Non-Pharmacological approach for the management of gastroesophageal reflux disease.

Treatment of Gastro-Esophageal Reflux Disease (GERD) is becoming a challenge. Proton pump inhibitors (PPIs) are commonly prescribed but have many risks, particularly in long-term use. In an earlier pilot study, we have reported benefits of short-term practice of a new life-style, two meals a day with only liquids in between, for management of GERD. Present case report demonstrates benefits of long-term practice of this dietary regimen. A 61 year old patient complaining of night refluxes was diagnosed to have severe GERD with ulcerations at gastroesophageal junction and was advised to take two meals a day with only water, fruit juice, tea, or milk in intervening period. His reflux symptoms improved within fortnight and he remained well for long-time. Endoscopy done after seven years revealed competent and clear gastroesophageal junction. It is concluded that suggested life-style, "Akram's life-style", for GERD is a useful alternate to risky medical and surgical interventions.

An active principle of Nigella sativa L., thymoquinone, showing significant antimicrobial activity against anaerobic bacteria.

AIM/BACKGROUND: Thymoquinone (TQ) is the major active principle of Nigella sativa seed (black seed) and is known to control many fungi, bacteria, and some viruses. However, the activity of TQ against anaerobic bacteria is not well demonstrated. Anaerobic bacteria can cause severe infections, including diarrhea, aspiration pneumonia, and brain abscess, particularly in immunodeficient individuals. The present study aimed to investigate the in vitro antimicrobial activity of TQ against some anaerobic pathogens in comparison to metronidazole. METHODS: Standard, ATCC, strains of four anaerobic bacteria (Clostridium difficile, Clostridium perfringens, Bacteroides fragilis, and Bacteroides thetaiotaomicron), were initially isolated on special Brucella agar base (with hemin and vitamin K). Then, minimum inhibitory concentrations (MICs) of TQ and metronidazole were determined against these anaerobes when grown in Brucella agar, using serial agar dilution method according to the recommended guidelines for anaerobic organisms instructed by the Clinical and Laboratory Standards Institute. RESULTS: TQ showed a significant antimicrobial activity against anaerobic bacteria although much weaker than metronidazole. MICs of TQ and metronidazole against various anaerobic human pathogens tested were found to be between 10-160 mg/L and 0.19-6.25 mg/L, respectively. CONCLUSIONS: TQ controlled the anaerobic human pathogenic bacteria, which supports the use of N. sativa in the treatment of diarrhea in folk medicine. Further investigations are in need for determination of the synergistic effect of TQ in combination with metronidazole and the activity of derivatives of TQ against anaerobic infections.

An old dietary regimen as a new lifestyle change for Gastro esophageal reflux disease: A pilot study.

Treatment of gastro esophageal reflux disease (GERD) is becoming a challenge for medical profession. Proton pump inhibitors (PPIs) are commonly recommended but many disadvantages of these drugs are being reported, particularly when used for long term. Transient lower esophageal sphincter relaxations (TLESRs) are important cause of acid reflux. Gastric distention in upper stomach is the strongest stimulus for generation of TLESRs and is aggravated by intake of food in between meals. In an earlier cases report, two meals a day with intake of only fluids in between was suggested as a remedy for GERD. Present pilot study was conducted on 20 patients with endoscopically proven reflux esophagitis (Los Angles Grade a, b or c), who followed our advice to take meal twice a day with consumption of only soft drinks (fruit juices, tea, coffee, water, etc) in between and no medication for two weeks. On 14th day 15 patients (75%) were free of reflux symptoms, 2 (10%) had partial improvement and 3 (15%) reported no difference. It is concluded that two meals a day with intake of only fluids in between, whenever the patient feels hungry or thirsty, is a useful dietary regimen for the management of GERD. Further investigations are needed to confirm the benefits of this physiological lifestyle change.

GERD is becoming a challenge for the medical profession: is there any remedy?

Gastroesophageal reflux disease is becoming a common and serious problem. Proton pump inhibitors are considered as drugs of choice however, long term use leads to complications. Transient lower esophageal sphincter relaxation inhibitors, i.e., gamma-aminobutyric acid B receptor agonists, baclofen, and metabotropic glutamate receptor 5 antagonists, ADX10059, were tried in resistant cases, but caused central nervous and hepatic side effects, respectively. Irregular dietary habits possess the strongest association with GERD, because intake of food in between meals aggravates gastric distention in upper stomach and generates TLESRs, triggering reflux. During fasting, migrating myoelectrical complex clears stomach of food. Considering relationship between irregular dietary habits and GERD pathophysiology, it is suggested that two regular meals a day with only fluids in between will reduce reflux and lead to healing of inflammation caused by repeated refluxes. Initially, the suggested regimen eliminated symptoms of GERD in 4 cases in 10 days. Later, in a pilot study on 20 patients of endoscopically diagnosed GERD, it benefitted 15 cases; 100% of Los Angles grade 'a', 66% of grade 'b' and 33% of grade 'c'. Long term studies are proposed to confirm usefulness of this dietary regimen for management of GERD, alone and in combination with drugs.

The effect of thymoquinone, an active component of Nigella sativa, on isoproterenol induced myocardial injury.

Myocardial injury constitutes a major cause of morbidity and mortality in humans. Present study aimed to investigate protective role of thymoquinone, which is an active principle of Nigella sativa (N. sativa) seed (Commonly called as black seed), in isoproterenol induced myocardial injury, a classical example of excess catecholamines related coronary insufficiency and stress cardiomyopathy. Thymoquinone, in olive oil, was administered orally (12.5, 25 and 50mg/kg) to three groups of Wistar albino rats for 7 days, while two control groups were given plain olive oil. Thereafter, thymoquinone receiving groups and one control group were injected, subcutaneously, with isoproterenol (125mg/kg) for 2 days. Myocardial injury was assessed by biochemical markers (plasma LDH, TBARS, GR & SOD and myocardial GSH/GSSG ratio) and cardiac histopathology. Plasma LDH, TBARS and GR increased in control groups receiving isoproterenol, while there was a dose related decrease in these markers in thymoquinone treated groups, down to levels in controls given olive oil only. Decrease in plasma SOD and myocardial GSH/GSSG ratio and histological changes produced with isoproternol were also reversed in thymoquinone treated rats. Results of our study revealed that thymoquinone protects the heart from injury induced by isoproterenol.

Anticancer activity of Nigella sativa (black seed) - a review.

Nigella sativa (N. sativa) seed has been an important nutritional flavoring agent and natural remedy for many ailments for centuries in ancient systems of medicine, e.g. Unani, Ayurveda, Chinese and Arabic Medicines. Many active components have been isolated from N. sativa, including thymoquinone, thymohydroquinone, dithymoquinone, thymol, carvacrol, nigellimine-N-oxide, nigellicine, nigellidine and alpha-hederin. In addition, quite a few pharmacological effects of N. sativa seed, its oil, various extracts and active components have been identified to include immune stimulation, anti-inflammation, hypoglycemic, antihypertensive, antiasthmatic, antimicrobial, antiparasitic, antioxidant and anticancer effects. Only a few authors have reviewed the medicinal properties of N. sativa and given some description of the anticancer effects. A literature search has revealed that a lot more studies have been recently carried out related to the anticancer activities of N. sativa and some of its active compounds, such as thymoquinone and alpha-hederin. Acute and chronic toxicity studies have recently confirmed the safety of N. sativa oil and its most abundant active component, thymoquinone, particularly when given orally. The present work is aimed at summarizing the extremely valuable work done by various investigators on the effects of N. sativa seed, its extracts and active principles against cancer. Those related to the underlying mechanism of action, derivatives of thymoquinone, nano thymoquinone and combinations of thymoquinone with the currently used cytotoxic drugs are of particular interest. We hope this review will encourage interested researchers to conduct further preclinical and clinical studies to evaluate the anticancer activities of N. sativa, its active constituents and their derivatives.

Herpes zoster in eastern Saudi Arabia: clinical presentation and management.

BACKGROUND: Herpes zoster (HZ), caused by varicella zoster virus (VZV), initially produces chicken-pox, then the virus lies dormant in the dorsal root ganglia. The virus can reactivate after many years and results in HZ along ganglion's distribution. Old age, trauma, stress, diabetes mellitus, and immune suppression are important risk factors for the reactivation. Herpes zoster is characterized by unilateral radicular pain and vesicular eruption that is generally limited to the dermatome innervated by the affected ganglion. In immunocompromised individuals, disseminated zoster may develop. The aims of therapy in HZ are to control pain or reduce its severity by the use of analgesics, reduce the duration and eruption of new lesions, and prevent complications, particularly postherpetic neuralgia (PHN) by appropriate antiviral therapy. METHODS: All cases of HZ seen in the dermatology clinic at King Fahd Hospital of the University (KFHU) from 1988 to 2006 were included in the study. Their diagnoses were based on the clinical presentation. The following parameters were collected and analyzed: age, sex, nationality, symptoms, dermatomal distribution, complications, coexisting diseases, and disease management. RESULTS: Of 22 749 new cases seen in the dermatology clinic over 18 years, 141 were HZ, with an occurrence of 0.62%. Male to female ratio was 2:1 and the age ranged from 14 months to 80 years. The thoracic dermatomes were the most commonly involved. The most frequent coexisting disease was diabetes mellitus, and the most common complication of HZ was PHN. Most patients with HZ ophthalmicus developed eye complications. CONCLUSION: The occurrence of HZ is 0.62% in patients reporting to the dermatology clinic of the hospital. Males are little more affected than females. The thoracic dermatomes are the most frequently involved. Diabetes mellitus is the most frequent coexisting disease. Postherpetic neuralgia is the most common complication of HZ.

Oral and intraperitoneal LD50 of thymoquinone, an active principle of Nigella sativa, in mice and rats.

BACKGROUND: Thymoquinone is the major active principle of Nigella sativa (N. sativa) and constitutes about 30% of its volatile oil or ether extract. N. sativa oil and seed are commonly used as a natural remedy for many ailments. Using modern scientific techniques, a number of pharmacological actions of N. sativa have been investigated including immunostimulant, anti-inflammatory, anticancer, antioxidant, antihistaminic, antiasthmatic, hypoglycemic, antimicrobial and antiparasitic. There are only few reports regarding the toxicity of thymoquinone. METHODS: The present study was carried out to determine LD50 of thymoquinone both in mice and rats, orally as well as intraperitoneall, by the method of Miller and Tainter. Autopsy and histopathology of liver, kidney, heart and lungs were also determined. RESULTS: The LD50 in mice after intraperitoneal injection was determined to be 104.7 mg/kg (89.7-119.7, 95% confidence interval) and after oral ingestion was 870.9 mg/kg (647.1-1094.8, 95% confidence interval). Whereas, LD50 in rats after intraperitoneal injection was determined to be 57.5 mg/kg (45.6-69.4, 95% confidence intervals) and after oral ingestion was 794.3 mg/kg (469.8-1118.8, 95% confidence intervals). The LD50 values presented here after intraperitoneal injection and oral gavages are 10-15 times and 100-150 times greater than doses of thymoquinone reported for its anti-inflammatory, anti-oxidant and anti-cancer effects. CONCLUSION: Thymoquinone is a relatively safe compound, particularly when given orally to experimental animals.