The Use of Ginkgo Biloba L. as a Neuroprotective Agent in the Alzheimer’s Disease

Alzheimer’s disease, a neurodegenerative disease, is one of the most common causes of dementia if elderly people worldwide. Alzheimer’s disease leads to the alienation of individuals and their exclusion from social and professional life. It is characterized mainly by the degradation of memory and disorientation, which occurs as a result of the loss of neuronal structure and function in different brain areas. In recent years, more and more attention has been paid to use in the treatment of natural bioactive compounds that will be effective in neurodegenerative diseases, including Alzheimer’s disease. G. biloba L. and its most frequently used standardized extract (EGb 761), have been used for many years in supportive therapy and in the prevention of cognitive disorders. The paper presents an overview of reports on the pathogenesis of Alzheimer’s disease, as well as a summary of the properties of G. biloba extract and its effects on the possible pathogenesis of the disease. By exploring more about the pathogenesis of the disease and the benefits of G. biloba extract for patients with Alzheimer’s disease, it will be possible to create an individualized therapeutic protocol to optimize the treatment.

CTNI-12. PHASE II MULTICENTRIC ITALIAN TRIAL ON REPOSITIONING OF THE ANTIPSYCHOTIC DRUG CHLORPROMAZINE AND ITS SYNERGISM WITH TEMOZOLOMIDE IN MGMT UNMETHYLATED GLIOBLASTOMA PATIENTS: THE RACTAC TRIAL

The poor prognosis of patients affected by glioblastoma (GBM) prompts the search for new and more effective therapies, particularly for GBMs with unmethylated MGMT. In this regard, drug repurposing, can represent a safe and inexpensive way to bring novel pharmacological approaches from bench to bedside. Chlorpromazine, a medication in use since six decades for the therapy of psychiatric disorders, shows in vitro features that make it eligible for repositioning in GBM therapy. In our experimentation on six GBM cell lines, chlorpromazine inhibited cell viability in an apoptosis-independent way, induced polyploidy, reduced cloning efficiency as well as neurosphere formation and downregulated the expression of stemness genes. Notably, we found that chlorpromazine synergized with temozolomide, in reducing cell viability and strongly cooperated in reducing cloning efficiency and inducing cell death in vitro for all the GBM cell lines assayed. With these assumptions, we started a multicentric Phase II clinical trial on newly diagnosed GBM patients with unmethylated MGMT by adding chlorpromazine to temozolomide in the adjuvant phase of the standard first-line therapeutic protocol. The experimental procedure involves the combination of CPZ with standard treatment with TMZ in the adjuvant phase of the Stupp protocol. CPZ is administered orally at a dose of 50 mg/day – GG 1-28 – of every cycle of the adjuvant treatment with TMZ. At present, 28 patients out of 41 patients planned have been enrolled, without relevant toxicity.

Homeopathic treatment of perianal fistula in a dog - Case Report / Tratamento homeopático da fístula perianal num cão - Relato de caso

Perineal fistulas are frequently diagnosed in dogs in clinical practice. They are characterized by an inflammatory lesion in the perianal region or adjacent tissues, causing pain and discomfort to patients. In many cases, fistulas can be ulcerated. In general, corticosteroids and immunosuppressants are the treatment of choice for perianal fistulas. However, they cause various side effects. Surgical intervention is also an option, but sequelae may occur, such as fecal incontinence, the most frequent of them. From this perspective, it is evident that conventional treatments do not provide the complete restoration of the patients' health. On the other hand, homeopathic treatments are gaining space in the veterinary clinical routine with successful results for various diseases that affect animals. This study aimed to report the case of a German Spitz male dog diagnosed with perianal fistula exclusively treated by homeopathy. The prescription of medicines was based on the law of similars, and the medicines Arnica montana, Belladonna, Hamamellis virginiana, and Nitric acidum were chosen. The therapeutic protocol established restored the affected tissues' function with a complete resolution of the disease in 15 days. No complications were recorded.

Early multidrug treatment of SARS-CoV-2 (COVID-19) and decreased case fatality rates in Honduras

INTRODUCTION: Within 2 months of first detection of SARS-CoV-2 in Honduras, its government promoted nationwide implementation of multi-drug COVID-19 inpatient and outpatient treatment protocols. This was associated with a case fatality rate decrease from 9.33% to 2.97%. No decrease was seen in Mexico, a similar Latin American country that did not introduce multi-drug treatment protocols at that time. OBJECTIVE: The primary objective of the study was to use statistical process control to assess the likelihood that the decrease in case fatality rate in Honduras was due to chance, using Mexico as a control country. METHODS: Fourteen day running average COVID-19 case fatality rates in Honduras and Mexico were used to create Shewhart control charts during the first 6 months of the epidemic. The date of implementation in Honduras of the inpatient and outpatient multi-drug COVID-19 protocols were plotted on control charts, with a Mexican COVID-19 case fatality control chart for comparison. RESULTS: The case fatality rate for COVID-19 in Honduras dropped below the lower control limit 9 days after implementation of an inpatient and outpatient multi-drug therapeutic protocol, from an average 9.33% case fatality rate to 5.01%. The Honduran COVID-19 case fatality rate again dropped below the lower control limit to 2.97%, 17 days after launching a substantial government program to make the protocol medications accessible to underserved areas. Shewhart control chart plots of case fatality rates in Honduras suggest a plausible temporal association between the implementation dates of both the initial protocol implementation on May 3, 2020, and the outreach effort on June 10, 2020, and statistically significant control chart anomalies. No control chart anomalies were seen during that time in Mexico. CONCLUSION: Decreases in COVID-19 case fatality rates in Honduras were associated with both the initial publication a multi-drug COVID-19 therapeutic protocol and a subsequent outreach program.

Implant infections after breast reconstruction surgery following mastectomy: Experience from a Greek breast unit

BACKGROUND: Despite the dominance of implant-based breast reconstruction after mastectomy, during recent years, it has been correlated to some complications. The aim of this study is to present the Greek experience about management of implant infections after breast reconstructions and to investigate the relationship between possible risk factors and breast pocket fluid cultures. METHODS: In total, 260 patients underwent implant-based breast reconstruction due to breast cancer in our center from 2016 until 2020. 46 patients, that underwent implant or expander replacement after breast reconstruction due to mastectomy were included in the present study. RESULTS: 260 patients underwent breast reconstruction in our center and in 46 (18%) of them an implant replacement was required. 21 patients (8%) presented clinically with an implant infection, but 12 of them (5%) had positive cultures from the breast pocket fluid. On the contrary, 25 patients (10%) presented no clinical signs of implant infection, but 5 of them (2%) had a positive culture. In addition, we demonstrated a correlation between implant infection and positive cultures (p = 0.009), along with an association between chemotherapy before implant placements and negative cultures (p = 0.035). Finally, the most common pathogen was Staphylococcus epidermidis (29%), followed by Escherichia coli (24%) and Staphylococcus aureus (18%). CONCLUSION: Implant infection still remains a very serious complication after breast reconstruction surgery. The establishment of a therapeutic protocol, with specific antimicrobial and surgical targets seems as an effective strategy against implant infections.

ADD ON EFFECT OF GR̥ ÑJANAKA PĒYA ALONG WITH A THERAPEUTIC DIETARY PROTOCOL IN RAKTĀRŚAḤ (BLEEDING PILE) – A NON-RANDOMIZED CONTROLLED TRIAL

A non-randomized controlled trial was carried out in 40 participants with intervention for 15 days and a follow up of 7 days. Clinical signs and symptoms of raktārśaḥ were assessed before and after the intervention and after fol- lowing up, by using the subjective parameters scale including, Frequency of bleeding, Nature of bleeding, Change in colour of the mucosa of pile mass, Character of defecation and Period of straining. Grñjanaka pēya along with a therapeutic protocol in raktārśaḥ has shown significant positive changes in subjective parameters like frequency of bleeding (p<0.01 level), nature of bleeding (p<0.01 level), changes in the mucosa, period of straining and char- acter of defecation after the 15 days of intervention in the study group. Keywords: Raktārśaḥ, Gr̥ ñjanaka pēya, Therapeutic dietary protocol, Subjective parameters

The ability of platelet-rich plasma to regenerate a non-vital immature permanent teeth

Objectives: To test the ability of platelet-rich plasma clinically and radiologically for pulp regeneration of immature teeth with apical periodontitis. Material and Methods: An experimental study was conducted From (March/2018-July/2020) 12 upper central immature incisors with acute apical periodontitis and necrotic pulp from six patients receiving regenerative endodontic treatment using concentrated platelets rich plasma were performed by the same endodontist at Mediclinic Middle East Hospitals. Informed consent, including explanation of risks and alternative treatments or no treatment were prepared and filled by the patient parents. The therapeutic protocol was involved accessing the pulp chamber; irrigation copiously with sodium hypochlorite; applying calcium hydroxide as intracanal medicament and a provisionally sealing it after 4 weeks. The canal was cleaned, dried and injected with concentrated platelets rich plasma which serve as a scaffold for pulp regeneration. MTA was used to seal the chamber before final filling with composite. Evaluations: All teeth were monitored clinically (mobility, palpation, percussion, and sensitivity cold test) and radiographically. Results: Twenty months follow-up all teeth showed resolution of periapical radiolucencies, continued root development with positive response to sensitivity cold test and no discoloration. Conclusion: The results of this study confirmed the previous finding that pulp regeneration can be gained by using cPRP successfully Keywords Immature teeth; Necrosis; cPRP; Regeneration.

Principais técnicas fisioterápicas em cães: Revisão de literatura

É crescente na medicina veterinária as técnicas e especialidades voltadas ao aprimoramento e prestação de serviços que objetivam o bem-estar animal e qualidade de vida. Nesse sentido, a reabilitação animal busca a recuperação e reestabelecimento das funções do animal, ou de forma que fique mais próxima das condições normais, seja promovendo analgesia, resolução da inflamação, a melhoria na locomoção, bem como a redução do desconforto. A fisioterapia, por sua vez, é uma especialidade que desenvolve várias técnicas, podendo ser utilizada para promover tanto a estimulação local como generalizada. Pode também ser empregada como método conservador ou, ainda, ser associada à métodos cirúrgicos. Apresentamos de maneira geral e sintetizada, conceitos, técnicas e a importância da reabilitação física animal, por meio de uma revisão bibliográfica, buscando realizar uma abordagem voltada às alterações ortopédicas, neurológicas e doenças degenerativas e/ou crônicas. Para isso, foi realizada uma revisão de literatura em bases de dados e livros, publicados entre 2000 a 2020, tanto em língua inglesa como portuguesa, com os seguintes descritores: cães, medicina veterinária, reabilitação, fisioterapia, fisiatria, controle da dor, ortopedia, medicina veterinária integrativa. A fisioterapia demonstra-se benéfica no tratamento e prevenção de patologias ortopédicas, neurológicas e também no controle da obesidade canina. Várias técnicas e equipamentos podem ser empregados, sendo o protocolo terapêutico individual, devendo sempre ser elaborado com base nas necessidades e limitações de cada paciente. Para isso, é imprescindível que o médico veterinário fisiatra tenha pleno conhecimento das técnicas de reabilitação. Palavras-chave: Reabilitação, ortopedia, atrofia, medicina integrativa Abstract It is growing in veterinary medicine the techniques and specialties focused on the improvement and provision of services that aim to promote the welfare and quality of life of the animal. In this sense, animal rehabilitation seeks the recovery and reestablishment of the animal's functions, or in a way that is closer to normal conditions, by either promoting pain relief, reducing inflammation, improving locomotion, as well as reducing discomfort. Physiotherapy, in turn, is a specialty that develops various techniques, and can be used to promote both local and generalized stimulation. It can also be used as a conservative method or, still, be associated with surgical treatment. We present, in a general and synthesized way, concepts, techniques, and the importance of animal physical rehabilitation, by means of a bibliographic review, trying to make an approach focused on orthopedic and neurological alterations, and degenerative and/or chronic diseases. For this, we conducted a literature review in databases and books, published between 2000 and 2020, both in English and Portuguese, with the following descriptors: dogs, veterinary medicine, rehabilitation, physiotherapy, physiatry, pain control, orthopedics, integrative veterinary medicine. Physiotherapy has proven beneficial in the treatment and prevention of orthopedic and neurological pathologies, and also in the control of canine obesity. Several techniques and equipment can be used, and the therapeutic protocol is individual, and should always be prepared based on the needs and limitations of each patient. For this, it is essential that the veterinary physiatrist has full knowledge of rehabilitation techniques. Keywords: Rehabilitation, orthopedics, atrophy, integrative medicine

Functional Evaluation of a “Lingual Ring” Oral Device Applied on Patients Affected by Temporo-Mandibular Disorders TMDs: A Comparative Clinical Trial

This study aims to evaluate the functional variations of the electromyographic response and clinical symptomatology in TMD patients. This study has been performed and compared before and after the application of a therapeutic protocol based on the use of an oral device working on the proper mandibular repositioning through the proprioceptive-based lingual re-education called “Lingual Ring”. Between January to December 2016, 32 TMD patients have been recruited out of a series of 321 individuals recruited at the Neurosensorial and Motorial Surgery Department, in Palermo (Italy). All the patients underwent the Surface Electromyography (sEMG) of Masseter and Temporal muscles, with different registrations at T0, T1, T2, and T3; to evaluate the variations of the Electromyographic values, it was assigned the application of the Lingual Ring as the only therapy. The study demonstrated a neat rebalancing of the EMG tracks and important improvements with the TMD related issues. The clinical responses, due to the treatment at the end of the therapeutic protocol, were: absence or reduction of muscular or articular pain; absence or reduction of articular noises; absence or reduction of the cephalalgia. Hence, significant results, both clinical and in terms of instrumental EMG, were assessed. We can affirm that the adopted methodology allowed the monitoring of the Electromyographic variation and clinical symptoms. Moreover, the usage of the “Lingual Ring device” allowed to carry out a simple and immediate therapeutic protocol that is minimally invasive, ensuring a clear rebalancing of the EMG tracks as well as the TMD related pain.