Evaluating the antiproteinuric efficacy of cilnidipine in diabetic kidney disease

Background: Diabetic kidney disease is a life threatening and disabling complication of uncontrolled diabetes mellitus. Clinical proteinuria is a well-established marker of renal dysfunction. A dual L/N-type calcium channel blocker cilnidipine dilates the afferent and efferent arterioles of the glomerulus decreasing the intraglomerular pressure and showing antiproteinuric effects. The present study was conducted to assess the antiproteinuric efficacy of cilnidipine in patients of diabetic kidney disease.Methods: This interventional study was conducted on 50 patients of both genders aged 18 years and above with diabetic nephropathy (stage-2 to stage 4) visiting the medicine OPD at HIMS, Dehradun over a period of six months, the patients were given tablet cilnidipine (5-20 mg) once or twice a day. Baseline urine protein creatinine ratio (UPCR), serum creatinine and the estimated glomerular filtration rate (eGFR) was recorded at baseline and repeated after a period of 12 weeks. The end point was the decrease in UPCR after a period of 12 weeks. Students-paired T test was used for analysing the intragroup data.Results: After 12 weeks of treatment with cilnidipine, a significant reduction was observed in the urinary protein creatine ratio (mean盨D) from 3.2�23 at baseline to 3.09�09 respectively (p<0.05). Along with this there was also a reduction in the in serum creatinine which was significant (p<0.05) as well as an increase in the eGFR value which was also statistically significant (p<0.001).Conclusions: Cilnidipine reduces the UPCR as well as improves the kidney function in patients with diabetic kidney disease.

The study of awareness and adherence in patients receiving anti-hypertensive drugs: a hospital based study

Background: Hypertension is an important worldwide public health challenge. It has changed from a trivial cause of death and disability to one of the global burden diseases. The biggest obstacle for inadequate therapeutic control of blood pressure is meagre knowledge, poor attitude, inadequate treatment practices and lack of adherence towards antihypertensive treatment. The present study was planned to assess the awareness of hypertension on various aspects and to evaluate treatment adherence in hypertensive patients.Methods: This cross-sectional study was conducted on 100 hypertensive patients of both genders visiting medicine OPD at HIMS, Dehradun over a period of six months. A structured and validated questionnaire was used to assess the knowledge, attitude and practice (KAP) among patients. Morisky 8-Item Medication Adherence Questionnaire was used to assess the adherence towards antihypertensive medications. For statistical analysis Chi square test was used.Results: Out of the 100 patients the median KAP scores were 6(5),5(1) and 10(4) respectively. Most of the subjects had high median scores on attitude but majority of the subjects had low knowledge and self-care practice scores. Further Analysis of data revealed that a poor score in self-care practice was significantly associated to the gender(p<0.004) as well as to the level of education(p<0.006).Only 40% patients were adherent to their medication, this result was statistically associated with the level of education (p<0.00001).Conclusions: Hypertensive patients in our community have good attitude but poor knowledge and self-care practices towards management of hypertension. Patients were also found to be non-adherent to their antihypertensive medications.

CLINICO – HISTOPATHOLOGICAL SPECTRUM OF CUTANEOUS VASCULITIS: A RETROSPECTIVE STUDY OF 62 CASES

Context: Cutaneous Vasculitis is the inflammation of vessel walls which leads to hemorrhagic or ischemic events. The histopathological classification of cutaneous vasculitis depends on the vessel size and the dominant immune cell mediating the inflammation. Object: We studied the etiological factors and clinico-pathological spectrum of patients with cutaneous vasculitis at a tertiary referral centre of north India. Design: Skin biopsies of all patients with clinically suspected cutaneous vasculitis presenting over 5 years, between 2009-2014 were reviewed. Cutaneous vasculitis was classified on the basis of etiology (primary or secondary), on the basis of size of vessel wall as well as on the dominant inflammatory cell infiltrating the vessels. Results: Over 5 years, 62 / 103 patients evaluated for vasculitic syndromes had histologically proven vasculitis. Clinically, vasculitis was primary (77.4%) or secondary (22.5%) to drugs, infections, underlying connective tissue diseases and malignancy. Neutrophilic (n=30), lymphocytic (n=18), eosinophilic (n=10), and granulomatous (n=4) vasculitis were the major histopathological groups. Small vessel involvement was seen in 97% cases. Conclusion: Skin biopsy remains the gold standard for diagnosing cutaneous vasculitis. Small vessel vasculitis was the most common type of cutaneous vasculitis with the dominant cell type being neutrophilic. Eosinophilic infiltrate was exclusively associated with primary vasculitis.

Cystatin C: An Early Marker of Cardiac Complications in Diabetics.

Introduction: Cardiovascular disease is one of the common complications of Diabetes mellitus. Serum Cystatin C level has been suggested as a marker for cardiac complications in diabetes. Material and Methods: We studied serum Cystatin C level in Diabetics to fi nd if correlation exists between cardiac complications and elevated Cystatin C levels. Results: A total of 50 diabetics were studied out of whom 25 had cardiac complications and the rest did not have cardiac complications. No signifi cant diff erence was observed between Serum Cystatin C levels of diabetics with cardiac complications (mean 1∙5±0∙45) and diabetics without cardiac complications (1∙4±0∙46) although Cystatin C levels were found to be elevated in diabetic cases. Conclusion: Keeping in view the signifi cant diff erence (p=0∙000) in Cystatin C levels of healthy and diabetic patients, it is reasonable to accept the importance of Cystatin C as an indicator of diabetes and its associated complications.

Osteolytic lesions of hand and feet: a seven-year experience from a tertiary referral centre of North India

There are 106 bones in hands and feet but their lesions are not commonly reported. This was a retrospective study of all osteolytic lesions involving bones of the hands or feet presenting to the only tertiary referral centre of the north Indian state of Uttarakhand during the 7-year period from January 2006 to December 2012. A compilation of the various demographic, clinical, radiological and histopathological findings was made. Of the 52 lesions encountered in the 7-year record, 75% were asymptomatic. 20 (38.4%) were benign tumours, 20 (38.4%) tumour-like lesions, 9 (17.3%) inflammatory and post traumatic lesions and only 3 (5.7%) were malignant lesions. Giant cell tumour was the most common benign tumour, aneurysmal bone cyst the most common tumour-like lesion and non-specific osteomyelitis was the most common inflammatory and post-traumatic pathology. All phalangeal lesions were non-malignant and 62% were either giant cell tumours or giant cell reactions. Giant cell reaction was confined to upper limb bones; metatarsals were afflicted exclusively with giant cell tumours (n=3) while malignant lesions affected the metacarpals in two and carpal bones in one instance. Aneurysmal bone cysts were seen exclusively in the tarsal (n=4) and carpal bones (n=2), a very rare finding. More cases need to be studied to define patterns of lesions of hands and feet. The definitive diagnosis is essential as many patients with osteolytic lesions may not require surgical intervention.

The Influence of the 21 Yogic Breathing Technique on Essential Hypertension.

In 2:1 breathing exhalation is twice of inhalation. The study was performed to study the influence of 2:1 yogic breathing technique on patients of essential hypertension. 30 patients of essential hypertension between ages of 20-50 years were selected. After a rest of 15-20 minutes in a comfortable sitting posture their baseline physiological parameters recorded on a digital polygraph were, Electromyogram (EMG), Galvanic skin response (GSR), Finger tip temperature (FTT), Heart rate(HR) and Respiratory rate(RR). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded by automated digital Sphygmomanometer. Then they were guided to do 2:1 breathing maintaining respiratory rate of around 6/min. Subjects were then instructed to do 2:1 breathing twice a day for 5-7 minutes for next 3 months. Subjects reported back weekly for recording of BP. The physiological parameters of the subjects were assessed again by polygraph at the end of three months of practicing 2:1 yogic breathing. The mean fall of SBP over 12 weeks was 12 mm Hg (8%) and DBP was 7 mm Hg (7%). P value < 0.001 in both. After practicing 2:1 breathing for 3 months there was statistically significant reduction of SBP, DBP, HR RR, EMG, GSR and rise in FTT. The study showed that 2:1 breathing technique caused a comprehensive change in body physiology by altering various parameters that are governed by the autonomic nervous system. It is an effective modality for management of essential hypertension.