Title: Peri-Operative Role of Proteases (Bromelain + Rutosides) in Surgical Patients- A Prospective Clinical Trial
Authors: Dr Swarup Chakraborty, Dr Pinaki Roy
DOI: https://dx.doi.org/10.18535/jmscr/v8i4.70
Abstract
Background: Proteases are naturally occurring enzymes that have received traditional footage in medical treatment. Enzyme preparations have also entered modern medicine since 1960s. Trypsin, Bromelain and Rutosides preparations have recently boomed into the medical prescriptions, claiming a better resolution of inflammatory symptoms, thereby anticipating a faster healing of the surgical wound.
This study aims to prospectively approach and determine the efficacy of these newer proteases with respect to certain fixed parameters of surgical prophylaxis.
Methods: A prospective study on 50 elective surgery patients during a period of 12 months comparing placebo with bromelain trypsin and rutoside oral combinations.
Results: Statistically significant reduction in post-operative edema, seroma and hematoma formation, reduced pain and surgical site infection with better surgical scar coupled with reduction in secondary suturing rates were observed.
Conclusion: The current study thus concludes that oral protease combinations in the peri operative period favorably accelerates healing process culminating into a shorter and better recovery.
References
- Henderson R. Catalytic activity of alpha-chymotrypsin in which histidine-57 has been methylated. Biochem J 1971;124 (1):13-18.
- Xue M, Jackson CJ. Extracellular matrix re-organization during wound healing and its impact on abnormal scarring. Adv. Wound Care 2015;4(3):119-36.
- Comparative study of flavonoids in experimental models of inflammation Alejandra Ester Rotelli, , Teresita Guardia, Américo Osvaldo Juárez, Nadir Ernesto de la Rocha, Lilian Eugenia Pelzer. Pharmacological Research 48, (6), 2003; 601–606. 21.
- Latha B, Ramakrishnan KM, Jayaraman V, Babu M; Action of trypsin-chymotrypsin (chymoral forte ds) preparation on acute phase proteins following burn injury in humans. Burns 1997 Mar1;23: S3-7
- Bromelain: biochemistry, pharmacology and medical use. Cell Mol Life Sci. 2001 Aug;58(9):1234-45.
- Rutoside decreases human macrophage-derived inflammatory mediators and improves clinical signs in adjuvant-induced arthritis Tina Kauss1, Daniel Moynet, Jérôme Rambert, Abir Al-Kharrat, Stephane Brajot, Denis Thiolat, Rachid Ennemany, Fawaz Fawaz and M Djavad Mossalayi Arthritis Research & Therapy 2008,10.
- Sulniute R, ShenY, Guo YZ,…et al. Plasminogen is critical regulator of cutaneous wound healing. Thrombosis Haemostasis. 2016 May;115(05):1001-9.
- Ambrus JL, Lassman HB, De Marchi JJ, Absorption of exogenous and endogenous proteolytic enzymes. Clin. Pharmacol Therapeut. 1967 May1;8(3):362-8
- Bruni M, Quarti GT, Baresi A, Bellinzoni G. A follow up of the protein pattern after operations in patients treated with an oral enzyme. Arzneimittel- Forschung. 1980;30 (11):1922-5.
- Apsangikar P, Naik M, Tike C. Analysis of an open multicentric study of the efficacy, safety and tolerability of Chymoral forte in resolving signs and symptoms of inflammation in patients of traumatic injuries. Hospital Today. 2005;10(1).
- Taussig SJ, et al. Bromelain, the enzyme complex of pineapple (Ananascomosus) and its clinical application. An update. J Ethnopharmacol. 1988; 27:191-203.
- Felton GE. Fibrinolytic and antithrombotic action of bromelain may eliminate thrombosis in heart patients. Med Hypotheses. Nov1980;6(11):1123-33 La Cassa C, Villegas I, Alacron de la Lastra C, Motilva V, Martin Calero MJ. Evidence for protective and antioxidant properties of rutin, a natural flavone, against ethanol induced gastric lesions. J Ethnopharmacol. 2000; 71: 45-53.
- La Cassa C, Villegas I, Alacron de la Lastra C, Motilva V, Martin Calero MJ. Evidence for protective and antioxidant properties of rutin, a natural flavone, against ethanol induced gastric lesions. J Ethnopharmacol. 2000; 71: 45-53
- Kondreddy S et al. Int Surg J. 2019 Jan;6(1): 283-86.