New perspectives in the management of hypertension: role of herbal medicines

To compare the efficacy of coded herbal medicine [Hyprol] and losartan in hypertensive type II diabetic patients. Case control study. This study was carried out at the Out-patient Department of JPMC, Karachi and Herbal Clinics of Karachi from January 2014 to June 2014. This study is a case control prospective study to compare the effects of Losartan with herbal medicine [Hyprol] in type 2 diabetic hypertensive patients. 200 patients were enrolled and divided in two groups [A] [Control group] and [B] [Test group] treated with Losartan and Hyprol respectively. With ARB [Losartan] baseline to final change for SBP as well as DBP was significantly reduced i.e. 22.45% [p<0.001] and 16.84% [p<0.001] respectively and FBS was reduced by 21.85% [p<0.001] while Hyprol shows comparable results i.e. difference in SBP, DBP and FBS was 14% [p<0.001], 15.31% [p<0.001], 34.57% [p<0.001] respectively. ARBs are the first line drug of choice for hypertension since long time. Use of herbal medicine is an alternative mean of therapy to treat these patients and limit its cardiovascular and renal complications

Clinical evaluation of coded herbal medicine [hypoess] and angiotensin receptor blocker [candesartan] in essential hypertensive patients

The basic aim of this research study was to determine the comparative effect of herbal treatment in comparison with standard allopathic medicine in control and treatment of essential hypertensive patients. Prospective and comparative study. This study was carried out in Department of Pharmacology, HCM and D, FH and MS, Hamdard University, Karachi, from January 2014 to July 2014. A total of 200 patients were enrolled in study and were given Hypoess in one hundred patients while remaining one hundred patients received allopathic medicine Candesartan. In test group one hundred patients were treated with herbal drug [Hypoess] and it decreased mean systolic blood pressure of study patients with a decrease of 15.17% whereas, a reduction of 20.56% was found with allopathic medicine Candesartan Cilexetil. Similarly a decrease of 18.07% was found in mean diastolic blood pressure with herbal medicine in test group patients and a decrease of 21.65% was observed in case of allopathic drug in mean diastolic blood pressure of control group patients. The effects of herbal medicine were found statistically significant in controlling blood pressure and it has been found as an alternative option to treat essential hypertensive patients with its cost-effectiveness

observe the role of angiotension receptor blocker losartan in treating prehypertension

The primary objective of the present study was to determine whether in patients with prehypertension six months of treatment with an angiotensin II, type I receptor antagonist [at a dose of 8mg once a day] reduces the incidence of hypertension in borderline patients Randomized, open-labeled, prospective study. This study was conducted in the department of pharmacology and therapeutics, Basic Medical Sciences institute [BMSI], Jinnah Post Graduate Medical Centre [JPMC], Karachi, from July 2007 to January 2008. This study involved eighty untreated participants between 30 to 60 years of age of either sex with blood pressure on study entry in high-normal range i.e. systolic blood pressure of 130 to 139 mmHg and diastolic blood pressure of 85 to 89 mmHg, according to the classification developed by Joint National Committee on prevention, Detection, Evaluation, and Treatment of high blood pressure [JNC-VI]. All participants were randomized and enrolled in study after baseline investigations and informed written consent. All values have been expressed in standard error of mean [ +/- SEM]. Forty patients were treated with DRI and DR2 from day 0 to day 90[th] of study period respectively. InDRI group the mean systolic BY was decreased from 138 mmHg to 125.8 mmHg from day 0 to day 90[th] In DR2 group an increase was observed in systolic BY from 128 mmHg to 136 mmHg from day 0 to day 90[th]. An average percentage decrease of 8.21% in case of DR] while, 5.52% was increased in DR2 group. In same way a decrease of 11.82% in DR] group, while, an increase of 11.5% was observed in case of DR2 group in mean diastolic blood pressure respectively from day 0 to day 90[th] of study duration. Treatment of prehhypertension with an angiotension receptor antagonist May decreases incident hypertension. Additional studies will be needed to ascertain whether this or other strategies involving early pharmacological treatment of prehypertension would positively affect clinical outcomes

Role of polymorphonuclear leukocyte in diabetic foot

To study the etiopathogenesis of foot injuries in patients of uncontrolled diabetes mellitus. Retrospective study of tissue samples received from diabetic patients clinically diagnosed as gangrene. This study was conducted in the Department of Ophthalmology, JPMC, Karachi from July 2009 to June 2011. 150 cases of uncontrolled diabetes mellitus with wounds of foot were included. 150 cases of known diabetics with peripheral neuropathy and history of loss of sensation were subjected to follow up of 2 years follow up was done on the cases. As a first step blood sugar was brought under control and broad spectrum antibiotic was given. Wound debriment was done in all cases. The specimens were subjected to H/E and Gram's staining. In H/E, liquifactive necrosis, polymorphonuclear leukocyte, mononuclear cell infiltrate, few lymphocyte plasma cells and fibroblasts were seen. New blood capillaries were few or absent. both gram positive and gram negative organisms were isolated. 79% were gram positive and 21% were gram negative. Hyperglycemia causes relative anoxia in the micro environment of the tissue due to damage of peripheral neurons. Lack of adequate circulation leads to ischemia, which is super added by infection of the subcutaneous tissue. The resultant effect is liquifactive necrosis and complete lysis of tissue. Removal of such putrefied tissue is mandatory to stop further damage to the tissue

Lab diagnosis and evaluation of fungal keratitis

This study is aimed to evaluate the usefulness of Sabouraud dextrose agar in the confirmatory diagnosis of suspected cases of fungal keratitis. Pre-designed prospective study of corneal scraping obtained after detailed slit-lamp examination and documentation from all patients seen for non-viral microbial infective keratitis. This study was conducted in the Department of Ophthalmology, JPMC, Karachi from July 2008 to June 2011. 128 cases of non-viral microbial infective keratitis. Corneal scraping of 128 patients with microbial keratitis Smears of corneal scraping were stained with Gram's Method and inoculated specimens on Sabouraud dextrose agar [SDA] and incubated for 3-4 days. In a series of suspected cases of fungal keratitis, 119/128 [75% patients] had positive results for fungus in corneal scrapings by direct microscopy using Grams staining method and culture on Sabouraud dextrose agar [SDA]. 43% males and 32% females had Candidial keratitis and 11% males and 7% females had Fusarium infection. Other samples showed presence of Gram positive cocci on smears and were negative for SDA. Fungal keratitis continue to be an important cause of ocular morbidity, since it becomes difficult to clinically diagnose and differentiate between bacterial and mycotic keratitis in complicated cases. It is better to use a standard culture medium like Sabouraud agar [SDA] when confirming ocular mycosis

To study the efficacy of losartan on urinary uric acid excretion in thiazide induced hyperuricemic and hypertensive patients

The precise relationship of Hyperuricemia found in hypertensive patients is still obscure; this study is a urinary uric acid lowering intervention with Losartan in hypertensive patients induced by Thiazide diuretics. A number of pharmacological agents like loop diuretics, similarly low doses of aspirin [<3g daily] aggravate Hyperuricemia. The effect of Losartan on urinary uric acid excretion In Hypertensive patients with Thiazide induced Hyperuricemia were investigated in the Department of pharmacology and therapeutics, Basic Medical Sciences Institute Jinnah Postgraduate Medical Centre Karachi. It was randomized, open label, prospective, comparative study. Total 60 hypertensive Hyperuricemic patients were enrolled one by one in this study, selected from medical OPD and wards of Jinnah Postgraduate Medical Centre, Karachi. Patients were divided in three groups. Group-1 patients were treated with Thiazide 50 mg/day, Group-2 with Losartan + Thiazide 50 mg/day, and Group-3 with Losartan 50 mg/day. The effect on urinary uric acid level was measured, after every fortnightly. Treatment with Thiazide + Losartan group and Losartan group showed significantly increase in urinary uric acid excretion. Whereas, Thiazide group decrease in urinary uric acid level. In contrast to Thiazide and Losartan alone Thiazide + Losartan led to a greater increased in urinary uric acid excretion. The average percentage increase in urinary uric acid excretion in Thiazide + Losartan group was -13.27% and the average percentage increased in urinary uric acid excretion was 6.7% in Losartan group. Thus it can be concluded from the present study that urinary uric acid excretion was more increased in combination therapies. Ultimately Losartan decrease serum uric acid level and uricosuric effect of Losartan might be particularly useful in Hyperuricemic patients those on Thiazide diuretic [for hypertension and heart failure]

To evaluate the feasibility of treating prehypertension with an angiotension receptor blocker candesartan cilexetil

Prehypertension is considered a precursor of stage 1 hypertension and a predictor of excessive cardiovascular risk. The trial of preventing hypertension [TROPHY] was an investigator-initiated study to examine whether early treatment of prehypertension, defined for this study as systolic blood pressure of 130 to 139 mmHg and diastolic pressure blood pressure of 89 mmHg or lower and systolic pressure of 139 mmHg or lower, might prevent or delay the development of subsequent incident hypertension. The primary objective of the present study was to determine whether in patients with prehypertension six months of treatment with an angiotensin II, type I receptor antagonist [at a dose of 8mg once a day] reduces the incidence of hypertension in borderline patients

Comparison of propofol and sevoflurane for laryngeal mask airway insertion [LMA] in adults

To compare the effects of Porpofol and Sevoflurane in Laryngeal Mask Airway insertion. This study was quasi experimental was carried out in the Department of Anesthesiology, Surgical Intensive Care and Pain Management, Dow Medical College and Civil Hospital Karachi, Dow University of Health Sciences. The duration of the study was six months. In this study 60 patients schedule for elective surgery were enrolled which were divided into two groups. The average age of the patients was 25.1 +/- 10.6 years [95% CI; 23.7-29.0]. Out of 60 patients, 28 [46.6%] were males and 32 [53.3%] were females with 1:0.8 male to female ratio. Gender difference was not statistically significant between the groups [Chi-Square= 0.601; P=0.44]. The average age, weight and LMA insertion time were not statistically significant between groups. Induction time was significant between groups. Induction time was significantly higher in porpofol group [B] than in the sevoflurane group [A]. Condition of LMA insertion of 24 [80%] patients were excellent [score = 18] and 6 [20%] patients were satisfactory [Score between 16 to 17] in group A while condition of LMA insertion of 28 [93.3%] were excellent and 2 [6.7%] were satisfactory in group B. This study concludes that porpofol is a better anesthetic agent for insertion of LMA as compared to sevoflurane by using loss of eye lash reflex as the end point for induction

role of verapamil in long-term management of opioid dependence

To determine the effectiveness of calcium channel blocker, verapamil in long-term management of patients with chronic dependence on opioids. Patients were admitted for 10 days in hospital. No treatment was given during first three days of admission after abrupt termination of opioid to observe the acute opioid withdrawal signs and symptoms. Then the verapamil was given orally to each patient in a dose 40 mg twice daily from day 4 to day 10 of admission. Then patients were discharged on the same treatment and advised to attend OPD weekly for further 12 weeks. The treatment was continued till the 8[th] week and then the dose of verapamil was gradually tapered off during next two weeks that is weeks 9 and 10. During last two weeks that is week 11 and 12 patients were assessed without given any treatment. The intensity of signs and symptoms were recorded by using objective opiate withdrawal scale and modified subjective opiate withdrawal scale respectively. The physiological parameters were also recorded throughout the study. Urine analysis for opioids was done on day 1 and day 10 of admission and then on 4[th], 8[th] and 12[th] weeks of follow up. Verapamil significantly decreased the intensity of signs and symptoms of protracted opioid withdrawal from day 4 to week 12. There were no undesirable variations in physiological parameters. Urine analysis for opioids was positive on day 1 while zero on day 10, weeks 4, 8 and 12. Verapamil significantly decreased the intensity of signs and symptoms of protracted opioid withdrawal during long-term management of opioid dependence

Comparing the effects of verapamil and moxonidine in treatment of acute opioid abstinence syndrome

To compare the effectiveness of calcium channel blocker, verapamil and alpha two agonist, moxonidine in treatment of acute opioid withdrawal syndrome in patients with chronic dependence on opioids. Patients were divided into two groups. Group 1 had 27 patients, treated with verapamil 40 mg BID. Group 2 had 19 patients, treated with moxonidine 0.2 mg OD. All Patients were admitted for 10 days in hospital. Placebo was given during first three days of admission after abrupt termination of opioid to observed the acute opioid withdrawal signs and symptoms. Then the treatment was given to each patient daily from day 4 to day 10 of admission. The intensity of signs and symptoms were recorded by using objective opiate withdrawal scale and modified subjective opiate withdrawal scale respectively. The physiological parameters were also recorded daily throughout the patients stay in hospital. Urine analysis for opioids was done on day I and day 10 of admission. Verapamil and moxonidine both significantly decreased the intensity of signs and symptoms of acute opioid withdrawal from day 4 to day 10 of admission without any significant side effect but verapamil was found to be more efficacious than moxonidine. There was no undesirable variation in physiological parameters. Urine analysis for opioids was positive on day 1 while zero on day 10. Verapamil was found to be more effective than moxonidine for the treatment of acute opioid abstinence syndrome in indoor patients

Comparative effect of candesartan cilexetil and atenolol on glucose metabolism in essential hypertensive patients

To compare the changes on Glucose metabolism in essential hypertensive patients. Randomized, open-labeled, prospective comparative study. The study was carried out in the department of pharmacology and therapeutics, Basic Medical Sciences Institute [BMSI], Jinnah Post Graduate Medical Centre [JPMC], Karachi, from January 2007 to December 2008. In this study [80] newly diagnosed essential hypertensive patients were enrolled and divided into two groups [DR1] and [DR2] respectively. DRI patients received Candesartan 16 mg once a day and DR2 patients received Atenolol 50mg once a day for 3 months duration. At the end of study period the parameters examined were fasting and random blood glucose levels. The results have been expressed as mean +/- SEM [Standard error of Mean]. The mean fasting blood glucose level was decreased [from 90.22+ 1.34 mg/dl to 89.20 +/- 1.70 mg/dl; for DR1] versus DR2 in which mean fasting blood glucose level was increased [from 91.82 +/- 1.34 mg/dl to 97.91 +/- 1.22 mg/dl; p<0.001]. A reduction of 1.13% in case of DR1 and an increase of 6.63% were observed in case of DR2 group. The mean random blood glucose level was decreased for DRI group [from 151.12 +/- 0.99 mg/dl to 149.36 +/- 0.80 mg/dl] versus DR2 in which mean random blood glucose level was increased from [155.47 to +/- 0.96 mg /dl to 168.83 +/- 0.81 mg/dl; p<0.001]. A reduction of 1.16% was observed in case of DR1 group while and increase of 8.59% was observed in case of DR2 group, respectively. Candesartan cilexetil is a newer and safer alternative for the treatment of diabetic hypertensive patients in comparison to Atenolol treatment

Anti hypertensive efficacy of cardioselective beta-blocker atenolol and amlodipine in essential hypertensive patients

High blood pressure increases the risk of cardiovascular disease for millions of people worldwide and there is evidence that the problem is only getting worse. In the past decade, age adjusted rates of strokes incidence have risen. The incidence of end stage renal disease and the prevalence of heart failure have also increased. A major contributor to these trends is inadequate control of blood pressure in the population. The variety of treatments has been established with the passage of time from older to newer class. Researchers with passage of time proved on one side beneficiary drugs but also contraindicated in various types of patients. Keeping in view the necessity of treatment of hypertension at its initial stages in essential hypertensive patients to prevent cardiovascular complications in essential hypertensive patients. In present study the objective was to compare blood pressure lowering effects of cardio selective beta blocker Atenolol with calcium channel blocker Amlodipine in essential hypertensive patients

Comparison of Losartan and Amlodipine in hypertensive type-II diabetic patients

The present study assesses whether Losartan and Amlodipine, alone or in combination, prevent microalbuminuria in hypertensive type II diabetic patients. Department of pharmacology, Basic Medical Sciences Institute [BMSI], Jinnah Post Graduate Medical Centre, Karachi from June 2006 to January 2007. In this study 60 hypertensive diabetic patients were divided into 3 groups having 20 each. Group 'N' patients were kept as control, group 'A' patients were treated with Losartan, 50 mg once daily, group 'B' with Amlodipine 10 mg once daily and Group 'C' patients were given a combination of both the drugs i.e. tab losartan and tab amlodipine. Tablet Glibenclamide 5 mg was given according to the glicemic control. Although all the three groups showed a comparable effect in lowering both the systolic and diastolic blood pressure but the effect on proteinuria was variable. Losartan treated patients in Group 'A' shows marked reduction of proteinuria but non-significant change in creatinine clearance. In Group 'B' the patients who were treated with Amlodipine showed significant reduction in creatinine clearance, but non-significant change in proteinuria and Group 'C' patients showed countable reduction in proteinuria but a non-significant increase was observed in creatinine clearance. The results suggest that in hypertensive type II diabetic patients Losartan is worthwhile reducing both systolic and diastolic blood pressure and proteinuria significantly