OBJECTIVE:This study aimed to evaluate the relationships between demographic characteristics, clinical features, treatment modalities, and outcomes in patients with acute methadone intoxication in Yazd. METHODS:This retrospective, hospital-based cohort study analyzed the clinical data of 1,400 patients diagnosed with methadone intoxication. Demographic data, clinical symptoms, laboratory tests, treatment methods, and outcomes were obtained from patients' medical records and the hospital information system. RESULTS:The majority of patients (68.4%) were male, and most intoxication incidents occurred in the 15-30-year age group (37.4%). The most common clinical manifestations were decreased level of consciousness (97.5%), respiratory depression (84.9%), and miosis (82.0%). The most frequent complications were elevated creatine phosphokinase (CPK) (19.6%), aspiration pneumonia (10.4%), seizures (6.0%), and acute respiratory distress syndrome (ARDS) (0.9%). Endotracheal intubation was required in 12.9% of cases. The overall mortality rate was 1.4%. Logistic regression analysis identified elevated CPK (OR = 2.06, 95% CI: 1.16-3.66, P = 0.014), ARDS (OR = 27.86, 95% CI: 4.55-170.74, P < 0.001), and the need for endotracheal intubation (OR = 31.64, 95% CI: 8.37-119.60, P < 0.001) as independent predictors of mortality. CONCLUSIONS:Acute methadone intoxication in this region predominantly affects young males and presents with significant central nervous system and respiratory depression. Although the mortality rate is relatively low, the development of ARDS, rhabdomyolysis (indicated by elevated CPK), and the requirement for endotracheal intubation are important risk factors associated with a significantly higher likelihood of death.
INTRODUCTION:Oral health is associated with an individual's overall health and daily function, as well as having an impact on mental health. As such, this study evaluated the cytotoxic and biocompatibility profile of fourth-generation polyethyleneimine (PEI) nanodendrimers using a human gingival fibroblast cell line [1]. The aim was to determine the concentration- and time-dependent cytotoxic effects of PEI nanodendrimers to assess their suitability for potential dental applications. MATERIALS AND METHODS:This laboratory study investigated the potential cytotoxicity and biocompatibility of fourth-generation PEI nanodendrimers. PEI nanodendrimers were synthesized, and their cytotoxic effects were tested on human gingival fibroblast cells (2PI2HGF) at varying concentrations (1-128 µg/mL) over 48 and 72 hours. Viability of the cells was determined by MTT assay, and growth curves were constructed to determine the rate of cell proliferation in response to the addition of the PEI dendrimer. RESULTS:Cytotoxicity was shown to increase with increasing concentrations of PEI dendrimers. For example, after 48 and 72 hours of exposure to a range of concentrations (1-128 µg/mL), viability levels dropped from 99.18% to 67.7% and 97.3% to 65.1%, respectively. It should also be noted that the extent of reduced cell viability was influenced by both the duration of exposure and the dendrimer concentration. CONCLUSION:These results indicate that while PEI dendrimers show significant potential for use in dentistry, they also demonstrate considerable cytotoxicity and subsequent concern over their biocompatibility. Future research should therefore focus on improving the safety and efficacy of dendrimer materials in the context of developing therapies for oral health. These findings contribute to the growing body of evidence on nanomaterials in dentistry and highlight the need to balance antimicrobial efficacy with acceptable cytotoxicity for clinical translation.
BACKGROUND AND OBJECTIVE:For the management of postoperative pain, opioids have typically been half their efficacy, but they are associated with notable side effects such as sedation, nausea, and respiratory depression. Nefopam is a non-opioid analgesic, within the benzoxazocine class, that has been suggested as an important adjunctive analgestic in multimodal analgesia (MMA). However, the extent to which analgesics outside of opioids are accepted as part of Enhanced Recovery After Surgery (ERAS) programs is controversial. The difficulty of predicting pain management outcome, considering the variability in postoperative pain, means that study of the analgesic effect of intravenous nefopam given different strategies, is essential in the use of nefopam for spinal surgery. METHODS:We completed a systematic search of PubMed, Scopus, and Google Scholar until July 20, 2025. We included randomized controlled trials (RCTs) that assessed intravenous nefopam for treating postoperative pain in patients who had spine surgery. The extracted data were pooled, and we performed a random-effects meta-analysis. Subgroup analyses were planned to compare bolus use, infusion use, and bolus plus infusion use. RESULTS:Seven RCTs, involving a total of 471 patients, were included in the eligibility criteria. The overall pooled analysis found no differences in postoperative pain scores between the nefopam and control conditions. The standardized mean difference (SMD) was -0.28 (95% confidence interval [CI]: -0.74 to 0.18), which indicated no difference in efficacy. The sub-group analysis found that bolus administration had the greatest analgesic effect (SMD = -0.70) and infusion or bolus + infusions had little or no clinical benefit. The infusion sub-group had the greatest heterogeneity (I2 = 86.9%) suggesting variability in studies for this delivery method. CONCLUSION:The use of intra-venous nefopam offers a small analgesic benefit in spine surgery, which is best seen when applied intermittently or as a bolus rather than as a continuous infusion. Though it is not particularly effective as a standalone agent, bolus does have potential as an adjunct and should be included as part of a more multimodal analgesia approach. Further high quality RCTs with larger sample sizes are warranted to better define the optimal application of nefopam and dosing in patients undergoing spinal surgery.
BACKGROUND:Postoperative pain management in spine surgery is challenging. While opioids are effective, their significant adverse effects, including respiratory depression, necessitate opioid-sparing strategies. The Erector Spinae Plane (ESP) block has emerged as a promising regional technique. This study investigates whether the addition of methylprednisolone to bupivacaine in an ESP block enhances postoperative analgesia and reduces opioid consumption in patients undergoing lumbar spine surgery. METHOD:This prospective, randomized clinical trial (Ethical Approval ID: IR.SBMU.RETECH.REC.1403.467) included 64 patients (18-65 years) for two- or three-level lumbar spine surgery. Patients were randomized into two groups: the control group (bupivacaine alone) and the intervention group (bupivacaine combined with methylprednisolone). Data were collected on intraoperative metrics (e.g., fluid therapy, blood loss, operation time), opioid consumption, postoperative pain scores (NRS), incidence of nausea and shivering, blood glucose levels, and need for rescue analgesia up to one month post-surgery. RESULTS:The methylprednisolone group showed significantly lower narcotics consumption (intraoperatively and in the PACU). The pain level (NRS) was also lower in this group for up to four weeks post-operation. There were no significant inter-group differences in surgery duration, anesthetic consumption, bleeding, or the incidence of nausea and chills. CONCLUSION:The use of methylprednisolone as an adjuvant to bupivacaine in the ESP block improves the quality and duration of analgesia in spine surgery patients. However, the transient elevation in blood glucose levels highlights the need for careful glucose monitoring.
Anthracyclines are vital chemotherapy drugs for treating various cancers, including solid tumors and blood cancers; however, they cause dose-dependent cardiotoxicity, manifesting as cardiomyopathy, arrhythmias, and heart failure (HF). Cardiotoxicity, driven by oxidative stress, mitochondrial dysfunction, and other mechanisms, limits its use and affects long-term patient outcomes. Meanwhile, sodium-glucose co-transporter-2 (SGLT2) inhibitors, originally developed for type 2 diabetes, offer cardiovascular benefits beyond glucose control, such as reduced HF hospitalization and mortality. These benefits stem from improved myocardial energetics, reduced fibrosis, and improved regulation of cardiac ion homeostasis. Experimental studies, including animal models, have shown that SGLT2 inhibitors, such as empagliflozin, preserve cardiac function and reduce inflammation in anthracycline-induced cardiotoxicity. Clinical data, although limited to small retrospective studies, suggest lower mortality and fewer cardiovascular events in anthracycline-treated cancer patients using SGLT2 inhibitors. However, variability in the study design highlights the need for a systematic evaluation. This systematic review aimed to critically assess the cardiovascular outcomes associated with SGLT2 inhibitor use in cancer patients treated with anthracyclines, evaluating their dual role in glycemic control and cardioprotection, and to identify evidence gaps to inform therapeutic strategies for optimizing long-term cardiovascular health in this vulnerable population.
BACKGROUND:The diagnosis and follow-up of Crohn's disease (CD) often require invasive instrumental examinations, which carry a high risk of iatrogenic injury. This study aimed to determine the frequency of ultrasound features in each stage of the Pediatric Crohn's Disease Activity Index (PCDAI). METHODS:This cross-sectional study included 22 pediatric patients with Crohn's disease. Disease activity was assessed using the PCDAI. The state of CD activity was categorized into four groups: remission (PCDAI scores less than 10), mild (PCDAI scores of 10-27.5), moderate (PCDAI scores of 30-37.5), and severe (PCDAI scores > 40). Clinical data collected included the thickness of the ascending colon loop, the thickness of the ileal loop, the number of lymph nodes, the short-axis diameter of lymph nodes (mm), spleen span, presence of free fluid, fistulas, liver echogenicity, vascularity around the loops, lumen narrowing, terminal ileum compression, mesenteric fat hypertrophy, intestinal wall and mesenteric fat echogenicity, and Superior Mesenteric Artery indices. These data were documented for analysis. RESULTS:As disease activity progressed from mild to severe, intestinal wall echogenicity, fat echogenicity, mesenteric fat, vascularity, and lumen narrowing significantly increased (P < 0.05). The mean ileal loop thickness also significantly increased (P = 0.005), rising from 2.12 ± 0.58 in mild cases to 4.49 ± 1.43 in severe cases. However, the mean ascending colon loop thickness, the number of lymph nodes, the short-axis diameter of lymph nodes, and spleen span were not statistically significant (P > 0.05). Changes in the superior mesenteric artery indices across the different PCDAI phases were also not statistically significant (P > 0.05). CONCLUSIONS:Ultrasound is a convenient and reproducible tool for monitoring CD activity in pediatrics. This study demonstrated significant findings, including the increase in intestinal wall echogenicity, fat echogenicity, mesenteric fat hypertrophy, vascularity, and lumen narrowing as the disease activity progressed from mild to severe. Particularly, the mean ileal loop thickness showed a significant increase in the severe phase compared to the mild phase.
Effective management is one of the most important factors in mitigating postoperative endodontic pain (PEP). The purpose of this network meta-analysis was to compare the therapeutic effects and safety of different drugs commonly used for pain relief after non-surgical endodontic treatment. We searched the Scopus, PubMed, and Google Scholar databases until February 2024. Titles, abstracts, and full texts were identified according to predetermined criteria. Data were extracted from the selected publications, and a quality assessment was performed for the included studies. Sixteen RCTs with 2,021 participants were included in the meta-analysis. All included studies investigated the impact of NSAIDs on pain reduction in nonsurgical endodontic treatment. A statistically significant reduction in pain was observed at 8 h (pooled effect = -3.10, I2 = 100%), 12 h (pooled effect = -1.69, I2 = 99.2%), 24 h (pooled effect = -1.48, I2 = 99.9%), 48 h (pooled effect = -1.42, I2 = 99.4%), and 72 h (pooled effect = -0.64, I2 = 73.1%) of follow-up. The funnel plot was symmetrical, and sensitivity analysis excluded one article in 72 h follow-up. Overall, this meta-analysis demonstrated that NSAIDs and corticostreoids are statistically effective in relieving pain after non-surgical endodontic treatment. However, owing to the significant differences between studies and heterogenicity, additional randomized controlled trials are needed to validate this correlation further.
Alpha-N-acetylgalactosaminidase (nagalase), a lysosomal enzyme encoded by the NAGA gene, plays a critical role in the degradation of glycoconjugates, modulation of immune responses, and regulation of vitamin D metabolism. Dysregulation of nagalase is associated with several pathological conditions, including Schindler disease, psychiatric disorders, viral infections, and notably, cancer. Elevated serum levels of nagalase, particularly the Naga6 isoform, have been observed in cancer patients and individuals with enveloped viral infections, contributing to immune evasion by impairing macrophage activation through Gc protein deglycosylation. Moreover, nagalase activity has been implicated in rare blood group changes observed in some malignancies. Although ELISA-based assays offer potential for quantifying nagalase, their clinical application is hindered by assay interferences and cross-reactivity. The immunotherapeutic potential of Gc protein-derived macrophage activating factor (GcMAF), in combination with vitamin D3 and ascorbate, has shown promise in enhancing anti-tumor immunity, particularly in prostate cancer. Nevertheless, conflicting data and methodological criticisms have led to skepticism regarding its efficacy. This review comprehensively explores the biochemical variants of nagalase, its physiological and pathological roles, its diagnostic utility as a biomarker, and emerging therapeutic strategies targeting its activity, including gene silencing and monoclonal antibody development. The findings underscore the need for rigorous clinical studies to validate the diagnostic and therapeutic potential of nagalase in oncology and immunology.
Cardiac amyloidosis (CA) is a challenging acquired heart disease caused by the deposition of β-pleated amyloid proteins, often leading to nonspecific symptoms that complicate the diagnosis. This case report describes an 83-year-old male patient presenting with chest pain and cough, revealing significant cardiomegaly and pericardial effusion on imaging. Initial diagnostic modalities, including echocardiography and endomyocardial biopsy (EMB), have yielded inconclusive results. Despite a negative EMB result, further investigation using positron emission tomography/computed tomography ruled out cardiac sarcoidosis. A second EMB was performed to confirm the diagnosis of CA. This case underscores the importance of combining clinical symptoms with paraclinical assessments and advocating additional testing when discrepancies arise, highlighting the complexities in diagnosing CA. This case report emphasizes the necessity for clinicians to integrate clinical symptoms with diagnostic findings when assessing for cardiac amyloidosis. This illustrates the potential for false-negative biopsies and the importance of considering further testing to ensure an accurate diagnosis, ultimately enhancing diagnostic accuracy and patient management in cases of suspected cardiac amyloidosis.
Sarcopenia is an age-associated progressive deterioration of skeletal muscle, not only affecting the muscle function of elderly individuals but also contributing to various health issues and increased mortality. Current diagnostic tools are faced with limitations, hindering their widespread clinical application. This review examines the potential of myokines, peptides released from contracting muscles, as innovative biomarkers for sarcopenia. We explore the wide range of auto-, para-, and endocrine functions of myokines and the pathways of their physiological action, as well as address ongoing research results on the role of myokines as biomarkers for the timely diagnosis of sarcopenic individuals. Of all myokines, the ones that show the highest potential include irisin, myostatin, follistatin and brain-derived neurotrophic factor (BDNF). Their physiological action is exerted through complex pathways involving multiple molecules. Most studies show that these molecules can be used as biomarkers for the timely diagnosis of sarcopenia, whether by using each one individually or as a panel of biomarkers. However, several studies showed no correlation between the plasma levels of these peptides and a sarcopenia diagnosis. Finally, a number of studies also exhibited gender-affected relationships. While the quality of studies is promising, research on the use of myokines as biomarkers of sarcopenia is needed to more accurately determine the cut-off plasma values of such markers. By overcoming the shortcomings of existing methodologies, utilizing myokines in daily clinical practice could offer a promising path toward more effective prevention, diagnosis, and treatment strategies, ultimately improving outcomes for the aging population.
BACKGROUND:Type 2 diabetes mellitus (T2DM) increases the risk of fractures. This meta-analysis compared the effects of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and dipeptidyl peptidase-4 inhibitors (DPP-4i) on fracture risk in patients with T2DM. METHOD:A systematic search of PubMed, Web of Science, Embase, and Google Scholar was conducted up to August 6, 2023. Seven cohort studies (n = 1,199,267 participants at baseline; n = 357,119 after propensity matching) comparing SGLT-2i use with DPP-4i use and reporting fracture outcomes were included. Data were extracted and analyzed using a random-effects model. Subgroup analyses were performed by age (<70 and ≥70 years) and sex. RESULTS:In general, SGLT-2i therapy was linked to reduced fracture risk when compared to DPP-4i (OR: 0.89, 95% CI: 0.81-0.98). Heterogeneity was high (I2 = 64.3%). Upon stratified analysis by age, no statistically significant difference was observed between the fracture risk in the <70 years and ≥70 years subgroups upon comparison of SGLT-2i with DPP-4i. No significant difference was also observed in the female subgroup. CONCLUSION:This meta-analysis indicates SGLT-2i therapy could be linked with reduced overall fracture risk in comparison to DPP-4i in the general population of T2DM. The benefit was not seen in subgroup analysis based on age and sex. Additional research, ideally with increased cases within subgroups, is required to determine the impact of these drugs on fracture risk in patient subgroups.
Cardiomyopathy associated with amphetamine-dextroamphetamine (Adderall) use is an emerging and under-recognized clinical concern, particularly in the context of chronic stimulant exposure. While most reported cases involve non-ischemic myocardial dysfunction, the potential for Adderall to accelerate atherosclerosis and contribute to ischemic cardiomyopathy remains unexplored. This case report aims to document the potential severity of Adderall-induced cardiomyopathy with concomitant coronary artery disease (CAD), examine the pathophysiological link between chronic stimulant exposure and accelerated atherosclerosis, and emphasize the need for vigilant cardiovascular monitoring in patients on long-term stimulant therapy. We report the case of a 43-year-old man with no known cardiovascular history who presented with progressive dyspnea and signs of heart failure. He disclosed a five-year history of high-dose Adderall use (45-65 mg daily) and tobacco consumption but had no prior history of hypertension, diabetes, or known CAD. Evaluation revealed a severely reduced left ventricular ejection fraction (10-15%), consistent with dilated cardiomyopathy. Coronary angiography unexpectedly revealed severe three-vessel CAD, necessitating urgent coronary artery bypass grafting (CABG). Postoperative recovery was uneventful, and the patient was initiated on guideline-directed heart failure therapy, with structured follow-up and strict recommendations for stimulant cessation and lifestyle modification. This case illustrates the multifactorial cardiotoxicity of chronic Adderall use, including direct myocardial injury, fibrotic remodeling, vasospasm, and accelerated coronary atherosclerosis. Unlike prior reports of reversible non-ischemic cardiomyopathy, this case required surgical revascularization, underscoring the irreversible nature of the damage in some patients. It uniquely highlights the synergistic contribution of stimulant-induced toxicity and underlying CAD to the development of severe cardiac dysfunction.
OBJECTIVES:Clinically, liver regeneration is often impaired by infections causing endotoxemia, although mechanisms are unclear. Since energy supply is essential for liver regeneration, we assessed whether formoterol (FMT), a β2-adrenergic agonist that increases peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1α), the master regulator of mitochondrial biogenesis (MB), restores liver regeneration after partial hepatectomy (PHX) in endotoxin (LPS)-treated mice. METHODS:Mice underwent sham-operation, two-thirds PHX, PHX with LPS injection (PHX+LPS, 5 mg/kg, i.p.), or PHX+LPS followed by FMT (0.1 mg/kg, i.p.) after 2 h. RESULTS:At 48 h after PHX, 5'-bromo-2'-deoxyuridine incorporation, mitotic cells, proliferating cell nuclear antigen, and cyclin-D1 markedly increased, signifying liver regeneration. By contrast, after PHX+LPS, liver regeneration was almost completely suppressed. FMT restored liver regeneration after PHX+LPS. PGC1α, mitochondrial transcription factor-A (controlling mitochondrial DNA replication/transcription), and mitochondrial oxidative phosphorylation proteins ATP synthase-β and NADH dehydrogenase-3 decreased after PHX+LPS, signifying suppressed MB. FMT largely reversed these effects. Mitochondrial oxidative stress stimulates inflammation by activating inflammasomes. In addition to promoting MB, PGC1α reportedly inhibits oxidative stress and inflammation. 8-Hydroxy-deoxyguanosine, NLRP3, and inflammatory cytokines increased after PHX+LPS, demonstrating increased oxidative stress and inflammasome activation. Many necro-inflammatory foci occurred in liver sections after PHX+LPS. FMT increased expression of antioxidant protein thioredoxin-2, decreased oxidative stress, and blunted inflammatory responses. Additionally, FMT decreased alanine aminotransferase release and necrosis caused by PHX+LPS. CONCLUSIONS:FMT restores liver regeneration during endotoxemia and decreases liver injury and inflammation, most likely by increasing PGC1α. Therefore, FMT is a promising therapy for liver failure caused by loss of liver mass complicated with sepsis.
Lung cancer remains a leading cause of cancer-related mortality worldwide, and early detection is essential for improving patient outcomes. This study evaluates the role of artificial intelligence (AI) in lung nodule detection, focusing on its potential to enhance the accuracy of early lung cancer diagnosis. We assess the performance of AI tools, particularly convolutional neural networks (CNNs), in identifying and segmenting lung nodules from computed tomography (CT) and X-ray images. Our findings indicate that AI systems achieve a sensitivity of 70-90%, comparable to that of experienced radiologists, while reducing false-positive rates. In pulmonary nodule detection on CT scans, AI demonstrated over 95% sensitivity with fewer than one false-positive per scan. The implementation of AI as a "second reader" significantly improved detection accuracy. Despite these advancements, challenges remain, including high false-positive rates, issues with generalizability across diverse populations, regulatory concerns, and skepticism among healthcare professionals. This study highlights the promise of AI in supporting radiologists and improving lung cancer screening while emphasizing the need for further research to enhance specificity and address existing limitations.
Radiopharmaceutical therapy (RPT) is an advanced targeted cancer treatment that delivers radiation through specialized radiolabeled compounds to selectively destroy cancer cells while minimizing damage to healthy tissues. This theranostic approach integrates diagnosis and therapy, enhancing treatment precision and improving the therapeutic index compared to conventional chemotherapy. RPT agents consist of a radioactive isotope conjugated to a targeting molecule, enabling specific binding to cancer-associated antigens or receptors. Upon binding, these agents induce cell death through DNA damage caused by ionizing radiation. The choice of radionuclide, including beta and alpha emitters, plays a crucial role in determining therapeutic efficacy and potential side effects. This study aims to provide a comprehensive analysis of RPT, focusing on its mechanisms of action, clinical applications, and emerging challenges. We discuss the therapeutic potential of various radionuclides and highlight key clinical trials demonstrating efficacy across different malignancies. Additionally, we address critical issues such as optimizing delivery systems, managing radiotoxicity, and refining the dose-response relationship. Future directions include the development of novel radiopharmaceuticals and personalized treatment approaches. Further investigation is essential to overcome existing limitations and maximize the clinical benefits of RPT for patients with advanced cancers. Our findings contribute to a deeper understanding of RPT and offer insights into strategies for improving therapeutic outcomes and patient care.
BACKGROUND:"Laterality", or "lateral preference" indicates how differently or rather 'differentially' one tends to use a pair of sense organs or limbs. The most widely studied aspect of laterality is handedness. However, research on footedness has not received the same level of attention. Previous studies primarily relied on questionnaires to determine limb dominance, which may not provide the most accurate assessments. The present study aims to generate reliable objective data regarding both upper and lower limb dominance by analyzing surface electromyography (sEMG) parameters. Additionally, it seeks to correlate these findings with perceived limb dominance as indicated by questionnaire responses. METHODS AND MATERIAL:It was a cross-sectional observational study. The physiological parameters were recorded in the Clinical Physiology Laboratory. 20 male, healthy participants of 19-20 years participated in the study voluntarily. After recording of their demographic data, the study participants were assessed twice to ascertain the dominance of both upper and lower limbs. At first, they responded to the study questionnaires to report self-determined dominance of upper and lower limbs. Following this, the performance of both upper and lower limbs was evaluated by recording of surface EMG of specific muscles of the limbs at rest and during sustained contraction using a pre-defined load till the onset of fatigue. On the basis of normality test, the data were expressed as median with interquartile range. Wilcoxon signed rank test was performed to compare the parameters of sEMG. SPSS software version 20.0 (IBM Inc., USA) was used to analyse the data. A two-tailed P value less than 0.05 was taken as the cut-off level of significance. RESULTS:Based on questionnaire analysis, out of 20 participants, one was left-handed and the rest were right-handed. Six participants were found to use both legs and the rest were right leg dominant. Following analysis, no significant difference between the parameters of surface EMG (sEMG) of the corresponding muscles of the two upper and lower limbs was found. Even no significant difference between the time to set fatigue in right and left upper and lower limbs was observed. CONCLUSIONS:The result of the present study indicates that the dominant and the non-dominant limbs have attained differences in such a manner that it has not affected their performances significantly. However, their different, though sometimes overlapping aspects of motion and movements is helpful for the performance of a given task.
Ayurveda, a traditional Indian medical system, offers a comprehensive approach to health promotion, disease prevention, and body rejuvenation, emphasizing wellness, vitality, and holistic well-being. Triphala, a well-established polyherbal Ayurvedic formulation, comprises equal proportions of Emblica officinalis (Amalaki or Amla), Terminalia bellerica (Bibhitaki or Bahera), and Terminalia chebula (Haritaki or Harad), demonstrating exceptional efficacy in gastrointestinal health and rejuvenation therapy. Triphala Rasayana, a polyherbal formulation, has been employed in Ayurveda, Siddha, and Unani medicine systems to address various health conditions. Its medicinal attributes include antioxidant, anticancer, antidiabetic, antimicrobial, immunomodulatory, and anticataract properties, making it a vital component in gastrointestinal treatment, particularly for functional gastrointestinal disorders. With its rich history in Ayurveda, Triphala's unique tridoshic properties harmonize the body's three essential energies - Vata, Pitta, and Kapha - fostering overall well-being and diverse health applications. The phytochemical composition of Triphala Rasayana is scrutinized, revealing essential bioactive compounds like phenolic acids, tannins, and flavonoids, which contribute to its antioxidant, anti-inflammatory, and antimicrobial effects. The therapeutic properties of Triphala span antidiabetic, hepatoprotective, and immunomodulatory effects, underpinned by studies demonstrating its benefits for oxidative stress, metabolic disorders, and immune enhancement. The review also underscores Triphala's role in gastrointestinal health, promoting beneficial microbiota and alleviating digestive issues, alongside its cardioprotective effects. Concluding with a call for advanced research into its pharmacodynamics and molecular mechanisms, the document advocates for integrating this potent Ayurvedic remedy into modern therapeutic regimens.
Atrial fibrillation (AF) is the most prevalent arrhythmia, significantly increasing the risk of stroke and thromboembolism. Oral anticoagulants (OACs), including direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs), have been shown to reduce these risks effectively. However, the administration of OACs carries a notable risk of spontaneous intracranial hemorrhage (ICH), a severe complication associated with high morbidity and mortality. Patients with a history of ICH face a complex decision regarding the resumption of anticoagulation therapy, as the likelihood of recurrence is heightened in this population. Current literature reveals inconsistencies in research findings regarding the safety and efficacy of restarting OACs after ICH. A lack of definitive guidelines addressing this issue leaves clinicians uncertain about optimal management strategies. This systematic review aims to analyze existing observational studies and randomized controlled trials (RCTs) to evaluate the safety and effectiveness of resuming OACs in patients with AF who have experienced ICH. The review underscores the urgent need for high-quality research to inform clinical practices and develop comprehensive guidelines for managing anticoagulation therapy in this vulnerable group.
Metabolic syndrome is a group of pathological disorders increasing the risk of serious diseases including cardiovascular disease, stroke, type 2 diabetes. Global widespread of the metabolic syndrome has put a heavy social burden. Interestingly, a crucial link between the metabolic syndrome and a psychiatric disorder may frequently coexist, in which certain shared mechanisms might play a role for the pathogenesis. In fact, some microRNAs (miRNAs) have been detected in the overlap pathology, suggesting a common molecular mechanism for the development of both disorders. Subsequent studies have revealed that these miRNAs and several metabolites of gut microbiota such as short chain fatty acids (SCFAs) might be involved in the development of both disorders, in which the association between gut and brain might play key roles with engram memory for the modulation of immune cells. Additionally, the correlation between brain and immunity might also influence the development of several diseases/disorders including metabolic syndrome. Brain could possess several inflammatory responses as an information of pathological images termed engrams. In other words, preservation of the engram memory might be achieved by a meta-plasticity mechanism that shapes the alteration of neuron linkages for the development of immune-related diseases. Therefore, it might be rational that metabolic syndrome and psychiatric disorders may belong to a group of immune-related diseases. Disrupting in gut microbiota may threaten the body homeostasis, leading to initiate a cascade of health problems. This concept may contribute to the development of superior therapeutic application with the usage of some functional components in food against metabolic and psychiatric disorders. This paper reviews advances in understanding the regulatory mechanisms of miRNAs with the impact to gut, liver and brain, deliberating the probable therapeutic techniques against these disorders.
OBJECTIVES:The significant correlation between acute myocardial infarction and subsequent hepatorenal dysfunction could result in a higher mortality rate in patients. The study aimed to evaluate the effect and mechanisms of coenzyme-Q10 (Q10) administration on hepatorenal dysfunction in an isoprenaline (ISO)-induced myocardial infarction model in rats. MATERIALS AND METHODS:Twenty male rats were assigned into four groups (n = 5). Groups 1-2 were administered intraperitoneally with normal saline, groups 3-4 were pretreated with Q10 (10 mg/kg, i.p.) for 28 days, and groups 2 and 4 received ISO (200 mg/kg, i.p.) on the last two days. Body, kidney, and liver weights, antioxidants and biochemical biomarkers, and histopathological investigation of the liver and kidney tissues were performed. RESULTS:The administration of ISO significantly (P < 0.05) increased oxidative stress and altered the liver and renal function integrity and morphology. Pretreatment with Q10 demonstrated a protective effect against biochemical and histological alterations through significantly enhanced antioxidant actions, notably increasing the levels of superoxide dismutase, catalase, glutathione, and glutathione transferase; reduced liver enzymes (aspartate transaminase, aspartate aminotransferase, alkaline phosphatase, and lactate dehydrogenase), decreased urea and creatinine concentrations and reduced the gravity of histomorphological changes in hepatic and renal tissues of ISO treated rats. CONCLUSION:Overall, our result suggests that Q10 confers hepatic and renal protection against ISO-induced hepatorenal dysfunction accompanying myocardial infarction through its antioxidant effects and amelioration of fibrotic changes.
