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Bromelain may be of interest to plastic surgeons because of its apparent ability to reduce pain, edema, inflammation, and platelet aggregation, as well as its ability to potentiate antibiotics, which may be beneficial in postoperative healing. Bromelain's reported efficacy in burn débridement and ischemia/reperfusion may also have positive applications in plastic surgery. Although bromelain is widely used and generally considered to be a safe substance, more randomized, controlled clinical trials are necessary to further elucidate its clinical potential.
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Roger A. Orsini, M.D.
Plastic Surgery Educational
Foundation Technology
Assessment Committee
Easton, Md.
Summary: Bromelain may be of interest to plastic surgeons because of its
apparent ability to reduce pain, edema, inflammation, and platelet aggregation,
as well as its ability to potentiate antibiotics, which may be beneficial in post-
operative healing. Bromelain’s reported efficacy in burn de´bridement and
ischemia/reperfusion may also have positive applications in plastic surgery.
Although bromelain is widely used and generally considered to be a safe sub-
stance, more randomized, controlled clinical trials are necessary to further
elucidate its clinical potential. (Plast. Reconstr. Surg. 118: 1640, 2006.)
he pineapple plant, Ananas comosus, has
long been used for medicinal purposes. Na-
tive cultures used it as a digestive aid and as
a remedy for skin disorders.
A compound called
bromelain, which was found to be highly con-
centrated in mature pineapple stems,
has since
been linked to the medicinal properties. Re-
search on bromelain has been conducted for
decades in Europe and Asia, and in recent years,
it has been of interest in the United States.
Although most of the available information
comes from in vitro and animal studies or anec-
dotal evidence, rather than randomized, con-
trolled clinical trials, bromelain has been shown
to exhibit beneficial therapeutic effects while
maintaining low toxicity and producing few
harmful or undesired side effects.
In particular,
bromelain is reported to have antiinflammatory,
antiedematous, anticoagulant, and antimeta-
static properties, and has also been shown to
enhance antibiotic activity.
Bromelain is a crude, aqueous extract derived
from pineapple stems and fruits. It is composed
primarily of sulfhydryl proteolytic enzymes that
have protein-digesting and milk-clotting proper-
ties. Although there has been some controversy
over the years as to whether the enzymes found in
the stem and fruit are distinguishable as separate
enzymes, current literature indicates that there
are four distinct proteases in pineapples; the two
major enzymes are now described as stem brome-
lain and fruit bromelain.4,5 Several additional com-
ponents have been found in bromelain, including
peroxidase, acid phosphatase, several protease in-
hibitors, and organically bound calcium,5but
their activities are not well understood. Some stud-
ies indicate that proteolytic enzymes are not solely
responsible for bromelain’s pharmacological ef-
fects. Thus, further research is needed to deter-
mine whether the other components contribute
to bromelain’s medicinal properties.
Bromelain is categorized as a food additive by
the U.S. Food and Drug Administration and is on
the list of substances generally recognized as safe.6
The commercially available product is most often
made from stem bromelain, whereby the extract is
removed from cooled pineapple juice through
centrifugation, ultrafiltration, and lyophilization4
and the remaining substance is made available to
the public in the form of a powder, cream, tablet,
or capsule. It is available in pure form or in mul-
tienzyme combinations (Debridase, Phlogenzym,
and Traumanase).
Bromelain appears to be most effective when
taken orally. In vitro studies have shown that low
doses of bromelain are readily degraded by pro-
tease inhibitors in blood plasma and that oral ad-
ministration may help bromelain retain its pro-
teolytic activity.7Theoretically, bromelain could
also be degraded in the digestive tract; however,
the glycosylated nature of bromelain4contributes
to its functional stability8and may also prevent
proteolytic degradation in the intestine.1It has
been suggested that bromelain be taken on an
empty stomach, as it can interact with certain types
of food.9
Recommended dosages of bromelain are avail-
able only through the scientific literature and vary
depending on clinical indication. Most studies
From Shore Aesthetic and Reconstruction Associates.
Received for publication June 28, 2006; accepted July 12,
Copyright ©2006 by the American Society of Plastic Surgeons
DOI: 10.1097/
suggest 500 to 1500 mg/day taken in divided
doses. Bromelain’s activity is measured in gelatin-
digesting units, milk-clotting units, Federation In-
ternationale Pharmaceutiques units, or Rorer
units, and many manufactures sell bromelain
products that are standardized to 2000 gelatin-
digesting units in 500-mg tablets.9
Bromelain may be of particular interest in
plastic surgery because of its apparent antiedema-
tous, anti-inflammatory, and anticoagulation
properties. Additional evidence suggests that bro-
melain may be beneficial in pain reduction,
wound healing, burn de´bridement, and ischemia/
reperfusion. It may even be an effective adjuvant
to antibiotic therapy. The various mechanisms in-
volved in these processes are just beginning to be
Bromelain may be effective at reducing pain.
In early studies, patients who were treated with
bromelain experienced statistically significant de-
creases in pain associated with mediolateral
episiotomy10 and in pain response to bradykinin
that was topically applied to open blisters.11 In a
more recent study of mild acute knee pain in
healthy adults, bromelain was shown to have a
dose-dependent effect on the reduction of phys-
ical symptoms and improvement of general
well-being.12 However, bromelain was not effective
and was no better than standard treatment, pla-
cebo, or control in reducing pain associated with
delayed-onset muscle soreness.13
Several studies have shown bromelain’s anti-
edematous properties. In a double-blind, placebo-
controlled study, bromelain was shown to reduce
edema and ecchymoses in patients who experi-
enced surgical (e.g., rhinoplasty) or nonsurgical
trauma to the face. The investigator suggested that
the resolution of edema and ecchymoses in the
bromelain-treated subjects required one-third to
one-half fewer days than would have been ex-
pected if these same patients had received placebo
instead of active treatment.14 In a study of isch-
emia/reperfusion injury in rabbits, Neumayer et
al. observed reduced interstitial edema in rabbits
treated with Phlogenzym (MUCOS Pharma
GmbH & Co., Geretsried, Germany), a combina-
tion of bromelain, trypsin, and rutin, compared
with rabbits that were not treated.15
There is evidence that bromelain acts as an
anti-inflammatory agent. In a rat model of knee
joint acute inflammation, inflammatory exudates
from bromelain-treated rats had reduced concen-
trations of prostaglandin E2and substance P, two
key mediators of the immune response.16 Another
mechanism of action relates to bromelain’s ability
to alter leukocyte expression of cell surface mol-
ecules. Hale et al. found that bromelain removes
several types of cell surface molecules, thereby
decreasing leukocyte adhesion and activation, ul-
timately resulting in decreased inflammation.7
Recent studies suggest that bromelain may be
beneficial in treating inflammatory diseases. In a
mouse model of inflammatory bowel disease, bro-
melain was found to decrease the clinical and
histological severity of spontaneous colitis and co-
lonic inflammation. While the proteolytic activity
of bromelain seemed to be related to the reduc-
tion in inflammatory bowel disease symptoms, the
exact mechanisms of action have yet to be
determined.17 Secor et al. found that systemic bro-
melain treatment reduced the inflammatory pro-
cess in a mouse model of allergic airway disease.18
In addition, anecdotal evidence suggests that bro-
melain may be effective in treating mild ulcerative
colitis. A 67-year-old woman and a 60-year-old
woman, both with ulcerative colitis, reported im-
proved conditions after self-treatment with bro-
melain. In both cases, improvement of disease was
confirmed by endoscopic examination.19
Wound Healing
Bromelain may have beneficial effects in soft-
tissue wound healing. In a double-blind, con-
trolled clinical trial investigating the effects of bro-
melain on episiotomy wounds, Howat and Lewis
reported faster rates of reduction of edema and
bruising in subjects who received bromelain treat-
ment compared with subjects who received
placebo.20 The authors noted, however, that none
of the results reached statistical significance. In a
study of wound healing in healthy adults, an oral
nutritional supplement containing bromelain,
other proteases, vitamins, and minerals was shown
to decrease the soft-tissue would-healing time
when administered during the early phase of
wound healing. However, it is important to note
that the efficacy of each component of the sup-
plement was not determined, and it is unknown if
Volume 118, Number 7 Bromelain
the components had an additive or synergistic
Platelet Aggregation
Several earlier studies have suggested that bro-
melain may be an effective anticoagulant. In vitro
and in vivo studies22,23 have shown bromelain to
reduce adenosine 5=-diphosphate–induced plate-
let aggregation by degrading fibrinogen. Brome-
lain was more effective at degrading purified fi-
brinogen rather than fibrinogen in plasma,
possibly because of the action of protease inhib-
itors in the plasma.23 In a more recent study, Gla¨-
ser and Hilberg report that bromelain decreased
adenosine 5=-diphosphate– and thrombin recep-
tor–activated peptide-6–induced platelet aggrega-
tion, most likely by altering fibrinogen receptors
and blocking the formation of fibrin.24
Bromelain has been shown to enhance the
action of antibiotics. In an early study, bromelain
was found to increase tissue permeability to anti-
biotics, although the results were not statistically
significant.11 Tinozzi and Venegoni found a sta-
tistically significant increase in serum and tissue
levels of amoxicillin in subjects treated with the
antibiotic and bromelain.25 More recently, brome-
lain was shown to be effective at enhancing the
activity of antibiotics in children with sepsis. Sha-
hid et al. observed a statistically significant de-
crease in the number of days it took for fever to
subside and for the withdrawal of hemodynamic
support in the children who received Phlogenzym
with antibiotics compared with the children who
received antibiotic therapy alone.26
Burn De´bridement
Bromelain may be an effective alternative to
surgical escharotomy in patients with deep burns.
Results of in vitro and in vivo studies show that
bromelain preparations can effectively de´bride
full-thickness burns in pig skin in less than 24
hours. The preparations affected only burned skin
and resulted in minimal blood loss.27 Debridase
(Biotechnology General LTD, Kiryat Malchi, Is-
rael), a bromelain-derived preparation, has also
been shown to be an effective burn-de´briding
agent. In a preliminary study of 130 patients with
deep second- and third-degree burns, Rosenberg
et al. found that, in most cases, treatment with
Debridase resulted in complete de´bridement of
eschar after only one or two brief applications;
however, the investigators note that data were in-
complete for a large number of patients, and the
noncomparative nature of the study did not allow
for a comparison between Debridase and standard
of care.28 In a porcine model of burn-induced
compartment syndrome, circumferential limb
burns treated with Debridase exhibited a statisti-
cally significant reduction in intracompartmental
pressures compared with untreated burns, and
enzymatic digestion of burn eschar effectively
cleaned the wound area without damaging viable
Neumayer et al. found that Phlogenzym had a
protective effect on skeletal muscle during isch-
emia/reperfusion studies in rabbits. The authors
suggest that bromelain’s ability to reduce platelet
and leukocyte aggregation may have reduced clot-
ting in the microvessels, thereby preventing the
no-reflow phenomenon.15
Toxicity and Side Effects
Bromelain has been shown to have low toxic-
ity. In several animal studies, the median lethal
dose during oral administration was greater than
10 g/kg. When bromelain was administered in-
travenously and intraperitoneally, the median le-
thal dose ranged from 20 to 35 mg/kg and from
36.7 to 85.2 mg/kg, respectively.1
Most studies of bromelain report a low inci-
dence of adverse effects. In a review of clinical
studies that investigated bromelain’s effect on os-
teoarthritis, no serious adverse events were re-
ported; however, there were some cases of gastro-
intestinal problems, headache, tiredness, dry
mouth, skin rash, and unspecified allergic reac-
tions. In these studies, bromelain was adminis-
tered at dosages ranging from 540 to 1890 mg/
day. Higher dosages of bromelain tended to have
higher incidences of adverse drug reactions com-
pared with standard treatment.30
Other investigators have reported isolated
cases of allergic reaction and exacerbation of
asthma symptoms as a result of occupational
exposure to bromelain.31–33 In most cases, ad-
verse reactions occurred after inhalation of bro-
melain; however, some patients experienced
gastrointestinal discomfort after peroral chal-
lenge with pineapple. The respiratory and gas-
trointestinal symptoms in these cases were
found to be the result of immunoglobulin E–me-
diated reactions to bromelain.
Some authors have suggested that bromelain’s
anticoagulant properties could increase bleeding
Plastic and Reconstructive Surgery December 2006
when it is taken in combination with other med-
ications, such as aspirin and warfarin.9,34
Despite the few reports of adverse events, bro-
melain is generally considered to be safe, but it is
important to note that most of the human studies
involving bromelain included adult subjects.
Thus, there is little information on the safety of
bromelain for children younger than 18 years of
age. In addition, little information is available on
the safety of bromelain when it is administered at
higher doses, when it is taken in combination with
other medications, or when it is taken long term.
Although bromelain has been studied for de-
cades in Europe and Asia and more recently in the
United States, most of the available literature de-
scribes results of in vitro or animal studies. Very
few randomized, controlled clinical trials have
been conducted. In order for bromelain to be
widely accepted as a therapeutic agent, more re-
search is needed. In particular, more trials are
needed to establish the efficacy and optimal dos-
age for each clinical indication. In addition, since
many bromelain preparations contain other en-
zymes and substances, more research is need to
identify bromelain’s contribution to the therapeu-
tic effects of these products.
The pineapple compound bromelain has long
been used for its medicinal properties. Although
the mechanisms of action are just beginning to be
understood, many studies have suggested that the
proteolytic component of bromelain is primarily
responsible for the pharmacological effects. Bro-
melain may be of interest to plastic surgeons be-
cause of its apparent ability to reduce pain, edema,
inflammation, and platelet aggregation, as well as
its ability to potentiate antibiotics, which may be
beneficial in postoperative healing. Bromelain’s
reported efficacy in burn de´bridement and isch-
emia/reperfusion may also have positive applica-
tions in plastic surgery. Although bromelain is
widely used and generally considered to be a safe
substance, more randomized, controlled clinical
trials are necessary to further elucidate its clinical
Roger A. Orsini, M.D.
Shore Aesthetic and Reconstruction Associates
505 Dutchmans Lane
Easton, Md. 21601-4302
The Plastic Surgery Educational Foundation Tech-
nology Assessment Committee would like to recognize
Jennifer Swanson of the American Society of Plastic Sur-
geons/Plastic Surgery Educational Foundation staff for
her work and support of this project.
The author has no financial interest in any of the
products, devices, or drugs mentioned in this article.
1. Lotz-Winter, H. On the pharmacology of bromelain: An up-
date with special regard to animal studies on dose-dependent
effects. Planta Med. 56: 249, 1990.
2. Heinicke, R. M., and Gortner, W. A. Stem bromelain: A new
protease preparation from pineapple plants. Econ. Bot. 11:
225, 1957.
3. Taussig, S. J., Yokoyama, M. M., Chinen, A., et al. Bromelain:
A proteolytic enzyme and its clinical application. Hiroshima
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4. Maurer, H. R. Bromelain: Biochemistry, pharmacology and
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tidases. Methods Enzymol. 244: 555, 1994.
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Food and Drug Administration, Center of Food Safety and
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7. Hale, L. P., Greer, P. K., and Sempowski, G. D. Bromelain
treatment alters leukocyte expression of cell surface mole-
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8. Khan, R. H., Rasheedi, S., and Haq, S. K. Effect of pH,
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10. Zatuchni, G. I., and Colombi, D. J. Bromelains therapy for the
prevention of episiotomy pain. Obstet. Gynecol. 29: 275, 1967.
11. Bodi, T. The effects of oral bromelains on tissue permeability
to antibiotics and pain response to bradykinin: Double blind
studies on human subjects. Clin. Med. 73: 61, 1966.
12. Walker, A. F., Bundy, R., Hicks, S. M, et al. Bromelain reduces
mild acute knee pain and improves well-being in a dose-
dependent fashion in an open study of otherwise healthy
adults. Phytomedicine 9: 681, 2002.
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inary comparison of bromelain and ibuprofen for delayed
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Volume 118, Number 7 Bromelain
16. Gaspani, L., Limiroli, E., Ferrario, P., and Bianchi, M. In vivo
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murine model of allergic airway disease. Cell. Immunol. 237:
68, 2005.
19. Kane, S., and Goldberg M. J. Use of bromelain for mild
ulcerative colitis. Ann. Intern. Med. 132: 680, 2000.
20. Howat, R. C. L., and Lewis, G. D. The effect of bromelain
therapy on episiotomy wounds: A double blind controlled
clinical trial. J. Obstet. Gynaecol. Br. Commonw. 79: 951, 1972.
21. Brown, S. A., Coimbra, M., Coberly, D. M, et al. Oral nutri-
tional supplementation accelerates skin wound healing: A
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24. Gla¨ser, D., and Hilberg, T. The influence of bromelain on platelet
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25. Tinozzi, S., and Venegoni, A. Effect of bromelain on serum
and tissue levels of amoxicillin. Drugs Exp. Clin. Res. 4: 39,
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melin inhalation. Clin. Allergy 8: 21, 1978.
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Plastic and Reconstructive Surgery December 2006
... Bromelain is a natural complex of proteolytic enzymes that are derived from fruit or stem of the Ananas cosmosus (pineapple). It has been used as another phytopharmaceutical in folk medicine for centuries due to its anti-inflammatory, anti-cancer, immune-modulating, as well as anti-thrombotic properties, to name just a few, as well as its safety for administration [158][159][160]. In musculoskeletal injuries or disorders, it is also known to reduce acute pain and swelling [161]. ...
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Tendinitis (tendinopathy) is a pro-inflammatory and painful tendon disease commonly linked with mechanical overuse and associated injuries, drug abuse, and lifestyle factors (including poor diet and physical inactivity) that causes significant healthcare expenditures due to its high incidence. Nuclear factor kappa B (NF-kB) is one of the major pro-inflammatory transcription factors, along with other inflammation signaling pathways, triggered by a variety of stimuli, including cytokines, endotoxins, physical and chemical stressors, hypoxia, and other pro-inflammatory factors. Their activation is known to regulate the expression of a multitude of genes involved in inflammation, degradation, and cell death. The pathogenesis of tendinitis is still poorly understood, whereas efficient and sustainable treatment is missing. Targeting drug suppression of the key inflammatory regulators represents an effective strategy for tendinitis therapy, but requires a comprehensive understanding of their principles of action. Conventional monotherapies are often ineffective and associated with severe side effects in patients. Therefore, agents that modulate multiple cellular targets represent therapeutic treatment potential. Plant-derived nutraceuticals have been shown to act as multi-targeting agents against tendinitis via various anti-oxidant and anti-inflammatory mechanisms, whereat they were able to specifically modulate numerous signaling pathways, including NF-kB, p38/MAPK, JNK/STAT3, and PI3K/Akt, thus down-regulating inflammatory processes. This review discusses the utility of herbal nutraceuticals that have demonstrated safety and tolerability as anti-inflammatory agents for the prevention and treatment of tendinitis through the suppression of catabolic signaling pathways. Limitations associated with the use of nutraceuticals are also described.
... Similarly, there is no evidence available on the efficacy of bromelain offered at higher concentrations, whether used in conjunction with other drugs or over lengthy periods of time. [161]. ...
Full-text available
Bromelain is an effective chemoresponsive proteolytic enzyme derived from pineapple stems. It contains several thiol endopeptidases and is extracted and purified via several methods. It is most commonly used as an anti-inflammatory agent, though scientists have also discovered its potential as an anticancer and antimicrobial agent. It has been reported as having positive effects on the respiratory, digestive, and circulatory systems, and potentially on the immune system. It is a natural remedy for easing arthritis symptoms, including joint pain and stiffness. This review details bromelain’s varied uses in healthcare, its low toxicity, and its relationship to nanoparticles. The door of infinite possibilities will be opened up if further extensive research is carried out on this pineapple-derived enzyme.
... Bromelain also has immunomodulatory affects which activates the natural killer cells and modulates the immune response of T and B cells in the blood (Engwerda, Andrew, Ladhams, & Mynott, 2001). Bromelain prevents excessive platelet adhesion that reduces the risk of thrombosis (Orsini, 2006;Padma, Jayakumar, Mathai, Chintu, & Sarath, 2012). Additionally, it is antioedematous and anti-carcinogenic, and it has anti-inflammatory and antibiotic properties (Reddy, Grossman, & Rogers, 2013). ...
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Bromelain is a proteolytic enzyme extracted from Ananas comosus and has great potential to affect several physiological functions. The current study examined the effect of bromelain added to commercial feed at concentrations of 0 g (control), 10 g (B1) and 20 g (B2) per kg diet on growth, feed utilization, intestinal morphology, digestive enzyme and immune response of juvenile Sterlet (Acipenser ruthenus) for 56 days. At the end of this experiment, the highest final body weight was detected in fish fed diet of B2 compared to control. The protein content of whole fish was higher in fish fed diet of B1 and B2, but the content of calcium, iron, copper and zinc was noted lower in fillets of fish fed diet of B1 and B2. Supplementation with bromelain significantly increased the height of mucosal folds, enterocytes and the supranuclear zone of the epithelial cells compared to control diet. The enzymatic activity of lipase and pepsin was significantly (p < 0.05) higher in fish fed diet of B1 and B2. The highest activity of lysozyme, total protein level and total immunoglobulin and the proliferative activity of T and B cells were detected in fish fed diet of B2 compared to control, where no significant (p > 0.05) difference was found in ceruloplasmin, metabolic activity of spleen macrophages and potential killing activity of spleen phagocytes between different treatments.
In the past few years, we have been very familiar with the waste hierarchy concept of the 3 R’s, Reduce, Reuse and Recycle. This review article aims to suggest a possible way to reuse the agro-waste sector. It will focus on the zero waste food industry. While consuming our day-to-day food unknowingly we throw away some of the important portions of fruits and vegetables which can help us fight diseases and stay healthy. Therefore, we need proper management to utilize these beneficial components present in those fruit scrapes. An abundant amount of food waste is been produced during the processing of food from the different food industries. In addition to this, agro wastes like peels, seeds, etc. are also generated from fruit and vegetable agriculture. This paper mainly focuses on the agro-waste of the food industry, which can be consumed when the bioactive compound is extracted and is available as a functional food. The bioactive compounds have the potential to control blood pressure, diabetes, inflammation, etc. Thus, by incorporating these bioactive compounds we can enhance the quality of food. Recently functional food is consumed by a large population for its beneficial effect on our body.
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Background: Pain, edema, and trismus are predictable sequelae for surgical extraction of impacted mandibular third molars (M3M). The present study aimed to compare the anti-phlogistic potential of bromelain and aceclofenac in the reduction of post-surgical sequalae in the extraction of impacted M3M. Method: A randomized controlled, triple-blinded clinical study included 72 patients scheduled for surgical removal of impacted M3M under local anesthesia. Randomization was performed and subjects were equally allocated to groups A (control) and B (study), who intended to receive aceclofenac and bromelain, respectively. The primary outcome variables were pain, edema, and trismus evaluated on postoperative days 2 and 7 and compared with baseline values. The secondary variables evaluated were the quantity of rescue analgesics required and the frequency of adverse effects in both groups for 7 postoperative (PO) days. Data were analyzed with a level of significance of P < 0.05. Results: Group B demonstrated a significant decrease in the severity of edema and trismus compared to group A on both PO days 2 and 7 (P < 0.001). Bromelain demonstrated similar analgesic efficacy with an insignificant difference compared to aceclofenac (P > 0.05). Conclusion: The present study showed that the efficacy of bromelain was comparable to that of aceclofenac in reducing inflammatory complications following surgical removal of impacted M3M. Bromelain can be considered a safe and potent alternative to routinely used aceclofenac when addressing inflammatory outcomes after surgery.
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Burn injury in the craniofacial region causes significant health and psychosocial consequences and presents unique reconstructive challenges. Healing of severely burned skin and underlying soft tissue is a dynamic process involving many pathophysiological factors, often leading to devastating outcomes such as the formation of hypertrophic scars and debilitating contractures. There are limited treatment options currently used for post-burn scar mitigation but recent advances in our knowledge of the cellular and molecular wound and scar pathophysiology have allowed for development of new treatment concepts. Clinical effectiveness of these experimental therapies is currently being evaluated. In this review, we discuss current topical therapies for craniofacial burn injuries and emerging new therapeutic concepts that are highly translational.
Dietary supplements are frequently used in surgical patients. Surgeons should be uptodate with regards to the efficacies and potential complications related to these supplements. This manuscript provides the most updated practices and evidence of commonly used supplements.
Over the course of recent years, nanoparticles have been the center of attention used to treat many health related diseases. Nanoparticles are used due to it being efficient and having the ability to overcome certain biological barrier such as tumor, malignant melanoma, and treating HIV. Nanoparticles are known to have many different manipulating structures and characteristics which gives these particles a huge advantage in treating cancer. Nanoparticles are also used in tumor suppression due to their extraordinary ability of modifying their cell surface. One of the other great advantages of nanoparticles is to treat malignant melanoma. Two of the main components used in malignant melanoma therapy is poly(ε-caprolactone) (PCL) and poly(ethylene glycol) (PEG). Both components being FDA approved, have extraordinary effects in drug delivery through nanotechnology if used in a conjugated manner. One of the barriers faced in malignant melanoma therapy is losing the ability to encapsulate and retain a drug if ligands on the surface adjust the chemical properties of the polymer, which can be overcome by the use of dopamine. Nanoparticles have been greatly advantageous in breaking through barrier of successful HIV therapy. To treat this retroviral disease, the use of solid lipid nanoparticles is made due to it being able to improve the long-term stability of colloidal nanoparticles.
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Objectives: Considering the optimal efficacy of bromelain for pain relief and wound healing, this study aimed to assess the effect of bromelain on wound healing, pain, and bleeding at the donor site following free gingival grafting (FGG). Materials and methods: This randomized, controlled double-blind clinical trial was performed on 26 patients with gingival recession. The patients were randomly divided into two groups of bromelain and placebo (n=13). Treatment was started on the day of surgery and was continued for 10 days. Pain, bleeding, and epithelialization at the donor site were the variables evaluated in this study using a questionnaire. The level of pain was determined using a visual analog scale (VAS) considering the number of analgesic tablets taken within 7 days postoperatively. Bleeding was determined according to the patient's report, and epithelization was assessed by applying 3% hydrogen peroxide (H2O2) to the donor site. The donor site epithelialization was assessed at 7 and 10 days after surgery. Results: Bromelain caused a significant reduction in pain at the donor site (2.605±0.509) compared to the placebo (4.885±0.519; P<0.05). The number of donor sites with complete epithelialization was higher in the bromelain group compared to the placebo, but this difference was not statistically significant (P>0.05). The two groups were the same regarding postoperative bleeding (P>0.05). Conclusions: The results showed that oral bromelain (500 mg/day) can be effective in the reduction of pain at the donor site after FGG and may also enhance wound healing. Oral bromelain does not increase the risk of postoperative bleeding.
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Background: Hyaluronic acid is an ideal facial filler, however, although established as both safe and effective, complications do occur. Treatment recommendations that combine both expert opinions and clinical trial data are currently lacking, partly due to difficulties with diagnoses, nonspecific diagnostic investigations, and certain disorders presenting with similar symptoms, thereby confounding diagnosis and treatment. Methods: The purpose of this article was to provide the aesthetic clinician with practical recommendations regarding complication diagnosis arising as a consequence of hyaluronic acid filler rejuvenation treatment. It also provides recommendations for their management using step-wise treatment algorithms that are based on published expert opinions, as well as the author’s clinical experience. Results: Algorithms are provided for the most common categories of complication associated with hyaluronic acid filler treatment, that is, skin discoloration, edema, nodules, infection, and vascular compromise. Conclusions: These guidelines are not intended to be complete or exhaustive but may prove informative for aesthetic clinicians who are responsible for treating patients with hyaluronic acid fillers. It may help to guide them on recognizing potential complications and it provides clear guidance on optimum treatment pathways.
The effects of bromelain were examined in rats with subcutaneous carrageenin-induced inflammation. After oral in vivo administration, bromelain (10 and 20 mg/kg p.o.) induced a significant decrease of both PGE(2) and substance P concentrations in the exudate. When added to the inflammatory exudate in vitro, the drug (25, 50, 100 mug/ml) did not affect PGE(2) concentrations and induced an increase in the substance P levels. Our data indicate that bromelain reduces the production of two key mediators of inflammation. This effect does not seem to be related to a direct action of the drug on PGE(2) and SP released in the exudate in response to the inflammatory stimulus. Copyright (C) 2002 S, Karger AG, Basel.
Bromelains consist of a group of proteolytic enzymes of Bromeliaceae. They are commonly used in pharmaceutical industries, food production and in diagnostic laboratories. Bromelains are known to cause IgE-mediated reactions of both the immediate type and the‘late phase reaction of immediate type reaction’ with predominantly respiratory symptoms. We report four cases of occupational allergy to bromelain in workers of a blood grouping laboratory. These observations prompted us to investigate the sensitization rate to bromelain in all workers of the particular diagnostic laboratory who had contact with bromelain. These results were compared with those obtained from healthy, randomly selected individuals without evident bromelain exposure. Our findings indicate that (i) bromelain is a strong sensitizer, (ii) sensitization usually occurs due to inhalation and not to ingestion, (iii) bromelain allergy is occupationally acquired, and adequate precautions are necessary. We can further state that (iv) skin testing with relatively pure allergens such as isolated proteases like bromelain may induce systemic reactions, even at very high dilutions.
The proteolytic enzymes in this plant product, not yet in commercial production, may find application, as do similar agents from other sources, in the bating of hides, tenderizing of meat, chill-proofing of beer and other directions suggested in this article.
A 58-year-old pharmaceutical worker regularly developed asthma and rhinitis when handling bromelain, a purified protease of pineapple (Ananas comosus), at her workplace, where she had been employed for about 10 years. RAST and prick test showed strong positive reactions to bromelain. Both inhalation test with 0.03 mg bromelain and peroral challenge by ingestion of 190 g pineapple resulted in asthmatic reactions; the latter challenge was accompanied by gastrointestinal symptoms. Five of six workers sensitized to papain, showed positive RAST and skin test results to bromelain, two of them also showed immediate asthmatic reactions after bronchial challenge with bromelain. Out of sixty asthmatics not exposed to airborne proteases but probably to these as constituents of foods, two had positive skin test results and eight had positive RAST results to bromelain; but in no case was there clear evidence for clinical sensitization. The presented data prove conclusively that bromelain is capable of inducing IgE mediated respiratory and gastrointestinal allergic reactions. Furthermore, there is evidence for immunological cross-reaction between the two plant proteases bromelain and papain in human subjects.
Two cases are reported of bronchial asthma caused by inhalation of bromelin, a proteolytic enzyme utilized in some anti-inflammatory medicine. Prick test results with bromelin extract were positive. Inhalation tests gave immediate reactions which were blocked by sodium cromoglycate, but not corticosteroids.
Bromelain, a standardized complex of proteases from the pineapple plant, is absorbed unchanged from the intestine of animals at a rate of 40%; in animal experiments it was found to have primarily anti-edema, antiinflammatory, and coagulation-inhibiting effects. These effects are due to an enhancement of the serum fibrinolytic activity and inhibition of the fibrinogen synthesis, as well as a direct degradation of fibrin and fibrinogen. Bromelain lowers kininogen and bradykinin serum and tissue levels and has an influence on prostaglandin synthesis, thus acting antiinflammatory. In in vitro and in animal studies, experimentally induced tumours could be inhibited by bromelain. Although many studies do not give extensive statistical data, the effects of bromelain in animal studies seem to be dose-dependent. Further investigations have to be carried out.
Bromelains consist of a group of proteolytic enzymes of Bromeliaceae. They are commonly used in pharmaceutical industries, food production and in diagnostic laboratories. Bromelains are known to cause IgE-mediated reactions of both the immediate type and the 'late phase reaction of immediate type reaction' with predominantly respiratory symptoms. We report four cases of occupational allergy to bromelain in workers of a blood grouping laboratory. These observations prompted us to investigate the sensitization rate to bromelain in all workers of the particular diagnostic laboratory who had contact with bromelain. These results were compared with those obtained from healthy, randomly selected individuals without evident bromelain exposure. Our findings indicate that (i) bromelain is a strong sensitizer, (ii) sensitization usually occurs due to inhalation and not to ingestion, (iii) bromelain allergy is occupationally acquired, and adequate precautions are necessary. We can further state that (iv) skin testing with relatively pure allergens such as isolated proteases like bromelain may induce systemic reactions, even at very high dilutions.