Poor adherence with ACE inhibitors is a risk factor of CVA with oral hypoglycemic agents in diabetic patients

Poor adherence with medicine declines the clinical outcome of pharmacotherapy. It may carry serious sequelae especially in case of antihypertensive drugs like cerebrovascular accident [CVA]. This study has been planned to find the association of poor adherence with anti-hypertensive with CVA in diabetic and non- diabetic patients. One hundred CVA patients who were admitted through Emergency in Abbasi Shaheed hospital, a tertiary care hospital in Karachi, were recruited from Jun 2013 till Dec 2013. The criteria of inclusion was, diagnosed case of CVA, with primary hypertension, availability of patient's therapeutic record, consent of the patient or legal successor/heir. The criteria of exclusion was, secondary hypertension, newly diagnosed primary hypertensive patients and complete adherence with medication. Morisky medication adherence scale was applied. Therapeutic record was accessed. The mean age was 62.15 years with 3:1 male to female ratio. Adherence to medicine was graded <6. Patients with hypertension were 41 and with diabetes and hypertension were 59. Majority of patients were on monotherapy as compared to polytherapy [62% versus 38%].The mode of therapy was significantly different [P<0.05] in the two groups. ACE Inhibitors, Calcium Channel Blockers, Beta Blockers and other agents were used by 45.16%, 35.48%, 16.12% and 03.24% patients respectively. The aforementioned drugs were used by 57.14%, 33.33% and 09.52% respectively in 21 patients who were on antihypertensive and oral hypoglycemic agents. A statistical significant difference [P<0.05] was seen in the case of ACE Inhibitors. Similarly they were used by 42.10%, 39.47% and 18.42% in 38 patients respectively, who were on antihypertensive and insulin. No statistical significant difference [P>0.05] was seen in any combination [p>0.05]. Thus it is concluded that poor adherence with ACE inhibitors may be a risk factor of CVA in diabetic patients using oral hypoglycemic agents

Thrombo-embolic risk in high estrogenic phase of normal menstrual cycle in healthy women

Objective: this study is conducted to compare the risk of thrombo-embolism during different phases of menstrual cycles

Methodology: 105 healthy premenopausal unmarried females of 18 -21 years with a history of previous three normal menstrual cycles and 32 age matched male volunteers were recruited in the study. The phase of menstrual cycle of female volunteers was established by taking menstrual history. Bleeding time was determined by Duke's method

Results: bleeding time in 105 females was 73.03 +/- 1.89 Seconds and in 32 males was 69.33 +/- 4.94 Seconds which were not significantly different statistically [p=0.063]. Among females, 69 volunteers were in follicular phase of their hormonal cycle. Bleeding time in 29 females in early follicular phase was 70.86 +/- 3.38 Seconds and 40 females in late follicular phase was 68.25 +/- 4.03 Seconds. Statistically significant difference was not seen [p=0.095] when the two phases were compared. Bleeding time is not found to be reduced in late follicular phase as compared to early follicular phase, even high concentration of estrogen is present in the body in this phase as per normal menstrual physiology

Conclusion: high Estrogen in normal menstrual cycle does not increase thrombo-embolic risk in healthy women

Concomitant use of lisinopril reduces the effect of aspirin on bleeding

To determine the Lisinopril and Aspirin interaction through their concurrent effect on bleeding in adult male rabbits. Twenty four healthy adult male rabbits were used. Bleeding time of each animal was determined by Duke's Method. They were divided randomly in three groups containing equal number of animals into Control, Aspirin, Lisinopril and Combination groups. After oral administration of the drug[s], the bleeding time of the animals was again determined by same method. Prolongation of bleeding time was significant [p<0.05] in Aspirin and combination groups but insignificant [p>0.05] in Lisinopril group after 1 hour. It was significant [p<0.05] in Aspirin and Lisinopril groups but insignificant [p>0.05] in Combination group after 24 hours. This change was observed after 48 hours too. Concurrent use of Lisinopril reduces the effect of Aspirin on Bleeding after a certain time period