Verapamil and loperamide; to compare the inhibitory effects on isolated guinea pig ileum

In smooth muscle cells, an increase in cytosolic free calcium concentration is an essential step for the cells to contract. The increase in calcium concentration occurs by influx from the extra cellular medium through calcium ion channels. Calcium channels have potential role in regulation of motility in gastrointestinal tract so there is growing interest in calcium channel blockers as a potential pharmacological approach to the treatment of various gastrointestinal motor disorders. In this study we evaluate the inhibitory effects of verapamil on spontaneous contractions of isolated guinea pig ileum and compare them with inhibitory effects of loperamide. Isolated intestinal segments of sixteen guinea pigs were used in this study. Serial dilutions [10-18 -10-3 gm/ml] of loperamide and verapamil were administered; effects observed and recorded by 7B Grass Polygraph machine. We observed that at lower concentrations, loperamide showed more inhibitory effects than verapamil while at higher concentrations [10-4 and 10-3 gm/ml] verapamil showed more inhibitory effects than loperamide on the contractions of isolated guinea pig ileum. This study gave us a clue that verapamil found a potent inhibitor of small intestinal contractions as loperamide. However one can presume further that calcium channel blocker verapamil acting on calcium channel receptor on GIT will be developed with more specific effects on smooth muscle of intestinal tract

Effect of injectable contraceptives on body mass index [BMI] in women attending family planning clinic at Hyderabad

To see the effect of injectable contraceptives on Body Mass Index [BMI] of women. A descriptive study. Family Planning Clinic at Hyderabad Sindh. One year from February 2005 to February 2006. This study was carried out on 50 patients of reproductive age 24-35 years. Patients with Cardiac, Renal and Liver dysfunction were excluded. Diabetic women taking sedative and hypnotics, anti-tubercular treatment were also excluded. All routine investigations were performed. BMI was done on initial visit and then on each follow-up visit and data was analyzed. Fifty women were selected. They were grouped into Group A and Group B, 25 women in each group. Group A received Depo Medroxy Progesterone [DMPA] and Group B received Norethisterone Enanthate [NET-EN]. On initial visit mean BMI of Group A was 23.03 +/- 0.1 kg/m2 while of Group B was 23.72 +/- 0.2 kg/m2. After completion of study mean increase in BMI of Group A was 0.52 kg/m2 and that of Group B was 0.54 kg/m2. Mean increase in BMI of both group is negligible. Both are equally effective in relation with BMI

Role of angiotensin converting enzyme inhibitors [Ramipril] and angiotensin receptor blocker [Losartan] on microalbuminuria in diabetes mellitus type-II

All the patients included in the study were divided into three groups. Group A patients received Angiotensin converting enzyme inhibitor [Ramipril] for a period of six months, the urinary albumin decreased in them by 34.89% while group B patients received Angiotensin receptor blockers [Losartan] for the same period and urinary albumin decreased by 39.73%. The resistant cases of both the groups were included in group C and this group was given a combination of Angiotensin converting enzyme inhibitors and Angiotensin receptor blockers i.e., Ramipril and Losartan in these resistant cases the urinary albumin decreased by 35.8%. Angiotensin converting enzyme inhibitors, Angiotensin receptor blockers and combination of both are effective in reducing the excretion of albumin in diabetic patients having microalbuminuria. These drugs beneficially influence the altered glomerular haemodynamics in patients with diabetes mellitus the measurement of albuminuria can prevent the renal damage and that it is a modifiable risk factor

Non-steroidal anti-inflammatory drugs: identifying the risk factors in the patients

Objective: the objective of this study was to identify the risk factors in NSAID users

Study design and setting: comparative prospective study, performed at the Department of Pharmacology and Therapeutics BMSI, JPMC with the collaboration of Departments of Medicine and Rheumatology JPMC Karachi from February 2008 to August 2008

Materials and methods: this study was performed on endoscopically diagnosed patients of NSAID induced peptic ulcers, in whom a clinical trial was performed between Ranitidine [H2 Receptor blocker] and new proton pump inhibitor Esomeprazole. Eighty Patients were selected and evaluated for presence of risk factors and dyspepsia after consumption of NSAIDs or low dose aspirin for last 6 months to 1 year. They were asked to fill in a specially designed proforma regarding the use of NSAIDs, which also included the questions for their social setup, habits and diseases for which they were taking them. All the patients were tested for presence of H. pylori infection and anti-H. Pylori IgG antibody titers were determined by enzyme-linked immunosorbent assay. Patients taking anticoagulants and steroids were excluded from the study

Results: important factors that have been shown to increase the risk of NSAID-associated GI complications in our study included female gender [76%] presence of H.pylori infection [71%], combination of two NSAIDs [23.75%] and high-dose NSAID use [20%]. Other factors that may increase risk include social habits like heavy consumption of tea [30%], pan or Gutka consumption [8.75%]. Current evidence supports that H. pylorus potentates the risk of NSAID-induced gastrointestinal ulcers or clinical events, and a strategy of H. pylori testing and treatment in NSAID users may be adopted

Conclusions: the incidence of NSAID related gastrointestinal problems was present in 10- 15% of patients who belonged to high risk group. Identifying them is strongly recommended to avoid serious complications. H. pylori infection may also be eradicated before initiating NSAID therapy

Elisa method for evaluation of anti A60 IgG for the diagnosis of tuberculosis

Background/Objectives: An ELISA test based on mycobacterial antigen A60 for the estimation of Anti [A60] IgG in the serum has been used successfully for the rapid diagnosis of tuberculosis in studies done in the European countries, China and India. To demonstrate and evaluate anti-tuberculosis anti-body IgG for rapid diagnosis of both pulmonary and extra pulmonary tuberculosis, this study was carried out in our set up

Methods: ELISA assay based on mycobacterial antigen A60 [Anda Biologicals, France] was used to the sera obtained from 69 cases of tuberculosis and 136 controls in the population of Karachi, Sindh -Pakistan

Results: Of 136 controls, only 17.7% were positive for IgG antibodies and showing 82.3% specificity. A very high sensitivity [88.8%] was seen in sputum positive active pulmonary tuberculosis. Relatively low [75%] sero-positivity was seen in cases of sputum negative active pulmonary tuberculosis compared to those of sputum positive active pulmonary tuberculosis. In cases of extra pulmonary tuberculosis, 47.3% sensitivity was observed. In case of healed tuberculosis quite a large number of cases was found positive for IgG [62.5%]

Conclusion: The estimation value of anti tuberculosis antibody IgG against A60 for the rapid diagnosis is proved from our data. Considering all the cases of active tuberculosis and the controls the global sensitivity of 69.8% and specificity of 82.4% were obtained when IgG antibodies estimation were taken into account

Role of indapamide on hypertensive left ventricular hypertrophy

Left ventricular hypertrophy [LVH] is a sequelae of sustained prolonged systemic hypertension Initially it is a compensatory mechanism but later on the left ventricular hypertrophy carriers the risk of arrhythmias, congestive cardiac failure, angina, systolic as well as diastolic dysfunction, greater intensity and risk of myocardial infarction and cardiac rupture. The Framingham Heart Study and other studies have shown LVH as an independent risk factor for cardiovascular morbidity and mortality. Some classes of drug cause regression of LVH e.g. ACE inihibitor, AT[1] receptor blockers, calcium channel blockers, B blockers and methyldopa. The effect of diuretics on regression are equivocal. we gave indapamide 2.5mg to 7 pts with echocardiographic evidence of LVH and found that LVID [mm] [mean + SEM] decreased from 50.7 +/- 1.2 to 50.20 +/- 1.70, IVST [mean + SEM] decreased from 14.10 +/- 0.4 to 11.9 +/- 0.30, PWT [mean +SEM] decreased from 13.0 +/- 0.3 to 11.2 +/- 0.2 and LVMI [mean +SEM] decreased from 176.42 +/- 6.13 to 145.25 + 6.04g/m[2]

study of vesicovaginal fistulae repair at gynaecological surgical camp at peoples medical college hospital Nawabshah

To evaluate the predisposing factors for vesicovaginal fistulae [VVF], route of fistula repair and outcome of surgery. Total 21 patients of VVF were admitted. 15 - 24 October 2002 Department of Obstetrics of Obstetrics and Gynaecology at PMCH Nawabshah, Sindh Out of 2I VVF, 14 of them were due to obstetrical trauma, 5 occurred due to gynaecological surgery and 2 were congenital. 18 cases were repaired vaginally and 2 were repaired with abdominal approach. One case was not repaired due to impacted bladder stone. Success repair was in 18 cases and 2 were failed. The success rate was 90%. The key for success was adequate tissue mobilization, division of scar tissue and good postoperative care

Adverse drug reactions: clinical assessment of drug induced disease

Physicians are often confronted with patients who state that they are 'allergic' to a drug. The goal of this review article is to help physicians to develop management plans for patients who present with drug induced diseases. It provides information that allows physicians to differentiate between reactions that are truly allergic in nature and those that are not immunologically mediated. The suggestions which may be helpful in the assessment are discussed and guidance is provided whether a drug may be safely readministered. Unfortunately until we are unable to thoroughly understand the mechanisms responsible for drug induced reactions, our management tools will remain limited

Effectiveness and complications of multi load [MLU 375] intrauterine device among females attending family planning clinic

Objective: To see the effectiveness and complications of intrauterine device [IUCD]; multi load [MLU 375] among females attending a family planning clinic. Design: A prospective study. Setting: A family planning clinic at Hyderabad, Sindh from June 2003 to May 2004

Subjects and Methods: Out of 145 women, a total of 75 [51.72%] were registered after screening for the insertion of IUCD Multi load [MLU 375]. Effectiveness and complications of IUCD [MLU 375] were recorded through a proforma. IUCD insertion was done under aseptic technique. Women were advised for follow up after 1, 6 and 12 months of insertion. They were provided a booklet for keeping their menstrual cycle record

Results: Most of the women were educated and belonged to urban area. Mean age of women was 24.4 years. Majority of women 23 [30.66%] had 5 children. After one month follow up, 32 [42.66%] women complained of menorrhagia, 21 [28%] complained of lower abdominal pain, 17 [22.33%] increased vaginal discharge while 5 [6.66%] did not complain of any symptom. After six month follow up, 69 [92%] women were symptom free and satisfied with this method, 5 [6.6%] developed pelvic infection and only 1 [1.34%] had displaced IUCD, which was removed under general anesthesia. After 12 month follow up, 74 [98.66%] women continued this method and only 1 [1.34%] woman was given alternative method of contraception. Pregnancy rate was zero

Conclusion: IUCD [MLU 375] is a highly effective, safe and reversible method of contraception with zero pregnancy rate and also has minimal complications which decrease simply by good counseling and regular follow up

Comparative study of non steroidal anti inflammatory durgs in postoperative pain

To compare the efficacy of ketoprofen and diclofenac sodium in the management of postoperative pain. Patients and The study was conducted in Surgical Unit-I with the collaboration of Pharmacology Department Liaquat University of Medical and Health Sciences Jamshoro from May 2002 to February 2003 [10 months]. This study was carried out on 100 patients, 50 for each group [group-A ketoprofen and group-B diclofenac sodium]. Assessment of analgesic action of two drugs was carried out on a prepared proforma designed for the study. Grading of severity of pain was based on clinical grounds and visual analogue scale. Postoperative requirement of these analgesic drugs regarding dosage, duration and efficacy were compared. Hundred postoperative patient-, were selected in this study, which included 50 patients in each group. Majority of patients belonged to 20 - 40 years of age with mean age in group-A of 35.58 years, and in group--9, 29.96 years. Male to female ratio in group-A was 1:19. and group-B=1:13. All underwent major surgical procedures under general anaesthesia and were assessed for postoperative pain relief. Severe pain was experienced by most of the patients in group-A [45-90%] and group-B [44-88%]. Onset of analgesia of each drug varied from 15 - 30 minutes, but it revealed early response i.e 15-20 minutes in group-A [46-92%] as compared to group-B [42-84%]. Average duration of analgesia was 8 - 12 hours, but maximum effect i.e 12 hours was seen in group-A [45-90%] as compared to group-B [39-78%]. Opioids were given to 30% of patients in group-A and 36% of patients in group-B. Side effects were seen more in cases of group-B as compared to group A. NSAIDs are as effective as opioids in postoperative pain relief. They also decrease the use of opioids post-operatively. Ketoprofen is more potent analgesic as compared to diclofenac sodium because of its dual mode of action i.e. peripheral as well as central. It has minimum side effects