A clinical study on shodhananga snehapana with special reference to Samyak Snigdha Lakshana

Snehana (internal oleation) is the major preparatory procedure to be performed before Shodhana (Biopurification).The entire procedure of Shodhana depends upon the proper mobilization of humors (Dosha) from peripheral circulation (Shakha) to intestinal circulation (Koshtha),which is achieved with the help of Snehana and Svedana. Oleation leads and decides total outcome of The Bio purification therapy; Hence in this study standard guidelines are applied for performing internal oleation in an effective manner to avoid Ayoga (insufficient use) and Atiyoga (excessive use) of Snehana. For that we start and increased dose of lipids in an appropriate manner considering Agni (power of digestion) and Koshtha (nature of bowels) of patients. The study was carried out on total 30 healthy volunteers undergoing Vasantik Vamana. Shodhananga Snehapana with Shuddha Ghrita was administered according to Agni and Koshtha of patients. Samyak snigdha Lakshanas were assessed using special scoring pattern. Statistical analysis using paired‘t’ test were done. Onset of samyak snigdha lakshana occurs in sequence. Vatanuloman, Agnidipti, Gatra Mruduta, Klama, Snehodvega, Adhastat Sneha Darshana was seen in all patients; whereas, glani, Anga Laghava, Twak Snighdata were noted in less percentage of patients.

Pharmacokinetic Study of Oral 14C-Radiolabeled Hyzetimibe, A New Cholesterol Absorption Inhibitor

Background and objectives: Hyzetimibe is a candidate drug being investigated as the second-in-class cholesterol absorption inhibitor; it lowers plasma levels of low-density lipoprotein cholesterol (LDL-C) by blocking the Niemann-Pick C1-like 1 protein, a transporter mainly expressed in the intestine that allows dietary cholesterol to enter the body from the intestinal lumen. Previous studies on the metabolism of hyzetimibe in healthy volunteers were not enough to show the biotransformation and excretion pathway; in particular, whether hyzetimibe maintains pharmacological action for duration sufficient to pass through the hepatic-intestinal circulation remains unknown. Furthermore, it remains unclear whether the differences between the chemical structures of ezetimibe and hyzetimibe would result in different pharmacokinetic characteristics. Given that the molecular target is in the intestine and the substantial hepatic-intestinal circulation is a metabolic characteristic of the drug, a study of hyzetimibe as an oral 14C-radiolabeled drug, compared with routinely metabolized drugs, would play an important role in uncovering pharmacokinetic details.Methods: After an overnight fast and before taking medication, six healthy male volunteers swallowed an investigational product suspension containing 20 mg/∼100 μCi of 14C-labeled hyzetimibe as a single dose. Whole-blood, plasma, urine, and fecal samples were collected, and hyzetimibe and its metabolites were measured. Pharmacokinetic variables of hyzetimibe and its metabolites were calculated and statistically analyzed according to obtained concentration data. Safety data were collected throughout the study.Results: The major metabolite detected in plasma was hyzetimibe-glucuronide, which accounted for 97.2% of the total plasma radioactivity. The mean cumulative excretion of total radioactivity of the dose was 16.39% in urine and 76.90% in feces. Unchanged drug and hyzetimibe-glucuronide were identified as the major components in the feces and the urine, respectively. The main metabolic conversions of hyzetimibe were glucuronidation (M1), mono-oxidation (M4), and mono-oxidation with additional sulfonation (M7). Hyzetimibe was considered generally safe and well tolerated.Conclusion: This study of 14C-radiolabeled hyzetimibe provides a full profile of the biotransformation and excretion routes of hyzetimibe to improve the understanding of the pharmacokinetic characteristics of hyzetimibe. The changed hydroxyl group in the hyzetimibe structure made it easier for that drug, compared with ezetimibe, to combine with glucuronic acid and subsequently increased the urinary excretion of hyzetimibe vs. ezetimibe. These differences highlight the need to investigate in more detail the different pharmacokinetic impacts on the efficacy and safety of hyzetimibe and ezetimibe.

Effects of vasoactive drugs on hepatic and intestinal circulation and intestinal barrier in patients with septic shock

In this study, 60 patients with septic shock were selected over the course of 1 year, and the effects of dopamine and norepinephrine combined with dobutamine on hepatic and intestinal circulation and intestinal barrier in patients with septic shock were studied by comparison between the control group and the experimental group. All patients received mechanical ventilation to maintain breathing at 14 to 20 times/min. The experimental group was treated with vascular active drugs after adequate rehydration, and the control group only received adequate rehydration. There were extremely significant differences (p<0.01) in the total effective rate of each group. There were significant differences in the hemodynamic indexes in each group (p<0.05). There was a significant difference in total 24-hour bile output (p<0.01). There were significant differences in liver function and blood lipid values in patients (p<0.01). There were significant differences in the repair of epithelial injury at 0 hour, 48 hours and 96 hours (p<0.01). There were significant differences in the transmembrane resistance of monolayer cells (p<0.01). The expression differences of three proteins ZO-1, occludin and β-actin were also significant, among which the three proteins in the control group were weak, while those in groups A and B were strong. The expression of tight junction protein in monolayer cells was weakly positive in expression and strong in other proteins. In conclusion, vasoactive drugs had significant effects on hepatic and intestinal circulation and intestinal barrier in patients with septic shock.

Phrenic Artery Hemorrhage after Percutaneous Portal Vein Stenting to Treat Cavernous Transformation Following Living Donor Liver Transplantation: A Case Report

Cavernous transformation is a condition which has an acutely developing harmful effect over intestinal circulation compromising the patients' life before development of portal hypertension and its results. We present the case of phrenic artery hemorrhage after successful percutaneous portal vein stenting to treat cavernous transformation following LDLT. The patient survived the hazard complication with prompt surgery. Three factors may be related to the rare complication in the case were analyzed, including affluent new vessels around the diaphragm related to LDLT procedure, high puncture site allowing the diaphragm been injured, and anticoagulation given before the puncture and soon after the procedure. Cautions should be taken for the interventional procedures in this extreme condition. Cavernous transformation is a condition which has an acutely developing harmful effect over intestinal circulation compromising the patients' life before development of portal hypertension and its results (see the work of Harmanci and Bayraktar (2007)). It is even worse when this happens in a patient after LDLT (living donor liver transplantation). Herein we have presented a case of phrenic artery hemorrhage after successful percutaneous portal vein stenting to treat cavernous transformation following LDLT. The patient survived the hazard complication with prompt surgery.

Peculiaridades da circulação mesentérica em recém-nascidos e suas implicações em doenças gastrintestinais do período neonatal

OBJETIVO:Descrever peculiaridades da circulação mesentérica neonatal e caracterizar fatores de suscetibilidade ao desenvolvimento de doenças gastrintestinais e alterações do fluxo sanguíneo da artéria mesentérica superior por meio da dopplerfluxometria. FONTES DE DADOS: Livros-textos e publicações indexadas no Medline e SciELO nos últimos 20 anos, utilizando-se as palavras chaves: "mesenteric artery", "superior mesenteric artery", "newborn intestinal circulation", "necrotizing enterocolitis", "doppler flow velocimetry". SÍNTESE DOS DADOS: Alterações do fluxo sanguíneo mesentérico são um dos fatores predisponentes da enterocolite necrosante, doença neonatal de alta morbimortalidade que acomete principalmente prematuros. A circulação mesentérica é peculiar no período neonatal tanto em relação ao seu estado basal, quanto à sua resposta frente a estímulos fisiológicos. Variações da irrigação mesentérica podem ser inerentes à própria fase de desenvolvimento vascular intestinal do recém-nascido pré-termo, com possíveis agravos de fatores perinatais como: insuficiência placentária, asfixia, infecção, cateterismo umbilical, drogas (indometacina e cafeína), fototerapia, alimentação artificial e progressão rápida da dieta. A dopplerfluxometria permite o estudo da irrigação de órgãos-alvo e pode quantificar o fluxo sanguíneo, a resistência vascular e predizer situações de risco para doenças do trato gastrintestinal no período neonatal. CONCLUSÕES: O recém-nascido apresenta peculiaridades de irrigação sanguínea gastrintestinal. A dopplerfluxometria da artéria mesentérica superior é um método não invasivo que determina as condições circulatórias no território intestinal.