Difference in Antihypertensive Medication Pattern in the First Year Compared to More than a Year of Maintenance Hemodialysis: A Northern India Tertiary Care Experience

Introduction?There is a high prevalence of hypertension in maintenance hemodialysis patients. Information regarding prevalent pattern of antihypertensive medications will help modify it to prevent future cardiovascular morbidity and mortality. Materials and Methods?In this cross-sectional study, patients on maintenance hemodialysis, aged ?18 years visiting Nephrology outpatient department (OPD) from April 2019 to May 2020 were included. The patients were divided into two groups based on their dialysis vintage, ?12 months and >12 months. Their antihypertensive medication patterns and two-dimensional (2D) echocardiography (ECHO) findings were compared. Independent t-test was used to compare continuous variables. One-way analysis of variance was used to study the antihypertensive drug-dosing pattern in both the groups. Results?Out of 250 patients, 131 had a dialysis vintage of ?12 months, whereas 119 had a vintage of >12 months. There was no significant difference in the number of antihypertensive agents used in either of the vintage groups. Calcium channel blockers (87.02 and 89.07%, respectively, in ?12 and >12 months' vintage groups) and ? blockers (64.12 and 65.54%, respectively, in ?12 and >12 months' vintage groups) were the commonly used antihypertensive agents. Metoprolol use was higher in ?12 months' group, whereas carvedilol usage was higher in >12 months' group (p?=?0.028). Mean pill burden was more than five in both the groups. Concentric left ventricular hypertrophy was significantly more common in >12 months' group. Renin–angiotensin system (RAS) blocking agent use was limited to 3% of patients. Conclusion?This study shows a high antihypertensive pill burden in dialysis patients likely due to underlying chronic volume overload in addition to the perceived efficacy of certain class of drug in a frequent dosing pattern. Low use of RAS blocking agent was also underlined. This study highlights the need to bring about changes in the antihypertensive prescription pattern in line with the existing evidence

Assessment of Tear Secretions in Healthy Indian Volunteers.

Dry eye syndrome is currently seen with increasing frequency throughout the world including India. An evaluation of tear physiology in the form of tear secretion and tear film stability is the most important aspect of dry eye diagnosis. The aim of this study is to investigate the age and gender related changes in the result of these tear function tests (Schirmers Test and Tear Break up time) in normal Indian population. This crosssectional observational study included 120 normal subjects (60 Male and 60 females) with no ocular symptoms or ocular surface disorders. Schirmer and tear film break-up time tests were assessed in both eyes of each subject. The study subjects were divided into 4 groups according to their ages (< 20y, 20-40y, 41-60y and > 60y) each group was composed of 60 eyes of 30 subjects (15 male and 15 female subjects). The One way ANOVA test and the Statagraphic software was used for statistical analysis. We detected a statistically significant decline in both the tear function tests with increasing age. Tear function tests did not show statistically significant difference according to sex. This study suggests that the age of subjects should be taken into consideration in the evaluation of tear function test results. It is also revealed that Indian population values are different from Caucasian and Chinese values. We propose age specific cut off values of tear function tests in Indian population to aid in the diagnosis of dry eye in Indian conditions.

Cardiac autonomic activity in young females with primary dysmenorrhea.

Various studies have reported the effect of different phases of normal menstrual cycle on the autonomic control over the cardiac activity using heart rate variability (HRV) analysis. However, information on cardiac autonomic activity in young females suffering from primary dysmenorrhea (PD) is scant. Hence, the aim of the present study was to assess the HRV and blood pressure (BP) in different phases of menstrual cycle in women with PD and to compare these findings with eumenorrheic females. Sixty healthy unmarried female subjects (30 females with PD and 30 control subjects), in the age group of 18-25 years, having regular 28-32 days menstrual cycle were recruited for the study. Anthropometric measurements such as height, weight, BMI and WHR were measured. Blood pressure was measured with automatic blood pressure monitor and lead II ECG recordings were done to obtain HRV, during menstrual, follicular and luteal phases of menstrual cycle in both groups. The data recorded were subjected to time and frequency domain analysis. The results showed that dysmenorrheic women had significantly high BMI (P<0.05). Analysis of HRV during the different phases of the menstrual cycle between two groups revealed significantly increased (P<0.01) mean HR and significantly reduced (P<0.01) mean RR and RMSSD in all the 3 examined phases, SDNN significantly less (P<0.05) and systolic BP significantly higher (P<0.001) during the luteal phase in study group compared to control. Also, we observed a statistically significant decrease in TP and LF ms2 (P<0.05), HF ms2 & nu (P<0.01) in menstrual phase, HF ms2 (P<0.05) and HF nu (P<0.01) in luteal phase, while LF nu and LF-HF ratio were found to be significantly higher (P<0.01) in menstrual and luteal phases in women with PD compared to control group. This study has shown decreased HRV in the form of increased sympathetic tone and decreased parasympathetic activity in dysmenorrheic women which may be considered an important cardiovascular risk factor.

Bioethics and Patent Law: USA, UK and India. A Bibliometric Analysis.

Abstract: This article discusses the view of bioethics in terms of “need of ressearch” and gives more weight to various cultural traditions and their respective moral beliefs. It is argued that this view is implausible for the following three reasons: it renders the disciplinary boundaries of bioethics too flexible and inconsistent with metaphysical commitments of biomedical sciences, it is normatively useless because it approaches cultural phenomena in a predominantly descriptive and selective way, and it tends to justify certain types of discrimination. Compromise on moral matters attracts ambivalent reactions, since it seems at once laudable and deplorable. When a hotly-contested phenomenon like assisted dying is debated, all-or-nothing positions tend to be advanced, with little thought given to the desirability of, or prospects for, compromise. In order to qualify as appropriately principled, the ensuing negotiations require disputants to observe three constraints: they should be suitably reflective, reliable and respectful in their dealings with one another. The product that will result from such a process will also need to split the difference between the warring parties. In assisted dying, I argue that a reduced offence of 'compassionate killing' can achieve this. Clinical research is revolutionizing the practice of medicine in an unprecedented way. Some current legal and ethical concerns evolving from this revolution are addressed, pointing to the emerging concepts in jurisprudence, which regards medical research as an important contribution to patient empowerment, to medical risk management and in managing the resources of a national health system. While bioethics as a field has concerned itself with methodological issues since the early years, there has been no systematic examination of how ethics is incorporated into research on the ethical, legal and social implications. We aim of better understanding the methods, aims, and approaches to ethics that its researchers employ. We found that the aims of ethics are largely prescriptive and address multiple groups. This is a life concern issue. It is an important issue for researchers, teachers as well as for student. This articles main aim is to provide systematic outline of the complex relationship between bioethics and patent between India, USA and UK. This study suggests that trusting relationships may be more conducive than any particular discussion strategy to facilitating doctor-patient discussions of health care costs. Better public understanding of how medical decisions affect insurer costs and how such costs ultimately affect patients personally will be necessary if discussions about insurer costs are to occur in the clinical encounter. It will give an overview of the bioethics and Patent. The literature survey has indicated that there is no comprehensive work has been done by any researcher on this topic. Therefore the present study would concentrate on the work being carried out by Indian, USA and UK R & D scientists vis-a-vis Global researchers. Studies aims to map basic human needs such as human health, food and a safe environment, touches on fundamental values, such as human dignity and the genetic integrity of humanity, can raise human rights issues such as access to health and benefits from scientific progress, raises concerns over equitable access to the fruits of new technologies, the consent of those involved in research, and protection of the environment and compare these among India, USA and UK. The research map out many issues and policy communities, but main aspect is the ethical implications of protecting biotechnological inventions through the intellectual property (IP) system. A Bioethicist assists the health care and research community in examining moral issues involved in our understanding of life and death, and resolving ethical dilemmas in medicine and science. This research provides a systematic outline of the complex relationship between bioethics and IP. It will give an overview of bioethics. It sketches core principles in the interaction of IP and bioethics among these three countries. The basic data for the bibliometric analysis has been collected from SCI and for mapping different parameters suitable analytical software eg. SPSS, BibTech Mon is used. The analysis arises questions such as: Does India do enough work in this field. Which country is fastest growth among these.

Comparison of cardiac autonomic activity between malnourished and healthy children.

Severe malnutrition can significantly compromise autonomic nervous system. However, less is known about the cardiac autonomic activity in mild and moderate grades of malnutrition in children. Therefore, the objective of this study was to assess the effect of mild/moderate malnutrition on heart rate variability (HRV), a non invasive tool to estimate the cardiac autonomic activity. A cross sectional, community based study was conducted in which 35 malnourished children (mean age: 6.06±2.04 yrs), on the basis of anthropometric parameters, were enrolled in the study group by random samplings, who were the children of urban slum dwellers and 35 age and sex matched healthy children, were taken as controls. Grading of malnutrition was done according to Indian Academy of Pediatrics (IAP) classification. Anthropometry, basal heart rate (BHR), blood pressure were determined. Time domain and frequency domain indices of HRV were assessed using RMS Polyrite D (version 2.4). Weight, height, mid arm circumference (MAC) and body mass index (BMI) were found to be statistically lower in the study group. There was a strong negative correlation between MAC and LF component (P<0.01). BHR was found to be increased in the malnourished group (P=0.027). Low frequency (LFnu) & LF-HF ratio were found to be increased (P=0.000 & P=0.001 respectively) while high frequency (HFnu) component was decreased (P=0.000) in malnourished group. Our results suggested that impaired cardiac autonomic nerve function characterized by sympathetic over activity may occur in malnourished children. This study also enables us to compare, in future works, HRV in pediatric subjects with different grades of malnutrition.

Correlation of anthropometric parameters with QTc interval in malnourished children.

Various studies have reported the effect of severe malnutrition on electrolyte levels and electrocardiographic parameters. However, only a few have reported these findings in mild and moderate grades of malnutrition in children. Therefore, the objective of this study was to assess the effect of malnutrition (mainly mild and moderate grades) on corrected QT interval (QTc) and QT dispersion (QTcd) and electrolyte changes. A total of 20 malnourished children in the age group of 2-11 yrs were enrolled in the study group and 20 age and sex matched healthy children were taken as controls. Anthropometry, serum levels of albumin & electrolytes were determined. QTc and QTcd (difference between maximum & minimum corrected QT interval) were measured with the help of RMS Polyrite D. Our results have shown that body weight, height, body mass index (BMI), serum levels of albumin, potassium & calcium were lower (P<0.01) in malnourished children. QTc (P<0.01) & QTcd (P<0.01) were significantly greater in malnourished children than controls. We concluded that increase in QTc and QTcd intervals is associated with electrolyte disturbances in malnourished children. Electrolyte disturbance correction and appropriate nutrition therapy followed by further cardiac evaluation must be taken into account in the management of these patients.

Spectrum of malignancies in Allahabad, North India: a hospital-based study.

OBJECTIVE: To study the spectrum of malignancies in the Allahabad region of North India. This was a hospital-based analysis of malignancies from January 1991 to October 2006. MATERIALS AND METHODS: The basic information in the cancer registry included data on personal identification, demographic characteristics, diagnosis, primary site and morphology of tumours. The basis of diagnosis was histological examination of the biopsy material. RESULTS: Total of 58,031 biopsies were examined, out of which 3,133 (5.4%) were diagnosed as malignancies. Of these, 1,893 (60.4%) patients were males and 1,240 (39.6%) were females, yielding a male: female sex ratio of 1.5:1. The majority of cases (2,772, 88.5%) were above the age of 30, with predominance at 41-50 years of age group (804, 25.6%). Most commonly reported tumours were those of oral cavity (370; 11.8%), oesophagus (267; 8.5%), stomach (239, 7.6%), oropharynx (207, 6.6%), cervix (192, 6.1%), breast (190, 6.0%), larynx (101, 3.2%), skin (81, 3.2%), prostate (77, 2.4%) and the urinary bladder (66, 2.1%). CONCLUSIONS: It is concluded from this retrospective study of tumours reported at this hospital over 16 years, that oral and oropharyngeal malignancies were the commonest malignancies in men, while in females, carcinoma of cervix and breast were the most frequent.