Efficacy of Lanthanum Carbonate and Sevelamer Carbonate as Phosphate Binders in Chronic Kidney Disease-A Comparative Clinical Study.

(1) Background: Hyperphosphatemia is correlated with an increased rate of mortality and morbidity due to cardiovascular diseases in chronic kidney disease (CKD) patients. It can be improved by restricting dietary intake of phosphate and oral phosphate binders, such as lanthanum carbonate and sevelamer carbonate. (2) Objective: To evaluate the clinical efficacy of sevelamer carbonate in comparison to lanthanum carbonate as phosphate binders for the treatment of hyperphosphatemia in CKD patients. (3) Methods: A randomized control comparative clinical study was conducted for one year on 150 CKD patients associated with hyperphosphatemia, divided into two groups, i.e., Group 1 (n = 75) treated with sevelamer carbonate 800 mg thrice daily and Group 2 (n = 75) treated with lanthanum carbonate 500 mg thrice daily. The patients were assessed at the time of enrollment in the study, after three months and after six months from baseline for different parameters, i.e., complete blood count, liver function tests, renal function tests, electrolytes, and serum phosphate level. (4) Results: 150 CKD patients aged 51-60 participated in the study. The mean age of patients was 54 ± 4.6 years, and males (55.71%) were more common than females (44.29%). Hypertension was the common comorbidity in both groups with chronic kidney disease. After six months of treatment, the mean serum phosphate level was significantly decreased from 8.31 ± 0.09 mg/dL to 5.11 ± 0.18 (38%) in Group 1 and from 8.79 ± 0.28 mg/dl to 4.02 ± 0.12 (54%; p < 0.05) in Group 2, respectively. In both groups, no significant difference was found in other parameters such as parathyroid hormone, calcium, uric acid, LFT, RFT, CBC, etc. (5) Conclusion: Lanthanum carbonate is more efficacious in lowering serum phosphate concentrations and effectively managing hyperphosphatemia as compared to sevelamer carbonate.

Effectiveness of Empagliflozin With Vitamin D Supplementation in Peripheral Neuropathy in Type 2 Diabetic Patients.

BACKGROUND: Neuropathy is the most prevalent broad-spectrum microvascular complication of diabetes. The present study aims to evaluate the effect of empagliflozin with vitamin D supplementation on diabetic peripheral neuropathy. METHODS: A prospective, randomized, controlled study was conducted for six months including 150 type 2 diabetic patients, divided into three groups (n=50/group): Group 1, patients on oral hypoglycemic agents; Group 2, patients on empagliflozin and Group 3, patients on empagliflozin with vitamin D. Biochemical parameters were estimated for outcome measurements and patients' neuropathic pain was analysed using Douleur Neuropathique 4 Questions, Neuropathic Pain Symptom Inventory and Ipswich Touch the toes test questionnaire. Data were analysed using a one-way analysis of variance. RESULTS: Diabetic neuropathy in males was more prevalent (more than 50%) as compared to females in all three groups, with an average age of 50±6 years, along with a diabetic history of 15±4.5 years and a glycated hemoglobin A1C (HbA1C) level of >10%. The mean value of serum vitamin D level significantly increased by 64.7% (19±5 to 54±8 ng/mL; p<0.05). A remarkable decrease (by 17.4%) from baseline in the HbA1C level was observed after six months of treatment only in Group 3, whereas in other groups (1 and 2), there was a non-significant decrease in HbA1C levels when compared to baseline. Moreover, a significant improvement in neuropathic condition was seen only in Group 3. CONCLUSION: The results indicated that empagliflozin with vitamin D supplementation significantly controlled or reduced HbA1C and improved diabetic neuropathic symptoms in patients. It is suggested that this combination can be considered as the primary therapeutic approach for neuropathic complications in diabetic patients.

Mechanisms of Antidiabetic Activity of Methanolic Extract of Punica granatum Leaves in Nicotinamide/Streptozotocin-Induced Type 2 Diabetes in Rats.

The current study aimed to establish the mechanisms of antidiabetic activity of methanolic extract of Punica granatum leaves (MEPGL) in nicotinamide/streptozotocin-induced type 2 diabetes in rats. Phytochemical screening, HPLC analysis, and acute toxicity study of MEPGL were carried out. Various concentrations of MEPGL (100, 200, 400, and 600 mg/kg) were administered orally to diabetic rats for 45 days on a daily basis. The antidiabetic effect of MEPGL was examined by measuring blood glucose, plasma insulin, and glycated hemoglobin (HbA1c) levels, as well as with an oral glucose tolerance test. The antioxidant effect of MEPGL was determined by analyzing hepatic and renal antioxidant markers, namely superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), reduced glutathione (GSH), and lipid peroxidation. The other biochemical markers alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), urea, and creatinine, as well as total cholesterol, triglycerides, and high-density lipoprotein (HDL) were also studied. Type 2 diabetes significantly altered these parameters, while oral administration of the MEPGL significantly ameliorated them. Moreover, the pancreatic histopathological changes were attenuated with MEPGL treatment. In a nutshell, oral MEPGL administration in diabetic rats showed antidiabetic activity due to its antioxidant activity, most probably due to the gallic acid, ellagic acid, and apigenin found in MEPGL.

Antidiabetic and antioxidant potential of Emblica officinalis Gaertn. leaves extract in streptozotocin-induced type-2 diabetes mellitus (T2DM) rats.

ETHNOPHARMACOLOGICAL RELEVANCE: In traditional Indian medicine, all parts of Emblica officinalis Gaertn plant including the fruit, seed, leaves, root, bark and flowers are used in various herbal preparations for the treatment of diabetes mellitus, chronic diarrhea, anti-inflammatory and antipyretic. AIM OF THE STUDY: To evaluate the hypoglycemic and antioxidants effects of the hydro-methanolic (20:80) extract of leaves of Emblica officinalis Gaertn. (HMELEO) in streptozotocin induced diabetic rats. MATERIAL AND METHODS: The hypoglycemic effect was measured by blood glucose and plasma insulin level. The oxidative stress was measured in liver and kidney by level of antioxidant markers i.e. lipid peroxidation (LPO), superoxide dismutase (SOD), reduced glutathione (GSH), glutathione peroxidase (GPx) and catalase (CAT), and the biochemical parameters, i.e. blood serum levels of creatinine, urea, serum glutamic pyruvic transaminases (SGPT), serum glutamic oxaloacetic transaminases (SGOT), alkaline phosphatase (ALP), total cholesterol and triglyceride levels were the salient features observed in diabetic control and treated rats. RESULTS: Oral administration of the HMELEO at a concentration of 100, 200, 300 and 400 mg/kg b.w. daily for 45 days showed a significant (P<0.05) decrease in fasting blood glucose and increase insulin level as compared with the diabetic rats. Also it significantly (P<0.05) reduced all biochemical parameters (serum creatinine, serum urea, SGOT, SGPT and lipid profile). The treatment also resulted in a significant (P<0.05) increase in reduced glutathione, glutathione peroxidase, superoxide dismutase, catalase, and decrease LPO level in the liver and kidney of diabetic rats. CONCLUSION: The results clearly suggest that the hydro methanolic extract of leaves of Emblica officials Gaertn. treated group may effectively normalize the impaired antioxidant status in streptozotocin induced diabetes at dose dependent manner than the glibenclamide-treated groups. The extract exerted rapid protective effects against lipid peroxidation by scavenging of free radicals and reducing the risk of diabetic complications.

In vitro evaluation of antimicrobial and antioxidant activities of methanolic extract of Jasminum humile leaves.

OBJECTIVE: To evaluate in vitro antimicrobial and antioxidant activities of methanolic extract of Jasminum humile (J. humile) leaves extract. METHOD: Methanolic extract of J. humile was evaluated for its antimicrobial activity by using agar well diffusion method & their possible antioxidant assay by two complementary test systems, namely DPPH and hydrogen peroxide scavenging activity. These various antioxidant activities were compared to standard antioxidants such as ascorbic acid for both the tests. RESULTS: In the DPPH & hydrogen peroxide scavenging activity, the IC(50) value of methanol extract was 70.43 µg/mL & 60.79 µg/mL respectively. Further, the extract showed inhibitory activity for Gram-positive and negative bacteria at different concentrations. The maximum antibacterial activity of extract was exhibited against Staphylococcus aureus (S. aureus) at concentration 50 mg/mL when compared with ciprofloxacin CONCLUSIONS: These results clearly indicate that J. humile is effective in scavenging free radicals and has the potential to be a powerful antioxidant. Thus, the results obtained in the present study indicate that J. humile leaves extract could be considered as a potential source of natural antioxidants and that could be used as an effective source against bacterial diseases.