A study on the hypoglycemic and hypolipidemic effects of an ayurvedic drug Rajanyamalakadi in diabetic patients

A study was undertaken for evaluating the hypoglycemic and hypolipidemic effects of an ayurvedic medicine “Rajanyamalakadi” containing Curcuma longa, Emblica officinalis and Salacia oblonga in type II diabetic patients over a period of 3 months. Ethical committee consent for the study was given by the Director, Indian Systems of Medicine, Kerala. A total of 43 patients with established diabetes mellitus as adjudged from clinical features and FBS values, appeared for the camp (Age group 35–75 yrs). An informed consent for the study was obtained from each patient. The clinical proforma was given to each patient to collect data such as height, weight, diet pattern, previous history of illness etc. The ongoing antidiabetic medications were stopped under medical supervision and the patients were provided with ‘Rajanyamalakadi’ tablets (dose 1–2 tablets each weighing 500mg). The dosage of the drug was decided by the supervising medical officer on a case to case basis, taking note of the clinical conditions and responsiveness of the patients. The patients were monitored for three months, who were divided into 6 groups based on their age and again into two groups, 5 & 6, based on their mean FBS values. ie; Normal Persons, Diabetics of age groups 35–45yrs, 46–55yrs, >55yrs and those with FBS < 145.9 mg% and > 145.9 mg%. The Ayurvedic medicine “Rajanyamalakadi” has showed significant antidiabetic, hypolipidemic and antioxidant effects. In addition to that significant ameliorating effects on the elevated serum AST and ALT activities were also demonstrated by the treatment. The nutraceuticals present in the drug like Terpenoids, Polyphenols, Curcumin etc are responsible for the medicinal effects.     

Influence of pranayamas and yoga-asanas on serum insulin,blood glucose and lipid profile in type 2 diabetes

A distinguishable feature of type 2 diabetes besides hyperglycemia and deranged lipid profile is an impaired insulin secretion, peripheral insulin resistance and obesity which has become a major health concern worldwide. India with an estimated 31million diabetics in 2000 and 79mllions by the yr 2030 has the highest number of type 2 diabetics in the world. In this study, we aimed to see if yoga-asanas and pranayamas have any influence in modifying certain biochemical parameters. Sixty patients of uncomplicated type 2 diabetes (age 35–60 yrs of 1–10 yrs duration) were divided into two groups: Group 1 (n=30): performed yoga along with the conventional hypoglycemic medicines and group 2 (n=30): patients who only received conventional medicines. Duration of the study was 45 days. Basal recordings of blood glucose (fasting and post-prandial), lipid profile and serum insulin were taken at the time of recruitment and the second reading after forty five days. Results showed a significant improvement in all the biochemical parameters in group 1 while group 2 showed significant improvement in only few parameters, thus suggesting a beneficial effect of yoga regimen on these parameters in diabetic patients.     

Influence of aerobic treadmill exercise on blood glucose homeostasis in noninsulin dependent diabetes mellitus patients

The role of treadmill exercise on blood glucose homeostasis in noninsulin dependent diabetes mellitus (NIDDM) were studied using males between age of 45 and 60 years (X-52), who were clinically and biochemically-confirmed cases of NIDDM were taken into study group. Control group comprised of 10 males between age group of 45 to 60 (X-53) years. All the subjects were assessed by physician and were investigated to confirm diabetic status. The whole study period was extended for 6 weeks. The significant decrease in postprandial blood sugar (44.4 mg% for the study group and 32.2mg% for the control group) with a significant inter group difference (P<0.05) was observed. The mean decrease in fasting blood sugar (39.4mg% for the study group and 27.4mg% for the control group), with a marginal inter group difference (P<0.05) was observed. The treadmill exercise was found to be a definite tool in addition to drug and diet in glycemic control.     

Hypolipidemic effect of water extract ofFicus bengalensis in alloxan induced diabetes mellitus in rabbits

Hypolipidemic effect of the water extract of the bark ofFicus bengalensis was investigated in alloxan induced diabetes mellitus in rabbits. Treatment for one month (50 mg/kg body weight/day) brought down the level of total serum cholesterol (TC) in subdiabetic and diabetic rabbits (five in each group) from 82±11 mg% and 118±10.6 mg% to 42.7±3.1 mg% and 51.7±4.7 mg% respectively. Low density lipoprotein cholesterol and very low density lipoprotein cholesterol values came down from 34±10 mg% and 95±24 mg% to 16±3 mg% and 29±4 mg% in subdiabetic and diabetic rabbits. Triacylglycerol level before treatment was 121±21.6 mg% and 416±70 mg% in subdiabetic and diabetic rabbits. Treatment brought it down to 45±5 mg% and 81±27.5 mg%. Glycosylated hemoglobin was brought down from 2.1±0.3% to 1.5±0.1% in subdiabetic group and from 4.28±0.5% to 2±0.3% in diabetic group, indicating that treatment with water extract effectively controlled blood sugar. After treatment with water extract serum lipid values were nearly equal to those in healthy controls (normal) in subdiabetic rabbits, while in diabetic group, the values were only slightly above those of normal.     

Serum lipids and malondialdehyde levels in primiparous patients with pregnancy induced hypertension

Background  Pregnancy induced hypertension (PIH) contributes to 15.6% maternal mortality in India. In Behrampur, Orissa, maternal deaths due to PIH was 32%, which is twice the national incidence. Hence in this population, some factors associated with severity of PIH were studied. Serum lipid concentrations and malondialdehyde (MDA) levels were correlated with severity of PIH and birth weight of the neonate. Patients & Methods  70 primiparous PIH patients and 20 healthy controls were studied. Serum lipids and MDA were estimated. Maternal blood pressures and birth weights of the neonate were recorded. Results and Conclusion  Serum cholesterol, triglyceride, LDL, VLDL and MDA were significantly elevated in primiparous PIH patients when compared to control subjects. Average birth weight of babies born to mothers with PIH was less than those born to control subjects. The most significant factor was that in this geographical area, 26% of the primiparous patients with PIH were below 20 years of age while only 15% of the controls were less than 20 years, indicating that younger maternal age was a contributing factor to PIH.     

Preliminary study on the effect of a herbal formulation “Deepaniyavati” in hyperlipidemia

To examine the effect of “DeepaniyaVati”, a herbal formulation in the management of hyperlipidemia, a randomized group pre-test post-test study trial was carried out on fifty male (30 to 70 yrs) hyperlipidemic volunteers who were asked to follow their normal routine diet and activity pattern throughout the investigation period. The formulation, prepared by mixing nine plant products in equal proportion, when given in a daily dose of 2g, twice a day for a period of one month, brought about an observable improvement in all the lipid parameters by significantly reducing total cholesterol (10%), low density lipoprotein cholesterol (12.76%), very low density lipoprotein cholesterol (27.4%), triglycerides (34.7%) and bringing these values much nearer to the normal levels. In control group, no such effect was noticed. A concomitant significant increase in the HDL-C levels suggests the possible utility of “Deepaniya Vati” in the management of hyperlipidemia and the need for further detailed study.     

Microalbuminuria in Obese Young and Middle Aged Population: A Potential Marker of Cardiovascular Risk

Microalbuminuria is an established cardiovascular risk indicator in diabetes, hypertension and the general population. There is lack of information on MAU in healthy obese Indian adults and an ongoing debate whether obese adults deserve targeted identification and clinical intervention for MAU and prediabetes. We aimed to screen the healthy obese, young (group I) and middle aged (group II) adults for prevalence of MAU and prediabetes and study its association with Framingham risk score. The study included 50 healthy obese young (20–30 years) and middle aged adults (31–50 years), attending the outpatient clinic of Dept. of Medicine for a duration of 2 months (July–August). The patients were screened for fasting blood sugar, lipid profile and MAU. Of the total patients 28 % had MAU, 32.14 % of which had prediabetes and 33.33 % had diabetes whereas 10 % were normoglycemic. The group I patients had 50 % cases of MAU and group II had 25 % patients with MAU. Group II 63.63 % pre-diabetics. The values of MAU obtained were correlated with age, gender, body mass index, systolic and diastolic blood pressure, FBS, waist to hip ratio using Pearson’s Coefficient (p < 0.05). The 10 year CVD risk calculated using FRS in subjects with MAU was higher as compared to those without MAU. Thus we conclude that Indian, young and middle aged obese adults to be at a risk of prediabetes, MAU and CV risk warranting their routine screening for better clinical outcomes.     

A preliminary report on the role of yoga asanas on oxidative stress in non-insulin dependent diabetes mellitus

Nineteen subjects of non-insulin dependent diabetes mellitus (NIDDM) between the age group of 30–60 yrs were studied to see the effect of specific yoga asanas on fasting and postprandial blood glucose (FBG, PPG), serum malondialdehyde (MDA) and glycosylated hemoglobin (HbA₁) in addition to drug treatment and diet control. The duration of diabetes ranged from 1–10 years. Patients with renal, cardiac and proliferative retinal diseases were excluded from the study. The same patients served as their own control. Subjects were called in the morning to the cardio-respiratory laboratory and were given training by a yoga expert. Yoga asanas included Suryanamskar, Tadasan, TriKonasan, Padmasan, Pranayam, Paschimottanasan, Ardhmatsyendrasan, Pavanmukthasan, Sarpasan and Shavasan. The asanas were done every day for 40 days for 30–40 min. FBG, PPG, serum MDA and HbA₁ were estimated before and after 40 days of yoga asanas regimen. Significant reduction was seen in FBG from 220 mg/dl to 162 mg/dl, PPG from 311 mg/dl to 255 mg/dl, MDA from 6 nmol/l to 3 nmol/l and HbA₁, from 8.8% to 6.4%. Subjects felt better and were relieved of their stresses and had an improvement in their day to day performance. The decrease was statistically significant (p<0.0001 for FBG and PPG, p<0.001 for MDA and for HbA₁).     

Stimation of reference interval of lipid profile in Assamese population

12hrs fasting samples of 1485 apparently healthy, Assamese population in the age group of 20–80 yrs., mostly from the urban area of Assam were tested for serum lipid profile that includes total cholesterol, triacylglycerol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and very low density lipoprotein cholesterol (VLDL-C) over a period of three years. The values (median and range in mg/dl) obtained were 170 (93–263); 110 (40–256); 40 (23–73); 103 (40–173) and 22 (8–51) respectively. After grouping these subjects according to the age and sex no significant difference were observed between most of the groups. Median and upper range of total cholesterol, HDL-C and LDL-C were found to be higher in women than in men in all the age groups. But triacylglycerol and VLDL-C concentrations were observed to be higher in the men than women except in age group of 61–70 yrs. It can be suggested that lipid values obtained in this study can be used as the reference value, based on which clinical correlation can be made.     

Serum lipids in hypothyroidism: Our experience

In order to determine whether the screening of lipid profile is justified in patients with hypothyroidism we estimated serum lipids in cases having different levels of serum TSH. 60 patients of hypothyroidism in the age group of 20 to 60 yrs were studied for thyroid profile over a period of one year. On the basis of serum TSH level the cases were divided into three groups: In the first group TSH concentration was 8.8±2.99 μlU/ml, 95% confidence interval (Cl) 8.8±1.07, whereas serum total cholesterol and LDL-chol levels were 196±37.22 and 126±29.17 mg/dl respectively. The statistical analysis of these two groups showed a significant correlation between raised TSH levels and serum total cholesterol and LDL-chol (P<0.05 & P<0.01) respectively. We conclude that hypothyrodism is associated with changes in lipid profile.     

Studies on the age dependent changes in serum adenosine deaminase activity and its changes in hepatitis

Serum Adenosine deaminase (ADA) activity in normal healthy control subjects increases upto 30 years, remains steady between 31–60 years of age and shows a steep increase in the age group of 61–70 years. This was compared with serum aspartate transaminase (AST) and alanine transaminase (ALT) activity which also showed a gradual increase upto 40 years of age and decreased thereafter. The activities of serum ADA, AST and ALT increased in patients with hepatitis of all age groups compared to their respective controls. The degree of increase in the activities of the above enzymes in hepatitis, decreased with age. The present study also shows that while studying serum ADA activity in hepatitis for diagnostic purposes, the value obtained in a particular age group should be compared with normal range of values for the respective age group only.     

Assessment of oxidative stress and effect of antioxidant supplementation during radiotherapy in carcinoma of upper digestive tract

Oxidative stress was studied by estimating plasma levels of malondialdehyde (MDA), beta carotene, vitamin E and erythrocytic superoxide dismutase(E-SOD) activity in 50 cases of carcinoma of upper digestive tract which included carcinoma of oral cavity, pharynx and oesophagus. While plasma MDA level was found to be increased (3.5±1.0 nmole/ml), a significant decrease in beta carotene (81.2±14.5mg%), vitamin E (8.5±1.1 mg/L) level and E-SOD activity (657.0±80.6 U/G Hb) were observed in carcinoma of upper digestive tract. Patients were treated with radiotherapy which itself was toxic enough and produced its deleterious effects by generation of reactive oxygen species (ROS). As antioxdiants can detoxify ROS, beneficial effect if any, of antioxidant administration during radiotherapy was studied in two groups of patients, group A (n=5, supplemented with antioxidants) and group B (n=5, without antioxidant supplementation). Plasma MDA level was found to be elevated in both the groups but the increase in group B was significant, compared to pretreatment level. Further, body weight was found to be significantly decreased in group B patients, which was maintained in group A patients. Moreover, group A patients showed significant elevation in beta carotene concentration, thus showing beneficial effect of administration of antioxidants during radiotherapy without disturbing the desirable therapeutic effect of radiotherapy.     

Serum lipid profile in diabetics with and without retinopathy

Diabetics showed significantly raised levels of total and LDL cholesterol, (257.0±68.88 mg% 173.5±67.7mg% respectively) compared to controls matched with age, sex and socioeconomic status. No significant difference was observed in these parameters in diabetics with and without retinopathy.     

Hypocholesterolemic effect of water extract of the bark of banyan tree,Ficus bengalensis

The hypocholesterolemic effect of the water extract of the bark ofFicus bengalensis was investigated in 3 groups of rabbits, 5 in each group. Group 1 rabbits served as healthy controls and were fed with groundnut oil 1 ml/kg body wt. (bw) for five weeks. Groups 2 and 3 were made hypercholesterolemic by feeding orally cholesterol suspended in groundnut oil (1 ml/kg bw) at a dose of 100 mg/kg bw/day. Group 2 animals (untreated) continued to get the same amount of cholesterol for another four weeks. Group 3 animals received water extract of the bark (50 mg/kg bw/day) in addition to cholesterol as above. At the end of the 5th week, water extract not only prevented the elevation of serum cholesterol in the treated animals (Group 3) but also brought down its level to 160±14 mg% as compared to untreated animals (Group 2) 290±42 mg%. There was improvement in other parameters of lipid profile namely HDL & LDL+VLDL cholesterol and triacylglycerol.     

Assessment of Oxidative DNA Damage by Alkaline Comet Assay in Human Essential Hypertension

The objective of the present study was to investigate the antioxidant status and the extent of oxidative DNA damage in lymphocytes and their relation with essential hypertension (EHT). A total of 100 South Indian subjects aged 30–65 were included for the study. Of these 50 were normotensive controls (group-1) with blood pressure ≥120/80 mm Hg, 50 were newly diagnosed (group-2) and were not on any antihypertensive drugs, but had systolic blood pressure ranging between 140 and 160 mmHg and diastolic blood pressure 95–100 mmHg and 50 newly diagnosed essential hypertensive patients underwent drug therapy for 1 year was considered as group-3. Enzymatic and non-enzymatic antioxidants significantly decreased and lymphocyte DNA damage was significantly increased in newly diagnosed hypertensive patients compared with control group. The major decrease in DNA damage and significant improvement in enzymatic and non-enzymatic antioxidants were observed after 1 year of antihypertensive therapy in treated group compared with newly diagnosed hypertensive patients. Total antioxidant status and lymphocyte DNA damage showed a strong negative correlation in all the three groups. Essential hypertension associated with oxidative stress which in turn causes genotoxic susceptibility to variety of disease including cancer. In the absence of DNA repair process and DNA checkpoint mechanisms, the genomic integrity is susceptible to extensive damage. In our study, increased oxidative DNA damage and decreased antioxidant levels were frequently observed in the newly diagnosed essential hypertensive patients, suggesting that oxidative stress is important in the pathogenesis of EHT. Therefore, the present study has additional clinical implication. Further investigations with large number of patients along with antioxidant supplement are highly warranted.     

Evaluation of Oxidative Stress and DNA Damage in Benign Prostatic Hyperplasia Patients and Comparison with Controls

In the present study, oxidative stress and lymphocytic DNA damage in both pre-op and post-op benign prostrate hyperplasia (BPH) patients with age >50 years was evaluated and compared with normal healthy subjects (controls- without any evidence of disease) of the same sex and age group. From December 2007 to November 2009, oxidative stress in 45 BPH patients were evaluated both before (pre-op patients) and after 7 days of surgery (post-op patients) in terms of measurements of plasma levels of (1) various anti-oxidative enzymes, (2) non-enzymatic antioxidants and (3) malondialdehyde which is a product of lipid peroxidation. The lymphocyte DNA damage was also evaluated by single cell alkaline gel electrophoresis in terms of tail length migration in these patients. These values were compared with their respective control subjects of similar sex and age group. The activities of antioxidant enzymes and the levels of antioxidant, reduced glutathione were found significantly decreased (p < 0.05) in serum samples of pre-operative group of BPH patients as compared to the controls. These altered parameters increased significantly (p < 0.05) and returned to their near normal control values, but not up to baseline values, in post operative patients i.e. after the cancer load was decreased by surgery. Lymphocytic DNA damage was found to be significantly increased in pre-op group as compared to controls and was reduced after surgery in post-op group. The present study therefore, shows significantly increased levels of oxidative stress and DNA damage in BPH patients which were reduced after removal of tumour load. Thus oxidative damage plays an important role in prostate tumourogenesis and timely management of oxidative stress can be of importance in preventing the occurrence of BPH.     

Lipid Parameters, Doses and Blood Levels of Calcineurin Inhibitors in Renal Transplant Patients

The calcineurin inhibitors (CNIs) [cyclosporin A (CsA) and tacrolimus (Tac)] are currently the most widely prescribed drugs for maintenance of immunosuppression after renal transplantation. These immunosuppressants are associated with side effects such as hyperlipidemia. We evaluated the differential effects of different CNIs on serum lipid parameters in renal transplant patients. Moreover, the aim of this study is to investigate the relationships between doses and blood levels of CNIs, and blood levels of CNIs and lipid parameters retrospectively. Two groups of 98 non-diabetic renal transplant patients, each treated with different CNIs, were studied: group A (n = 50, mean age: 31 ± 10 years), CsA, mycophenolate mofetil/azathioprin, steroid; group B (I = 48, mean age: 34 ± 12 years), Tac, mycophenolate mofetil/azathioprin, steroid. In renal transplant patients, CNIs blood levels and doses were examined at 1, 3, 6, 9, and 12 months after transplantation. Biochemical laboratory parameters including plasma lipids [total-cholesterol (CHOL), low-density lipoprotein (LDL)–CHOL, high-density lipoprotein (HDL)–CHOL, and triglycerides (TG)], CNI levels and doses were examined at 1, 3, 6, 9, and 12 months after transplantation. None of the patients received anti-lipidemic drugs during the study period. Blood levels of CNIs were detectable in all whole-blood samples by Cloned- Enzyme-Donor Immunoassay (CEDIA). The relationship between CNIs blood levels and CHOL, (LDL)–CHOL, HDL–CHOL, TG were evaluated. The mean serum CHOL levels and LDL–CHOL levels of patients in group A were found significantly higher than the patients in group B during the 12 month of follow up (p < 0.05). There was no significant difference in TG and HDL–CHOL plasma levels between group A and group B (p > 0.005). In group A the daily dose of CsA was significantly correlated with the mean blood levels of CsA at the 1st and 3rd months (r = 0.387, p = 0.005; r = 0.386, p = 0.006), respectively. In group A, the daily dose of CsA was significantly correlated with the mean serum TG levels during the 12 month of follow up (r = 0.420, p = 0.003). In group B, the daily dose of Tac was significantly correlated with the mean blood level of Tac (r = 0.335, p = 0.020) at the 1st month. No correlation was found between mean Tac blood levels and lipid parameters during the 12-month of follow up (p > 0.05). Significant positive correlation was observed between the CsA blood levels and LDL–CHOL levels (r = 0.338, p = 0.027) at the 3rd month. In the renal transplant patients with well functioning grafts, CsA therapy is associated with increased CHOL and LDL–CHOL ratio which represents an increased atherogenic risk tended to be associated with CsA. Serum LDL–CHOL levels may be effected by blood CsA levels.     

Effect of induced protein malnutrition and subsequent rehabilitation on the biochemical profile of pancreas of rats

A condition of malnutrition was induced in rats during post weaning stage, by feeding rats with diet containing low protein and high carbohydrate viz. diet with 25% protein [Group I-control rats]. diet with 9% protein [Group II-moderately malnourished] and diet with 6% protein [Group III-severely malnourished]. The rats were sacrified on 21st day. 35th day.42nd day and 90th day. As compared to control rats, somatic weight and pancreatic weight of group II rats was 55 to 80% and 50 to 80% while group III rats were only 50 to 70% and 30 to 40%, respectively. A decrease in cell number, as well as, cell size was evident in malnourished rats from their DNA[10 to 20% of control] and protein [20 to 70% of control] content.. At adulthood, activity of trypsin declined and was 86 and 64% of controls respectively, in groups II and III, while amylase and lipase activities registered a rise at 35 d followed by a decline there after. Malnourished rats were fed the 25% protein diet for 2 weeks after each period of malnutrition, inorder to see the extent of recovery subsequent to induction of a state of malnutrition. Recovery of somatic weight and weight of the pancreas were maximum when the duration of malnutrition was short i.e. following 35 days, recovery being more in group III than group II. Recovery of DNA and protein content was independent of each other. In malnourished rats trypsin activity increased, amylase activity showed a decline, and lipase activity did not respond to the nutritional rehabilitation.     

Circadian Time Structure of Circulating Plasma Lipid Components in Healthy Indians of Different Age Groups

The circadian rhythm of human circulating lipid components was studied under nearnormal tropical conditions in 162 healthy volunteers (103 males and 59 females; 7 to 75 years of age). They followed a diurnal activity from about 06:00 to about 22:00 and nocturnal rest. These volunteers were divided into four groups: Group A (7–20 years), Group B (21–40 years), Group C (41–60 years) and Group D (61–75 years), comprising 42, 60, 35 and 25 participants, respectively. A marked circadian rhythm was demonstrated for each studied variable in each group by population-mean cosinor analysis (almost invariably p < 0.001). Furthermore, circadian rhythm characteristics were compared among the 4 groups by parameter tests and regressed as a function of age, separately for males and females. A second-order polynomial characterized the MESOR of HDL cholesterol, phospholipids and total lipids, as well as the 24-h amplitude of total cholesterol and phospholipids. The 24-h amplitude of total lipids decreased linearly with age. The 24-h acrophase of the oldest age group (Group D) was advanced in the case of total cholesterol, HDL cholesterol, and total lipids, whereas that of phospholipids was delayed. Mapping the circadian rhythm (an important component of the broader time structure or chronome, which includes a. o., trends with age and extra-circadian components) of lipid components is needed to explore their role in the aging process in health.