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Aziz M, Malik LU, Javed E, Sami SZ, Maaz M, Khan MA, Farmaan M, Farooq O, Iqbal U, Kumar A, Arsal SA, Amin SB, Okon II. Racecadotril Versus Loperamide for Acute Diarrhea of Infectious Origin in Adults: A Systematic Review and Meta-Analysis. Health Sci Rep 2025; 8:e70849. [PMID: 40415979 PMCID: PMC12098968 DOI: 10.1002/hsr2.70849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Revised: 04/17/2025] [Accepted: 04/28/2025] [Indexed: 05/27/2025] Open
Abstract
Background and Aims Loperamide and racecadotril are two antidiarrheal medications with different mechanisms of action that are highly important for the treatment of diarrhea as a result of infectious pathology. Acute infectious diarrhea has a profound impact on our surroundings because of its detrimental effects on individual health. Medication such as racecadotril, among various other drug classes, plays a pivotal role in treating these diseases via the management of symptoms through its antisecretory, proabsorptive effects on the intestinal tract. The main objective of this analysis was to evaluate and contrast the usefulness and safety profiles of these drugs by combining information from randomized controlled trials and highlighting important side effects reported, such as constipation and stomach discomfort. Method A total of 117 records were found after a thorough literature search was carried out across several databases, including PubMed, Google Scholar, and the Cochrane Library. The Cochrane Collaboration technique was utilized to evaluate the potential for bias. RevMan 5.2 data analysis was performed via a random effects model. The results are displayed as the mean difference (MD) with 95% CI for continuous data and relative risk (RR) with 95% confidence intervals (CIs) for dichotomous data. Statistical significance was established at p < 0.05. Results Compared with loperamide, racecadotril significantly improved the clinical response (relative risk [RR] and 95% confidence interval [CI]). Additionally, the analysis of secondary outcomes revealed varying effects on abdominal pain, constipation, and abdominal enlargement, with moderate heterogeneity observed (I² = 56%). Conclusion Compared with loperamide, racecadotril is a better therapeutic option for adult diarrhea caused by infection.
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Affiliation(s)
- Maryam Aziz
- Department of MedicineDow University of Health SciencesKarachiPakistan
| | - Laiba Urooj Malik
- Department of MedicineShaheed Mohtarma Benazir Bhutto Medical CollegeKarachiPakistan
| | - Erum Javed
- Department of MedicineKarachi Medical and Dental CollegeKarachiPakistan
| | - Syeda Zuha Sami
- Department of MedicineShaheed Mohtarma Benazir Bhutto Medical CollegeKarachiPakistan
| | - Muhammad Maaz
- Department of MedicineShaheed Mohtarma Benazir Bhutto Medical CollegeKarachiPakistan
| | - Muhammad Arham Khan
- Department of MedicineShaheed Mohtarma Benazir Bhutto Medical CollegeKarachiPakistan
| | - Muhammad Farmaan
- Department of MedicineShaheed Mohtarma Benazir Bhutto Medical CollegeKarachiPakistan
| | - Omer Farooq
- Department of Medicine, Khyber Medical CollegeUniversity of PeshawarPeshawarPakistan
| | - Umer Iqbal
- Department of MedicineShaheed Mohtarma Benazir Bhutto Medical CollegeKarachiPakistan
| | - Aashish Kumar
- Department of MedicineShaheed Mohtarma Benazir Bhutto Medical CollegeKarachiPakistan
| | - Syed Ali Arsal
- Department of MedicineShaheed Mohtarma Benazir Bhutto Medical CollegeKarachiPakistan
| | - Shafin Bin Amin
- Department of MedicineJinnah Sindh Medical UniversityKarachiPakistan
| | - Inibehe Ime Okon
- Department of ResearchMedical Research Circle (MedReC)BukavuDR Congo
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Haedrich J, Huber R. Crohn's disease, irritable bowel syndrome, and chronic fatigue: the importance of communication and symptom management-a case report. J Med Case Rep 2025; 19:9. [PMID: 39789666 PMCID: PMC11721286 DOI: 10.1186/s13256-024-05010-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 12/12/2024] [Indexed: 01/12/2025] Open
Abstract
BACKGROUND Crohn's disease and irritable bowel syndrome may both cause abdominal pain and diarrhea. Irritable bowel syndrome not only is an important differential diagnosis for Crohn's disease but also occurs in one out of three patients with Crohn's disease in remission in parallel. If not adequately diagnosed and treated, additional functional symptoms such as fatigue and/or muscle pain may develop, indicating a more severe course. CASE PRESENTATION A 64-year-old Caucasian male with long-standing, widely inactive Crohn's disease presented with persistent diarrhea, bloating, abdominal pain, general fatigue, unexplained hip pain, and frequent shivering with cold extremities, which had worsened following a gastrointestinal infection and psychological stress. A plausible explanation of his symptoms, based on an understanding of mind-body interactions, the autonomic nervous system, and temperature regulation, combined with symptom relief, was associated with rapid and sustainable improvement. After 2.5 years of follow-up, the patient is almost symptom-free. CONCLUSIONS This case report exemplifies the interrelation between organic (Crohn's disease) and functional diseases (irritable bowel syndrome, chronic fatigue syndrome, and somatoform pain). It further demonstrates that these connections may be overlooked in daily practice and that providing a plausible explanation in combination with symptom relief may be important for patients with functional syndromes.
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Affiliation(s)
- Johannes Haedrich
- Center for Complementary Medicine, Department of Internal Medicine II, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, 79106, Freiburg, Germany
| | - Roman Huber
- Center for Complementary Medicine, Department of Internal Medicine II, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, 79106, Freiburg, Germany.
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Tanveer R, Neale PA, Melvin SD, Leusch FDL. Application of in vitro bioassays to monitor pharmaceuticals in water: A synthesis of chronological analysis, mode of action, and practical insights. CHEMOSPHERE 2024; 359:142255. [PMID: 38729441 DOI: 10.1016/j.chemosphere.2024.142255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/02/2024] [Accepted: 05/04/2024] [Indexed: 05/12/2024]
Abstract
Pharmaceutical compounds in wastewater have emerged as a significant concern for the aquatic environment. The use of in vitro bioassays represents a sustainable and cost-effective approach for assessing the potential toxicological risks of these biologically active compounds in wastewater and aligns with ethical considerations in research. It facilitates high-throughput analysis, captures mixture effects, integrates impacts of both known and unknown chemicals, and reduces reliance on animal testing. The core aim of the current review was to explore the practical application of in vitro bioassays in evaluating the environmental impacts of pharmaceuticals in wastewater. This comprehensive review strives to achieve several key objectives. First, it provides a summary categorisation of pharmaceuticals based on their mode of action, providing a structured framework for understanding their ecological significance. Second, a chronological analysis of pharmaceutical research aims to document their prevalence and trends over time, shedding light on evolving environmental challenges. Third, the review critically analyses existing bioassay applications in wastewater, while also examining bioassay coverage of representative compounds within major pharmaceutical classes. Finally, it explores the potential for developing innovative bioassays tailored for water quality monitoring of pharmaceuticals, paving the way for more robust environmental monitoring and risk assessment. Overall, adopting effect-based methods for pharmaceutical monitoring in water holds significant promise. It encompasses a broad spectrum of biological impacts, promotes standardized protocols, and supports a bioassay test battery approach indicative of different endpoints, thereby enhancing the effectiveness of environmental risk assessment.
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Affiliation(s)
- Rameesha Tanveer
- Australian Rivers Institute, Griffith University, Southport, Qld 4222, Australia.
| | - Peta A Neale
- Australian Rivers Institute, Griffith University, Southport, Qld 4222, Australia.
| | - Steven D Melvin
- Australian Rivers Institute, Griffith University, Southport, Qld 4222, Australia.
| | - Frederic D L Leusch
- Australian Rivers Institute, Griffith University, Southport, Qld 4222, Australia.
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Nylander O, Sjöblom M, Sedin J, Dahlgren D. Effects of α2-adrenoceptor stimulation on luminal alkalinisation and net fluid flux in rat duodenum. PLoS One 2022; 17:e0273208. [PMID: 36006975 PMCID: PMC9409570 DOI: 10.1371/journal.pone.0273208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 08/03/2022] [Indexed: 12/03/2022] Open
Abstract
The sympathetic nervous system is highly involved in the regulation of gastrointestinal functions such as luminal alkalinisation and fluid absorption. However, the exact mechanisms are not clear. This study aimed to delineate how α2-adrenergic receptor stimulation reduces duodenal luminal alkalinisation and induces net fluid absorption. This was tested by perfusing the duodenum of anesthetized rats with isotonic solutions devoid of Cl- and/or Na+, in the absence and presence of the α2-adrenoceptor agonist clonidine. The clonidine was also studied in rats treated with dimethylamiloride (a Na+/H+ exchange inhibitor), vasoactive intestinal peptide, and the nicotinic receptor antagonist hexamethonium. Clonidine reduced luminal alkalinisation and induced net fluid absorption. The Cl--free solution decreased luminal alkalinisation and abolished net fluid absorption, but did not prevent clonidine from doing so. Both the Na+-free solution and luminal dimethylamiloride increased luminal alkalinisation and abolished net fluid absorption, effects counteracted by clonidine. The NaCl-free solution (D-mannitol) did not affect luminal alkalinisation, but reduced net fluid absorption. Clonidine reduced luminal alkalinisation and induced net fluid absorption in rats perfused luminally with mannitol. However, clonidine did not affect the vasoactive intestinal peptide-induced increase in luminal alkalinisation or fluid secretion. Pre-treatment with hexamethonium abolished the effects of clonidine on luminal alkalinisation and net fluid flux. In summary, our in vivo experiments showed that clonidine-induced reduction in luminal alkalinisation and induction of net fluid absorption was unrelated to luminal Na+ and Cl-, or to apical Na+/H+ or Cl-/HCO3- exchangers. Instead, clonidine seems to exert its effects via suppression of nicotinic receptor-activated acetylcholine secretomotor neurons.
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Affiliation(s)
- Olof Nylander
- Division of Physiology, Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Markus Sjöblom
- Division of Physiology, Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - John Sedin
- Division of Physiology, Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - David Dahlgren
- Division of Physiology, Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
- * E-mail:
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López-Lázaro M. Opium, street opium and cancer risk. Curr Pharm Des 2022; 28:2039-2042. [PMID: 35674306 DOI: 10.2174/1381612828666220607104805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/04/2022] [Indexed: 11/22/2022]
Abstract
Opium is defined as the air-dried latex obtained by incision from the unripe capsules of Papaver somniferum L. Opium is a complex mixture that contains approximately 10% morphine and 2% codeine. It is commonly used to prepare opium tinctures for people with chronic diarrhea. Morphine and related opioids are powerful but highly addictive analgesics; designing less addictive opioids is an active area of pharmaceutical research that may lead to significant improvements in chronic pain management. Recently, the International Agency for Research on Cancer (IARC) classified opium consumption as carcinogenic to humans (Group 1) based on sufficient evidence of carcinogenicity in human studies. However, all human studies analyzed by the IARC Working Group included participants who consumed opium that was mixed, adulterated, and/or contaminated with known and probable human carcinogens (e.g., tarry residues of combusted opium, arsenic, lead, and chromium). The Working Group considered that these carcinogens were part of the complex mixture that opium is, rather than co-exposure or confounders. No evidence of carcinogenicity was available for pure opium in human, animal, or mechanistic studies. To avoid confusion and concern in health professionals and patients using medicinal opium preparations, and in scientists involved in the design and development of new opium derivatives, opium should be classified in Group 3 (not classifiable as to its carcinogenicity to humans). The term 'street opium' could be used to refer to opium that probably contains human carcinogens not present in pure opium, and should remain in Group 1 (carcinogenic to humans).
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Affiliation(s)
- Miguel López-Lázaro
- Department of Pharmacology, Faculty of Pharmacy, University of Seville, Sevilla, Spain
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Dual Inhibition of Phosphodiesterase and Ca++ Channels Explains the Medicinal Use of Balanites aegyptiaca (L.) in Hyperactive Gut Disorders. PLANTS 2022; 11:plants11091183. [PMID: 35567184 PMCID: PMC9105777 DOI: 10.3390/plants11091183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 02/03/2023]
Abstract
The present study attempted to evaluate and rationalize the medicinal use of the methanolic extract of the fruits of Balanites aegyptiaca (B. aegyptiaca) in the treatment of hyperactive gut disorders. The in vivo, castor oil-induced diarrhea model in mice was followed to test its antidiarrheal effect. To test the antispasmodic effect and to explore its pharmacodynamic details, isolated small intestines (ileum) obtained from rats were selected to provide physiological conditions for the ex vivo assays. In the in vivo assays, the orally administered extract of B. aegyptiaca protected mice from diarrheal drops with resultant percent inhibitions of 40% and 80% at the respective doses of 200 mg/kg and 400 mg/kg, while the highest protection (100%) was observed with a positive control drug, loperamide, at 10 mg/kg. In the ileum, B. aegyptiaca produced an antispasmodic effect in a concentration-dependent manner by inhibiting the carbachol (CCh; 1 µM) and high K+ (80 mM)-evoked spasms with resultant EC50 values of 1.44 mg/mL (1.08–1.78) and 1.27 mg/mL (0.98–1.66), respectively. Papaverine, a known phosphodiesterase enzyme (PDE) inhibitor and blocker of Ca++ channels (CCB), also inhibited both CCh and high K+ induced contractions at comparable EC50 values of 8.72 µM (7.92–9.24) and 8.14 µM (7.62–8.84), respectively. Contrary to the extract and papaverine, verapamil showed distinctly higher potency in regard to inhibiting high K+, compared to CCh-evoked spasms that had EC50 values of 0.16 µM (0.13–0.261) and 2.54 µM (2.28–2.92), respectively. The inhibitory effects of B. aegyptiaca on PDE were further confirmed when the pre-incubated extract shifted the isoprenaline-mediated relaxation curves (CRCs) towards the left, similar to papaverine, whereas the CCB-like effect was confirmed when the pre-incubated tissues with B. aegyptiaca caused deflection in the Ca++ CRCs towards the right, constructed in Ca++ free medium with suppression of the maximum response. Thus, this study provides detailed, mechanistic support for the medicinal use of B. aegyptiaca in the treatment of hyperactive gut disorders.
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Osugi Y, Ishiguro K, Kobayashi D. Association Between Antidiarrheal Drug Prescription and Return Visits Among Adult Patients With Acute Diarrhea. Cureus 2021; 13:e18807. [PMID: 34796079 PMCID: PMC8590859 DOI: 10.7759/cureus.18807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/20/2022] Open
Abstract
Whether antidiarrheal medications have benefits or demerits when administered to adult patients with diarrhea remains controversial. We aimed to evaluate the association between antidiarrheal drug prescription and clinical outcomes in adult patients with acute diarrhea. This retrospective cohort study was conducted by collecting secondary data of patients' health records at St. Luke’s International Hospital from April 1, 2004, to March 31, 2016. We included all participants aged 20-59 years who visited the division of general internal medicine or the emergency room in the hospital due to acute diarrheal symptoms. We excluded those who had chronic diarrhea or were immunocompromised (e.g., those with cancer or immunosuppressant usage). Our primary outcome was return visits within two weeks; the secondary outcome was admission to the hospital due to acute diarrhea within two weeks from the first visit. We compared the outcomes between patients with and without antidiarrheal drug prescriptions. During the study period, a total of 10,246 patients were included, of which 204 (2.0%) were prescribed antidiarrheal drugs. The mean age of the patients was 35.0 (standard deviation: 10.7) years, and 4,130 (40.3%) were men. Patients who were prescribed antidiarrheal drugs were more likely to be prescribed antibiotics (p<0.01). The adjusted odds ratios for return visits among patients with and without antidiarrheal drug prescription were 1.24-1.59, which were not significant. We demonstrated that antidiarrheal drug prescription was not associated with return visits or hospital admission among adult patients with acute diarrhea. This finding suggests that antidiarrheal medications have more benefits than risks in adult patients with acute diarrhea.
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Affiliation(s)
- Yasuhiro Osugi
- General Medicine, Toyota Regional Medical Center, Toyota, JPN
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[Definition and treatment of superior mesenteric artery revascularization and dissection-associated diarrhea (SMARD syndrome) in Germany]. Chirurg 2021; 93:173-181. [PMID: 34100984 PMCID: PMC8821061 DOI: 10.1007/s00104-021-01427-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 11/28/2022]
Abstract
Hintergrund Die A. mesenterica superior (AMS) wird im Rahmen von Pankreasresektionen (PR) und mesenterialen Gefäßeingriffen (MG) freigelegt und disseziert. Eine dadurch entstandene Schädigung des umliegenden ex- und intrinsischen vegetativen Nervenplexus kann zu einer passageren oder therapierefraktären Diarrhö führen. Fragestellung Die vorliegende Studie soll einen Überblick über den derzeitigen Stellenwert der AMS-Revaskularisations- und -Dissektions-assoziierten Diarrhö („superior mesenteric artery revascularisation and dissection-associated diarrhea“[SMARD]-Syndrom) in Deutschland geben. Material und Methoden Nach selektiver Literaturrecherche (SLR) mit der Fragestellung, ob und wie häufig eine postoperativ neu aufgetretene Diarrhö nach PR und MG vorkommt, wurde eine Onlineumfrage versendet. Ergebnisse Die SLR (n = 4) bestätigte, dass eine postoperativ neu aufgetretene Diarrhö eine häufige Komplikation nach Präparation zur Revaskularisation (RV) bzw. Dissektion (DIS) der AMS ist (Inzidenz ca. 62 %). Therapierefraktäre Verläufe sind selten 14 %. 54 von 159 Zentren beteiligten sich an der Umfrage. 63 % gaben an, eine AMS-RV/-DIS im Rahmen von PR oder MG durchzuführen. Der Durchschnitt an PR pro Zentrum lag 2018 bei 47 und bei 49 im Jahr 2019. Fünf MG erfolgten durchschnittlich in beiden Jahren pro Zentrum. Drei Patienten litten durchschnittlich am SMARD-Syndrom. Diskussion Diese Umfrage erfasst erstmals den derzeitigen Stellenwert des SMARD-Syndroms in Deutschland. Bisher fehlen Empfehlungen zur Therapie einer solchen Diarrhö. Die Ergebnisse zeigen, dass zunächst eine symptomatische Therapie erfolgen sollte. Aufgrund der Komplexität der Pathophysiologie sind kausale Therapieansätze bislang nicht entwickelt.
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Alonso-Cotoner C, Abril-Gil M, Albert-Bayo M, Mall JPG, Expósito E, González-Castro AM, Lobo B, Santos J. The Role of Purported Mucoprotectants in Dealing with Irritable Bowel Syndrome, Functional Diarrhea, and Other Chronic Diarrheal Disorders in Adults. Adv Ther 2021; 38:2054-2076. [PMID: 33738725 PMCID: PMC7971407 DOI: 10.1007/s12325-021-01676-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/16/2021] [Indexed: 12/12/2022]
Abstract
Chronic diarrhea is a frequent presenting symptom, both in primary care medicine and in specialized gastroenterology units. It is estimated that more than 5% of the global population suffers from chronic diarrhea. and that about 40% of these subjects are older than 60 years. The clinician is frequently faced with the need to decide which is the best therapeutic approach for these patients. While the origin of chronic diarrhea is diverse, impairment of intestinal barrier function, dysbiosis. and mucosal micro-inflammation are being increasingly recognized as underlying phenomena characterizing a variety of chronic diarrheal diseases. In addition to current pharmacological therapies, there is growing interest in alternative products such as mucoprotectants, which form a mucoadhesive film over the epithelium to reduce and protect against the development of altered intestinal permeability, dysbiosis, and mucosal micro-inflammation. This manuscript focuses on chronic diarrhea in adults, and we will review recent evidence on the ability of these natural compounds to improve symptoms associated with chronic diarrhea and to exert protective effects for the intestinal barrier.
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Affiliation(s)
- Carmen Alonso-Cotoner
- Servei de Aparell Digestiu, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Universitat Autònoma de Barcelona, Facultat de Medicina, Bellaterra, Barcelona, Spain
- CIBER de Enfermedades Hepaticas y Digestivas (CIBERHED), Instituto de Salud Carlos III, Madrid, Spain
| | - Mar Abril-Gil
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Mercé Albert-Bayo
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - John-P Ganda Mall
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Elba Expósito
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Ana M González-Castro
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Beatriz Lobo
- Servei de Aparell Digestiu, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
- Universitat Autònoma de Barcelona, Facultat de Medicina, Bellaterra, Barcelona, Spain.
| | - Javier Santos
- Servei de Aparell Digestiu, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
- Universitat Autònoma de Barcelona, Facultat de Medicina, Bellaterra, Barcelona, Spain.
- CIBER de Enfermedades Hepaticas y Digestivas (CIBERHED), Instituto de Salud Carlos III, Madrid, Spain.
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Pessoa RF, Duarte Figueiredo IA, Dantas Ferreira SR, Lima de Farias Cavalcanti Silva AR, Marinho Paiva RL, Cordeiro LV, de Oliveira Lima E, Cabrera SP, Sarmento Silva TM, de Andrade Cavalcante F. Investigation of ethnomedicinal use of Commiphora leptophloeos (Mart.) J. B. Gillett (Burseraceae) in treatment of diarrhea. JOURNAL OF ETHNOPHARMACOLOGY 2021; 268:113564. [PMID: 33166628 DOI: 10.1016/j.jep.2020.113564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/07/2020] [Accepted: 11/05/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Commiphora leptophloeos (Mart.) J.B. Gillett, popularly known as "imburana", "imburana-de-cheiro" or "imburana-de-espinho", has been used in folk medicine for the treatment of gastrointestinal diseases, such as diarrhea. The indian tribes "Kairir-Shokó and shokó use the bark to treat diarrhea. However, there is no scientific evidence to justify the therapeutic use of this species. AIM OF THE STUDY To investigate the ethnomedicinal use of Commiphora leptophloeos, with respect to the antimicrobial, antisecretory, antimotility and antispasmodic activities of the crude ethanolic extract obtained from its leaves (CL-EtOHL) and the mechanism underlying this action in rodents. MATERIAL AND METHODS In the evaluation of antibacterial and antifungal activities was determined the minimum inhibitory concentration (MIC) of the extract, against different strains of bacteria and fungi. All experimental protocols were approved by the Animal Ethics Committee of the Federal University of Paraíba (045/2016). In addition, behavioral screening and acute toxicity assessment of CL-EtOHL were performed in female mice (n = 6). In the investigation of antidiarrheal activity (n = 6), frequency of defecation and number of liquid stools, were classified during 4 h, and intestinal fluid and transit were measured. In addition, the antispasmodic effect on rat ileum (n = 5) was also investigated. RESULTS The ethanolic extract is rich in flavonoids and the main were identified as C-glycosylated flavonoids (isoorientin, orientin, and vitexin). In the evaluation of antimicrobial and antifungal activity, the extract showed moderate efficacy only against the tested strains of Candida krusei ATCC-6258, Candida parapsilosis ATCC-22019 and Candida glabrata ATCC-90030. The extract had no toxic effect until 2000 mg/kg. In castor oil-induced diarrhea, CL-EtOHL inhibited, in a dose-dependent manner, both total defecation frequency (ED50 = 380.4 ± 145.4 mg/kg) and the number of watery stools (ED50 = 151.2 ± 76.3 mg/kg). The extract showed no effect on fluid accumulation or normal intestinal transit. On the other hand, when the animals were pretreated with castor oil, the extract decreased the distance traveled by the activated charcoal (ED50 = 177.0 ± 50.3 mg/kg). In the investigation of antispasmodic effect, CL-EtOHL antagonized the contractions induced by KCl 30 mM (IC50 = 208.2 ± 25.9 μg/mL) and CCh 10-6 M (IC50 = 95. ± 22.0 μg/mL). To verify the participation of muscarinic receptors in this effect, cumulative carbachol curves were performed in the absence and presence of the extract, and a non-competitive pseudo-irreversible antagonism of these receptors was observed. CONCLUSION The data indicate that ethanol extract obtained from the leaves of Commiphora leptophloeos has an antidiarrheal effect due to inhibition of the intestinal motility and antispasmodic effect, through the antagonism of muscarinic receptors. In addition, we suggest that flavonoids isolated from CL-EtOHL may be responsible for antidiarrheal activity of this extract. This explains its ethnomedicinal use in the treatment of diarrhea.
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Affiliation(s)
- Rayane Fernandes Pessoa
- Programa de Pós-graduação Em Produtos Naturais e Sintéticos Bioativos/Universidade Federal da Paraíba, Brazil
| | | | | | | | | | - Laísa Vilar Cordeiro
- Programa de Pós-graduação Em Produtos Naturais e Sintéticos Bioativos/Universidade Federal da Paraíba, Brazil
| | - Edeltrudes de Oliveira Lima
- Programa de Pós-graduação Em Produtos Naturais e Sintéticos Bioativos/Universidade Federal da Paraíba, Brazil; Departamento de Ciências Farmacêuticas/Universidade Federal da Paraíba, Brazil
| | | | | | - Fabiana de Andrade Cavalcante
- Programa de Pós-graduação Em Produtos Naturais e Sintéticos Bioativos/Universidade Federal da Paraíba, Brazil; Departamento de Fisiologia e Patologia/Universidade Federal da Paraíba, Brazil.
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Mkala EM, Mutungi MM, Mutinda ES, Oulo MA, Wanga VO, Mwachala G, Hu GW. Understanding the Ethnobotany, Chemistry, Pharmacology, and Distribution of Genus Hydnora (Aristolochiaceae). PLANTS (BASEL, SWITZERLAND) 2021; 10:494. [PMID: 33807757 PMCID: PMC8001087 DOI: 10.3390/plants10030494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 12/13/2022]
Abstract
The genus Hydnora (Hydnoraceae) is one of the basal angiosperms in the order Piperales, found in the semi-arid regions of Africa, and the Southern Arabian Peninsula. Plants in this genus play essential roles in communities around the world as revealed by various studies. Currently, there are eight species of the genus Hydnora; seven in Africa and one in the Arabian Peninsula. Notably, Hydnora abyssinica A.Br. and Hydnora africana Thunb. are widely distributed compared to other species. They are widely used for their medicinal and nutritional values. The information on ethnobotany, chemistry, pharmacology, and distribution of genus Hydnora was gathered using phytochemical and ethnobotanical books, electronic sources, and published articles. Preliminary phytochemical screening shows that flavonoids, phenolics, proanthocyanidins, and tannins are the main compounds in H. abyssinica and H. africana. Furthermore, 11 compounds have been isolated from H. abyssinica. The biological activities of H. abyssinica and H. africana have been reported. They include antibacterial, antiproliferative, antioxidant, antidiarrhea, and antifungal potentials. Despite the Hydnora species being practiced in ancient folkloric medicine, their traditional uses and pharmacological value are poorly documented. Based on the available information on ethnobotany, phytochemistry, pharmacology, and distribution, we aim to provide research gaps and challenges for a better understanding of this genus. This may be resourceful in the development of effective phytomedicines, and aid in conservation. The available studies on this genus on some aspects such as phytochemistry, pharmacological activities, and distribution are under-reported hence the need for further research.
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Affiliation(s)
- Elijah Mbandi Mkala
- CAS Key Laboratory of Plant Germplasm Enhancement and Specialty Agriculture, Wuhan Botanical Garden, Chinese Academy of Sciences, Wuhan 430074, China; (E.M.M.); (M.M.M.); (E.S.M.); (M.A.O.); (V.O.W.)
- Sino-Africa Joint Research Center, Chinese Academy of Sciences, Wuhan 430074, China
- University of Chinese Academy of Sciences, Beijing 100049, China
- East African Herbarium, National Museums of Kenya, P.O. Box 451660-0100 Nairobi, Kenya;
| | - Moses Mutuse Mutungi
- CAS Key Laboratory of Plant Germplasm Enhancement and Specialty Agriculture, Wuhan Botanical Garden, Chinese Academy of Sciences, Wuhan 430074, China; (E.M.M.); (M.M.M.); (E.S.M.); (M.A.O.); (V.O.W.)
- Sino-Africa Joint Research Center, Chinese Academy of Sciences, Wuhan 430074, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Elizabeth Syowai Mutinda
- CAS Key Laboratory of Plant Germplasm Enhancement and Specialty Agriculture, Wuhan Botanical Garden, Chinese Academy of Sciences, Wuhan 430074, China; (E.M.M.); (M.M.M.); (E.S.M.); (M.A.O.); (V.O.W.)
- Sino-Africa Joint Research Center, Chinese Academy of Sciences, Wuhan 430074, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Millicent Akinyi Oulo
- CAS Key Laboratory of Plant Germplasm Enhancement and Specialty Agriculture, Wuhan Botanical Garden, Chinese Academy of Sciences, Wuhan 430074, China; (E.M.M.); (M.M.M.); (E.S.M.); (M.A.O.); (V.O.W.)
- Sino-Africa Joint Research Center, Chinese Academy of Sciences, Wuhan 430074, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Vincent Okelo Wanga
- CAS Key Laboratory of Plant Germplasm Enhancement and Specialty Agriculture, Wuhan Botanical Garden, Chinese Academy of Sciences, Wuhan 430074, China; (E.M.M.); (M.M.M.); (E.S.M.); (M.A.O.); (V.O.W.)
- Sino-Africa Joint Research Center, Chinese Academy of Sciences, Wuhan 430074, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Geoffrey Mwachala
- East African Herbarium, National Museums of Kenya, P.O. Box 451660-0100 Nairobi, Kenya;
| | - Guang-Wan Hu
- CAS Key Laboratory of Plant Germplasm Enhancement and Specialty Agriculture, Wuhan Botanical Garden, Chinese Academy of Sciences, Wuhan 430074, China; (E.M.M.); (M.M.M.); (E.S.M.); (M.A.O.); (V.O.W.)
- Sino-Africa Joint Research Center, Chinese Academy of Sciences, Wuhan 430074, China
- University of Chinese Academy of Sciences, Beijing 100049, China
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Antidiarrheal Effect of Sechang-Zhixie-San on Acute Diarrhea Mice and Network Pharmacology Deciphering Its Characteristics and Potential Mechanisms. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:8880298. [PMID: 33381214 PMCID: PMC7749774 DOI: 10.1155/2020/8880298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/05/2020] [Accepted: 12/01/2020] [Indexed: 12/14/2022]
Abstract
Sechang-Zhixie-San (SCZX) is an ancient prescription used for pediatric diarrhea by the Yi people in China, which consists of Rodgersia sambucifolia Hemsley (known as Yantuo and abbreviated as YT) and Bentonite (BN). Now, it is also a Chinese patent medicine used in the clinic to treat infantile diarrhea. Besides evaluating the antidiarrheal effect of SCZX on diarrhea mice induced by Folium Sennae, the purpose of this study is to outline the characteristics of the antidiarrheal effect and reveal the potential mechanisms of SCZX through the analysis of the mechanism and active components of YT via network pharmacology and molecular docking, combined with the research progress of BN obtained from the literature. SCZX (3.12 and 12.48 g/kg) effectively inhibited diarrhea in mice, significantly lowering the loose stool rate (LSR), loose stool level (LSL), and loose stool index (LSI). Using network pharmacology, the "herb-compound-target-pathway-pharmacological action" network was mapped to indicate the antidiarrheal mechanism of YT. And the docking results revealed that 4 components of YT including quercetin, geranyl-1-O-α-L-arabinopyranosyl-(1 ⟶ 6)-β-D-glucopyranoside, 3α-O-(E)-p-hydroxy-cinnamoyl-olean-12-en-27-oic acid, and daucosterol showed significant docking activities with STAT3, EGFR, and SLC10A2, involving 11 pathways such as Th17 cell differentiation, Jak-STAT signaling pathway, ErbB signaling pathway, and HIF-1 signaling pathway. According to our research results and literature reports, the antidiarrheal could be summarized into five aspects: inhibiting intestinal inflammation, acting as a barrier to the intestinal mucosal, regulating water and ion transport, involving the purification of intestinal microorganisms, and intestinal transmission, which might be dependent on multiple proteins and intervention in multiple pathways.
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Pessoa MLDS, Silva LMO, Araruna MEC, Serafim CADL, Júnior EBA, Silva AO, Pessoa MMB, Neto HD, Lima EDO, Batista LM. Antifungal activity and antidiarrheal activity via antimotility mechanisms of (-)-fenchone in experimental models. World J Gastroenterol 2020; 26:6795-6809. [PMID: 33268962 PMCID: PMC7684460 DOI: 10.3748/wjg.v26.i43.6795] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/12/2020] [Accepted: 10/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND (-)-Fenchone is a bicyclic monoterpene present in essential oils of plant species, such as Foeniculum vulgare and Peumus boldus, used to treatment of gastrointestinal diseases. Pharmacological studies report its anti-inflammatory, antioxidant, and antinociceptive activity.
AIM To investigate antidiarrheal activity related to gastrointestinal motility, intestinal secretion and antimicrobial activity.
METHODS A castor oil-induced diarrhea model was used to evaluate antidiarrheal activity. Intestinal transit and gastric emptying protocols were used to assess a possible antimotility effect. Muscarinic receptors, presynaptic α2-adrenergic and tissue adrenergic receptors, KATP channels, nitric oxide were investigated to uncover antimotility mechanisms of action and castor oil-induced enteropooling to elucidate antisecretory mechanisms. The antimicrobial activity was evaluated in the minimum inhibitory concentration model, the fractional inhibitory concentration index using the (-)-fenchone association method with standard antifungal agents.
RESULTS (-)-Fenchone (75, 150 and 300 mg/kg) showed antidiarrheal activity, with a significant decrease in the evacuation index. This activity is possibly related to a percentage of reduced intestinal transit (75, 150 and 300 mg/kg). The antimotility effect of (-)-fenchone decreased in the presence of pilocarpine, yohimbine, propranolol, L-NG-nitroarginine methyl ester or glibenclamide. In the enteropooling model, no reduction in intestinal fluid weight was observed. (-)- Fenchone did not show antibacterial activity; on the other hand, inhibits the growth of strains of fungi with a minimum fungicide concentration of 32 μg/mL. However, when it was associated with amphotericin B, no synergism was observed.
CONCLUSION The antidiarrheal effect of (-)-fenchone in this study involves antimotility effect and not involve antisecretory mechanisms. (-)-Fenchone presents antifungal activity; however, it did not show antibacterial activity.
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Affiliation(s)
- Michelle Liz de Souza Pessoa
- Department of Pharmaceutical Sciences, IPeFarM, Federal University of Paraíba, João Pessoa 58051-970, Paraíba, Brazil
| | | | - Maria Elaine Cristina Araruna
- Department of Pharmaceutical Sciences, IPeFarM, Federal University of Paraíba, João Pessoa 58051-970, Paraíba, Brazil
| | | | - Edvaldo Balbino Alves Júnior
- Department of Pharmaceutical Sciences, IPeFarM, Federal University of Paraíba, João Pessoa 58051-970, Paraíba, Brazil
| | - Alessa Oliveira Silva
- Department of Pharmaceutical Sciences, IPeFarM, Federal University of Paraíba, João Pessoa 58051-970, Paraíba, Brazil
| | | | - Hermes Diniz Neto
- Department of Pharmaceutical Sciences, IPeFarM, Federal University of Paraíba, João Pessoa 58051-970, Paraíba, Brazil
| | - Edeltrudes de Oliveira Lima
- Department of Pharmaceutical Sciences, IPeFarM, Federal University of Paraíba, João Pessoa 58051-970, Paraíba, Brazil
| | - Leônia Maria Batista
- Postgraduate Program in Natural and Synthetic Bioactive Products, Universidade Federal da Paraiba, João Pessoa 58051-900, Brazil
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Chen K, Xin J, Zhang G, Xie H, Luo L, Yuan S, Bu Y, Yang X, Ge Y, Liu C. A combination of three probiotic strains for treatment of acute diarrhoea in hospitalised children: an open label, randomised controlled trial. Benef Microbes 2020; 11:339-346. [PMID: 32720832 DOI: 10.3920/bm2020.0046] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Acute diarrhoea continues to be a leading cause of morbidity, hospitalisation, and mortality worldwide, and probiotics have been proposed as a complementary therapy in the treatment of acute diarrhoea. The goal of this study is to assess the efficacy and safety of three combined probiotic strains, Bifidobacterium lactis Bi-07, Lactobacillus rhamnosus HN001, and Lactobacillus acidophilus NCFM, as an adjunct to rehydration therapy in treatment of acute watery diarrhoea in hospitalised children. Eligible diarrheal children were randomised into intervention group (IG, n=96, conventional treatment for diarrhoea in combination with probiotics) and control group (CG, n=98, conventional treatment for diarrhoea without probiotics). The primary assessments of this study were duration of diarrhoea and hospital stay and improvement in diarrhoea symptoms. Significantly more children in the IG showed improvements in diarrhoea (defined as a decrease of stool frequency to no more than four times per day and an improved stool consistency within 24-48 h after the treatment) than those in the CG (96.9 vs 79.6%, P<0.05). Children supplemented with the mixed strains had a 22.5 h shorter (121.4±13.7 h vs 143.9±19.8 h) mean duration of diarrhoea and 1.2 d shorter hospital stays (5.1±1.2 d vs 6.3±1.4 d) than children only receiving the rehydration therapy (P<0.05). The prevalence of constipation of children in the IG (3.1%) was markedly lower (P<0.05) than that of children in the CG (13.3%) after treatment. In conclusion, the mixture of three probiotic strains given to children aged 1-3 years resulted in shorter durations of diarrhoea and hospitalisation and a higher percentage of improved children.
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Affiliation(s)
- K Chen
- Department of Nutrition, Chengdu Women's & Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, Sichuan 6100131, China P.R
| | - J Xin
- Infinitus (China) Company Ltd., Hangzhou, Zhejiang, China P.R
| | - G Zhang
- Department of Pediatric Intensive Care Unit, Chengdu Women's & Children's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China P.R
| | - H Xie
- Department of Pediatrics, Dayi Maternal and Child Health Care Hospital, Chengdu, Sichuan, China P.R
| | - L Luo
- Department of Pediatrics, Dayi Maternal and Child Health Care Hospital, Chengdu, Sichuan, China P.R
| | - S Yuan
- Department of Nutrition, Chengdu Women's & Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, Sichuan 6100131, China P.R
| | - Y Bu
- Department of Pediatrics, Dayi Maternal and Child Health Care Hospital, Chengdu, Sichuan, China P.R
| | - X Yang
- Department of Pediatrics, Dayi Maternal and Child Health Care Hospital, Chengdu, Sichuan, China P.R
| | - Y Ge
- Infinitus (China) Company Ltd., Hangzhou, Zhejiang, China P.R
| | - C Liu
- School of Exercise and Nutritional Sciences, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182-7251, USA
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de Souza ILL, de Vasconcelos MA, da Silva ADS, Silva PCB, Veloso CAG, de Araújo DIAF, Costa VCDO, Pessôa HLF, Tavares JF, da Silva MS, da Silva BA, Cavalcante FDA. Toxicological and Pharmacological Activities of Leptohyptis macrostachys (Benth.) Harley and J.F.B.Pastore (Lamiaceae) on Intestinal Smooth Muscle. Front Pharmacol 2020; 11:1042. [PMID: 32754035 PMCID: PMC7366869 DOI: 10.3389/fphar.2020.01042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/26/2020] [Indexed: 11/13/2022] Open
Abstract
Leptohyptis macrostachys, previously known as Hyptis macrostachys Benth., is used in folk medicine to relieve the symptoms of asthma, cough, and bronchitis. Recently, we showed that the ethanol extract obtained from Leptohyptis macrostachys has selective spasmolytic activity on guinea pig ileum. Therefore, the aim of this study was to characterize the spasmolytic mechanism of this extract, investigated whether it presents toxicological and antidiarrheal activities. Therefore, the crude ethanolic extract of Leptohyptis macrostachys was analyzed by high-performance liquid chromatographic-diode array detection (HPLC-DAD). The spasmolytic effect was evaluated on guinea pig ileum, toxicological activity using rats and antidiarrheal activity using male and female mice. In HPLC-DAD analysis, Rosmarinic acid (5.44%) was the most abundant phenolic compound, being considered as a chemical marker. The spasmolytic potency of the extract on histamine-induced contraction was reduced in the presence of 1 mM TEA+, a selective big-conductance K+ channels blocker (BKCa). The extract produces a dose-dependent antidiarrheal activity, inhibiting equipotently defecation frequency and liquid stool formation. In addition, the extract has inhibited in a dose-dependent manner both castor oil-induced intestinal transit and intestinal fluid content. Thus, the spasmolytic activity of the extract involves positive modulation of BKCa and its antidiarrheal activity is related to inhibition of intestinal motility and secretion.
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Affiliation(s)
- Iara Leão Luna de Souza
- Departamento de Ciências Biológicas e Saúde, Universidade Estadual de Roraima, Boa Vista, Brazil
| | | | - Anne Dayse Soares da Silva
- Programa de Pós-graduação em Química e Biotecnologia, Instituto de Química, Universidade Federal de Alagoas, Maceió, Brazil
| | | | | | | | | | - Hilzeth Luna Freire Pessôa
- Departamento de Biologia Molecular, Centro de Ciências Exatas e da Natureza, Universidade Federal da Paraíba, João Pessoa, Brazil
| | - Josean Fechine Tavares
- Instituto de Pesquisa em Fármacos e Medicamentos, Universidade Federal da Paraíba, João Pessoa, Brazil
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal da Paraíba, João Pessoa, Brazil
| | - Marcelo Sobral da Silva
- Instituto de Pesquisa em Fármacos e Medicamentos, Universidade Federal da Paraíba, João Pessoa, Brazil
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal da Paraíba, João Pessoa, Brazil
| | - Bagnólia Araújo da Silva
- Instituto de Pesquisa em Fármacos e Medicamentos, Universidade Federal da Paraíba, João Pessoa, Brazil
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal da Paraíba, João Pessoa, Brazil
| | - Fabiana de Andrade Cavalcante
- Instituto de Pesquisa em Fármacos e Medicamentos, Universidade Federal da Paraíba, João Pessoa, Brazil
- Departamento de Fisiologia e Patologia, Centro de Ciências da Saúde, Universidade Federal da Paraíba, João Pessoa, Brazil
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Chamomile decoction modulates water, neutral NaCl and electrogenic ionic exchange in mice intestinal epithelium. FOOD BIOSCI 2020. [DOI: 10.1016/j.fbio.2020.100608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pitta MR, Campos FM, Monteiro AG, Cunha AGF, Porto JD, Gomes RR. Tutorial on Diarrhea and Enteral Nutrition: A Comprehensive Step-By-Step Approach. JPEN J Parenter Enteral Nutr 2019; 43:1008-1019. [PMID: 31544264 DOI: 10.1002/jpen.1674] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/14/2019] [Accepted: 05/30/2019] [Indexed: 01/26/2023]
Abstract
This tutorial suggests a current strategy toward a multiprofessional therapy based upon a comprehensive step-by-step approach to the course of intensive care unit diarrhea episodes. Evidence published in the last 10 years, obtained through a database search (PubMed), shows that its prevalence is quite variable. Although multicausal, it is often erroneously associated with the supply of enteral nutrition. Several complications affect not only nutrition status but also the development of skin lesions, which can become the focus of infections, and the length of hospital stay. Here, we propose an early, objective, directed, and multimodal approach, aiming at optimizing care for these patients. In a dynamic walkthrough, the reader will find a guide for the general diagnosis and for colitis resulting from Clostridium difficile infections, as well as current instructions and recommendations for drug treatment and supportive therapy for these 2 modalities. We also bring together ways to prevent and treat associated skin lesions in this setting. Because it is neglected in the critical environment, diarrhea is still a poorly addressed disease, and its complications bring about a significant worsening in quality of life and hospital stay.
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Abstract
PURPOSE OF REVIEW Chronic diarrhea is a common problem in all age groups but is a particularly challenging diagnostic problem in the elderly, since many different conditions need to be considered. The purpose of this review is to discuss the evaluation of chronic diarrhea in older individuals. It highlights those conditions that seem to occur with increased frequency in the elderly, discusses the diagnostic tests that are of greatest value in sorting out these problems, and presents an approach to evaluation that is both practical and affordable. RECENT FINDINGS There appears to be little value in distinguishing irritable bowel syndrome with diarrhea (IBS-D) from functional diarrhea in most patients, including older individuals. Both conditions need a thoughtful analysis of potential causes that may lead to more focused treatment. Older individuals may be more at risk of having certain structural disorders, and these need to be considered when constructing a differential diagnosis. In addition, elderly patients may have atypical presentations of specific disorders that require an increased index of suspicion. Diagnostic tests generally seem to perform well in older patients but have not been validated in this cohort of patients. Although the pretest probabilities of certain diseases are different in the elderly, the conventional algorithm for assessment of chronic diarrhea should lead to a diagnosis in most cases. Better studies are needed to adequately quantitate the likelihood of different diagnoses and the operating characteristics of diagnostic tests in older patients with chronic diarrhea. Lacking that information, physicians can still do a good job of making a diagnosis in these patients by adopting a stepwise approach.
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Makrane H, Aziz M, Mekhfi H, Ziyyat A, Legssyer A, Melhaoui A, Berrabah M, Bnouham M, Alem C, Elombo FK, Gressier B, Desjeux JF, Eto B. Origanum majorana L. extract exhibit positive cooperative effects on the main mechanisms involved in acute infectious diarrhea. JOURNAL OF ETHNOPHARMACOLOGY 2019; 239:111503. [PMID: 30217790 DOI: 10.1016/j.jep.2018.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/09/2018] [Accepted: 09/03/2018] [Indexed: 06/08/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Origanum majorana L. (Lamiaceae) is commonly used in Moroccan folk medicine to treat infantile colic, abdominal discomfort and diarrhea. Liquid stools and abdominal discomfort observed in acute infectious diarrhea are the consequences of imbalance between intestinal water secretion and absorption in the lumen, and relaxation of smooth muscle surrounding the intestinal mucosa. AIM OF THE STUDY The objective of our study was to see if aqueous extract of Origanum majorana L. (AEOM) may exhibit an effect on those deleterious mechanisms. MATERIALS AND METHODS The effect of AEOM on electrogenic Cl- secretion and Na+ absorption, the two main mechanisms underlying water movement in the intestine, was assessed on intestinal pieces of mice intestine mounted, in vitro, in Ussing chambers. AEOM effect on muscle relaxation was measured on rat intestinal smooth muscle mounted in an isotonic transducer. RESULTS 1) AEOM placed on the serosal (i.e. blood) side of the piece of jejunum entirely inhibited in a concentration-dependent manner the Forskolin-induced electrogenic chloride secretion, with an IC50 = 654 ± 8 µg/mL. 2) AEOM placed on the mucosal (i.e. luminal) side stimulated in a concentration-dependent manner an electrogenic Na+ absorption, with an IC50 = 476.9 ± 1 µg/mL. 3) AEOM (1 mg/mL) inhibition of Forskolin-induced electrogenic secretion was almost entirely prevented by prior exposure to Ca++ channels or neurotransmitters inhibitors. 4) AEOM (1 mg/mL) proabsorptive effect was greater in the ileum and progressively declined in the jejunum, distal colon and proximal colon (minimal). 5) AEOM inhibited in a concentration-dependent manner smooth muscle Carbachol or KCl induced contraction, with an IC50 = 1.64 ± 0.2 mg/mL or 1.92 ± 0.8 mg/mL, respectively. CONCLUSION the present results indicate that aqueous extract of Origanum majorana L. exhibit positive cooperative effects on the main mechanisms that are involved in acute infectious diarrhea.
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Affiliation(s)
- Hanane Makrane
- Laboratory of Physiology, Genetic and Ethnopharmacology, Faculty of Sciences, Mohammed The First University, PB. 717, 60000 Oujda, Morocco
| | - Mohammed Aziz
- Laboratory of Physiology, Genetic and Ethnopharmacology, Faculty of Sciences, Mohammed The First University, PB. 717, 60000 Oujda, Morocco
| | - Hassane Mekhfi
- Laboratory of Physiology, Genetic and Ethnopharmacology, Faculty of Sciences, Mohammed The First University, PB. 717, 60000 Oujda, Morocco
| | - Abderrahim Ziyyat
- Laboratory of Physiology, Genetic and Ethnopharmacology, Faculty of Sciences, Mohammed The First University, PB. 717, 60000 Oujda, Morocco
| | - Abdelkhaleq Legssyer
- Laboratory of Physiology, Genetic and Ethnopharmacology, Faculty of Sciences, Mohammed The First University, PB. 717, 60000 Oujda, Morocco
| | - Ahmed Melhaoui
- Laboratory of Organic Chemistry, Macromolecular and Natural Products, Faculty of Sciences, Mohammed The First University, PB. 717, 60000 Oujda, Morocco
| | - Mohamed Berrabah
- Laboratory of Chemistry, Mineral and Analytical Solid, Department of Chemistry, Faculty of Sciences, Mohammed The First University, PB. 717, 60000 Oujda, Morocco
| | - Mohamed Bnouham
- Laboratory of Physiology, Genetic and Ethnopharmacology, Faculty of Sciences, Mohammed The First University, PB. 717, 60000 Oujda, Morocco
| | - Chakib Alem
- Laboratory of Biochemistry, Department of Biology, Faculty of Sciences & Techniques, Errachidia, Morocco
| | - Ferdinand Kouoh Elombo
- Laboratoires TBC, Faculty of Pharmaceutical and Biological Sciences, Lille, France; Laboratory of Pharmacology, Pharmacokinetics, and Clinical Pharmacy, Faculty of Pharmaceutical and Biological Sciences, Lille, France
| | - Bernard Gressier
- Laboratory of Pharmacology, Pharmacokinetics, and Clinical Pharmacy, Faculty of Pharmaceutical and Biological Sciences, Lille, France
| | | | - Bruno Eto
- Laboratoires TBC, Faculty of Pharmaceutical and Biological Sciences, Lille, France.
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Physico–Chemical Interaction between Clay Minerals and Albumin Protein according to the Type of Clay. MINERALS 2019. [DOI: 10.3390/min9070396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Clay minerals are widely utilized in pharmaceutical and dermatological sciences as a gastrointestinal medicine or skin remediation agent. In order to verify the feasibility of clays as an injection, pill, or topical agent, it is important to study their interactions with biological components, such as proteins. In this study, we utilized a protein fluorescence quenching assay and circular dichroism spectroscopy to evaluate general aspects of protein denaturation and conformational change, respectively. Three different clays; layered double oxide (LDO), montmorilonite (MMT) and halloysite nanotube (HNT), were treated with albumin and the physico-chemical effect on the protein’s conformation was investigated. MMT was shown to influence the conformational change the most, owing to the large accessible adsorption site. HNT showed meaningful circular dichroism (CD) band collapse as well as fluorescence quenching in the protein, suggesting a potential harmful effect of HNT toward the protein. Among the three tested clays, LDO was determined to affect protein structure the least in terms of three-dimensional conformation and helical structure.
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The Effects of Fecal Donors with Different Feeding Patterns on Diarrhea in a Patient Undergoing Hematopoietic Stem Cell Transplantation. Case Rep Hematol 2019; 2019:4505238. [PMID: 31049232 PMCID: PMC6462343 DOI: 10.1155/2019/4505238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/20/2018] [Accepted: 02/27/2019] [Indexed: 12/14/2022] Open
Abstract
Almost 90% of patients undergoing hematopoietic stem cell transplantation (HSCT) experience diarrheal episodes, which represent a severe, often life-threatening complication for these patients. Although fecal microbiota transplantation (FMT) represents an alternative treatment option for infection-related diarrhea, the application of FMT in HSCT patients is greatly restricted for safety reasons. Furthermore, the therapeutic outcomes of FMT as a diarrhea treatment are somewhat related to the choice of the FMT donor. Here, we comprehensively profiled the dynamic changes in the intestinal microbiota after FMT from two donors with different feeding patterns and the same severely diarrheal recipient undergoing HSCT via a 45-day clinical observation. Importantly, no adverse events attributed to FMT were observed. The stool volume and frequency of the patient were reduced when we used feces from donor #1 (mixed feeding), but these changes were not observed after FMT from donor #2 (exclusive breastfeeding). Interestingly, no obvious differences in overall diversity (Shannon) or richness (Chao1) between the two donors were observed. Additionally, Bifidobacterium accounted for 29.9% and 18.1% of OTUs in the stools of donors #1 and #2, respectively. Lactobacillus accounted for 16.3% and 2.9% of the stools of donors #1 and #2, respectively. Furthermore, through longitudinal monitoring of the patient, we identified 6 OTUs that were particularly sensitive to the different FMT complements. Together, we present a case report suggesting that the overall diversity of the intestinal microbiota may not be the only important element in the selection of an effective FMT donor.
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Imenshahidi M, Hosseinzadeh H. Berberine and barberry (Berberis vulgaris): A clinical review. Phytother Res 2019; 33:504-523. [PMID: 30637820 DOI: 10.1002/ptr.6252] [Citation(s) in RCA: 194] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 10/20/2018] [Accepted: 11/03/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Mohsen Imenshahidi
- Department of Pharmacodynamics and Toxicology, School of Pharmacy; Mashhad University of Medical Sciences; Mashhad Iran
- Pharmaceutical Research Center, Pharmaceutical Technology Institute; Mashhad University of Medical Sciences; Mashhad Iran
| | - Hossein Hosseinzadeh
- Department of Pharmacodynamics and Toxicology, School of Pharmacy; Mashhad University of Medical Sciences; Mashhad Iran
- Pharmaceutical Research Center, Pharmaceutical Technology Institute; Mashhad University of Medical Sciences; Mashhad Iran
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Fabio DSM, Antonio FSC, Elismar DCM, Rachel MR, Antonio CRB, Marilene ODRB. Antidiarrhoeal and antispasmodic activity of leaves of Syzygium cumini L. (Myrtaceae) mediated through calcium channel blockage. ACTA ACUST UNITED AC 2018. [DOI: 10.5897/ajpp2017.4868] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Sheikh IA, Ammoury R, Ghishan FK. Pathophysiology of Diarrhea and Its Clinical Implications. PHYSIOLOGY OF THE GASTROINTESTINAL TRACT 2018:1669-1687. [DOI: 10.1016/b978-0-12-809954-4.00068-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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