Discussing treatment strategies for acute mechanical intestinal obstruction caused by phytobezoar: A single-center retrospective study.

BACKGROUND: This study aims to discuss management strategies regarding phytobezoar induced ileus based upon clinical results. METHODS: In the present study, between December 2012 and December 2018, a total of 25 patients who were diagnosed with phytobezoar were evaluated retrospectively. Patients who had acute mechanical intestinal obstruction due to phytobezoars at different segments of gastrointestinal (GI) tract were included in this study. The clinical data (such as clinical findings, laboratory results, radiological evaluations, treatment methods) of the patients were examined. RESULTS: Twenty five patients were included in this study. Of the 25 patients, 13 were women (52%). The median age was 60 (31-84) years, and the overall median length of the stay was 7 (2-28) days. Previous abdominal surgery had been recorded for 13 patients (72%). Two patients (8%) were followed up conservatively, whereas 20 (80%) patients had needed surgical intervention. One (4%) patient underwent surgery for distal ileal obstruction due to the pieces of bezoar that crumbled with previous endoscopic intervention. Three of the patients had complications, such as surgical site infection, wound dehiscence and paralytic ileus in the postoperative period. There were no differences between milking and gastrotomy/enterotomy groups according to the length of stay and postoperative complications. One patient died on the 13th postoperative day due to multi-organ failure. The mortality rate was 4%. CONCLUSION: Phytobezoars, which are common with many other different surgical entities, can be located at any segment of the gastrointestinal tract and may cause obstruction, strangulation and/or even perforation. Contrast-enhanced CT scan must be performed in case of suspicion and to rule out any other causes of acute mechanical intestinal obstruction. Conservative and endoscopic procedures may be useful for selected patients, but the surgical treatment may be needed for the vast majority of the patients with phytobezoar. The surgery is safe for phytobezoar if the enterotomy site is chosen wisely.

Análise de correspondência aplicada para a identificação de plantas benéficas da região de Salinas-MG / Correspondence analysis applied for the identification of beneficial plants of the Salinas-MG region

Plantas nativas são utilizadas na alimentação humana e na cura de enfermidades. No que diz respeito às plantas medicinais, o emprego das substâncias nelas contidas, advém do conhecimento empírico. Já as PANC’s são conhecidas pela infinidade de benefícios à saúde, no entanto, há uma variedade de compostos desconhecidos por parte da comunidade científica. Diante do mencionado, objetivou-se coletar informações acerca das plantas com propriedades benéficas e, posteriormente dissipar este conhecimento. Foram feitas visitas in loco para obtenção de dados, e estes tratados pela técnica estatística de análise de correspondência. Foi feito, ainda, uma pesquisa na literatura para a comprovação dos dados encontrados na análise, e, por fim foram criadas cartilhas contendo as informações em relação a utilização das plantas endêmicas da região.

Acute Illness Associated With Cannabis Use, by Route of Exposure: An Observational Study.

Background: Little is known about the relative harms of edible and inhalable cannabis products. Objective: To describe and compare adult emergency department (ED) visits related to edible and inhaled cannabis exposure. Design: Chart review of ED visits between 1 January 2012 and 31 December 2016. Setting: A large urban academic hospital in Colorado. Participants: Adults with ED visits with a cannabis-related International Classification of Diseases, Ninth or 10th Revision, Clinical Modification (ICD-9-CM or ICD-10-CM), code. Measurements: Patient demographic characteristics, route of exposure, dose, symptoms, length of stay, disposition, discharge diagnoses, and attribution of visit to cannabis. Results: There were 9973 visits with an ICD-9-CM or ICD-10-CM code for cannabis use. Of these, 2567 (25.7%) visits were at least partially attributable to cannabis, and 238 of those (9.3%) were related to edible cannabis. Visits attributable to inhaled cannabis were more likely to be for cannabinoid hyperemesis syndrome (18.0% vs. 8.4%), and visits attributable to edible cannabis were more likely to be due to acute psychiatric symptoms (18.0% vs. 10.9%), intoxication (48% vs. 28%), and cardiovascular symptoms (8.0% vs. 3.1%). Edible products accounted for 10.7% of cannabis-attributable visits between 2014 and 2016 but represented only 0.32% of total cannabis sales in Colorado (in kilograms of tetrahydrocannabinol) during that period. Limitation: Retrospective study design, single academic center, self-reported exposure data, and limited availability of dose data. Conclusion: Visits attributable to inhaled cannabis are more frequent than those attributable to edible cannabis, although the latter is associated with more acute psychiatric visits and more ED visits than expected. Primary Funding Source: Colorado Department of Public Health and Environment.

Botanical species being used for manufacturing plant food supplements (PFS) and related products in the EU member states and selected third countries.

A great wealth of plants and plant derived preparations are used in the intention to supplement the basic nutrition in order to sustain and promote health. They may be used directly or consumed as manufactured plant food supplements (PFS) in dosed form. The use of these plants may already have a long tradition as fruit, vegetable or (folk) medicinal plants. Due to globalisation, more and more plants originating from all over the world are now offered and marketed in European countries, including species from China, South Africa and the American continent. For reasons of security, EU wide lists of plants accepted or prohibited to be used in food supplements are in elaboration. A crucial point is the correct identification of the plant material. The identity can be assessed by morphological, chemical and DNA specific methods. The active substances usable in PFS are secondary plant products that are often characteristic for certain plant groups (taxa), species or plant parts. They comprise not only polyphenols, essential oils, carotenoids and phytosterols, but also glucosinolates or saponins. The quality of the plant material used for PFS depends on a variety of factors, including the natural phytochemical, intraspecific variation with the occurrence of chemotypes, the ontogenetic variation, the considered plant parts and environmental influences during plant growth. In the production of the raw materials for PFS international standards (good agricultural practice, fair trade) should be applied.

Safety assessment of plant food supplements (PFS).

Botanicals and botanical preparations, including plant food supplements (PFS), are widely used in Western diets. The growing use of PFS is accompanied by an increasing concern because the safety of these PFS is not generally assessed before they enter the market. Regulatory bodies have become more aware of this and are increasing their efforts to ensure the safety of PFS. The present review describes an overview of the general framework for the safety assessment of PFS, focusing on the different approaches currently in use to assess the safety of botanicals and/or botanical compounds, including their history of safe use, the tiered approach proposed by the European Food Safety Authority (EFSA), the Threshold of Toxicological Concern (TTC) and the Margin of Exposure (MOE) concept. Moreover, some examples of botanical compounds in PFS that may be of concern are discussed. Altogether, it is clear that "natural" does not equal "safe" and that PFS may contain compounds of concern at levels far above those found in the regular diet. In addition, the traditional use of a PFS compound as a herb or tea does not guarantee its safety when used as a supplement. This points at a need for stricter regulation and control of botanical containing products, especially given their expanding market volume.

A case report of hepatic veno-occlusive disease after ingesting dainties.

Hepatic veno-occlusive disease (HVOD) is rarely encountered and easily misjudged as Budd-Chiari syndrome. It is often related to stem cell transplantation in recent years. We report a case of HVOD that is related to ingestion of some palatable local dishes. The diagnosis was confirmed by liver biopsy pathology with specific observation of inflammatory changes and fibrosis of venules intima, dilated sinusoids and central veins. Chronic diarrhea is unique for this case as a result of ingesting harmful stuffs. This case demonstrated that supervision and instruction of food recipe and traditional medicine are crucial, and prompt diagnosis, supportive care and specific treatment are essential to decreasing the morbidity and mortality of HVOD.

The effect of phytoestrogens on the reproductive tract.

Environmental estrogens may be derived from plants (phytoestrogens), pharmaceuticals or synthetic compounds. They exert estrogenic and/or potentially antiestrogenic effects on farm animals, wildlife and humans. Exposure to these compounds results in some abnormalities in the reproductive tract, changes in the estrous cycle, and possibly protection against the development of hormone-dependent cancer. The data obtained from animal studies suggest that the timing of exposure to phytoestrogens is important, and neonatal exposure causes the most pronounced effects.

Do pesticides reduce our total exposure to food borne toxicants?

In addition to the long history of disease and death from natural toxicants in plants, there is a growing literature about the abundant levels and varieties of natural toxicants in our foods. These natural chemicals cause mutagenicity, carcinogenicity, teratogenicity, neurotoxicity and visceral organ toxicity in routine laboratory tests. While many of these chemicals occur at rather fixed levels in foods, there is evidence that a large number of natural toxicants increase or decrease with levels of plant stress. When plants are stressed from infection or predation, they characteristically respond with a rapid increase in defensive chemicals. Because increases in natural toxicants are stress mediated, the prevention of infection and predation can reduce the levels of the natural toxicants in our food supply. In addition, fungal infections induce a chemical response from the plant, and also excrete their own array of toxins, sometimes at high levels. Crop protection chemicals are used to reduce plant stress, but there is no program today to balance the risk from crop protection chemicals (which are extensively tested and heavily regulated) against the possible benefit of decreased risk from natural plant and fungal toxicants (which are only sporadically tested and are largely unregulated). Because crop protection chemicals are logically linked to inhibition of the expression of natural toxicants, there may be considerable food safety benefits from an approach to pesticide risk management that evaluates the risk versus risk equation. On the other hand, inattention to the issue of suppression of natural toxicants may lead to an unintended increase in our exposure to this wide array of naturally occurring chemicals.

Low trehalase activity is associated with abdominal symptoms caused by edible mushrooms.

BACKGROUND: The purpose of the study was to evaluate whether maldigestion of trehalose causes abdominal symptoms and which available diagnostic method best distinguishes intolerant from tolerant subjects. METHODS: A 25-g oral trehalose load test was performed in 64 subjects. The 19 experiencing clear symptoms constituted the trehalose-intolerant subjects. Changes from base-line levels of blood glucose, breath hydrogen, and methane and symptoms were recorded after the test. Trehalase activity was determined in serum and on a duodenal biopsy specimen obtained by endoscopy. RESULTS: Intolerant subjects were best differentiated from tolerant subjects by changes in breath gases (hydrogen and methane) and duodenal trehalase to sucrase ratio. The change in breath gases correlated inversely with duodenal trehalase activity, duodenal trehalase to sucrase ratio, and plasma trehalase activity. The correlation between serum and duodenal trehalase activities was on the order of 0.6. Two subjects were found to have trehalase deficiency. CONCLUSIONS: It is obvious that trehalose maldigestion can cause symptoms similar to those of lactose maldigestion and intolerance. Three factors control the genesis of symptoms: 1) the activity of small-bowel trehalase: if it is low, trehalose is maldigested and more trehalose is passed into the colon; 2) the maldigested trehalose, which causes osmotic water flow into the colon, resulting in loose stools and diarrhea; and 3) most importantly, the microflora of the colon, from which symptoms will arise if there are bacteria capable of producing gases from maldigested trehalose. If colonic bacteria cannot produce gases, then distention of the abdomen and intestinal gas expulsion as eructations and flatus will not occur.

Intestinal obstruction by trichobezoars in five cats.

Between 1997 and 1999, five domestic crossbred cats (four long haired, one short haired) presented with a palpable abdominal mass and were shown to have small intestinal trichobezoars at laparotomy or necropsy. Hair balls were associated with partial or complete intestinal obstruction and were situated in the proximal jejunum to distal ileum. In four cats obstructions were simple, while the remaining cat had a strangulating obstruction. Three of the cats were 10 years or older, and two were less than 4 years. In the three older cats abdominal neoplasia was suspected and investigations were delayed or declined in two of these cats because of a perceived poor prognosis. Predisposing factors identified in this series of cats included a long-hair coat, flea allergy dermatitis, inflammatory bowel disease and ingestion of non-digestible plant material. This report shows that the ingestion of hair is not always innocuous and that intestinal trichobezoars should be considered in the differential diagnoses of intestinal obstruction and intra-abdominal mass lesions, particularly in long-haired cats.