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1.
Article | IMSEAR | ID: sea-217799

ABSTRACT

Background: The endurance training plays a key role in maintaining not only the physical fitness but also overall wellness of an individual. It boosts up the immune system and cardiovascular endurance. The training responses were found to be better in hypertensive patients as compared to normotensives. Aims and Objectives: The aims of this study were to evaluate the effect of endurance training on blood pressure (BP) response to sustained hand grip in the study group and control group before and after 3 months of training. Materials and Methods: Sixty apparently healthy young subjects divided into two groups: Exercise group (30 subjects) control group (30 subjects). Exercise group performed endurance training by running on treadmill alternately for 3 months, while control group did nothing. Tests were carried out with the help of CANWin machine which uses Tacho Cardio Gramme response to sustained hand grip for assessment of sympathetic function reactivity. For the test, subjects were asked to maintain the pressure on dynamometer for 5 min at 30% of maximum voluntary contraction. The BP was recorded at first before start of isometric contraction and at 5 min after the onset of isometric contraction. Results: No statistically significant difference was found in the mean systolic BP (SBP) and mean diastolic BP (DBP) between the exercise and the control group before exercise and after 5 min during exercise. Statistically significant difference was found in the mean change in DBP, but no significant mean change in SBP was found between exercise and control group before exercise and 5 min after (during exercise) after completing endurance training. A significant difference was observed among the exercise group in the change in SBP at 5 min after hand grip during exercise. Conclusion: Parasympathetic functions show favorable changes with aerobic exercise, while sympathetic system does not show such responses.

2.
Article | IMSEAR | ID: sea-217551

ABSTRACT

Background: Abdominal obesity is associated with insulin resistance, in turn, hyperinsulinemia and visceral adiposity lead to an increased uric acid (UA) absorption in renal tubules. Aim and Objectives: Accumulation of visceral fat is an underlying component of metabolic syndrome. Furthermore, the waist-hip ratio is an indirect tool for assessing visceral fat. The present study evaluates the association of UA levels with the waist-hip ratio. Materials and Methods: 160 subjects aged 18–60 years were enrolled in the study (those having any anatomical deformity, diabetes, and/or hypertension for more than 5 years were excluded from the study). Their anthropometric parameters, blood pressure, lipid profile, fasting plasma glucose, and serum UA levels were measured. Results: The study population was divided into three groups based on UA levels. The waist-hip ratio in a group of the hyperuricemic population was more as compared to groups of normal and below normal UA levels population and the association of UA level with waist-hip ratio was found to be significant (P = 0.045). Conclusion: The over-inflow of free fatty acid to the liver from accumulated visceral fat may be linked to the de novo purine synthesis through the pentose phosphate pathway, which may accelerate the production of UA.

3.
Int J Pharm Pharm Sci ; 2020 Apr; 12(4): 21-25
Article | IMSEAR | ID: sea-206076

ABSTRACT

Objective: This study was undertaken to investigate the hepatoprotective and antioxidant activity of Quercus ilex leaves extract (QILE) on ethanol-induced toxicity in Wistar rats. Methods: Hepatotoxicity was induced by administering ethanol (40%) at a dose of 7.9 gm/kg/day; p. o. (1:1 of ethanol in olive oil) for 28 d. Silymarin 100 mg/kg/day; p. o. was used as a standard drug. The whole study was divided into a prophylactic and curative study. In the prophylactic study, the Silymarin and QILE (test drug) 100, 200, and 400 mg/kg Body Weight(BW) given orally one hour before administration of 40% ethanol administration for 28 d. In the curative study, 7 d of treatment of Silymarin and QILE 200 and 400 mg/kg BW was given orally after 28 d of ethanol administration to different groups. Results: Hepatoprotectivity was confirmed by the highly significantly (p<0.001) restoration of elevated biochemical parameters like SGPT, SGOT, ALP, TB, and highly significantly (p<0.001) depleted Albumin and Total protein levels by 200 mg/kg BW QILE in comparison to the positive control group. QILE 200 mg/kg highly significantly (p<0.001) raised the antioxidants by draining the elevated oxidative stress markers in comparison of positive control group. At dose levels QILE 200 mg/kg, significant (p<0.05) protection from loss in body weight and in liver weight was found when the comparison was done with the positive control group. Histopathology revealed that QILE 200 mg/kg reduced the markers of cell necrosis. Conclusion: Present study revealed that Quercus ilex leaves have antioxidant and hepatoprotective activity due to its chemical constituents.

4.
Indian J Exp Biol ; 2005 Apr; 43(4): 346-50
Article in English | IMSEAR | ID: sea-59235

ABSTRACT

Effect of alcoholic and aqueous extracts of the fruits of F. racemosa Linn., on the spontaneous movements of both the whole worm and nerve muscle preparation of Setaria cervi and on the survival of microfilariae in vitro was studied. Alcoholic as well as aqueous extracts caused inhibition of spontaneous motility of whole worm and nerve muscle preparation of Setaria cervi characterized by increase in amplitude and tone of contractions. Initial stimulatory effect was not observed with aqueous extract on whole worm preparation, while effect of alcoholic extract on whole worm and nerve muscle preparation was characterized by an increase in amplitude and tone of contractions followed by paralysis. The concentrations required to inhibit the movement of the whole worm and nerve muscle preparation for alcoholic extract of fruits of F. racemosa were 250 and 50 microg/ml, respectively, whereas aqueous extract caused inhibition of the whole worm and nerve muscle preparation at 350 and 150 microg/ml, respectively, suggesting a cuticular barrier. Both alcoholic and aqueous extracts caused death of microfilariae in vitro. LC50 and LC90 were 21 and 35 ng/ml, respectively for alcoholic, which were 27 and 42 ng/ml for aqueous extracts.


Subject(s)
Animals , Ethanol , Ficus/chemistry , Filaricides/isolation & purification , Fruit/chemistry , Lethal Dose 50 , Microfilariae/drug effects , Movement/drug effects , Neuromuscular Junction/drug effects , Plant Extracts/isolation & purification , Setaria Nematode/drug effects , Water
5.
Indian J Exp Biol ; 2001 Jun; 39(6): 542-5
Article in English | IMSEAR | ID: sea-61505

ABSTRACT

Acetylcholine (Ach), levamisole and pyrantel pamoate all cause stimulation of spontaneous rhythmic movements of whole worm and nerve muscle preparation of filarial nematode Setaria cervi. These stimulant effects are manifested only in the presence of available Ca2+ or extracellular Ca2+. Electrical stimulation of nerve muscle preparation of Setaria cervi elicited depolarization and increase in amplitude and tone of contractions. Electrical current stimulates Ca2+ entry leading to depolarization and during the phase of depolarization addition of any of the three stimulants viz. Ach, levamisole or pyrantel pamoate fails to elicit any response on nerve muscle preparation. The findings indicate that electrical stimulation, excitatory neurotransmitter Ach and stimulant anthelmintics levamisole and pyrantel pamoate all produce their stimulant effect by triggering entry of Ca2+ into the muscle cell. Further, blocking the calcium channels by nifedepine and thereby the entry of Ca2+ into the cells blocks the stimulant effect of Ach levamisole and pyrantel pamoate.


Subject(s)
Animals , Calcium Channels/physiology , Electric Stimulation , Ion Channel Gating , Setaria Nematode/physiology
6.
Indian J Physiol Pharmacol ; 1999 Apr; 43(2): 147-50
Article in English | IMSEAR | ID: sea-107081
7.
Indian J Exp Biol ; 1998 Sep; 36(9): 887-90
Article in English | IMSEAR | ID: sea-59826

ABSTRACT

Synthetic compounds of 5/6/7/8 mono or disubstituted 1H/1-phenyl-9H pyrido (3,4 b) indole series were screened for their antifilarial activity in vitro by observing their effect on the spontaneous movements of the whole worm and nerve muscle preparation of S. cervi (Nematoda:Filarioidea). Of the 10 compounds tested only compound 87/581 was able to modify the movements of whole worm and nerve muscle preparation. This compound caused inhibition of spontaneous motility of whole worm and nerve muscle preparation of S. cervi characterized by initial short lasting stimulation followed by irreversible paralysis. The concentration required to inhibit the movements of n.m. preparation was 10 micrograms/ml as compared to 25 micrograms/ml for the whole worm preparation, suggesting a cuticular permeability barrier. Prior addition of compound 87/581 to the bath fluid blocked the calcium ion dependent stimulant effect of Ach and pyrantel pamoate. Further the initial stimulant effect of the compound was blocked by prior addition of nifedipine a calcium channel blocker. The findings suggest that the action is due to blockade of voltage sensitive calcium channels.


Subject(s)
Animals , Calcium Channel Blockers/chemistry , Calcium Channels/drug effects , Filaricides/chemistry , Indoles/chemistry , Nifedipine/pharmacology , Setaria Nematode/drug effects , Structure-Activity Relationship
8.
Indian J Physiol Pharmacol ; 1997 Oct; 41(4): 397-403
Article in English | IMSEAR | ID: sea-106572

ABSTRACT

The effect of aqueous and alcoholic extracts of the leaves of Mallotus philippensis (Lam.) Muell. Arg. was studied on the spontaneous movements of the whole worm and nerve-muscle (n.m.) preparation of Setaria cervi and on the survival of microfilariae in vitro. Both the extracts caused inhibition of spontaneous motility of whole worm and the n.m. preparation of S. Cervi characterized by initial stimulation followed by depression in amplitude. The tone and rate of contractions remained visibly unaffected. Aqueous extract at higher concentration showed immediate reduction in tone. The concentration required to inhibit the movements of n.m. preparation was 1/5th for aqueous and 1/11th for alcoholic extract compared to that for the whole worm, suggesting a cuticular permeability barrier. The stimulatory response of acetylcholine was blocked by aqueous extract on whole worm movements. On the microfilariae the LC50 and LC90 were 18 and 20 ng/ml for aqueous and 12 and 15 ng/ml for alcoholic extracts respectively.


Subject(s)
Animals , Ethanol/chemistry , Filaricides/isolation & purification , Movement/drug effects , Plant Extracts/pharmacology , Plants, Medicinal/chemistry , Setaria Nematode/drug effects
9.
Indian J Exp Biol ; 1997 Feb; 35(2): 168-72
Article in English | IMSEAR | ID: sea-61310

ABSTRACT

Effect of aqueous and alcoholic extracts of the roots of A. adscendens was studied on the spontaneous movements of whole worm and nerve muscle (n.m.) preparation of S. cervi and on the survival of microfilariae in vitro. Aqueous as well alcoholic extracts caused inhibition of spontaneous motility of whole worm and n.m. preparation of S. cervi characterized by initial, short lasting small increase in amplitude and tone of contractions followed by paralysis. The initial stimulatory effect was not observed by aqueous extract on n.m. preparation. The concentration required to inhibit the movements of n.m. preparation was 1/4th for aqueous and 1/3rd for alcoholic extract suggesting a cuticular permeability barrier. The effect of acetylcholine on n.m. preparation was concentration related being more with a concentration of 5 micrograms/ml as compared to 1 microgram/ml. Both alcoholic as well as aqueous extracts caused death of microfilariae in vitro, LC50 and LC90 being 8 and 16 ng/ml for aqueous, 3 and 12 ng/ml for alcoholic extracts respectively.


Subject(s)
Animals , Anthelmintics/chemistry , Female , Liliaceae/chemistry , Plant Roots/chemistry , Setaria Nematode/drug effects
10.
Indian J Physiol Pharmacol ; 1996 Jul; 40(3): 265-6
Article in English | IMSEAR | ID: sea-106600

ABSTRACT

A patient with orbital cysticercosis is being presented, where albendazole therapy was successfully used. Serial CT scans of the lesions showed definite signs of resolution. The role of albendazole therapy in cysticercosis has been discussed. The relevant literature has been reviewed in brief.


Subject(s)
Adult , Albendazole/therapeutic use , Anthelmintics/therapeutic use , Cysticercosis/drug therapy , Female , Humans , Orbital Diseases/drug therapy , Tomography, X-Ray Computed
11.
Indian J Physiol Pharmacol ; 1996 Jul; 40(3): 237-40
Article in English | IMSEAR | ID: sea-108841

ABSTRACT

Hyperlipidemia in patients of secondary glomerulopathies, a well established entity with very little knowledge of its management modifies its prognosis by predisposing these patients to develop atherosclerosis, coronary artery disease, hypertension cerebro-vascular accidents and also thromboembolic phenomenon leading to renal vein thrombosis and renal failure. Guggulsterone was administered orally in these patients in a daily divided dose of 75 mg for a period of 8 weeks together with supportive measures like high protein diet, diuretics and hematinics. Total serum lipid, total serum cholesterol, triglycerides, phospholipids, HDL, LDL, and VLDL were analysed at 4 and 8 weeks of therapy. Significant reduction was observed in the values of total serum lipid and total serum cholesterol. Other parameters of lipid profile showed downward trend except rise of HDL with insignificant difference. There was no significant side effect throughout the study.


Subject(s)
Adolescent , Adult , Aged , Hypolipidemic Agents/therapeutic use , Child , Child, Preschool , Female , Humans , Hyperlipidemias/drug therapy , Infant , Infant, Newborn , Kidney Diseases/blood , Kidney Glomerulus/metabolism , Male , Middle Aged , Pregnenediones/therapeutic use
12.
Indian J Physiol Pharmacol ; 1996 Jul; 40(3): 245-8
Article in English | IMSEAR | ID: sea-107463

ABSTRACT

Nerve muscle preparation of Setaria cervi (Nematoda:Filarioidea) exhibits spontaneous rhythmical movements when suspended in isolated organ bath containing modified Ringer's solution. Pyrantel pamoate (50 ng/ml) when applied caused initial short lasting stimulation followed by irreversible paralysis. When suspended in calcium free bathing fluid the movements of n.m. preparation showed a gradual decrease both in amplitude and rate of contraction til the movements ceased completely. The effect was similar when EDTA was added to the bath fluid. The stimulant effect of Pyrantel pamoate was blocked in calcium free solution and in bath applied EDTA. Calcium channel blocker Nifedipine in a concentration of 500 ng/ml blocked the effect of Pyrantel pamoate (50 ng/ml). Neither stimulation nor depression of movements was evident with higher concentration of PP (250 mg/ml) the stimulant effect of Pyrantel pamoate was blocked while the depressant effect characterized by decrease in amplitude of calcium is essential for the stimulant effect of Pyrantel pamoate and its response on n.m. preparation is similar to Acetylcholine.


Subject(s)
Acetylcholine/pharmacology , Animals , Antinematodal Agents/pharmacology , Calcium Channels/drug effects , Cattle , Filarioidea/drug effects , Neuromuscular Junction/drug effects , Pyrantel Pamoate/pharmacology
13.
Indian J Physiol Pharmacol ; 1996 Jul; 40(3): 241-4
Article in English | IMSEAR | ID: sea-107190

ABSTRACT

Effects of prolonged lithium administration was seen on the action of various psychoactive drugs in animals. Apomorphine induced pecking in pigeons increased significantly by lithium treatment for 14 days, from 1445.3 +/- 202.5 in control to 2785.8 +/- 205.8 in Gp. B. Haloperidol-induced catalepsy score in albino rats increased significantly following chronic lithium treatment compared to control. Chlorpromazine-induced hypothermia in rabbits was immediate but transient, while in lithium treated rabbits induction of hypothermia was delayed, sustained and of greater magnitude. This action of lithium may be mediated by increasing the permeability of blood-brain barrier, or enhancing the sensitivity of alpha-adrenoceptors in brain.


Subject(s)
Administration, Oral , Animals , Apomorphine/pharmacology , Chlorpromazine/pharmacology , Columbidae , Drug Synergism , Female , Haloperidol/pharmacology , Lithium/pharmacology , Male , Psychotropic Drugs/pharmacology , Rabbits , Rats
14.
Indian J Physiol Pharmacol ; 1995 Apr; 39(2): 117-21
Article in English | IMSEAR | ID: sea-106731

ABSTRACT

Whole worm of Setaria cervi and its nerve muscle preparation exhibit rhythmical movements when suspended in modified Ringer's solution in an isolated organ bath. Deprivation of calcium from the bathing fluid results in gradual reduction in the amplitude and rate of contraction till the movements ceased completely. Similar results were obtained by adding EDTA (5 micrograms/ml) to the bath. The effect was concentration related and was evident early with higher concentration of EDTA. Acetylcholine which increases spontaneous movements of the whole worm as well as N.M. preparation failed to do so when the movements were inhibited either in calcium free solution or in the presence of EDTA. Addition of calcium channel blocker, Nifedipine to the bathing fluid also resulted in concentration related reduction of movements of the preparation of Setaria. Further, the stimulant response of Ach was also reduced by Nifedipine and this too was related to the concentration of calcium channel blocker in the bath. The evidence clearly indicates that presence of calcium is essential for the stimulant response of Ach on S. cervi, which like mammalian tissues contain calcium channels that can be blocked by specific blocking agents.


Subject(s)
Acetylcholine/pharmacology , Animals , Calcium Channels/drug effects , Edetic Acid/pharmacology , Electrophysiology , Movement/drug effects , Muscle Contraction/drug effects , Neuromuscular Junction/drug effects , Nifedipine/pharmacology , Setaria Nematode/drug effects
15.
Indian J Physiol Pharmacol ; 1994 Oct; 38(4): 272-6
Article in English | IMSEAR | ID: sea-106688

ABSTRACT

In the present study, pregnant women in different trimesters of pregnancy were randomly allocated to untreated control group (Gp A; n = 58), and zinc treated group (Gp B; n = 104). Both groups were administered ferrous sulphate 60 mg, and folic acid 5 mg, twice daily throughout the period of study. Gp B subjects were also administered 45 mg elemental zinc, in a single daily post lunch dose. Maternal blood and urine samples collected in each trimester, and at the time of delivery, and blood taken from the umbilical cord were tested for Cu levels. Maternal Hb was also estimated. In Gp A, mean serum Cu increased significantly from 117.15 +/- 2.12 micrograms/dl in I trimester to 138.57 +/- 0.92 micrograms/dl in III trimester (P < 0.001). In Gp B, serum Cu declined significantly from 115.64 +/- 1.12 micrograms/dl in I trimester to 111.10 +/- 0.99 micrograms/dl in III trimester (P < 0.001). Urinary Cu declined significantly from 47.24 +/- 2.31 micrograms/24 hrs in I trimester to 37.43 +/- 2.06 micrograms/24 hrs in III trimester (P < 0.01). Zn treatment did not alter differentially the serum Cu levels in anaemic and normohaemic subjects. Gp B cord blood serum Cu was significantly lower as compared to respective controls, significance being proportional to duration of zinc administration. Hb levels increased significantly in all subjects. Increase in Hb in Gp B was significantly higher in comparison to that in Gp A (P < 0.05). Elemental zinc when administered to pregnant women in a dose of 20-45 mg/day, causes improvement in Hb level, without leading to hypocupremia.


Subject(s)
Administration, Oral , Copper/blood , Female , Hemoglobins/analysis , Humans , Pregnancy , Pregnancy Trimester, First , Pregnancy Trimester, Second , Pregnancy Trimester, Third , Zinc/metabolism
16.
Indian J Physiol Pharmacol ; 1994 Oct; 38(4): 300-2
Article in English | IMSEAR | ID: sea-107637

ABSTRACT

Zinc levels were estimated from the maternal and cord blood drawn at delivery and in the amniotic fluid drawn before delivery in 9 pregnancies resulting in congenitally abnormal foetuses and 21 pregnancies resulting in normal healthy babies. Zinc levels were significantly lower (P < 0.01) in maternal and cord blood serum in congenitally malformed babies as compared to healthy normal controls. Amniotic fluid zinc levels were significantly higher (P < 0.01) in pregnancies with malformed babies. The use of zinc levels as marker for foetal malformation has been suggested.


Subject(s)
Amniotic Fluid/chemistry , Biomarkers/blood , Congenital Abnormalities/diagnosis , Female , Fetal Blood/chemistry , Humans , Infant, Newborn , Pregnancy/blood , Prenatal Diagnosis , Zinc/blood
17.
Indian J Physiol Pharmacol ; 1994 Jul; 38(3): 193-6
Article in English | IMSEAR | ID: sea-106999

ABSTRACT

In a prospective study a single dose PGE2 gel 0.5 mg was given in 97 Low Bishop Score subjects, 12 hrs prior to indicated oxytocin or PGE2 tab induction for cervical ripening. Analysis of 97 subjects shows that it is very highly effective. 56 primi and 21 multi delivered spontaneously with gel administration only while 4 primi and 2 multi delivered vaginally following oxytocin and 3 more cases delivered vaginally following PGE2 tab administration and fewer caesarian section (11) were performed. The endo cervical administration of PGE2 was well tolerated and systemic PGE2 effects were minimal.


Subject(s)
Administration, Oral , Cervix Uteri/drug effects , Cesarean Section , Dinoprostone/administration & dosage , Female , Gels , Humans , Labor Onset/drug effects , Labor, Induced , Oxytocin/pharmacology , Parity , Pregnancy , Prospective Studies
18.
Indian J Physiol Pharmacol ; 1994 Jul; 38(3): 197-201
Article in English | IMSEAR | ID: sea-108868

ABSTRACT

A method has been developed for the standardization of Indian ayurvedic drugs containing iron, using inorganic ion exchange material antimony (V) arsenosilicate cation exchanger. The iron present in the drug was absorbed quantitatively on the columns of the exchanger, eluted with a suitable solvent and then titrated against a standardized EDTA solution.


Subject(s)
Alloys/chemistry , Antimony/chemistry , Edetic Acid/chemistry , India , Ion Exchange Resins/chemistry , Iron/analysis , Medicine, Ayurvedic , Microspheres , Trace Elements/analysis
19.
Indian J Physiol Pharmacol ; 1993 Oct; 37(4): 276-84
Article in English | IMSEAR | ID: sea-108295

ABSTRACT

Women in different trimesters of pregnancy (Group B; n = 106) were administered 200 mg zinc sulphate (elemental Zn 45 mg) orally/day from the day of reporting till delivery. Untreated group of 62 served as control. Levels of zinc in maternal serum, umbilical cord blood serum, and urine were estimated. Pregnancy outcome was assessed in terms of incidence of prematurity, IUGR, birth weight; apgar score and gestational age. Serum zinc levels in Gp. A declined significantly from 113.00 +/- 2.80 ug/dl in I trimester to 83.78 +/- 2.20 ug/dl in III (P < 0.001). Following zinc supplementation (Gp. B) serum zinc levels increased significantly from 109.70 + 3.23 micrograms/dl to 205.40 +/- 4.47 micrograms/dl (P < 0.001). Urinary excretion of zinc in Gp. A declined significantly with increase in the period of gestation. However in Gp. B, elimination of Zn increased significantly in proportion with the serum levels (P < 0.001) cord blood serum zinc level was normal irrespective of maternal serum Zn levels. Following oral Zn supplementation, levels increased significantly from below 127.0 micrograms/dl to above 158.0 micrograms/dl in Gp. B (P < 0.001). Maternal serum and cord blood serum zinc ratios were fairly constant in Gp. A as well as in Gp. B. Birth weight of babies born with Zn supplementation was significantly higher than control and was related to duration of oral zinc supplementation (P < 0.001). Gestational age of babies in Gp. B was significantly higher than respective controls when Zn supplementation was given for more than 3 months (P < 0.01), and was related to duration of zinc therapy (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Administration, Oral , Apgar Score , Birth Weight/drug effects , Female , Fetal Blood , Fetal Growth Retardation/prevention & control , Gestational Age , Humans , Infant, Newborn , Infant, Small for Gestational Age , Obstetric Labor, Premature , Pregnancy , Pregnancy Outcome , Sulfates/administration & dosage , Zinc Compounds/administration & dosage , Zinc Sulfate
20.
Indian J Physiol Pharmacol ; 1993 Jul; 37(3): 213-6
Article in English | IMSEAR | ID: sea-108322

ABSTRACT

Atenolol, a cardio selective beta-adrenergic blocker, frequently prescribed in various cardiac ailments, has not been thoroughly investigated for its adverse reaction profile in Indian patient. The present ADR monitoring study which was open, prospective and collaborative was therefore planned. A total of 440 patients with various heart disease were enrolled after a strict inclusion and exclusion criteria from Maulana Azad Medical College, New Delhi and J.N. Medical College, Aligarh. fifteen patients dropped out leaving 435 for final analysis. Cold extremities occurred in 1.18% headache and dizziness in 1.41% breathlessness in 0.94% oedema in 0.70% and bradycardia in 0.47%. Adverse drug reaction in our study were less than those reported from Western countries. Better patient selection, optimal dose could have reduced the frequency of ADR in the present study. Racial factor and season might be operating to bring down ADR to atenolol in Indian patients.


Subject(s)
Atenolol/adverse effects , Cardiovascular Diseases/complications , Humans , Middle Aged
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