Hemorrhoidal Bleeding Research Articles

P-772. Whole Genome Analysis of Mycobacterium intracellulare isolates from Colonic Biopsy In Inflammatory Bowel Disease Patients

Abstract Background A long debate has prevailed over cause of Crohn's disease with published evidence for Mycobacterium paratuberculosis (MAP).Our study was designed to look for mycobacterial pathogens by culture and DNA PCR in patients with inflammatory bowel disease(IBD). Phylogenetic Analysis of M. intracellulare isolate genomes compared with reference M. intracellular strain ATCC 13950T Circular representation of four M. intracellulare isolate genomes compared with reference M. intracellular strain ATCC 13950T. Inner to outer four concentric rings show isolates from this study. The information is read from outer circle to inner as follows: genome size, genes on the forward strand, genes on the reverse strand, t-RNA, and r-RNA of reference strain.The percentage similarity is represented by different color codes. Zoomed portion represent absent genetic region in four isolates. Methods Colonic biopsy and Blood Buffy coat samples were processed for cultures and DNA detection for mycobacterial pathogens (including MAP) in 889 patients with inflammatory bowel disease; Crohn’s disease (CD)( clinical manifestations, endoscopic,radiological and histological features as per ECCO consensus guidelines), Intestinal tuberculosis,Controls (Adult patients with hemorrhoidal bleeding and no other colonic disease undergoing sigmoidoscopy). Results Four cultures from CD patients grew Mycobacterium intracellulare. Whole Genome Sequencing identified deletion regions in the studied isolates, with 156 protein-coding genes absent in all four isolates compared to the reference genome (M. intracellulare Strain ATCC 13950T). Antibiotic resistance and virulence factor analyses indicated resistance to rifampicin and isoniazid and an abundance of virulence factor genes in M. Intracellulare species. Pan and core gene analyses suggested a closed pan-genome in M.intracellulare, with limited distribution of antibiotic resistance genes. Conclusion M. Intracellulare is reported in immune-compromised patientsin several studies. The results of the core genome phylogenetic analysis suggest that factors beyond the isolation sources of M.intracellulare strains may contribute to shape their evolutionary trajectory. Functional analysis indicated a gradual decrease in metabolic capacity across clusters, suggesting an ongoing genome streamlining process in M. Intracellulare species. Essential gene prediction identified strain specific essential genes, emphasizing the importance of energy-related processes. Homologous recombination rate analysis suggested recombination in M. intracellulare strains, with specific parameters showing variation compared to other pathogenic species. This comprehensive study contributes valuable information about the genomic characteristics, evolution, and functional profiles of M. intracellulare strains. Disclosures All Authors: No reported disclosures

Hemorrhoidal disease: what role can rectal artery embolization play?

Hemorrhoidal artery embolization, also known as Emborrhoid, has emerged in recent years as a minimally invasive treatment option for patients with recurrent and unresponsive to medical therapies hemorrhoidal bleeding symptoms. We present here an overview of the profile of rectal artery embolization based on the most relevant and recent literature. A comprehensive review of literature on Hemorrhoidal artery embolization, was conducted on PubMed-Medline. The most relevant literature was summarized narratively. Current literature confirms the feasibility, efficacy and safety of rectal artery embolization for bleeding hemorrhoids. To date, the results of nearly 250 patients who have undergone hemorrhoid embolization have been published in several studies. All these authors have reported high immediate technical success, with also high clinical success, ranging from 63% to 94%, without major complications. Because of its beneficial safety profile, rectal artery embolization represents an attractive option for selected patients. In case of recurrence of bleeding it is possible to consider repeating the embolization procedure. Treatment failure may be due to the presence of anatomical variants such as dominant middle rectal arteries, which can be investigated and treated in the second session if necessary. Rectal artery embolization represents a valuable addition to the therapeutic armamentarium of bleeding hemorrhoidal disease, if patients are selected appropriately.

Modern Views on the Treatment of Hemorrhoid Disease Complicated by Post Hemorrhagic Anemia

Research purpose: to improve the surgical treatment results of patients with bleeding hemorrhoids complicated by posthemorrhagic anemia through the development of rational methods of surgical treatment. Patients and methods: A method of operation by first ligating blood vessels to the internal hemorrhoids without any instruments with simultaneous removal of external hemorrhoids has been developed. Research design: The study included 56 patients operated on for chronic bleeding hemorrhoids complicated with posthemorrhagic anemia from 2018 to 2022. All patients underwent a method to ligate blood vessels to internal hemorrhoids without any instruments along with simultaneous removal of external hemorrhoids. In the postoperative period in these patients, the pain syndrome was less pronounced, the patients behaved relatively actively, reflex urinary retention was not noted, postoperative bleeding and postoperative stricture of the anal canal were not observed, the patients were in the hospital for an average of 11.08 hospital days, and closed hemorrhoidectomy was 16.09 bed days. Findings: The operation is low-cost; there is no need for expensive high-tech equipment; it is effective for all stages of hemorrhoids; the surgical field is wide; visibility is unlimited; the operation is performed by all proctologists without special training. Low trauma; there is no open wound in the anal canal, i.e., “X”-shaped and interrupted sutures are applied for transanal hemorrhoidal ligation of blood vessels to internal hemorrhoids and mucopexy. Conclusion: short recovery period, low intensity of postoperative pain, absence of postoperative urinary retention, postoperative bleeding, and anal stricture.

Does hemorrhoidal artery embolization really benefit patients with hemorrhoids?

This letter offers commentary on an article published in a recent issue of the World Journal of Gastroenterology . Hemorrhoidal artery embolization is a promising approach to severe hemorrhoidal bleeding treatment, but inappropriate patient selection and the use of different embolization procedures may affect the clinical efficacy and cause serious complications. In this article, the most appropriate candidate patients, embolization materials, embolization methods, and clinical evaluation methods are discussed to improve the safety and effectiveness of the procedure.

Effectiveness of Thantrikai Chooranam in the Treatment of Raththa Moolam (Bleeding Hemorrhoids)

Hemorrhoidal disease, a prevalent benign anorectal disorder, has a substantial influence on patients' quality of life and entails significant health and financial strains. The focus of this study is to evaluate the therapeutic value of Siddha medicine, Thantrikai Choornam, in alleviating first-degree internal hemorrhoids (Raththa Moolam). Method: A descriptive case series was carried out at the Government Siddha Medical College & Hospital in Palayamkottai, involving 20 patients (80% male, mean age 45.94±2.60 years) reported having bleeding hemorrhoids. Participants were prescribed Thantrikai Choornam (2 g, twice daily) for 24 days. Clinical symptoms such as bleeding, discomfort, constipation, and other parameters were graded both before and after treatment. Results: Substantial improvements were observed following treatment, with 75% of patients observing an overall decrease in bleeding severity from grade 3 to 0, along with a resolution of anal pain. Constipation alleviated for 85% of individuals. The average hemoglobin level raised from 11.88 to 12.25 g/dL. The statistical analysis demonstrated noteworthy reductions in the majority of complaints (p < 0.05). Conclusion: This case series illustrates that Thantrikai Choornam delivers a beneficial intervention for first-degree hemorrhoids, with considerable improvements in primary symptoms. The outcomes offer a call to further investigations into Siddha medicines role in contemporary therapeutic practices for managing hemorrhoidal disease.

Efficacy of Mahatiktakam Ghrita as Avapeedak Snehapan in the management of Rakta Arsha (first-degree bleeding hemorrhoids): A study protocol for a single-arm, open-label clinical trial

Abstract BACKGROUND: Avapeedak Snehapan, the oral administration of medicated ghee, is used for symptomatic relief in first-degree bleeding hemorrhoids. A single-arm, open-label clinical trial was conducted to assess the safety and therapeutic potential of Mahatiktakam Ghrita for managing this condition. OBJECTIVE: This study evaluates the therapeutic effects of Mahatiktakam Ghrita as Avapeedaka Snehapana in managing first-degree bleeding hemorrhoids and reducing associated symptoms. MATERIALS AND METHODS: This single-arm, open-label clinical trial will enroll 61 participants, aged 30–50 years diagnosed with first-degree bleeding hemorrhoids, indicated for Snehapana therapy, as per selection criteria from the Outpatient Department of Chattrapati Shahu Maharaj Shikshan Sansthan’s Ayurved Mahavidyalaya, Aurangabad, Maharashtra, India. Participants will undergo a preparatory phase of Deepana–Pachana using Gandharvahastadi Kashaya, administered in a dose of 15 mL mixed with 45 mL of lukewarm water, taken twice daily on an empty stomach until optimal digestive capacity (Agni Deepti) is achieved. Once attained, a trial dose of 30 mL Mahatiktakam Ghrita will be administered in the morning, allowing for assessment of the time required for complete digestion. The optimal dose (Uttama Matra) will be calculated based on this trial dose to determine the amount of ghee digestible within 24 h. Snehapana therapy with Uttama Matra will then be administered on alternate days, ranging from three to seven doses, depending on symptomatic relief. Symptoms such as anal pain, bleeding frequency, appetite, and stool consistency will be monitored. The first follow-up will be performed after the completion of oleation therapy, and a second follow-up will take place after the completion of the dietary regimen (Samsarjana Krama), lasting 12–28 days based on the number of administered doses of Sneha. Primary outcomes include changes in the level of bleeding, pain appetite, stool consistency and secondary outcomes include complete blood count, bleeding time, clotting time, and erythrocyte sedimentation rate assessed at baseline, post-snehapana, and post-Samsarjana karma. DISCUSSION: This research explores the effectiveness of Mahatiktakam Ghrita as an accessible Ayurvedic treatment for first-degree bleeding hemorrhoids, assessing symptom relief and safety, and its effect on bleeding, pain, and hematological parameters. Findings may support integrating Ayurvedic therapies into broader hemorrhoid management strategies. The study is registered with the CTRI (CTRI/2023/07/054623; dated July 3, 2023).

Risk of Hemorrhoidal Bleeding in Patients Treated with Direct Oral Anticoagulants (DOACs)

(1) Background: Lower gastrointestinal bleeding (LGIB) accounts for 20% of all gastrointestinal bleeds. LGBI originates in the colon, rectum, and anus, mainly in patients who are receiving antiaggregant or anticoagulant treatment. The major causes are diverticular disease, colitis, hemorrhoids, and angiodysplasia. The literature studies underline that Direct Oral Anticoagulants (DOACs) are effective in reducing the risk of thromboembolic events but are associated with a higher risk of lower gastrointestinal bleeding (LGIB), particularly lower hemorrhoid bleeding. (2) Methods: The aim of our review is to revise the risk of hemorrhoid bleeding, pathophysiology, and management in patients taking DOACs in light of the most modern evidence. (3) Conclusions: central to the management of hemorrhoid bleeding in patients receiving DOAC therapy is the consideration of a tailored approach that respects the delicate equilibrium between the need for thromboembolic prophylaxis and the potential for bleeding complications. Cessation of anticoagulation, if clinically feasible, constitutes a fundamental cornerstone in the control of hemorrhage. This pause in therapy aims to mitigate the exacerbation of bleeding risk while offering a window for the implementation of local measures to manage hemorrhoid bleeding.

Transanal eco-Doppler evaluation after hemorrhoidal artery embolization.

Hemorrhoidal artery embolization (Emborrhoid) is a novel method for the treatment of severe hemorrhoidal bleeding. Despite having a technical success rate of 93%-100%, the clinical success ranges between 63% and 94%, with a rebleeding rate of 13.6%. To evaluate the effectiveness of this procedure in reducing hemorrhoidal flow and hemorrhoidal bleeding. This prospective observational pilot study was conducted at Division of General Surgery 1 and Tertiary Referral Pelvic Floor Center, Treviso Regional Hospital, Italy. In a 2 months period (February-March 2022), consecutive patients with hemorrhoidal bleeding scores (HBSs) ≥ 4, Goligher scores of II or III, failure of non-operative management, and a candidate for Emborrhoid were included. Endoanal ultrasound with eco-Doppler was performed preoperatively and 1 month after the procedure. The primary endpoint was to quantify the changes in arterial hemorrhoidal flow after treatment. The secondary endpoint was to evaluate the correlation between the flow changes and the HBS. Eleven patients underwent Emborrhoid. The overall pretreatment mean systolic peak (MSP) was 14.66 cm/s. The highest MSP values were found in the anterior left lateral (17.82 cm/s at 1 o'clock and 15.88 cm/s at 3 o'clock) and in the posterior right lateral (14.62 cm/s at 7 o'clock and 16.71 cm/s at 9 o'clock) quadrants of the anal canal. After treatment, the overall MSP values were significantly reduced (P = 0.008) although the correlation between MSP and HBS changes was weak (P = 0.570). A statistical difference was found between distal embolization compared with proximal embolization (P = 0.047). However, the coil landing zone was not related to symptoms improvement (P = 1.000). A significant difference in MSP changes was also reported between patients with type 1 and type 2 superior rectal artery (SRA) anatomy (P = 0.040). No relationship between hemorrhoidal grades (P = 1.000), SRA anatomy (P = 1.000) and treatment outcomes was found. The preliminary findings of this pilot study confirm that Emborrhoid was effective in reducing the arterial hemorrhoidal flow in hemorrhoidal disease. However, the correlation between the post-operative MSP and HBS changes was weak. Hemorrhoidal grade, SRA anatomy and type of embolization were not related to treatment outcomes.

In vitro Antimicrobial Activity, Antioxidant Activity and Synergistic/Antagonistic Effect of Arum maculatum L. in Mersin Province, Turkey

Arum maculatum is used for the treatment of colitis and internal bleeding haemorrhoids among the local people in Turkey. This study was designed to evaluate the antioxidant and antimicrobial activity and protective effects of the leaf and root methanol extract of Arum maculatum L. The phenolic compound content of the root and leaf extract was determined as 207.135±0.07 µg GAE g-1, and 386.054±0.7 µg GAE g extract-1, respectively. The total flavonoid amount was determined as 53.386±0.220 µg QE g-1 and 347.704±0.352 µg QE g-1 extract, respectively. DPPH free radical scavenging of leaf and root extracts was determined as 76.69% and 67.33%, respectively.. The metal chelating effect was determined as 46.585±0.025 mg EDTA/g extract and 35.610±0.087 mg EDTA g extract-1 for roots and leaves, respectively. All extracts were effective against all tested bacteria, and Staphylococcus mutans ATTC 10449 was the most sensitive bacterium with the lowest MIC value (0.20 mg mL-1, 0.81 mg mL-1) for leaf and root extracts, respectively. The biggest diameter of growth inhibition zone (8±2.44 mm, 9±3.26) compared to Chloramphenicol. Arum leaf extracts showed a synergistic effect with OFX against Escherichia coli and Staphylococcus mutans, and Arum root extracts have a synergistic effect with OFX against Staphylococcus aureus and Staphylococcus mutans. These results displayed that A. maculatum has notable natural bioactive compounds with antioxidant and antibacterial properties.

DIAGNOSIS AND MANAGEMENT OF HEMORRHOIDS : A SYSTEMATIC REVIEW

Background: Hemorrhoids are vascular tissues that naturally develop in the submucosa of the anal canal. They are composed of blood vessels with many arteriovenous connections, smooth muscle, and loose connective tissue, which explains why hemorrhoidal bleeding is usually brilliant red. Aims : This systematic review is to review the diagnosis and managements of hemorrhoids. Methods: This study demonstrated compliance with all requirements by means of a comparison with the standards established by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020. Thus, the specialists were able to guarantee that the research was as current as feasible. Publications released between 2014 and 2024 were considered for this search strategy. This was accomplished by utilizing a number of distinct online reference sites, including Pubmed, ScienceDirect, and SagePub. It was determined that reviews, previously published works, and partially completed works would not be included. Result: In the PubMed database, the results of our search brought up 7536 articles, whereas the results of our search on SAGEPUB brought up 4560 articles, our search on SCIENCE DIRECT brought up 5110 articles. The results of the search conducted for the last year of 2014 yielded a total 3250 articles for PubMed, 1369 articles for SAGEPUB and 1565 articles for SCIENCE DIRECT. In the end, we compiled a total of 8 papers, 5 of which came from PubMed, 1 of which came from SAGEPUB and 2 of which came from SCIENCE DIRECT. We included eight research that met the criteria. Conclusion: In summary, the illness hemorrhoids is prevalent yet complicated. Patients who have hemorrhoidal signs and symptoms should be closely examined to rule out other possible masquerade conditions. Hemorrhoids can be managed in a variety of ways, and the best course of action depends on the unique needs of each patient as well as clinical considerations.

RNA editing events and expression profiles of mitochondrial protein-coding genes in the endemic and endangered medicinal plant, Corydalis saxicola.

Corydalis saxicola, an endangered medicinal plant endemic to karst habitats, is widely used in Traditional Chinese Medicine to treat hepatitis, abdominal pain, bleeding hemorrhoids and other conditions. However, to date, the mitochondrial (mt) genome of C. saxicola has not been reported, which limits our understanding of the genetic and biological mechanisms of C. saxicola. Here, the mt genome of C. saxicola was assembled by combining the Nanopore and Illumina reads. The mt genome of C. saxicola is represented by a circular chromosome which is 587,939 bp in length, with an overall GC content of 46.50%. 40 unique protein-coding genes (PCGs), 22 tRNA genes and three rRNA genes were identified. Codon usage of the PCGs was investigated and 167 simple sequence repeats were identified. Twelve homologous fragments were identified between the mt and ct genomes of C. saxicola, accounting for 1.04% of the entire mt genome. Phylogenetic examination of the mt genomes of C. saxicola and 30 other taxa provided an understanding of their evolutionary relationships. We also predicted 779 RNA editing sites in 40 C. saxicola mt PCGs and successfully validated 506 (65%) of these using PCR amplification and Sanger sequencing. In addition, we transcriptionally profiled 24 core mt PCGs in C. saxicola roots treated with different concentrations of CaCl2, as well as in other organs. These investigations will be useful for effective utilization and molecular breeding, and will also provide a reference for further studies of the genus Corydalis.

No Place like Home: Home-Based Intravenous Arsenic Trioxide for the Treatment of Acute Promyelocytic Leukemia (APL)

Introduction: APL has transitioned from a highly fatal malignancy to a disease that is curable with a combination of all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO). Intravenous (IV) administration of ATO remains the standard of care for consolidation, however, its use is associated with long infusion times, electrolyte disturbances, and QTc prolongation that has historically required frequent outpatient infusion center administration and monitoring. Following induction, patients receive a cumbersome schedule of ATO through daily infusions 5 days each week (typically Monday-Friday) 4 weeks on 4 weeks off for 4 cycles. Oral formulations of ATO are poorly water soluble, have not demonstrated adequate absorption in the gastrointestinal (GI) tract leading to significant GI upset and are not approved for use in the United States. Beginning in 2020, patients treated at our institution were given the option of receiving ATO at home through a partnership via Qualitas Specialty Pharmacy of RWJBarnabas Health. This retrospective review evaluates the feasibility, safety, and efficacy of administration of ATO in the home infusion setting for patients with APL receiving ATO consolidation. Methods: Through retrospective chart review, we evaluated patients who received consolidation therapy of ATO through home infusion from 2020-2023. Eligible patients included those with an ECOG of <2, absence of baseline QTc prolongation (defined as >500ms), and patients without significant kidney dysfunction or hepatotoxicity at baseline. We evaluated each patient for adverse effects such as QTc prolongation, electrolyte disturbances, liver function test (LFT) abnormalities, neutropenic fever, bacteremia, unplanned Emergency Room (ER) or urgent care visits, and unexpected hospitalizations (via Common Terminology Criteria for Adverse Events version 5). Results: Fifteen patients aged 19-79 (median = 43) were reviewed with 60% being male and 40% female. Sixty percent had a baseline ECOG 1 and 40% had an ECOG 0. Twenty percent of patients had a prior malignancy (n=3). Eighty percent of the patients experienced grade (gd) 1-3 electrolyte abnormalities (47% gd 1 hyperphosphatemia, 13% gd 1 hyperkalemia, 7% gd 2 hyperkalemia, 7% gd 3 hyperkalemia, 13% gd 1 hypokalemia, 13% gd 1 hypermagnesemia, 7% gd 3 hypermagnesemia, 7% gd 1 hypomagnesemia, 33% gd 1 hypernatremia, 33% gd 1 hyponatremia, & 7% gd 2 hyponatremia). Of the 15 patients receiving treatment, 27% experienced gd 1 alanine aminotransferase (ALT) increase, 13% of patients experienced gd 1 aspartate aminotransferase (AST) increase, and 7% of patients experienced gd 2 hyperbilirubinemia. For QTc prolongation, 53% of patients experienced gd 1 prolongation, 7% of patients experienced gd 2 prolongation, and 13% of patients experienced gd 3 prolongation. One out of the 15 patients experienced treatment delays due to QTc prolongation. While forty percent of patients visited either the ER and/or urgent care during consolidation therapy, no visits were deemed therapy related. Reasons for urgent evaluation included infections (n=3), vertigo (n=1), low back pain (n=1), facial numbness (n=1), fall (n=1), abdominal pain (n=1), and hemorrhoidal bleeding (n=1). Two patients were hospitalized, due to a renal infarct (n=1) and a subdural hematoma after a fall (n=1). None of the 15 patients experienced febrile neutropenia/bacteremia while receiving consolidation therapy. Of the 11 patients who completed consolidation at the time of this abstraction, all (100%) had complete remission demonstrated on post-consolidation bone marrow. One of the 11 patients relapsed within 6 months of consolidation; however, is now in remission following two additional consolidation courses and a bone marrow transplant. Four patients have not yet completed four cycles of ATO consolidation. One patient was transitioned from home infusion to clinic treatment due to out-of-pocket cost. Conclusions: Our study demonstrates that home infusion of ATO is both safe and highly effective for patients. Therapy was well tolerated with predictable and manageable toxicity. Prospective studies are needed to evaluate the efficacy and safety in comparison to patients receiving ATO in the infusion center as well as to assess patient-reported and cost outcomes. Given the safety profile of home-based ATO, we have implemented at home ATO consolidation as standard therapy for all eligible patients.

Clinical Experience of a Smart Articulating Digital Device for Transanal Minimally Invasive Surgery.

The constrained access associated with transanal minimally invasive surgery has led surgeons to deploy robotic-assisted platforms to offset inherent maneuverability limitations and, perhaps, skills deficits. A handheld, powered 5-mm lightweighted laparoendoscopic electromechanical digital device (HandX, HumanXtensions, Israel) with hardware and software components that convert surgical hand movements precisely to the instrument's articulating tip and enable robotic transanal minimally invasive surgery with full tip roticulation for hook diathermy and suturing. After bench and biomedical model training, HandX was used in 3 transanal minimally invasive surgery procedures (2 male patients and 1 female patient, mean age 66.3 years). The rectal lesions averaged 30 mm in maximum dimension and were located posteriorly (n = 2) and laterally (n = 1) a mean of 3 cm from the anal verge. Standard transanal minimally invasive surgery setup and instrumentation (Gelport Path, Applied Medical with Airseal, and Conmed) were used, adding the HandX device for circumferential lesion marking and hemostatic full-thickness excision as well as defect suturing where appropriate. All procedures were completed without undue prolongation (operating times <1 hour) despite nuisance hemorrhoidal bleeding in 1 patient. All lesions were fully excised, with 2 being T1 cancers and 1 tubulovillous adenoma with high-grade dysplasia. All patients were discharged within 48 hours postoperatively (1 experienced secondary hemorrhage on postoperative day 5). HandX capably facilitated endoscopic robot-like instrument movement for transanal minimally invasive surgery without disrupting workflows. With time dedicated to instrument understanding and training, HandX increased dexterity with a small operating room footprint and may offer greater cost-effectiveness than other platforms.

Biochemical, Physicochemical, Preliminary Phytochemical Evaluation of Kadukkai Poo Choornam

Background: Kadukkai Poo Choornam is a poly herbal formulation in Siddha system of medicine mainly indicated for the management of bleeding hemorrhoids. According to Siddha system, medicine is a substance that helps to alleviate or eradicate the disease, gives strength to the body and normalizes the functions of the body. In Siddha system mainly the herbal formulations gained worldwide attention due to its long-term benefits in terms of overall wellness with lesser side effects. But there is striving for global acceptance due to lack of scientific validation and documentation. To overcome these limitations and ensure the quality, safety and therapeutic efficacy modern methods can be incorporated. Aim and Objective: The aim of this study is to evaluate the biochemical, phytochemical and physico chemical properties of kadukkai poo choornam. Methodology: The extraction of the drug was done by soxhelt method and phytochemical screening was done for the presence of alkaloids, glycosides, phenols, terpenoids carbohydrates, quinones, steroids, Saponins and proteins. Biochemical analysis was carried out to detect the presence of sulphate, chloride, carbonate, starch, ferrous iron, tannic acid, phosphate, zinc, reducing sugar and albumin. The Physicochemical analysis also carried out using standard procedures. Results: The phytochemical screening revealed the presence of alkaloids, glycosides, phenols, terpenoids, carbohydrates, tannins and quinones. The developed qualitative densitometric HPTLC fingerprint can be used as an identifying biological marker for the drug extracts. In biochemical analysis the presence of Sulphate, chloride, reducing sugar, tannins and unsaturated compound. Physicochemical analysis revealed the values of total ash, acid insoluble ash, water soluble ash, sulphated ash, pH, volatile oil, foaming index and swelling index. Conclusion: This study is an attempt to validate the therapeutic efficacy of kadukkai poo choornam for the management of hemorrhoids. And the above study can be used in further clinical studies and drug standardization. Keywords: Kadukkai poo choornam, biochemical analysis, physicochemical, phytochemical screening, Polyherbal formulation, hemorrhoids

Saraca asoca: From Traditional Herb to Modern Drug as a Cure for Various Diseases

Background: Saraca asoca (Ashoka, family; Caesalpiniaceae) is an indigenous sacred tree, native to India. It has been used in various traditional medicinal systems and is one such plant that is highly therapeutic but its use in disease management is underrated in today’s era and has lost its importance. Objective: This narrative review is written to provide the information on medicinal importance of S. asoca and the significance of S. asoca in various traditional medicinal systems. Methods: Different databases were searched to gather information. Research articles, abstracts, and reviews are included in this review. Results: Saraca asoca is known for its unique pharmacological role in treating various uterine complications, menstrual disorders, and bacterial infections, bleeding hemorrhoids, urinary and dermatological problems. The stem bark of the tree is the principal constituent for treating menorrhagia and genito-urinary disorders. The stem bark, leaves, and seeds of S. asoca are known to contain flavonoids, tannins, alkaloids, glycosides, polyphenolics, fatty acids, and saponins. The reported major phytoconstituents responsible for its therapeutic uses are epicatechin, procyanidin B2, lyoniside, nudiposide, catechin, leucocyanidin, and leucopelargonidin. Various pharmacological activities of this plant are discussed in this review. Conclusion: It has been proved that Saraca asoca possesses several pharmacological properties and is useful in treating various diseases. More studies on quality control, standardization, and clinical trials on S. asoca should be performed, so that this plant could be utilized as an effective anti-cancer drug which could be a promising source for the herbal and pharmaceutical industry.

COVID-19 in patients with congenital bleeding disorders in Russia

Background. Internationally published data about the course of COVID-19 in patients with congenital bleeding disorders (CBDs) are limited. There are questions about how COVID-19 affects the course of CBDs and, conversely, how CBDs affect the course of coronavirus infection.Aim — to analyze the course of COVID-19 in patients with CBDs in Russia.Materials and methods. A cross-sectional survey was conducted at the National Medical Research Center for Hematology (Moscow) for the period from June 25 to July 31, 2022. A cluster of 187 patients from different regions and cities of Russia were interviewed with a questionnaire based on survey administration software (Google forms) containing 27 questions.Results. COVID-19 affected 115 (62 %) of 187 surveyed patients and 22 (19 %) patients suffered from coronavirus infection twice. Hospitalization was required for 14 (12 %) patients with an average age of 42 years (10 patients with severe hemophilia A, 1 patient with moderate hemophilia B, 2 patients with von Willebrand disease and 1 patient with hypoproconvertinemia). During COVID-19 bleeding was observed in 9 (8 %) patients and was represented by hemarthrosis, ecchymosis, hematomas, nosebleeds, menorrhagia, hemorrhoidal bleeding, hemorrhage in the eyeball. There were no cases of thrombosis among 115 COVID-19 patients. Among patients with CBDs who had COVID-19, compared with patients who had not COVID-19, von Willebrand disease was statistically significantly more common (p = 0.04). Changes in the course of CBD after COVID-19 were noted by 21 (18 %) of 115 patients: 11 (10 %) of those who were ill noted increased joint pain, 9 (8 %) complained of joint pain that had not been previously experienced; 10 % of patients described changes of hemorrhagic syndrome.Conclusion. The probability of hospitalization of patients with CBDs and COVID-19 older than 40 is statistically significantly higher. Von Willebrand disease can be considered as a potential risk factor for COVID-19. Given the absence of cases of thrombosis in the interviewed group of patients, the results of the study suggest that the presence of hypocoagulation in patients with CBDs may be a protective pathophysiological mechanism that prevents the development of COVID-19-associated thrombotic complications.

Catheter-directed hemorrhoidal embolization for rectal bleeding due to hemorrhoids (Goligher grade I-III): prospective outcomes from a Spanish emborrhoid registry.

To evaluate the safety and efficacy of catheter-directed hemorrhoidal embolization (CDHE) by microcoil embolization for rectal bleeding due to hemorrhoids classified as Goligher grade I-III. Eighty patients (62.5% males) with a mean age of 48 ± 9 years were recruited prospectively. All patients had symptomatic bleeding hemorrhoids. All patients were classified according to Goligher classification: grade I (13.7%), grade II (71.1%), grade III (15%), and no grade IV were recruited in this study. In all cases, microcoils were used to embolize the superior rectal artery(SRA), and microspheres if recurrence of bleeding occurred. Follow-up evaluation (1, 3, 6, and 12 months) included clinical examination and anoscopy. A questionnaire was conducted to determine improvement regarding bleeding, quality of life before, and the degree of patient satisfaction of each participant. Technical success was achieved in 100% of the cases. Fifty-five (68.7%) participants had the absence of rectal bleeding after 12 months of embolization. VAS and QL improved 4 points and 1.5 respectively after embolization. A total of 25/80 (31.3%) had a recurrence in rectal bleeding. Seventeen (21.3%) patients underwent a second embolization, and four patients (5%) were treated with open hemorrhoidectomy. No major complications were observed. Sixteen participants had minor complications. Subjective post-treatment symptom and QL surveys showed significant differences from the baseline survey. Likewise, the degree of satisfaction in the telephone survey at 12 months revealed a high degree of patient satisfaction (8.3±1.1). The present study demonstrates that CDHE is a feasible, well-tolerated, ambulatory, anal sphincter-sparing procedure for the treatment of internal hemorrhoids. CDHE is a simple procedure, well tolerated and accepted by patients, that preserves the anal sphincter and presents few complications when metal devices or microspheres are used as embolic agents. • The technical success rate of CDHE, defined as the closure of all the SRA in their distal segment, was achieved 100% of all patients. However, a second embolization treatment was required since 21.25% of the patients experienced rectal bleeding. • Overall, CDHE's safety profile is acceptable. After the procedure and 1 year of follow-up, no significant complications were observed. • Encouraging clinical outcomes have demonstrated CDHE in individuals with hemorrhoids and mild prolapse Goligher grades I-III with persistent rectal bleeding.

Acute (profuse) hemorrhoidal bleeding

Objective. Hemorrhoids is one of the most common diseases in adult coloproctological practice, the main manifestation of which is bleeding of different degree of activity and complexity. The aim of the study was to analyze the results of diagnostics and treatment of patients with different stages of hemorrhoids for 3 years. Materials and methods. The results of diagnostics and treatment of patients with different stages of hemorrhoids treated in the coloproctological unit for 3 years (20192021) were analyzed. Results. The article considers the hemorrhoidal bleeding and the possibility of classification to optimize treatment; an algorithm used for rendering medical care to this group of patients is presented. The case histories of patients with hemorrhoids, treated at the First Republican Clinical Hospital of Udmurt Republic, were analyzed. Conclusions. Patients with profuse hemorrhoidal bleeding need hospitalization to the resuscitation unit, immediate identification and treatment of hemorrhagic shock. The offered protocol (algorithm) of managing patients permitted to work in a team, improve the quality of rendering medical care to patients with profuse hemorrhoidal bleeding and avoid lethal outcomes.

Pica sebagai Manifestasi Anemia Defisiensi Besi: Suatu Laporan Kasus

Prevalence of anemia in Indonesia based on Basic Health Research (2018) was 23.7%. Symptoms of iron deficiency anemia were pallor, malaise, palpitation, shortness of breath, headache, sore tongue. But sometimes can be found abnormal behavior in the form of PICA. This article reports on a-52-year-old man who sought medical treatment and was diagnosed with iron deficiency anemia with pica manifestation. The pica manifestation was characterized by a repeated desire to consume raw rice due to bleeding from hemorrhoids. Patient was given oral iron replacement therapy contain 100 mg of Fe (III) hydroxide polymaltose complex and folic acid 0.35 mg alternating with vitamin C 500 mg daily. Total iron daily dose given were 200 mg, divided in two doses. The patient received dietary education and was advised to consult a Gastroenterohepatology Subspecialist for the management of hemorrhoids, but it has not been done yet. The desire for raw rice consumption disappeared and the hemoglobin level increased to 12.4 g/dL after six weeks of therapy. The patient continued to take iron supplements until January 2023 but did not have follow-up visits to the clinic. In January 2023, the patient underwent hemorrhoid surgery due to bleeding accompanied by and a non-reducible lump that had been present for three days. Iron supplements continued for one month post-operation and then discontinued. The latest hemoglobin level was 15.3 g/dL without iron supplements. The symptoms of pica in this patient disappeared along with an increased hemoglobin level, and the management of severe anemia in this patient showed an adequate response. Bleeding has never occurred again after the surgery. Curative measures for hemorrhoidal bleeding are crucial, while iron supplementation is only a supportive therapy.

Abstract No. 40 Embolization of the Superior and Middle Rectal Arteries for the Treatment of Symptomatic Hemorrhoidal Disease using the Combination of Metallic Coils and Microspheres

To investigate the feasibility and initial results of superior and median rectal artery embolization for patients with symptomatic hemorrhoidal bleeding disease. Prospective, single-center cohort that included 10 consecutive patients who underwent superior (SRA) and middle rectal arteries (MRA) embolization with microspheres (1100 μm) and metallic coils, with a follow-up period of 6 months. Embolizations planning and guidance was performed using Embo_ASSIST software with virtual injection (GE Healthcare, IL). Inclusion criteria comprised: Symptomatic hemorrhoidal disease refractory to clinical treatment, and with Goligher classification II or III. Exclusion criteria were previous surgery for hemorrhoidal disease and Goligher classification IV. Technical success was defined as successful catheterization and embolization of the hemorrhoidal arteries using the EmboASSIST software. Hemorrhoid severity (HSS) and the quality of life (QoL) scores were used to evaluate the clinical outcomes. Procedure-related adverse event was defined according to the Society of interventional Radiology in minor or major complications. Ten patients (4 men, 6 women) underwent rectal arteries embolization for hemorrhoidal bleeding disease, with a mean age of 59 (± 13) years old. Goligher classification were level II in 70% and 3 in 30% of patients. Technical success was achieved in all patients. SRA were embolized in 100% and MRA in 80% (90% unilateral and bilateral in 10%). Mean time off work after hospital discharge was 1.4 (±0.7) days. Median procedures time was 102,5 (± 38) minutes. The HSS and QoL scores improved 91% and 85% respectively, without clinical recurrence at the 6 months follow-up (table 1). One patient (10%) had a rectal ischemia that required surgical treatment. Embolization of both superior and middle rectal arteries was feasible and improved symptoms and quality of life in patients with grade II-III hemorrhoidal disease. No clinical recurrence was observed during the first 6-month follow-up.