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Medicines, Volume 7, Issue 6 (June 2020) – 7 articles

Cover Story (view full-size image): Genista tridentata L. is a wild plant used in Portugal to treat several inflammatory diseases. Plant extracts were evaluated to validate the medicinal properties, and phytochemical studies established that genistein, rutin, and biochanin A may be the metabolites responsible for the anti-inflammatory properties. View this paper
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9 pages, 1693 KiB  
Article
Autologous Biologic Treatment with Fat, Bone Marrow Aspirate and Platelet Rich Plasma Is an Effective Alternative to Total Knee Arthroplasty for Patients with Moderate Knee Arthrosis
by Chadwick Prodromos and Susan Finkle
Medicines 2020, 7(6), 37; https://0-doi-org.brum.beds.ac.uk/10.3390/medicines7060037 - 25 Jun 2020
Cited by 3 | Viewed by 3501
Abstract
Background: Osteoarthrosis (OA) of the knee afflicts millions worldwide. Total Knee Arthroplasty (TKA) is common, but associated with substantial cost and morbidity. Prior studies of intra-articular injection of fat, bone marrow aspirate (BMA), and platelet rich plasma (PRP) have shown clinical benefit. We [...] Read more.
Background: Osteoarthrosis (OA) of the knee afflicts millions worldwide. Total Knee Arthroplasty (TKA) is common, but associated with substantial cost and morbidity. Prior studies of intra-articular injection of fat, bone marrow aspirate (BMA), and platelet rich plasma (PRP) have shown clinical benefit. We hypothesized that injection of autologous adipose tissue, BMA, and PRP would provide significant benefit for patients with moderate knee OA resulting in avoidance of total knee arthroplasty (TKA) in most, with discontinuance of NSAIDs and other drugs. Methods: 42 TKA candidate patients (47 knees) with moderate (Kellgren-Lawrence 2 and 3) knee OA who had failed conservative treatment had autologous adipose tissue, BMA, and PRP injection as an alternative to TKA in office using only local anesthetic. Patients had discontinuance of all nonsteroidal anti-inflammatory medicines (NSAIDs) and other analgesics, except acetaminophen, prior to treatment. Patients were evaluated with Knee injury and Osteoarthritis Outcome Score Physical Shortform (KOOS-PS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Single Assessment Numeric Evaluation (SANE) prior to treatment, and at 6 months, 1, and 2 years after treatment. Results: Follow up exceeded 80% at all time points. There were no significant adverse events. TKA was avoided in 97% at one and 86% at two years after treatment. Mean SANE, KOOS-PS, and WOMAC scores significantly improved at 6 months, 1, and 2 years post-treatment. WOMAC and SANE scores were higher at two versus one year post-treatment. Conclusions: Combined fat, BMA, and PRP injection is a safe and effective treatment for moderate knee OA, with reliable avoidance of TKA and possible continued improvement at two year follow-up. Full article
(This article belongs to the Special Issue Recent Advances in Stem Cell Treatment)
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8 pages, 2395 KiB  
Case Report
A Combination of Magnetic Resonance Imaging Techniques to Localize the Dural Defect in a Case of Superficial Siderosis—A Case Report
by Hiroyuki Katoh, Shuhei Shibukawa, Keiko Yamaguchi, Akihiko Hiyama, Tomohiko Horie, Masato Sato and Masahiko Watanabe
Medicines 2020, 7(6), 36; https://0-doi-org.brum.beds.ac.uk/10.3390/medicines7060036 - 25 Jun 2020
Cited by 4 | Viewed by 3924
Abstract
Background: Superficial siderosis is a progressively disabling disease caused by recurrent subarachnoid hemorrhage with accumulation of hemosiderin in the surface of the central nervous system. Although a wide variety of conditions may cause superficial siderosis, approximately half of the cases are reported to [...] Read more.
Background: Superficial siderosis is a progressively disabling disease caused by recurrent subarachnoid hemorrhage with accumulation of hemosiderin in the surface of the central nervous system. Although a wide variety of conditions may cause superficial siderosis, approximately half of the cases are reported to be associated with a defect in the ventral spinal dura mater, in which case treatment entails surgical repair of the defect. Here, we report a case of superficial siderosis and report on our method to pinpoint the dural defect using a combination of magnetic resonance imaging (MRI) techniques. Methods and Results: A 74-year-old female presented suffering from hearing loss and progressive ataxia over a duration of seven years. A T2-weighted MRI study revealed hypointensity in the superficial areas of the central nervous system, leading to the diagnosis of superficial siderosis, and the presence of a fluid-filled collection in the anterior spinal canal of C7 to T10 suggested that a dural defect was the cause of the repeated hemorrhage. A balanced turbo field echo (BTFE) MRI sequence revealed possible dural defects at T1–T2 and T5–T6, and a dynamic improved motion-sensitized driven-equilibrium steady-state free precession (dynamic iMSDE SSFP) sequence revealed an irregular flow of cerebrospinal fluid through the dura at the T5–T6 level. The dural defect was confirmed and sutured through a minimal T5–T6 laminectomy without neurological consequences, and the patient reported mild improvement in gait one year after surgery. Conclusions: A combination of MRI sequences provided the necessary information to confidently perform minimal surgery to repair the dural defect. We recommend coupling a balanced steady-state free precession (SSFP) sequence to provide high resolution, high contrast images of anatomical structures and a dynamic iMSDE SSFP sequence to confirm cerebrospinal fluid motion through the defect. Full article
(This article belongs to the Section Neurology and Neurologic Diseases)
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14 pages, 1058 KiB  
Article
Chromatographic, Chemometric and Antioxidant Assessment of the Equivalence of Granules and Herbal Materials of Angelicae Sinensis Radix
by Valentina Razmovski-Naumovski, Xian Zhou, Ho Yee Wong, Antony Kam, Jarryd Pearson and Kelvin Chan
Medicines 2020, 7(6), 35; https://0-doi-org.brum.beds.ac.uk/10.3390/medicines7060035 - 23 Jun 2020
Cited by 2 | Viewed by 3617
Abstract
Background: Granules are a popular way of administrating herbal decoctions. However, there are no standardised quality control methods for granules, with few studies comparing the granules to traditional herbal decoctions. This study developed a multi-analytical platform to compare the quality of granule products [...] Read more.
Background: Granules are a popular way of administrating herbal decoctions. However, there are no standardised quality control methods for granules, with few studies comparing the granules to traditional herbal decoctions. This study developed a multi-analytical platform to compare the quality of granule products to herb/decoction pieces of Angelicae Sinensis Radix (Danggui). Methods: A validated ultra-performance liquid chromatography coupled with photodiode array detector (UPLC-PDA) method quantitatively compared the aqueous extracts. Hierarchical agglomerative clustering analysis (HCA) and principal component analysis (PCA) clustered the samples according to three chemical compounds: ferulic acid, caffeic acid and Z-ligustilide. Ferric ion-reducing antioxidant power (FRAP) and 2,2-Diphenyl-1-picrylhydrazyl radical scavenging capacity (DPPH) assessed the antioxidant activity of the samples. Results: HCA and PCA allocated the samples into two main groups: granule products and herb/decoction pieces. Greater differentiation between the samples was obtained with three chemical markers compared to using one marker. The herb/decoction pieces group showed comparatively higher extraction yields and significantly higher DPPH and FRAP (p < 0.05), which was positively correlated to caffeic acid and ferulic acid, respectively. Conclusions: The results confirm the need for the quality assessment of granule products using more than one chemical marker for widespread practitioner and consumer use. Full article
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10 pages, 748 KiB  
Review
Chrysippus and the First Known Description of Cataract Surgery
by Juliusz Grzybowski and Andrzej Grzybowski
Medicines 2020, 7(6), 34; https://0-doi-org.brum.beds.ac.uk/10.3390/medicines7060034 - 22 Jun 2020
Cited by 2 | Viewed by 3670
Abstract
Although the origin of cataract surgery is unknown, the earliest identified mention of cataract surgery comes from Chrysippus in the 3rd century B.C.E. This historical review analyses this first description of cataract surgery from both philosophical and linguistic perspectives, within the original context [...] Read more.
Although the origin of cataract surgery is unknown, the earliest identified mention of cataract surgery comes from Chrysippus in the 3rd century B.C.E. This historical review analyses this first description of cataract surgery from both philosophical and linguistic perspectives, within the original context in which early cataract surgeries were performed, as well as within the context of contemporary medical knowledge. Full article
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12 pages, 481 KiB  
Review
Oral Manifestations of Inflammatory Bowel Disease and the Role of Non-Invasive Surrogate Markers of Disease Activity
by Davide Giuseppe Ribaldone, Selvaggia Brigo, Michela Mangia, Giorgio Maria Saracco, Marco Astegiano and Rinaldo Pellicano
Medicines 2020, 7(6), 33; https://0-doi-org.brum.beds.ac.uk/10.3390/medicines7060033 - 16 Jun 2020
Cited by 22 | Viewed by 5343
Abstract
Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC), can be associated with several extra-intestinal manifestations requiring a multidisciplinary management both in terms of work-up and therapy. Oral lesions are common in patients with IBD, with a prevalence ranging [...] Read more.
Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC), can be associated with several extra-intestinal manifestations requiring a multidisciplinary management both in terms of work-up and therapy. Oral lesions are common in patients with IBD, with a prevalence ranging from 5% to 50%. These can represent an oral location of IBD as well as a side-effect of drugs used to treat the intestinal disease. Oral manifestations, occurring in patients with IBD, can be divided in nonmalignant, specific, and non-specific ones, and malignant lesions. While there is undoubtedly a need to search for an IBD in patients with oral lesions associated with intestinal symptoms, the work-up of those with an exclusive oral lesion should be personalized. Fecal calprotectin is a non-invasive marker of intestinal inflammation and may be used to select which patients need to undergo endoscopic examination, thereby avoiding unnecessary investigations. The pharmacological armamentarium to treat oral lesions associated with IBD includes topical or systemic corticosteroids, immunosuppressive agents, and biologic drugs. Full article
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8 pages, 254 KiB  
Article
Circulatory Failure among Hospitalizations for Heatstroke in the United States
by Tarun Bathini, Charat Thongprayoon, Tananchai Petnak, Api Chewcharat, Wisit Cheungpasitporn, Boonphiphop Boonpheng, Ronpichai Chokesuwattanaskul, Narut Prasitlumkum, Saraschandra Vallabhajosyula and Wisit Kaewput
Medicines 2020, 7(6), 32; https://0-doi-org.brum.beds.ac.uk/10.3390/medicines7060032 - 14 Jun 2020
Cited by 10 | Viewed by 3444
Abstract
Background: This study aimed to assess the risk factors and the association of circulatory failure with treatments, complications, outcomes, and resource utilization in hospitalized patients for heatstroke in the United States. Methods: Hospitalized patients with a principal diagnosis of heatstroke were identified in [...] Read more.
Background: This study aimed to assess the risk factors and the association of circulatory failure with treatments, complications, outcomes, and resource utilization in hospitalized patients for heatstroke in the United States. Methods: Hospitalized patients with a principal diagnosis of heatstroke were identified in the National Inpatient Sample dataset from the years 2003 to 2014. Circulatory failure, defined as any type of shock or hypotension, was identified using hospital diagnosis codes. Clinical characteristics, in-hospital treatment, complications, outcomes, and resource utilization between patients with and without circulatory failure were compared. Results: A total of 3372 hospital admissions primarily for heatstroke were included in the study. Of these, circulatory failure occurred in 393 (12%) admissions. Circulatory failure was more commonly found in obese patients, but less common in older patients aged ≥60 years. The need for mechanical ventilation, blood transfusion, and renal replacement therapy were higher in patients with circulatory failure. Hyperkalemia, hypocalcemia, metabolic acidosis, metabolic alkalosis, sepsis, ventricular arrhythmia or cardiac arrest, renal failure, respiratory failure, liver failure, neurological failure, and hematologic failure were associated with circulatory failure. The in-hospital mortality was 7.1-times higher in patients with circulatory failure. The length of hospital stay and hospitalization costs were higher when circulatory failure occurred while in the hospital. Conclusions: Approximately one out of nine heatstroke patients developed circulatory failure during hospitalization. Circulatory failure was associated with various complications, higher mortality, and increased resource utilizations. Full article
19 pages, 3105 KiB  
Review
Genista tridentata L.: A Rich Source of Flavonoids with Anti-Inflammatory Activity
by Diana C. G. A. Pinto, Mark A. M. Simões and Artur M. S. Silva
Medicines 2020, 7(6), 31; https://0-doi-org.brum.beds.ac.uk/10.3390/medicines7060031 - 30 May 2020
Cited by 8 | Viewed by 3855
Abstract
Background: Genista tridentata L. is an endemic species from the Iberian Peninsula used in Portuguese traditional medicine to treat inflammation-related diseases; this and other health-promoting effects are usually associated with the flavonoids produced by this species. In fact, anti-inflammatory properties were established for [...] Read more.
Background: Genista tridentata L. is an endemic species from the Iberian Peninsula used in Portuguese traditional medicine to treat inflammation-related diseases; this and other health-promoting effects are usually associated with the flavonoids produced by this species. In fact, anti-inflammatory properties were established for several of these flavonoid derivatives. Methods: A careful survey of the reported data, using mainly the Scopus database and Genista tridentata and Pterospartum tridentatum as keywords, was done. We have examined the papers involving the plant and those about the most relevant flavonoids anti-inflammatory activity. Results: The literature survey demonstrates that species are used to treat several health problems such as antihyperglycemia, hypertension, and inflammatory episodes. It was also possible to establish its richness in flavonoid derivatives, from which several are potential anti-inflammatory agents. Conclusions: From our described and discussed analysis, it can be concluded that Genista tridentata is an excellent source of bioactive flavonoids. Moreover, its traditional use to treat inflammation episodes may be due to its flavonoid content, from which genistein, biochanin A, rutin, and daidzein can be emphasized. Full article
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