Shridhar Dwivedi

Revisiting Terminalia arjuna - An Ancient Cardiovascular Drug.

Terminalia arjuna, commonly known as arjuna, belongs to the family of Combretaceae. Its bark decoction is being used in the Indian subcontinent for anginal pain, hypertension, congestive heart failure, and dyslipidemia, based on the observations of ancient physicians for centuries. The utility of arjuna in various cardiovascular diseases needs to be studied further. Therefore, the present review is an effort to give a detailed survey of the literature summarizing the experimental and clinical studies pertinent to arjuna in cardiovascular disorders, which were particularly performed during the last decade. Systematic reviews, meta-analyses, and clinical studies of arjuna were retrieved through the use of PubMed, Google Scholar, and Cochrane databases. Most of the studies, both experimental and clinical, have suggested that the crude drug possesses anti-ischemic, antioxidant, hypolipidemic, and antiatherogenic activities. Its useful phytoconstituents are: Triterpenoids, β-sitosterol, flavonoids, and glycosides. Triterpenoids and flavonoids are considered to be responsible for its beneficial antioxidant cardiovascular properties. The drug has shown promising effect on ischemic cardiomyopathy. So far, no serious side effects have been reported with arjuna therapy. However, its long-term safety still remains to be elucidated. Though it has been found quite useful in angina pectoris, mild hypertension, and dyslipidemia, its exact role in primary/secondary coronary prevention is yet to be explored.

Anaphylaxis following intravenous ranitidine: a rare adverse reaction of a common drug.

Ranitidine hydrochloride is a widely used drug that is generally well-tolerated. Anaphylaxis is rarely observed with ranitidine. We report a case who developed severe anaphylaxis following single dose of intravenous ranitidine. The article highlights the importance of recognition of this serious adverse event and re-emphasizes the need for cautious use of drugs, especially in those with known history of allergy.

Insulin Resistance in Young Obese Subjects and Its Relation to Smoking (A Pilot Study)

Insulin resistance is a condition in which cells fail to respond to the normal actions of insulin. Dietary fat, obesity and smoking have been attributed to increase insulin resistance. However, the prevalence of insulin resistance in young obese subjects and its relation to smoking is not well established. This study comprising seventy-five healthy young adults was undertaken to find insulin resistance in obese smokers and non smokers both. Present study showed an overall prevalence of raised homeostatic model assessment of insulin resistance in 14.7xa0% otherwise healthy young subjects (20–30xa0years age group). Non-smokers did not show any significant correlation between insulin resistance and body mass index at either stage (normal, pre-obese as well as obese). Smokers also did not show any significant difference of insulin resistance in normal and pre-obese stages. However, marked increase in homeostatic model assessment of insulin resistance was observed in obese smokers. Homeostatic model assessment of insulin resistance showed a linear trend in relation to body mass index and its values were found to be higher in smokers. Obesity combined with smoking demonstrated statistically significant increase in homeostatic model assessment of insulin resistance.

An observational study of cutaneous adverse drug reactions in a teaching hospital

Background Pharmacotherapy is often impeded by adverse drug reactions (ADRs). Among these ADRs cutaneous reactions are the major class being easily identified and reported. If not noted early it has potential to develop into serious lesions. Objective To evaluate the clinical patterns of various drug induced cutaneous reactions. Setting A Teaching hospital in India. Methods All suspected cutaneous reactions to systemic drugs which were submitted to the ADR monitoring centre during a 6-month period (March 2014–August 2014) were analysed. Causality relationship, severity assessment and preventability assessment was also done. Results Out of 134 cutaneous ADRs, 56xa0% occurred in females, majority of cases were found in the age group of 41–50xa0years. The most common type of ADR was maculopapular rash (46.3xa0%) and majorly implicated drug class was antibiotics (51.3xa0%). Most (72.3xa0%) were mild. Polypharmacy and multiple comorbid conditions were important predisposing factors. Over half of the cases (58xa0%) were not preventable. Conclusion Cutaneous adverse reaction patterns and their causes vary as the result of changing use of drugs. In India, antibiotics are responsible for the majority of the cutaneous adverse drug reactions, and maculopapular rash is the side effect that is most reported.

Study of adverse drug reactions in patients with diabetes attending a tertiary care hospital in New Delhi, India

The present prospective observational study was carried out in a tertiary care hospital in New Delhi, India from May 2014 to June 2015 to report adverse drug reactions (ADRs) in patients with type 2 diabetes mellitus (T2DM) using antidiabetic drugs. A total of 220 patients (121 males, 99 females) were enrolled. ADRs were recorded on the prescribed form. Causality and severity assessment was done using Naranjos probability scale and modified Hartwig and Siegels severity scale, respectively. Commonly prescribed drugs were biguanides, peptide hormone and sulphonylurea. A total of 26 ADRs were recorded (16 in males and 10 in females). Most commonly observed ADRs were related to endocrine and gastrointestinal system. Severity assessment of ADRs showed seven (26.9%) ADRs as moderate, and 19 (73.1%) as mild. No severe reactions were observed. ADRs were mostly related to endocrine and gastrointestinal system. More information on prescribed drugs and their side effects is required for ensuring patient safety.

Stevia rebaudiana the unique medicinal plant with sweet taste having hypoglycemic and hypolipidemic activities

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Comments on "Yoga: From cardiovascular benefit to the gates of God".

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The men who picked the truant notes in heart sounds

Since the invention of stethoscope by Rene Laennec, auscultation has become sine qua non of clinical examination, especially for cardiovascular system. Many clinical signs are named after the first describer, as a tribute to their efforts. So is true for cardiac murmurs. Sir Graham Steell was a British cardiologist who described the high pitched diastolic murmur of pulmonary regurgitation. Diastolic murmur of severe aortic regurgitation is named after American physician, Austin Flint, who actually disapproved eponyms. American physician Richard Clarke Cabot and his colleague Locke described early diastolic murmur of severe anemia, which is thought to be due to high flow in left coronary artery. The name of Carey Coomb, a British cardiologist, is associated with mid-systolic murmur of mitral valvulitis in acute rheumatic fever. Left anterior descending arterial stenosis sometimes produces an early diastolic murmur and it was first described by American physician William Dock. The machinery murmur of patent ductus arteriosus was first described by George Alexander Gibson. Key-Hodgkin murmur is the diastolic murmur of aortic regurgitation, named after Thomas Hodgkin and Charles Ashton Key. French pediatrician Henri Louis Roger described the holosystolic murmur of ventricular septal defect and his name is also associated with Maladie de Roger. Sir George Frederic Still, an English paediatrician, whose name is associated with juvenile idiopathic arthritis described the innocent functional murmur mostly heard in children. It was Louis Gallavardin, a French physician, who described the phenomenon of dissociation of musical component and noisy component of aortic stenosis. Though the popularity of such eponyms are on wane due to advent of phonocardiography and ECHO Doppler, one hopes some newer descriptions of murmurs due to changing profile of cardio-vascular diseases will emerge in near future.

Adverse effects of herbal medicine.

Editor – We wite with reference to the manuscript ‘Adverse effects of herbal medicine: an overview of systematic reviews’ by Posadzki etxa0al ( Clin Med February 2013 pp 7–12), which reviews the severity of the adverse effects of herbal drugs.nnIt was gratifying to note that very few of the