A comparison between Captopril, Valsartan, Carvedilol and Conventional therapy in the treatment of heart failure

A comparison was done between captopril, valsartan, carvedilol & the conventional therapy in patients with heart failure. The difference was reflected on the survival rate and hospital admissions. Eighty patients were enrolled in this study, all were diagnosed as having heart failure (Class I – IV). They were grouped into four groups each consisted of 20 patients. group I were given captopril 25mg twice daily, group II were given valsartan 80mg once daily, group III had carvedilol 12.5mg twice daily, and group IV were given the conventional therapy (digoxin, diuretics, nitrates …. etc.). Blood pressure and heart rate were checked at baseline (before treatment) & after one and two months after initiation therapy. Data were compared to those of 15 healthy & subjects included in the study as well. Results revealed that a significant (p<0.05) reduction in blood pressure was noticed for the four groups. The heart rate was increased significantly (p<0.05) in the captopril & valsartan groups after two months while decreased significantly following carvedilol & conventional treatment. As a whole, a high percentage of improvement in the functional class of NYHA was found in the valsartan (80%) & the carvedilol (70%) groups, as no health deterioration was noticed in any of these two groups & no one died. While the improvement percentage was to a lesser extent among patients on captopril the conventional therapy (10% and 20% respectively) with reported deaths. The number of hospitalization during the follow up period was reduced significantly (p<0.001) in the valsartan and carvedilol groups and to a lesser extent in the captopril group while there was no significant reduction in hospital admissions of patients on the conventional therapy. According to this, carvedilol or valsartan improved cardiac function, quality of life, reduced mortality and morbidity in patients with heart failure leading to a better short & long term prognosis

The topical application of clofibrate in the treatment of acne vulgaris

Acne vulgaris is a common skin disease. The therapeutic approach to this disease includes standard topical and systemic agents to newly introduced alternative medications. This study suggests a new indication for clofibrate (the lipid lowering agent) & that is to be used topically in the treatment of acne vulgaris. The proposed mechanism is by decreasing lipid biosynthesis which takes place in the sebaceous gland. A total of 60 patients with visible papules and pustules of severe acne were enrolled in this study . Their age range between 13 – 31 years (24 males & 36 females). Healthy age matched controls (30 subjects) without any skin diseases were also participated is this study. Clinical investigations involved disappearance of signs and symptoms of the disease while the biochemical investigations involved measuring total cholesterol, HDL, LDL, & TG levels, SGOT, SGPT in the sera of all volunteers done before and 10 days after the topical application of clofibrate (500mg once daily). The effectiveness of the topical application of clofibrate was approved in the treatment of acne vulgaris as a new clinical application of this drug and a novel strategy for the treatment of the disease as there was significant improvement 75% of the patients & moderate improvement for the rest of the patients . In comparison with controls, patients with acne had higher total serum cholesterol and LDL levels with no significant difference in TG, HDL & enzyme levels. However, after the topical application of clofibrate, total serum cholesterol and LDL levels were decreased while no significant changes observed in the TG, HDL, GOPT, GPT serum levels. The results revealed that circulating lipid were slightly higher in patients with acne than control subjects but declined after treatment. Healing was accompanied with improvement in the symptoms of the disease. This might suggest that the lipid profile is one of the contributing or aggravating factors for this disease

Introduction of polyvinyl pyrrolidone (PVP) In the non surgical periotherapy of Rapidly progressive periodontitis

The non surgical periotherepy are based on the bacteriologic back ground of periodontal diseases. More than 46 different verulant species were composing the bacterial flora. Tetracycline, doxycyline, minocyline were used systemically and / or topically in association with conventional scaling and root planning, as well chlorhexidine and wide variety of antiseptics were used. Rapidly progressive type A and type B being a complex disease showing a specific entity and a complex bacterial flora, a curative non surgical remedy not yet well realized. The polyvinyl pyrrolidone (PVP) a highly effective wide broad spectrum bactericidal, fungicidal and virocidal antiseptic used in low concentration (3%) as an intrapocket irrigation solution accompanied with conventional ultrasound scaling and root planning. Eight patients having rapidly progressive periodontal (3 of type A , 5 of type B) were involved in this study, 12 therapeutic sessions were performed during 6 months. Once a week, in the first month, twice a month in the next 3 months, then once a month in the later 2 months. The result showed a significant improvement of the clinical parameters, gingival bleeding index (GBI), clinical pocket depth (CDD) and clinical tooth mobility (CTM) and with radiologic evidences of bone formation. The result suggests that PVP could be the promising effective, safe, clinically applicable, easy to use, and cheap remedy of complex periodontal diseases

Clinical and biochemical comparative study between alternate and every day clofibrate – lovastatin combination therapy on mixed hyperlipidaemia

Mixed hyperlipidaemia is the most common form of hyperlipidaemias,where the patients have an elevation in both triglycerides and cholesterol levels with a high risk of atherosclerosis and chronic heart diseases. The therapeutic approach for this disorder described a range from nonpharmacologic lifestyle modifications to newly introduced pharmacologic options.Depending on the basis of recent reports involve fibrate - statin combination and associated with increase the incidence of side effects (myopathy, hepatotoxicity) and therapeutic cost, we suggest and investigate in our study a clinical trial for management of this metabolic disorder by using clofibrate and lovastatin on alternate days instead of the standard daily combination of the same drugs. The study compares the safety, efficacy and cost of both therapeutic regimens for three months follow - up period. A total of 44 patients with a known mixed hyperlipidaemia were enrolled in this study. Of the 40 patients who completed the study, 20 (10 males, 10 females) received alternate - day therapy (group I), their age and weight ranges were (40-65) years and (62-85) Kg, respectively. The remaining 20 (10 males, 10 females) received every day therapy (group II), their age and weight ranges were (42- 67) years and (65-89) Kg, respectively. Ten healthy age – matched control subjects (5 males , 5 females) . The biochemical investigations involve measuring total serum cholesterol, triglyceride, LDL and HDL cholesterol levels as parameters of lipid - lowering agent efficacy; while SGOT,SGPT and CK levels as parameters of safety. All of these parameters were determined at baseline (day 0) and after three months of treatment for both therapeutic groups. The study revealed that there was no significant difference between both treatment groups regarding the percent changes in lipid profiles from baseline values. These profiles had been returned to normal limits in all patients in both groups. The mean of SGOT levels for both treatment groups was significantly higher than that of control, but with group II the extent was more, while for SGPT levels group II only was significantly higher (less safety) than control one. With respect to CK levels and for both treatment groups, only slight elevation (not significant) occurred compared with control, but with group II the extent was more.With group I, the therapeutic cost was reduced by nearly 50% compared with group-II. By this clinical and biochemical trial, we decreased the side effects and cost of fibrate - statin combination while keeping their efficacy in lowering serum lipids