Successful endoscopic sclerotherapy is effective in securing hemostasis for bleeding lesions and remains the first line and only needed therapy for most of the patients (pts), but bleeding reoccurs ...in 10% to 30% pts, and 4% to 14% of the pts die after acute nonvariceal upper gastrointestinal bleeding (UGIB). The need for hospitalization and its duration for all the bleeding pts is still a controversial question.
To create the simple scoring system able to determine low risk pts for rebleeding and mortality by establishing the relative importance of risk factors for rebleeding and mortality after successful endoscopic sclerotherapy of acute nonvariceal UGIB.
Prospective study included 3 15 pts who where admitted to hospital because of acute nonvariceal UGIB. All of them underwent gastroscopy with successful sclerotherapy within 12 hours after the admission. We investigated the episode of rebleeding and death during the initial hospitalization, and analyzed the following parameters: age, gender, drug intake, shock, bleeding stigmata, location of bleeding lesion and comorbidity.
Rebleeding occurred in 53 pts (16.8%) and was determined by shock, bleeding stigmata and comorbidity. Eleven pts (3.5%) died and shock, rebleeding and comorbidity were all independent, statistically significant predictors of pts' mortality. The numerical scores for determination of pts with different risk levels for rebleeding and mortality have been developed using the significant predictors of rebleeding and death. The score values for rebleeding ranged from 3 to 9 and pts with values < or = 4 had low risk of rebleeding. We identified 59 pts (18.7% of all) with score for rebleeding < or = 4. Score values for mortality risk ranged from 3 to 8 and the values < 5 revealed negligible risk of death. In our group we found 290 pts (92.1% of all) with low mortality score values.
Following the successful initial endoscopic sclerotherapy, these scores can help to identify pts with low risk of rebleeding and negligible risk of death, so they can be treated as outpatients.
Summary
We examined the association of alcoholic cirrhosis in 33 patients with areal bone mineral density (BMD) and the assessed bone geometric strength of their proximal femora. Lower areal BMD, ...cross-sectional area and section modulus, thinner cortex, and higher buckling ratio suggest that the alcoholic liver cirrhosis is associated with lower measures of bone strength.
Introduction
Hepatic bone disease is an important complication of chronic liver disease and is associated with significant morbidity through fractures resulting in pain, deformity, and immobility. In this study, we examined the association of alcoholic cirrhosis and liver insufficiency stage with areal bone mineral density (aBMD) and additionally employed hip structure analysis (HSA) as an advanced method to assess bone geometric strength of the proximal femur in men with alcoholic liver cirrhosis.
Methods
The study included 33 male patients with alcoholic liver cirrhosis and a control group of 36 healthy patients. Laboratory testing included the following biochemical markers of bone turnover: serum levels of osteocalcin and C-telopeptide of type 1 collagen. Areal BMD was measured by dual x-ray absorptiometry on the proximal femora. Structural parameters were then derived from these scans using hip structure analysis software.
Results
After adjusting for age, body height, and weight, we found lower cross-sectional area (
p
= 0.005) and section modulus (
p
= 0.005), thinner cortex (
p
= 0.012), and higher buckling ratio (
p
= 0.043) in the neck region among patients with cirrhosis. The findings suggest that alcoholic liver cirrhosis is associated with lower measures of bone strength. These findings were consistent with decreased osteocalcin values and increased C-telopeptide of type 1 collagen in patients with cirrhosis, indicating reduction in bone formation and increased bone resorption.
Conclusion
Our results emphasize that HSA-derived structural indices of proximal femoral structure may be an important index of greater fragility in patients with alcoholic cirrhosis.
The present study describes DPPH (2,2-diphenyl-1-picrylhydrazyl) radical scavenging activity and antimutagenic properties of the essential oil of myrtle (Myrtus communis L.). Plant samples were ...collected from the two distant localities (southernmost and northern point) of the Montenegro coastline. Chemical profiles of the two samples were evaluated by GC-MS. In both of the samples monoterpenes were found to be the predominant compounds. Among them alpha-pinene, linalool, 1,8-cineole, and myrtenyl acetate were the major compounds. Significant differences between the samples were found in the ranges of alpha-pinene (14.7%-35.9%) and myrtenyl acetate (5.4%-21.6%). Both oils exhibited moderate DPPH scavenging activity, with IC50 values of 6.24 mg/mL and 5.99 mg/mL. The antimutagenic properties were assayed against spontaneous and t-BOOH-induced mutagenesis in Escherichia coli oxyR mutant IC202, a bacterial strain deficient in removing ROS. Reduction of the spontaneous mutagenesis in presence of myrtle EO was only slight, up to 13% at the highest concentration tested. When the oxidative mutagen was used, EO expressed higher reduction of mutagenesis, in a concentration dependent manner, with statistical significance for effect at the highest concentration tested (28%). Suppression of t-BOOH induced mutagenesis was correlated with the observed scavenging activity.
We studied the protective effect of monoterpenes myrcene, eucalyptol and linalool against
t-butyl hydroperoxide (
t-BOOH) induced genotoxicity in reverse mutation assay with
Escherichia coli WP2 ...IC185 strain and its
oxyR mutant IC202, and with the comet assay in human hepatoma HepG2 and human B lymphoid NC–NC cells. The monoterpenes were tested in concentration ranges 0.05–1.5
mg/plate and 0.01–1.0
μg/ml in bacteria and mammalian cells, respectively. Suppression of
t-BOOH induced mutagenesis was detected only in IC202 strain, and correlated with the observed inhibition of lipid peroxidation by the three monoterpenes. Linalool and myrcene strongly suppressed
t-BOOH induced mutagenesis. Eucalyptol, in addition to moderate suppression of
t-BOOH induced mutagenesis, suppressed also spontaneous mutagenesis. In NC–NC cells linalool and myrcene reduced
t-BOOH induced DNA damage by about 50% at 0.01
μg/ml, while eucalyptol was less efficient (about 50% reduction at 1.0
μg/ml). In HepG2 cells linalool and eucalyptol reduced DNA damage by 30% and 40%, respectively, while myrcene was ineffective. The repair of
t-BOOH induced DNA damage, studied in HepG2 cells, was not affected by monoterpenes. The results indicate that linalool, eucalyptol and myrcene have substantial protective effect against oxidant induced genotoxicity, which is predominately mediated by their radical scavenging activity.
Aims
Because the Staphylococcus aureus is one of the most well‐known pathogens associated with medical devices and nosocomial infections, the aim of the study was to examine antibiofilm potential of ...emodin against it.
Methods and Results
Antibacterial activity was examined through microdilution assay. Antibiofilm testing included crystal violet staining of biofilm biomass and morphology analysis by Atomic force microscopy (AFM). Furthermore, aerobic respiration was monitored using the Micro‐Oxymax respirometer. For investigation of gene expression qRT‐PCR was performed. Emodin demonstrated strong antibacterial activity and ability to inhibit biofilm formation of all tested strains. The effect on preformed biofilms was spotted in few strains. AFM revealed that emodin affects biofilm structure and roughness. Monitoring of respiration under emodin treatment in planktonic and biofilm form revealed that emodin influenced aerobic respiration. Moreover, qRT‐PCR showed that emodin modulates expression of icaA, icaD, srrA and srrB genes, as well as RNAIII, and that this activity was strain‐specific.
Conclusion
The results obtained in this study indicate the novel antibiofilm activity of emodin and its multiple pathways of action.
Significance and Impact of Study
This is the first study that examined pathways through which emodin expressed its antibiofilm activity.
Antimicrobial resistance (AMR) has emerged as a major threat to public health globally. Accurate and rapid detection of resistance to antimicrobial drugs, and subsequent appropriate antimicrobial ...treatment, combined with antimicrobial stewardship, are essential for controlling the emergence and spread of AMR. This article reviews common antimicrobial susceptibility testing (AST) methods and relevant issues concerning the advantages and disadvantages of each method. Although accurate, classic technologies used in clinical microbiology to profile antimicrobial susceptibility are time-consuming and relatively expensive. As a result, physicians often prescribe empirical antimicrobial therapies and broad-spectrum antibiotics. Although recently developed AST systems have shown advantages over traditional methods in terms of testing speed and the potential for providing a deeper insight into resistance mechanisms, extensive validation is required to translate these methodologies to clinical practice. With a continuous increase in antimicrobial resistance, additional efforts are needed to develop innovative, rapid, accurate, and portable diagnostic tools for AST. The wide implementation of novel devices would enable the identification of the optimal treatment approaches and the surveillance of antibiotic resistance in health, agriculture, and the environment, allowing monitoring and better tackling the emergence of AMR.
Intrahepatic cholestasis of pregnancy (ICP) is a gestation-specific liver disorder, defined most often as the onset of pruritus, usually from the third trimester of pregnancy, associated with ...abnormal liver test results and/or increased total serum bile acids and spontaneous relief after delivery. The 21-year-old patient was admitted to our ward in the 11th week of pregnancy due to raised liver enzymes. The first onset of pruritus and jaundice appeared a month before hospitalization. Immunology tests and
were negative. We excluded viral etiology, while alpha-1-antitrypsin, serum and urine copper levels, and thyroid hormones were within the reference values. The patient denied she had taken any medicines and herbal preparations before and during pregnancy. Total bile acids in the serum were significantly elevated (242 μmol/L). The abdominal ultrasound revealed a regular finding. Liver biopsy suggested a cholestatic liver disorder. After a presentation of all risks, the patient decided to stop the pregnancy. After a month, the hepatogram was within the reference values. Very rarely an ICP can occur in early pregnancy (first trimester), which calls for close monitoring. The risk of serious adverse fetal outcomes and spontaneous preterm delivery is proportional with increased levels of maternal serum bile acid.
Aims
In the present work, the Libyan wild‐growing Thymus capitatus essential oil (EO) was evaluated for its biological properties.
Methods and Results
Carvacrol (68·19%) and thymol (12·29%) were ...found to be the main compounds of the oil. Antioxidant properties, determined by 2,2‐diphenylpicrylhydrazyl (DPPH) assay, revealed that IC50 values were 119, 403 and 105 μg ml−1 for oil, thymol and carvacrol respectively. Microdilution method showed strong antibacterial and especially antifungal potential. Tetrazolium (MTT) colorimetric assay indicated moderate cytotoxicity towards human cell lines MRC‐5, HCT 116 and HT‐29 (IC50 = 30–150 μg ml−1). In adhesion‐inhibition assay oil and main compounds reduced adhesion of Escherichia coli and Listeria monocytogenes on colon cells HT‐29 (51 and 39% of inhibition against L. monocytogenes and E. coli respectively).
Conclusions
Essential oil of Th. capitatus showed moderate cytotoxic activity, together with excellent antimicrobial effect, in particular against fungi, and significant potential to reduce pathogen colonization in colon.
Significance and Impact of the Study
This is the first report that EO of Th. capitatus could protect against colonization of pathogens to colon epithelium. Thymus capitatus from Libya should be recognized as possible new source of natural antioxidants, antimicrobials as well as possible source of new chemotherapeutics.
The progression of the nonalcoholic fatty liver disease to nonalcoholic steatohepatitis (NASH) is multifactorial, and there is still a lack of approved medications for its treatment. The study aimed ...to evaluate the impact of combined treatment with Pentoxifylline and Metformin on biochemical parameters in patients with Nash. Setting: Outpatient hepatology clinic.
A prospective trial was conducted. The first cohort included patients with biopsy-proven Nash, while the second cohort consisted of patients with biopsy-confirmed NAFLD. Blood tests were checked at baseline and every three months. Pentoxifylline at a dosage of 400 mg t.i.d. and Metformin at the dosage of 500 mg t.i.d. were introduced for six months in Nash group. The impact of the treatment was assessed based on biochemical results after combined treatment with low-cost medications.
All 33 Nash patients completed 24 weeks of treatment. We observed significant improvement (p<0.05) of median values after treatment for the following parameters: serum uric acid levels decreased by 51.0 mmol/L, calcium decreased for 0.27 mmoL/L, magnesium showed an increase of 0.11 mmoL/L. Insulin resistance improved as a reduction of HOMA - IR by 1.3 was detected. A significant decrease of median in liver enzymes, alanine aminotransferase, aspartate aminotransferase and gamma-glutamyltransferase by 24.0 U/L, 9.1 U/L, 10.8 U/L respectively, was noted.
Pentoxifylline and Metformin may provide possible treatment option in Nash. Some new potential benefit of the therapy in improving liver function whilst decreasing cardiovascular risk was perceived.
Medieval fortresses represent an important tangible heritage of a nation’s culture and a valuable development asset for a particular destination on which its place-branding strategy for tourism could ...be built upon. Traditionally in Serbia, heritage protection and conservation have been mainly concentrated on the tangible aspects of cultural sites and monuments. Nevertheless, with the advent of urban heritage integration in the local sustainable development processes and place-branding strategies, a greater appreciation of the spirit of the place and its intangible components, as well as the need to adapt it to local contexts with more participatory forms of heritage planning, have started to emerge. A wide range of stakeholders brought the involvement and participation of both the local government and community members, including residents, as an indispensable element of the protection actions and broader urban development policies. The paper aims to validate the correlation between both intangible and tangible cultural heritage and its contemporary use for place branding and tourism development. In doing so, we have employed the case study method on the two fortresses on the Danube in Serbia to show the ways in which local stakeholders have mobilized their forces in cooperation with the university to use their cultural heritage assets for tourism and more extensive sustainable territorial development. We have found that despite new inclusive forms of governance, which is attracting the attention of planning and heritage practitioners in Serbia, the contemporary approach of integrative protection and the intangible aspects of cultural heritage are still not fully utilized. For this reason, in this study, we consider methods based on environmental aesthetics approaches to cultural heritage that point out the significant inclusion of immaterial intangible cultural heritage in an unbreakable bond with material tangible heritage. The most remarkable result of our research is that while a vast number of stakeholders with local knowledge and sense of the spirit of the place have been involved in the planning process, intangible aspects of the analyzed heritage cases are present in educational projects, and are only partially present if it comes to implementation. This clearly demonstrates that the focus on tangible aspects and spatial interventions of the place branding of cultural heritage is still dominant in Serbia, despite acknowledgment of the economic and social aspects of sustainability in the planning phase in educational projects.
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