Myocardial performance in asymptomatic essential hypertension.

Prevalence, determinants, and prognostic value of left ventricular function in subjects with asymptomatic essential hypertension are still incompletely known. The goal of this study was to investigate the effects of asymptomatic untreated essential hypertension on left ventricular structure and function. The left ventricular functions were assessed among 127 hypertensive and 80 healthy subjects. American society of echocardiography (ASE) convention was applied to measure the stroke volume, percentage ejection fraction, percentage fractional fiber shortening, cardiac output and cardiac index. The stroke volume, cardiac output and cardiac index were normal but significantly high among hypertensive compared to normotensive subjects (P<0.05). The percentage ejection fraction and fractional fiber shortening were significantly reduced among hypertensives compared to normotensives (P<0.05). The significant impairment of percentage fractional fiber shortening is due to alteration in dimension of left ventricular wall thickness, left ventricular cavity and left ventricular geometry. This carries prognostic implication and requires further documentations, investigations and researches. Percentage ejection fraction and fractional fiber shortening is considered a hallmark of normal left ventricular function. The left ventricular contractile state was negatively correlated to left ventricular after load parameters. So the main objective of management of hypertensive subjects should be, to reduce the after load to improve the left ventricular contractile state.

Evaluation of maternal myocardial performance during normal pregnancy and post partum.

AIMS: Little information exists about the use of noninvasive methods to characterized left ventricular mechanical adaptation during normal pregnancy. The aim of this study was to evaluate left ventricular performance during normal pregnancy and study the effect of maternal factors. METHODS AND RESULTS: The study was conducted at Govt. Medical College and New Civil Hospital, Surat between February 2006 to March 2008. M-mode and Doppler echocardiography was performed in 31 normal pregnant women at 30-40 weeks and 8-12 weeks postpartum. Heart rate, stroke volume, cardiac output and left ventricular mass increased significantly, while total vascular resistance decreased significantly during last trimester of pregnancy. Left ventricular contractility indices (percentage ejection fraction and fraction shortening) were within normal limit during pregnancy but fractional shortening was significantly higher post-partum than in the last trimester of pregnancy (p < 0.05). Maternal age was related to the transmitral peak velocity of early filling (E, p = 0.001) and the E to A ratio (p < 0.001), while height was related to heart rate (p < 0.001), stroke volume (p = 0.003), cardiac output (p < 0.001) and left ventricular mass (<0.005). CONCLUSION: This study express that along with gestation, maternal anthropometric profile may affect cardiac performance. Systolic performance was better in tall individuals and diastolic performance was better in younger individuals.

"A case of cardiac amyloidosis with syncope".

A 56 year gentleman referred to our hospital for evaluation of syncope. He was seen previously at a local clinic and treated for cardiac failure with diuretics and was doing well on medication. He started having recurrent episode of syncope. He had his last visit to the local physician three days prior to admission when he had palpitation and was prescribed digoxin in addition to the usual medicine. Patient started having syncope from 3rd day and was referred to our hospital for evaluation. Patient's electrocardiogram as well as echocardiography was a classical finding of cardiac amyloidosis and a fat pad biopsy confirmed the diagnosis. After withdrawing digoxin and after two days on pacemaker, the patient regained normal heart rate and was discharged on diuretics.

Ulcer healing properties of ethanolic extract of Eugenia jambolana seed in diabetic rats: study on gastric mucosal defensive factors.

Diabetes has been reported to cause an increase in offensive and decrease in defensive gastric mucosal factors, the imbalance of which can cause ulceration and delay the ulcer healing. Eugenia jambolana has been documented to have both antidiabetic and antiulcer activities. The present study evaluates the effects of ethanolic extract of E. jambolana on gastric ulcer healing and on rat gastric mucosal defensive factors in gastric ulcer with co-occurring diabetes. E. jambolana extract was administered orally in the dose of 200 mg/kg once daily for 10 days. E. jambolana extract increased mucin secretion, mucosal glycoprotein and glutathione levels and decreased the lipid peroxidation in gastric mucosa of diabetic rats. Its treatment also reversed the decrease in life span of gastric mucosal cells as indicated by decreased cell shedding in the gastric juice but found to have no effect on cell proliferation, indicating enhanced defensive status. E. jambolana extract was effective in reversing the delayed healing of gastric ulcer in diabetic rats near to the normal level. E. jambolana showed better ulcer healing effect than glibenclamide, because of its both antihyperglycemic and mucosal defensive actions. It could thus, be a better choice for treating gastric ulcers co-occurring with diabetes.

Antidiabetic and antiulcer effects of extract of Eugenia jambolana seed in mild diabetic rats: study on gastric mucosal offensive acid-pepsin secretion.

Diabetes has been reported to increase propensity to peptic ulceration through its effect both on offensive and defensive mucosal factors. Seeds of Eugenia jambolana (EJ) have been reported to have both antidiabetic as well as ulcer protective effects. The present study evaluates the antidiabetic effects of ethanolic extract of dried seed kernel of Eugenia jambolana (EJE) and its comparative effect on gastric ulceration and acid-pepsin secretion with standard antisecretory FL-blocker. Ranitidine and antidiabetic glibenclamide with a premise that Eugenia jambolana may show better ulcer healing effects by promoting defensive or reducing offensive mucosal factors in mild diabetes (MD) rats. MD was produced in adult rats by administration of streptozotocin (45 mg/kg, ip). EJE was given orally in the doses of 100-400 mg/kg for 10 days and in the dose of 200 mg/kg for 30 days respectively to study its dose- and time-dependent effects on various diabetic parameters like blood glucose, serum cholesterol and triglycerides, insulin level and glycosylated hemoglobin. For ulcer protective and gastric secretion studies, EJE (200 mg/kg) was given orally for 10 days against 2 h cold restraint stress (CRS)-, 4 h pylorus ligation (PL), aspirin (ASP, 200 mg/kg, 4 h)--and 95% ethanol (EtOH, 1 ml/200 g, 1 h)-induced gastric ulcers and offensive acid-pepsin secretion after 4 h PL with co-occurring MD in rats. EJE showed dose-dependent decrease in blood glucose level in MD rats. Blood glucose level remained stable in mild diabetic rats from 3rd day onwards after streptozotocin administration (taken as 1st day for treatment) and EJE (200 mg/kg) showed anti-hyperglycemic effect on 10th day of its administration. Further, EJE in the above dose also decreased cholesterol level with little or no effect on triglycerides level and reversed the decrease and increase in insulin and glycosylated hemoglobin level near to the normal level as observed alter 30 days treatment in MD rats. MD rats exhibited an increased propensity to gastric ulceration induced by CRS, ASP, EtOH and PL and caused increase in acid-pepsin secretion. EJE was not only effective in reversing the increased propensity to ulceration in diabetic rats but also decreased the acid-pepsin output better than glibenclamide. The ulcer protective effect of Eugenia jambolana seems to be due to its antidiabetic and gastric antisecretory effects.

A case of mitral stenosis with achalasia.

A 65-year-old woman with rheumatic heart disease and severe mitral stenosis developed dysphagia. As her dysphagia could not be directly attributed to an enlarged left atrium, she underwent barium swallow, which established the diagnosis of achalasia. This case report shows two unrelated diseases present in the same patient which individually can cause dysphagia.

Effect of ethanolic extract of Eugenia jambolana seeds on gastric ulceration and secretion in rats.

Eugenia jambolana (Jamun) fruit has been reported to give soothing effect on human digestive system. Present study includes the effect of ethanolic extract of seeds of E. jambolana (EJE) against gastric ulcers induced by 2 h cold restraint stress (CRS), aspirin (ASP, 200 mg/kg, 4 h), 95% ethanol (EtOH, 1 ml/200 g, 1 h) and 4 h pylorus ligation (PL) in rats. To ascertain the mechanism of action of EJE, its effect was studied on mucosal offensive acid-pepsin secretion, lipid peroxidation (LPO, free radical) and defensive mucin secretion, cell proliferation, glycoprotein and glutathione (GSH, an antioxidant). Acute and subacute toxicity studies were also conducted for the safety profile of Eugenia jambolana. EJE 200 mg/kg, when administered orally for 10 days in rats was found to reduce the ulcer index in all gastric ulcer models. It tended to decrease acid-pepsin secretion, enhanced mucin and mucosal glycoprotein and decreased cell shedding but had no effect on cell proliferation. It showed antioxidant properties indicated by decrease in LPO and increase in GSH levels in the gastric mucosa of rats. Acute toxicity study indicated LD50 to be more than 10 times (>2000 mg/kg) of the effective ulcer protective dose while subactue toxicity study (>1000 mg/kg) indicated no significant change in the general physiological and haematological parameters, liver and renal function tests. The result of the present study indicates that E. jambolana seed has gastro-protective properties mainly through promotion of mucosal defensive factors and antioxidant status and decreasing lipid peroxidation.

Effect of aqueous extract of neem (Azadirachta indica) leaves on offensive and diffensive gastric mucosal factors in rats.

Standardized aqueous extract of Neem (Azadirachta indica) leaves (AIE) has been reported to show both ulcer protective and ulcer healing effects in normal as well as in diabetic rats. To study the mechanism of its ulcer protective/healing actions, effects of AIE (500 mg/ kg) was studied on various parameters of offensive acid-pepsin secretion in 4 hr pylorus ligation, pentagastrin (PENTA, 5 microg/kg/hr)-stimulated acid secretion and gastric mucosal proton pump activity and defensive mucin secretion including life span of gastric mucosal cells in rats. AIE was found to inhibit acid-pepsin secretion in 4 hr pylorus ligated rats. Continuous infusion of PENTA significantly increased the acid secretion after 30 to 180 min or in the total 3 hr acid secretion in rat stomach perfusate while, AIE pretreatment significantly decreased them. AIE inhibited the rat gastric mucosal proton pump activity and the effect was comparable with that of omeprazole (OMZ). Further, AIE did not show any effect on mucin secretion though it enhanced life span of mucosal cells as evidenced by a decrease in cell shedding in the gastric juice. Thus, our present data suggest that the ulcer protective activity of AIE may be due to its anti-secretary and proton pump inhibitory activity rather than on defensive mucin secretion. Further, acute as well as sub acute toxicity studies have indicated no mortality with 2.5 g/kg dose of AIE in mice and no significant alterations in body or tissues weight, food and water intake, haematological profile and various liver and kidney function tests in rats when treated for 28 days with 1 g/kg dose of AIE.