Jamun (Syzygium cumini) seed and fruit extract attenuate hyperglycemia in diabetic rats

Objective To evaluate the potential of both jamun (Syzygium cumini) seed and fruit extracts against hyperglycemia. Methods Male Sprague Dawley rats were used to evaluate hypoglycemic potential of jamun extracts. Purposely, jamun fruit and seed's ethanolic extracts based diets were provided to normal and high sucrose diet induced hyperglycemic/diabetic rats for sixty days. The serum glucose and insulin levels were monitored at monthly intervals to evaluate hypoglycemic effect of jamun extracts. Results The results of instant research depicted that both seed and fruit extracts reduce the blood glucose level significantly and also regulate the insulin levels in hyperglycemic rats. It was noted that jamun fruit extract attenuated serum glucose levels to 5.35% and 12.29% in normal and hyperglycemic rats, respectively; while insulin levels were improved by 2.82% and 6.19%, correspondingly. Whereas, jamun seed extract reduced glucose to 7.04% & 14.36% and showed 3.56% & 7.24% higher insulin levels in normal & hyperglycemic rats, respectively. Conclusions The present research revealed that both jamun fruit and seeds have potent prophylactic role against hyperglycemia. In this respect, diet based regimen may be tailored using jamun fruit/seed and their extracts to alleviate hyperglycemia.

Citrus peel extract and powder attenuate hypercholesterolemia and hyperglycemia using rodent experimental modeling

Objective To investigate hypocholesterolemic and hypoglycemic potential of citrus peel extract and powder using rodent experimental modeling. Methods Considering the fact, rat feeding trial was carried out for a period of 56 d to access the prophylaxis of citrus peel flavonoids by employing normal (study I), hyperglycemic (study II) and hypercholesterolemic (study III) rats. Each study was further divided into three groups to ensure the provision of selected diets, i.e., control, functional and nutraceutical diets. Each study was further divided into three groups to ensure the provision of selected diets, i.e., control, functional and nutraceutical diets. Results Declining trend for total cholesterol was observed in all studies with maximum reduction (8.55%) in rat group fed on nutraceutical diet in study III. Likewise, levels of low density lipoproteins and triglycerides reduced 11.39% and 7.89% respectively in hypercholesterolemic rats. Moreover, nutraceutical diet alleviated the sera glucose level by 8.96% in study II. Conclusions Conclusively, inclusion of citrus peel bioflavonoids in dietary therapies is a promising strategy to modulate lipidemic and glycemic attributes without imparting any deleterious effect on hematological parameters.

Anti-hypercholesterolemic and anti-hyperglycaemic effects of conventional and supercritical extracts of black cumin (Nigella sativa)

Objective To explore the hypoglycaemic and hypocholesterolemic potential of conventional and supercritical extracts of black cumin. Methods Purposely, rat modelling was carried out for 2 months by designing three studies i.e. study I (normal rats), study II (hyperglycaemic rats) and study III (hypercholesterolemic rats). Each study was further divided into three groups based on diet i.e. control, functional diet (contained extract of black cumin prepared by using conventional solvent) and nutraceutical diet (contained extract of black cumin prepared by supercritical fluid extraction system). Results During whole trial, an abating trend was observed in the level of serum cholesterol with maximum reduction (12.8%) in nutraceutical group of study III. Low density lipoprotein and triglyceride level was also lowered maximum in study III as 17.1% and 11.6%, respectively. Whereas, highest decline in glucose level was in nutraceutical group of study II as 11.2%. Conclusions Inclusion of black cumin extracts in diet significantly lowers the occurrence of hyperglycaemia and hypercholesterolaemia. Furthermore, hypoglycaemic and hypocholesterolemic potential of nutraceutical diet is more prominent as compared to functional diet.

Dietary supplementation of bitter gourd reduces the risk of hypercholesterolemia in cholesterol fed sprague dawley rats

Functional and health endorsing benefits of various foods are often attributed to their phytochemistry. The bitter gourd holds potential in improving the health of the individuals owing to its incredible versatility in phytochemistry. However, the efficacy of different parts of bitter gourd needs attention of the researchers. In the current exploration, different parts of bitter gourd were evaluated for their cholesterol lowering potential in cholesterol fed Sprague dawley rats. For the purpose, four types of bitter gourd part i.e. whole fruit, seedless fruit, seeds, and seed extracts were used and compared with placebo in hypercholesterolemic rats. In placebo, momentous increase in serum cholesterol, triglycerides and LDL levels was observed. All parts attenuate the cholesterol 18.79 to 40.17% triglycerides 25.97 to 37.01% and LDL 14.49 to 26.09%. However, 1% extract powder was most effective in reducing the cholesterol and triglycerides. From the present study, it is deduced that bitter gourd extract can be supplemented in food products for the management of hypercholesterolemia. However, future studies in human subjects needs to be conducted for meticulousness of the present findings

Nigella sativa fixed and essential oil improves antioxidant status through modulation of antioxidant enzymes and immunity

The onset of 21[st] century witnessed the awareness among the masses regarding the diet-health linkages. The researchers attempted to explore traditional products/plants were in the domain of pharmacy and nutrition focussing on their health benefits. In the present research intervention, we investigate the role of Nigella sativa fixed oil [NSFO] and essential oil [NSEO] in improving antioxidant status and modulation of enzymes. The National Institute of Health [NIH] provided us 30 Sprague Dawley rats that were equally placed in three groups. The groups were fed on their respective diets [56 days] two experimental diets i.e. D[2] [NSFO @ 4.0%] and D[3] [NSEO @ 0.30%] and control. The indices pertaining to antioxidant status, antioxidant enzymes, and parameters pertaining to immunity were evaluated at 4 weeks interval. The experimental diets [NSFO@ 4.0% and NSEO@ 0.30%] modulated the activities of antioxidant enzymes i.e., catalase [CAT], superoxide dismutase [SOD], glutathione transferase [GST], glutathione reductase [GR] and glutathione peroxidase [GPx], positively. Indices of antioxidant status like tocopherols and glutathione were in linear relationship with that of GPx, GR and GST [P<0.01]. Myeloperoxidase activities were in negative correlation with GST [P<0.01] but positive correlation with some other parameters. In the nutshell, the fixed and essential oil of Nigella sativa are effective in improving the indices pertaining to antioxidant status, however, the immune boosting potential needs further clarification. However, authors are of the view that there is need to explore the molecular targets of Nigella sativa fixed and essential oils. Findings from such studies would be useful to validate this instant study for health promoting potential against diabetes mellitus and cardiovascular disorders

Balloon valvuloplasty in dysplastic pulmonary valve stenosis: immediate and intermediate outcomes

To determine the immediate and intermediate outcome in dysplastic and doming pulmonary valve stenosis in children and to determine various factors associated with unsuccessful outcome. An interventional study. The Children's Hospital, Lahore, Pakistan, from June 2006 to December 2012. All patients presenting with severe pulmonary valve stenosis were enrolled in the study. Balloon valvuloplasty was performed on all patients. Successful outcome [residual gradient < 36 mmHg] was compared with matched doming pulmonary valve stenosis control group valvuloplasty. Difference in various quantitative variables was calculated using independent t-test and Mann Whitney U test. Categorical variables were compared using Chi square and Kruskal-Wallis test. Multivariate analysis was performed to determine various factors associated with outcome. Kaplan- Meier survival table was used to determine freedom from re-intervention proportions. One hundred and fifty two patients [Dysplastic group A, n=73; Doming group B, n=79] with median age of 24 months [range 3 - 192 months] and M:F; 2:1 were included in the study. Mean gradient decreased from 96 +/- 33 mmHg to 29 +/- 20 mmHg. Group A had significantly higher number of patients with unsuccessful outcome [9.6%, p=0.02]. Preprocedure gradient > 75 mmHg was the most significant factor associated with unsuccessful outcome [p < 0.001]. Median follow-up duration was 3 years [range 1 - 6 years]. Freedom from re-intervention proportion at 1, 3 and 6 years was 91.3%, 86.7% and 78.9% respectively in group A compared to 100%, 96.5% and 96.5% respectively in group B. Immediate postprocedure gradient > 60 mmHg was the only significant factor associated with re-intervention in group A [p=0.001]. The results from balloon valvuloplasty in dysplastic pulmonary valve were suboptimal when compared to doming valves. However, it provides a high freedom from re-intervention rate in intermediate follow-up. Intervention at moderate severity can result in better outcome

Green tea catechins based functional drink [Green cool] improves the antioxidant status of SD rats fed on high cholesterol and sucrose diets

In the recent epoch, functional and nutraceuticals foods are gaining wide range of acceptability from the consumers. In the present research investigation, efforts were directed to exploit the green tea phytochemicals. Functional beverage was prepared with catechins and epigallocatechins gallate [EGCG] added individually @ 550 mg/500mL in respective drink. Prepared drinks were evaluated for their physicochemical analysis. Efficacy trial was also conducted, in which diets consisting of high sucrose and cholesterol were provided to rats with concurrent intake of functional drinks. CIE-Lab Color analysis of functional drinks showed that indices of color tonality were nonsignificantly affected. However, decreasing trend in pH and increased tendency in acidity of drink was noted. While scores for sensory evaluation remained in acceptable range showing suitability for industrial applications. Results of efficacy trial revealed that functional drinks improved serum antioxidant potential of rats. Thus results paved the way for the development of functional beverages using green tea catechins for vulnerable segments

Congenital heart defects associated with atrial heterotaxy

To determine the frequency of various congenital cardiac defects associated with atrial heterotaxy and the difference between spectrum of cardiac defects in right atrial isomerism [RAI] and left atrial isomerism [LAI] in these patients. Cross-sectional observational study. Department of Cardiology, The Children's Hospital and Institute of Child Health, Lahore, from July 2006 to June 2011. All children presenting to the hospital with suspected congenital heart defect were included in the study. Echocardiography based sequential segmental analysis was used, taking atrial symmetry, interrupted inferior vena cava [IVC] and juxtaposed aorta to IVC relation into account for identifying atrial heterotaxy. Various segmental defects were noted for RAI and LAI. Children had atrial heterotaxy [M:F; 1.7:1] with 61.6% [n=82] having LAI. Most common lesions associated with RAI included complete atrioventricular [AV] septal defect [n=48, 94.1%], single AV valve [n=45, 88.2%] and pulmonary outflow tract obstruction [n=41, 80.4%]. LAI was associated with ventricular septal defect [n=68, 82.9%], atrial septal defect [n=63, 76.8%, mostly secundum variety], and miscellaneous left sided obstructive lesions. Atrial heterotaxy encompasses a wide spectrum of congenital cardiac defects. The frequency of various defects associated with RAI or LAI in local South Asian population of Lahore, Pakistan is similar to those as reported in the Western literature

Optimal dose of adenosine effective for supraventricular tachycardia in children

To determine the optimal adenosine dose effective in supraventricular tachycardia [SVT] and underlying conditions affecting the effective dose in children. Experimental study. Department of Cardiology, The Children's Hospital and Institute of Child Health, Lahore, from July 2008 to June 2011. All children presenting with SVT were administered adenosine in rapid boluses according to PALS guidelines using incremental doses of 100, 200 and 300 micro g/kg. The response was recorded on 12 lead ECG. Preexcitation was documented and echocardiography performed on all children after attaining sinus rhythm. Mann Whitney test and Kruskal-Wallis test were used as a test of significance to determine any difference in effective adenosine dose between normal heart and various underlying conditions, taking p < 0.05 as significant. Eighty five patients were treated for 110 episodes of SVT with adenosine. M:F ratio was 2.2:1. Their age ranged from 6 days to 14 years with mean age of 27.9 months. Adenosine was effective in reverting 97 episodes of SVT to sinus rhythm [88.2%]. A dose of upto 100 micro g/kg was only effective in 36.4% episodes of SVT. Two hundred micro g/kg was effective in 44.3% of those not responding to 100 micro g/kg dose [n = 31/70, cumulative 64.5%]. A dose of 300 micro g/kg was effective in further 25 patients not responding to lower doses [n = 25/38, 65.8%; cumulative 88.2%]. Mean effective dose of adenosine was 185.3 +/- 81.0 micro g/kg with median effective dose of 200 micro g/kg. Significantly higher dose of adenosine was required in children with underlying pre-excitation, n = 18/97 [220.8 +/- 67.6 micro g/kg vs. 177.2 +/- 81.9 micro g/kg, p = 0.039]. Adenosine is an effective medicine in treating SVT in children. A higher dose of 200 micro g/kg may be used as first bolus particularly in children with pre-excitation

Supplementation of Nigella sativa fixed and essential oil mediates potassium bromate induced oxidative stress and multiple organ toxicity

The plants and their functional ingredients hold potential to cure various maladies and number of plants hold therapeutic potential. The present research was designed study the health promoting potential of black cumin [Nigella sativa] fixed oil [BCFO] and essential oil [BCEO] against oxidative stress with special reference to multiple organ toxicity. For the purpose, thirty rats [Strain: Sprague Dawley] were procured and divided into three groups [10 rats/group]. The groups were fed on their respective diets i.e. D[1] [control], D[2] [BCFO @ 4.0%] and D[3] [BCEO @ 0.30%] for a period of 56 days. Mild oxidative stress was induced with the help of potassium bromate injection @ 45 mg/Kg body weight. Furthermore, the levels of cardiac and liver enzymes were assayed. The results indicated that oxidative stress increased the activities of cardiac and liver enzymes. However, supplementation of BCFO and BCEO was effective in reducing the abnormal values of enzymes. Elevated levels of lactate dehydrogenase [LDH], CPK and CPKMB were reduced from 456 to 231, 176 to 122 and 45 to 36 mg/dL, respectively. Similarly, liver enzymes were also reduced. However, the results revealed that BCEO supplementation @ 0.30% is more effectual in ameliorating the multiple organ toxicity in oxidative stressed animal modelling. In the nutshell, it can be assumed that black cumin essential oil is more effective in reducing the extent of potassium bromate induced multiple organ toxicity [cardiac and liver enzymes imbalance] that will ultimately helpful in reducing the extent of myocardial and liver necrosis

Socioeconomic status and impact of treatment on families of children with congenital heart disease

To assess the socioeconomic status, treatment being offered and the impact of congenital heart disease treatment on families. Observational study. The Children's Hospital / Institute of Child Health, Lahore, from 1st March to 31[st] August 2010. All patients undergoing a cardiac surgical or angiographic intervention were enrolled. Socioeconomic status was assessed by Kuppuswamy socioeconomic status scale with income group modification. The impact was measured by the source of financing, effect on family financing source and schooling and health of siblings. Of 211 patients undergoing treatment in the study period, surgery was the definitive treatment in 164 [77.7%] and angiographic intervention in 47 [22.3%] patients. Male to female ratio was 1.5:1. The mean age of the patient was 39.1 +/- 3.2 months [range 01 day to 15 years]. Majority of families belonged to middle [66.4%, n=140] and lower [27%, n=57] socioeconomic class. The mean cost of medicines and disposables was PKR 78378.2 +/- 8845.9 [US$ 933.1 +/- 105.3] in open heart surgery, PKR 12581 +/- 7010.8 [US$ 149.8 +/- 83.5] in closed heart surgery and PKR 69091 +/- 60906 in angiographic interventions. In 63.1% patients, families contributed towards these costs either completely [12.3%] or partly [50.8%] with significant contribution from the hospital. Adverse effect on families ranged from leave without pay to losing jobs or business [46%], and selling their assets [11.3%]. It also affected schooling and health of siblings [22.7% and 26.1% respectively]. Majority of children with congenital heart disease belonged to middle and lower socioeconomic status in this study. Main definitive treatment was surgery. The cost of health care facilities posed a marked socioeconomic burden on those families

Anatomical variations of pulmonary artery and associated cardiac defects in tetralogy of Fallot

To determine pulmonary artery variations and other associated cardiac defects in patients with Tetralogy of Fallot [TOF]. Cross-sectional, descriptive study. The Children's Hospital and the Institute of Child Health, Lahore, from April 2006 to October 2007. All patients with TOF, who underwent cardiac catheterization during this period, were included. Standard cine-angiograms were recorded and pulmonary artery sizing was done using z-scoring. A total of 216 patients with TOF were catheterized. Pulmonary Artery [PA] abnormalities were present in 84 [38.9%] patients. The commonest abnormality was isolated Left Pulmonary Artery [LPA] stenosis [n=27, 32.14%] followed by isolated hypoplasia of Main Pulmonary Artery [MPA] [n=18, 21.43%] and supra-valvular stenosis in [n=11, 13.1%] patients. LPA was absent in one patient, while 2 patients had both absent right and left PA with segmental branch pulmonary arteries originating directly from MPA. Associated cardiac lesions included right aortic arch in 34 [15%], additional muscular VSD vary in 13 [5.5%], Patent Ductus Arteriosus [PDA] in 11 [6%] and Major Aortopulmonary Collateral Arteries [MAPCA] in 2 [1.9%] patients. Significant coronary artery abnormality was present in 10 [4.6%] children. Pulmonary artery abnormalities were present in 38.9% of patients with TOF. Isolated LPA origin stenosis and MPA hypoplasia were the most common abnormalities. Significant associated cardiac lesions were present in one-third of the patients and included PDA, additional muscular VSD, coronary artery abnormalities and MAPCA

Pattern of ventricular Septal defects and associated complications

To determine the frequency of various types of Ventricular Septal Defect [VSD] in local population and their complications. Case series. The Pediatric Cardiac Unit of the Children Hospital and Institute of Child Health, Lahore, from January 2006 to December 2007. All patients aged between one day to 18 years presenting to the unit with isolated VSD during the study period were evaluated using 2-D, continuous wave Doppler and colour Doppler techniques on transthoracic echocardiography. Where necessary, transesophageal echocardiography and/or angiography data was used to further clarify the anatomy. Of the 854 patients with isolated VSD, 710 were of perimembranous type [83.1%], 100 were muscular type [11.7%], 25 were doubly committed subarterial [DCSA] type [2.9%] and 19 patients were having inlet VSD [2.2%]. The mean age was 2.1 +/- 3 years. Females were 332 [38.8%] and males were 522 [61.1%]. Aortic Valve Prolapse [AVP] was seen in 77 patients [10.8%]. The mean age for this subgroup was 5.8 +/- 4 years with 54 [70.1%] males and 23 [29.9%] females. Of those, 36 [47.3%] had various degree of aortic regurgitation. Right ventricular outflow tract obstruction of variable severity was found in 4 patients. Two of these patients had echocardiographic evidence of subacute bacterial endocarditis. Perimembranous [PM] VSD is the commonest type of ventricular septal defect presenting to a tertiary care hospital. The incidence of AVP and AR is high [10.8%] and was found almost entirely in perimembranous outlet VSDs rather than DCSA. This observation has special implication in Pakistan where pool of unoperated VSDs is large

Steroids in the management of acute myocarditis in children

To compare hospital shy, need and duration of inotropic support, mortality to assess immediate outcome and long term recovery in patients with or without steroids. In acute myocarditis, virus is replicating and steroids can be harmful. This clinical trial was conducted on children admitted to a single centre from February 2003 to September 2004 in the Department of Paediatric Cardiology, the Children Hospital and Institute of Child Health, Lahore. Echocardiography was used to confirm dilated dysfunctioning heart with EF under 45%. 100 consecutive children with myocarditis were studied. Mean duration of symptoms was +/- 7.47 in group-is and +/- 13.01 in group-B. The patients presented in shock and severe CCF requiring inotropic support were 43 [86%] in group-A and 38 [76%] in group-B. mean hospital stay [7.47 days] in group-A and 5.68 in group-B, duration of inotropic support [5.34 and 3.95] in group-A and B], hospital mortality [1 and 3] were analyzed and found insignificant statistically. Full recovery [p patients in group-A and 7 in group-B], partial recovery [16 and 13], no recovery [7 and 9] were compared. There was no significant difference. Results of this clinical trial conclude though steroids in acute myocarditis are not harmful but has no significant effect on immediate outcome and long term recovery

Transcatheter occlusion of secundum atrial septal defects with the self centering amplatzer septal occluder-Initial experience

Between September 1999 to April 2001, 14 children and adults with age ranging between 343 years and weight ranging from 10-82 Kg were selected to undergo transcatheter occlusion of secundum atrial septal defect with self centering Amplatzer septal occluder. Echocardiographic criteria for exclusion were a defect >26mm or an insufficient septal tissue rim <4mm from either AV valve, coronary sinus or the right pulmonary veins. 11 of the 14 patients were successfully treated with the device. The defect diameter ranged from 621mm on T E.E and balloon stretched diameter varied from 16-30mm.11 devices ranging from 16-34mm were placed within the ASD and implanted. The procedural time ranged from 55165 minutes. 3 of the 14 patients could not be treated due to technical problems. 10 out of 11 treated patients demonstrated complete defect closure immediately after implantation of device as witnessed on colorflow Doppler examination while complete closure of defect was observed in all the patients after 24 hours. During follow up period of 8-737 days closure with no residual shunt has been demonstrated in all patients. Thus the Amplatzer septal occluder has proved to be effective and safe device for closing secundum atrial septal defects

Transcatheter occlusion of moderate to large sized patent ductus arteriosus using amplatzer duct occluder: an Attractive alternative to surgery

The PDA coming to medical attention in our set up are generally large and surgery has been the standard form of treatment. Use of coils and other devices for such large PDA's is challenging and may be accompanied by up to 38 percent incidence of residual shunts. The aim of this study was to assess the immediate and short-term results of anterograde catheter closure of moderate to large sized patent ductus arteriosus [PDA] using the new self-expandable, respositionable Amplatzer duct occluder [ADO] device. Thirteen patients [6M, 7F] underwent attempted transcatheter closure of a PDA using the ADO at a mean age of 9.1 years [range 2 to 15] and a mean weight of 24.8kg [range 8 to 53]. The mean PDA diameter at its narrowest segment was 4.8 +/- 1.5 mm. Follow-up evaluation was performed with chest x-ray and color flow mapping within 24 hours and at 1 month after closure. All thirteen patients had successful device placement. Angiography showed that 9 patients had complete immediate closure, 3 had a trace shunt [foaming through the device with no jet], and 1 had a small residual shunt [with a jet]. Within 24 h, color Doppler revealed complete closure in all patients. The median fluoroscopy time was 10.3 min [range 6.8 to 16], All patients were discharged home the next day. There were no complications. Of the 13 patients, 12 completed the 1-month follow-up, all [95 percent confidence interval [Cl] 86 percent to 100 percent] with complete closure. Anterograde transcatheter closure using the new ADO is an effective therapy for patients with moderate and large PDA diameter up to 10mm. It is a safe and attractive alternative to surgical closure

Effectiveness and safety of paediatric interventional cardiac catheterisation in a subregional cardiothoracic unit

To assess the effectiveness and safety of padiatric interventional cardiac catheterisation during the development of the service. Sub-regional Paediatric cardiothoracic Centre. All paediatric admissions of cardiac catheterisation between January, 1985 and December, 1992. Data were collected on all patients in whom interventional cardiac catheterization was performed excluding babies undergoing balloon atrial septostomy. Results were compared with those reported previously by the larger centers. One hundred and seventy eight interventional procedures were performed in 158 patients, progressing form pulmonary valvuloplasty [1985] and aortic valvuloplasty [1986] to arterial duct occlusion and coit embolisation of shunts [1991]. During the study period there was a rise in the number and variety of conditions for which interventional cardiac catheterisation was performed. In terms of morbidity, mortality and technical success, results compared favourably with those published from larger centers. Interventional cardiac catheterisation in children can be established effectively and safely in a relatively smaller set up