Secondary angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease: Results from the nationwide inpatient sample

BACKGROUND Chronic kidney disease is associated with angiodysplasia of gastrointestinal tract leading to increased risk of gastrointestinal bleeding.AIM To determine the nationwide prevalence,trends,predictors and resource utilization of angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease hospitalizations.METHODS The Nationwide Inpatient Sample database from 2009 to 2014,was utilized to conduct a retrospective study on patients with angiodysplasia associatedgastrointestinal bleeding and end-stage renal disease.Hospitalizations with endstage renal disease were included in the Nationwide Inpatient Sample database and a subset of hospitalizations with end-stage renal disease and angiodysplasiaassociated gastrointestinal bleeding were identified with International Classification of Diseases,9th revision,Clinical Modification codes for both endstage renal disease(585.6)and angiodysplasia(569.85,537.83).RESULTS The prevalence of angiodysplasia-associated gastrointestinal bleeding was 0.45%(n=24709)among all end-stage renal disease patients(n=5505252)that were hospitalized.Multivariate analysis indicated that the following were significant factors associated with higher odds of angiodysplasia associated-gastrointestinal bleeding in end-stage renal disease patients:an increasing trend from 2009-2014(P<0.01),increasing age(P<0.0001);African American race(P=0.0206);increasing Charlson-Deyo Comorbidity Index(P<0.01);hypertension(P<0.0001);and tobacco use(P<0.0001).Diabetes mellitus(P<0.0001)was associated with lower odds of angiodysplasia associated-gastrointestinal bleeding in end-stage renal disease patients.In comparison with urban teaching hospitals,rural and urban nonteaching hospitals were associated with decreased odds of angiodysplasia associated-gastrointestinal hemorrhage.CONCLUSION Angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease patients showed an increasing trend from 2009-2014.Advanced age,African American race,overall high comorbidities,hypertension and smoking were significant factors for angiodysplasia-associated gastrointestinal bleeding in bleeding in these patients.

Racial disparity in colorectal cancer: Gut microbiome and cancer stem cells

Over the past two decades there has been remarkable progress in cancer diagnosis, treatment and screening. The basic mechanisms leading to pathogenesis of various types of cancers are also understood better and some patients, if diagnosed at a particular stage go on to lead a normal pre-diagnosis life. Despite these achievements, racial disparity in some cancers remains a mystery. The higher incidence, aggressiveness and mortality of breast, prostate and colorectal cancers(CRCs) in AfricanAmericans as compared to Caucasian-Americans are now well documented. The polyp-carcinoma sequence in CRC and easy access to colonic epithelia or colonic epithelial cells through colonoscopy/colonic effluent provides the opportunity to study colonic stem cells early in course of natural history of the disease. With the advent of metagenomic sequencing, uncultivable organisms can now be identified in stool and their numbers correlated with the effects on colonic epithelia. It would be expected that these techniques would revolutionize our understanding of the racial disparity in CRC and pave a way for the same in other cancers as well. Unfortunately, this has not happened. Our understanding of the underlying factors responsible in African-Americans for higher incidence and mortality from colorectal carcinoma remains minimal. In this review, we aim to summarize the available data on role of microbiome and cancer stem cells in racial disparity in CRC. This will provide a platform for further research on this topic.

Protection of Viola odorata L.against Neurodegenerative Diseases:Potential of the Extract and Major Phytoconstituents

Background:Neurodegenerative diseases cause cognitive impairment owing to neuronal death and deterioration.Only a few brain-protecting chemical investigations yielded neuroprotective medications.Viola odoata L.is a traditional medicinal herb that has lately been shown to have strong pharmacological effectiveness against major neurological illnesses with fewer adverse effects.Objective:The objective of the current review is to provide a thorough overview of the key biologically active components and extract of Viola odorata L.in their capacity to safeguard nerve cells.Methods:Science Direct,PubMed,Springer Nature,and Google Scholar were scoured for relevant articles using the terms“Viola odorata L.”,and in the heading and abstract or main text,“neuroprotective activity”,“neurode-generative disease”,“pharmacological potential”,and“therapeutic activity”along with“extract”or“phytocon-stituents”.Neuroprotective activity of Viola odorata L.extract or phytoconstituents were used to classify and investigate the articles that passed the screening process.Results:A total of one hundred twenty one papers were reviewed based on the collected data.The following topics have been elaborated upon in the text:pathological factors of neurodegenerative diseases;role of medic-inal plants in neurodegenerative diseases;Viola odorata L.taxonomy,pharmacological activities,toxicity and adverse effect;neuroprotective activity of extract and various active components of Viola odorata L.The primary phytocomponents of Viola odorata L.were discovered to be anthocyanins,flavonoids,melatonin,salicylic acid,cumarins and various alkaloids,which are primarily responsible for its neuroprotective action.These natural plant compounds can boost antioxidant levels,reduce harmful oxidants,alleviate nerve pain,decrease the pro-duction of pro-inflammatory cytokines such as IL-6,IL-1β,and TNF-α𝛼,lower the total amount of nitrite produced,and trigger various neuroprotective mechanisms in the nervous system.It has been also concluded in several in-vestigations that Viola odorata L.extract and some of its major molecular components can protect against toxic affronts,either directly through neuroprotective mechanisms or indirectly through antioxidant properties.Conclusion:Despite the need for further research,the presence of bioactive components in Viola odarata L.that hold the potential to become effective neuroprotective therapeutic agents shows its potential use in treating neurodegenerative diseases characterized by neuro-inflammation and neurotransmitter deficiency.