Ginger ( Zingiber officinale ) is a plant originated mainly from Southeast Asia. It is now considered as one of the most- healthiest and most delicious spices on all over the globe [1]. The rhizome is an underground part of the stem known as ginger root or simply called ginger. Ginger can be used in a variety of ways like as dried powder, oil, juice and can also be use freshly and it is one of the most common agents for the preparation of spicy foods. Ginger has a number of bioactive phenolic compounds such as gingerols, gingerenone A, zingerone, shogaols, paradols, quercetin, 6-dehydrogingerdione and so on [2]. Besides these, ginger also has several terpene compounds such as β-bisabolene, α-curcumene, zingiberene, α-farnesene, and β-sesquiphellandrene. Not only have these, it also contains polysaccharides, lipids, organic acids, and raw fibers [2]. All these active compounds make ginger as a powerful antioxidant and anti-inflammatory agent [1,2]. Recently, Joe Leech has reviewed several health benefits of ginger and its most active polyphenolic fraction gingerol as it showed commanding potentials against several human disorders [3]. Numerous studies showed that gingerol reduces the risk of both bacterial and viral infections [4,5]. Specifically, it was found to be highly effective against the oral bacteria associated with the gingivitis and periodontitis [4] and effective against the respiratory syncytial viral infection [5]. For these reasons, ginger has been regularly used for the improvement of digestion, reduction of nausea, and also to aid in fighting against the flu and common cold [1-5]. Although at this moment, the World Health Organization (WHO) said that ginger can have a “positive impact on your health but it has no means of a medically proven treatment against coronavirus disease (COVID)-19” although further investigations are still needed to be confirmed. [6].              Osteoarthritis (OA) is the most common disease of joints, afflicting millions of people all over the globe but still none of the compound(s) discovered that inhibit the progressive degradation of the joints. In recent years, I with colleagues investigated some novel therapeutic targets at molecular levels [7-9], which might be useful for drug designers for osteoarthritis patients. In addition, my colleagues and I also have successfully tested the therapeutic potential of several natural dietary products on the OA knee cells as anti-osteoarthritic agents against the joints degradation [10-12]. Similarly, studies on ginger testing for OA patients showed that ginger and its active constituents have modestly efficacious and reasonably safe for treatment of patients with joints disorders [13-15], but still further studies are needed on larger group of OA patients to warrant their efficacy as a useful treatment for joint pain and disability. Not only for OA patients, ginger and its active constituents have also been successfully tested as important therapeutic agents for the treatment of cancer patients. Numerous cellular-based studies showed that ginger and its active ingredients particularly gingerol perform anti-cancer activities by modulating the expression of cancer associated genes and their associated cell signaling pathways such as inhibition of transforming growth factor (TGF)-β, interferon (IFN)-γ, tumor necrosis factor (TNF)-α, cyclooxygenase (COX)-2, B-cell lymphoma (Bcl)2, survivin, Vascular endothelial growth factor (VEGF), genes and suppression of nuclear transcription factor (NF)-κB, signal transducer and activator of transcription (STAT)3, Akt activities, etc. in different cancer cell types [16-19]. Furthermore, the consumption of ginger has also been well known as anti-diabetic agent as several studies on humans and animals showed that it reduces the blood glucose levels and hemoglobin A1c (HbA1c) [20-23]. Not only have these, it also reduces the chances for the onset of heart associated disorders as it significantly decreases apolipoprotein B/apolipoprotein A-I ratio and also decreases the levels of oxidative–by-product malondialdehyde (MDA) [23,24]. Moreover, ginger has also potential to reduce body weight and now is also known as weight-reducing agents [25-27]. Recently, Maharlouei et al. performed meta-analysis for analyzing the potential of ginger on overweight and obese individuals and concluded that intake of ginger not only reduces bogy weight, waist-to-hip ratio, hip ratio but also reduces glucose levels and increases HDL-cholesterol levels [25]. Another recent study performed by Sayed et al. demonstrated in obese animal model concluded that intake of ginger water reduces, not only body weight but also improves expenditure of energy [26]. These data have also been supported by Ebrahimzadeh et al. systematic review performed on 27 research articles, out of them 17 were performed on animal models, 6 were cellular-based studies and whereas 4 were directly performed on humans [27]. Most of the animal and cellular based studies supported the ginger intake reduces the body weight but the findings from the clinical trials showed non-significant changes of anthropometric measurements and body composition in obese humans [27]. Therefore, further studies on humans on a large scale are recommended to prove the potential of ginger as a weight reducing agent. Intake of ginger is also beneficial for patients with chronic dyspepsia as it induces stomach gastric emptying and antral contractions [28]. Importantly, intake of ginger is also very effective for females having menstrual pain if they have started taking it at the start of their menstrual period [29]. Most importantly, it is also suggested that intake of ginger by menstrual females is equally or even more effective as general painkillers such as Novafen, mefenamic acid [30,31]. Furthermore, consumption of ginger also found to be effective in improving the brain functions and declining the neural ageing process [32,33]. Numerous animal and cellular based studies concluded that active ingredients of ginger perform anti-inflammatory activities in the brain which directly or indirectly protect age-associated decline of brain functions [32-35].  In short, the ongoing mode of treatment for disorders like osteoarthritis, cardiovascular, cancer, diabetes, etc. are based on the synthetic drugs such as non-steroidal anti-inflammatory drugs, anti-diabetic synthetic drugs, chemo/radio-therapeutic agents, etc . are somewhat effective but causes adverse side effects and are expensive too. Therefore a safe, effective and inexpensive mode of treatment is always needed to control the onset/progression of diseases. Ginger and its constituents have potential to inhibit number of potent disease associated genes TGF-β, COX2, TNF-α, INF-γ, BCl 2 , NF-κB, STAT-3, Akt, and so on. Therefore, ginger and its active constituent are recommended as novel therapeutic agents, but further confirmatory studies are still required, particularly at the level of human clinical trials.  

Objectives: The disruption of the reciprocal regulation between vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF) has been associated with the pathogenesis of diabetic retinopathy (DR). This study assessed the levels of VEGF, PEDF, indices of glycemia, and lipid profile in diabetic patients with retinopathy. Methods: One hundred fifty participants comprised 50 type 2 diabetic patients with DR, 50 without DR and 50 non-diabetic normotensive controls, aged 30–80 years, were randomly recruited for this case-control study. The study was carried out from November 2017 to December 2018. VEGF, PEDF, glycated hemoglobin (HbA1c), fasting plasma glucose, and lipid profile were determined using standard methods. Blood pressures (BP) and anthropometric indices were measured. Chi-squared test of independence, analysis of variance, and Pearson’s correlation were used to analyze data. Statistical significance was set at P < 0.05 and 95% confidence interval. Results: Both diabetic groups had significantly higher (P = 0.001) systolic and diastolic BP, VEGF, PEDF, HbA1c, fasting plasma glucose, triglycerides, total, high-density lipoprotein-cholesterol (HDL-C), and low-density lipoprotein-cholesterol (LDL-C) levels and significantly lower (P = 0.005) VEGF/PEDF than the controls. However, the diabetics with retinopathy had significantly higher (P = 0.001) HDL-C, LDL-C, VEGF, and PEDF levels compared to the diabetics without retinopathy. There were no significant differences (P > 0.05) in the levels of VEGF, PEDF, and VEGF/PEDF in both groups of diabetics that had good glycemic control and poor glycemic control. There was also no significant difference (P > 0.05) in the levels of VEGF and PEDF between the dyslipidemic and non-dyslipidemic subjects in both diabetic groups. Conclusion: DR is associated with higher levels of VEGF and PEDF while good glycemic control and dyslipidemia seem not to have a profound effect on VEGF and PEDF levels in diabetics with or without DR. Higher PEDF levels are associated with higher atherogenic risk in the diabetics with retinopathy.

Objective: This study aimed to correlate possible predisposing and protective factors involved with autoimmune diseases (ADs) in a Brazilian microregion. Methods: This case-control study recorded 362 cases of ADs prevalent in the Águas Formosas microregion, state of Minas Gerais, Brazil, between January and December 2016, through the application of a questionnaire. Overall, 724 controls were randomly selected according to gender and age. Logistic regression was used to calculate the adjusted odds ratio (OR), confidence interval, and P-value to compare the strength of association between the variables of interest assessed. Results: Individuals with Graves’ disease (OR: 11.9977), followed by rheumatoid arthritis (RA), psoriasis, lupus, Hashimoto’s thyroiditis (HT), and vitiligo, were strongly associated with the risk of developing the disease after the hepatitis B vaccine. Having consumed cow milk before 6 months of life was a factor associated only with psoriasis (OR: 0.3321) and RA (OR: 0.2880). Type 1 diabetes patients were associated only with surgical procedures (OR: 0.1160), just as physical and psychological traumas were associated only with vitiligo (OR: 5.9848). Contact with chemicals was more related to vitiligo (OR: 0.7142), RA, psoriasis, lupus, and thyroiditis. Physical exercise was the most significant protective factor for vitiligo (OR: 0.4904), followed by HT, RA, psoriasis, and lupus; and the consumption of filtered water with candles was a protective factor for vitiligo (OR: 0.3325). Conclusion: The associations suggest that predisposing and protective factors for ADs play a pivotal role in their onset, enabling health management, control, and intervention of this population.

Objectives: Heart rate variability (HRV) has been shown to represents a promising quantitative marker of autonomic activity. Studies have shown that diabetic patients and animal models have derangements in certain biochemical parameters with reduced cardiac nerve density following development of diabetic cardiac autonomic neuropathy (DCAN). This study, therefore, aims to correlate HRV indices, cardiac histology, and cardiac nerve density with selected biochemical markers in the DCAN rat model using high fat diet (HFD) and streptozotocin (STZ) induction. Methods: DCAN was induced in Wistar rats using HFD for 8 weeks with 25 mg/kg STZ daily for 5 days. DCAN features were then assessed using Holter electrocardiography (ECG), invasive biomarkers, and cardiac histology. Results: DCAN group had significantly higher advanced glycated end product levels (P < 0.0001), noradrenaline (P = 0.010), and insulin resistance (P = 0.016) compared with controls. The level of antioxidants, sorbitol dehydrogenase activity (P = 0.009), nerve growth factors (P < 0.0001), and choline acetyl-transferase (P = 0.031) was, however, significantly reduced. Furthermore, HRV indices which were also reduced with DCAN induction correlated significantly with levels of biomarkers and cardiac nerve density. Conclusion: HRV is a cheap and easy tool for assessing DCAN that significantly correlates with markers of autonomic activity. Holter ECG and HRV evaluation should be considered early in patients with diabetes.

Objective: Doxorubicin-mediated chemotherapy has been linked in cancer patients with acute toxic manifestations. This study aimed to assess the protective effect of natural honey against doxorubicin-induced toxicity in mice. Methods: Forty male BALB/C mice were divided randomly and equally into four groups of ten mice. Group I was on a normal diet and served as the control. Group II received only honey to investigate its antitoxic effects (oral administration at 10 g/kg for 10 days). Group III was injected with a single dose of doxorubicin (10 mg/kg i.p.). Group IV received both doxorubicin and honey. On day 11, blood was taken from the various groups of mice and the quantitative and qualitative changes were observed in the white blood cells. The levels of hepatic, renal, and cardiac toxicity biomarkers including aspartate aminotransaminase (AST), alanine minotransaminase (ALT), blood nitrogen urea (BUN), serum creatinine, lactate dehydrogenase (LDH), and creatinine kinase (CK) were also assessed. Results: This study revealed that doxorubicin caused acute toxicity, including weight loss, depletion of white blood cells, and altered liver, kidney, and cardiac parameters (P < 0.05). White blood cells in the blood picture from the doxorubicin-injected mice exhibited toxicological changes, including abnormal morphology, disorganized nuclei, dispersed chromatin strands, and granules. The consumption of honey improved the liver, kidney, and heart biomarkers of toxicity in doxorubicin-injected mice (P < 0.05). Honey reduced the levels of ALT, AST, BUN, serum creatinine, LDH, and CK in doxorubicin-injected mice (P < 0.05). Conclusion: The findings suggest that the consumption of natural honey can alleviate doxorubicin-induced toxicity in cancer patients.

Objective: Synovial sarcoma (SS) is one of the most frequent malignant soft-tissue tumors, and nearly 65% arise in the lower extremities. Survival prediction and the risk factors of the patients are poorly understood. Thus, this study examined the survival and prognostic variables of metastatic limb SS (LSS). Methods: Clinical data of LSS patients with metastasis at the presentation from 1975 to 2017 were obtained from the Surveillance, Epidemiology, and End Results database program database. Kaplan–Meier method was used to describe the survival curves. Univariate and multivariate Cox regression analysis were conducted to reveal the real prognostic predictors. Results: Male predominance was observed in the metastatic LSS group from a total number of 217 patients. This population was composed of 49.8% not other specified subtype, 32.7% spindle cell subtype, 17.1% biphasic subtype, and 0.5% epithelioid cell subtype. The 3-year overall survival (OS) and cancer-specific survival (CSS) rates of the entire group were 27.2% and 28.3%, respectively. Tumor size <10 cm, surgery, radiotherapy, and chemotherapy were calculated as independent predictors of improved OS and CSS by multivariate analyses. Conclusion: SS is still a disease with a poor prognosis. This can increase the survival rate and time by the well-planned treatment.  

Objectives: Acute kidney injury (AKI) is a major cause of morbidity and mortality. Whether aminophylline administration can prevent or treat AKI among pediatric patients are not clear. This meta-analysis aimed to assess the efficacy and effectiveness of aminophylline for pediatric AKI. Methods: We carried out a systematic search of six databases: PubMed, EMBASE/Excerpta Medica, Scopus, Cochrane library, and Google Scholar from January 1995 up till May 2019. Summary measures of risk ratios and standard mean difference were calculated using the random effects model. Results: We identified seven papers containing data on aminophylline use in children with AKI. Meta-analysis of single-arm studies indicated no statistically significant difference in mean rate of serum creatinine clearance (−0.39 [−0.80–1.58], P = 0.52), mean urine output (1.99 [−1.43–5.42]; P = 0.25), or mean blood urea nitrogen levels (0.83 [−1.86–3.03], P = 0.54) before and after aminophylline administration. However, among double-arm studies, aminophylline administration in the intervention arm significantly reduced the serum creatinine level as compared to control arm (mean diff = −34 [−55.18–−12.83]; P = 0.002). Mean urine output (−112.68 [−27.43–48.9], P = 0.17), incidence of AKI (RR = 1.05 [0.80–1.37], P = 0.72), and mortality rates (RR = 0.79 [0.42–1.47], P = 0.45) were found to be statistically insignificant. Conclusions: Aminophylline administration in children with AKI reduces serum creatinine level without significant adverse effects or effect on the incidence of AKI, urine output, or mortality. Further, large-scale well-planned randomized controlled trials are needed to evaluate its use and its potential long-term effects.

Objectives: The study aimed to review the literature on the use of ultraviolet-C (UV-C) sterilization to assess its clinical efficacy in reducing risk and transmission of nosocomial infections as well as its associated health safety or hazards. Methods: Four main search engines were used to identify potential studies which included: (1) Google Scholar, (2) ScienceDirect, (3) PubMed, and (4) Cochrane. Studies in English and published from 2010 to 2020 were considered. Studies on efficacy were limited to those in unseeded hospital environments, examining environmental disinfection, and with true experimental, randomized controlled trial, or quasiexperimental study designs. No additional criterion was used for safety studies due to the scarcity of literature. In the end, a total of 17 studies were selected. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Risk of bias assessment and manual data extraction and tabulation were done. Results: Twelve eligible efficacy studies were identified together with five safety studies. It was found that UV-C irradiation had positive results when used as an adjunct for existing cleaning protocols. The germicidal effect of UV-C is potent against microorganisms including viruses, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci. Safety study results showed dermal effects of UV-C exposure including DNA lesions, formation of cyclobutane pyrimidine dimers in cells, and effects on the skin’s stratum corneum. Conclusion: It was found that UV-C can be utilized as an adjunct to terminal manual cleaning because of its efficacy as a germicidal agent. Further studies must still be done to exact a standard for safe exposure dose, especially for 222 nm germicidal lamps. Direct evidence is needed for any targeted implementation of UV-C during Coronavirus Disease 2019 (COVID-19) pandemic.

Acute esophageal necrosis (AEN) is a rare and often fatal pathology of unclear etiology affecting the distal two-thirds of the esophagus. Typically, elderly patients with multiple comorbidities present with signs of upper gastrointestinal (GI) hemorrhage. On endoscopy, the mucosa is black due to ischemic necrosis, resulting in the commonly used term “black esophagus.” We present a rare case of a 61-year-old male presenting with shortness of breath and hematemesis diagnosed as AEN through endoscopy. This case illustrates the importance of considering AEN as part of differential diagnoses in a rising elderly population with multiple comorbidities that present with upper GI hemorrhage. Treatment should be aimed at maintaining hemodynamic stability with high-dose proton pump inhibitors.