Effect of American ginseng (Panax quinquefolius L.) on arterial stiffness in subjects with type-2 diabetes and concomitant hypertension

ETHNOPHARMACOLOGICAL RELEVANCE

Substantial pre-clinical and some clinical data are available showing that Asian ginseng (Panax ginseng C.A. Meyer) varieties or its particular ginsenosides exert a vasodilatating effect, thus may modulate vascular function. However, the clinical evidence for American ginseng (Panax quinquefolius L.) is scarce. Therefore, this study evaluates the effect of American ginseng (AG) on arterial stiffness, as measured by augmentation index (AI), and blood pressure (BP), in type 2 diabetes patients with concomitant hypertension.

MATERIALS AND METHODS

Using a double-blind, placebo-controlled, parallel design, each participant was randomized to either the selected AG extract or placebo at daily dose of 3g for 12 weeks as an adjunct to their usual antihypertensive and anti-diabetic therapy (diet and/or medications). AI and BP were measured by applanation tonometry at baseline and after 12 weeks of treatment.

RESULTS

A total of 64 individuals with well-controlled essential hypertension and type 2 diabetes (gender: 22 M:42 F, age:63 ± 9.3 years, BP: 145 ± 10.8/84 ± 8.0 mmHg, HbA1c: 7.0 ± 1.3%, fasting blood glucose (FBG): 8.1 ± 2.3 mmol/L) completed the study. Compared to placebo, 3g of AG significantly lowered radial AI by 5.3% (P=0.041) and systolic BP by 11.7% (P<0.001) at 12 weeks. No effect was observed with diastolic BP.

CONCLUSIONS

Addition of AG extract to conventional therapy in diabetes with concomitant hypertension improved arterial stiffness and attenuated systolic BP, thus warrants further investigation on long-term endothelial parameters before recommended as an adjunct treatment.

Etiology and epidemiology of obstructive jaundice in Continental Croatia

The etiology and epidemiology of obstructive jaundice in Continental Croatia has been studied in 174 patients. The objective of this research was also to explore the importance and efficiency of endoscopic retrograde cholangiopancreatography (ERCP) as a non-surgical method of treatment of obstructive jaundice in the population of Continental Croatia. Obstructive jaundice is the illness of elderly population which is also confirmed by the information on the average age of our patients. The frequency of illness is higher among female population, and the most frequent cause of obstructive jaundice are gallstones (54.1% of patients). In 29.8% of patients the primary or secondary malignant disease was the cause of blockage in gall flow and subsequent jaundice, and the most frequent malignant cause of obstructive jaundice is pancreas cancer in 11.5% of patients. The mean value of serum concentrations of total bilirubin, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase and gamma glutamiltransferase 24 hours before the biliary decompression by ERCP has been significantly above the upper referential value, and 24 hours after the ERCP it has dropped to normal with their statistically significant difference (p < 0.0001). The normal values of markers for synthetic liver function (total proteins and prothrombin time) have been noticed as well as elevated values of inflammatory markers in obstructive jaundice independently of etiology. Out of the total number of patients, 37.7% required the surgical treatment while 60.3% of patients were treated by ERCP, i.e. either the stone extraction or the implantation of endobiliary stent was performed.

Effect of American ginseng (Panax quinquefolius L.) on glycemic control in type 2 diabetes

Since diabetes tends to progressively worsen over time, glycemic control often deteriorates in spite of taking regular therapy. Therefore, numerous research studies are by and large focused on finding more efficient therapy, both new medicines for treating type 2 diabetes mellitus, as well as supplements that could serve as an addition to conventional treatment modalities. A variety of herbal preparations have been shown to have modest short-term beneficial effects on glycemia, but of these, the best studied is American ginseng (AG). AG has been shown to be effective in improving glycemic control in type 2 diabetes through increasing post-prandial insulin levels and decreasing postprandial glycemic response. However, high variability in ginsenosides may result in just as high variability in antidiabetic efficacy of over-the-counter ginseng products. Therefore, the availability of standardized extracts of AG could assist greatly in advancing our knowledge on the role of this traditionally used herb and result in a wider application of ginseng product in diabetes management. The aim of this review is to outline the efficacy and safety of American ginseng for AG preparations on glycemic control in patients with type 2 diabetes as well as to increase awareness of the evidence supporting the use of these therapies in diabetes care.

The antioxidative protecting role of the Mediterranean diet

Recent meta-analysis shows that adherence to a Mediterranean diet (MD) can significantly decrease the risk of overall mortality, mortality from cardiovascular diseases, as well as incidence of mortality from cancer, and incidence of Parkinson's and Alzheimer's disease. All of these diseases could be linked to oxidative stress (OS) as antioxidative effect of MD is getting more attention nowadays. Although a lot of research has been done in this area and it suggests antioxidative protective role of MD, the presented evidence is still inconclusive. The aim of this paper is to review studies investigating the effect of MD on OS, as well as to identify the areas for further research.

Atrial fibrillation, atrioventricular blocks and bundle branch blocks in hemodialysis patients

Atrial fibrillation is one of the most frequent arrhythmias diagnosed in clinical practice and it is also relatively common in dialysis patients. Atrioventricular and intraventricular conduction disturbances are less investigated in hemodialysis patients and data about their prevalence are insufficient. The objective of this study was to determine the prevalence of atrial fibrillation, atrioventricular blocks and bundle branch blocks in hemodialysis patients and to analyze different clinical risk factors. The study included 140 patients on long-term hemodialysis treatment. The presence of atrial fibrillation, atrioventricular blocks and bundle branch blocks was determined by electrocardiogram. Patients were divided into groups depending on the presence or absence of atrial fibrillation/bundle branch blocks and investigated variables were compared. Atrial fibrillation was present in 11 (7.9%) of the 140 patients. In multivariate analysis, age and higher concentration of uric acid were associated with atrial fibrillation. Prevalence of first-degree atrioventricular block was 2.9% (4 patients) and second- and third-degree atrioventricular blocks were not found. Prevalence of bundle branch blocks was 17.1% (24 patients): 5% of patients had a complete right bundle branch block, 6.4% had an incomplete right bundle branch block, 3.6% had a complete left bundle branch block and 2.1% of patients had an incomplete left bundle branch block. The prevalence of atrial fibrillation and bundle branch blocks in this study was relatively high in patients on hemodialysis and greater than that observed in general population. Presence of atrial fibrillation was associated with older age and higher concentration of uric acid.

Correlation of endothelin-1 concentration and angiotensin-converting enzyme activity with the staging of liver fibrosis

Increased serum angiotensin-converting enzyme (SACE) activity and serum concentration of endothelin-1 (ET-1) were found in liver cirrhosis. We investigated a correlation between the different stages of liver fibrosis and SACE activity and serum ET-1 concentration. Seventy patients with pathohistologically established chronic liver disease were divided in three groups according to Ishak criteria for liver fibrosis: minimal fibrosis (Ishak score 0-1, n =20), medium fibrosis (Ishak score 2-5, n=20) and cirrhosis (Ishak score 6, n=30). SACE activity and ET-1 concentration were determined using commercial ELISA kits. SACE activity and ET-1 concentrations were proportional to the severity of disease, the highest being in patients with liver cirrhosis. Maximal increase in SACE activity was found between minimal and medium fibrosis while maximal increase in ET-1 concentration was revealed between medium fibrosis and cirrhosis. The analysis of the Receiver Operating Characteristic (ROC) curve for SACE activity suggested a cut-off value to separate minimal from medium fibrosis at 59.00 U/L (sensitivity 100%, specificity 64.7%). The cut-off value for serum ET-1 concentration to separate medium fibrosis from cirrhosis was 12.4 pg/mL (sensitivity 96.8%, specificity 94.4%). A positive correlation between SACE activity and ET-1 concentration was registered (Spearman's ñ = 0.438, p = 0.004). Both SACE activity and ET-1 concentration were increased in all stages of liver fibrosis. Cut-off points for SACE activity and ET-1 concentration could be a biochemical marker for the progression of fibrosis. Positive correlation between SACE activity and ET-1 concentration might indicate their interaction in the development of liver cirrhosis.

Oxidative stress markers in patients with post-traumatic stress disorder

Recent study data support the role of oxidative stress in diverse psychiatric disorders. Oxidative stress results from an oxidant/antioxidant imbalance, an excess of oxidants and/or a depletion of antioxidants. There are numerous studies that indicate that free radicals (FRs) damage neurons, and then play an important role in the pathophysiology of schizophrenia and depression. Active oxygen can cause considerable damage and disrupt the important physiological functions of proteins, lipids, enzymes and DNA. The aim of our study was to investigate the possible differences in the concentration of tromboxane B2, 8-OHdG and protein carbonyls, as significant markers of oxidative damage, and urate, albumin and total protein concentrations as antioxidative molecules in PTSD patients in comparison to the healthy control group. The study included 74 male participants who were active soldiers in the Croatian armed forces from 1991 to 1995. 46 subjects with chronic and current PTSD were recruited from the Department of Psychiatry of Dubrava University Hospital during 2010, 28 healthy subjects were recruited in the same period during the regular medical examination at the Dubrava University Hospital. Study results have shown that there is no statistically significant difference in urinary concentrations of 8-OHdG, serum thromboxane B2, and serum urates between two studied groups. Statistically significant difference of the protein carbonyl concentrations was examined. Concentrations were significantly lower in the PTSD group than in the control group. The clinical significance of these results was examined using ROC analysis. The obtained ROC curves did not separate the groups in a satisfactory manner.

Antifibrotic activity of Taraxacum officinale root in carbon tetrachloride-induced liver damage in mice

AIM OF THE STUDY

Dandelion (Taraxacum officinale) has been traditionally used in the treatment of various liver disorders. The present study was aimed to assess the efficacy of dandelion root water-ethanol extract (DWE) in carbon tetrachloride (CCl(4))-induced hepatic fibrosis.

MATERIALS AND METHODS

The mice were treated with CCl(4) dissolved in olive oil (20%, v/v, 2 ml/kg) intraperitoneally (i.p.), twice a week for 4 weeks. DWE was administered i.p. once daily for next 10 days, in doses of 200 and 600 mg/kg of body weight. The degree of hepatic fibrosis was determined by hydroxyproline content and Mallory trichrome staining. Oxidative stress was determined by measuring hepatic superoxide dismutase (Cu/Zn SOD) activity. The expression and specific tissue distribution of glial fibrillary acidic protein (GFAP), alpha-smooth muscle actin (alpha-SMA), and metallothionein (MT) I/II in the liver were determined by immunohistochemistry.

RESULTS

Hepatic Cu/Zn SOD activity has been decreased in intoxicated mice and normalized in DWE treated groups. MT I/II immunopositivity was strongly reduced in the CCl(4) group. DWE treatment successfully decreased hepatic fibrinous deposits, restored histological architecture, and modulate the expression of GFAP and alpha-SMA. Concomitantly, MT I/II expression increased in the DWE treated groups.

CONCLUSIONS

Our results suggest the therapeutic effect of DWE on CCl(4)-induced liver fibrosis by the inactivation of hepatic stellate cells and the enhancement of hepatic regenerative capabilities. The present results provide scientific evidence to substantiate the traditional use of Taraxacum officinale root in hepatic disorders.

Endothelin-1, big endothelin-1, and nitric oxide in patients with chronic renal disease and hypertension

The complex pathogenesis of chronic renal disease (CRD) depends on endothelin (ET) axis (ETs and ET receptors) and nitric oxide (NO) because of their vasoactive effects and their role in general modulation of vascular homeostasis. Various renal cells synthesize ETs and NO that play a significant role in renal hemodynamics as well as in water and salt excretion via urine. ET-1 is a strong vasoconstrictor. Besides its vasoactive effects, ET-1 modulates mitosis and apoptosis in a cell type-dependent manner, and may play an important role in CRD pathogenesis. The aims of this study were to emphasize the role and interactions of ET-1, Big ET-1, and NO in CRD. Concentrations of these vasoactive molecules were measured in plasma/serum and/or urine of 57 patients with diabetic nephropathy (subgroup 1), arterial hypertension (subgroup 2) or CRD with chronic renal insufficiency (subgroup 3), and in healthy control subjects (n=18). In comparison with control group, urine concentration of Big ET-1 was significantly increased (13.13 pmol/L vs. 11.34 pmol/L; P<0.001) in CRD patients, whereas plasma and urine concentrations of ET-1 did not differ significantly. NO concentrations were also significantly increased in CRD patients (serum, 72.55 micromol/L; P<0.001, and urine 141.74 micromol/L; P<0.05) as compared to control group. Study results indicated that Big ET-1 and NO could be useful diagnostic parameters in CRD for their diagnostic sensitivity and diagnostic specificity (Big ET-1 in urine: 56.1 and 88.9%, and NO in serum: 66.7 and 83.3%, respectively). In addition, Big ET-1 may prove useful in the differential diagnosis of diabetic nephropathy (78.6% diagnostic sensitivity and 88.9% diagnostic specificity).

Homocysteine and serum lipids concentration in male war veterans with posttraumatic stress disorder

The evidence of increased cardiovascular disease (CVD) risk in posttraumatic stress disorder (PTSD) is accumulating. The present study aimed to determine whether chronic, combat-related PTSD is associated with serum lipid and homocysteine concentrations that could indicate higher CVD risk. The authors tested 66 war veterans with PTSD, 33 war veterans without PTSD, and 42 healthy volunteers for serum concentrations of homocysteine, total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and triglycerides. All the subjects were men and the analyses were adjusted for age, body mass index and smoking. Potential influences of depression, anxiety, and psychotic symptoms on the outcome measures were checked by introducing the scores from the Hamilton Depression Rating Scale (HAM-D-17), the Hamilton Anxiety Scale (HAMA), and the Positive and Negative Syndrome Scale (PANSS) into the overall statistical model. No differences in total cholesterol, LDL-C, HDL-C and triglycerides were found between the groups. Non-smoking PTSD war veterans had higher homocysteine concentrations (mean=10.4 micromol/L, SD=1.7) when compared to non-smoking war veterans without PTSD (mean=8.2 micromol/L, SD=4.0, P=0.014) and both smoking (mean=8.7 micromol/L, SD=2.3, P=0.008) and non-smoking healthy volunteers (mean=8.8 micromol/L, SD=2.2, P=0.021). The results of our cross-sectional study are possibly confounded by many factors, especially behavioral and life-style related which are difficult to control comprehensively and might have influenced serum lipids and homocysteine concentration in a complex manner. An increase in the homocysteine concentration observed in the non-smoking PTSD patients needs further investigation with a carefully designed prospective study to confirm associated, possibly enhanced CVD risk.

The association between upper gastrointestinal lesions and high-sensitivity C-reactive protein in coronary artery disease patients

BACKGROUND

Although high-sensitivity C-reactive protein (hs-CRP) testing is not specific for coronary atherosclerosis, elevated hs-CRP is recently accepted as an independent predictor of future cardiovascular events. Also, a connection between upper gastrointestinal lesions (UGILs) and coronary artery disease (CAD) has been observed. The authors hypothesized that UGILs increase hs-CRP in CAD patients.

MATERIAL/METHODS

One hundred fifty patients with stable CAD were enrolled in the study. Demographic and clinical variables and chronic medication used were gathered from a structured questionnaire. UGIL severity was determined by a modified Lanza score, H. pylori status by histology of the gastric mucosa, and the severity of CAD by a modified Gensini score. Independent correlation between hs-CRP and UGIL was tested by logistic regression analysis.

RESULTS

The overall hs-CRP value was higher in patients with UGIL than in those with normal endoscopic results (8.14+/-4.53 mg/l vs. 4.64+/-3.06 mg/l, P<0.0001). hs-CRP level positively correlated with UGIL severity (r=0.434, P<0.0001). Correlation between UGIL and hs-CRP level remained significant after adjustment for coronary risk factors, medication used, CAD severity, and H. pylori status (standardized coefficient beta=1.272, P<0.0001). However, when hs-CRP level was used as a categorical variable, multivariate analysis revealed independent correlation only between UGIL and hs-CRP categories > or =6.1 mg/l.

CONCLUSIONS

Elevated hs-CRP levels may be predictive of UGIL; thus endoscopy should be considered in CAD patients with elevated hs-CRP even with no dyspeptic symptoms. Because CRP plays an active role in atherothrombosis, UGILs with subsequent elevated CRP levels could increase cardiovascular risk in those patients.

[Gastroduodenal mucosal lesions and coronary atherosclerosis severity in patients with coronary artery disease]

AIM

Due to high metabolic activity and oxygen demands, ischemia of gastroduodenal (GD) mucosa is an important factor in the pathogenesis of its impairment. Comparing the degree of coronary atherosclerosis, for evaluation of severity of atherosclerosis, with the prevalence and severity of GD mucosal lesions, we wanted to investigate the possible ischemia of GD mucosa could contribute to its impairment.

PATIENTS AND METHODS

This prospective study included 150 coronary artery disease (CAD) patients, 109 (72.7%) male and 41 (27.3%) female, average age 62.61 +/- 10.23 years. We noted clinical and anthropometric parameters, standard laboratory findings, treatment until inclusion into the study and standard cardiovascular risk factors. The severity of CAD was assessed by several parameters: 1) number of coronary arteries affected with atherosclerosis, 2) modified Gensa score, and 3) number of coronary arteries with stenosis > 50%. The severity of GD mucosal lesions was assessed by modified Lanza score, and Helicobacter pylori infection was confirmed by biopsy and pathohistological analysis of GD mucosa. Predictive value of different independent factors regarding the presence of GD mucosal lesions was assessed by multivariate analysis.

RESULTS

The severity of CAD in patients with or without GD mucosal lesions did not differ by any of used scoring methods: 1) number of coronary arteries affected by atherosclerosis (2.15 +/- 0.85 vs. 2.00 +/- 0.87, p = 0.292), 2) modified Gensa score (71.22 +/- 51.78 vs. 69.89 +/- 54.18, p = 0.881), 3) number of coronary arteries with stenosis > 50% (3.89 +/- 2.05 vs. 3.47 +/- 2.25, p = 0.244). We also noticed that there had been no correlation between severity of CAD and severity of GD mucosal lesions. Correlation of number of coronary arteries affected with atherosclerosis with Lanza score resulted in r = 0.029, p = 0.721, correlation of Genza score with Lanza score resulted in r = 0.019, p = 0.082, and correlation of the number of coronary arteries with stenosis > 50% with Lanza score resulted in r = 0.079, p = 0.337.

CONCLUSION

According to available method for evaluating the severity of CAD, in CAD patients ischemia has no or very minor role in pathogenesis of GD mucosa impairment.

The role of endothelin-1 and nitric oxide in the pathogenesis of hypertension in diabetic patients

The pathogenesis of renal hypertension has not yet been fully clarified. As the potential role of endothelin-1 (ET-1) and nitric oxide (NO) has been postulated, their concentrations were determined in plasma and urine of diabetic patients. The study included 30 diabetic patients (both IDDM and NIDDM) with initial or advanced diabetic nephropathy (decreased endogenous creatinine clearance, proteinuria) and 20 healthy control subjects. The correlation with blood pressure and other renal function parameters was monitored and compared with the control group. Also, the effect of ACE inhibitors (ACEI) on ET-1 and NO patterns was monitored in correlation with arterial hypertension. In diabetic patients that did not receive ACEI therapy, the increase in plasma ET-1 was associated with both systolic and diastolic blood pressure elevation, whereas in those administered ACEI the increase in plasma ET-1 was associated with a systolic blood pressure decline. In addition, the increase in plasma NO was accompanied by a statistically significant decline of both systolic and diastolic blood pressure in diabetic patients receiving ACEI.

In vivo study of propolis supplementation effects on antioxidative status and red blood cells

In vivo study has been conducted on 47 healthy women and men in order to investigate whether daily intake of powdered propolis extract during 30 days has any influence on the following blood parameters: activity of superoxide dismutase, glutathione peroxidase and catalase, concentration of plasma malondialdehyde, total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides, glucose, uric acid, ferritin and transferrin, together with routine red blood cell parameters. The effect of daily propolis intake seems to be time and gender related. For the men test group after the initial 15 days of propolis treatment, 23.2% (p=0.005) decrease in concentration of malondialdehyde was observed. After 30 days of treatment, statistically significant (p=0.010) 20.9% increase in superoxide dismutase activity and change in some of the red blood cell parameters were detected. For the women test group, the propolis treatment did not induce a change in any of the measured parameters.

Evidence of an acute phase response in dogs naturally infected with Babesia canis

The erythrocyte sedimentation rate (ESR), white blood cell count (WBC), haematocrit (HCT) and platelet number (PLT) were quantified and compared with the acute phase proteins (APPs) in dogs naturally infected with Babesia canis and healthy dogs. Both groups were treated with imidocarb dipropionate on the day of admission and both groups were monitored for all parameters on the admission day and on the first, second, third, fourth and seventh days in order to determine the presence of an acute phase reaction, to assess the diagnostic value of these markers in uncomplicated canine babesiosis and to evaluate the use of APPs in treatment monitoring. It was demonstrated that an acute phase response occurs in dogs naturally infected with Babesia canis, with significant increases in the concentration of major acute phase proteins. The serum concentration of C-reactive protein (CRP), serum amyloid A (SAA) and the erythrocyte sedimentation rate (ESR) decreased daily after treatment and approached reference range values by the eighth day. PLT and haematocrit (HCT) increased daily after treatment and approached reference range values by the fourth day. WBC and haptoglobin increased after treatment and then decreased from the third and fourth days, respectively, to the eighth day. The diagnostic sensitivity of CRP, SAA and PLT was significantly higher compared to haptoglobin, ESR, HCT and the WBC count. CRP and SAA were of clinical use in monitoring the response to antibabesial treatment.

Serum concentration of zinc, copper, manganese and magnesium in patients with liver cirrhosis

The role of trace elements in the pathogenesis of liver cirrhosis and its complications is still not clearly understood. Serum concentrations of zinc, copper, manganese and magnesium were determined in 105 patients with alcoholic liver cirrhosis and 50 healthy subjects by means of plasma sequential spectrophotometer. Serum concentrations of zinc were significantly lower (median 0.82 vs. 11.22 micromol/L, p < 0.001) in patients with liver cirrhosis in comparison to controls. Serum concentrations of copper were significantly higher in patients with liver cirrhosis (median 21.56 vs. 13.09 micromol/L, p < 0.001) as well as manganese (2.50 vs. 0.02 micromol/L, p < 0.001). The concentration of magnesium was not significantly different between patients with liver cirrhosis and controls (0.94 vs. 0.88 mmol/L, p = 0.132). There were no differences in the concentrations of zinc, copper, manganese and magnesium between male and female patients with liver cirrhosis. Only manganese concentration was significantly different between Child-Pugh groups (p = 0.036). Zinc concentration was significantly lower in patients with hepatic encephalopathy in comparison to cirrhotic patients without encephalopathy (0.54 vs. 0.96 micromol/L, p = 0.002). The correction of trace elements concentrations might have a beneficial effect on complications and maybe progression of liver cirrhosis. It would be recommendable to provide analysis of trace elements as a routine.

[A randomized, double-blind, placebo-controlled study of the antilipemic efficacy and tolerability of food supplement policosanol in patients with moderate hypercholesterolemia]

This randomized, double-blind, placebo-controlled crossover study was performed in 67 patients of both sexes aged 20 to 78 years with moderate hypercholesterolemia to investigate the antilipemic efficacy and tolerability of food supplement policosanol--a mixture of aliphatic primary alcohols from rice (Oryza sp.). After a 8-week run-in period in which patients were placed on therapeutic lifestyle changes, in particular cholesterol-lowering diet, they were randomly assigned to receive policosanol 10 mg capsules or placebo capsules once daily with the evening meal for 8 weeks. During next 8 weeks those receiving policosanol during the first 8 weeks, received placebo and those taking placebo during the first 8 weeks, received policosanol. Total cholesterol (C), LDL-C, HDL-C, HDL2-C, HDL3-C, triglycerides, oxidized LDL, apoproteins A I and B and lipoprotein (a) as well as AST, ALT, GGT, CK, blood glucose and bilirubin were determined before the treatment, after the first part of the study i.e. after the first 8 weeks and at the end of the study, i.e after the second 8 weeks. Policosanol significantly reduced plasma total cholesterol and increased apoprotein A I but did not change plasma triglycerides, HDL-C, HDL2-C, HDL3-C, LDL-C, oxidized LDL, Lp (a) and apoproteinS. It was well tolerated, with no drug-related effects on safety parameters such as serum aminotransferases, blood glucose, bilirubin, and CK, neither did it cause any clinical adverse reactions.

Effects of Rice Policosanol on Serum Lipoproteins, Homocysteine, Fibrinogen and C-Reactive Protein in Hypercholesterolaemic Patients

BACKGROUND

Policosanol is an agent that includes mixtures of aliphatic primary alcohols extracted primarily from sugar-cane wax. This mixture has been shown to lower total and low-density lipoprotein (LDL) cholesterol in animal models, healthy volunteers and hypercholesterolaemic patients.

PATIENTS AND METHODS

This study investigated the efficacy and tolerability of rice policosanol (Oryza sp.) 10 mg/day in 70 hypercholesterolaemic patients of both sexes aged 20-78 years in a randomised, double-blind, crossover, placebo-controlled, single-centre trial. After an 8-week run-in period during which patients were placed on therapeutic lifestyle changes, in particular a cholesterol-lowering diet, they were randomly assigned to receive rice policosanol 10mg tablets or placebo tablets once daily with the evening meal for 8 weeks. During the next 8 weeks those patients who received policosanol during the first 8 weeks received placebo, and those who received placebo during the first 8 weeks, received policosanol. Total, LDL, high-density lipoprotein (HDL), HDL2 and HDL3 cholesterol, triglycerides, oxidised LDL (ox-LDL), apoproteins (Apos) AI and B, lipoprotein (a) [Lp(a)], fibrinogen, homocysteine and C-reactive protein (CRP) levels were measured.

RESULTS

Rice policosanol significantly reduced plasma total cholesterol from 7.37 +/- 1.42 mmol/L to 6.99 +/- 1.33 mmol/L (p = 0.007) and increased Apo AI from 1.49 +/- 0.39 mmol/L to 1.58 +/- 0.38 mmol/L (p = 0.037) but did not change plasma triglycerides, HDL, HDL2, HDL3 and LDL cholesterol, ox-LDL, Lp(a), Apo B, fibrinogen, homocysteine or CRP levels.

CONCLUSION

Rice policosanol 10 mg/day moderately decreased plasma total cholesterol and increased Apo AI. Rice policosanol was also well tolerated, with no drug-related effects on safety parameters such as serum aminotransferases and creatine phosphokinase detected or found on physical examination.

Antioxidants in patients with hyperthyroidism

Hyperthyroidism is a hypermetabolic state accompanied by increased oxygen utilization, increased production of reactive oxygen species and consequentially measurable changes in antioxidative factors. Therefore, the activities of whole blood glutathione peroxidase (GPx) and erythrocyte superoxide dismutase (SOD), total antioxidant status (TAS) in serum and erythrocytes, and serum urate and transferrrin concentrations were determined in 70 women: 14 with newly diagnosed Graves' disease (group A); 28 with hyperthyroidism on therapy with methimazole (group B, divided into two subgroups, B1 and B2) and 28 healthy women (group C). In comparison with control group C, GPx activity was significantly decreased in all patient groups (p < 0.05), whereas SOD activity was significantly decreased in group A (p < 0.01) and significantly increased in group B (p < 0.01). In comparison with the control group, serum TAS activity was significantly decreased in group A, and erythrocyte TAS activity in all patient groups. Study results suggest that the impaired antioxidative factor balance leads to the development and presence of oxidative stress in women with hyperthyroidism. The severity of these alterations, considered contradictory by some authors, appears to depend on the use of therapy.

[Biochemical markers in acute coronary syndrome]

For many years, cardiac markers have been used to assist cardiologists in the diagnosis and management of patients with cardiovascular disease. At first, enzyme activities of aspartate aminotransferase, lactate dehydrogenase and creatine kinase have been used in diagnosing patients with chest pain in order to differentiate those with acute myocardial infarction. In the field of cardiac markers, emphasis is currently put on the use of protein markers such as myoglobin, and cardiac troponin T or I. Troponins are very highly cardiac specific and their concentration in blood increase only from four to six hours after the onset of chest pain. Today we obligatorily use two markers, the first being the early one (myoglobin, isoform of creatine kinase), which is very sensitive and shows up in the circulation one to two hours after myocardial damage. Confirmation of myocardial damage can be obtained by definite markers (troponin I or T), which are highly specific of myocardial damage.

[Inflammation markers in acute coronary syndrome]

Inflammation is a component of atherosclerotic plaque, but it is also a possible pathogenetic factor of acute coronary event responsible for coronary instability. Inflammatory markers are considered as new risk factors for atherosclerosis. Among others (C-reactive protein (CRP) is the best known marker of inflammatory response which is most frequently found in patients with acute myocardial infarction preceded by a period of instability. High values of inflammatory markers indicate poor prognosis after acute myocardial infarction. Therapy may lower the inflammatory component and the risk of coronary disease. Specific response of inflammatory marker during diagnostic and percutaneous coronary interventions indicates more severe coronary disease.

Paraoxonase activity and concentration of indicators of lipids status in the serum of cardiac patients

In this research, we measured the activity of paraoxonase (basal and activated) enzyme, and components of lipid status components (total cholesterol, LDL cholesterol, HDL cholesterol and Apo A I) in the serum of patients, undergoing bypass surgery. We also tested how the applied EKC affected changes of defined indicators. Measuring of all the given parameters was conducted prior to the operation, 90 minutes, 1.5 hour, 6 hours, 24 hours and 72 hours, on 29 patients (11 of them did undergo myocardium revascularization with the application of EKC, while the rest of them did not). Activity of paraoxonase (both basal and activated) changes significantly during the postoperative period, in relation to pre-operative values, p < 0.05. Total cholesterol concentration is reduced in both examined groups, regardless of the application of EKC. This trend is also accompanied by LDL cholesterol concentration. On the other hand, HDL cholesterol concentration during post-operative period does not indicate any significant statistical change in relation to pre-operative values, while we noticed difference with regard to EKC application, 90 minutes after surgery. This change of lipid status indicator is partly due to heparin, a stimulator of lipoprotein lipase that was applied during the surgery. Our conclusion is that lipid profile changes significantly after the bypass surgery, mostly regardless of the application of EKC.

Serum total, LDL, HDL cholesterol and triglycerides related to age, gender and cigarette smoking in patients with first acute myocardial infarction

The aim of this study was to examine relationships between total cholesterol, LDL, HDL cholesterol, triglycerides and age, gender, and cigarette smoking in 190 patients (132 men and 58 women) aged 34-87 years with first AMI. The control group included 103 patients (57 men and 46 women) aged 29-90 years without a history of angina pectoris or AMI. High total cholesterol (over 5.2 mmol/L) was observed in 75% of patients with AMI vs. 48% of patients in the control group (p < 0.001). Patients with AMI had significantly higher total cholesterol and LDL cholesterol levels than controls (p < 0.0001). HDL cholesterol levels were significantly lower among patients with AMI than among the control group patients (p < 0.0001). Serum total cholesterol and LDL cholesterol is higher in patients with AMI up to 60 years old, but lower in patients older than 60 years. Women aged less than 50 years had significantly higher HDL cholesterol (p < 0.001), lower LDL cholesterol (p < 0.001), and lower total cholesterol (p < 0.05) than those over 50 years. Smokers with AMI who smoked over 20 cigarettes per day had significantly higher total cholesterol, LDL cholesterol and triglycerides levels than the non-smokers (p < 0.05). These findings suggest important influences of hyperlipoproteinemia and cigarette smoking upon development of myocardial infarction, especially in younger patients.

Changes in vitamin E concentration after surgery and anesthesia

The aim of this randomized study was to examine changes in vitamin E concentration in female subjects (age 30-60, ASA I) after cholecystectomy and halothane (N = 16) or isoflurane (N = 16) anaesthesia. Vitamin E concentration was measured two days before, and then one, five and twenty-four hours and four days after surgery. High-pressure liquid chromatography was used for its determination. Simultaneously activities of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyltransferase (GGT) were determined.

STATISTICAL ANALYSIS

ANOVA, Tukay HSD test. The research has been accepted by the Drugs Committee of the Karlovac County Hospital. Preoperative vitamin E concentrations in the halothane group were 8.69 +/- 2.35 micrograms/L, median 8.67 micrograms/L and in the isoflurane group 9.43 +/- 2.4 micrograms/L, median 9.08 micrograms/L. Statistically lower vitamin E concentrations compared with preoperative values were noted one hour (P < 0.05), 5 hours (P < 0.01), 24 hours (P < 0.01), as well as 4 days (P < 0.01) after the operation. The lowest vitamin E concentrations were noted 24 hours after the operation with statistically insignificantly higher values in the isoflurane group (halothane group 5.98 +/- 2.08 micrograms/L, isoflurane group 6.58 +/- 1.51 micrograms/L). Analyzing enzyme (ALT, AST and GGT) pre- and postoperative values, no statistically significant differences between the investigated groups and during the time were observed. Statistically significant differences were found between individual measurement times, with no statistical significance of the differences between the halothane and isoflurane groups. It seems that neither the difference in halothane and isoflurane biotransformation nor their distinct effect on perfusion of some organs are the determining factors in post-operative changes in vitamin E concentration.

A contribution to the world selenium map

Atomic absorption spectrophotometric method was used to determine the serum selenium levels of 86 healthy individuals. Variations in age, sex, and geographically different urban regions of Yugoslavia were investigated. A group of 63 healthy children, ages 8-15 yr, were examined. Mean +/- standard deviation of the serum selenium concentration was 57 +/- 9 micrograms/L; age and geographic area had no effect on the Se status of children, but the difference between boys and girls was significant (P less than 0.05). A group of 23 men from Zagreb, ages 22-37 yr, were examined. The group was divided into three age subgroups and no difference was found among these groups. The mean Se concentration was 69 +/- 18 micrograms/L, and a statistically significant difference was found only between the group of adults and the group of children (P less than 0.05).

[The chemical war in Croatia]

During the present war against the Republic of Croatia, chemical weapons have been used by the Yugoslav Federal Army (YFA) against both civilians and Croatian Army soldiers. The use of irritants was suspected (Vukovar, Bogdanovci and Vinkovci, October-November, 1991; Solin in the Split area, September, 1991) and proved (Velika Gorica in the Zagreb area, September, 1991; Cakovec, November, 1991) in many cases. The use of psychochemical incapacitating agents (Bilje near Osijek, July, 1991), as well as of psychostimulants in YFA own soldiers (Zadar, August, 1991) has been suspected on clinical findings or laboratory tests. The use of acetylcholnesterase inhibitors was proved in one aggressor's diversion (Zadar, Krusevo, July, 1991). Phosphorus from projectiles and fuming boxes caused poisoning and skin burns due to incineration (Vukovar, November, 1991). YFA used the civilian's fear of chemical and biological weapons, throwing untoxic substances all over the Croatian territory. Great ecocide problems have occurred with massive industry devastation (Sisak, Osijek, October, 1991-January, 1992), with enumerous amounts of toxic substances released into the soil and river aquatoria.