Effects of shilajit on the bone tissue of alcohol administered rats.

Purpose: The purpose of the current study was to examine the effect of Shilajit; a herbomineral, supplementation on the mechanical strength of alcohol treated rat bone. Methods: Experimental animals each were assigned to six groups: group A(control): control rats were given water orally for a period of ten weeks; group B (treated): Animals were given processed shilajit (PS; 100mg/kg/day); group C (treated): Animals were given processed shilajit (PS; 200mg/kg/day); group D: animals were given 30% alcohol; group E: animals were given 30% alcohol and shilajit (100mg/kg/day) orally; group F: animals were given 30% alcohol and shilajit (200mg/kg/day) orally for ten weeks. Bone tissue mechanical strength along with bone weight, liver antioxidative enzymes and alkaline phosphatase (ALP) were assessed for all the treatment groups. Results: Mechanical strength of the bone tissue (both femur as well as tibia) was found to be significantly enhanced upon shilajit supplementation to alcohol treated group. Also, the activities of anti oxidant enzymes and alkaline phosphatase in the liver of alcohol administered groups were restored upon shilajit administration. Conclusion: These findings suggest that shilajit is very efficacious and competent in the maintenance of bone health

Alterations in intestinal permeability and endotoxemia in severe acute pancreatitis.

Background: Intestinal permeability increases early in the course of acute pancreatitis and is associated with sepsis and organ failure. Aim: To evaluate the intestinal permeability (IP) and anti-endotoxin antibodies immunoglobulin G and A (AEA IgG and A) in severe acute pancreatitis (SAP) as compared to healthy controls and determine their significance in relation to various complications of SAP. Methods: IP was measured by urinary lactulose/mannitol (LM) excretion ratio and antiendotoxin antibodies by Endocab ELISA kit at days one and seven of admission (D1 and D7). Results: Thirty one patients of SAP [mean age (42.0±15.8) years, APACHE II scores (8.8±5.4) and CT severity index (6.4±2.0)] were included in this study. Infected pancreatic necrosis was detected in 13 (42%) patients of whom three died. Six died of persistent organ failure. Median values of LM ratio at D1 and D7 were similar to those in healthy controls. Patients experiencing complications [organ failure (4/9, 44%), infected pancreatic necrosis (5/10, 50%) and death (1/ 2, 50%)] manifested a substantial increase in their intestinal permeability at D7. Anti-endotoxin antibodies IgG were lower (p=0.003) in patients than the controls at admission. AEA IgG were lower (p=0.03) in non-survivors as compared to survivors at D7. Conclusion: Patients experiencing complications of severe acute pancreatitis showed an increase in intestinal permeability. Higher endotoxemia predicted poor outcome in severe acute pancreatitis.

Effect of antioxidant therapy on hospital stayand complications in patients with early acutepancreatitis: A randomised controlled trial.

Background: Oxidative stress (OS) in acute pancreatitis (AP) has been pathologically linked with the systemic inflammatory response and antioxidant supplementation may have a clinical benefit. Methods : In this prospective, randomised open label, controlled pilot study, patients admitted within 72 hours of onset of pain were randomised to receive either placebo (only standard medical treatment; SMT) or antioxidants (vitamin C 500 mg, N-acetyl cysteine 200 mg 8 hourly and antoxyl forte 1 capsule hourly with standard medical treatment; SMT+AO) daily, following informed consent. Patients with co-morbid illness and pregnancy were excluded. Primary efficacy measures were length of hospital stay and complications whilst secondary measures were biochemical markers of oxidative stress (thiobarbituric acid reactive substances [TBARS] and superoxide dismutase [SOD] and total antioxidant capacity [TAC] and vitamin C) at Days 1, 3 and 7. Results: Of 53 patients, 30 patients were randomised to SMT and 23 patients to SMT+AO. The mean duration of hospital stay in the SMT group (10.3±7 days) was more compared to SMT+AOT (7.2±5 days), but was not statistically significant (p=0.07), complications were similar in the 2 groups. At Day 7, OS was significantly lower in the SMT+AO group when compared with the SMT group (TBARS, p=0.05; SOD, p=0.03) with a significant increase in FRAP and vitamin C (p=0.01). Conclusions: Antioxidant supplementation may decrease the length of hospital stay and complication rate in patients with AP, but a larger clinical trial is needed to support this hypothesis. Further, it decreased the OS and improved the antioxidant status in patients with AP.

Variations in the levels of oxidative stress and antioxidants during early acute pancreatitis.

Aim: Acute pancreatitis (AP) is fatal when severe and oxidative stress (OS) is postulated to play an important role in its pathophysiology and the development of complications. OS and antioxidant status therefore need to be profiled during early AP. Methods: Patients presenting to the Gastroenterology wards with early AP i.e. within 72 hours of onset of pain were included in the study. Also samples from 50 healthy controls were obtained for comparison. OS was estimated by levels of blood superoxide dismutase (SOD) and lipid peroxidation (thiobarbituric acid reactive substances; TBARS) and antioxidant status (AOS) by the ferric reducing ability of plasma (FRAP) and vitamin C at days 1, 3, and 7 of admission. Results: OS was significantly higher in cases as compared with controls (p<0.001) on all days and showed a gradual decrease from day 1 to 7 (p<0.05). TBARS showed a higher fall in mild AP and better clinical outcome (p<0.003). Regarding the AOS, FRAP was significantly lower in cases (p<0.001) and decreased significantly from day 1 to 3 (p=0.017). Conclusions: High OS was observed during early phase of AP and a gradually improving AOS was associated with a better clinical outcome in patients with AP.

Micronutrient antioxidant intake in patients with chronic pancreatitis.

Increased oxidative stress has been postulated to be an important mechanism in the pathophysiology of chronic pancreatitis (CP). Micronutrient deficiency may increase the oxidative stress as they assist in free radical clearance. The present study was undertaken to assess the intake of micronutrients, i.e. vitamins E and C, carotene, selenium, copper, zinc, manganese, magnesium, sulphur, riboflavin, methionine and choline in patients with CP. All consecutive patients with CP attending the Pancreas Clinic at the All India Institute of Medical Sciences were enrolled in the study. The usual dietary intake was estimated by the 24-hour dietary recall method and food frequency questionnaire. Dietary restrictions, if any, were also noted. The micronutrient intake of patients not on any nutritional supplements (n=75, 65 males and 10 females, mean age 31.06 +/- 10.64 years) was compared with age- and sex- matched healthy controls (n=75). The micronutrients were calculated as per the Nutritive value of Indian Foods given by the National Institute of Nutrition, Indian Council of Medical Research, India and the US dietary intake guidelines as applicable. It was found that the Body Mass Index (BMI) of patients was significantly lower than that of healthy controls. The total intake in terms of calorie was lower in patients when compared to controls. The dietary intake of vitamin E, riboflavin, choline, magnesium, copper manganese and sulfur was significantly lower than that of controls as well as the Recommended Dietary Allowance (RDA). Dietary intake of selenium and vitamin C was within the limits of the RDA but was lower than that of controls, while the intake of carotene was similar in both the groups and met the RDA. We conclude that patients with CP had significantly decreased micronutrient intake owing to diet modification due to pain. Micronutrient deficiency might contribute to increased oxidative stress in these patients.