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Background: Chronic Kidney Disease (CKD) is characterized by irreversible sclerosis and loss of nephrons. The renal mass progressively declines over a prolonged period, depending on the underlying etiology. In CKD the most common feature is hypovitaminosis D which alter the vascular smooth muscle cell proliferation and reprogram the osteoblastic changes, finally leading to increase arterial wall thickness.Methods: A cross sectional study carried out over a 2-year period in Department Nephrology and General Medicine OPD, MIMS, Vizianagaram, Andhra Pradesh, India. 120 in which 60 are normal healthy individuals and 60 are CKD patients with stage 3 to 5. In all the participants serum creatinine, blood urea, serum triglycerides serum total cholesterol, HDL cholesterol estimated and serum 25 OH vitamin D are estimated.Results: The diagnostic criteria for CKD like blood urea, serum creatinine and eGFR were significantly higher in CKD when compared to control. In the present study, systolic and diastolic blood pressure was significantly increased in CKD compared with control. The Carotid Intima Media Thickness (CIMT) both left and right side were significant higher in CKD when compared with control. There is a significantly decreased levels of serum vitamin D in CKD (14.53 ng/mL±6.88) when compared with control (28.87 ng/mL±6.28).Conclusions: Present study finding suggested that there is a raised value of CIMT in CKD patients. High triglycerides, cholesterol and decreased HDL and declined vitamin D low hemoglobin, decreased eGFR, increased systolic blood pressure, raised CIMT value were found to be significantly increased in CKD patients.
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Background: Several clinical trials have been reported that sedentary lifestyle modification including physical activity (PA) and weight loss significantly alters the sort-term as well as long-term incidence of diabetes. The present study explored the level of physical activity and its barriers among south Indian naïve patients who are attending the tertiary care teaching hospital.Methods: A prospective observational, questionnaire-based study. Patients with diabetes (both Type-1 and 2) who were attended diabetic clinic in the Department of General Medicine, Maharaja Institute of Medical Sciences (MIMS), Vijayanagaram, Andhra Pradesh, India was selected and recruited. Demographic data, clinical data were collected from the study participants. International Physical Activity questionnaire was used to determine each patient level of physical activity (PA). Physical activity is graded into low (<600 metabolic equivalent (MET)), moderate (600-3000 MET) and high (>3000 MET).Results: A total of 300 subjects were completed the entire study. Majority (62.7%) of the patients were suffering from Type-2 diabetes mellitus. Both male and female study subjects had low physical activity (70.5% and 74.1%) and moderate PA was seen in only one thirds of the patients. Patients with low physical activity had low glycaemic control compared to patients who were involved in moderate PA. Moderate PA patients had adequate glycaemic control (65.9 vs 34.1%, P <0.001). A total of 42.0% of subjects were suffering from one of the joint pains and friction joints, due to the following reason subjects were not involved in the PA.Conclusions: Low level of physical activity was observed in the study population, which is a risk factor for several micro-vascular complications over a period of time. It is very important to address the barriers of PA and vigorous counselling is needed which directs towards increasing PA.
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Background: Diabetes mellitus (DM) and Hypertension (HTN) are the two major chronic disorders frequently coexisting, with increased incidence with age. HTN is about twice as common in patients with DM. Prescribing pattern are powerful tools to ascertain the role of drugs in society. There are many variations in prescribing patterns of antihypertensive drugs in patients with HTN and DM. Since these patients requires lifelong treatment it has enormously increased the burden of patients particularly in developing countries like India. Physician needs to be more concerned while choosing drugs for the patients with HTN and DM. In a tertiary care hospital, there is a real need for drug utilization study to determine the appropriate, more safe and effective patterns of drug therapy among diabetic hypertensive patients.Methods: A Cross sectional observational study was conducted in Maharajah’s Institute of Medical Sciences from December 2016 to May 2018. A total of 360 prescriptions of the patients with hypertension and coexisting diabetes were analyzed. The prescriptions prescribed to these patients were collected, assessed and the following parameters were noted. The treatment pattern of different group of drugs for HTN with co-existing DM was evaluated. The intended work was divided into three steps: Step 1: To collect the prescriptions of hypertensive patients with DM. Step 2: To separate the prescriptions prescribing anti hypertensive Drugs. Step 3: To statistically analyze the prescriptions. Relevant information was recorded in a structured proforma & data was evaluated.Results: In this study it was found that 36% of the patients were in the age group of 51-60 years with female preponderance among diabetic hypertensive patients. 77% of patients were treated with single antihypertensive drug and 23% of patients were treated with antihypertensive drug combinations. In monotherapy, telmisartan was most commonly prescribed. In combination therapy, amlodipine and telmisartan followed by amlodipine and atenolol were used.Conclusions: In this study monotherapy was preferred compared to combination therapy and adherence to the JNC 7 guidelines was good except in case of usage of diuretics.
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Background: In Chronic kidney Disease (CKD) a significant risk factor for mortality is Cardiovascular disease (CVD) and the most prevalent cardiovascular risk factor is left ventricular hypertrophy (LVH). Anemia, hypertension and volume overload are risk factors for LVH in CKD. So, the present was aimed at comparing the risk factors between CKD with and without LVH.Methods: A cross sectional study carried out over a 2 year period in Department Nephrology and General Medicine OPD, MIMS, Vizianagaram, Andhra Pradesh. A total of 120 patients are included in this study and divided in to CKD stage III to V based on estimated GFR. Based on 2D echocardiography data CKD cases are further divided in to CKD with LVH and CKD without LVH.Results: The Left ventricular mass index was significant higher in CKD with LVH (128.89±19.28) when compared with CKD without LVH (108.20±10.28). The left ventricular mass index was noted in more number in stage V of CKD. It is also observed that the left ventricular mass index was negatively correlated with haemoglobin and eGFR and was positively correlated with systolic blood pressure and serum NT-proBNP.Conclusions: Present study finding suggested that the incidence of LVH is higher in CKD patients. LVH was positively correlated with hypertension and NT-proBNP and negatively correlated with anemia and estimated GFR.
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Background: Several observational studies, well controlled randomized trials and meta-analyses reported that patients treated with statins has high risk of new onset diabetes mellitus (NODM), but the exact incidence and mechanism is still unclear and controversy. The present study was planned to find out the incidence of prediabetes and NODM and possible mechanism of action.Methods: This was a prospective, cross‑sectional study carried out at the Department of General Medicine for a period of one and half year between August 2017 and February 2019. Normoglycemic patients whose fasting blood glucose levels below 100 mg/dL and at least one year of treatment with statins were recruited in the study. Glycaemic status, development of prediabetes and NODM and insulin resistance were the primary outcomes whereas lipid profile, adverse drug effects of statins were secondary outcomes. Collected data was analysed by suitable statistical methods.Results: A total of 146 patients were recruited and 120 completed the entire study. Mean fasting blood glucose levels before initiation of statin therapy was 89.45±10.21. After one year of statin therapy, patients were separated as prediabetics and new onset diabetics and there mean fasting blood glucose levels were 116.24±12.86 (n=10) and 152.44±20.12 (n=12) respectively. A total of 12 (10.0%) patients were developed NODM and 10 (8.2%) patients developed prediabetes at the end of statin therapy. Atorvastatin 40mg was most frequency prescribed statin followed by Atorvastatin 20mg. A total of 70 (58.3%) study participants developed mild to moderate drug related adverse effects (ADRs), statin‑induced myalgia (55.7%) was the most common ADR.Conclusions: Patients treatment with statins had developed prediabetes and NODM. Atorvastatin 40mg and greater dose significantly induced NODM. Fasting blood glucose levels should be measured periodically with prescription contains higher doses of statins
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Background: The incidence of ischemic heart disease/ myocardial infarction is rapidly increasing in India. However, the traditional risk factors alone could not explain this excess of Coronary Heart Disease (CHD). So, we are in need of a tool to assess the severity and prognosis of these acute coronary syndromes. Lipoprotein (a) [Lp(a)] and High Sensitive C-Reactive Protein (hs-CRP) have been recognised as independent risk factors for CHD in many retrospective case control studies. As the data shows inconsistency in the prediction of risk by Lp(a) and hs-CRP, the study is carried out to compare and correlate the levels of Lp(a) and hs-CRP in coronary heart disease patients with controls.Methods: An observational case control study was conducted at Maharaja’s Institute of Medical Sciences, Nellimarla, with 120 participants. 80 admitted with CHD were categorised as type 2 diabetic and non-diabetic. Remaining 40 participants were age matched controls, who have attended the OP for general health check-up. Samples collected from the participants were analysed for Lp(a), hs-CRP and HbA1c.Results: Lp(a) levels were significantly elevated in CHD patients with diabetes (69.2±27.5) and non-significant in CHD patients without diabetes (50.4±24.3) as compared to their controls (36.6±22.5). There was significant correlation and elevation of hs-CRP in CHD patients with diabetes (6.0±2.6) and without diabetes (3.7±2.0) as compared to their controls (0.7±0.4).Conclusions: The present study shows a lack of association of Lp(a) levels in CHD patients with and without diabetes. A strong correlation of the inflammatory marker, hs-CRP was observed between the CHD patients with and without diabetes and even as compared to their controls. It may be concluded that hs-CRP is a better and independent marker than Lp(a) in patients with CHD.
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Background: Nephropathy is responsible for an End Stage Renal Disease (ESRD) in type 2 diabetics if uncontrolled. The monotherapy/combination of Angiotensin Converting Enzyme inhibitor (ACEi) and Angiotensin II Receptor Blockers (ARBs) can retard the progression of urine albumin to creatinine ratio in diabetic nephropathy but, the data shows an inconsistency in the efficacy of these drugs. So, the present study was aimed at comparing the reno-protective effect of ACEi/ARBs in type 2 diabetics.Methods: A prospective, randomized study is conducted at Maharaja’s Institute of Medical Sciences, Nellimarla, Vizianagaram, Andhra Pradesh, India with 100 patients, who are randomly categorised and equally distributed among the two groups and treated with Enalapril (ACEi) and Losartan (ARBs) for 6 months. 24-hour urine albumin to creatinine ratio and HbA1c are recorded before and after the treatment.Results: Enalapril and losartan showed a non-significant reduction in urine albumin to creatinine ratio from 196.2±17.5 to 185.9±15.2 (p=0.66) and 236.8±16.3 to 193.7±20.6 (p=0.11) respectively. A strict glycemic control has shown a reduction in HbA1c in both the groups.Conclusions: Present findings suggested that losartan is relatively more effective than enalapril in reducing the 24-hour urine albumin to creatinine ratio of diabetic nephropathy patients. Along with these drugs, regulation of blood glucose will assist in retarding the progression of nephropathy in type 2 diabetics.
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Background: Medical education has been asserted as one of the most challenging, demanding, and stressful fields of study, as medical students are expected to acquire diverse competencies such as academic, clinical, and interpersonal skills. Pharmacology is rapidly evolving and expanding conquering many diseases in its stride. The survey-based study we aim to grasp the MBBS students’ opinion regarding the teaching practices in pharmacology. Aim was to Study and compare the Effectiveness of Computer Based Teaching Versus Conventional Teaching Perception About Pharmacology Among Second Year MBBS Undergraduate Medical Students.Methods: A comparative study was conducted at Department of Pharmacology, Maharajah’s Institute of Medical Sciences, Nellimarla, Vizianagaram, Andhrapradesh. Two hundred second year MBBS medical students (n = 200) were divided into two groups.Results: In this study results shows P value and statistical significance the two-tailed P value is less than 0.0001 by conventional criteria, this difference is considered to be extremely statistically significant. Confidence interval the mean of Pre-test score minus Post test score equals -3.1900 and 95% confidence interval of this difference from -3.4503 to -2.9297.Conclusions: The importance of pharmacology in clinical decision making is well understood by the majority of students and they aim to act in that behest. Also, we find that computer based learning is a new and important tool coming up in the arsenal of the pharmacology teacher.
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Background: Skeletal muscle relaxants are a heterogeneous group of drugs. As a group, they are structurally and pharmacologically diverse. Skeletal muscle relaxants are usually used as adjunct therapy when initial therapy fails. They are commonly used to treat fibromyalgia, low back pain, neck pain, tension head ache, myofascial pain and muscle spasm.Methods: There were 28 mice were randomly divided into seven groups, each group consists of 4 mice. Group 1(Control): Mice were treated with normal saline and placed on rotating rod with a speed of 18 rpm (ideal speed). Group 2 (Standard-S1): Mice were treated with Nitrazepam at the dose of 2mg/kg body weight and placed on rotating rod. Group 3 (Standard-S2): Mice were treated with Nitrazepam at the dose of 3mg/kg body weight and placed on rotating rod. Group 4 (Standard-S3): Mice were treated with Nitrazepam at the dose of 4mg/kg body weight and placed on rotating rod. Group 5 (Test-T1): Mice were treated with Thiocolchicoside at the dose of 2mg/kg body weight and placed on rotating rod. Group 6 (Test-T2): Mice were treated with Thiocolchicoside at the dose of 3mg/kg body weight and placed on rotating rod. Group 7 (Test-T3): Mice were treated with Thiocolchicoside at the dose of 4mg/kg body weight and placed on rotating rod.Results: In this model inter drug comparisons were carried out with nitrazepam and thiocolchicoside. It was found that both nitrazepam and thiocolchicoside produced central muscle relaxant effect when assessed by rotarod. On iter drug comparision of nitrazepam and thiocolchicoside it was found that by increasing concentration of drug, increased the muscle relaxant property.Conclusions: When assessed by rotarod, it was found that both nitrazepam and thiocolchicoside demonstrated muscle relaxant property but with increased doses of thiocolchicoside produced more muscle relaxant property than the increase in doses of nitrazepam.
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Background: Diuretic compounds that stimulate the excretion of water with small traceable ions are potentially useful in most of disorders including those exhibiting edema such as congestive heart failure, nephritis, toxemia of pregnancy, premenstrual tension, and hypertension. The aim was to evaluate the diuretic activity of aqueous extract of roots of Cissampelos pareira (AQERCP) by Lipschitz method in albino rats. Methods: Five groups of Albino rats were used to evaluate the diuretic activity of AQERCP by using metabolic cages. The Group I serves as normal control received vehicle (carboxymethyl cellulose 2% in normal saline), the Group II furosemide (10 mg/Kg, p.o) in vehicle; other Groups III, IV, and V were treated with low (100 mg/kg), medium (200 mg/kg), and high (400 mg/kg) doses of AQERCP in vehicle. Immediately, after the extract treatment all the rats were hydrated with saline (15 ml/kg, p.o) and placed in the metabolic cages (3/cage), specially designed to separate urine and faeces, kept at 21°C±0.5°C.The total volume of urine collected was measured at the end of 5th hr. During this period, no food and water was made available to animals. Various parameters such as total urine volume and concentration of sodium, potassium, chloride ions in the urine were measured and estimated respectively. Results: In this model, when compared to vehicle treated control group the AQERCP at different dose levels (100, 200 and 400 mg/kg) has significantly increased the urine volume and also enhanced the elimination of sodium, potassium and chloride ions in urine. Conclusion: The results showed that single dose administration of AQERCP as 100, 200 and 400 mg/Kg and standard frusemide (10 mg/kg b.wt) has significantly (p<0.05*, p<0.01**, p<0.001***) increased the urine output along with an increase in concentration of sodium, potassium, and chloride. AQERCP 400 mg/Kg produced a greater diuretic activity, which is comparable to the effect of standard furosemide (10 mg/kg).The present study has supported and justified the basis for folklore use of roots of C. pareira as a diuretic agent.