Indian system of medicine used concurrently with standard conventional medicine improves quality of life in patients of cardio vascular diseases (C.V.D)

Worldwide there is increased shift towards usage of traditional medicine in patients of chronic diseases like Cardio Vascular Disorders. In India, these medicines are used concurrently. Objective of the study was to ascertain prevalence and effect of concurrent traditional drug therapy with standard pharmacotherapy in patients with CVD. The present study used a cross sectional study design to assess the prevalence and a prospective cohort design to assess the effect of concurrent Ayurvedic medicines with standard pharmacotherapy in terms of quality of life. After screening 600 patients, 128 were found taking such medicines. Out of these, 100 were recruited as cases (Group-I), while 100 who were matched in terms of age, body mass index, ejection fraction, and receiving standard therapy only were recruited as controls (Group-II). Assessment parameters included demographic, biochemical, ejection fraction through echocardiography, distance covered in six Minute walk Test (6MWT), Quality of Life (QOL) through Kansas City Cardio-myopathy Questionnaire (KCCQ) and Seattle Angina Questionnaire (SAQ) with follow up at 6 months. Prakriti as mentioned in Ayurveda was also assessed using a questionnaire. Both groups were comparable at base line. Total 87 in Group-I and 91 in Group-II completed the study. Further, 76% patients were diagnosed with heart failure (HF) and 24% with coronary artery disease (CAD). There was no change in distance covered in 6MWT in both HF or CAD groups. But there was improvement in all cases in domains of KCCQ and SAQ as compared to controls. To conclude, concurrent use of traditional medicine with standard conventional care in CVD may improve quality of life in cardiovascular disorders.

Deciphering the dilemma of parametric and nonparametric tests

The potential source of complexity while analyzing the data is to choose on whether the data collected could be analyzed properly by the application of parametric tests or nonparametric tests. This concern cannot be underrated as there are certain assumptions which should be fulfilled before analyzing the data by applying either of the two types of tests. This article describes in detail the difference between parametric and nonparametric tests, when to apply which and the advantages of using one over the other

Heart failure report

Despite advancements in diagnosis and pharmacotherapy, heart failure (HF) remains as a major health problem. The prevalence in the general population is estimated to range from 0.3% to 2.0%, increases considerably with age, and approximately doubles with every additional decade of life. In the last two decades, hospital admission rates for HF have increased steadily. The prevalence of HF can be estimated at 1–2% in the Western world and the incidence approaches 5–10/1000 persons/year. Estimates of the occurrence of HF in the developing world are largely absent. In a recent US population-based study, the prevalence of HF was 2.2% (95 confidence interval 1.6–2.8%), increasing from 0.7% in persons aged 45 through 54 years to 8.4% for those aged 75 years or older. In this article, we look at the major papers published in HF in the past 1 year

Iron deficiency in chronic systolic heart failure(indic study)

Background: Chronic systolic heart failure (HF) is characterized by the left ventricular dysfunction, exercise intolerance and is associated with neurohormonal activation that affects several organs such as kidney and skeletal muscle. Anemia is common in HF and may worsen symptoms. Iron deficiency (ID) is also common in HF patients with or without anemia. Iron is the key cofactor in oxidative metabolism in skeletal muscle and the Krebs cycle. There is a paucity of data regarding iron metabolism in chronic systolic HF in India. Methods: IroN Deficiency In CHF study (INDIC) is an observational study that investigated forty chronic heart failure patients for the presence of ID. Serum ferritin (micrograms per liter), serum iron (micrograms per liter), total iron binding capacity (micrograms per liter), transferring (milligrams per deciliter), and transferrin saturation were measured to assess iron status. Results: There were 67.5% (27/40) patients who had ID with a mean serum ferritin level of 76.4 μg/L. Of the 27 iron deficient patients, 22 (55%) had an absolute ID, and 5 had a functional ID. Eight out of 27 of the iron deficient patients were anemic (20% of the total cohort, 30% of the iron deficient patients). Anemia was seen in 6 other patients, which was possibly anemia of chronic disease. There was a trend for more advanced New York Heart Association (NYHA) class (NYHA III and NYHA IV) patients with ID (37.4% vs. 30.77%, P = 0.697). Conclusion: In our study, ID was very common, affecting more than half of the patients with systolic HF. Absolute ID was the most common cause of ID and patients with ID had a tendency to have advanced NYHA class. Our study also demonstrated that ID can occur in the absence of anemia (iron depletion)

Indian system of medicine used concurrently with standard conventional medicine improves quality of life in patients of cardio vascular diseases (C.V.D)

314-321Worldwide there is increased shift towards usage of traditional medicine in patients of chronic diseases like Cardio Vascular Disorders. In India, these medicines are used concurrently. Objective of the study was to ascertain prevalence and effect of concurrent traditional drug therapy with standard pharmacotherapy in patients with CVD. The present study used a cross sectional study design to assess the prevalence and a prospective cohort design to assess the effect of concurrent Ayurvedic medicines with standard pharmacotherapy in terms of quality of life. After screening 600 patients, 128 were found taking such medicines. Out of these, 100 were recruited as cases (Group-I), while 100 who were matched in terms of age, body mass index, ejection fraction, and receiving standard therapy only were recruited as controls (Group-II). Assessment parameters included demographic, biochemical, ejection fraction through echocardiography, distance covered in six Minute walk Test (6MWT), Quality of Life (QOL) through Kansas City Cardio-myopathy Questionnaire (KCCQ) and Seattle Angina Questionnaire (SAQ) with follow up at 6 months. Prakriti as mentioned in Ayurveda was also assessed using a questionnaire. Both groups were comparable at base line. Total 87 in Group-I and 91 in Group-II completed the study. Further, 76% patients were diagnosed with heart failure (HF) and 24% with coronary artery disease (CAD). There was no change in distance covered in 6MWT in both HF or CAD groups. But there was improvement in all cases in domains of KCCQ and SAQ as compared to controls. To conclude, concurrent use of traditional medicine with standard conventional care in CVD may improve quality of life in cardiovascular disorders

Clinical efficacy of water extract of stem bark of Terminalia arjuna (Roxb. ex DC.) Wight and Arn. in patients of chronic heart failure: A double-blind, randomized controlled trial

Background: The stem bark of Terminalia arjuna (Roxb. ex DC.) Wight and Arn. (Arjuna) is used in Indian system of medicine (Ayurveda) for treatment of various cardiac diseases, including heart failure. However, well designed clinical trials exploring its efficacy and safety in chronic heart failure (CHF) are lacking. Purpose: To ascertain the add-on efficacy and safety of a standardized water extract of stem bark of Arjuna (Arjuna extract) in CHF patients on standard pharmacotherapy. Study design: Double-blind, parallel, randomized, placebo-controlled add-on clinical trial. Methods: After approval of institutional ethics committee, 100 patients of CHF of New York Heart Association (NYHA) functional class II on standard pharmacotherapy having an echocardiographic left ventricular ejection fraction (LVEF) ≤ 40% were consecutively recruited with informed consent and randomized 1:1 to Arjuna extract 750 mg or matching placebo twice daily. The primary outcome measure was change in LVEF at 12 weeks. Secondary outcome measures included changes in (i) NYHA functional class, (ii) distance covered in 6 min walk test (6MWT), (iii) quality of life (QoL), as determined by the Kansas City Cardiomyopathy Questionnaire (KCCQ), (iv) plasma brain natriuretic peptide, (v) plasma cytokines (interleukin-6, high sensitivity C-reactive protein and tumour necrosis factor-α) and (vi) oxidative stress markers [serum thiobarbituric acid reactive substances (TBARS), red blood cell (RBC) superoxide dismutase (SOD), RBC catalase and RBC glutathione (GSH)] at 6 and 12 weeks. Safety assessment was done by adverse event monitoring and laboratory investigations. Results were expressed as mean ± SD or median (interquartile range) and analysed with intention-to- treat principle using appropriate two-sided statistical tests. A p-value < 0.05 was considered significant. Results: Arjuna extract was well-tolerated, but did not change LVEF (24.3 ± 7.1 versus 25.5 ± 7.7%; p = 0.4) or secondary outcome measures except preservation of RBC catalase activity [1275(104, 10350) versus 1243.5(104, 10350) U/g haemoglobin; p = 0.01] compared to placebo. Significantly greater percentage increases occurred in distance covered in 6 MWT, RBC-SOD, RBC catalase, RBC GSH and in symptom severity and stability domains of KCCQ in patients on Arjuna extract versus those on placebo, on a post-hoc analysis, between subgroups of patients who improved in these outcomes. Conclusion: Arjuna extract did not improve LVEF in CHF patients over 12 weeks, although there was improvement in functional capacity, antioxidant reserves and symptom-related QoL domains in some patients

Beneficial Effect of Ocimum sanctum (Linn) against Monocrotaline-Induced Pulmonary Hypertension in Rats

Background: The study was designed to explore any beneficial effect of Ocimum sanctum (Linn) (OS) in experimental pulmonary hypertension (PH) in rats. OS is commonly known as “holy basil” and “Tulsi” and is used in the Indian System of Medicine as antidiabetic, antioxidant, hepatoprotective, adaptogenic, and cardioprotective. Methods: Monocrotaline (MCT) administration caused development of PH in rats after 28 days and rats were observed for 42 days. Treatments (sildenafil; 175 µg/kg, OS; 200 mg/kg) were started from day 29 after the development of PH and continued for 14 days. Parameters to assess the disease development and effectiveness of interventions were echocardiography, right and left ventricular systolic pressures, and right ventricular end diastolic pressure, percentage medial wall thickness (%MWT) of pulmonary artery, oxidative stress markers in lung tissue, NADPH oxidase (Nox-1) protein expression in lung, and mRNA expression of Bcl2 and Bax in right ventricular tissue. Results: OS (200 mg/kg) treatment ameliorated increased lung weight to body weight ratio, right ventricular hypertrophy, increased RVSP, and RVoTD/AoD ratio. Moreover, OS treatment decreases Nox-1 expression and increases expression of Bcl2/Bax ratio caused by MCT. Conclusion: The present study demonstrates that OS has therapeutic ability against MCT-induced PH in rat which are attributed to its antioxidant effect. The effect of OS was comparable with sildenafil