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The aim of this paper was to review based on the existing literature the impact of coronary artery tortuosity on coronary pathology. Primarily, an attempt was made to establish the implication of coronary tortuosity as a physio-pathological mechanism of inducing ischemia in patients with non-obstructive coronary artery disease (CAD). Because the prevalence of tortuosity is higher in severe hypertensive patients, a second purpose of this paper was to review this association by understanding the physio-pathological processes and fluid dynamics in hypertrophic heart. Particularly, the effect of coronary tortuosity on systolic function with reference to longitudinal function and ventricular relaxation was addressed. Finally, the technical difficulties imposed by coronary tortuosity to percutaneous coronary interventions were discussed.Pakistan is amongst the developing countries, which have been strongly affected by several emerging and re-emerging disease outbreaks as a consequence of climate change. Various studies have clearly demonstrated the impact of climate change on human health in Pakistan. This has increased the rate of morbidity and mortality, related not only to vector-borne, water-borne and food-borne diseases but has also contributed to the prevalence of neurological, cardiovascular and respiratory disorders. It is therefore important to take adequate measurements for water management and improve sanitary conditions especially in case of natural disasters. In order to effectively control the emerging and re-emerging infections in the country, an early, more Rigorous response is required, by the national health department, to monitor and evaluate the spread of infections in future. Therefore, precise planning and management strategies should be defined in order to circumvent the damage caused by the natural disasters associated with climate changes. This mini-review gives an overview about the public health issues associated with environmental change with special reference to Pakistan. This will provide a baseline for policymakers to develop public health surveillance programs in Pakistan.COVID-19 has resulted in an ongoing global pandemic, which spread largely among people who have had close contact with the infected person. The immunopathology of the SARS-CoV-2 virus includes the production of an excess amount of pro-inflammatory cytokines "a cytokine-storm". The respiratory system (main), cardiovascular system and the gastrointestinal tract are the most affected body systems during viral infection. It has been found that most of the patients who require admission to hospital are elderly or have chronic underlying diseases. Higher cases of malnutrition and co-morbidities like diabetes mellitus and cardiovascular diseases are reported in elderly patients due to which, the immune system weakens and hence, the response to the virus is diminished in magnitude. A deficiency of micronutrients results in impaired immune responses leading to improper secretion of cytokines, alterations in secretory antibody response and antibody affinity which increases susceptibility to viral infection. The deficiency of various micronutrients in COVID-19 patient can be treated by appropriate nutritional supplements, prescribed after evaluating the patients' nutritional status. Here we aim to highlight the role of a few particular nutrients namely Vitamin D, Vitamin C, Omega-3 fatty acids, Zinc and Magnesium along with the synergistic roles they play in enhancing immunity and thus, maintaining homeostasis.

, non-fermented coconut inflorescence sap (NFCIS) and its fermented form, toddy (FCIS) are the two well-known traditional drinks in South India. Both the saps show high rejuvenation effect and NFCIS is used for the curing of bronchial suffocation, anemia, tuberculosis and piles in traditional medicine. But, a few scientific studies have been reported on their health benefits so far. Presently, the antioxidant effect of both non-fermented (NFCIS) and fermented form (FCIS) of coconut inflorescence were analyzed in experimental animals.

The free radical scavenging property of FCIS and NFCIS was analyzed

. The effect of these saps on mitigating sodium fluoride (NaF) deteriorated redox status was evaluated in mice.

NFCIS exhibited high antioxidant activity than its fermented form. NFCIS reduces metal ions and scavenge hydroxyl and DPPH radicals with IC

values 6.5±1.9 and 44±3.14µL/mL, respectively. Supplementation of NFCIS for 14 days increased SOD, CAT and GPx activities and GSH level in liver by 51.67, 52, 27.88 and 35.77%, respectively against NaF induced decline with a concomitant decrease in lipid peroxidation to 40.76%. Saps rich in minerals indicate pharmaceutical and nutritional value.

The study revealed the antioxidant efficacy of non-alcoholic natural drink,

and recommends an alternative for synthetic carbonated soft drinks. The regular consumption of

may protect the body from various chronic diseases especially where the oxidative stress played as a key role.

The study revealed the antioxidant efficacy of non-alcoholic natural drink, Neera and recommends an alternative for synthetic carbonated soft drinks. The regular consumption of Neera may protect the body from various chronic diseases especially where the oxidative stress played as a key role.The ongoing coronavirus pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) and unique in various facets. The earlier experience from the past severe acute respiratory syndrome (SARS) epidemics seem to be insufficient and there is need for better strategies in public health and medical care. Ayurved & Yog are well known for their preventive and therapeutic aspect, but not getting utilized properly for prevention of Covid 19 crisis which may also be helpful as supportive therapy along with current line of management. This paper is aimed at unrevealing the role of Ayurved and Yoga guidelines established by Department of AYUSH for prevention from SARS-CoV-2 by providing help to improving the quality of supportive/prophylactic therapy in relation with their immunity.

Recurrent bleeding from gastroesophageal varices is the most common life-threatening complication of portal hypertension. According to guidelines, transjugular intrahepatic portosystemic shunt (TIPS) should not be used as a first-line treatment and should be limited to those bleedings which are refractory to pharmacologic and endoscopic treatment (ET). To our knowledge, long-term studies evaluating the role of elective TIPS in comparison to ET in patients with recurrent variceal bleeding episodes are rare.

This study was designed as a retrospective single-institution analysis of 70 patients treated with TIPS and 56 with ET. Patients were followed-up from inclusion in the study until death, liver transplantation, the last follow-up observation or until the end of our study.

Recurrent variceal bleeding was significantly more frequent in ET group compared to patients TIPS group (66.1%

. 21.4%, p < 0.001; χ2-test). The incidence of death secondary to recurrent bleeding was higher in the ET group (28.6%

. 10%). Cumulative survival after 1 year, 2 years and 5 years in TIPS group compared to ET group was 85%

. 83%, 73%

. 67% and 41%

. 35%, respectively. The main cause of death in patients with cumulative survival more than 2 years was liver failure. Median observation time was 47 months (range; 2-194 months) in the TIPS group and 40 months (range; 1-168 months) in the ET group.

In present study TIPS was more effective in the prevention of recurrent variceal bleeding and had lower mortality due to recurrent variceal bleeding compared to ET.

In present study TIPS was more effective in the prevention of recurrent variceal bleeding and had lower mortality due to recurrent variceal bleeding compared to ET.

Inflammation is a hallmark of heart failure (HF) and among inflammatory biomarkers, the most studied remains the C-reactive protein (CRP). In recent years several biomarkers have emerged, such as sST2 and soluble urokinase-type plasminogen activator receptor (suPAR). This study set out to examine the relative importance of long-time prognostic strength of suPAR and the potential additive information on patient risk with chronic HF in comparison with pronostic value of CRP and sST2.

Demographics, clinical and biological variables were assessed in a total of 182 patients with chronic HF over median follow-up period of 80months. Inflammatory biomarkers (i.e.,CRP, sST2, and suPAR) were performed.

In univariate Cox regression analysis age, NYHA class, MAGGIC score and the five biomarkers (N-terminal pro brain natriuretic peptide [NT-proBNP], high-sensitive cardiac troponin T [hs-cTnT], CRP, sST2, and suPAR) were associated with both all-cause and cardiovascular mortality. In the multivariate model, only NT-pre.

The main findings of our study are (1) that among the three inflammatory biomarkers, only suPAR levels were independently associated with 96-month mortality for patients with chronic HF and (2) that an algorithm based on clinical score, a cardiomyocyte stress biomarker and an inflammatory biomarker could help to a more reliable long term risk stratification in heart failure.

This study examined effect of berberine and piperine on neuroprotective potential of neostigmine in the management of neurological disorders.

Berberine and neostigmine were weighed (30g), dissolved in distilled water (30mL) separately, while, 30mg piperine was dissolved in ethanol (0.45mL), made up to 30mL with distilled water. Antioxidant activities in 2, 2-diphenyl-1-picrylhydrazyl radical (DPPH), 2, 2-azinobis (3-ethylbenzothiazoline-6-sulfonate) radical (ABTS), Fe-chelation, ferric reducing properties (FRAP), nitric oxide (NO) and hydroxyl (OH) radical scavenging abilities and Fe

, cisplatin and sodium nitroprusside (SNP) induced lipid peroxidation (LPO), and acetylcholinesterase (AChE), butyrylcholinesterase (BChE) and monoamine oxidase (MAO) activities were assessed



The result revealed that tested compounds inhibited enzymes activities dose-dependently. However, berberine (IC

=0.17mg/mL) had slight higher AChE inhibitory effect than piperine and neostigmine (p<0.05). Also, berberine had the highest BChE inhibitory effect (IC

=0.16mg/mL) while piperine exhibited the highest MAO inhibitory effect (IC

=0.21mg/mL). Berberine, piperine and neostigmine exhibited high antioxidant properties and inhibited Fe

, cisplatin and SNP induced LPO



Both alkaloids demonstrated antiradical scavenging ability comparable to neostigmine action against Alzheimer's disease (AD). The modulatory and antioxidant berberine and piperine properties on these enzymes (AChE, BChE and MAO) could be possible underlying mechanisms in employing these compounds as a complementary therapy in neurodegenerative diseases (NDDs) management.

Both alkaloids demonstrated antiradical scavenging ability comparable to neostigmine action against Alzheimer's disease (AD). The modulatory and antioxidant berberine and piperine properties on these enzymes (AChE, BChE and MAO) could be possible underlying mechanisms in employing these compounds as a complementary therapy in neurodegenerative diseases (NDDs) management.

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