The effects of Gymnema Sylvestre supplementation on lipid profile, glycemic control, blood pressure, and anthropometric indices in adults: A systematic review and meta-analysis.

There is a growing interest in the considerable health benefits of Gymnema Sylvestre (GS) supplementation, as some studies have reported that it may improve cardiometabolic risk factors. However, the widespread impact of GS supplementation on the parameters mentioned above is not fully resolved. Consequently, this study aimed to examine the effects of GS supplementation on lipid profile, glycemic control, blood pressure, and anthropometric indices in adults. Eligible randomized controlled trials (RCT), published up to November 2021, were identified through PubMed, Scopus, and ISI Web of Science databases. Six studies were included and analyzed using a random-effects model to calculate weighted mean differences (WMDs) with 95% confidence intervals (CI). All studies were conducted in adults that used a GC supplement (>1 week) and assessed our selected cardiovascular risk factors. Outcomes revealed that GS supplementation significantly decreased triglyceride (p < .001), total cholesterol (p < .001), low-density lipoprotein (p < .001), fasting blood sugar (p < .001), and diastolic blood pressure (p = .003). Some limitations, including notable heterogeneity, low quality of studies, and lack of diversity among research participants, should be considered when interpreting our results. Our outcomes suggest that GS supplementation may improve cardiovascular risk factors. Future large-high-quality RCTs with longer duration and various populations are needed to firmly establish the clinical efficacy of the plant.

Vitamin A supplementation is effective for improving the clinical symptoms of urinary tract infections and reducing renal scarring in girls with acute pyelonephritis: a randomized, double-blind placebo-controlled, clinical trial study.

INTRODUCTION: It is believed that tubulointerstitial inflammation plays a role in the formation of renal scarring secondary to acute pyelonephritis (APN). Vitamin A is an anti-inflammatory agent that is involved in the re-epithelialization of damaged mucosal surfaces. OBJECTIVE: The aim of this study was to evaluate the efficacy of vitamin A supplementation in combination with antibiotics for improving urinary tract infections (UTIs) symptoms and preventing renal scarring in girls with APN. STUDY DESIGN: This randomized, double-blind, placebo-controlled clinical trial was conducted on 90 girls aged 2 to 12 years old between 2015 and 2017. Patients with UTIs and first episode of APN diagnosed based on 99 mTc-DMSA scintigraphy (uptake defect) were assessed for eligibility. Patients were randomly divided into two groups that either received 10 days of oral vitamin A (intervention group) or 10 days of placebo (control group) in addition to antibiotics during the acute phase of infection. The clinical response was considered as the primary outcome [duration (positive days) of UTI symptoms during trial treatment period] and secondary outcomes (no change, improving and or worsening of 99 mTc-DMSA scan results 6 months after treatment from baseline). P < 0.05 was considered to be statistically significant. RESULTS: Seventy-four patients (vitamin A group: 36 patients, placebo: 38 patients) were included in the analysis. The mean age was 5.25 ± 1 year old. Three patients (7.89%) in the placebo group and 2 patients (5.55%) in the vitamin A group had vesicoureteral reflux (VUR) (p = 0.114). Duration of fever (vitamin A group: 1.8 days, placebo: 3.1 days, p = 0.0026), urinary frequency (1.3 days vs. 2.8 days, p = 0.003) and poor feeding (2.3 days vs. 4.2 days, p = 0.005) were significantly lower in the vitamin A group. Following the second 99 mTc-DMSA scan, worsening of lesions was observed among 8 (22.2%) and 17 (44.7%) patients in the vitamin A and placebo groups, respectively (p = 0.003). 63.8% (23 patients) of the vitamin A group and 21% (8 patients) of placebo group showed lesion improving in the photopenic region. (P < 0.0001) There was no evidence of vitamin A intolerance. DISCUSSION: Our results show the efficacy of vitamin A supplementation on reducing renal scarring secondary to APN and on fever, urinary frequency and poor feeding duration in girls with APN. CONCLUSION: Vitamin A supplementation is effective for improving the clinical symptoms of UTI and reducing renal injury and scarring following APN in girls with first APN. However, larger randomized clinical trials (RCTs) with longer follow up are needed to confirm these effects.

Our modified technique of combined antegrade-vein graft cardioplegia infusion versus conventional antegrade method in coronary artery bypass grafting. A randomized clinical trial.

BACKGROUND: To determine the efficacy of antegrade cardioplegia supplemented with venous graft perfusion in patients scheduled for coronary artery bypass grafting (CABG). METHODS: 223 consecutive patients scheduled for isolated CABG were randomized to receive either continuous crystalloid cardioplegia via vein grafts on completion of each distal anastomosis plus intermittent blood cardioplegia through aortic root (group 1, n = 110) or antegrade blood cardioplegia alone (group 2, n = 113). Two groups were similar in terms of preoperative patients' and procedural characteristics. The primary end-points were low output syndrome (LOS) variables. RESULTS: The inotrope and intra-aortic balloon pump demand during weaning were significantly higher in the control group (31.8% vs. 20%, p = 0.043 and 7.9% vs. 1.8%, p = 0.034 respectively). Postoperative level of potassium and arterial base excess (BE), stood in the normal range in both groups, despite significant inter-group differences. Peak serum level of myocardial injury biomarkers (CK, CK-MB, and cTnI) at 12 h following operation, though markedly greater in the group 2, did not reach the cut-off point of myocardial necrosis. Postoperative arrhythmia was more commonly encountered in the control group (p = 0.045). The duration of ventilation and hospital stay were considerably longer in the group 2. In a subgroup with LVEF<30%, the length of ICU stay was more prolonged in the control group, as well (p = 0.0145). The significant differences among groups regarding LOS parameters were more remarkable in the two high-risk subgroups (LVEF<30%, left main coronary stenosis). CONCLUSIONS: Given the better postoperative cardiac performance, we recommend this method to all CABG candidates, particularly in higher-risk patients.

A randomized, controlled study evaluating effects of amlodipine addition to chelators to reduce iron loading in patients with thalassemia major.

AIM: Cardiomyopathy due to iron overload can be fatal in patients with thalassemia major. Calcium channel blockers seem to be effective to reduce iron loading. Our goal was to study effects of amlodipine addition to chelators on iron loading in patients with thalassemia major. METHODS: This randomized, controlled, and single-center trial was performed on 56 patients with thalassemia major. Patients were randomized 1:1 to combined group (iron chelator plus amlodipine) or control group (iron chelator) for 1 year. Iron content was measured by magnetic resonance imaging; heart T2*, and liver T2*. Serum ferritin was also measured. RESULTS: After 12 months of treatment, myocardial T2* values had significant improvement in combined group (21.9 ± 8.0 ms to 24.5 ± 7.6 ms; P < .05); Difference between two groups was significant (P = .02). Combined treatment had no effect on hepatic T2* value (9.6 ± 2.8 ms to 9.5 ± 3.6 ms); difference between two groups was not significant (P = .2). In addition, a significant reduction was seen in serum ferritin levels in two groups. Mild gastrointestinal upset was the most common untoward effect. CONCLUSION: Addition of amlodipine to iron chelators has beneficial effects for reduction of iron loading in patients with thalassemia major. This combination therapy seems safe.

Serum markers of inflammation and oxidative stress in chronic opium (Taryak) smokers.

A relationship between the expression of inflammation markers, oxidative stress and opium use has not been clearly established. This study was done to determine serum high-sensitivity C-reactive protein (hs-CRP), quantity of C3 and C4 complement factors, immunoglobulins, nitric oxide (NO) and total antioxidant capacity (TAC) in opium smokers and non-drug-using control participants. The present study was done on 44 male opium smokers and 44 controls of the same sex and age (20-40 years). The control group was healthy individuals with no lifetime history of drug abuse or dependence. All of the opium abusers were selected from those who had a history of opium use, for at least one year, with a daily opium dosage not less than 2g. Addicts known to abuse alcohol or other drugs were excluded. Serum hs-CRP concentration was measured using ELISA method and serum C3, C4 and immunoglobulins concentration were determined by Single Radial Immunodiffusion (SRID) method. NO production was estimated through Griess reaction and TAC was assessed by Ferric Reducing/Antioxidant Power (FRAP) test. Serum hs-CRP, complement factors (C3 and C4) and FRAP levels were significantly higher in the opium smokers (8.93 ± 1.93; 138.47 ± 13.39; 68.79 ± 7.02 and 972.75 ± 11.55, respectively) relative to the control group (0.72 ± 0.09; 93.36 ± 8.73; 33.08 ± 7.39 and 761.95 ± 18.61, respectively). These results permit us to conclude that opium smokers indeed present with a low to moderate grade inflammation, which is defined by an increase in acute phase proteins.

Cytokine profiles in long-term smokers of opium (Taryak).

OBJECTIVES: There are few studies with conflicting results on the effects of in vivo administration of opioids on immune function. The aim of this study was to evaluate the serum levels of interferon (IFN)-γ, interleukin (IL)-4, IL-10, IL-17, and hs-C-reactive protein (hs-CRP) in opium smokers. METHODS: The study was conducted between 44 male opium addicts and 44 controls aged 20 to 40 years. The control group was healthy individuals with no lifetime history of substance abuse. All the opium abusers were selected from those who had a history of use of opium, as a regular habit, at least for 1 year, with a daily opium dosage of not less than 2 g. Addicts known to abuse alcohol or other drugs were excluded. Serum samples were collected from all participants and tested for the cytokine and hs-CRP levels by ELISA (enzyme-linked immunosorbent assay) method. Statistical analysis was performed using the Student t test. RESULTS: The mean serum levels of IFN-γ, IL-10, and IL-17 in the opium addicts were significantly higher than those observed in the control group. The mean concentration of serum IL-4 in opium addicts did not differ from that in the control group. Systemic IL-10 levels correlated positively and significantly with CRP in opium addicts. CONCLUSIONS: Long-term, daily use of opium is associated with higher Th1 (IFN-γ), Tr1 (IL-10), and Th17 (IL-17) cytokines concentration in serum. Interferon-γ and IL-17 are involved in inducing and mediating proinflammatory responses. Our data suggest that an immunoregulatory response is occurring with the upregulation of IL-10.