of comorbidities, including before diagnosed diabetes mellitus and new diagnosed post-transplant diabetes mellitus (PTDM). Its pathophysiology differs from that of type 2 diabetes in the general population and reflects a complex interplay between pre-existing metabolic vulnerability (e.g. obesity, insulin resistance, impaired fasting glucose), perioperative stressors, and chronic immunosuppression. Commonly used immunosuppressive drugs, such as calcineurin inhibitors (particularly tacrolimus), mTOR inhibitors, and glucocorticosteroids, affect not only pancreatic function but also contribute to weight gain and chronic inflammation. Therapeutic goals should therefore be individualized according to time since transplantation, comorbidity burden, risk of hypoglycemia, and liver graft and renal function. Aim of the study: The objective of this study is to summarize recent literature on the diagnosis and treatment of PTDM and type 2 diabetes mellitus after liver transplantation. Materials and methods: In this narrative review, we searched the PubMed database to analyze the latest evidence on the treatment and diagnosis of PTDM, and type 2 diabetes mellitus diagnosed before liver transplantation. Results: We discuss diagnostic approaches as well as pharmacological and non-pharmacological treatment strategies for these metabolic disorders in patients receiving long-term immunosuppression. Conclusions: Interdisciplinary care and integration of lifestyle interventions are essential to optimize metabolic and cardiovascular risk management in liver transplant recipients. There remains a strong need for further clinical trials evaluating the safety and efficacy of oral antidiabetic agents in this specific patient population.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) represent a novel class of antidiabetic agents recognized not only for their efficacy in glycemic control and weight management but also for their distinctive cardiovascular benefits. Type 2 diabetes mellitus, a prevalent chronic metabolic disorder worldwide, frequently coexists with chronic inflammatory airway diseases (CIADs), including chronic obstructive pulmonary disease (COPD), asthma, and obstructive sleep apnea (OSA). In recent years, growing attention has been directed toward the potential role of GLP-1RAs in the context of CIADs. This review examines the mechanistic underpinnings of GLP-1RAs in CIADs and evaluates their therapeutic potential in COPD, asthma, and OSA. Clinical evidence indicates that GLP-1RAs can reduce the risk of acute exacerbations in COPD, attenuate obesity-associated asthma exacerbations, and improve respiratory outcomes in patients with OSA. Although certain findings remain inconsistent and prospective clinical studies are still limited, the therapeutic promise of GLP-1RAs in CIADs has been preliminarily supported. Further large-scale randomized controlled trials are warranted to clarify their precise effects in chronic inflammatory airway diseases and to assess long-term efficacy and safety.

The alarming rise of multidrug-resistant (MDR) bacteria, particularly Salmonella spp., has prompted an urgent search for alternative and synergistic antimicrobial strategies. In this study, a novel, green, and multicomponent nanocomposite was synthesized by integrating zinc oxide nanoparticles (ZnO NPs), chitosan (CS), the β-lactam antibiotic ceftazidime (CAZ), and the antidiabetic agent metformin (MTF) straightforward and economical manner. Bacillus subtilis strain ATCC 6633 was used to biosynthesize ZnO NPs, acting as a reliable bio-nanofactory. Various characterization techniques such as FTIR, XRD, TEM, and zeta potential analysis verified the successful integration and structural integrity of the ZnO NPs within the CS nanocomposite containing CAZ and MTF (ZnO/CS/CAZ/MTF). The FTIR spectra confirmed the presence of proteins that act as binding and supportive agents during the biosynthesis process. The produced nanomaterials have a significant positive surface charge of +28.61 mV, which enhances their stability. The particle sizes of the NPs ranged from 9.93 to 17.44nm. The nanocomposite exhibited strong antibacterial activity against MDR Salmonella enterica subsp., enterica serovar Typhi ATCC 19214, showing a significantly increased inhibition zone of 42mm and a greatly reduced minimum inhibitory concentration (MIC) value of 8µg/ml, compared to the separate components. The minimum bactericidal concentration (MBC) value was found to be consistent with the MIC result, emphasizing the potent bactericidal action of the prepared nanocomposite. In silico molecular docking further supported these findings by revealing favorable interactions between the nanocomposite constituents and the outer membrane proteins (OMPs) of Salmonella enterica serovar Typhimurium (PDB ID: 4W4M) and S. typhi (PDB ID: 3UU2). Key interactions included hydrogen bonding, ionic forces, and metal coordination with critical residues. Cytotoxicity assessment using WI-38 lung fibroblast cells revealed an IC₅₀ of 84.26µg/ml, indicating acceptable preliminary biocompatibility. The present study demonstrates the novelty of a ZnO-based multicomponent nanocomposite that uniquely integrates CAZ, MTF, and CS. This novel formulation exhibited synergistic antibacterial effects against multidrug-resistant Salmonella enterica alongside acceptable in vitro safety. The findings underscore the potential of microbially synthesized nanocomposites as promising candidates for combating antibiotic-resistant bacterial infections and support further preclinical investigations.

Herbal medicine has a long-standing history in the treatment of various ailments, but conventional formulations often suffer from poor solubility, low bioavailability, and variable pharmacokinetics. Integration of nanotechnology with herbal pharmacology—termed herbal nanopharmacology—offers solutions to these limitations, enabling targeted delivery, controlled release, and enhanced therapeutic efficacy. This review explores recent advances in herbal nanocarriers, including liposomes, polymeric nanoparticles, solid lipid nanoparticles, and nanostructured lipid carriers, focusing on formulation strategies, characterization techniques, pharmacological applications, and clinical translation challenges. Future perspectives emphasize precision herbal therapy, synergistic formulations, and regulatory considerations.

ABSTRACT The advancement in environmentally sustainable synthetic methodologies for the bioactive heterocycles has become a central focus in modern organic chemistry. In this work, we have disclosed an efficient, cost‐effective, and environmentally benign protocol for the synthesis of pyrimido[4,5‐ b ]quinoline and pyrido[2,3‐ d ]pyrimidine scaffolds involving cyclic 1,3‐dicarbonyls, aryl aldehydes, and 6‐aminouracil. Using L‐proline taurinate (LPT) as a homogeneous ionic catalyst, this method facilitates the efficient synthesis of target compounds in excellent yields. The broad substrate scope was validated through reactions involving various aryl/heterocyclic aldehydes and 1,3‐dicarbonyls such as 1,3‐cyclohexanedione, dimedone, 5‐methyl‐1,3‐cyclohexanedione, and Meldrum's acid. Fourteen derivatives, including 12 new compounds, were obtained using this method in excellent yields (88%–97%) within 10–25 min. The synthesized derivatives were well confirmed through spectral studies. The plus points of this approach include the use of an environmentally benign catalyst, straightforward product isolation, gram‐scale synthesis, and recyclability for up to five cycles. In addition, all the synthesized derivatives were docked into the active site of the α ‐amylase protein (PDB ID: 5E0F) to evaluate their potential as antidiabetic agents and observed the binding energy between −8.18 and −9.78 kcal/mol.

Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycaemia, which leads to severe complications such as nephropathy, neuropathy, retinopathy, and cardiovascular diseases. Among various therapeutic approaches, inhibition of carbohydrate-hydrolyzing enzymes, particularly α-amylase and α-glucosidase, has emerged as an effective strategy to delay glucose absorption and control postprandial hyperglycaemia in non-insulin-dependent diabetes mellitus (NIDDM). In recent years, increasing attention has been directed toward natural sources for identifying potent enzyme inhibitors, with phytoconstituents such as alkaloids, flavonoids, terpenoids, glycosides, anthocyanins, and phenolic compounds showing significant promise. These bioactive plant-derived compounds not only act as α-amylase and α-glucosidase inhibitors but also exhibit multifaceted mechanisms, including stimulation of insulin secretion, improvement of insulin sensitivity, and regulation of glucose homeostasis. This review highlights the therapeutic potential of medicinal plants and their phytoconstituents as promising alternatives or complementary strategies for the management of diabetes mellitus.

Introduction: GLP-1 receptor agonists (GLP-1RAs) are drugs used in the treatment of type 2 diabetes and obesity, and are believed to have potential neuroprotective properties. Decreased glucose metabolism in the brain, the development of neuronal insulin resistance, and abnormal tau protein phosphorylation and amyloid-β deposition all play important roles in the pathogenesis of Alzheimer's disease (AD). Numerous preclinical studies in animal models have demonstrated that GLP-1 analogs, such as liraglutide and lixisenatide, are capable of crossing the blood-brain barrier, stimulating neurogenesis, limiting tau hyperphosphorylation, reducing amyloid-β deposition, and improving synaptic and cognitive functions. Data from clinical and observational studies suggest that GLP-1RA use in patients with type 2 diabetes is associated with a reduced risk of developing dementia, including AD. In large retrospective analyses, semaglutide therapy reduced the likelihood of a first diagnosis of Alzheimer's disease by 40–70% compared with other antidiabetic agents. In a randomized trial, liraglutide prevented the decline in brain glucose metabolism in patients with AD, but had no significant effect on amyloid-β levels or cognitive function. Review methods: A comprehensive analysis of research papers available on PubMed and Google Scholar was conducted using keywords: Alzheimer's disease, neurodegeneration, GLP-1 analogues, liraglutide, dementia, tau, diabetes, obesity Conclusion: Accumulating evidence suggests that GLP-1 agonists may be a promising therapeutic option for the prevention and treatment of neurodegenerative diseases. However, further randomized clinical trials are necessary to confirm their efficacy in patients with Alzheimer's disease. Keywords: Alzheimer's disease, neurodegeneration, GLP-1 analogues, liraglutide, dementia, tau, diabetes, obesity

Type2 diabetes mellitus (T2DM) necessitates long-term pharmacological management, with drug safety now a pivotal factor in therapy selection. Sodium‒glucose cotransporter2 inhibitors (SGLT2is) and dipeptidyl peptidase4 inhibitors (DPP4is) are widely prescribed oral antidiabetic agents; however, their comparative safety profiles remain under debate. A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science was performed up to June 2, 2025. Forty-two randomized controlled trials (RCTs) that compared SGLT2is with DPP4is in adults with T2DM were included. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using Review Manager (RevMan) 5.3. Heterogeneity was assessed with I2, and publication bias with funnel plots and Egger's test. SGLT2is were associated with a higher overall risk of total adverse events (AEs) (RR1.05, 95%CI 1.01-1.08). Infection-related risks included increased genital infections (RR5.31, 95%CI 3.93-7.18) and urinary tract infections (UTIs) (RR1.45, 95%CI 1.25-1.70), with no difference in upper respiratory tract infections (URTIs) (RR0.78, 95%CI 0.61-1.02). For organ injury, a non-significant trend toward renal injury was noted (RR1.83, 95%CI 0.92-3.67), with no difference in liver injury (RR0.64, 95%CI 0.28-1.46) or fracture (RR0.83, 95%CI 0.25-2.70). Severe outcomes-including hypoglycemia (RR1.07, 95%CI 0.88-1.29), mortality (RR1.48, 95%CI 0.59-3.71), diabetic ketoacidosis (DKA) (RR2.99, 95%CI 0.31-28.45), and major adverse cardiovascular events (MACEs) (RR1.21, 95%CI 0.35-4.19)-did not differ. Hypersensitivity risk was also comparable (RR1.25, 95%CI 0.65-2.42). SGLT2is have an overall favorable safety profile but increase the risks of genitourinary infections and transient renal impairment. Risk stratification and monitoring are essential for high-risk individuals, for whom DPP4is may be safer. These findings provide robust RCT-based evidence to inform individualized treatment and guideline updates. This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. The protocol was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD420251115623).

Diabetes mellitus is a leading global health problem, with type 2 diabetes being the main type and already very inefficient treatments posing a challenge. Plant-based compounds, especially those that are naturally occurring have become very popular lately and are regarded as major sources of new antidiabetic drugs owing to the diversity of their structures and the fact that they act on multiple targets at the same time. One of these groups of compounds is coumarins, which have proved to be an important class of bioactive substances with considerable antidiabetic properties. The review that we are presenting gives an inclusive report on the occurrence of natural coumarins and their derivatives with antidiabetic activity being reported, along with the discussion of their mechanisms of action that include among others the inhibition of the enzymes that digest carbohydrates, increase of the insulin sensitivity, regulation of the glucose uptake, protection of the pancreatic β-cells and regulation of oxidative stress and inflammation. Also, the structure-activity relationships of coumarin derivatives are discussed to bring out the important functional features that are responsible for the biological activity. Moreover, the latest developments in drug design, molecular docking studies and the therapeutic prospects of coumarin-based antidiabetic agents have been reviewed. Overall, this review has pointed out the plant-based coumarins as being very versatile scaffolds in the development of antidiabetic therapeutics that are both safe and effective with fewer side effects.

Murraya koenigii (L.) Spreng, often known as Curry or Kari, has long been used in traditional medicine as a multi-potential medicinal plant and as a food seasoning. Curry possesses bioactivity and is known to be active as an antitumor, antioxidant, antimutagenic, anti-inflammatory, antidiabetic, antidysenteric, stimulant, and antibacterial agent. This bioactivity depends on its metabolite profile, which changes during development. This study aimed to determine the metabolite profile and bioactivity of Curry leaves across developmental stages using GC-MS metabolomic profiling. The results of the research revealed a total of 35 with 19 classified as terpenoids, 6 as esters, 4 as organic acids, 1 to the fatty acid group, and 5 to the unknown class from compounds in young, mature, and old Curry leaves. Caryophyllene was the dominant compound in young, mature and old leaves, with anti-inflammatory, antibacterial, anticancer, and germ-fighting activities. In mature leaves, the dominant compound was 1-Methyl-pyrrolidine-2-carboxylic acid, which functions as a moisturizing agent and humectant agent. Referring to the variety of compounds and bioactivities found in Temurai leaves, they have the opportunity to be developed as medicinal ingredients.