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Managing chronic heart failure patient in chronic kidney disease.


The enhanced Thiobarbituric acid reactive substances in circulation of tumor-bearing animals was accompanied by a significant decrease in the levels of vitamin C, vitamin E, reduced glutathione, superoxide dismutase, catalase and glutathione peroxidase. Administration of TaBet (500 mg/kg body weight) significantly suppressed DMBA-induced hamster buccal pouch carcinomas, decreased lipid peroxidation and enhanced the levels of antioxidants.

Forty isolates of C. albicans were used in this study. All these isolates were quantified for germ tube formation without exposure to the drug and were used as the control group for data analysis. Isolates were also exposed to three subtherapeutic concentrations of chlorhexidine gluconate (0.00125, 0.0025 and 0.005%) for 30 min (limited exposure); the antiseptic was then removed and germ tube formation of these isolates was quantified microscopically following incubation in a germ tube-inducing medium.

Arjunolic acid (AA), a triterpenoid, was isolated from the ethyl acetate and methanol extracts of Terminalia arjuna core wood. The purity of AA was analysed by its melting point, FT-IR and NMR spectroscopy analyses. In vitro cytotoxicity was assessed using Ehrlich ascites carcinoma (EAC) and Dalton's lymphoma (DAL) cell lines by incubating with different concentrations of AA. The cancer cell death percentage at 100 µg concentrations of AA ranged between 66% and 70% on the DAL and EAC cell lines, respectively. This infers that AA causes considerable membrane damage to cancer cells.

Eighteen healthy male smokers (age 28.16+/-9.45 years) and equal number of age-matched non-smoker controls participated in the study. The baseline brachial artery reactivity studies were performed using high frequency ultrasound according to standard protocol under identical conditions to determine endothelium-dependent, flow-mediated dilation and endothelium-independent nitroglycerine-mediated dilation. The two groups were matched regarding age, body mass index, blood pressure, serum cholesterol, mean resting vessel diameters and post-occlusion flow velocities (all p=NS). While flow-mediated dilation was significantly impaired amongst smokers compared to controls (4.71+/-2.22 v. 11.75+/-5.94%, p <0.005), the nitroglycerine-mediated dilation was similar in the two groups (20.35+/-3.89 v. 19.68+/-3.74%, p=NS). Subsequently the smokers were given Terminalia arjuna (500 mg q8h) or matching placebo randomly in a double blind cross-over design for two weeks each, followed by repetition of brachial artery reactivity studies to determine various parameters including flow-mediated dilation after each period. There was no significant difference as regards vessel diameter and flow velocities between the two therapies. However, the flow-mediated dilation showed significant improvement from baseline values after Terrminalia arjuna therapy but not with placebo (9.31+/-3.74 v. 5.17+/-2.42%, p <0.005).

A new ellagitannin named; arjunin, four known tannins and two phenolic acids were isolated from Terminalia arjuna. The structures were elucidated by spectroscopic analyses.

Smoking, largely through increased oxidative stress, causes endothelial dysfunction which is an early key event in atherosclerosis. Smoking cessation and antioxidant vitamin therapy are shown to have beneficial role by restoring altered endothelial physiology. The present study was aimed to determine whether Terminalia arjuna, an Indian medicinal plant with potent antioxidant constituents, would improve endothelial dysfunction in smokers.

Reactive oxygen species (ROS) are implicated in many pathogenic processes including the cardiovascular system. Detoxification of ROS by antioxidants (AO) therefore affords protection against such diseases. There is a growing body of evidence suggesting that antioxidants contribute to cardioprotection. Therefore, nine plants that are components of Ayurvedic formulations used for the therapy of cardiovascular diseases were investigated to determine whether antioxidant activity is one of the mechanisms by which these plants exert cardioprotection. Initially aqueous freeze dried extracts of the plants were prepared and the antioxidant activity was measured (a) in vitro, by DPPH (1,1-diphenyl-2-picrylhydrazyl) radical scavenging and deoxyribose damage protection assays, and (b) in vivo, by effects on lipid peroxidation. Terminalia arjuna showed significant DPPH radical scavenging activity with EC(50) 8.3 +/- 0.3 microg/mL (similar to L-ascorbic acid). The potency of this activity was much lower in Cassia fistula (EC(50) = 59.0 +/- 2.7 microg/mL). The other seven extracts demonstrated no such activity in the concentration range tested. In the deoxyribose damage protection assay, T. arjuna> demonstrated no significant effect in the concentration range 0-20 microg/mL, but above -20 microg/mL concentration (20-125 microg/mL), a pro-oxidant activity was observed (although markedly less than demonstrated by L-ascorbic acid). A similar trend was observed with Vitex negundo. In contrast, C. fistula afforded a 30% protection against such damage at 125 microg/mL concentration. Other plant extracts did not show any activity in this assay. At a dose of 90 mg/kg (single dose) T. arjuna, cardiac lipid peroxidation in male Wistar rats was reduced by 38.8% +/- 2.6% (p<0.05) whereas the reduction was only 11.6% +/- 3.5% in the case of C. fistula even at a dose of 120 mg/kg. Of all the plants tested, T. arjuna demonstrated the highest antioxidant activity. Overall results show that only some plants used in the therapy of cardiovascular disease exert their beneficial effects via antioxidant activity.