Short-term Results of Platelet-Rich Plasma in the Treatment of Chronic Anal Fissure: Randomized Controlled Clinical Study.

BACKGROUND: Anal fissure is one of the most common benign anal disorders, and medical treatments play an important role in its management. OBJECTIVE: The purpose of this study was to investigate the short-term effects and success of platelet-rich plasma in the treatment of chronic anal fissure. DESIGN: The study is a 2 parallel group, randomized, controlled clinical trial. SETTINGS: The study was performed in 2 tertiary university hospitals. PATIENTS: Forty-four patients with chronic anal fissure were randomly assigned to platelet-rich plasma treatment or control group. Presenting symptoms and pain scores were recorded on enrollment. The control patient self-administered topical glyceryl trinitrate. Platelet-rich plasma was injected locally in the intervention group followed by self-administered glyceryl trinitrate. MAIN OUTCOME MEASURES: The primary outcome measure is a reduction in pain scores. RESULTS: On day 10 and 1 month after treatment, the mean pain score was significantly lower in the patients treated with platelet-rich plasma than in the controls (p = 0.005 and p < 0.005). By 1 month after treatment, the mean pain score declined by 5.7 points in the platelet-rich plasma-treated group compared with a 4.1 mean pain score decline in the control group (mean difference:1.6 points (95% CI, 0.3-2.9)). According to the repeated-measures analyses, pain scores decreased in both groups, but the decrease in the treatment group was statistically higher than in the control group (p < 0.001). Complete epithelialization and recovery rates were significantly higher in the platelet-rich plasma group than in controls at all follow-up times, with p values ranging from 0.034 to <0.001. The observed difference in complete epithelialization after 2 months of treatment between the platelet-rich plasma group and the control group was 56.2% with a 95% CI of 14.03% to 98.4%. LIMITATIONS: This study was limited by its small sample size, and long-term follow-up of the patients was not presented. CONCLUSIONS: Platelet-rich plasma reduced concerns and accelerated epithelialization and healing in patients with chronic anal fissures. See Video Abstract at http://links.lww.com/DCR/B461.RESULTADOS A CORTO PLAZO DEL PLASMA RICO EN PLAQUETAS EN EL TRATAMIENTO DE LA FISURA ANAL CRÓNICA: ESTUDIO CLÍNICO CONTROLADO ALEATORIZADO. ANTECEDENTES: La fisura anal es uno de los trastornos anales benignos más comunes y los tratamientos médicos juegan un papel importante en su manejo. OBJETIVO: El propósito de este estudio fue investigar los efectos a corto plazo y el éxito del plasma rico en plaquetas en el tratamiento de la fisura an33al crónica. DISEO: El estudio es un ensayo clínico controlado, aleatorizado y de dos grupos paralelos. ESCENARIO: El estudio se llevó a cabo en dos hospitales universitarios terciarios. PACIENTES: Cuarenta y cuatro pacientes con fisura anal crónica fueron asignados aleatoriamente al grupo de tratamiento con plasma rico en plaquetas o al grupo control. Los síntomas de presentación y las puntuaciones de dolor se registraron en la inscripción. Los pacientes de control se autoadministraron trinitrato de glicerilo tópico. El plasma rico en plaquetas se inyectó localmente en el grupo de intervención seguido de trinitrato de glicerilo autoadministrado. PRINCIPALES MEDIDAS DE RESULTADO: La principal medida de resultado es una reducción en las puntuaciones de dolor. RESULTADOS: El día 10 y un mes después del tratamiento, la puntuación media de dolor fue significativamente menor en los pacientes con plasma rico en plaquetas que en los controles (p = 0.005 y p <0.005, respectivamente). Un mes después del tratamiento, la puntuación media de dolor disminuyó 5.7 puntos en el grupo tratado con plasma rico en plaquetas en comparación con una disminución de la puntuación media de dolor de 4.1 en el grupo de control (diferencia media: 1.6 puntos [intervalo de confianza del 95%; 0.3-2.9] Según los análisis de medidas repetidas, las puntuaciones de dolor disminuyeron en ambos grupos, pero la disminución en el grupo de tratamiento fue estadísticamente mayor que en el grupo de control (p <0.001). Las tasas de epitelización completa y recuperación fueron significativamente más altas en los pacientes con plasma rico en plaquetas que en los controles en todos los tiempos de seguimiento, con valores de p que van desde 0.034 a <0.001. La diferencia observada en la epitelización completa después de dos meses de tratamiento entre el grupo de plasma rico en plaquetas y el grupo de control fue del 56.2% con un intervalo de confianza del 95% del 14.03% al 98.4%. LIMITACIONES: Este estudio estuvo limitado por el pequeño tamaño de la muestra y porque no se proporcionó un seguimiento a largo plazo de los pacientes. CONCLUSIONES: El plasma rico en plaquetas redujo las molestias y aceleró la epitelización y la curación en pacientes con fisuras anales crónicas. Consulte Video Resumen en http://links.lww.com/DCR/B461. (Traducción-Dr. Jorge Silva Velazco).

Is the neutrophil-to-lymphocyte ratio a potential diagnostic marker for peptic ulcer perforation? A retrospective cohort study.

OBJECTIVES: Peptic ulcer perforation (PUP) accounts for 5% of all abdominal emergencies and is recognized as a gastrointestinal emergency requiring rapid and efficient clinical evaluation and treatment. The mortality rate ranges from 10% to 40% among patients with perforation. In the present retrospective study, we examined the potential utility of the neutrophil-to-lymphocyte ratio (NLR) in early diagnosis of PUP; we asked whether this ratio allowed PUP and peptic ulcer disease to be distinguished. METHODS: We enrolled the following patients: 58 with PUP, 62 with noncomplicated peptic ulcer diseases (NCPU), and 62 controls, between May 2010 and 2015. Patients who underwent surgical repair to treat PUP were included in the study group. Another group consisted of NCPU patients who had a noncomplicated peptic ulcer. The control group consisted of patients presenting with nonspecific abdominal pain to the emergency department. RESULTS: The mortality rate was 5.2% in the PUP group. The white blood cell count, C-reactive protein, and NLRs were higher in the PUP compared to the other groups (P<.001 for all). The white blood cell count and NLR did not differ between the NCPU and control groups. The sensitivities, specificities, positive predictive values, and negative predictive values of the NLRs were 68.0%, 88.0%, 82.9%, and 72.9%, respectively. CONCLUSIONS: We suggest that preoperative NLR aids in the diagnosis of PUP and can be used to distinguish this condition from peptic ulcer disease. Thus, the NLR should be calculated in addition to the clinical examination.

The predictive value of Alvarado score, inflammatory parameters and ultrasound imaging in the diagnosis of acute appendicitis.

OBJECTIVE: Acute appendicitis (AA) is one of the most common surgical emergencies. Despite extraordinary advances in modern investigations, the accurate diagnosis of AA remains an enigmatic challenge. The aim of this study was to compare and evaluate the diagnostic accuracy of inflammatory parameters [C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR)], ultrasound (US) and Alvarado score (AS) in reducing the rate of negative appendectomies. MATERIAL AND METHODS: Two hundred seventy-eight patients were included in this study. Patients were separated into two main groups as the surgery group (n=184) and non-operative group (n=94). Complete blood count, ESR and PCT levels were assessed, abdominal US was performed and AS was calculated for all patients. RESULTS: In the surgery group, clinical predictive factors for histopathologic results such as AS ≥7, AA signs on US, neutrophilia and leukocytosis were significant. Neutrophilia and leukocytosis had the highest accuracy rate among these factors. Inflammatory parameters were not predictive for histopathologic results, although higher CRP and PCT levels were significant in perforated and necrotizing appendicitis. Multifactorial regression analyses showed that AS was not of significant predictive value in the non-operative group. CONCLUSION: There was no superiority of AS and/or US in the diagnosis of AA. Recent findings have shown the most reliable parameters in the diagnosis of AA to be primarily 'neutrophilia' and secondarily 'leukocytosis'. Other results of this study indicated that inflammatory parameters (CRP, PCT, ESR) were not superior to other parameters but CRP and PCT levels were significantly high in complicated cases.

De Garengeot's hernia: a case of acute appendicitis in a femoral hernia sac.

The presence of an appendix vermiformis in a femoral hernia sac is called De Garengeot's hernia. It is a very rare clinical condition and requires emergency surgery. However, preoperative diagnosis of De Garengeot's hernia is difficult. Herein, we report a 58-year-old female who presented with sudden-onset painful swelling in the right groin region. Diagnosis was established based on computed tomography findings, and appendectomy with mesh-free hernia repair was performed. The postoperative period was uneventful, and the histopathologic examination of the specimen revealed gangrenous appendicitis.

Virtual screening for compounds that mimic protein-protein interface epitopes.

Modulation of protein-protein interactions (PPI) has emerged as a new concept in rational drug design. Here, we present a computational protocol for identifying potential PPI inhibitors. Relevant regions of interfaces (epitopes) are predicted for three-dimensional protein models and serve as queries for virtual compound screening. We present a computational screening protocol that incorporates two different pharmacophore models. One model is based on the mathematical concept of autocorrelation vectors and the other utilizes fuzzy labeled graphs. In a proof-of-concept study, we were able to identify serine protease inhibitors using a predicted trypsin epitope as query. Our virtual screening framework may be suited for rapid identification of PPI inhibitors and suggesting bioactive tool compounds.

Recurrent pyogenic cholangitis in a case with congenital biliary anomaly.

Recurrent pyogenic cholangitis is endemic to South-east Asia but has been very rarely reported from natives of other parts of the world. A 43-years-old woman was presented with sepsis that had a history of recurrent epigastric pain and fever attacks. Her liver tests were unremarkable suggesting any hepatobiliary diseases. Recurrent pyogenic cholangitis and congenital extrahepatic biliary anomaly have been diagnosed after serial diagnostic and therapeutic procedures including endoscopic retrograde cholangiography, MR-cholangiography, percutaneous transhepatic cholangiography and finally left hepatectomy. She was cured completely following surgical treatment.

Relationship of dehydroepiandrosterone sulfate levels with atherosclerosis in patients with subclinical hypothyroidism.

BACKGROUND: Subclinical hypothyroidism is related with increased risk of cardiovascular diseases. The decreased levels of dehydroepiandrosterone sulphate (DHEA-S) are associated with hyperlipidemia, atherosclerosis and obesity. The lower levels of DHEA­S might be an important factor in development of atherosclerosis in subclinical hypothyroidism. METHODS: A total of 126 patients (62 with subclinical hypothyroidism and 64 healthy individuals) were included in this prospectively designed study between January 2017 and December 2019. All individuals were evaluated according to DHEA­S levels, carotid intima media thickness (CIMT) and anthropometric measurements. Blood samples were obtained from patients after 8 h fasting. The groups were statistically compared. RESULTS: The mean ages of control group and patients with subclinical hypothyroidism were 36.9 ± 11.0 years and 39.6 ± 11.0 years, respectively (p = 0.165). The mean waist circumferences in controls and patients were 89 ± 10.7 cm and 91.3 ± 11.1 cm, respectively (p < 0.001). The DHEA­S levels were 131.04 ± 96.02 µg/dl in patients, and these levels were significantly decreased in patients with subclinical hypothyroidism (p = 0.024). The levels of DHEA­S were found to be negatively correlated with CIMT (p < 0.001, c = 0.406). CONCLUSIONS: The early detection of cardiac and metabolic dysfunctions in subclinical hypothyroidism is important to avoid complications. We found a negative correlation between DHEA­S levels and metabolic and cardiovascular risk factors in subclinical hypothyroidism. We believe that our results would attract more attention to the studies investigating relationships between DHEA­S levels and cardiovascular complications of subclinical hypothyroidism.

An Analysis of Percutaneous Endoscopic Gastrostomy Complications.

OBJECTIVE: To determine the indications of early and late complications in 224 patients who underwent Percutaneous Endoscopic Gastrostomy (PEG) procedure. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of General Surgery, Karatay University and Medipol University, Turkey, from January 2014 to December 2020. METHODOLOGY: Patients' age, gender, primary diseases, PEG indications, morbidity, mortality, and complications were recorded by performing the PEG procedure. Hospitalisation, follow-up periods of the patients, and the re-insertion of PEG were evaluated. RESULTS: The most common indication for PEG tube insertion was nutritional disorder associated with cerebrovascular diseases in 81 (37%) patients. No mortality was perceived due to the PEG tube insertion. However, mortality was observed in 84 (38.4%) patients in the first six months, in 6 (2.7%) patients between the sixth and twelfth month, and in 8 (3.7%) patients after the twelfth month. All these mortalities were attributed to the primary disease. In the early and late periods, complications were observed in the total of 45 (20.4%) patients. Among them, 17 (7.7%) patients experienced early period complications, whereas 28 (12.7%) patients experienced late period complications. CONCLUSION: Enteral nutrition should be preferred in order to avoid complications of parenteral nutrition in the patients who need long-term nutrition. In enteral nutrition, PEG should be preferred to surgical gastrostomy because it has less morbidity and mortality, can be done at the bedside and outpatiently when necessary, does not require general anesthesia, and is cheaper and practical. KEY WORDS: Gastrostomy, Percutaneous Endoscopic gastrostomy, Enteral nutrition, PEG complications.

Diagnostic and prognostic significance of inflammatory parameters in acute diverticulitis: A retrospective cohort study.

BACKGROUND: The optimum biochemical or hematological marker to determine diagnosis and severity of acute diverticulitis has not been established. We aimed to compare the utility of hematological parameters in the diagnosis and severity of acute diverticulitis. METHODS: Sixty-nine patients in diverticular disease (acute diverticulitis and diverticulosis subgroups) and 36 patients in control group were included in the study. The biochemical analysis performed at the time of diagnosis included white blood cell, mean platelet volume, neutrophil count, platelet count (PLT), C-reactive protein, and calculation of neutrophil count/lymphocyte and PLT/lymphocyte ratios. Patients in the diverticulitis group were divided into four stages according to the Hinchey classification based on abdominal CT findings. RESULTS: The mean platelet-lymphocyte ratio in the diverticulitis and diverticulosis groups was significantly lower than that in the control group (p<0.05). The best sensitivity and specificity values to distinguish acute diverticulitis and diverticulosis were 63.64% and 72.22% for the neutrophil-lymphocyte ratio (NLR) at a cutoff value of 2.78 and above and 30.30% and 86.11% for the platelet-lymphocyte ratio at a cutoff value of 87.46 and above. The diagnostic accuracy rates to distinguish between the diverticulitis and the control groups that the best sensitivity and specificity values were found to be NLR at a cutoff value of 11.55 and above and 100% and 100% for the platelet-lymphocyte ratio at a cutoff value of 12.28 and above. The NLR values were significantly lower in patients with Hinchey Stage 1 disease than those in patients with Stages 2 and 3 disease (respectively, p=0.003 and p=0.006). CONCLUSION: NLR and platelet-lymphocyte ratio can serve as useful biomarkers for the differential diagnosis and severity in acute diverticulitis.

Effects of polyurethane membrane on septic colon anastomosis and intra-abdominal adhesions.

BACKGROUND: Anastomotic leakages and adhesions after gastrointestinal tract surgery are still a significant cause of morbidity and mortality. The rate of anastomotic leakage is 3%-8%, whereas the mortality from leakage is over 30%. Intra-abdominal sepsis is a well-known cause of anastomotic leakage. In addition, intra-abdominal adhesion is a major cause of hospital admissions and reoperations and is associated with morbidity and mortality. In this study, we aimed to investigate the effects of a polyurethane membrane on anastomotic healing and intra-abdominal adhesions. METHODS: This study used 32 Wistar albino rats divided into four groups. Standard resection of left colon 2 cm above the peritoneal reflection and colonic anastomosis were performed after causing abdominal sepsis through caecal ligation and perforation. The control groups (1 and 3) received no further treatment. The experimental groups (2 and 4) received the polyurethane membrane around the colonic anastomosis. Burst pressure, hydroxyproline, interleukin-6 (IL-6), nitric oxide (NO), tissue plasminogen activator (tPA), and tumor necrosis factor-alpha (TNF-α) levels were measured, and histopathological characteristics of the anastomosis were analyzed after re-laparotomy. Moreover, adhesion scores were measured. RESULTS: No statistically significant differences were found in the mean burst pressure levels between sacrificed animals on days three and five (p=0.259, p=0.177). When all the groups were compared, no significant difference was observed in the hydroxyproline, NO, and IL-6 levels (p=0.916, p=0.429, p=0.793, p=0.332, p=0.400, p=0.317). However, in groups 2 and 4, the tPA levels were significantly increased by Opsite therapy (p=0.001, p=0.003), and a statistically significant difference was observed in the adhesion scores (p<0.035). Groups 2 and 4 had significantly lower adhesion scores than groups 1 and 3. CONCLUSION: We found that Opsite therapy had no positive or negative effects on histopathological and biochemical healing in the experimental septic colon anastomosis model. However, the perianastomotic application of polyurethane membrane effectively decreased the intra-abdominal adhesions.

Factors affecting the mortality at patients with burns: Single centre results.

BACKGROUND: Burns are a primary cause of mortality along with the severe physical and psychological morbidities in patients and their families. Such kinds of injuries bring about considerable financial burdens due to the treatment processes and sequels. The present study aims to investigate the factors that affect the mortality of burns. METHODS: The archives files of the patients admitted because of burn injuries in our burn centre between September 2008 and December 2016 were examined in this study. Some of the lab values, such as age, sex, percentage of total burn surface area (TBSA), referral status, burning site, degree of burns, time of admission to hospital, aetiology of burning, blood and blood products collection, complete blood count, routine biochemistry, coagulation parameters, C-reactive protein (CRP), sedimentation rate, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), were examined while evaluating the patients' mortalities. RESULTS: A total of 133 patients were included in this study. The patient's age (p=0.001), the degree of burns (p<0.001), surface area of burns (p<0.001), the time of hospital admission (p<0.001), burning aetiology (p=0.006), erythrocyte suspension, fresh frozen plasma, along with the administration of albumin transfusion (p<0.001), mean platelet volume (MPV) (p=0.028), NLR (p<0.001) and PLR (p<0.030) values were found to be associated with mortality in patients with burns. CONCLUSION: In this study, age, burn grade, TBSA, hospital admission time, burn aetiology, erythrocyte, fresh frozen plasma and albumin transfusion, MPV, NLR and PLR values were found to be associated with mortality in patients with burns. With this study, it is possible to produce the treatment guidelines to reduce mortality by taking these parameters into consideration, which were determined to be associated with mortality while evaluating the patients with burns.

Effects of garlic oil (allium sativum) on acetic acid-induced colitis in rats: Garlic oil and experimental colitis.

BACKGROUND: Inflammatory bowel disease (IBD) is an important health problem. The most important hypotheses for the pathogenesis of this disease are the deterioration of immune responses and loss of tolerance against bacteria in the enteric flora. Although IBD has been widely investigated, its treatment remains difficult. This study aims to investigate the effects of garlic oil (GO) on an experimental colitis model. METHODS: Twenty-eight rats were randomly divided into four equal groups as follows: group 1 (sham), group 2 (control), group 3 (topical treatment) and group 4 (topical and systemic treatment). An acetic acid-induced colitis model was produced in groups 2, 3 and 4 and was administered normal saline, topical GO and topical and systemic GO, respectively. RESULTS: Hydroxyproline levels were lower in the treatment groups than in the control group. TNF-α levels were significantly lower in group 3 than in group 2. Macroscopic scores were significantly lower in group 4 than in group 2. Significant differences were observed between the treatment and control groups according to their epithelial loss. CONCLUSION: GO can reduce colonic damage and inflammation in the acetic acid-induced colitis model, with effects on both local and systemic treatments, but with a more pronounced effect in local treatment.

Voyages to the (un)known: adaptive design of bioactive compounds.

De novo drug design has emerged as a valuable concept for the rapid identification of lead structure candidates. In particular, fragment-based molecular assembly methods have been successfully employed for the automated design of screening compounds. Here, we review the current status of these approaches, with an emphasis on adaptive techniques that can be used to artificially evolve novel bioactive molecules. Evolutionary algorithms (EAs) and particle swarm optimization (PSO) are presented as preferred techniques for iterative virtual synthesis and testing. By the inclusion of straightforward synthesis rules, druglike compounds can be obtained. Evolving compound libraries are particularly suited for hit and lead finding in situations where resources are limited and the complete testing of a large screening compound collection is prohibitive.

2,4-Diaminopyrimidines as histamine H4 receptor ligands--Scaffold optimization and pharmacological characterization.

The human histamine H(4) receptor (hH(4)R) is a promising new target in the therapy of inflammatory diseases and disorders of the immune system. For the development of new H(4)R antagonists a broad ligand-based virtual screening was performed resulting in two hits. The dissection of their common annelated aromatic core into its heteromonocyclic components showed that 2,4-diaminopyrimidine is a potent hH(4)R affinity scaffold, which was comprehensively investigated. Structure-activity relationship studies revealed that slight structural changes evoke extensive differences in functional activities and potencies: while o- and p-substituted benzyl amines mainly showed partial agonism, m-substituted and rigidified ones exhibited inverse agonist efficacy.

Risk factors special to eastern culture for the development of anal fissure.

AIM: To reveal the effect of diet, bowel functions and toilet habits on the development of anal fissure. METHODS: One hundred patients complaining of anal fissure were included to the case group; and one hundred age- and gender-matched patients referred for other reasons except for anorectal complaints were included to the control group. The information was obtained by face to face interviews using questionnaires. RESULTS: Statistically significant differences were found in coffee, fruit, and meat consumption between the groups. The patients suffering from anal fissure avoided paprika consumption. The rate of anal fissure incidence was higher in squat toilet users. CONCLUSION: This study is the first study which evaluates the risk factors such as paprika consumption and squat toilet usage that are specific to Eastern culture. Further studies including large numbers of population are needed to evaluate different risk factors for anal fissure development (Tab. 2, Ref. 11). Full Text (Free, PDF) www.bmj.sk.

The protective and anti-inflammatory effect of methylene blue in corrosive esophageal burns: An experimental study.

BACKGROUND: In developing countries, esophageal burns are quite common. They are caused by the ingestion of corrosive substances that may lead to esophageal perforation in the short-term and stricture formation in the long-term. Prevention of stricture progression in the esophagus is the main aim of the treatment for corrosive esophageal burns. We aimed to investigate the protective and anti-inflammatory effects of methylene blue (MB) treatment on corrosive esophageal burns. METHODS: Twenty-eight rats were used in the study and randomly divided into four equal groups; group 1 (Sham), group 2 (control), group 3 (topical treatment), and group 4 (topical plus systemic treatment). Except for group 1 (Sham group), all three groups received sodium hydroxide (NaOH) in order to generate esophageal burns. In addition, group 2 was given normal saline, group 3 topical MB, and group 4 topical and systemic MB. RESULTS: Hydroxyproline levels were found to be lower in each of the treatment groups as compared to the control group (p=0.005 for group 3 and p=0.009 for group 4). There were no differences in the tumor necrosis factor-α (TNF-α) levels between the groups. The stenosis index (SI) in the treatment groups was also lower than the control group (p=0.016 for group 3 and p=0.015 group 4). The histopathologic damage score (HDS) was prominently lower in group 4 as compared to the control group (p=0.05). CONCLUSION: MB is effective in treating tissue damage caused by corrosive esophageal burns and in preventing esophageal stenosis. Complication rates of corrosive esophageal burns may be decreased by using MB in the initial treatment stage.

Idiopathic weight loss due to an entero-enteric fistula from a gossypiboma retained for 27 years.

Gossypiboma refers to a mass formed around surgical instruments or materials left in the body postoperatively. The occurrence of gossypibomas remains an important problem, despite improvements in surgical procedures and operating room facilities. The clinical presentation of gossypiboma can vary depending on the host response. This report describes a case of abdominal gossypiboma after splenectomy. A 48-year-old man who had undergone splenectomy 27 years ago was admitted to our clinic suffering from non-specific symptoms for 2 weeks. He was cachectic, but laboratory test results were normal. Abdominal ultrasonography and computed tomography revealed a mass in the left hypochondrium. An entero-enteric fistula and an encapsulated foreign body (surgical compress) were detected during an exploratory laparotomy, and the foreign body was removed. Preventing gossypibomas is very important because of their potential to create medico-legal problems and increase mortality and morbidity. Therefore, forgotten surgical material should be considered in all patients with a surgical history, and surgery should be performed carefully.

A retrospective analysis of 2713 hospitalized burn patients in a burns center in Turkey.

BACKGROUND: Burn trauma is a significant health problem that has physical, psychological, and economic repercussions on affected patients. The aim of this study was to present epidemiological and demographic characteristics of patients treated over an 8-year period at a reference burn treatment center located in the northeast of Turkey and serving a population of approximately four million people. METHODS: Each patient's medical record was reviewed, and demographic features, source of burns, place of residence, total body surface area (TBSA), surgical treatment, duration of hospital stay, and mortality rates were analyzed. RESULTS: The most frequent cause of burn was scalding from hot liquids (2013 cases, 74.2%). Freeze burn was observed in 16 (0.6%) cases due to climatic conditions of the region where our burn center is located. Grouping based on TBSA revealed that 88.7% patients had TBSA of 0%-15%, 8% patients had TBSA of 15%-30%, and 3.3% patients had TBSA ≥ %30.The most common microorganism was Pseudomonas aeruginosa. A total of 24 patients (0.9%; 8 males, 16 females) died, including 7 children and 17 adults. CONCLUSION: Removal of tandirs and replacement with high ovens, restriction of cheese and butter production under primitive circumstances, encouraging cheese and butter production via dairy farm systems, and raising people's awareness through training programs could greatly reduce the number of the burn accidents occurring in this region.

Identification of natural-product-derived inhibitors of 5-lipoxygenase activity by ligand-based virtual screening.

A natural product collection and natural-product-derived combinatorial libraries were virtually screened for potential inhibitors of human 5-lipoxygenase (5-LO) activity. We followed a sequential ligand-based approach in two steps. First, similarity searching with a topological pharmacophore descriptor (CATS 2D method) was performed to enable scaffold-hopping. Eighteen compounds were selected from a virtual hit list of 430 substances, which had mutual pharmacophore features with at least one of 43 known 5-LO inhibitors that served as query structures. Two new chemotypes exhibited significant activity in a cell-based 5-LO activity assay. The two most potent molecules served as seed structures for a second virtual screening round. This time, a focused natural-product-derived combinatorial library was analyzed by different ligand-based virtual screening methods. The best molecules from the final set of screening candidates potently suppressed 5-LO activity in intact cells and may represent a novel class of 5-LO inhibitors. The results demonstrate the potential of natural-product-derived screening libraries for hit and lead structure identification.

Beneficial effects of garlic (Allium sativum) oil in experimental corrosive esophageal burns effects of garlic oil in esophageal burns.

BACKGROUND: Corrosive esophageal burns, particularly common in developing countries, lead to different problems in different age groups. The ingestion of corrosive substances can cause such problems as stricture of the esophagus, to acute perforation, and even death. Because stricture formation is related to the severity of the initial injury, the prevention of stricture constitutes a main goal of treatment. The aim of this study was to investigate the protective and anti-inflammatory effects of garlic (Allium sativum) oil in corrosive esophageal burn. METHODS: Twenty-eight rats were randomly divided into 4 equal groups: group 1 (sham), group 2 (control), group 3 (topical treatment), and group 4 (topical and systemic treatment). In groups 2, 3, and 4, corrosive esophageal burns were generated by applying sodium hydroxide to a 1.5-cm segment of the abdominal esophagus. Normal saline was applied to group 2, topical garlic oil to group 3, and topical and systemic garlic oil were used in group 4. RESULTS: The level of hydroxyproline was lower in the topical treatment groups than in the control group (p=0.023). There was difference in tumor necrosis factor alpha level between the systemic treatment groups and the control group (p=0.044). Treatment with garlic oil decreased stenosis index (SI) and histopathological damage score (HDS) in corrosive esophageal burn rats. The SI in the topical treatment group was significantly lower than that of the control group (p=0.016). The HDS was significantly lower in group 4 when compared with the control group (p=0.019). CONCLUSION: Garlic oil is an effective agent in promoting the regression of esophageal stenosis and tissue damage caused by corrosive burns. While the protective effect of garlic oil on tissue damage is more significant when applied topically, the anti-inflammatory effect is more pronounced when applied systemically. Therefore, we believe that the application of garlic oil in patients with corrosive esophageal burns can reduce complication rates.