Case Presentation: Herein, the case of a 50-year-old Caucasian man being reported with progressive bilateral hearing loss. The patient had a history of total blindness which had developed shortly after a cranial osteotomy for optic nerve decompression without any specific diagnosis 15 years ago. He had also been suffering chronic psoriasis vulgaris. Because of his enlarged skull, a diagnosis of bone Paget's disease was suspected and plain radiographs revealed a polyostotic Paget's disease with characteristic radiologic signs. In searching for his refractory constipation causes, an elevated level of tissue transglutaminase IgA (tTG IgA) antibody was demonstrated. Alendronate sodium 40 mg daily was started and a gluten-free diet was recommended to him but he was not adherent to the treatments and lost to follow-up.

Conclusion: This case further supports the idea of considering PDB as an osteoimmunologic disorder, like psoriasis and CD, because of similar biochemical features, including elevated levels of Cytokines such as interleukin-6 and tumor necrosis factor- α as well as bone resorption markers such as OPG and urinary deoxypyridinoline. So, the treatment of Paget’s disease of the bone may benefit from progresses in osteoimmunology-targeted therapies. Also a probable causal relationship between PDB and CD either by production of neutralizing antibodies in CD against OPG or by inducing PDB in genetically susceptible patients through oxidative stress, has been postulated here.

Case Presentation: In this study, we reported an 83-year-old female patient with ARMM. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) showed uneven thickening of the intestinal wall about 7.0 cm from the anal margin, and no typical T1 high signal was seen on MRI. Dual-energy spectral CT showed that the effective atomic number (Zeff) of the tumor and the iodine concentration in the arterial phase (AP) and venous phase (VP) were different from other rectal malignancies reported in the previous literature. Sigmoidoscopy showed a large polypoid mass approximately 7.0 cm from the anal verge. Immunohistochemical staining showed that about 60% of Melan A and HMB-45 were positive, S-100 protein and Ki-67 were positive, and the pathological diagnosis was ARMM.

Conclusion: This was the first dual-energy spectral CT imaging report of ARMM. The Zeff and iodine concentration in the arterial phase and venous phase could help distinguish between ARMM and other rectal malignancies.

Background: Plants of the genus Haloxylon have been used for a long time in traditional medicine, and they are distributed in the western Mediterranean region to the Middle East, Iran, Mongolia, Burma, and southwest China. The studied parts of Haloxylon species include aerial parts, leaves, branches, seeds, roots, rhizosphere, soil, and whole plants, used to treat several diseases, including sexual disorders, hepatobiliary disorders, eye disorders, skin diseases and hemorrhoids, diarrhea, and effective in the treatment of various ailments such as snake bite, stomach ache, diabetes, wounds, earache and sciatica pain, windbreak dune fixation, feeding of livestock and firewood.

Objectives: Till now, no review on the genus Haloxylon has been conducted. This review aimed to provide updated information on the genus Haloxylon, including traditional medicinal uses, valorization and exploitation of medicinal plants, phytochemistry, botanical characterization, pharmacological and toxicological research focusing on the medicinal properties of several Haloxylon species, especially their antioxidant, antibacterial, anti-inflammatory, cytotoxic and antifungal activities, as well as the effect of each bioactive molecule isolated from these species and their pharmacological use, including the preclinical evaluation of new drugs.

Materials and Methods: The present work was conducted using various scientific databases, including Science Direct, Scopus, PubMed, Google Scholar, etc. Correct plant names were verified from plantlist.org. The results of this search were interpreted, analyzed, and documented based on the obtained bibliographic information.

Results: Among all species of the Chenopodiaceae family, 6 species of the Haloxylon genus have approved antioxidant activity, 5 species have antibacterial activity, 3 species have anti-inflammatory activity, 2 species have cytotoxic activity, and 3 species have antifungal activity. The majority of the chemical constituents of this plant include flavonoids, alkaloids, phenols, saponins, glycosides, and tannins. Among them, the main bioactive constituents would be present in the alkaloid fraction. The study of more than 9 Haloxylon plants has identified more than 46 compounds. Pharmacological research proved that crude extracts and some pure compounds obtained from Haloxylon had activities for the treatment of different diseases. The objective of the present study was focused on antioxidant, antibacterial, anti-inflammatory, cytotoxic and antifungal diseases. From the study of the phytochemistry of the Haloxylon family, it was concluded that all studied plants had active compounds. Among them, 11 isolated molecules have medicinal activities with antioxidant properties, 10 molecules showed antibacterial effects, more than 6 molecules have anti-inflammatory properties, more than 9 isolated molecules have medicinal activities against cytotoxic diseases, and more than 28 molecules have antifungal effects. Therefore, the safety of Haloxylon herbal medicine should be considered a top priority in the early stages of development and clinical trials.

Conclusion: Several previously conducted studies have validated multiple traditional uses of Haloxylon species. Further research is needed on Haloxylon plants before they can be fully utilized in the clinic as a potent drug candidate, as researchers are mainly focusing on alkaloids, diterpenoids, and triterpenoids, whereas there are many other types of compounds that may possess novel biological activities.

Objectives: The primary objective of the study was to assess the anti-hemorrhoidal potential of the ethanolic seed extract of Scaphium affine.

Methods: After the soxhlet extraction method, the seed extract from Scaphium affine was first submitted to phytochemical standardization and then GC-MS analysis. Rats were given Croton oil and Jatropha oil to develop hemorrhoids, and Scaphium affine seed extract (ESA) was administered orally for 5 days and 3 days, respectively, at doses of 1000 and 500 mg/kg. The Rectoanal coefficient (RAC) was calculated as an inflammatory marker. The hemorrhoidal tissues were also subjected to cytokine profiling, biochemical estimation and histopathology.

Results: ESA demonstrated the presence of flavonoids, saponins, phytosterols, phenols, and tannins. GCMS analysis elucidated the presence of hexadecanoic acid 2 hydroxy -1,3 propane diyl ester,9 Octadecanoic acid ethyl ester, Cyclohexane 1,4 di methyl cis, Farnesol isomer,1, E-11, Z-13 octa decatriene, Stigmasterol, N-(5 ethyl -1,3,4-thiadiazol-yl) benzamide, N, N Dinitro 1,3,5,7 tetraza bicyclo 93,3,1) as major phytoconstituents. The results depicted more potent anti-hemorrhoidal activity of ESA at 1000 mg/kg, p.o., which was evident through a decrease in RAC. A significant decline in the levels of IL-1β, IL-6, and TNF-α expression was observed, along with the restoration of altered antioxidants and enzymes. Histopathological analysis confirmed the tissue recovery as it revealed minimal inflammation and decreased dilated blood vessels in treated animals.

Conclusion: Based on the results it can be concluded that seeds of Scaphium affine showed significant anti-hemorrhoid agents which may be attributed to their anti-inflammatory and anti-oxidant potential due to the presence of certain phytoconstituents in it. The study also supports the traditional use of seeds of Scaphium affine for the first time in the treatment of hemorrhoids.

Methods: A randomized clinical trial was used in this investigation. Patients who had been referred to the surgical clinic of the Madani Hospital in 2021 with hemorrhoid complaints were participants in a random selection process. Participants were separated into control groups (getting non-invasive regular treatments) and the intervention group after being informed and given ethical approval (Receiving Daflon 500 mg twice daily for 4 weeks). Patients' symptoms, potential sequelae, and illness recurrence were assessed in both chosen groups at each visit, and data was gathered until the desired sample size was reached.

Results: This study was performed on 200 patients who received Daflon 500 mg (intervention, N = 100) or placebo (control, N = 100). The number of visits required to achieve therapeutic goals did not differ statistically significantly between the intervention and control groups (P > 0.05). The mean recovery time was 56.5 ± 12.53 days for the intervention group and 61.04 ± 13.63 days for the control group, which is considered statistically significant (P < 0.05). A total of 56 patients (28.0%) relapsed and 144 patients (72.0%) recovered. This rate in the intervention group included 78 (78.0%) recovery and 22 (22.0%) relapsed and in the control group 66 (66.0%) recovered and 34 (34.0%) relapsed, clinically it suggests that treatment Daflon can prevent relapse of the disease, although the statistical results of this study do not support this hypothesis (P = 0.059).

Conclusion: The study's findings demonstrated that Daflon therapy is a superior and more effective treatment option for all grades of hemorrhoids. Moreover, the medication's side effects are manageable, making it a well-tolerated choice.

Background: Ayurvedic medicine is one of the oldest and most traditional healthcare systems in India. There is limited documentation available regarding the information of traditional medicinal uses of plants even though various rural folks and elders have long been using plant-based formulations for curing human ailments. Hence, there is an urgent need to document this traditional knowledge to endorse the Ayurveda or Indigenous medicinal system before such valuable knowledge becomes inaccessible and extinct.

Objective: The present study was carried out to profile the current status of medicinal plants used by Traditional Vaidya’s/practitioners/locals, and discuss the status of Ayurveda and indigenous systems in the Northern states of India i.e., Haryana and Rajasthan.

Methods: To study currently available medicinal plants used by traditional Vaidyas in Northern states of India such as Haryana and Rajasthan, a survey among 50 Vaidyas of each state was undertaken. Information was gathered through interview and questionnaires consisting of 20 questions regarding their knowledge, expertise, targeted ailments, herbal formulations, and preservation techniques.

Results: According to the collected information, these Vaidyas have almost 4 to 40 yrs. of experience and acquired their knowledge in a variety of ways, including from academic institutions or their ancestors. By feeling the pulse in the wrist, these Vaidyas were able to diagnose ailments associated with the three doshas (Vata, Pitta, and Kapha) with medical precision via sensing the wrist's pulse. Different illnesses associated with kidney, lungs, digestive system, leukosis, diabetes, blood pressure etc. were treated by these traditional Vaidyas. In addition to prescribing medicines, Vaidyas carefully observe the patient's routine, physical health and their age group for better medication. Several indigenous medicinal herbs such as Ashwagandha, safed musli, gokhru, garmunda, bawli ghans, giloy, triphala, ginger, patthar chatta, Aloe vera, Stevia, and many other herbs are being used by these traditional Vaidyas for their herbal formulations.

Conclusion: This survey highlights Ayurveda and its use of plants in the field of medicine, through validation based on knowledge of traditional Vaidyas. This article also highlights the indigenous system and some important Indian medicinal plants of Haryana and Rajasthan and their therapeutic use in daily life. This survey enlightens the traditional Vaidyas and their knowledge of the Ayurveda medicinal system. This step might strengthen the validity of these products and provide a lead to target new formulation preparations. Many high-profile formulations could be prepared in the future, if most of these reputed traditional Vaidyas get organized.

Objective: To highlight the recent developments in terms of safety, clinical efficacy, and marketed formulation for the effective management of hemorrhoids.

Method: Reported literature available on Scopus, PubMed, Science Direct, Clinicaltrails.gov, and from many reputed foundations has been studied to summarize the recent development and clinical studies for the management of hemorrhoids.

Results and Conclusion: The high incidence of hemorrhoids obliges the development of new molecules; therefore, safe and efficient drugs to confer protection against hemorrhoids are urgently needed. This review article mainly focuses on the newer molecules to overcome hemorrhoids and also emphasizes various studies carried out in the past.

Objective: The treatment of hemorrhoids in modern medicine is still found to be in its infancy, as there is no precise treatment for the specific disease. Tridax procumbens Linn (T. procumbens) belongs to the family Asteraceae. From the literature, the plant was found to have a traditional use for the treatment of hemorrhoids. Hence, the present research was focused on evaluating the antiinflammatory mediated anti-hemorrhoidal potential of ethanolic whole plant extract of T. procumbens (EWETP) in croton oil-induced hemorrhoidal rats.

Methods: An in vitro study was conducted to evaluate the percentage inhibition of protein (egg albumin) denaturation by Tridax procumbens. This study determined the initial protective role of plant extracts against inflammatory proteins. An in vivo, anti-inflammatory-mediated anti-hemorrhoidal study was carried out on T. procumbens in various groups of croton oil-induced hemorrhoidal rats. Wistar albino rats were selected for the present research, and hemorrhoids were induced in experimental animals using a croton oil preparation containing 6% croton oil, deionised water, pyridine, and diethyl ether. Pilex ointment was taken as a reference drug in this study. Inflammation seems to be a major pathway for the progression of hemorrhoids. Hence, in the present research, Evans blue (EB) extravasation technique was applied to quantify inflammatory proteins. On the last day of the study, blood samples were drawn from experimental animals to analyse serum and blood for TNF- α, IL-6, and the percentage of neutrophils count. Recto anal coefficient was calculated to measure croton oil-induced rectal inflammation in animals. Histopathological studies were carried out separately on a second set of animals to identify the protective role of T.procumbens on rectal tissue cell histology. Molecular docking studies were carried out to rule out the possible interaction of plant phytoconstituents with the COX-2 enzyme.

Results: Results showed that intra rectal application of croton oil preparation in albino rats developed hemorrhoids by elevating serum TNF-α and IL-6 in positive control group animals compared to normal group rats. Treatment of albino rats with T. procumbens at doses of 200 mg/kg and 400 mg/kg in groups IV and V has shown a significant reduction in serum TNF-α and IL-6. Furthermore, in the study, T. procumbens exhibited a significant dose-dependent reduction of EB dye extravasation in study animals. The study observations also revealed the inhibitory effect of plant extract on the blood percentage of neutrophils count and recto anal coefficient compared to the positive control group rats. Histopathological studies conducted on rectoanal tissues showed the presence of minimal rectal tissue changes in plant extract-treated group animals compared to positive control group rats. Molecular docking studies explored the possible interaction of phenolic compounds of plant extract with the COX enzyme.

Conclusion: It was concluded that Tridax procumbens had a protective role against inflammatory mediators in hemorrhoids. In hemorrhoidal rats, ethanolic leaf extract was found to reduce the plasma percentage of neutrophils and other inflammatory cytokines, TNF-α, and IL-6. It could be used as a therapeutic anti-inflammatory mediated anti-hemorrhoidal agent.

Objective: To analyze pathophysiological characteristics/co-morbidities precipitating myocardial ischemia in patients with HTN LVH and provide a rationale for recommending beta-blockers (BBs) to prevent/treat ischemia in LVH.

Methods: We searched PubMed, SCOPUS, PubMed, Elsevier, Springer Verlag, and Google Scholar for review articles and guidelines on hypertension from 01/01/2000 until 01/05/2022. The search was limited to publications written in English.

Results: HTN LVH worsens ischemia in coronary artery disease (CAD) patients. Even without obstructive CAD, several pathophysiological mechanisms in HTN LVH can lead to myocardial ischemia. In the same guidelines that recommend BBs for patients with HTN and CAD, we could not find a single recommendation for BBs in patients with HTN LVH but without proven CAD. There are several reasons for the proposal of using some BBs to control ischemia in patients with HTN and LVH (even in the absence of obstructive CAD).

Conclusion: Some BBs ought to be considered to prevent/treat ischemia in patients with HTN LVH (even in the absence of obstructive CAD). Furthermore, LVH and ischemic events are important causes of ventricular tachycardia, ventricular fibrillation, and sudden cardiac death; these events are another reason for recommending certain BBs for HTN LVH.

Objective: This narrative review is written to provide the information on medicinal importance of S. asoca and the significance of S. asoca in various traditional medicinal systems.

Methods: Different databases were searched to gather information. Research articles, abstracts, and reviews are included in this review.

Results: Saraca asoca is known for its unique pharmacological role in treating various uterine complications, menstrual disorders, and bacterial infections, bleeding hemorrhoids, urinary and dermatological problems. The stem bark of the tree is the principal constituent for treating menorrhagia and genito-urinary disorders. The stem bark, leaves, and seeds of S. asoca are known to contain flavonoids, tannins, alkaloids, glycosides, polyphenolics, fatty acids, and saponins. The reported major phytoconstituents responsible for its therapeutic uses are epicatechin, procyanidin B2, lyoniside, nudiposide, catechin, leucocyanidin, and leucopelargonidin. Various pharmacological activities of this plant are discussed in this review.

Conclusion: It has been proved that Saraca asoca possesses several pharmacological properties and is useful in treating various diseases. More studies on quality control, standardization, and clinical trials on S. asoca should be performed, so that this plant could be utilized as an effective anti-cancer drug which could be a promising source for the herbal and pharmaceutical industry.

Patients and Methods: We conducted a randomized 1:1, prospective observational monocentric study in 228 patients (144M/84F) with LGIB. 121 (69M/52F) received the High-Volume, while 107 (75M/32F) received Low-Volume. They completed a “satisfaction questionnaire” (taste and smell, mood, time of taking, general experience). We collected the results of the Boston Bowel Preparation Scale (BBPS) and the final diagnosis.

The study was retrospectively registered on clinicaltrial.gov with protocol number NCT0536 2227.

Results: A mean value of BBPS 6,3 was achieved by both groups (p=0.57). Regarding smell, taste, mood and time of taking (1 to 5), we do not find any statistically differences. The overall satisfaction between the two preparations was 2.90 for low-volume compared to 3.17 for Highvolume (p=0.06). No side effects were reported. The proportion of patients without an evident source of bleeding was higher in High volume preparations compared to Low-volume (39% vs. 30%, respectively).

Conclusion: Low volume bowel preparation showed the same efficacy and tolerability with better satisfaction compared with high volume. Low-volume could represent an effective and more desirable preparation for patients in the ED.

Objective: The study aims to describe the clinical profile, risk factors, and co-medications of CSC in a multispecialty hospital in the UAE.

Methods: Hospital based retrospective, observational study in which all the confirmed cases of CSC (272) seen between 2010 and 2019 were included. Supplementary data were collected on follow up visits or through telephonic calls.

Results:The male: female ratio was 17:1; low socio-economic status was (155; 73.45%), and occupations such as drivers (61; 28.9%) and outdoor laborers (59; 27.96%) were the most commonly affected. The majority (78.05%; 185) were single expatriates. Financial worries (105; 50.72%) constituted the leading cause of stress. The usage of corticosteroids (83; 30.51%), nasal decongestants (14.70%), or both (17; 6.25%) within one year was common; mostly (82; 30.14%) for rhinitis/respiratory states, though grossly under-recognized. Muscle relaxants and psychotropic medications were the other major medications used in 24 (8.82%) and 25 (9.19%) cases prior to CSC. Seven of 15 women had at least one condition that alters the endocrinal milieu: Pregnancy (3), recent child birth (1), erratic oral contraceptive intake (1), menopause with liver dysfunction (1), hormone replacement therapy for menopause and endometriosis (1), ovarian cyst and infertility (1) hypothyroidism (3), and cushing syndrome (1). Chronic/ recurrent forms were seen in 31.08%. There were too few glaucoma patients despite both CSC and glaucoma being common among our patients.

Conclusion: CSC in Al-Ain predominantly affected males with a specific occupational predisposition. Emotional distress, financial worries, allergic disorders, and endocrinal disorders (among females) were common. Adverse drug events were under-reported compared to the usage of steroid or decongestant users. Suspected pharmacological associations included drugs that modulated the vasomotor tone.]]> https://www.benthamscience.comarticle/124934Background: The plant species belonging to the genus Boerhavia (Nyctaginaceae) have been used extensively in ethnomedicine and Ayurveda in India. Rakta punarnava and Sveta punarnava are two of the species mentioned in various Ayurvedic formulations. Other species of Boerhavia, though not found in the Indian system of medicine, do hold importance in ethnomedicine systems in India and other countries.

Objective: Boerhavia, a polymorphic genus, has been treated as a single genus encompassing species belonging to a morphologically related genus, Commicarpus. Owing to this taxonomic quandary with regard to the merger or separation of the two genera by different workers, there are different reports on the number of species belonging to this genus. This has further resulted in flawed reporting of ethnomedicinal as well as ethnopharmacological studies. The present review focuses on resolving any confusion regarding taxonomic treatment and highlighting the ethnomedicinal uses supported by ethnopharmacological data and the phytochemistry of Boerhavia and Commicarpus species found in India.

Conclusion: In India, four species of Boerhavia and two species belonging to Commicarpus are found. The literature survey revealed that except for B. diffusa, no other species of Boerhavia has been explored in detail. This presents an opportunity to conduct research on Boerhavia species and find new phytochemicals with promising therapeutic effects.

Objectives: In this manuscript, we focus on the importance of indazole derivatives in the treatment of various gastrointestinal diseases.

Results and Conclusion: In the treatment of IBS, four positions (R¹, R², R³ and R⁴) of indazole were mainly substituted with aromatic aldehyde/substituted methyl, aromatic acid/formamide, benzamide/ sulfonamide and methyl groups, respectively. In case of diarrhea and metabolic syndrome treatment, substitutions with benzyl/isopropyl/acetaldehyde (R1 position) and carboxamide/ formamide (R² position) of indazole play a critical role. Also, in the treatment of diabetes melitus, all six positions of indazole derivative were substituted with substituted aryl/alkyl/aromatic acid, substituted formamide, substituted acetamide/hydrazide group, halo aryl, substituted aryl/aromatic acid and a long chain of alkyl-aryl alcohol groups, respectively. In the treatment of gastrointestinal cancers, all six positions of indazole derivative were substituted with benzylamide (R¹), octanediamide/ benzamide/formamide (R²), carbaldehyde (R⁴) and substituted phenyl (R⁵ and R⁶) groups, respectively. Six receptors (6NP0, 2YME, 4EFU, 4WZ8, 5U4W and 7KKP) associated with GI disorders (co-crystallized with indazole derivative) were identified. Analysis of the receptors showed that co-crystalized ligand molecules were well-interacted with receptors via pie-pie interaction, coordinate and sigma bonding within 4 Å distance. As per Ramachandran plot analysis, more than 90% of the amino acid residues were present in the most favored region. So, if sufficient focuses are imposed on the development of newer indazole derivatives to treat gastrointestinal diseases, it will work as a boon to society.

Objective: This study aims to carry out the ethanolic leaf extract of Lawsonia inermis (L. inermis) and evaluate its anti-hemorrhoidal activity both in vitro and in vivo. Furthermore, Molecular Docking was performed on the crystal structure of COX-2 with the selective compound 23d-(R) (PDB ID: 3NTG) protein.

Methods: The current study is to estimate an anti-inflammatory mediated anti-hemorrhoidal activity of ethanolic leaf extract of L. inermis at different doses of 200 mg/kg/ir and 400 mg/kg/ir in croton oil-induced hemorrhoidal rats. Pilex ointment is taken as a reference standard in the present study. Evan's blue extravasation technique were applied in the study to quantify the proinflammatory protein.

Results: From the study results, a dose-dependent effect was found for ethanolic leaf extract of Lawsonia inermis at 200 mg/kg and 400 mg/kg causing a significant reduction of serum Proinflammatory mediators TNF-α, IL-6, and plasma neutrophils in croton oil-induced hemorrhoidal rats.

Conclusion: Studies represented that the plant extract can significantly inhibit protein denaturation of egg albumin in in vitro and found to reduce croton oil induced inflammatory mediators in hemorhhoidal rats.

Methods: The study focused on the leaf’s volatile compounds determination from Myrtus communis (McEOs) and Mentha spicata (MsEOs) as well as the evaluation of phytochemical fractions and biological activities from their methanol extracts (McME and MsME).

Results: Phenolic compounds analysis revealed interesting concentrations of total phenols, flavonoids, and condensed tannins. The antibacterial activity tested on seven pathogenic bacteria has to be effectuated by the gel diffusion method. The extracts showed much better DPPH radical scavenging activity than the volatile compounds. The McEOs and MsEOs profiles analyzed by CG-MS showed a mixture of several compounds with a predominance of 1,8-Cineole (48.1%) and α-pinene (39.02%) in the case of McEOs. In the case of MsEOs, the predominant compounds were D-Carvone (78.79%), dihydrocarvone (6.16%), and 1.8 Cineole (2.33%).

Conclusion: It emerges from this study that the M. communis and M. spicata leaves, rich in phenolic and terpenic compounds, constitute a promising source of diversified biological activities and can be used in agro-food, cosmetic, and pharmaceutical sectors.

Case presentation: This is a case presentation of a 23-year-old pregnant woman with a personal history of immune thrombocytopenia and splenectomy performed 4 years ago, who presented at the emergency department with abdominal pain, nausea, vomiting, and diarrhea. The patient underwent resection and anastomosis of gangrene in the small intestine due to mesenteric venous ischemia.

Conclusions: The diagnosis of mesenteric venous thrombosis should be considered in the setting of acute abdomen in early pregnancy in women with prior history of coagulation disorder.

MicroRNAs as posttranscriptional regulators of gene expression are shown to be changed during and after irradiation. MicroRNA level changes might be utilized to predict response to RT in the near future, which might help clinicians to make the decision on treatment regimens if needed.

Individual radiation response results from the interactions among radiation treatment parameters and the biological background of each patient. In this review, we have listed and described miRNAs involved in response to RT in PCa and highlighted potential candidates for future biological tests predicting radiation response to RT, with the special focus on side effects of RT.

According to described literature, we concluded that let-7, miR-21, miR-34a, miR-146a, miR-155, and members of miR-17/92 cluster might be promising candidates for biological tests predicting radiosensitivity of PCa patients undergoing radiation treatment.

Predictive miRNA panels, especially for acute and late side effects of RT, can serve as a starting point for decisions for individualized RT planning. We believe that this review might be one step closer to understanding molecular mechanisms underlying individual radiation response of patients with PCa.

Objective: This objective is to understand intellectual property related to patent documents on EOs and nanotechnology.

Methods: The nanotechnology growth curve applied to EOs demonstrated that the period from 2015 to 2017 was the most prominent, with a peak in 2016. China is the dominant country, mainly through research developed in the academic area.

Results: The food industry area had the highest number of patents filed, highlighting the preservation line. Ginger essential oil, chitosan and Tween 80 were preferentially used as a core, wall material, and emulsifier, respectively. In the market, the use of EOs is more associated with the pharmaceutical/ cosmetics industry. In addition, the food industry market bets more on products based on hemp oil nanocapsules.

Conclusion: EO nanotechnology is promising for the development of sustainable food systems. However, this nanotechnology in Brazil has not yet advanced enough in the food industry, although there are government incentives that may change this paradigm in the future. The profile of the patent documents and the products in the market differ between the application and the types of oils. In addition, there is a gap between the volume of patent documents investigated and the transfer of technology to the commercial sector, but this constitution could be better explored, given the properties of EOs.

Objective: In this study, we aimed to synthesize potentially novel lipophilic rutin prodrugs. The suggested library of these rutin prodrugs includes changing the solubility profile to facilitate rutin transport across biological barriers, thereby improving drug delivery through topical application.

Methods: Six rutin derivatives were synthesized based on the ester prodrug strategy. The synthesized compounds were formulated as topical ointments, and their permeability via Franz diffusion was measured. An ultraviolet (UV) analytical method was developed in our laboratories to quantify rutin derivatives both as raw materials and in final dosage forms. The analytical method was then validated.

Results: The results of Franz diffusion analyses showed that transdermal permeability increased by 10-fold for decaacetylated rutin compared to the other esterified rutins. A simple analytical method for the analysis of the formulated rutin ester was developed and validated. Moreover, the formulated ointment of decaacetylated rutin in our research laboratory was found to be stable under stability accelerated conditions. Synthesis of potentially more lipophilic compounds would yield novel rutin prodrugs suitable for topical formulation.

Conclusion: This project provides a synthetic approach for many similar natural products. The research idea and strategy followed in this research project could be adapted by pharmaceutical and herbal establishments.

Objective: The present study was designed to justify this folkloric usage of the plant. Therefore, the aim of this study was to investigate the anti-inflammatory activity of D. vulgaris.

Methods: Petroleum ether, ethyl acetate and methanol extracts were prepared from the fruits, successively. Carrageenan-, serotonin-, and prostaglandin E2-induced hind paw edema; acetic acid-induced capillary permeability and 12-O-tetradecanoyl-phorbol-13-acetate–induced mouse ear edema models were used to assess the anti-inflammatory activity of the extracts. The analgesic activity was observed by using p-benzoquinone-induced abdominal constriction test.

Results: The petroleum ether extract displayed the highest activities in all of the used test models compared with the control group. Therefore, the constituents of this extract were determined by using gas chromatography-mass spectroscopy (GC–MS). Linoleic acid was found to be the major constituent of the petroleum ether extract of D. Vulgaris.

Conclusion: This study has provided some justification for the folkloric use of the plant.

Objective: This study was designed to investigate the antiproliferative effect of ethanolic extract of Cissus quadrangularis L. (CQ) against human cervical adenocarcinoma HeLa cell line and in silico analysis of selected active agents against apoptosis executioner enzyme caspase-3.

Methods: Cell viability was analyzed in HeLa cells at different concentrations (25-300 μg/ml) of CQ extract. Reactive oxygen species (ROS) generation, cellular apoptosis, cell cycle analysis and caspases-3 activation were evaluated. In silico, structure-based virtual screening analysis was carried out using AutoDock Vina and iGEMDOCK.

Results: Cell viability of HeLa cells was reduced significantly (p < 0.05) in a dose-dependent manner, however, CQ extract showed non-toxic to normal kidney epithelial NRK-52E cells. CQ extract induced the intracellular ROS level, nuclear condensation and reduced the mitochondrial membrane potential (MMP) with the induction of annexin V-FITC positive cells. CQ extract arrested cells in G0/G1 and G2/M checkpoints and activated caspase-3 activity significantly in HeLa cells. The molecular docking study showed a strong binding affinity of CQ phytocomponents against the caspase-3 (PDB ID: 1GFW) protein of human apoptosis. PASS analyses of selected active components using Lipinski’s Rule of five showed promising results. Further, drug-likeness and toxicity assessment using OSIRIS Data Warrior V5.2.1 software exhibited the feasibility of phytocomponents as drug candidates with no predicted toxicity.

Conclusion: This study suggested that active constituents in CQ extract can be considered as potential chemotherapeutic candidates in the management of cervical cancer.

Methods: The stem of M. rubicaulis was collected, subjected to double maceration using ethanol as a solvent. Then, Swiss albino rats (n=72) were taken. An acute toxicity study was conducted using different doses of the plant extract. The anti-inflammatory activity (100 mg/kg, 250 mg/kg) was evaluated using the carrageenan-induced paw edema test, while, analgesic activity (100 mg/kg, 250 mg/kg) was evaluated using a hot plate and tail immersion method. The result was analyzed using a one-way analysis of variance and post hoc analysis with the Tukey test.

Results: The acute toxicity study showed that the plant is safe for use in an animal model. The extract showed anti-inflammatory activity by a reduction in paw edema volume by 25% and 48%. Similarly, analgesic activity was shown by an increase in latency of paw licking and tail withdrawal by 41%, and 56% (hot plate method) and 39% and 54% (Tail immersion method), p<0.05.

Conclusion: It can be concluded that the ethanolic extract of Mimosa rubicaulis is safe and possesses both anti-inflammatory and analgesic activity.]]> https://www.benthamscience.comarticle/116685Background: Medicinal and healing plants have been used in treating human diseases for centuries because of their therapeutic effects. They may assist in curing common ailments such as a multitude of skin problems, various disorders from muscle spasms to cuts and wounds. They can be used to relieve symptoms of different illnesses from cold to some forms of arthritis or some allergies as well. The Asteraceae plant is a strong source of antimicrobial and antioxidant agents and this paper focuses on its specifications.

Objectives: The specific aim of this study was to investigate the antioxidant potential and radical scavenging of different solvents (Methanol and Ethanol) of five species i.e.Artemisia absinthium L., Arctium lappa L., Centaurea cyanus L., Silybum marianum L., and Echinops ritro L. belonging to the Asteraceae family.

Methods: Methanol and ethanol extracts of the above plants were prepared. The obtained extracts were evaluated for total phenolic content (TPC), total flavonoid content (TFC), total antioxidant capacity (TAC), chain-breaking activity (CBA), thiobarbituric acid (TBA) and 2, 2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity. Also, Ferric reducing antioxidant power (FRAP), Nitric oxide (NO) radical scavenging, Hydrogen peroxide (H₂O₂) radical scavenging and Superoxide (O₂ -) radical inhibition assay were measured. Phenolic compounds were determined and measured by high-performance liquid chromatography (HPLC) as well.

Results: The collected and analyzed data showed that the highest values for the TPC, TFC, TBA, and DPPH were related to methanol extract of A. lappa L. Moreover, maximum values for the CBA, H₂O₂ and O₂ - were observed in the ethanol extract of E. ritro L., while methanol extract of E. ritro L. showed the highest amount of FRAP and NO. Eventually, the highest value for TAC was related to A. absintium L. and it was also realized that methanol compared to ethanol solvent was more successful in the extraction procedure.

Conclusions: These findings suggest that A. lappa L. and E. ritro L. extracts can be considered as excellent natural antioxidant agents and the type of the solvent can affect the extraction of phenolic compounds. Sinapic acid as the highest level of phenolic acid was found in S. marianum L.

Methods: Nine Corriedale sheep that had been monitored for 10 minutes during a basal stage underwent 5-minute myocardial ischemia, followed by 60-minute reperfusion. Seven of them were subjected to an induced heart failure through an overdose of halothane, two of which were treated with intra-aortic counterpulsation during the reperfusion stage. The remaining two animals were monitored during their ischemia-reperfusion stage.

Results: Data obtained in the 5 animals suffering from heart failure followed by myocardial ischemia showed that: a) heart failure induction determined decrease in cardiac output, cardiac index and systolic and diastolic aortic pressure (AoP) with respect to their basal values (p<0.05), b) myocardial ischemia decreased the WTF compared with basal and induced heart failure values (p<0.05), c) during the reperfusion stage accompanied by induced heart failure, WTF increased with respect to values observed during the ischemia induction stage (p<0.05); nevertheless, basal values were not recovered after reperfusion (p<0.05). During this 60-minute stage, systolic and diastolic AoP values were lower (p<0.05) than those at the basal stage.

Conclusion: AIx and WTF values calculated from synchronically recorded values of aortic pressure and left ventricular wall thickness during the reperfusion stage in all animals (n = 9) showed a negative correlation (p<0.05). Analysed data provided evidence of a negative relationship between a left ventricular index of myocardial function and an arterial index obtained from AoP waves.

Objective: The present study was conducted to evaluate the laxative activity of hydroethanolic pericarp extract of Sapindus emarginatus (HESE) in animal models.

Methods: The saponin content in the extract was measured by the gravimetric analysis. The laxative activity of hydroethanolic pericarp extract of Sapindus emarginatus was evaluated by the weight of feces matter, charcoal meal hyperperistalsis test, and loperamide induced constipation model.

Results: The saponin content of the soapnut pericarp was 13.48% and the extract was found to be 11.92%. The results obtained from these models showed a significant dose-dependent increase in fecal weight, peristalsis index, and moisture content compared to control animals.

Conclusion: The present study concluded that the oral administration of HESE showed a significant laxative activity in different animal models. The presence of triterpene saponins is supposed to be responsible for this activity. Further studies are needed to confirm their mechanism behind the laxative effect. The administration of the extract was found to be effective in constipation therapy.

Exclusion Criteria: Patients are seen in A/E and ambulatory care who did not stay overnight and those who received antimicrobials for perioperative or medical prophylaxis were excluded.

Statistical Analysis: Statistical Analysis was done using excel program descriptive statistics were used to describe the baseline demographic data and clinical characteristics. Categorical variables are presented as counts and percentages, whereas continuous variables are presented as mean.

Results: A total of 666 patients’ medical records were reviewed during January 2020 to April 2020. Respiratory tract infections were the most common diagnosis encountered (456/666), representing 68.5% in total. A total of 994 courses of antimicrobials were prescribed during the study period. Antimicrobial was considered 'appropriate' in 70.3% (979/1393), and ‘not indicated' in 19.7% (273/1393) of cases. In the remaining 10% of cases (141/1393), antimicrobial was indicated but required antimicrobial stewardship team (A.M.S) intervention. The compliance to accept antimicrobial stewardship team recommendations and change therapy accordingly in our study was only 32.6% (133/412)

Conclusion: In this study, the prevalence of inappropriate antimicrobial prescribing is comparable to that found in other studies worldwide. However, the compliance with AMS recommendations is much lower than described in the literature.]]> https://www.benthamscience.comarticle/115803Introduction: The percentage of the heterosexual population that has experienced and regularly has anal intercourse ranges from 20% to 35% in the USA. This practice increases to 95% in certain populations, including lesbian, gay, bisexual, and transgender people. Due to the lack of data in the literature about the effect of proctologic surgery on anal intercourse, this study aimed to assess the impact of this surgery on sexual behavior in both genders.

Materials and Methods: From March 2016 to February 2018, an anonymous questionnaire was submitted to all patients aged >18 who had undergone proctologic surgery in one of two surgical units at tertiary referral centers and was assessed independently of gender. The exclusion criteria were incomplete healing and <3 months follow-up.

Results: In total, 929 patients answered the questionnaire in full. The overall prevalence of preoperative anal intercourse was 22.5%. The rate of anal intercourse among men was 16.7%, while among women, it was 28.9%. The overall postoperative rate of anal intercourse was 11.8%. The rate of postoperative anal intercourse among those who regularly engaged in anal intercourse preoperatively was 52.6%, with a 47.4% rate of non-completion (p <0.0001). The experiences reported during intercourse after surgery were mainly pain, stiffness, and partner discomfort.

Conclusion: Considering the statistically significant postoperative AI abandonment rate following all types of proctologic surgery, the surgeon has a duty to both treat the disease and to inform the patient about the possible consequences regarding its influence on anal intercourse.

Objective: The aim of this review article was to answer this question \"Does A. vera gel have efficacy in the management of GERD?\"

Methods: For preparing the manuscript, we used all accessible international databases, electronic resources (PubMed, Science Direct, Springer, Wiley and Google), and traditional books (Persian or English modern and traditional books), unpublished data (R&D reports, thesis and dissertation).

Results: There are five clinical studies on the efficacy of A. vera gel syrup on patients with GERD. In all the studies, the patients suffering from GERD were treated with 10 ml A. vera gel syrup twice daily and the efficacy of treatment was compared with omeprazole or ranitidine (n=2), or the adjuvant potency of A. vera gel syrup with pantoprazole (n=1) or aluminum-magnesium hydroxide (MG) (n=1) was evaluated. In one clinical study, the efficacy of A. vera gel syrup was evaluated on clinical signs of GERD without any control group. According to the results of clinical studies, A. vera gel syrup insignificantly eliminated the GERD symptoms without any adverse effects, when compared with omeprazole or ranitidine.

Conclusion: Due to the efficacy of A. vera gel syrup in GERD, understanding the precise mechanisms related to the efficacy of A. vera gel on GERD should be the subject of future studies.

Objective: The aim of this study was to investigate the anticancer effect of different extracts from the green hull of pistachio.

Methods: The cytotoxic effects of different solvent extracts on cancer and normal cells were examined by cell viability assay and flow cytometric analysis. The levels of the apoptotic gene and protein were investigated by Western Blot and ELISA, and qPCR. The intracellular free radical exchange was determined by oxidative and nitric oxide analyses. DNA damage level was measured by the 8-OHdG test. Phenolic and free fatty acid components were examined by LC-MS/MS and GC-MS, respectively.

Results: It was determined that the n-hexane fraction showed a higher cytotoxic effect on cancer cells. Oxidative and cell cycle analyses indicated that the n-hexane fraction arrested cell cycle of HT-29 at the sub-G1 phase by increasing DNA damage through oxidative stress. In addition, gene expression analysis of the HT-29 treated with the n-hexane fraction indicated that apoptotic and autophagic gene expressions were significantly upregulated. LC-MS/MS analysis of the n-hexane fraction revealed the presence of 15 phenolic compounds, containing mainly gallic acid and catechin hydrate, and GC-MS analysis determined the presence of the following fatty acids: 9-octadecenoic acid, 9,12-octadecadienoic acid and hexadecenoic acid.

Conclusion: Based on these grounds, we suggest that the n-hexane fraction of pistachio green hull damages DNA, arrests the cell cycle at the G₁ subphase, and induces apoptosis through oxidative pathways in colon cancer.

Methods: We resume the recent literature on the issue to offer a practical and easy to use guide for clinicians.

Results: Rubber band ligation, injection sclerotherapy and infrared coagulation are cost effective, safe and effective treatments for patients with II- and III-degree hemorrhoids. Relapses are commons even if the procedures can be repeated until symptoms resolution. IV-degree hemorrhoids are not suitable of these treatments.

Conclusion: The proctological clinics must evaluate the quality of life offered to patients and discuss with them the appropriate treatment in order to select the most appropriate one for symptoms resolution and disease cure. Less is not always the best but can be an alternative to be offered.

Methods: Nevertheless, each device has its own specific feature, the stapler is basically made up with one or more circular lines of titanium staples whose height may be variable. The procedure is based on different steps: Introduction of the CAD, evaluation of the prolapse, fashioning purse string or parachute suture, the introduction of the stapler head beyond the suture, pull the wires through the window, close the stapler and keep pulled the wires of the suture held together with forceps, fire using two hands, open the stapler and remove it and check the staple line and then check the specimen. One of the latest innovations in stapled surgery is Tissue Selective Therapy. It is a minimally invasive procedure in which there is a partial circular stapled hemorrhoidopexy focused on the prolapsing piles with bridges of normal mucosa left.

Results: Several studies have reported that SH is a safe and effective procedure to treat hemorrhoidal prolapse. It is a quicker procedure with a shorter hospital stay and earlier return to work if compared with the conventional treatment. This is due to less postoperative pain, postoperative bleeding, wound complications and constipation. Furthermore, the first generation devices had worse outcomes if compared with those of the new generation stapler that showed lower postoperative complication rates with better anatomical and symptomatic results.

Conclusion: Stapled procedure for the treatment of symptomatic hemorrhoidal prolapse represents one of the most important innovations in proctology of the last century bringing with it the new revolutionary concept of the rectal intussusception as a determining factor involved in the natural history of the disease. Stapled hemorrhoidopexy marked an era in which the surgeon may offer the patients a safe, effective treatment with less pain and fast recovery.

Methods: In the last two decades many studies described the preoperative assessment and several attempts of classification for HD. This review focuses on the most relevant studies found in literature where classification systems and clinical evaluation with differential diagnosis have been evaluated.

Results: The knowledge of classification systems and differential diagnosis for HD has been shown to play a central role in the clinical assessment and the best treatment choice. Although there are new challenging techniques and devices for HD treatment, a preoperative assessment is always mandatory.

Conclusion: Preoperative clinical evaluation is essential for HD patient treatment and outcome. Classification systems are useful for the therapeutic choice and researches on new medical or surgical treatments. In fact, the international guidelines advise several therapeutic options depending on the severity of the HD.

Objective: The aim of this study is to assess the preliminary results of the emborrhoid technique (embolization of the superior rectal arteries branches) as a new tool for the proctologist to treat severe bleeding hemorrhoids causing anemia. Many categories of patients might benefit from this treatment, such as patients not eligible for conventional surgery, patients not responding to conventional treatment and fit patients with severe bleeding who refused endorectal surgical therapy.

Methods: From May 2017 to November 2018 a total of 16 patients with chronic rectal bleeding due to hemorrhoids underwent super-selective embolization of the superior rectal arteries at the department of General Surgery in La Spezia, S. Andrea Hospital, Italy. Median age was 59 years. 14 patients were males (87.5%).

Results: No post-procedural and short-term complications were observed at maximum follow up (12 months). The reduction of rectal bleeding with improvement of the quality of life was obtained in 14 patients (87.5%).

Conclusion: Our study, although small in number, demonstrates that embolization of superior rectal arteries with coils to treat severe bleeding due to hemorrhoids is safe and effective and does not lead to immediate complications.

Despite significant improvements in conservative treatments, excisional haemorrhoidectomy techniques are the most effective treatment for III- and IV degree.

Objective: To describe the complications following different surgical and instrumental techniques for hemorrhoids in a literature review. Special situations were reviewed to determine how they affect the management of the disease.

Methods: During August 2019, a narrative review of hemorrhoid surgery complications and special situations was performed using the Pubmed MESH DATABASE.

Conclusion: Pain, urinary retention and bleeding remain the most frequent complications after surgery for hemorrhoids; however, special situations must be taken into account in order to choose the best technique to prevent more severe complications.

Introduction: Internal haemorrhoids are vascular cushions located in the anal canal, above the dentate line and covered by columnar epithelium. They contribute to the faecal continence and the sensitivity of the anal canal. The enlargement and/or sliding of haemorrhoidal tissue produce symptoms and complications, the so-called haemorrhoidal disease.

Methods: A systematic research was realized, looking at the best evidence in literature, searching PubMed, Embase, Cochrane library and the most renowed textbooks of colorectal surgery from January 1980 to January 2020.

Result: Aetiology and pathophysiology of HD are still controversial, but multifactorial. Disruption of stromal scaffolding, enlargement of vascular component, elevated anal pressure and rectal redundancy represent key events in the development and complications of the disease. Local inflammation may also play a role. Goligher’s classification remains the most widely used. Thorough patient history and examination are paramount to diagnose HD, excluding other anal or colonic pathologies.

Conclusion: Several aspects of etiopathogenesis and pathophysiology remain controversial. Further studies are needed to obtain a better understanding of the disease.

Introduction: Many different procedures have been described in the literature with the common goal of reducing the blood flow into the hemorrhoidal piles. ‘HeLP’ (Hemorrhoids Laser Procedure) is a novel form of dearterialization to treat patients suffering from symptomatic hemorrhoids.

Methods: The procedure consists of the closure of the terminal branches of the superior rectal artery approximately 2-3 cm above the dentate line by means of laser shots originated by a diode laser platform. The arteries, at that level, have variable location and distribution. Therefore, a doppler probe set at the frequency of 20MHz helps identifying the arteries that would be missed otherwise. The laser beam is well tolerated by patients. For this reason, anesthesia is not required in most cases and the procedure allows a quick return to daily activities. In the case of concomitant severe mucosal prolapse, laser treatment can be combined with suture mucopexy. Three to six running sutures allow a complete lifting of hemorrhoidal piles, securing a long-term resolution of symptoms.

Results: ‘HeLP’ is indicated in patients with symptomatic hemorrhoids where conservative treatment failed and when mucosal prolapse is scarce or not symptomatic. The addition of mucopexy to laser treatment (HeLPexx) contributes to the overall resolution of symptoms when mucosal prolapse is an issue.

Conclusion: Emborrhoid is another novel, ‘hi-tech’ form of selective dearterialization used in selected cases of hemorrhoids where the main symptom is bleeding. It is generally used in cases where surgery is contraindicated due to severe concomitant diseases.

Methods: Research and online contents related to hemorrhoids’ treatment in special conditions are reviewed in order to help colorectal surgeons in daily practice.

Results: There are very limited data about the outcomes of hemorrhoids treatment in these subgroups of patients. Patients in pregnancy can be effectively treated with medical therapy, reserving surgical intervention in highly selected and urgent cases. In case of thrombosed haemorrhoids, the excision allows a fast symptoms’ resolution, with a low incidence of recurrence and a long remission interval. In case of immunosuppressed patients, there is no consensus for the best treatment, even in most HIV positive patients, a surgical procedure can be safely proposed when indicated. There is no sufficient data in the literature related to transplanted patients. The surgical treatment of hemorrhoids in patients with IBD, especially Crohn’s Disease, can be unsafe, although there is a paucity of literature on this topic. In case of previous pelvic radiotherapy, it must always be considered that severe complications, like abscesses and fistulas with subsequent pelvic and retroperitoneal sepsis, can occur after surgical treatment of hemorrhoids, so a conservative treatment is advocated. Moreover, caution is recommended in treating patients with coagulopathy, considering possible complications (mostly bleeding) also after outpatient treatments. In case of portal hypertension and cirrhosis, a ‘conservative treatment’ is recommended. Bleeding hemorrhoids can be treated with hemorrhoidectomy when they do not respond to other treatments.

Conclusion: International literature is very scant about the treatment of patients affected by hemorrhoids in particular situations. A word of caution and concern even about the indication for minor outpatient procedures must be expressed in these patients, in order to avoid possible life-threatening complications. The first-line treatment is the conservative medical approach associated with the treatment of the primary disease.

Recent studies have concluded that appropriate postoperative pain management leads to higher patient satisfaction, earlier mobilization, fewer drug complications, eliminated adverse events, faster recovery, and decreased health care cost.

However, despite advances in pain medicine, postoperative pain control remains problematic and remains an important unresolved issue that causes expense and patient dissatisfaction. Therefore, this situation calls for multi-modal pain management, choosing medication, dosing regimens and route of administration in an individualized way to optimize efficacy and minimize adverse effects.

Multiple approaches, including pharmacological and surgical interventions, have been used to manage pain after hemorrhoidal surgery.

Our aim was to check the latest instruments and strategies available in literature designed to find practical solutions to this challenging problem.

Objective: The study aims to evaluate the outcomes of LigaSure^TM hemorrhoidectomy (LH) analyzing main post-operative complications rate, length of stay, operating time, and time to return to work.

Methods: In this monocentric descriptive study, from June 2001 to February 2019, 1454 consecutive patients, treated with LH for grade III and IV hemorrhoids, were analyzed. Complications were classified in early, late, and long-term if they occurred within 1 month, between 1 and 2 months or after 2 months, respectively.

Results: 90.2% of patients were treated in day surgery regimen and the mean operating time was 14.3 minutes. The post-operative pain decreased from 3.7 mean VAS on the 1st postoperative day to 0.1 mean VAS on 30th post-operative day. Early complications rate was 2.1%: urinary retention accounted for 1.8% of patients. 0.3%-of patients experienced postoperative bleeding and only one required reoperation. Late complications rate was 5.8%: anal stenosis, incomplete healing, and anal fissure were detected in 3.6%, 1.2%, and 1% of patients, respectively. The long term complications rate was 5.3%: anal fistula, soiling, perianal abscess, and recurrence were identified in 0.2%, 0.1%, 0.3%, and 4.8% of patients, respectively.

Conclusion: LH is a safe and fast procedure with a proven minimal complication rate.

Methods: A narrative review of all the most relevant papers present on the three major databases (PUBMED, EMBASE and WEB OF SCIENCE) regarding conservative treatment was conducted.

Results: Conservative treatment is effective in managing the majority of patients complaining of early stages of the disease. Dietary and lifestyle modifications are the first therapeutic step necessary to achieve a regular defecation with soft stool whereas oral phlebotonic drugs can help to control symptoms. The use of topical medications, particularly during the acute phase or in the post-operative period can also be beneficial for all patients complaining of HD.

Conclusion: Despite a large number of available products in the market and the high incidence of HD, very few randomized controlled trials have been carried out and most of the studies are uncontrolled case series. Larger and better designed studies are necessary to establish the real benefit of all types of drugs for the treatment of early stages of HD.

Methods: Sprague Dawley rats' heart and myocardial cells I/R model were established in vivo and vitro, then 100 mg/kg and 10 μmol/l baicalin were administrated, respectively. The experiment was randomly divided into 4 groups (n=10): Control; I/R; IR+DMEM; and I/R+baicalin groups. Postoperation, the Left Ventricular (LV) End-Diastolic Pressure (LVEDP), the maximum velocity of LV contraction (dP/dtmax) and the maximum velocity of LV diastole (dP/dtmin) were recorded by the transthoracic echocardiography; the myocardial apoptosis percentage was analyzed by Annexin VFITC/ PI and TUNEL staining, and the apoptosis gene and protein were detected by RT-PCR and western blot. Furthermore, the protein expression of the calcium-sensing receptor (CaSR) and ERK1/2 phosphorylation were observed by western blot and Fura-2-acetoxymethyl ester. Moreover, primary rats’ cardiomyocytes were cultured and ERK1/2 specific inhibitor PD98059 was added to the culture medium. The cell survival rate, vitality and apoptosis were detected by MTT, lactate dehydrogenase (LDH) and TUNEL staining assay Kit, respectively.

Results: Our present study showed that baicalin significantly improved LV hemodynamic parameters and myocardial apoptosis in myocardial I/R injury rats. Furthermore, we found that baicalin could down-regulate the protein expression of CaSR, but up-regulate the protein expression of ERK1/2. Furthermore, when the cells were pretreated with ERK1/2 inhibitor PD98059, the cells survival rate significantly decreased, but LDH activity and apoptosis significantly increased. The results indicated that the effect of baicalin on myocardial I/R injury could be inhibited by ERK1/2 inhibitor.

Conclusion: In conclusion, our data suggests that baicalin attenuates I/R-induced myocardial injury maybe through the suppression of the CaSR/ERK1/2 signaling pathway.

Objective: The study aims to investigate whether YouTube videos on hemorrhoids and hemorrhoid surgery can be a useful e-learning source for the general population, surgical trainees and specialists.

Methods: A YouTube search was performed in October 2019 using the keywords “hemorrhoids” and “hemorrhoid surgery”, and the videos were divided into 2 groups according to the keywords. Three independent researchers assessed the metadata and classified them according to the level of accuracy (hemorrhoid group) and the level of usefulness (hemorrhoid surgery group). Cohen’s test and Kappa (K) value were used to evaluate the inter-investigators agreement.

Results: A total of 200 videos were analyzed, 100 for each keyword. Regarding the hemorrhoid group, 43 videos (48.3%) were misleading, 9 were accurate (10.1%), 18 were approximate (20.2%), and 19 were considered a personal experience (21.4%). Regarding the hemorrhoid surgery group, around 60% of the videos were lacking a clear explanation, while about 16% were inaccurate. Only the remaining 24% were considered useful for teaching.

Conclusion: Around half of the YouTube videos regarding hemorrhoids topic were found to be misleading or inaccurate and present a risk of harmful consequences. Credible videos with accurate information need to be uploaded by medical professionals and medical institutions and some sort of filtering, using categories by the staff of YouTube, appears to be necessary. Care must be taken to produce clear, high-quality operative clips with proper scientific commentary.

Materials and Methods: From January to February 2019, all the patients referred to the outpatient clinic of Rajalakshmi Hospital, who were complaining of first or second degree hemorrhoidal symptoms, were enrolled in the study. They were randomly assigned to either of the 2 arms. Group 1: patients were treated with the Proctosoll Allevia® and were under a controlled diet. Group 2: patients were only under a controlled diet without any treatment - control group.

Results: A total of 51 subjects were screened and 45 (13 F- 32 M) enrolled in the study. All the patients treated with topical application of the cream showed a statistically significant improvement of symptoms within 14 days from the beginning of the therapy if compared to patients who were treated only with a controlled diet. No major adverse events associated with the use of the new product were recorded.

Conclusion: The treatment of I-II degree symptomatic HD with Proctosoll Allevia® has demonstrated to be promising with a good profile of tolerability, safety and efficacy.

Objective: The present review aims to unravel the chemical composition of wild Allium species and their healthrelated effects, focusing on the main antioxidant compounds. For this purpose, a thorough study of the literature was carried out to compile reports related to health effects and the principal bioactive compounds. Considering the vast number of species, this review is divided into subsections where the most studied species are presented, namely Allium ampeloprasum, A. flavum, A. hookeri, A. jesdianum, A. neapolitanum, A. roseum, A. stipitatum, A. tricoccum, and A. ursinum, with an additional composite section for less studied species.

Methods: The information presented in this review was obtained from worldwide accepted databases such as Scopus, ScienceDirect, PubMed, Google Scholar and Researchgate, using as keywords the respective names of the studied species (both common and Latin names) and the additional terms of “antioxidants” “health effects” and “bioactive properties”.

Conclusion: The genus Allium includes several wild species, many of which are commonly used in traditional and folklore medicine while others are lesser known or are of regional interest. These species can be used as sources of natural bioactive compounds with remarkable health benefits. Several studies have reported these effects and confirmed the mechanisms of action in several cases, although more research is needed in this field. Moreover, considering that most of the studies refer to the results obtained from species collected in the wild under uncontrolled conditions, further research is needed to elucidate the effects of growing conditions on bioactive compounds and to promote the exploitation of this invaluable genetic material.

Aims: This review presents a critical analysis of the current state of knowledge about the ethno medicinal uses, phytochemistry and pharmacological properties of C. sempervirens L and its future applications.

Materials and Methods: Literature related to C. sempervirens and its synonyms were searched on the available online literature databases such as Google Scholar, PubMed, SciFinder, Scopus, Springer, ScienceDirect, Wiley, ACS, Scielo and Web of Science, thesis, dissertations, books, reports, local herbal encyclopedias and other relevant websites.

Results: A review of literature showed that decoction of cones and young branches of C. sempervirens gave astonishing effect in the treatment of hemorrhoids and to treat excessive sweating in the feet. Enormous pharmacological properties have been found including antiseptic, anti-inflammatory, antispasmodic, antioxidant, antimicrobial, hepatoprotective, wound-healing, anticoagulant, antihyperlipidemic, anticancer, neurobiological, antidiabetic, and antiosteoporotic. Approximately 109 phytochemical constituents have been searched out as isolates from various parts of this plant comprising mostly diterpenoids and biflavonoids.

Conclusion: Numerous in vivo and in vitro studies have provided support for the traditional uses of C. sempervirens but further research work is required towards isolating more active constituents and for validating its clinical utilization in the herbal formulations for humans as well as investigating any potential toxicity for future clinical studies.

Methods: Male C57BL/6J mice were fed with a normal diet (10% kcal as fat, lean group) or a high-fat diet (60kcal as fat, obese group) for 12 consecutive weeks. To detect the MIF expression and AMPK activation in response to I/R in isolated hearts from lean and obese mice, myocardial samples were collected from left ventricular areas at different time points. To determine whether MIF supplementation is protective against I/R injury, recombined MIF (10 ng/mL) was applied before ischemia. Myocardial infarct size was estimated by triphenyltetrazolium staining. Western blot was used to detect myocardial MIF expression, AMPK activation and membrane glucose transporter 4 (Glut4) expression.

Results: The expression of MIF was remarkably higher in obese group compared to lean group. Ischemia increased myocardial MIF expression and phosphorylation of AMPK in lean mice, whereas it had no significant effect on obese mice. Furthermore, administration of recombinant MIF increased ischemic AMPK activation and membrane Glut4 expression in both lean and obese mice, while it reduced the infarct size in lean mice only.

Conclusion: An impaired MIF/AMPK activation response and consequent reduced membrane Glut4 expression may play an important role in increasing myocardial susceptibility to I/R in obesity.

Methods: Our study was conducted on four hundred patients with exclusion of those with HCV, HBV, and/or HIV positive antibodies. An ethical committee approval and a given consent were taken prior to enrollment on the study. Our patients are grouped into the following; 100 patients undergoing upper GI endoscopy without biopsy as group I; 100 patients undergoing upper GI endoscopy with biopsy as group II; 100 patients undergoing lower GI endoscopy without biopsy as group III and 100 patients undergoing lower GI endoscopy with biopsy as group IV. HCV antibodies were done 3 months after endoscopy with exclusion of other risks of HCV infection by a detailed questionnaire.

Results: Only one case was reported positive after 3 months of procedure; it was after colonoscopy with biopsy using reusable forceps.

Conclusions: Strict infection control measures of the GI endoscopes despite being effective in preventing HCV transmission, the reuse of disinfected biopsy forceps may be associated with a risk of transmission. So, we recommend using disposable forceps for every patient to omit the risk of HCV transmission during endoscopy.

Methods: The different processing treatments such as cooking, fermentation, and germination were given to buckwheat seeds. The native and processed buckwheat were then analyzed for their nutritional properties such as moisture, ash, fat, crude fiber, protein, total phenol, tannin and phytate content using standard methods. The physicochemical properties were also determined using standard methods.

Results: Processing treatments significantly (p≤0.05) reduces the tannin and phytate content and significantly (p≤0.05) increases the total phenol content. Also, processing had a varied effect on Water Absorption Capacity (WAC), Oil Absorption Capacity (OAC), least gelation concentration and bulk density. The WAC and OAC of buckwheat flours were significantly (p≤0.05) varied from 2.15 to 3.89 g/g and 1.96 to 2.32 g/g, respectively.

Conclusion: The changes observed in physicochemical properties of buckwheat flour after processing treatments provided a crucial basis for its potential applications on an industrial scale.

Objective: The present study for the first time analyzed the antioxidant and cytotoxicity of the hydroalcoholic leaves extract and fractions from Pm.

Method: The cytotoxicity test will be evaluated by different assays (MTT and CV) against human prostate cancer (PC3) and mouse malignant melanoma (B16F10) cell lines, and the antioxidant test by DPPH method.

Results: β-Amyrin, oleanolic acid, β-sitosterol and stigmasterol were isolated of the most active, hexane fraction. These substances were tested against the tumor cell lines: β-sitosterol and stigmasterol showed the most relevant activity to PC3 in CV assay and, oleanolic acid to B16F10 by the MTT assay. In addition, it was possible to indicate that the mode of cell death for stigmasterol, presumably is apoptosis. In terms of antioxidant activity, the hydroalcoholic leaves extract presented higher activity (EC50 133.3 µg/mL) compared to the flower (EC50 152.3 µg/mL) and fruit (EC50 207.9 µg/mL) extracts. By the HPLC-MS, it was possible to identify the presence of flavones in the leaf extract (isoschaftoside, schaftoside, isovitexin, vitexin, isoorientin, orientin).

Conclusions: P. mucronata hexane fraction showed promising cytotoxic effect against cancer cell lines, and stigmasterol contributes to this activity, inducing apoptosis of these cells. Furthermore, as other Passiflora species, Pm extract showed antioxidant activity and flavones are its major phenolic compounds.]]> https://www.benthamscience.comarticle/84583

Experiment: Development of the chromatographic method was based on an experimental design approach. A five-level-three-factor central composite design requiring 20 experiments in this optimization study was performed in order to evaluate the effects of three independent variances including mobile phase ratio, flow rate and amount of acid in the mobile phase.

Conclusion: The optimum composition for mobile phase was found as a methanol:water:acetic acid mixture at 71.6 : 26.4 : 2 (v/v/v) ratio and optimum separation was acquired by isocratic elution with a flow rate of 1.3 mL/min. The analytes were detected using a UV detector at 240 nm. The developed method was validated in terms of linearity, precision, accuracy, limit of detection/quantitation and solution stability and successfully applied to the determination of dibucaine HCl, fluocortolone pivalate and fluocortolone caproate in pharmaceutical topical formulations such as suppositories and ointments.]]> https://www.benthamscience.comarticle/89031

Method: The tablets were formulated by wet granulation technique using three different superdisintegrants (croscarmillose, crospovidone and sodium starch glycolate) at three different levels. The tablets were evaluated for various physical properties like hardness, friability weight variation etc. and various mechanical properties like disintegration time, wetting time to select the best superdisintegrant. The selected superdisintegrant was further used as intra as well as extra granulating agent to develop fast disintegrating tablets of Fagonia schweinfurthii Hadidi dried extract. The optimized formulation was subjected to stability study as per the ICH guidelines. Finally, Ex-vivo antihistaminic study was conducted on guinea pig ileum for optimized formulation and compared with marketed tablet containing cetrizine HCl as API (Stanhist-10, Ranbaxy, Pvt. Ltd).

Results: Physical properties of all tablet batches were found to be acceptable and comply with various official specifications. The disintegration time and wetting time of optimized formulation (F’3) were found to be 1.15±0.08 and 0.56±0.04 min respectively. Results of Ex-vivo study showed a comparable histamine inhibition between optimized tablet (15%) and marketed tablet formulation (18.8%) in a dose of 5 µg/ml.

Conclusion: On the basis of in-vitro and Ex-vivo studies, it was concluded that prepared herbal fast disintegrating tablets were stable and had potent antihistaminic activity.]]> https://www.benthamscience.comarticle/80608

Methods: We undertook a structured search of bibliographic database for peer-reviewed research literature using a focused review question and inclusion/exclusion criteria. The quality of retrieved papers was appraised using standard tools. The characteristics of screened papers were described, and a deductive qualitative content analysis methodology was applied to analyze the interventions and findings of included studies using a conceptual framework.

Results: Twenty-one papers were included in the review, eight papers outlined the relationship of Cx43 and reperfusion arrhythmias. Eight papers pointed out the effect on the infarct size of Cx43.

Conclusion: The findings of this review confirm that Cx43 is the most abundant member of Cx family in the heart and is vital for myocardial protection during ischemia/reperfusion process and for ischemia/reperfusion injury. Many of its mechanism are still not very clear and require future research in the future.]]> https://www.benthamscience.comarticle/85237

Objective: The aim of this study was to determine the etiologies of dementia according to the Traditional Persian Medicine scientists' viewpoint and introduce their recommended herbal remedies for this disease.

Method: The authors explored six main Traditional Persian Medicine textbooks for the disease of dementia, its etiologies and related recommended herbal treatments. Two main keywords of “Lisarghes” and “Nesyan” were searched for this purpose. Medical databases, including PubMed, Scopus, Google Scholar, and Science Direct were searched for related articles published between 1966 and 2016 to review the pharmacological components and active ingredients of suggested herbal medicines.

Results: According to the Traditional Persian Medicine, dementia is resulted from brain dystemperament, a condition caused by cold and moist or cold and dry tempers. To treat this disease, Traditional Persian scientists recommended various herbal remedies. Current studies have demonstrated that some of these medicinal plants have beneficial effects for the aforementioned disease, including acetyl cholinesterase inhibitory function, neuroprotective effects, and memory enhancing role.

Conclusion: The Traditional Persian Medicine literature suggested different herbal remedies for treating dementia. Modern studies support the usefulness of some of these medicines. However, the effect of a large number of these remedies has remained unexamined, a matter which needs to be investigated in future researches.]]> https://www.benthamscience.comarticle/88767

Objective: Lack of an appropriate comprehensive review for off-label uses of this medication troubles physicians about making evidence-based decisions on prescribing it for its various outstanding off-label uses. This article attempts to provide physicians with the latest information concerning successful and unsuccessful use of polidocanol as an alternative treatment for esophageal and gastric varices, tendinopathy and epicondylitis, vascular malformations, varicocele, hydrocele and spermatocele, aneurysmal bone cysts, itching, management of gastrointestinal bleeding, simple renal cysts, reducing the incidence and severity of radio-induced dermatitis and hemorrhoids.

Method: The two databases of MEDLINE and Cochrane Library were searched for all human English studies, published in January 2006 to November 2017, which contained the keyword of “polidocanol” or its alternative MeSH terms.

Results: Our search identified a total number of 597 articles. Those articles that were only discussing the approved uses of polidocanol were excluded and the remaining 116 articles were reviewed. Eleven major and 30 minor off-label uses were found within included studies.

Conclusion: Numerous successful administrations of this drug in a variety of clinical conditions lead to promising perspectives toward it. Sclerotherapy with polidocanol as a minimal-invasive method (having similar outcomes like the prevalent surgeries) may reduce the rate of complications. Furthermore, for determining the most appropriate method and dosage, randomized clinical trials are needed, confirming and providing more clear instructions for different conditions.]]> https://www.benthamscience.comarticle/81748

Material and Methods: Phytochemical screening and high-performance liquid chromatography (HPLC). The antioxidant activity was determined by DPPH (2,2- diphenyl, 1-picrihidrazila) and FRAP (ferric fraction reductive) methods. The gastroprotective activity was evaluated against HAAF to classical models of acute gastric: absolute ethanol, acidified ethanol and Indomethacin (50, 100 and 200mg/kg/orally) and physical barrier mechanism (50mg/kg/orally, intraperitoneally), used Swiss mice (Mus musculus). The healing activity of HAAF was identified from tissue shrinkage rate in the control. The antimicrobial activity was observed from the Minimum Inhibitory Concentration method (MIC) and modulation associated with antibiotics (amikacin, gentamicin, benzylpenicilin, imipinem + cilastatin sodium, cephalothin, oxalacina and ampicillin) and antifungals (amphotericin B, nystatin, mebendazole and benzoilmetronidazol).

Results: Phytochemical prospection of Chromatography (HPLC) quantified gallic acid (4.25 %), chlorogenic acid (2.11%), caffeic acid (0.73%), rutin (0.08 %) and quercetin (0.29%). Measurement of total flavonoids (0.034 g of quercetin) and phenols (0.538 g of gallic acid) gram of extract showed significant amount. HAAF showed significant antioxidant potential in DPPH and FRAP assays. The MIC did not show clinically relevant activity (≥1024 µg/mL). HAAF displayed gastroprotective different doses (50, 100 and 200 mg/Kg) and Healing activity (100 mg/g).

Conclusion: The results obtained in this study provide biological evidence of the antioxidant potential, gastroprotective and wound healing effect of the species.]]> https://www.benthamscience.comarticle/81952

Results: Acting through a variety of downstream mechanisms, urocortin has been shown to alter cellular metabolism and modulate the mechanism of cell death occurring as a result of ischemia-reperfusion injury. New evidence continues to accumulate in support of urocortin’s beneficial role in cytoprotection.

Conclusion: We present here an updated review largely focused on the various mechanisms through which urocortin alters cellular metabolism, and discuss the clinical potential of urocortin’s cardioprotective ability in myocardial ischemia-reperfusion injury.]]> https://www.benthamscience.comarticle/83170

Conclusion: The article reviews the phytochemistry and phytopharmacology of the plant.]]> https://www.benthamscience.comarticle/70781

Objective: In this review, various pharmacological interventions to treat myocardial reperfusion injury including the antioxidant flavonols, hydrogen sulfide, adenosine, opioids, incretin-based therapies and cyclosporin A which targets the mitochondrial permeability transition pore are discussed.

Conclusion: The processes involved in reperfusion injury might provide targets for improved outcomes after myocardial infarction but thus far that aim has not been met in the clinic.]]> https://www.benthamscience.comarticle/80391Callistemon viminalis (weeping bottlebrush), belongs to the family Myrtaceae, is known to have medical importance. An ornamental plant stands for its numerous attributes such as antioxidant, moluscicidal, antibacterial, antifungal, allelopathic, anti-platelet aggregation, anti-quorum sensing, anti-infective, anti-helminthic and has also been found as an effective insecticidal activity. This plant possesses a wide range of secondary metabolites inclusive of triterpenoid, monoterpenes, steroid, steroida l glycoside, phenolic, tetra deca hydro xanthene diones, pyrrole derivatives, flavonoids and essential oils. An impression has been taken from previous research that the major constituents of C. viminalis are monoterpenes which are mainly responsible for different biological activities of C. viminalis. This review includes the information concerning the cultivation, morphology, microscopic studies, physiochemical, and phytochemistry, so as to exploit it further for the human welfare.]]> https://www.benthamscience.comarticle/82974

Results: Multiple studies using natural compounds have shown increased therapeutic efficacy of gemcitabine in pancreatic cancer models.

Conclusion: This review is focused on recent updates on cellular, preclinical and clinical studies utilizing natural anticancer agents with gemcitabine against pancreatic cancer.