Prescription pattern and rationality of antihypertensive drugs in patients of type 2 diabetes with hypertension: a pilot study

Background: As presence of hypertension (HTN) in type 2 diabetes significantly increases risk of morbidity and mortality, its control with rational use of antihypertensives is essential. Authors performed this study to understand the current prescribing pattern of antihypertensives in patients of type 2 diabetes and their assess the rationality to recommendations of JNC-8 guidelines.Methods: Authors performed a cross sectional survey of prescription of diagnosed patients of diabetes with HTN at a tertiary care hospital. Prescription of patients attending medicine OPD were scanned. Data was collected over 2 month and analyzed with descriptive statistics.Results: In 76 patients analysed, mean age was 54.9±9.3 years and 51.3% were females. Insulin and oral antidiabetic agents were prescribed in 16 (21.1%) and 73 (96.1%) patients respectively. One, two, three and four antihypertensive drugs were prescribed in 44 (57.9%), 28 (36.8%), 3 (3.9%) and 1 (1.3%) patients respectively and 24 (31.6%) of them were fixed dose combinations. Among antihypertensives, angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), thiazide diuretics, beta blockers (BBs) and calcium channel blockers (CCBs) were present in 29 (38.2%), 26 (34.2%), 22 (28.9%), 21 (27.6%) and 14 (18.4%) respectively. In individual drugs, ramipril (28.9%) was most common followed by telmisartan (26.3%), hydrochlorothiazide (26.3%), atenolol (16, 21.1%) and amlodipine (17.1%) were frequently prescribed. In adjuvant drugs, antiplatelet (52.6%) and statins (56.6%) were common. This pattern of prescription was as per the recommendations of recent JNC-8 guidelines for treatment of hypertension.Conclusions: ACEIs/ARB are the most preferred for HTN treatment in type 2 diabetes mellitus. Prescription of antihypertensives in our set up was rational as per JNC-8 recommendations.

Profile of bone marrow examination in HIV/AIDS patients to detect opportunistic infections, especially tuberculosis.

Morphological evaluation of 140 bone marrow aspirations received in haematopathology laboratory with serologically established HIV infection, along with other relevant special haematological tests, was done during 1st Jan 1999 - 31st Dec 2002 at state government run tertiary care General Hospital in Maharashtra state, India. Out of 140 cases: 118 (84.28%) patients had anaemia, 25 (17.86%) had leukopenia, while 13 (9.28%) were thrombocytopenic. Dyserythropoiesis was present in 18 (12.86%) cases, dysmyelopoiesis 37 (26.43%) and micromegakaryocytes were noted in 44 (31.43%) cases. Haemophagocytosis was evident in 8 (5.71%) cases. Plasmacytosis encountered in 120 (85.71%) cases was a common feature. Based on clinical profile and results of other investigations 56 (40%) patients were clinically diagnosed to be of Mycobacterium tuberculosis (TB). Of these, 18 (12.86%) bone marrow aspirates were positive for AFB, Mycobacterium tuberculosis. In 4 cases cryptococci were demonstrated (Mucicarmine stain). There was one case each of Histoplasma capsulatum and leishmaniasis. One patient showed dense parasitemia with Plasmodium falciparum. One patient had immunoblastic lymphoma and showed bone marrow infiltration. Findings in this study strongly indicate that in HIV/AIDS, AFB stain should be done on each marrow aspirate to rule out tuberculosis in countries like India; where TB and AIDS are marching together.

Detection of antibodies to Brucella abortus in animal handlers.

1. Our study showed a prevalence of 5.33% in animal handlers working in an urban city like Pune. The prevalence would definitely be higher in a population from a rural area. 2. All these cases who showed presence of antibodies to B. abortus, had varied clinical manifestations, characteristic of the protean manifestations in brucellosis. Likewise in our study we had cases ranging from arthritis, abortions and genito urinary manifestations. 3. All the antibody positive cases had significant antibody titres. The clinicians miss many cases of brucellosis because it is not considered as an alternative diagnosis. The clinician should keep in mind the possibility of an occupational or environmental exposure in cases of P.U.O. It would also be worthwhile to create awareness of the disease in such professions so that necessary precautions and periodic screening of such occupationally exposed people can be done. Studies are needed to assess the role of brucellosis as a cause of morbidity in India, which had not received the attention it deserved. Prevention of human brucellosis focuses mainly on elimination of infection in cattle along with hygiene, vaccine, and effective heating and pasteurization of dairy products and related foods.

Salmonella newport isolations from a general hospital in Pune.

Salmonella newport had not been reported from the Pune (Maharashtra) area till 1983. After the first isolate in 1984, the isolation rate showed a significant increase. A total of 64 isolates todate (two isolates in 1984, six in 1985 and 56 in 1986) have been encountered at Sassoon General Hospital, Pune. It has been commonly isolated from adults (54.7 per cent). Most of the strains were multi-drug resistant.