Isolation and quantification of a 17-epi-dammarane triterpenoid rhuslactone from roots of Rhus chinensis and its preventive effects on coronary heart disease and thrombosis in zebrafish / 中国中药杂志

Based on mass spectrometry(MS)-guided separation strategy, compound 1 was obtained from the roots of Rhus chinensis. By comprehensive analysis of high resolution-electrospray ionization-mass spectrometry(HR-ESI-MS), nuclear magnetic resonance(NMR) data, and quantum chemical calculation of NMR(qcc-NMR) parameters, compound 1 was elucidated as rhuslactone, a 17-epi-dammarane triterpenoid with a rare 17α-side chain. An HPLC-ELSD method for its quantification in R. chinensis was established and adopted for the quantification of rhuslactone in different batches of R. chinensis. Rhuslactone displayed a good linear relationship within the range of 0.021 3-1.07 μmol·mL~(-1 )(r=0.997 6), and the average recovery was 99.34% [relative standard deviation(RSD) 2.9%). Moreover, the results of the evaluation test of the preventive effects of rhusalctone on coronary heart disease(CHD) and thrombosis showed that rhuslactone(0.11 nmol·mL~(-1)) significantly alleviated heart enlargement and venous congestion and increased cardiac output(CO), blood flow velocity(BFV), and heart rate, thereby reducing thrombus formation in zebrafish with CHD. The effects of rhuslactone on CO and BFV were superior to that of digoxin(1.02 nmol·mL~(-1)), and its effect on improving heart rate was comparable to that of digoxin. This study provides experimental references for the isolation, identification, quality control, and application of rhuslactone from R. chinensis against CHD. It is worth mentioning that this study has discussed some omissions in the determination of the stereochemistry of C-17 in dammarane triterpenoids in the present coursebook Chemistry of Chinese Medicine and some research papers, that is, the compound may be 17-epi-dammarane triterpenoid. This paper has also proposed steps for the establishment of C-17 stereochemistry.

Green Synthesized Silver Nanostructure Using Rhus coriaria Fruit Extract Inhibits the Growth of Malignant MCF-7 Cell Line

Abstract Rhus coriaria, popularly known as sumac, has been used as a spice powder in the Middle East for centuries. It contains a broad range of naturally occurring compounds such as flavonoids, proteins, anthocyanins and volatile oils. It showed a putative importance in treatment of different disorders including cancers. In the current study, R. coriaria fruit extract was used for green synthesis of silver nanostructures (Ag-NSs) and their anticancer activity was tested against human breast cancer cells (MCF-7). The aqueous fruit extract was prepared. The synthesis of Ag-NSs under different conditions was optimized. The optimal reaction medium comprised 1:2 concentration of fruit extract and 3 mM concentration of silver nitrate solution. The green-synthesized Ag-NSs were confirmed by using UV-Visible spectroscopy at a range 300-700 nm, transmission electron microscopy (TEM), X-ray diffraction (XRD) and zeta potential measurements. The anti-proliferative activity of Ag-NSs was confirmed with inhibitory activity on MCF-7 cell line growth. The results showed that the IC50 values at 24 and 48h were 14.27 and 13.4 μg/ml, respectively. In conclusion the results of this study provide a simple, rapid, non-toxic and eco-friendly protocol for green-synthesis of Ag-NSs, which could be used as an alternative and interesting approach for safe and simple synthesis of Ag nanoparticles for biomedical uses.

Effect of total phenolic part of Rhus chinensis against myocardial ischemia in mice / 中国中药杂志

Rhus chinensis is an important resource plant. The aqueous extract of R. chinensis roots or stems was to produce Shuguantong Syrup, which is mainly used for the treatment of coronary heart disease and angina pectoris with definite curative effect. On this basis, the crude phenolic part of R. chinensis prepared by macroporous resin was evaluated for the cardio protective effect against myocardial ischemia in mice. The results showed that the phenolic part group with oral administration at the dosages of 190.8-381.6 mg·kg~(-1), compared with the model group, reduced the values of left ventricular end systolic diameter(LVEDs) and the left ventricular end diastolic diameter(LVEDd), and increased the cardiac ejection fraction(EF) and left ventricular fractional shortening(FS) rate, which could effectively improve cardiac function and exert its anti-myocardial ischemia effect, and reduce the rising levels of creatine kinase isoenzyme(CK-MB) and lactate dehydrogenase(LDH) in serum. HE staining showed that the phenolic part group reduced the infiltration of myocardial inflammatory cells and alleviated the degree of myocardial fibrosis and collagen deposition. TUNEL staining showed that the blue-green fluorescence of the phenolic part group decreased successively, and the degree of myocardial cell apoptosis was reduced. Immunohistochemical staining suggested that it could reduce the number of positive cells for p53 protein expression and significantly improve myocardial cell damage. All above data suggested that the phenolic part group had an anti-mycardial ischemis effect. Related mechanism studies revealed that the crude phenolic part could regulate the expressions of the p53 gene(p53), Bcl-2-associated X protein(Bax), B lymphoma-2 gene(Bcl-2), and caspase-3 protein(caspase-3) in myocardial tissue, suggesting that it could reduce cardiac remodeling and myocardial ischemic damage, and improve cardiac function by inhibiting myocardial apoptosis.This research laid a foundation for the elucidation of the pharmacological ingredients R. chinensis.

Analysis of the chloroplast genome characteristics of Rhus chinensis by de novo sequencing / 生物工程学报

Rhus chinensis is an important economic species, which could provide raw materials for pharmaceutical and industrial dyes. Rhus chinensis is famous for its resistance to drought, cold, and salt. It grows in temperate, warm temperate, and subtropical regions. We report here Rhus chinensis chloroplast genomes by de novo sequencing. The results show that the length of Rhus chinensis was 159 082 bp, exhibiting a typical four-part structure with two single-copy regions (long single copy [LSC] and short single copy [SSC] sections) separated by a pair of inverted repeats (IRs). The length of LSC and SSC was 85 394 bp and 18 663 bp, respectively. The genomes contained 126 genes, including 88 protein encoding genes, 8 rRNA and 30 tRNA genes. In the chloroplast genome, 61.97% of the sequence were gene coding region. In the sequence of gene encoding region, the vast majority of sequences were protein encoding region, accounting for 86.65%, followed by rRNA (10 620 bp, 10.77%) and tRNA (2 540 bp, 2.58%). In Rhus chinensis chloroplast genome, only 8 genes contain introns, all containing 1 intron except ycf3 gene (2 introns). The Rhus chinensis chloroplast genome contains 755 SSR locies. SSR mainly consists of dinucleotide and mononucleotide, accounting for 60% (453) and 28.74% (217) respectively. The clustering results show that Anacardiaceae were closest to Rhus chinensis, followed by Aceraceae and Sapindaceae. This study provides a molecular basis for the classification of Rhus chinensis.

Effect of Rhustox on Micropropagation of Scoparia dulcis L. through Leaf Explants Culture

Aim: To investigate the effect of Rhus toxicodendron (30CH) along with different compositions of phytohormones (Auxin and Cytokinin) on the basis of growth and multiplication of explants under optimum temperature under in-vitro conditions. Study Design: To establish and design the standard protocol for the in-vitro propagation through leaf explant of Scoparia dulcis under stress of phytohormones and homeopathic medicine Rhus toxicodendron (30CH). Place and Duration of Study: The plant materials were procured from the Herbal Botanical Garden Patna Science College, Department of Botany, Patna University, Patna, Bihar. The experimental part was carried out in Plant Tissue Culture Laboratory, between December 2017 to August 2018 in Department of Botany P.U. Patna. Methodlogy: The sterilized leaf explants were inoculated into MS media fortified with different phytohormones (Auxin and Cytokinin) and Rhus tox(30CH) under aseptic environmental conditions for the growth and development of callus, embryoids etc. Result: The explants in MS medium supplemented with auxins phytohormones and Rhus tox(30CH) exhibited that IAA (0.10 to 2.0 mg/l) and BAP (0.10 to 2.5 mg/l) induces green and compact calli. Whereas at 0.30mg/l of IAA and 0.50 mg/l BAP induced brown friable calli. 2,4-D (1.5 mg/l) and Kinetin (1.5-6.5mg/l) concentrations induced brown and friable calli. Rhus tox(30CH) (100 µl/100 ml) enhances proliferation with 2,4-D and Kinetin (1.5/1.5 mg/l.). Conclusion: After 42 days of culture initiation and establishment the callus was 520.0±1.12 mg in the mixture of 2,4-D and Kinetin (1.5 mg/l) in Rhus tox free medium. Whereas weight of callus were found to be 1092±0.74 mg after 42 days in the same medium of 2, 4-D and Kinetin (1.5/5.5 mg/l) supplemented with Rhus tox (100 µl/100 ml). Hence, the investigation proponded that the Rhus tox (CH30) has increased the rate of callus development and plantlet regeneration.

Evaluation of analgesic activity of Toxicodendron radicans in animal model using wistar albino rats

Background: Pain forms an integral part of many clinical conditions management is of great importance in every field of medicine. The core of medicine is to preserve and restore patient’s health and to minimize their suffering. Toxicodendron radicans (rhus toxicodendron) is a homoeopathic remedy with anti-inflammatory activity used for various arthritic pain. Rhus toxicodendron is commonly used in skin, mucus membrane affections, pain in joints, tendons, rheumatism in cold season, cellulitis and infection, fever. During the recent exponential rise in the use of alternative medicines and increasing integration into the health service little research has been done on alternative medicine in the context in which it is practiced.Methods: Wistar albino rats were divided into four groups. group 1 received control (normal saline), group 2 received vehicle (alcohol with distilled water in ratio 1:4), and group 3 received standard (diclofenac-10 mg/kg), group 4 and 5 consist of 2 test groups-rhus toxicodendron 30x and 200c respectively. Analgesic activity was assessed using Hot water tail immersion method and Eddy’s hot plate method. Preliminary pilot study was done with 4 doses rhus toxicodendron 6x, 12x, 30x, 200c respectively. Data was analysed by one-way ANOVA followed by Tukey Kramer multiple comparison test. P value <0.05 was considered as significant.Results: In Eddy’s hot plate method, rhus toxicodendron 30 showed increase in paw withdrawal time which was statistically very significant at the end of 1 hr compared to the control group whereas statistically rhus toxicodendron 200 showed extremely significant analgesic property. In hot water tail immersion method rhus toxicodendron 30 showed increase in tail withdrawal time at the end of 1hr compared to the control group which was significant statistically.Conclusions: This study shows that toxicodendron radicans homoeopathic formulations possess significant analgesic property.

The Role of Rhus toxicodendron: A Homoeopathic Remedy in its Various Attenuations on Patients with Rheumatic Disorders

Objective: The objectives of the study were to clinically evaluate the role of Rhus toxicodendron, a homoeopathic medicine, in its various attenuations (Q, 30C, 200C, 1M) prescribed as a single medicine or with other homeopathic medicines for relieving the signs and symptoms of arthritic disorders and also to determine their useful potencies, frequency of administration and building up a new dose repetition protocol and guidelines for practice. Methods: It was a multi-centric, observational study carried out between the years 2016-2018. A total of 91 patients with arthritic disorder were selected according to the pre-defined parameters. The detailed case recording was done for each case and the patients were monitored for assessing the status of their condition according to the pre-defined criteria and the results were evaluated. Results: Out of the 91 patients, 78 patients improved in varying degrees with marked improvement seen in 34 patients, moderate in 27 patients and mild in 17 patients. No improvement was seen in 13 patients. Conclusion: Outcome of the study shows that homeopathic medicines are useful in managing arthritic disorders. However, further study with predefined laboratory and radiological investigation needs to be conducted. Other objectives of the study which included identifying the most useful potencies of Rhus toxicodendron and their frequency of administration could not be achieved. From the available results, a dose repetition observation has been provided and further study for new repetition protocol and guidelines is being formulated for conducting further trials.

Composition analysis and antioxidant activities of the Rhus typhina L. stem / 药物分析学报

The present investigation reports the chemical composition of the Rhus typhina L. stem identified via mass spectrometry and NMR as gallic acid, 1-O-galloyl-β-D-glucose, tryptophan, scopolin, methyl gallate, fustin, quercetin, rutin, and 1,2,3,4,6-penta-O-galloyl-β-D-glucose. The antioxidant properties and the chemical composition contents of the R. typhina L. stem grown in different regions in China were de-termined. To determine the antioxidant activity, a total phenolic content analysis, 2, 2-diphenyl-1-pi-crylhydrazyl radical scavenging activity assay, ferric reducing antioxidant power assay, andβ-carotene linoleic acid model system were conducted. The results showed that the Rhus typhina L. stem possessed high antioxidant capacities due to its high phenolic content. The contents of the nine isolated compounds were determined by UPLC-ESI-MS/MS. The calibration curves of the nine isolated compounds were linear within the concentration range and the average recoveries were high. The result showed that 1-O-galloyl-β-D-glucose, gallic acid, methyl gallate, and 1,2,3,4,6-penta-O-galloyl-β-D-glucose could be the compounds mainly responsible for the antioxidant capacity of the R. typhina L. stem. This reveals that the R. typhina L. stem is a good source of antioxidants.

Cloning,expression and characterization of chalcone isomerase from medicinal plant Chinese sumac (Rhus chinensis) / 中国中药杂志

Flavonoids are a group of secondary metabolites found in plants. They have many pharmacological functions and play an important role in Chinese sumac( Rhus chinensis),which is a well-known traditional Chinese medicinal plant. Chalcone isomerase( CHI,EC 5. 5. 1. 6) is one of the key enzymes in the flavonoids biosynthesis pathway. In this paper,the full-length c DNA sequence encoding the chalcone isomerase from R. chinensis( designated as Rc CHI) was cloned by RT-PCR and rapid-amplification of c DNA Ends( RACE). The Rc CHI c DNA sequence was 1 058 bp and the open reading frame( ORF) was 738 bp. The ORF predicted to encode a 245-amino acid polypeptide. Rc CHI gene contained an intron and two exons. The sequence alignments revealed Rc CHI shared47. 1%-71. 6% identity with the homologues in other plants. Real-time PCR analysis showed that the total flavonoid levels were positively correlated with tissue-specific expressions of Rc CHI mRNA in different tissues. The recombinant protein was successfully expressed in an Escherichia coli strain with the p GEX-6 P-1 vector. In this paper,the CHI gene was cloned and characterized in the family of Anacardiaceae and will help us to obtain better knowledge of the flavonoids biosynthesis of the flavonoid compounds in R. chinensis.

Preparation of Rhus chinensis total phenolic acid pellets by extrusion-spheronisation method / 中国中药杂志

Extrusion-spheronisation method was used to prepare Rhus chinensis total phenolic acid pellets. The formula and preparation of R. chinensis total phenolic acid pellets were optimized. The formulas( drug loading capacity,diluent,wetting agent and anti-sticking agent) were determined by the single factor test with yield,appearance and performance as the indexes. The preparation was optimized by Box-Behnken design and response surface method,with the rate of extrusion,rate of spheronization and time of spheronization as the independent variables and the overall desirability value of yield,friability and roundness as the dependent variables. The optimal formula of pellets was as follows: drug loading capacity 28. 7%,MCC-lactose 9 ∶1,silicon dioxide as anti-sticking agent,and 60% ethanol as wetting agent. The optimal preparation was determined as follows: the rate of extrusion was 43 r·min-1,the rate of spheronization was 1 800 r·min-1,and the time of spheronization was 4 min. The absolute deviation between predicted value and estimated value under the conditions was less than 5. 0%,with a high degree of model fit. The preparation parameters obtained were accurate,reliable and reproducible. Under scanning electron microscopy( SEM),R. chinensis total phenolic acid pellets were uniform in diameter,round and smooth. The optimal formulation and process are stable and feasible for preparing R. chinensis total phenolic acid pellets.

Rhus coriaria L. increases serum apolipoprotein-A1 and high-density lipoprotein cholesterol levels: a double-blind placebo-controlled randomized clinical trial / 中西医结合学报

<p><b>BACKGROUND</b>Lipid-lowering effect of Rhus coriaria L. (Rhus) has been investigated in multiple animal studies with promising results. Nonetheless, its clinical efficacy has not been adequately examined.</p><p><b>OBJECTIVE</b>The aim of this study was to evaluate the lipid-lowering effects of Rhus among patients with hyperlipidemia.</p><p><b>DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS</b>The study was designed as a two-arm, double-blind placebo-controlled randomized clinical trial, using a parallel design. Eighty patients with primary hyperlipidemia were randomly assigned to receive Rhus capsules or placebo for 6 weeks.</p><p><b>MAIN OUTCOME MEASURES</b>The serum lipid levels, apolipoprotein-A1 (Apo-A1) and apolipoprotein-B (Apo-B) were measured.</p><p><b>RESULTS</b>Mean serum high-density lipoprotein cholesterol (HDL-C) and Apo-A1 levels were significantly increased in the Rhus group, compared with the placebo group, after 6 weeks of intervention (P = 0.001). The analysis of covariance test including age, gender, body mass index (BMI), and smoking as co-variables revealed that the increase in HDL-C and Apo-A1 levels remained significant, and increases in HDL-C were dependent on the increase in Apo-A1 levels. No significant difference was observed between Rhus and placebo groups in terms of mean reductions in total cholesterol, low-density lipoprotein cholesterol and triglyceride levels; however, more significant improvement was observed among obese patients (BMI ≥ 30 kg/m).</p><p><b>CONCLUSION</b>The study showed significant increases in HDL-C and Apo-A1 levels in response to Rhus supplementation in patients with hyperlipidemia.</p><p><b>TRIAL REGISTRATION</b>ClinicalTrials.gov ID: NCT02295293.</p>

Protective effect of Rhus verniciflua Stokes extract in an experimental model of post-menopausal osteoporosis / 대한해부학회지

Post-menopausal osteoporosis (PMO) is a major global human health concern. Owing to the need for therapeutic drugs without side effects, natural extracts containing various polyphenolic compounds that may exert estrogenic effects have been studied in depth. Rhus verniciflua Stokes (RVS), which has been used as a traditional herbal medicine for centuries in Korea, was recently revealed to exert estrogenic effects attributable to its bioactive ingredients sulfuretin and butein, which have strong estrogen receptor–binding affinities. In this study, the protective potential of RVS in PMO was evaluated by using an experimental animal model of PMO, which was established by ovariectomy (OVX) of female Sprague Dawley rats. The oral administration of RVS at 20 mg/kg or 100 mg/kg for 8 weeks markedly protected against OVX-induced atrophy of the uterine tube and reversed the elevation in the ratio of serum receptor activator of nuclear factor-κB ligand to osteoprotegerin, which is a marker of disease severity. In addition, RVS inhibited OVX-induced tibia bone loss, activated osteogenic activity, and suppressed osteoclastic activity in the tibial epiphyseal plate, a region of bone remodeling. Collectively, these factors indicated that the oral intake of RVS might be beneficial for the prevention of PMO.

The Effect of Rhus verniciflua Stokes Extracts on Photo-Aged Mouse Skin

BACKGROUND: Rhus verniciflua Stokes (RV) has traditionally been used in Korea as an indigenous food (Rhus chicken soup) and as an herbal medicinal plant. While the anticancer, antimicrobial, and anti-inflammatory properties of RV have been actively studied in the medical field, its antioxidant effects in the skin that resist the reactive oxygen species in keratinocytes and fibroblasts is less understood. OBJECTIVE: We designed to evaluate the effects of R. verniciflua Stokes extract (RVE) on the photo-aged skin by an in vitro experiment using human fibroblasts and an in vivo experiment using a photo-aged murine model. METHODS: For the in vitro experiments, human fibroblasts irradiated with ultraviolet (UV) B were treated with RVE or vehicle, and the growth levels and the expression level of type 1 procollagen were compared. For the in vivo experiment, photo-aged mice irradiated with UVB and UVA were administered drinking water with or without RVE, and histological changes and the expression level of type 1 procollagen and matrix metalloprotease (MMP)-13 were compared. RESULTS: In vitro experiments using fibroblasts irradiated with UVB showed that RVE promoted growth and significantly increased the expression of type 1 procollagen as compared to the control group. In the photo-aged mice, RVE increased collagen content in the dermis and promoted the synthesis of type 1 procollagen without any visible decrease in MMP-13 as compared to control group. CONCLUSION: In addition to the previously reported antioxidant effects of RVE, oral intake of RVE effectively inhibited photo-aging in hairless mice by enhancing collagen synthesis.

Rhus verniciflua Stokes attenuates cholestatic liver cirrhosis-induced interstitial fibrosis via Smad3 down-regulation and Smad7 up-regulation / 대한해부학회지

Cholestatic liver cirrhosis (CLC) eventually proceeds to end-stage liver failure by mediating overwhelming deposition of collagen, which is produced by activated interstitial myofibroblasts. Although the beneficial effects of Rhus verniciflua Stokes (RVS) on various diseases are well-known, its therapeutic effect and possible underlying mechanism on interstitial fibrosis associated with CLC are not elucidated. This study was designed to assess the protective effects of RVS and its possible underlying mechanisms in rat models of CLC established by bile duct ligation (BDL). We demonstrated that BDL markedly elevated the serological parameters such as aspartate aminotransferase, alanine transaminase, total bilirubin, and direct bilirubin, all of which were significantly attenuated by the daily uptake of RVS (2 mg/kg/day) for 28 days (14 days before and after operation) via intragastric route. We observed that BDL drastically induced the deterioration of liver histoarchitecture and excessive deposition of extracellular matrix (ECM), both of which were significantly attenuated by RVS. In addition, we revealed that RVS inhibited BDL-induced proliferation and activation of interstitial myofibroblasts, a highly suggestive cell type for ECM production, as shown by immunohistochemical and semi-quantitative detection of α-smooth muscle actin and vimentin. Finally, we demonstrated that the anti-fibrotic effect of RVS was associated with the inactivation of Smad3, the key downstream target of a major fibrogenic cytokine, i.e., transforming growth factor β (TGF-β). Simultaneously, we also found that RVS reciprocally increased the expression of Smad7, a negative regulatory protein of the TGF-β/Smad3 pathway. Taken together, these results suggested that RVS has a therapeutic effect on CLC, and these effects are, at least partly, due to the inhibition of liver fibrosis by the downregulation of Smad3 and upregulation of Smad7.

Tamizaje fitoquímico de tres especies del desierto del sahara occidental / Phytochemical screening of three species of western sahara

INTRODUCCIÓN: las plantas que crecen en el desierto requieren de características especiales para adaptarse a las condiciones adversas de esta región. Dentro de estos se destacan los géneros Pergularia, Hammada y Rhus, al poseer estructuras y mecanismos que les confieren una gran versatilidad en cuanto a sus usos medicinales. Las investigaciones encaminadas al estudio de su composición química y actividad biológica son limitadas. OBJETIVO: determinar la composición química preliminar de extractos de diferente polaridad de las especies Pergularia tomentosa L. (Apocynaceae), Hammada scoparia I. (Amaranthaceae) y Rhus tripartita L. (Anarcadiaceae). MÉTODOS: los materiales vegetales empleados fueron las hojas y las ramas de las especies. En el momento de la colecta no existía ni floración, ni fructificación en estas especies vegetales. Se realizó un proceso de extracción por maceración, se empleó etanol. A partir de éste extracto se efectuó un fraccionamiento preliminar y se usó disolventes de diferente polaridad; el hexano, acetato de etilo, metanol y butanol. A todas estas fracciones se le realizó un tamizaje fitoquímico. RESULTADOS: los metabolitos secundarios encontrados en la identificación preliminar de las tres especies fueron; los alcaloides, azúcares reductores, compuestos con agrupamientos lactónicos y compuestos fenólicos. CONCLUSIONES: en las tres especies, las fracciones metanólicas fueron las que mostraron una mayor variedad de metabolitos secundarios.

INTRODUCTION: plants growing in deserts require special characteristics to survive under the extreme conditions of these regions. Inside these groups of plants are the genus Pergularia, Hammada and Rhus having a great versatility of medical uses. Investigations about chemical composition and biological activities of these genuses are limited. OBJECTIVE: to determine the preliminary chemical composition of extracts from different polarity of Pergularia tomentosa L. (Apocynaceae), Hammada scoparia (Amaranthaceae) and Rhus tripartita L. (Anarcadiaceae). METHODS: plant materials used were the leaves and branches of the species. At the time of collection there was not flowering or fruiting in these plants. Extraction procedure was carried out by maceration with methanol. From this extract preliminary fractionation was done using solvents with different polarity: hexane, ethyl acetate, methanol and buthanol. All these fractions were phytochemical screened. RESULTS: the secondary metabolites found in the preliminary identification of the three species were: alkaloids, reducing sugars, compounds with lactone groups and phenolic compounds. CONCLUSIONS: in the three species, the methanolics fractions showed the most variety of secondary metabolites.

Eosinophilic Gastroenteritis Due to Rhus Ingestion Presenting with Gastrointestinal Hemorrhage

Rhus-related illnesses in Korea are mostly caused by ingestion of parts of the Rhus tree. Contact dermatitis occurrence after ingestion of Rhus-related food is very common in Korea. However, Rhus-related gastrointestinal disease is very rare. Herein, we present a case of eosinophilic gastroenteritis caused by Rhus ingestion. A 75-year-old woman was admitted with hematemesis and hematochezia after Rhus extract ingestion. Routine laboratory tests revealed leukocytosis without eosinophilia. Endoscopy showed friable and granular mucosal changes with touch bleeding in the second portion of the duodenum. Abdominal computed tomography revealed edematous wall thickening of the duodenum and proximal jejunal loops. Patch testing with Rhus extracts showed a strong positive reaction, suggesting Rhus as the allergen. Her symptoms improved after avoidance of the allergen.

Two Cases of Ingestion of Rhus Chicken Causing Acute Generalized Exanthematous Pustulosis / 대한피부과학회지

Rhus chicken is a common health food in Korea and is used as an herbal medicine to cure gastrointestinal diseases such as indigestion, loose stool, and peptic ulcers. Unfortunately, systemic contact dermatitis due to the ingestion of Rhus chicken occasionally occurs and its incidence is increasing. The clinical findings of systemic contact dermatitis induced by ingesting Rhus chicken are maculopapules, erythroderma, erythema multiforme-like lesions, vesicles, wheals, purpura, and pustules. Acute generalized exanthematous pustulosis (AGEP) is an acute generalized pustular eruption characterized by rash with sterile pustules, high fever, and neutrophilia. Most cases are caused by drugs, predominantly beta-lactams and macrolide antimicrobials, viral infections, and contact hypersensitivity. Rarely, intake of Rhus chicken can cause AGEP. Herein, we describe two cases of AGEP induced by ingestion of Rhus chicken.

A Case of Stevens-Johnson Syndrome with Acute Renal Failure Induced by Rhus-Chicken Ingestion / 대한내과학회지

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe, diffuse mucocutaneous reactions that can be elicited by drugs, infection, malignancy, and herbal supplements. A wide variety of mucocutaneous events, such as systemic contact dermatitis, have been reported to be elicited by Rhus chicken, although cases of SJS and TEN are rare. Here, we present a case of SJS caused by Rhus-chicken ingestion. A 48-year-old man who wanted to improve his health and treat a gastrointestinal problem ingested Rhus chicken in the traditional manner. Twenty-four hours later, he developed a multiple erythematous maculopapular skin rash with vesicles and bullaes on 30% of the body surface and multiple erosions on the lips. He was diagnosed with SJS/TEN and showed characteristic clinical findings induced by Rhus chicken. After the patient stopped Rhus-chicken ingestion and received methylprednisolone and antibiotics, his symptoms, signs, and laboratory findings improved. With this case, we emphasize that SJS and TEN can occur after ingesting Rhus chicken, although the incidence is very low.

Anti-TNFalpha Treatment for Two Cases of Acute Generalized Exanthematous Pustulosis Caused by Rhus Hypersensitivity / 대한내과학회지

Acute generalized exanthematous pustulosis (AGEP) is characterized by the rapid occurrence of many sterile, nonfollicular pustules on an edematous erythema accompanied by leucocytosis and fever. It is usually attributed to drugs, including herbal medications such as rhus in Korea. We report two cases of AGEP due to rhus hypersensitivity treated with anti-tumor necrosis factor (TNF)-alpha. The patients developed a generalized erythematous rash and edema, particularly on the face, with high fever and leukocytosis several days after ingesting rhus chicken or contacting rhus extract. Following treatment with a systemic steroid, the skin rash spread to the entire body and pustules arose on an edematous erythema. After stopping the systemic steroid and administering a subcutaneous injection of Etanercept, the pustular rashes, fever, and edema improved within 4 days. These results suggest that anti-TNF-alpha treatment may be effective for rapidly improving AGEP.

La política de recursos humanos y el compromiso con el derecho a la salud: Resultados de la primera medición de las Metas Regionales de recursos humanos para la salud 2007 -2015 en los países de la Región Andina / Human resources policy and commitment to the right to health: Results of the first measurement of the Regional Human Resources Targets for Health 2007 -2015 in the countries of the Andean Region

la persistencia de escasez de recursos humanos en función de las necesidades de salud, las limitaciones en la calidad de la formación y en el desempeño de los trabajadores y profesionales de la salud, las deficiencias en el diálogo entre educación y salud, la urgencia de lograr un trabajo digno para la fuerza de trabajo en salud, y la pobreza de las medidas para enfrentar los efectos de la migración de personal de salud, son catalogados por los países como problemas persistentes y comunes. Este consenso requiere la identificación de hitos técnicos concretos, que permitan a los equipos nacionales, evaluar sus avances y aprender de sus aciertos en materia de políticas y estrategias, como un recurso de innovación con proyección de largo plazo. (AU)