Self-Measured Blood Pressure and Target Organ Damage in Newly Detected Hypertension in South Gujarat, India

Introduction: Blood pressure transient spikes have been considered to be noise and only a hindrance to a proper assessment of typical blood pressure, which is defined as the actual underlying average blood pres-sure over a long period of time. The current study aimed to see if the highest Self measured Systolic blood Pressure could be utilized to forecast the occurrence of Target organ damage and evaluate the independent association between the maximum Self measured Systolic blood Pressure and Target organ damage in indi-viduals with untreated hypertension. Method: We evaluated the urine albumin/creatinine ratio (UACR) and carotid intima-media thickness (IMT) using ultrasonography in 462 hypertensive individuals who had never taken treatment for their hypertension. Residential blood pressure was recorded. Result: The maximal Self measured Systolic blood Pressure had considerably higher association coefficients with left ventricular mass index (LVMI) and carotid intima-media thickness than the mean Self measured Sys-tolic blood Pressure. Irrespective of the mean Self measured Blood pressure level, multivariate regression studies showed that the maximal Self measured Systolic blood Pressure was independently related with left ventricular mass index and carotid intima-media thickness. Conclusion: Transiently high blood pressure measurements recorded at Self measured shouldn't be dis-missed as noise but rather taken seriously as significant warning signs of hypertensive Target organ damage in the heart and arteries.

Mechanistic Investigation On Anti-Nociceptive Potential Of Bartogenic Acid Containing Barringtonia Racemosa Fraction In Experimental Models Of Pain

Barringtonia racemosa (B. racemosa) is a tropical medicinal plant possessing interesting biological activities. B. racemosa fruits are traditionally used in India for the treatment of pain, inflammation, and rheumatic conditions. Earlier, we have reported anti-inflammatory activity of ethyl acetate fraction (BREAF) obtained from B. racemosa fruits in animal models of inflammation and delayed-type hypersensitivity. The present study aimed to assess the anti-nociceptive activity of BREAF. Acetic acid-induced writhing test, and hot plate and tail immersion tests were employed to study the effect of BREAF on peripheral and central pain mechanisms, respectively. The involvement of opioid system was confirmed through naloxone antagonism. Formalin induced pain test was performed to assess the effect of BREAF on neurogenic and inflammatory pain components. Capsaicin induced pain models were used to investigate the involvement of transient receptor potential vanilloid 1 receptor. The BREAF reduced writhing episodes and delayed the onset of acetic acid-induced writhings. The raised percentage maximum protective effects by BREAF in hot plate and tail immersion tests suggest the efficacy of BREAF in pain alleviation. A reversal of the analgesic effect of BREAF following naloxone treatment indicates the involvement of opioid receptors. The BREAF also inhibited inflammatory and neurogenic components of formalin-induced pain. The inhibition of capasaicin induced pain to some extent by the BREAF indicates the possibility of involvement of TRPV1 receptors. This study reinforces the traditional use of B. racemosa in the treatment of painful conditions. However, further studies are reasonable to explore the detailed mechanism(s) of the anti-nociceptive action of BREAF.

Clinical Efficacy of Concurrent Therapy with Oral FDC Tablet of Euphorbia Prostrata plus Calcium Dobesilate and Topical FDC Cream of Euphorbia Prostrata plus Lidocaine in the Management of Haemorrhoids: A Prospective, Open-Labeled Multicentric Study

Objective: Haemorrhoids are associated with bleeding, pain, itching, exudation and swelling. So there is an unmet need foreffective treatment by both oral and topical drugs. Hence this study was designed to evaluate the efficacy of oral EuphorbiaProstrata fortified with Calcium Dobesilate and topical cream of Euphorbia Prostrata with Lidocaine. Methods: The study was aprospective, open label, single arm, multicentric study, in 30 patients with hemorrhoids treated with oral FDC EuphorbiaProstrata extract 100 mg plus Calcium Dobesilate 500 mg and topical FDC cream of Euphorbia Prostrata extract 1% w/w plusLidocaine 3% w/w for 14 days.Symptoms like bleeding, pain, itching, exudation and swelling were assessed and scored duringand at the end of the study. Results: There was decline from the baseline value scores right from day 4 i.e. bleeding (0.97±0.15),pain (0.60±0.13), itching (0.47±0.13), exudation (0.13±0.06) and swelling (0.43±0.09); after 7 days bleeding (0.15±0.07), pain(0.12±0.06), itching (0.15±0.07), exudation (0.15±0.07) and swelling (0.19±0.08) and after day 14 the symptoms of bleeding(0.09±0.06), pain (0.08±0.06) and swelling (0.08±0.06) were almost cured while symptoms like itching (0.00±0.00), exudation(0.00±0.00) disappeared completely. There was reduction in the number of patient’s population with symptoms towards the end ofthe study. Conclusion: Oral Euphorbia Prostrata extract 100 mg fortified with Calcium Dobesilate 500 mg and topical cream ofEuphorbia Prostrataextract 1% w/w with Lidocaine 3% w/w showed maximum improvement during first 4 days of therapy andachieved total improvement till the end of therapy thus providing multimodal targeted approach to treat a multimodalhaemorrhoidal disease.

Exercise Induced Bronchoconstriction In Medical Students

INTRODUCTION: Exercise induced bronchoconstriction (EIB) is transient narrowing of lower respiratory tract airways after exercise. It affects about 5 to 20 % of healthy individuals and 80% of Asthmatics. Obesity has been considered as one of the risk factor to the development of EIB. Symptoms of EIB are nonspecific and can be seen in a variety of disorders and studies have shown a lack of diagnosis specificity and sensitivity based on symptoms. AIM: The aim of this study was to evaluate frequency of EIB in Medical students of Govt. Medical College Miraj. We also tried to find out association of body mass index (BMI) with EIB. We also tried to find out correlation of subjective feeling of breathlessness (symptom of EIB) with actual findings of spirometry tests used to asses EIB. METHOD: This cross-sectional observational study was conducted on 80 male medical students. Exercise challenge test was conducted for participants. Pre and post-test values of Forced expiratory volume in one second (FEV1) and Peak expiratory flow rate (PEFR) were compared and students with ≥ 10% decrease in post-test FEV1 & PEFR were considered positive cases of exercise induced bronchoconstriction. Statistical analysis was done by using software, IBM-SPSS VER 20. RESULT:In our study frequency of EIB in medical students was 6.4%. Decrease in post-test FEV1 and PEFR values were statistically significant with Pvalue < 0.001. Our findings show that there was no association between BMI and EIB. Our study results also reveal strong correlation between subjective feeling of breathlessness measured in terms of visual analogue scale (VAS) and objective spirometry tests used to assess EIB. CONCLUSION: EIB is one of the major problems to be addressed as increasing frequency of EIB in healthy population could pose a threat when people attempt exercise training for their health benefits. Proper care with physician's consultation can minimize undue risks associated with EIB in healthy people.

A rare case of bilateral idiopathic brachymetacarpia and brachymetatarsia.

We present a rare case of bilateral idiopathic 4th metacarpal and metatarsal shortening. Patient was thoroughly investigated to rule out syndromic association. No intervention was done as the patient was asymptomatic.

Antimicrobial Activity of Aloe Vera Leaf Extract.

The antimicrobial activity of aloe vera extract was tested against pathogenic bacteria like Staphylococcus aureus, Klebisella pneumonia and E.coli and fungi like Aspergillus niger and Candida at a dose of 1:20 mg/ml and 2:40 mg/ml by using cup plate diffusion method. Various solvents such as petroleum ether, chloroform and methanol were used for extracts. The results reveal that, methanol and petroleum ether at a dose of 20 mg/ml has showed significant activity against Klebisella pneumonia and E.coli whereas in fungi, methanol extract showed significant activity against Aspergillus niger and Candida. Methanol extract has showed maximum inhibitory activity against E.coli and Candida. Petroleum ether has showed moderate inhibitory activity against Klebisella pneumonia and Candida. The zone of inhibition was measured and compared with standard Gentamycin (1 mg/ml). However, in none of the above mentioned extracts the inhibition zone was not more than that found in standard i.e., Gentamycin.

Detection of extra-cellular enzymes of anaerobic gram-negative bacteria from clinically diseased and healthy sites.

Anaerobic gram-negative bacteria (AGNB) produce enzymes that play a significant role in the development of disease. We tested 50 AGNB isolates, 25 each from clinically diseased and healthy human sites for in vitro production of caseinase, collagenase, etc. Majority of the isolates were Bacteroides fragilis and Porphyromonas gingivalis, which more commonly produced collagenase and haemolysin. Comparatively larger number of clinical AGNB produced collagenase (P = 0.004). No such difference was observed with other enzymes. Hence, collagenase is probably one of the key virulence markers of pathogenic AGNB, and the inhibitors targeting collagenases might help in the therapy of anaerobic infections.

Haemagglutination and siderophore production as the urovirulence markers of uropathogenic Escherichia coli.

A total of 160 strains of Escherichia coli isolated from urine of patients with clinically diagnosed urinary tract infection were included in the study and 50 faecal isolates of E. coli were studied. They were studied for virulence factors, namely mannose-resistant and mannose-sensitive haemagglutination (MRHA, MSHA) and siderophore production.Among 160 urinary isolates of E. coli , 40 (25%) showed MRHA, siderophore production was seen in 156 (97.5%). In 50 faecal isolates, two (4%) were MRHA, four (8%) MSHA and siderophore production in two (4%). The results suggest that MRHA and siderophore production positive strains can be considered as UPEC.

Coronary stenting in diabetics: six months clinical and angiographic outcome.

The aim of this study was to assess the clinical and angiographic outcome of coronary stenting in diabetics as compared to non-diabetic patients. A total of 114 patients undergoing coronary angioplasty with stenting were prospectively evaluated. There were 30 diabetic (group A) and 84 non-diabetic (group B) patients. There were no significant differences in both the groups with respect to other risk factors and clinical characteristics. Both the groups were also comparable in terms of lesion morphology and stent types. The clinical endpoints were recurrent angina, reinfarction, cardiac death and need for target vessel revascularisation. The angiographic endpoint was angiographic restenosis at six months. There were 70 males and 44 female patients with a mean age of 55 +/- 12 years. Angiographic follow-up was completed in 85 (74.7%) patients which included 25 (83.3%) patients in group A and 60 (71.4%) in group B. Among clinical events at 30 days, the incidence of recurrent angina was 10.0 percent versus 8.3 percent (group A and B; p = NS) and incidence of reinfarction was 6.6 percent versus 5.9 percent (group A and B; p = NS), respectively. At six months, recurrent angina was seen in 16.6 percent versus 15.4 percent (p = NS) and reinfarction was seen in 10.0 percent versus 8.3 percent (p = NS) in group A and B, respectively. There were no deaths in either group. The angiographic restenosis rate was significantly higher in diabetics compared to non-diabetics (40.0% vs 23.3%; p = 0.02). The need for target vessel revascularisation was higher in diabetics as compared to non-diabetics (16.0% vs 6.6%; p = 0.03). We conclude that in spite of using coronary stents, the diabetics have higher restenosis rate and higher target vessel revascularisation rate than the non-diabetic patients.

Evaluation of laboratory techniques for diagnosis of amoebiasis.

Evaluation of 82 cases of amoebiasis including 4 of liver abscess was done. Microscopy of 62 stool samples revealed trophozoites in 19 (30.6%) and cysts in 8 (12.9%). PVA preserved samples were stained by iron-hamatoxylin and trichrome. Twenty-nine samples (46.7%) were positive by culture on Endamoeba, NIH and Charcoal agar. Additional two culture positive cases were negative by direct microscopy. Three (75%) samples of liver abscess pus were culture positive. Of the sera screened for amoebic antibodies by ELISA, 13 (17.3%) were positive. Stool and blood of healthy controls and 25 gastroenteritis cases were similarly analysed. Of healthy controls one had a high ELISA titre.

Antimicrobial susceptibility of Salmonella typhi to quinolones & cephalosporins.

Antimicrobial sensitivity testing was carried out for 85 isolates of S. typhi by disc diffusion and microbroth dilution for estimation of minimum inhibitory concentration (MIC). The drugs used included amoxycillin, chloramphenicol, ciprofloxacin, ofloxacin, gentamicin, netilmicin, cefuroxime, ceftizoxime, cefoperazone and ceftazidime. Ninety three per cent of our isolates were resistant to amoxycillin and chloramphenicol but total susceptibility was seen to quinolones and aminoglycosides. We also found that 3 per cent of our isolates were resistant to cephalosporins and 23 per cent were in the intermediate range with an MIC of 12.5 or 25 micrograms/ml to these drugs. In spite of decreased efficacy, the strains continued to be fully susceptible to ciprofloxacin as could be seen from the extended dilutions in microbroth dilution tests. The study also revealed that there was lack of correlation between the two methods of sensitivity testing for cephalosporins. We feel that the development of resistance of S. typhi to third generation cephalosporins is a finding worth consideration for further studies.