Pattern of use of anti-hypertensive drugs amongst hypertensive patients in a tertiary care hospital: a cross sectional, observational study

Background: Hypertension is one of the primary modifiable risk factors for cardiac and renal diseases and is the single most important risk factor for stroke. Despite different guidelines for management of hypertension like Joint National Committee, British Hypertension Society, National Institute for Health and Care Excellence; there are still the clouds of controversy. The objective of the study was to evaluate the prescribing pattern of antihypertensive drugs among the patients attending medicine outpatient department of a tertiary care teaching hospitalMethods: A cross-sectional, observational study was conducted in our hospital over a period of six months. Relevant information was collected from medical records of 209 hypertensive patients fulfilling inclusion criteria. The collected data were sorted and analyzed.Results: Out of 209 patients, maximum were of age group of 45-65 years (55.02%). 115 (55.02%) were male and 94 (44.97%) were female. Diabetes mellitus (24.4%) was the most common associated disease with hypertension. Most of the patients had received single antihypertensive drugs (49.28%). Among the monotherapy category calcium channel blocker (82.78%) was the most commonly prescribed antihypertensive drug class followed by angiotensin receptor blocker (36.36%). Amlodipine (81.82%) was the most common among calcium channel blockers. The most frequent fixed drug combination prescribed consisted of amlodipine and atenolol. Most of the drugs were prescribed in generic name (90.9%).Conclusions: The treatment pattern, in general, conformed to standard treatment guidelines.

Donor notification and response rate of sero-reactive blood donors: a challenge and long way to go

Background: Supply of safe blood starts with healthy voluntary non remunerated blood donors. Blood donor screening and testing for TTI has become stringent all over the world. A fundamental part of preventing TTI is to notify and counsel reactive donors which help in preventing secondary transmission of infectious disease.Methods: This observational descriptive study is done to determine the number of contacted TTI reactive donors and their response rate after notification of their abnormal tests. It includes all the sero-reactive donors from July 2015 to June 2016 in the department of IHBT, GGSMCH. Blood donors who were sero-reactive for any TTI were recalled and tested again with ELISA kit of different manufacturer or lot number and by rapid card tests. Donors’ sero reactive on repeat testing were informed, counseled and referred to ICTC (for HIV) or Physician (for hepatitis B and hepatitis C). Confidentiality was maintained at every level.Results: During the study period, numbers of blood donors were 12621, out of which 343 blood donors were found to be sero-reactive. 23 donors were HIV, 230 Hepatitis C, 90 were HBsAg reactive. We could contact 182 out of 343 sero reactive donors telephonically. 161 sero-reactive did not attend blood bank phone call or their contact number was changed. Amongst the 182 contacted donors, 72 donors responded for the notification call and attended counseling.Conclusions: Response rate among reactive donors is quite low and a big challenge. This shows poor health care knowledge and social stigma regarding TTI among donors.

Clinicopathologycal Study of Gastrointestinal Tuberculosis and Role of Surgery in its Management

Background: Gastrointestinal tuberculosis is one of the commonest sites of extra pulmonary involvement. Most of the studies in the literature are on abdominal tuberculosis as a whole, which to a certain extent is responsible for confusion. Hence this study aims at a fresh look into Gastro intestinal tuberculosis as a separate entity. Aim and objectives: 1) to analyze the clinical features of Gastro Intestinal Tuberculosis. 2) To study the pathological features.3) to evaluate the role of surgery and to choose procedures in management of this disease. Methods: A total of 32 patients were included into this prospective study and divided into 4 groups based on the type of presentation namely, Obstruction – 18, Mass- 4, Perforation – 4 & Atypical – 6. They were subjected to thorough clinical evaluation and appropriately investigated. Results: Pain abdomen was the commonest symptom, 94% of the patients. 56% of the patients with obstruction. Commonest abdominal sign was abdominal distension, 66% of the patients. Ileocaecal region was the most common site, 50% of the patients. Ulcerative form was the most common gross pathology, 59% of the patients. Patients were subjected to either conservative management – 5 patients, Or Surgery , emergency in 17 patients and elective in 10 patients, depending on the Mode of presentation. Limited Ileocaecal resection was done in 9 patients and Right Hemicolectomy in 4 patients. Stricturoplasty was done in 8 patients. Complications were more common in emergency surgery. Conclusion: Patients commonly present with complications as intestinal obstruction. Ileocaecal region is the commonest site of disease .Conservative mode of management is preferable in patients not presenting with complications. Patients presenting with acute obstruction or perforation need emergency surgery.

Acute toxicity bioassay of dimethoate on freshwater airbreathing catfish, Heteropneustes fossilis (Bloch).

Pesticides are chemicals used for pest control in the agricultural fields. They finally reach the surrounding water bodies through surface runoff affecting the aquatic fauna. Dimethoate is frequently used organophosphate pesticide due to its high effectiveness and rapid breakdown into environmentally safe products. A 96 hr static acute toxicity test was carried out to determine the LC50 value of dimethoate, on the freshwater airbreathing catfish Heteropneustes fossilis (Bloch). The fish were exposed to 7 different concentrations of dimethoate (2.50, 2.75, 3.00, 3.25, 3.50, 3.75 and 4.00 mg l-1) for toxicity bioassay. Control (0.00 mg l-1) was also carried out. The data were subjected to Finney’s Probit analysis and processed with Trimmed Spearman-Karber statistical software. The LC50 values for dimethoate for 24, 48, 72 and 96 hr were 3.38, 3.23, 3.08 and 2.98 mg l-1, respectively. At higher concentration of dimethoate (3.25 mg l-1 and above) the fish showed uncoordinated behaviour such as erratic and jerky swimming, attempt to jump out of water, frequent surfacing and gulping of air, decrease in opercular movement and copious secretion of mucus all over the body.

Test for autonomic function to establish the norm: a useful tool for evaluation in various clinical disorders

Little information is available regarding the responses of the Jamaica population to the Valsalva manoeuvre (VM), a test to investigate the integrity of the autonomic nervous system (ANS). This study is aimed at investigating the cardiac automonic control in the Jamaican population, to explore the range of responses and to establish the norm. Such an explorative investigation provides an important tool to uncover autonomic dysfunction in psychosomatic, cardiopulmonary, metabolic and neural disorders. Fifity male and fifty female Jamaicans, who were apparently healthy and did not indulge in any drug use and smoking, are asked to perform the VM in a semirecumbent position. A tachograph (Grass model) and standard electrocardiographic leads are used for the graphic presentation of the subjects' beat-to-beat heart changes. The Valsava ratio (VR) is calculated by dividing maximum tachicardia and maximum bradicardia during the VM. The mean VR for the female (2.41 ñ 0.18) is greater than for the male (1.63 ñ 0.27) p < 0.001). Female subjects exhibit a higher basal hearth rate (88 ñ 6 as aginst 77 ñ 7 in the male) and a greater magnitude of bradycardia (33 as against 4 in the male). The values for VR are above the minimum of 1.5 proposed in the literature. Relatice roles of the sympathetic and parasympathetic nervous systems may differ in the male and the female subjects, thus accounting for a higher VR in the female. This test is simple, safe, noninvasive and reproducible and is useful to detect the abnormal autonomic function in various conditions, including states of pregnancy and stress