BackgroundDyslipidemia is one of the most frequently implicated risk factors for development of atherosclerosis. This study evaluated the efficacy of amla (Emblica officinalis) extract (composed of polyphenols, triterpenoids, oils etc. as found in the fresh wild amla fruit) in patients with dyslipidemia.MethodsA total of 98 dyslipidemic patients were enrolled and divided into amla and placebo groups. Amla extract (500 mg) or a matching placebo capsule was administered twice daily for 12 weeks to the respective group of patients. The patients were followed up for 12 weeks and efficacy of study medication was assessed by analyzing lipid profile. Other parameters evaluated were apolipoprotein B (Apo B), apolipoprotein A1 (Apo A1), Coenzyme Q10 (CoQ10), high-sensitive C-reactive protein (hsCRP), fasting blood sugar (FBS), homocysteine and thyroid stimulating hormone (TSH).ResultsIn 12 weeks, the major lipids such as total cholesterol (TC) (p = 0.0003), triglyceride (TG) (p = 0.0003), low density lipoprotein cholesterol (LDL-C) (p = 0.0064) and very low density lipoprotein cholesterol (VLDL-C) (p = 0.0001) were significantly lower in amla group as compared to placebo group. Additionally, a 39% reduction in atherogenic index of the plasma (AIP) (p = 0.0177) was also noted in amla group. The ratio of Apo B to Apo A1 was reduced more (p = 0.0866) in the amla group as compared to the placebo. There was no significant change in CoQ10 level of amla (p = 0.2942) or placebo groups (p = 0.6744). Although there was a general trend of FBS reduction, the numbers of participants who may be classified as pre-diabetes and diabetes groups (FBS > 100 mg/dl) in the amla group were only 8. These results show that the amla extract used in the study is potentially a hypoglycaemic as well. However, this needs reconfirmation in a larger study.ConclusionsThe Amla extract has shown significant potential in reducing TC and TG levels as well as lipid ratios, AIP and apoB/apo A-I in dyslipidemic persons and thus has scope to treat general as well as diabetic dyslipidemia. A single agent to reduce cholesterol as well as TG is rare. Cholesterol reduction is achieved without concomitant reduction of Co Q10, in contrast to what is observed with statins.Trial registrationRegistered with Clinical Trials Registry- India at www.ctri.nic.in (Registration number: CTRI/2015/04/005682) on 8 April 2015 (retrospectively registered).Electronic supplementary materialThe online version of this article (10.1186/s12906-019-2430-y) contains supplementary material, which is available to authorized users.
The aim of this study was to determine the utility of the mitral leaflet separation index (MLSI), for determining the results of percutaneous mitral commissurotomy (PMC) in the acute setting, in the cardiac catheterization laboratory. Forty-eight patients undergoing PMC were studied and 96 examinations were performed. The overall correlation with the MLSI was 0.95. The mitral valve area (MVA) was determined by 2D echo planimetry (MVAPLM ) and 0.83 of the MVA was derived using Gorlin's formula (MVAGOR ). The MLSI was significantly different in patients with severe mitral stenosis (MS) (MVAPLM <1 cm(2) , MLSI of 0.70 mm) compared with those with mild MS (MVAPLM >1.5 cm(2) , MLSI of 0.92 mm). The MLSI is a simple and effective method for assessment of the MVA. An MLSI >0.92, immediately after PMC, had an excellent sensitivity and specificity for the prediction of an effective MVA of >1.5 cm(2) .
Patent ductus arteriosus (PDA) is common congenital heart disease which may require treatment as transcatheter percutaneous device closure (PDA device closure) or surgical ligation in symptomatic full-term patients. Surgical ligation is an invasive procedure and has more complications especially in the neonates. Problems in PDA device closure are difficult vascular access, manipulation of catheters and sheath, residual shunts, residual obstruction of major arteries etc and these complications increase in low birth weight babies, but it is a less invasive procedure and has fewer complications than surgery, so should be tried in low birth weight patients also. We are presenting a case of 3 kg infant with large PDA (8 mm) presented with failure to thrive, lower respiratory tract infection and heart failure. He successfully underwent PDA device closure with 10 × 12 mm Cocoon PDA device. To the best of our knowledge, this is the first case of the use of such a large device in a 3 kg child with good results.
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