Leflunomide in Systemic Onset Juvenile Idiopathic Arthritis.

Methotrexate, the mainstay of treatment in Juvenile idiopathic arthritis, might not be effective in a few patients of polyarticular and systemic onset juvenile idiopathic arthritis. Use of biologicals like TNF-α blockers, the next line of preferred drugs is constrained by the high cost. We successfully used leflunomide in four patients.

The Cytokines and Heart Failure-A Review.

Heart Failure (HF) develops in several stages - the first stage is some disorder that places a hemodynamic burden on the myocardium or causes myocardial injury. The second stage is that of cardiac compensation, which involves neurohormonal activation to preserve cardiac output and tissue perfusion. And the final stage is the progression of HF, which is complex and is the result of the harmful effects of the compensatory mechanisms of the second stage; an immune-system activation manifested by increases in inflammatory cytokines, including tissue necrosis factor–alpha (TNF-á), soluble receptors of TNF-á (sTNFR1 and 2), interleukin (IL)-1, IL-6 and IL-10, and C-reactive protein (CRP). It has recently been recognized that elevated circulating levels of various proinflammatory cytokines (TNF- á, IL-1, IL-6) leading to free radical overproduction, as well as to cardiac myocyte and endothelial cell apoptosis, play a significant role in the pathophysiology of CHF. The extracellular domains of proinflammatory cytokine receptors (sTNFR1, sTNFR2 and sIL- 6R) are also elevated in CHF and provide more complete information on cytokine activation in this syndrome. This article reviews the contribution of inflammatory cytokines in the disease progression in patients with heart failure, their diagnostic as well as prognostic values and possibly therapeutic interventions on these biologic active molecules.

In Hospital Outcome of Myocardial Infarcton in Nondiabetic Patients with High on Admission Blood Glucose Level.

Background: Patients without a history of diabetes often develop hyperglycemia during an acute coronary syndrome (ACS). Our aim was to evaluate the impact of admission hyperglycemia on in hospital outcome of non-diabetic patients admitted for acute coronary syndromes. Methods: The retrospective study was conducted in National Institute of Cardiovascular Diseases among the patients with acute myocardial infarction without history of diabetes. 50 patients with ST elevation MI (STEMI) with complications, 50 patients with STEMI without complications, 50 patients with non-ST elevation MI (NSTEMI) with complications and 50 patients without complications were included in the study. Every patient got the treatment as per protocol of the institute. On admission blood glucose of the patients was recorded. Level of blood glucose was correlated with the frequency of complications. Results : Average on admission blood sugar level was higher in patients who developed complications with STEMI (11.4 vs 8.78 mmol/L). On admission blood sugar level was also significantly higher in patients with NSTEMI with complications (10.6 vs 8.6 mmol/L). The frequency of individual complications had no significant relation with the blood sugar level. Conclusion : Higher level of admission blood glucose is related to poor in hospital outcome in both STEMI & NSTEMI even in nondiabetic patients. It may be used as a predictor of poor outcome of patients with myocardial infarction.

Clinical Efficacy of Carvedilol In Treatment of Patients With Ischemic Heart Disease and Chronic Heart Failure.

Background: In the pathogenesis of CHF neurohormonal changes, in particular, changes of activity of sympathetic nervous system (SNS) occupies an important position. For this reason, researchers concentrated on the use β-blockers in therapy of patients with CHF. They reduce heart rate, improve diastolic function of the myocardium, reduce secretion of renin and restore the sensitivity of β- adrenoreceptors to its regulatory influences. We studied the influence of the 3rd generation betaadrenoblocker – Carvedilol in patients with CHF- including clinical efficacy and reduction of oxidative stress. Methods: The study was conducted in Saint-Petersburg State Medical University, from January 2000 to June 2000. 37 patients (33 male and 4 female) with CHF class III or IV despite receiving standard therapy of heart failure were enrolled in the study for the treatment with Carvedilol. All of the patients received Carvedilol for 6 months at a dose of 12.5-50mg/day with standard therapy of Heart Failure, which was not changed during next 6 months. Results: The average age of the patients was 56.8±2.3 years. The cause of CHF was IHD. 34 patients had chronic stable angina (CCS class II-IV). The majority of the patients had a history of myocardial infarction (91.8%); of these 73.5% of the patients had a history of repeated MI. Hypertension stage 2 and 3 was associated in 32.4% patients.Long-term therapy with Carvedilol led to improvement of the clinical status of the patients. After 6 months therapy with Carvedilol frequency of hospitalization was significantly reduced (1.36±0.23 vs. 0.33±0.1; p<0,01). The patients were symptomatically improved after 6 months therapy with Carvedilol. There was a tendency of reduction of LV mass by 12.1% (214.0±11.1 gm/m2 vs. 188.1±10.8 gm/m2, p<0.05). After treatment with Carvedilol there was significant increase in LVEF by 10% (30.0±1.5% to 33.0±0.1%; p<0.01) and increase in fractional shortening of LV by 22.2% (from 17.25±1.14 vs. 21.09±1.25; p<0.01). There was a significant reduction in plasma MDA, indicator of oxidative stress, in comparison with the baseline data. Conclusion: Carvedilol therapy in patients with Chronic heart failure improves clinical symptoms of patients with improvement in systolic & diastolic function of LV. Carvedilol also reduces oxidative stress in patients with heart failure.

Hepatoprotective effects of setarud against carbon tetrachloride-induced liver injury in rats.

To assess the hepatoprotective activity of a new herbal drug "setarud" in experimental liver fibrosis, 48 male Wistar rats were divided into four groups: controls, carbon tetrachloride (CCl4) group, and two treatment groups that received CCl4 and setarud at doses of 0.02 or 0.04 g/Kg/day for 30 days. Body weight gain, biochemical liver tests, bile flow rate and composition, and changes in liver morphology in the four groups were studied. CCl4 administration led to morphological and biochemical evidence of liver injury as compared to untreated controls. Setarud administration led to significant protection against CCl4-induced changes in body weight gain, liver morphology, bile flow and concentration. It was also associated with significantly lower serum liver enzyme levels (p<0.01), higher serum albumin level, and reduced increase in narcotic-induced sleeping time. Thus, setarud showed protective activity against CCl4-induced hepatotoxicity in rats. Further studies of its efficacy in liver disease are warranted.

Antitumour and antiinflammatory activities of hydroxamic acids and hydroxyurea

Antitumour activity has been evaluated using aceto [AHA], benzo [BHA], salicyl [SHA] cloroaceto [CHA], hydroxamic acids and hydroxyurea [HU] against Ehrlich ascites carcinoma [EAC] cells in Swiss albino mice. Anti-inflammatory activity of these compounds has also been studied in Sprague Dawley rats. Among these compounds only. CHA shows both antitumour and anti-inflammatory activities significantly. Although HU possesses highly effective antitumour activity, it does not show anti-inflammatory activity at all. Other compounds show differential antitumour and anti-inflammatory activities