Review of Related Literature

Nutritional and medicinal properties of Star fruit (Averrhoa carambola): A review

Star fruit (Averrhoa carambola), a popular fruit in many parts of the world, is considered
to have many beneficial nutritional and medicinal effects. However, harmful nephrotoxic
and neurotoxic effects have also been described. In this review, we have discussed the
reported beneficial effects of star fruit, explored the potential mechanisms for such
beneficial effects, and outline factors that may affect the safe level of consumption. The
beneficial effects include the following: antioxidant (mediated via L‐ascorbic acid,
epicatechin, and gallic acid), hypoglycemic (mediated via high fiber levels and 2‐
dodecyl‐6‐methoxycyclohexa‐2,5‐diene‐1,4‐dione), hypotensive (mediated via
apigenin), hypocholesterolemic (mediated via micronized fiber), anti‐inflammatory, anti‐
infective, antitumor effects, and immune‐boosting effects. The presence of chronic
kidney disease, gastroenteropathies, chronic pancreatitis, dehydration, consumption on
an empty stomach, and higher concentration of oxalate in fruit/juice consumed
predisposes to toxicity. The level of ingestion at which the beneficial effects transition to
nephrotoxicity and neurotoxicity is still to be accurately ascertained. Furthermore, the
relationship between the amount of star fruit ingested and the severity of toxicity is not
certain and warrants further study.

Efficacy of Sanitizers on Three Types of Tropical Fruits Having Different Skin

Characteristics

The efficacy of removal of known concentrations of E.coli and Staphylococcus

aureus from the fruit surfaces by different concentrations of Chlorine Dioxide,
Hypochlorite, Hydrogen Peroxide, water and heat treatments were studied on three
tropical fruits, star fruit, guava and pineapple. It was found that S. aureus was more
difficult to remove than E.coli from the surface of guava than from star fruit but
pineapple skin offered the highest resistance. This may be due to the firmer attachment
of S. aureus to fruit surfaces than E.coli, due to their ability to form biofilms. Star fruit’s
smooth, waxy cuticle, possibly discourage bacteria from adhering to its surface
compared to guava. Most of the same treatments were only able to reduce the bacteria
cells by <1 log CFU in the case of pineapple. The rough pineapple skin would probably
encourage firm attachment of bacterial cells and also shield them from sanitizing
agents.
Averrhoa bilimbi Linn.: A review of its ethnomedicinal uses, phytochemistry, and
pharmacology
Averrhoa bilimbi Linn. is principally cultivated for medicinal purposes in many tropical
and subtropical countries of the world. Literature survey about this plant shows that  A.
bilimbi is mainly used as a folk medicine in the treatment of diabetes mellitus,
hypertension, and as an antimicrobial agent. The prime objective of this review is to
accumulate and organize literature based on traditional claims and correlate those with
current findings on the use of A. bilimbi in the management of different ailments.
Through interpreting already published scientific manuscripts (1995 through 2015)
retrieved from the different scientific search engines, namely Medline, PubMed,
EMBASE, and Science Direct databases, published articles and reports covering
traditional and scientific literature related to A. bilimbi's potential role against various
ailments have been thoroughly evaluated, interpreted, and discussed. Several
pharmacological studies have demonstrated the ability of this plant to act as
antidiabetic, antihypertensive, thrombolytic, antimicrobial, antioxidant, hepatoprotective,
and hypolipidemic agent. A. bilimbi holds great value in the complementary and
alternative medicine as evidenced by the substantial amount of research on it.
Therefore, we aimed to compile an up-to-date and comprehensive review of A.
bilimbi that covers its traditional and folk medicine uses, phytochemistry, and
pharmacology. Hence, this paper presents an up-to-date and comprehensive review of
the ethnomedicinal uses, different chemical constituents, and pharmacological activities
of A. bilimbi. So far, the biologically active agents have not been isolated from this plant
and this can be a good scientific study for the future antidiabetic, antihypertensive, and
antimicrobial implications. Hence, this review targets at emphasizing the diverse
traditional claims and pharmacological activities of A. bilimbi with respect to carrying out
more scientific studies to isolate active principles through advanced technology.
Hand Sanitizers: A Review on Formulation Aspects, Adverse Effects, and
Regulations

Hand hygiene is of utmost importance as it may be contaminated easily from direct

contact with airborne microorganism droplets from coughs and sneezes. Particularly in
situations like pandemic outbreak, it is crucial to interrupt the transmission chain of the
virus by the practice of proper hand sanitization. It can be achieved with contact
isolation and strict infection control tool like maintaining good hand hygiene in hospital
settings and in public. The success of the hand sanitization solely depends on the use
of effective hand disinfecting agents formulated in various types and forms such as
antimicrobial soaps, water-based or alcohol-based hand sanitizer, with the latter being
widely used in hospital settings. To date, most of the effective hand sanitizer products
are alcohol-based formulations containing 62%–95% of alcohol as it can denature the
proteins of microbes and the ability to inactivate viruses. This systematic review
correlated with the data available in Pubmed, and it will investigate the range of
available hand sanitizers and their effectiveness as well as the formulation aspects,
adverse effects, and recommendations to enhance the formulation efficiency and safety.
Further, this article highlights the efficacy of alcohol-based hand sanitizer against the
coronavirus.
The phytochemistry and medicinal value of Psidium guajava (guava)

Psidium guajava (guava) is well known tropic tree which is abundantly grown for fruit.
Many countries have a long history of using guava for medicinal purposes. This plant
finds applications for the treatment of diarrhea, dysentery, gastroenteritis, hypertension,
diabetes, caries and pain relief and for improvement in locomotors coordination. Its
leaf’s extract is being used as a medicine in cough, diarrhea, and oral ulcers and in
some swollen gums wound. Its fruit is rich in vitamins A, C, iron, phosphorus and
calcium and minerals. It contains high content of organic and inorganic compounds like
secondary metabolites e.g. antioxidants, polyphenols, antiviral compounds, anti-
inflammatory compounds. The phenolic compounds in guava help to cure cancerous
cells and prevent skin aging before time. The presence of terpenes, caryophyllene oxide
and p-selinene produces relaxation effects. Guava leaves contain many compounds
which act as fungistatic and bacteriostatic agents. Guava has a high content of
important antioxidants and has radio-protective ability. Quercetin is considered as most
active antioxidant in the guava leaves and is responsible for its spasmolytic activity. Its
ethyl acetate extract can stop the germ infection and thymus production. Guava
possesses anti-viral, anti-inflammatory, anti-plaque and anti-mutagenic activities. Guava
extract shows antinociceptive activity and is also effective in liver damage inflammation
and serum production. Ethanolic extract of guava can increase the sperm quality as well
as quantity and can be used for the treatment of infertile males.
Kamias (Averrhoa Bilimbi), Starfruit (Averrhoa Carambola), and Karamay
(Phyllanthus Acidus) Fruit Extract as Alternative Stain Remover
This study generally aimed to determine the effectiveness of kamias, star fruit, and
karamay fruit extracts in removing stains. Previous studies revealed the effectiveness of
Kamias as a stain remover, while, this study compared the effectiveness of different fruit
extracts as a stain remover and the potential utilization of other fruit extracts from trees
that are locally available. We determined the cost of making stain remover using
kamias, karamay, and star fruit extracts, the ability of these fruit extracts as a stain
remover in terms of the degree of strain reduction and whitening of the cloth, and
ultimately, the significant difference between the various treatments. Results revealed
that the use of star fruit extract was the cheapest among the four treatments while the
highest cost was incurred using Karamay extract. There was a significant difference
observed between treatments. Bleach was the most effective in removing the stains and
whitening the fabric, followed by the kamias extract. In terms of removing stains,
whitening the cloth, and availability in the neighborhood, the extract was found to have
the best results. We, therefore, recommended the use of kamias extract as an
alternative organic stain remover for fabrics and be used by the households. Being
derived from natural fruit extract and contain no dangerous chemicals, the product is
safe for human use and environment-friendly.

Star fruit nephrotoxicity: a case series and literature review

Star fruit is a popular medicinal fruit in the tropics. Its hypoglycaemic properties are
considered useful in achieving glycaemic control in diabetes. Star fruit induced
nephrotoxicity is a rare cause of acute kidney injury in individuals with both normal and
reduced baseline renal function. We present three cases of acute kidney injury due to
star fruit nephrotoxicity from Sri Lanka, and discuss the published literature on this topic.

Three Sri Lankan patients, all with a background of diabetes, presented to us with acute
nausea and anorexia following recent consumption of star fruit. Two patients
complained of diarrhoea and one patient complained of intractable hiccoughs. They all
had elevated serum creatinine on admission. Two were known to have normal baseline
serum creatinine levels. On renal biopsy two had evidence of oxalate crystal deposition.
One did not show crystal deposition but had acute interstitial nephritis for which no
alternate cause could be identified. Two were treated with short courses of prednisolone
and two required acute haemodialysis. All recovered renal function, with both patients
with known baselines approaching their premorbid serum creatinine levels.

Consumption of star fruit, especially on an empty stomach or in a state of dehydration

may precipitate acute kidney injury. A history of star fruit ingestion must be actively
looked for in patients presenting with unexplained acute kidney injury. The use of star
fruit as a therapy for diabetes should be discouraged.

Detection of antimicrobial activity of banana peel (Musa paradisiaca L.)

on Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans: An in
vitro study

Banana is used widely because of its nutritional values. In past, there are studies that
show banana plant parts, and their fruits can be used to treat the human diseases.
Banana peel is a part of banana fruit that also has the antibacterial activity against
microorganisms but has not been studied extensively. Since, there are no studies that
relate the antibacterial activity of banana peel against periodontal pathogens. Hence,
the aim of this study is to determine the antimicrobial activity of banana peel extract
on Porphyromonas gingivalis (P. gingivalis) and Aggregatibacter
actinomycetemcomitans (A. actinomycetemcomitans).
Standard strains of P. gingivalis and A. actinomycetemcomitans were used in this study
which was obtained from the in-house bacterial bank of Department of Molecular
Biology and Immunology at Maratha Mandal's Nathajirao G. Halgekar Institute of Dental
Sciences and Research Centre. The banana peel extract was prepared, and the
antibacterial activity was assessed using well agar diffusion method and minimum
inhibitory concentration was assessed using serial broth dilution method.

In the current study, both the tested microorganisms showed antibacterial activity. In
well diffusion method, P. gingivalis and A. actinomycetemcomitans showed 15 mm and
12 mm inhibition zone against an alcoholic extract of banana peel, respectively. In serial
broth dilution method P. gingivalis and A. actinomycetemcomitans were sensitive until
31.25 μg/ml dilutions.

From results of the study, it is suggested that an alcoholic extract of banana peel has
antimicrobial activity against P. gingivalis and A. actinomycetemcomitans.

Antibacterial efficacy of local plants and their contribution to public health in rural
Ethiopia

Proper hand hygiene with soap and detergents prevents the transmission of many
infectious diseases. However, commercial detergents are less likely to be accessible or
affordable to poor people in remote rural areas. These people traditionally use some
plant parts as a detergent even though their antibacterial activity has not been yet
investigated. Therefore, this study aims to determine the antibacterial activities of some
of the plants against bacteria isolated from humans.

Plants selected for this study are Phytolacca dodecandra fruits, Rumex

nepalensis leaves, Grewia ferruginea bark and leaves. The samples of these plants
were collected from rural areas of Jimma town based on their ethno-botanical survey
and information on their local use. Acetone was used as a solvent to extract the
bioactive constituents of the plants. The antibacterial activities of the plants were
evaluated against reference strains and bacteria isolated from humans using disc
diffusion and macro dilution methods.

The plant extracts have shown varying antimicrobial activities against the bacterial
species tested. Susceptibility testing shows zones of inhibition ranging from
8.0 ± 1.0 mm to 20.7 ± 5.5 mm. The MIC and MBC of the plants against the bacterial
species tested were 3.13 and 12.5 mg/ml respectively. These variations are attributed to
different concentrations of the bioactive constituents of the extracts like saponins,
tannins, flavonoids and terpenoids.
The studied plants can contribute to achieve better personal hygiene since they are
effective against different bacterial agents and are freely available in rural areas.

Antibacterial activity of Sandoricum koetjape (Santol) leaf ethanolic extract

against Staphylococcus aureus and Escherichia coli

Sandoricum koetjape, also known as santol, is a tropical fruit belonging to the

Meliaceae family. This plant is used to cure diarrhea and fever, and to treat ringworm
and armyworm. On the other hand, Staphylococcus aureus is a Gram-positive
bacterium that lives in skin, hair, nose, throat and mucous membranes of warm-blooded
animals. Its infections are common and may be acquired in hospital settings.
Escherichia coli is a Gram-negative bacterium that can be found in the stomach and
intestines of humans and warm-blooded animals. Other strains of E. coli can cause
diarrhea, abdominal pain, cramping, nausea, and vomiting. In this study, S. koetjape
was used to determine its antibacterial property against S. aureus and E. coli. Ethanolic
extract of S. koetjape leaves was prepared into three treatment groups with
concentration of 25%, 50% and 75% along with the control groups. The groups were
subjected with the two bacteria (S. aureus and E. coli) to determine the antibacterial
activity of the extract. Answering the statement of the problem number 1, the effect of
the extract is the inhibition of growth of S. aureus and E. coli for a certain measure of
the zone of inhibition. There is a significant difference between the zone of inhibition
which suggests that the inhibitory effect of the various concentrations is different from
one another. By comparing the average zone of inhibition for both S. aureus & E. coli,
T3 is the most effective treatment among others. This study proved that the Sandoricum
koetjape leaf ethanolic extract had an effect against Staphylococcus aureus and
Escherichia coli.
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