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24 Aug 2016

Roshini Claire Anthony spoke with Adjunct Associate Professor Gamaliel Tan, head and senior orthopaedic consultant at Ng Teng Fong Hospital in Singapore, on how GPs can help diagnose and treat lower back pain.

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Teng Sung Shin, Joyce Lam Ching Mei, 03 Sep 2018
Bleeding disorders in children can be divided into acquired and congenital conditions, with the acquired being far more common than the congenital. Clinical bleeding manifestations can vary in severity. Identifying the root cause early is crucial to control and halt bleeding as well as to prevent the risk of future bleeding in a vulnerable age group. This can be achieved by a thorough and salient history, physical evaluation, and appropriate investigations. This review will describe the common causes of bleeding disorders in children and will suggest an approach to the workup and diagnosis of such disorders.
Rachel Soon, 12 Dec 2018

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Ginkgo biloba boosts lipid-lowering effects of statins

Tristan Manalac
12 Oct 2018

Supplementation with ginkgo biloba appears to improve the lipid-lowering effects of statin medication, resulting in an improved blood lipid profile, according to a recent meta-analysis.

“Combination of ginkgo biloba leaves with statins therapy may achieve greater improvement in serum lipids for patients with the mixed dyslipidaemia. However, whether concomitant treatment with each statin and ginkgo biloba leaves increases or reduces adverse events are largely unknown,” said researchers.

The meta-analysis included eight randomized controlled trials (RCTs), yielding a total of 664 dyslipidaemia patients. Of the participants, 330 received statins alone while 334 were given both statins and ginkgo biloba leaves. Generally, the trials were deemed to be of low quality with unclear risks of bias.

Adjuvant therapy with ginkgo biloba resulted in significant improvements in serum lipid parameters, according to a pooled analysis of all eight trials. Particularly, researchers observed significant drops in levels of triglycerides (mean difference [MD], –0.32 mmol/L; 95 percent CI, –0.43 to –0.20; p<0.00001), total cholesterol (MD, –0.61 mmol/L; –0.90 to –0.33; p<0.0001) and low-density lipoprotein cholesterol (LDL-C; MD, –0.32 mmol/L; –0.48 to –0.16; p<0.00001). [Front Biopharmacol 2018;9:659]

On the other hand, there was a significant increase in the serum levels of high-density lipoprotein cholesterol (HDL-C; MD, 0.26 mmol/L; 0.15–0.37; p<0.00001).

While subgroup analysis according to the type of statins used did not meaningfully change the primary results, there were notable differences between atorvastatin and simvastatin. For instance, atorvastatin use (weighted MD, 0.29; 0.13–0.44) led to a higher increase in serum HDL-C than simvastatin (weighted MD, 0.22; –0.08 to 0.52).

In comparison, simvastatin conferred superior improvements than atorvastatin in terms of serum LDL-C (weighted MDs, –0.52; –0.83 to –0.20 vs –0.23; –0.45 to –0.22), total cholesterol (weighted MDs, –0.95; –1.39 to –0.51 vs –0.50; –0.83 to –0.16) and triglycerides (weighted MDs, –0.42; –0.56 to –0.28 vs –0.28; –0.48 to –0.08).

Aside from gastrointestinal disturbances, no serious adverse events were reported in the three trials that had eligible data.

The underlying physiological and molecular mechanisms by which ginkgo biloba boosts the lipid-lowering effects of statins have yet to be elucidated, said researchers. However, the plant's antioxidant properties, antiplatelet activities and ability to promote blood flow through the release of nitric oxide are likely to play important roles. [J Cardiovasc Nurs 2002;16:21-32; Cardiovasc Drug Rev 2004;22:309-319]

Moreover, because of such enhancing effects, “adjuvant treatment with ginkgo biloba leaves to statins therapy might reduce the dose of statins,” leading to a drop in the hepatotoxic effects commonly associated with statins, researchers added.

However, it is important to note that most of the included trials carried unclear risks of bias, limiting the reliability of the present analyses and conclusion.

“More well-designed RCTs are needed to investigate the benefits of the combination of statins and ginkgo biloba leaves due to the methodological flaws of the included trials. Moreover, whether adding ginkgo biloba leaves to statins has additional cardiovascular risk reduction needs to be further investigated,” said researchers.

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Most Read Articles
24 Aug 2016

Roshini Claire Anthony spoke with Adjunct Associate Professor Gamaliel Tan, head and senior orthopaedic consultant at Ng Teng Fong Hospital in Singapore, on how GPs can help diagnose and treat lower back pain.

26 Dec 2017
Supplementation with omega-3 fatty acids in combination with rosuvastatin may yield significant reductions in triglycerides and nonhigh-density lipoprotein (HDL) cholesterol as compared with rosuvastatin monotherapy, according to data from the ROMANTIC (rosuvastatin-omacor in residual hypertriglyceridemia) trial.
Teng Sung Shin, Joyce Lam Ching Mei, 03 Sep 2018
Bleeding disorders in children can be divided into acquired and congenital conditions, with the acquired being far more common than the congenital. Clinical bleeding manifestations can vary in severity. Identifying the root cause early is crucial to control and halt bleeding as well as to prevent the risk of future bleeding in a vulnerable age group. This can be achieved by a thorough and salient history, physical evaluation, and appropriate investigations. This review will describe the common causes of bleeding disorders in children and will suggest an approach to the workup and diagnosis of such disorders.
Rachel Soon, 12 Dec 2018

MIMS Pharmacist presents an overview of superoxide dismutase (SOD) and its role in resisting the effects of oxidative stress and aging.