Aegle marmelos, commonly known as Bael and belonging to the family Rutaceae is an important medicinal plant in the traditional Indian system of medicine, the Ayurveda. The extract prepared by boiling the bark, leaves or roots in water is useful as laxative, febrifuge, and expectorant. The extract is also useful in ophthalmia, deafness, inflammations, catarrh, diabetes, and asthmatic complaints. The fruits are used in treating diarrhea, dysentery, stomach ache, and cardiac ailments. Scientific studies have validated many of Bael’s ethnomedicinal properties and its potential antimicrobial effects, hypoglycemic, astringent, antidiarrheal, antidysenteric, demulcent, analgesic, anti-inflammatory, antipyretic, wound-healing, insecticidal, and gastroprotective properties. In addition, studies have also shown that Bael and some of the Bael phytochemicals possess antineoplastic, radioprotective, chemoprotective, and chemopreventive effects, properties efficacious in the treatment and prevention of cancer. For the first time, the current review summarizes the results related to these properties and emphasizes aspects that require further investigation for Bael’s safe and effective use in the near future.
An 82-year-old Caucasian woman with a history of basal cell carcinoma on vismodegib presented with nausea, vomiting and intermittent abdominal pain. Laboratory results were remarkable for the elevation of liver enzymes. Endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiogram (PTC) did not show evidence of intrahepatic or extrahepatic obstruction of the biliary tract. During PTC external biliary catheter was placed; however, bilirubin continued to rise. Further, laboratory work-up and imaging studies ruled out other possible aetiologies for hepatotoxicity such as infections, autoimmune hepatitis and other drugs known to be hepatotoxic thus leaving vismodegib the most likely cause of hepatotoxicity.
Stenotrophomonas maltophilia is a common nosocomial organism but an uncommon cause of infective endocarditis. We report a case of S. maltophilia endocarditis of the native aortic valve. We have reviewed other cases of S. maltophilia endocarditis, associated complications, and treatment options.
Lemierre's disease is a rare but life-threatening condition characterized by an oropharyngeal infection complicating with thrombophlebitis of the internal jugular vein and disseminated abscesses. We are presenting a case of a young female who initially presented with fevers, chills, sore throat, and swollen neck later developed progressively worsening shortness of breath along with sudden onset pleuritic chest pain. She then developed progressively worsening acute hypoxic respiratory failure requiring intubation and mechanical ventilation. Interval chest X-ray showed worsening bilateral effusions. She also developed septic shock requiring pressors. Blood culture showed Fusobacterium, and antibiotics were changed accordingly following which there was a clinical improvement. The diagnosis of Lemierre's syndrome was then established based on her presenting age and bilateral pulmonary empyema in the setting of septicemia with Fusobacterium.
A 21-year-old woman presented to the hospital for right lower neck pain. The patient reported that the pain started after she attempted to stretch backward. In addition, she complained of pain and swelling over her right upper arm which started a day after the neck pain started. On admission, vitals were within normal limits. Physical examination was positive for erythema, swelling and tenderness in the upper right arm and right subclavicular region. CT angiography of the neck and CT of the cervical spine were unremarkable. Complete blood count and a complete metabolic panel were within normal range. Ultrasound venous of the right upper extremity showed a large echogenic thrombus of the right subclavian vein (figure 1). Given the above findings, further detailed history was obtained. The patient denied a family history of coagulation disorder. However, she admitted to being on oral contraceptive pills. Coagulation studies showed a normal protein S activity along with a negative factor V Leiden, anticardiolipin and prothrombin G20210A mutation. Antithrombin III level was slightly lower. The patient was subsequently placed on a heparin infusion and was scheduled to undergo thrombolysis. Venography performed before …
Goals: The aim was to assess the effectiveness of fecal microbiota transplantation (FMT) against medical therapy (MT). Background: FMT has shown good outcomes in the treatment of Clostridium difficile infection (CDI). We aimed to conduct a systematic review and meta-analysis to compare the effectiveness of FMT versus MT for CDI. Study: We performed a comprehensive search to identify randomized controlled trials comparing FMT against MT in patients with CDI. Outcomes of interest were clinical cure as determined by the resolution of diarrhea and/or negative C. difficile testing. Primary CDI is defined as the first episode of CDI confirmed endoscopically or by laboratory analysis. Recurrent C. difficile infection (RCDI) is defined as laboratory or endoscopically confirmed episode of CDI after at least 1 course of approved antibiotic regimen. Results: A total of 7 studies with 238 patients were included in meta-analysis. Compared with MT, FMT did not have a statistically significant difference for clinical cure of combined primary and RCDI after first session [risk ratio (RR): 1.52, 95% confidence interval (CI): 0.90, 2.58; P =0.12; I 2 =77%] and multiple sessions of FMT (RR: 1.68; CI: 0.96, 2.94; P =0.07; I 2 =82%). On subgroup analysis, FMT has statistically higher rate of response than MT (RR: 2.41; CI: 1.20, 4.83; I 2 =78%) for RCDI. However, for primary CDI there is no statistically significant difference between FMT and MT (RR: 1.00; CI: 0.72, 1.39; I 2 =0%). Conclusion: As per our analysis, FMT should not be utilized for every patient with CDI. It is more effective in RCDI, but the results were not significant in patients with primary CDI.
Purpose. Radiation-induced oral mucositis is an acute morbidity seen in patients undergoing treatment for head and neck cancers. In this study, we evaluated the efficacy of turmeric in preventing radiation-induced mucositis. Methods. This was a single-blinded, randomized, controlled clinical trial and was conducted with head and neck cancer patients requiring 70 Gy of radiation or chemoradiotherapy (daily radiotherapy plus carboplatin once a week). Eligible patients (n = 80) were randomly assigned to receive either turmeric gargle (n = 40) or povidone-iodine ([n = 40] active comparator condition) during chemo/radiotherapy during the period of treatment. Oral mucositis was assessed using the RTOG (Radiation Therapy Oncology Group) grading system before the start, during, and at the end of the treatment by an investigator unaware of the treatment. The primary endpoint of this study was the incidence of mucositis every week during the 7-week period. The secondary endpoint was the effect of turmeric gargle on the incidence of treatment breaks, loss of scheduled treatment days, and decrease in body weight at the end of the treatment. Results. This study clearly suggests that when compared with the cohorts using povidone-iodine gargle, the group using turmeric as a mouthwash had delayed and reduced the levels of radiation-induced oral mucositis and was statistically significant at all time points ( P < 0.001 to P < 0.0001). Additionally, the cohorts using turmeric had decreased intolerable mucositis ( P < 0.001) and lesser incidence of treatment breaks in the first half of the treatment schedule before 4 weeks ( P < 0.01) and reduced change in body weight ( P < 0.001). Conclusions. Gargling with turmeric by head and neck cancer patients undergoing radiation therapy provided significant benefit by delaying and reducing the severity of mucositis. Turmeric is readily available, relatively inexpensive, and highly accepted making it useful in cancer treatment.
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