ABSTRACT
Background: Microalbuminuria has been shown to predict cardiovascular disease (CVD) in patients with hypertension. Recently the FDC of losartan and hydrochlorothiazide (HCTZ) has been reported to be effective for achieving a target BP level and also improvement in cardiovascular prognosis. The present study was conducted to compare effect of losartan plus hydrochlorothiazide combination therapy and high dose amlodipine monotherapy on blood pressure and microalbuminuria.Methods: Total 184 patients with hypertension were randomly allocated to two groups. The patients in group 1 received Amlodipine 5 mg orally for first 4 weeks. The patients from group 2 received losartan 50 mg orally for first 4 weeks. Patients in group 1 were titrated to amlodipine 10 mg orally for next 4 weeks. The patients in group 2 were titrated to FDC of losartan (50 mg) plus HCTZ (12.5 mg) for next 4 weeks. Follow杣p visits were scheduled at 4 weeks and 8 weeks. Pulse rate, sSBP and sDBP were estimated at each follow杣p. Microalbuminuria was estimated at 8 weeks.Results: There was no significant difference in mean change in sSBP, sDBP and pulse rate between two treatment groups (p>0.05). There was greater reduction in microalbuminuria in group 2 patients (p<0.0001). The adverse effects such as flushing and lower extremity oedema were significantly more in amlodipine group (p<0.05).Conclusions: Losartan plus HCTZ has similar effect on BP, better safety profile and superior effect on microalbuminuria level reduction.
ABSTRACT
Aims: The study aimed to evaluate the preanalytical errors in the Indoor patient department in tertiary care Hospital.To calculate the percentage of preanalyticalerrors in the Indoor patient department in our Hospital and to recommend standard operative interventions to improve quality of results. To test the effectiveness of attention by continuous educational action at reducing preanalytical errors and improvingpatient care.Study Design:An observational study.Place and Duration of Study: The work was done from July 2014 to July 2015at a tertiary care Hospital India.Methodology:We retrospectively reviewed the samples and test request forms received at Biochemistry laboratory for one month. The outcome measures were incomplete laboratory forms, mislabeling samples, inappropriate tests, wrong container, poor quality of samples and transportation problems. Two weeks of interventions in the form of continuous educational training and education regarding standard operative procedures were given to stakeholders to raise awareness towards the preanalytical phase. Two weeks later, data was monitored again for one month. Results:2330 and 2130 samples and request forms were monitored before-after intervention respectively from wards for one month each. Of the total chances of preanalytical errors, 22.17% were due to inappropriate tests, 81.5% were related to incomplete patient information, 97% lacking clinical information, 18.8% errors related to specimen information, 3.5% errors were of the deranged quality of the specimen, and in4.5% transportation problems were observed. Subsequently, these were reduced to 10%, 20%, 16.4%, 7.5%, 2.3%, 3.1% respectively. A significant difference in percentage change was observed in all the above errors after the one-month interventions for the reduction in preanalytical errors. Conclusion:The results of the present study revealed that taking small steps in the form of implementing standard operative procedures for collection, storage and transport facilities and continuous educational training of stakeholders would reduce big errors occurring due to human factors in preanalytical phase. We need good interdepartmental communication and cooperation to achieve good laboratory results and patient well being. This study improved the quality of test results and patient care
ABSTRACT
Background: Severe malaria is a medical emergency that required prompt clinical assessment and management. Very few studies underwent to evaluate the best possible treatment for severe malaria. Methods: This is a prospective, randomized, open-labeled, study to evaluate the efficacy and safety of artesunate compared with quinine. Totally, 50 patients were included in each group. Patients above 18 years, peripheral smear positive and fulfilling the WHO criteria were included. The endpoint of the study was fever clearance time (FCT), parasite clearance time (PCT) and coma resolution time (CRT), and the adverse effect if any were compared for safety analysis. Results: FCT and PCT were much less with artesunate (29.64 and 39.72 hrs) as compared to quinine (51.12 and 55.20 hrs). CRT was less with quinine (25.80 hrs) than artesunate (42 hrs). The incidence of adverse effects such as hypoglycemia and QT prolongation are significant with quinine compared to artesunate. Conclusions: Artesunate is a better alternative for severe malaria with minimal side effects.