Comparison of glucosamine sulfate and a polyherbal supplement for the relief of osteoarthritis of the knee: a randomized controlled trial [ISRCTN25438351]

<p>Abstract</p> <p>Background</p> <p>The efficacy and safety of a dietary supplement derived from South American botanicals was compared to glucosamine sulfate in osteoarthritis subjects in a Mumbai-based multi-center, randomized, double-blind study.</p> <p>Methods</p> <p>Subjects (n = 95) were screened and randomized to receive glucosamine sulfate (n = 47, 1500 mg/day) or reparagen (n = 48, 1800 mg/day), a polyherbal consisting of 300 mg of vincaria (<it>Uncaria guianensis</it>) and 1500 mg of RNI 249 (<it>Lepidium meyenii</it>) administered orally, twice daily. Primary efficacy variable was response rate based on a 20% improvement in WOMAC pain scores. Additional outcomes were WOMAC scores for pain, stiffness and function, visual analog score (VAS) for pain, with assessments at 1, 2, 4, 6 and 8 weeks. Tolerability, investigator and subject global assessments and rescue medication consumption (paracetamol) were measured together with safety assessments including vital signs and laboratory based assays.</p> <p>Results</p> <p>Subject randomization was effective: age, gender and disease status distribution was similar in both groups. The response rates (20% reduction in WOMAC pain) were substantial for both glucosamine (89%) and reparagen (94%) and supported by investigator and subject assessments. Using related criteria response rates to reparagen were favorable when compared to glucosamine. Compared to baseline both treatments showed significant benefits in WOMAC and VAS outcomes within one week (P < 0.05), with a similar, progressive improvement over the course of the 8 week treatment protocol (45–62% reduction in WOMAC or VAS scores). Tolerability was excellent, no serious adverse events were noted and safety parameters were unchanged. Rescue medication use was significantly lower in the reparagen group (p < 0.01) at each assessment period. Serum IGF-1 levels were unaltered by treatments.</p> <p>Conclusion</p> <p>Both reparagen and glucosamine sulfate produced substantial improvements in pain, stiffness and function in subjects with osteoarthritis. Response rates were high and the safety profile was excellent, with significantly less rescue medication use with reparagen. Reparagen represents a new natural productive alternative in the management of joint health.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN25438351.</p

Role of Transarterial Embolization in the Management of Hepatic Artery Pseudoaneurysm Postlaparoscopic Cholecystectomy

Purpose To assess the safety and effectiveness of transarterial embolization (TAE) in the management of hepatic artery pseudoaneurysms following laparoscopic cholecystectomy (LC). Materials and Methods This is a retrospective study consisting of 13 patients who had undergone TAE for management of pseudoaneurysms of the hepatic artery or its branches following LC. Patients presented with symptoms such as hypotension, hematemesis, melena or gradual anemia post LC. Abdominal CT revealed hepatic artery pseudoaneurysm in all patients. TAE was performed with either coils or N-butyl cyanoacrylate or both. We evaluated technical and clinical effectiveness and complications of TAE. Results TAE was successful both technically and in stopping bleeding in all patients (100% technical and clinical success). No patient had rebleeding after TAE. Four patients required laparotomy for draining hemoperitoneum and clots. Endoscopic retrograde cholangiopancreatography (ERCP) for hemobilia or bile duct injury was done in eight patients. Following TAE, hepatic infarct was observed in three patients. Postembolization syndrome was seen in four patients and one patient died due to sepsis. Conclusions TAE is effective for treatment of hepatic artery pseudoaneurysms after LC. Hepatic infarcts and postembolization syndrome are the most common complications and can be managed conservatively

Role of Transarterial Embolization in the Management of Hepatic Artery Pseudoaneurysm Postlaparoscopic Cholecystectomy

Abstract Purpose To assess the safety and effectiveness of transarterial embolization (TAE) in the management of hepatic artery pseudoaneurysms following laparoscopic cholecystectomy (LC). Materials and Methods This is a retrospective study consisting of 13 patients who had undergone TAE for management of pseudoaneurysms of the hepatic artery or its branches following LC. Patients presented with symptoms such as hypotension, hematemesis, melena or gradual anemia post LC. Abdominal CT revealed hepatic artery pseudoaneurysm in all patients. TAE was performed with either coils or N-butyl cyanoacrylate or both. We evaluated technical and clinical effectiveness and complications of TAE. Results TAE was successful both technically and in stopping bleeding in all patients (100% technical and clinical success). No patient had rebleeding after TAE. Four patients required laparotomy for draining hemoperitoneum and clots. Endoscopic retrograde cholangiopancreatography (ERCP) for hemobilia or bile duct injury was done in eight patients. Following TAE, hepatic infarct was observed in three patients. Postembolization syndrome was seen in four patients and one patient died due to sepsis. Conclusions TAE is effective for treatment of hepatic artery pseudoaneurysms after LC. Hepatic infarcts and postembolization syndrome are the most common complications and can be managed conservatively.</jats:p

BRAIN FOG IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE, AND ASSOCIATION WITH USE OF PROBIOTICS

Abstract INTRODUCTION Brain fog has been extensively studied in patients with inflammatory bowel disease (IBD). Probiotics have been shown to increase the incidence of brain fog in patients independently. There is a high prevalence of probiotic consumption in patients with IBD in clinical practice, whether by a physician or not. We aimed to study if there was an association between brain fog and IBD patients who took probiotics and those who did not. METHODS We conducted a cross-sectional study of patients visiting IBD clinic. Patients over the age of 18 with a biopsy-proven diagnosis of inflammatory bowel disease, without any known pre-existing psychiatric illness or current use of opioid medications were included. They were divided into 2 groups: those with history of probiotic use and those without. Patients were given a questionnaire that included details about symptoms of brain fog. Groups were analyzed by chi-square for differences in baseline demographics, and Mann Whitney U test with repeated measures to compare outcomes between groups. A p value &amp;lt; 0.05 was considered statistically significant. RESULTS Of the 66 patients included (mean age 44±2 years), 35 (53%) were female and 59 (89.4%) were Caucasian. Among these patients, 31.8% (n=21) were on probiotics as dietary supplement with majority (67%, n= 14) taking probiotics for over a year. Overall, there was trend for an association between probiotic use and brain fog in all patients (p=0.080) but no statistical significance was attained. However, brain fog was significantly associated with probiotic use among Caucasian patients (p=0.044). Furthermore, there was a statistically significant association between brain fog and male patients using probiotics (p=0.004). Duration of probiotic use was also associated with brain fog (p=0.038). CONCLUSION Consumption of probiotics was independently associated with brain fog in men, as well as Caucasian patients with IBD respectively. Future prospective studies are warranted to examine causal relationship between probiotics and IBD-associated brain fog to guide prescription of probiotic supplements for IBD. </jats:sec