Patient’s adherence to antihypertensive drugs in a tertiary care hospital: A cross-sectional study

Background: Hypertension (HTN) is a serious public health problem. Good control of the disease has always been considered to be essential for reducing its morbidity and mortality. Poor adherence to treatment is the single most important reason for uncontrolled blood pressure, serious complications, and wastage of health-care resources. Aims and Objectives: This study aims to assess the antihypertensive medication adherence level among hypertensive study participants, and identify and evaluate the barriers to antihypertensive medication adherence. Materials and Methods: A hospital-based descriptive cross-sectional study was conducted in tertiary care medical college hospital in Madurai, Tamil Nadu, involving 332 patients and the collected data were presented as means (standard deviations) and percentages. Comparison of data was performed using Pearson’s Chi-square test. For all statistical analyses, commercially available computer program was used. Results: Among 332 study participants having age range of 31–78 years with a mean age of 57.49 ± 9.20 years, female (approx. 60%) were more than male (40%) participants. About 96.7% of respondents were aware that HTN could cause severe consequences with regard to their health and daily activity but more than half were taking medium salt (56.0%) and more than one-third (32.8%) were taking fatty rich diet. Only one-fourth (25.6%) had good medication adherence. Male participants (34.8%) were more adherent to medication than female (20.2%) and this was statistically significant with P = 0.003. Conclusion: Around 3/4th of study participants (72.9%) were poorly adherent to antihypertensive medication. Hence, there should be improvement in awareness for both the patients and the care providers.

A Case-Control Study on the Predictors of Neonatal Near-Miss: Implications for Public Health Policy and Practice

Purpose@#Neonatal near miss (NNM) allows for the detection of risk factors associated with serious newborn complications and death, the prevention of which could reduce neonatal mortality. This study was conducted with the objective of identifying predictors for NNM in a tertiary hospital in Bangalore city. @*Methods@#This was an unmatched case-control study involving 120 NNM cases and 120 controls. NNM was determined using Pileggi-Castro’s pragmatic and management criteria. Data was collected from in-patient hospital records and interviews of postpartum mothers. Multiple logistic regression of exposure variables was performed to calculate adjusted odds ratio (AOR) with 95% confidence interval (CI). @*Results@#Significant predictors were maternal age ≥30 years (AOR, 5.32; 95% CI, 1.12 to 9.29; P=0.041), inadequate antenatal care (ANC) (AOR, 8.35; 95% CI, 1.98 to 51.12; P=0.032), <3 ultrasound scans during pregnancy (AOR, 12.5; 95% CI, 1.60 to 97.27; P=0.016), maternal anaemia (AOR, 18.96; 95% CI, 3.10 to 116.02; P=0.001), and any one obstetric complication (hypertensive disorder in pregnancy, diabetes in pregnancy, preterm premature rupture of membranes, prolonged labour, obstructed labour, malpresentation) (AOR, 4.34; 95% CI, 1.26 to 14.95; P=0.02). @*Conclusion@#The predictors of NNM identified has important implications for public health policy and practice whose modifications can improve NNM. These include expanding essential ANC package to include ultrasound scans, ensuring World Health Organization recommendations of eight ANC visits, capacity building at all levels of health care to strengthen routine ANC and obstetric care for effective screening, referral and management of obstetric complications.

A Case-Control Study on the Predictors of Neonatal Near-Miss: Implications for Public Health Policy and Practice

Purpose@#Neonatal near miss (NNM) allows for the detection of risk factors associated with serious newborn complications and death, the prevention of which could reduce neonatal mortality. This study was conducted with the objective of identifying predictors for NNM in a tertiary hospital in Bangalore city. @*Methods@#This was an unmatched case-control study involving 120 NNM cases and 120 controls. NNM was determined using Pileggi-Castro’s pragmatic and management criteria. Data was collected from in-patient hospital records and interviews of postpartum mothers. Multiple logistic regression of exposure variables was performed to calculate adjusted odds ratio (AOR) with 95% confidence interval (CI). @*Results@#Significant predictors were maternal age ≥30 years (AOR, 5.32; 95% CI, 1.12 to 9.29; P=0.041), inadequate antenatal care (ANC) (AOR, 8.35; 95% CI, 1.98 to 51.12; P=0.032), <3 ultrasound scans during pregnancy (AOR, 12.5; 95% CI, 1.60 to 97.27; P=0.016), maternal anaemia (AOR, 18.96; 95% CI, 3.10 to 116.02; P=0.001), and any one obstetric complication (hypertensive disorder in pregnancy, diabetes in pregnancy, preterm premature rupture of membranes, prolonged labour, obstructed labour, malpresentation) (AOR, 4.34; 95% CI, 1.26 to 14.95; P=0.02). @*Conclusion@#The predictors of NNM identified has important implications for public health policy and practice whose modifications can improve NNM. These include expanding essential ANC package to include ultrasound scans, ensuring World Health Organization recommendations of eight ANC visits, capacity building at all levels of health care to strengthen routine ANC and obstetric care for effective screening, referral and management of obstetric complications.

Extended spectrum beta-lactamases in escherichia coli & klebsiella spp - prevalence, associated risk factors and clinical outcome in hospitalized patients.

Objective: Infection by extended spectrum beta-lactamase (ESBL) producing strains of Escherichia coli and Klebsiella spp. is variably associated with presence of co-morbid conditions, predisposing factors and poor outcome. Objective of this study was to determine the prevalence of ESBL producing strains along with the outcome and risk factors in patients infected with such strains. Materials and Methods: This observational study was conducted on 6910 clinical samples. E coli & Klebsiella spp. were identified with detection of ESBL production according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Patients’ clinical and demographic details along with risk factors and co-morbid conditions, type of response to antimicrobial therapy, length of hospital stay and mortality were collected. Results: 69.62% out of 563 E.coli and 62.80% out of 342 Klebsiella spp. were isolated from 6910 samples were ESBL producers respectively. Male:Female ratio was 1.36:1 and 2.37:1 for E coli and Klebsiella spp. respectively. Blood Stream Infection (p=.006), soft tissue infections (p=0.08), genital tract infections (p=0.03) and admission in intensive care units were significantly associated with risk of infection by Klebsiella spp. Immunosuppressive therapy (p=0.02) and diabetes mellitus (p=0.04) were significant comorbid conditions in ESBL producing E coli infections. The mean duration of hospital stay for ESBL producing E coli and Klebsiella spp. was 13.65 ± 12.6 and 17.89 ± 14.76 days with mortality of 8.6% and 13.34% respectively. Conclusions: Several co-morbid conditions and invasive devices were significantly associated with infection by ESBL-producing, strains of E. coli and Klebsiella spp. with longer duration of hospital stay and increased mortality in comparison to ESBL non-producers.

Antioxidant potential of the root of Vetiveria zizanioides (L.) Nash.

Vetiveria zizanioides, an aromatic plant commonly known as vetiver has been used for various ailments. The essential oil of vetiver root has been shown to possess antioxidant activity. However, antioxidant potential of spent root extract has not been reported. Hence, in the present study, ferric reducing, free radical scavenging and antioxidant activity of two genotypes namely KS1 and gulabi of V. zizanioides L. Nash root were investigated using in vitro assays - the ferric reducing antioxidant power (FRAP), 1,1-diphenyl-2-picrylhydrazyl (DPPH), total phenolic content (TPC), total antioxidant capacity (TAC) and reducing power (RP). KS1 genotype showed higher FRAP values, DPPH inhibition, TPC and RP potential compared to gulabi and the antioxidant activity increased with the concentration of the extract (10-1000 microg/mL). A significant protective effect of cv KS1 (100 microg/mL) extract was also observed in reduced glutathione (GSH) and malondialdehyde (MDA) concentrations of erythrocytes subjected to oxidative stress by tert-butyl hydroperoxide (t-BHP) and hydrogen peroxide (H202). The cv KS1 showed better antioxidant activity, compared to cv gulabi indicating the possibility of exploring the presence of different phytoconstituents in the two varieties.

An alpha-1 antitrypsin genetic variant from India.

The highly polymorphic human alpha-1 antitrypsin (AAT) gene codes for the most abundant circulating plasma serine protease inhibitor. Previously, genetic variants of the AAT gene were reported from different regions of the world. In the present study, the AAT gene was characterized in an Indian sample. The AAT gene was isolated and cloned from a liver biopsy sample through RT-PCR and the full-length gene was sequenced. Nucleotide sequence comparison with the human genome and the AAT sequences available in the GenBank (NCBI) demonstrated four unique variations--(i) an A to G variation at position 286 (Thr96Ala), (ii) an A to G variation at position 839 (Asp280Gly), (iii) a T to C variation at position 1182 that did not result in any change in the protein sequence (TTT to TTC both code for Phe) and (iv) an A to C variation at position 1200 (Glu400Asp) that resulted in replacement by an amino acid of similar nature. Other variations found were T to C at position 710 (Val273Ala) and T to C position 863 (Val288Glu), which were also reported earlier. In conclusion, this study reports the entire 1257 bp nucleotide sequence of protein coding region of the human AAT gene from an Indian sample. This preliminary finding is significant, as it reports for the first time the AAT gene sequence in the Indian sample.

Isolation of poly (A)+ mRNA for downstream reactions from some medicinal and aromatic plants.

In the present protocol for extraction of RNA, hexadecyltrimethylammoniumbromide (CTAB) and insoluble polyvinylpyrrolidone were used followed by LiCl precipitation, CsCl ultracentrifugation and finally poly (A)+ mRNA was isolated with the help of oligo(dT)-cellulose columns. The isolated poly (A)+ mRNA was found to be suitable for cDNA-AFLP and suppression subtractive hybridization applications. It is a modified and consolidated protocol based on previously described methods for isolated steps and works better for medicinal and aromatic plants. High yield of poly (A)+ mRNA coupled with its amenability for downstream reactions like RT-PCR, northern blotting and cDNA synthesis for library construction is a key feature of the present protocol.

Effect of glutamic acid and ketamine on morphine-induced analgesic response in rats.

Rats were treated with intraperitoneal injections of morphine (10 mg/kg) followed by glutamic acid (20 mg/kg.) and ketamine. (5 mg/kg). Pain thresholds were recorded as tail flick latencies for a period of 23 days and the mean area under curves calculated. Glutamic acid and ketamine, partially blocked the analgesic effects of morphine. Two types of effects were observed. In 4 animals, there was a partial blockade of the response, and in 2 animals there was a complete blockade followed by reversal in both the groups. It is suggested that two different mechanisms one excitatory and one inhibitory may be operating for the interaction of NMDA receptors with the opioid analgesic systems for modulating nociceptive responses.

High regenerative nature of Metha arvensis internodes.

Media and incubation conditions have been defined for highly efficient regeneration of shoots from internode explants of slow and fast growing cultivars of Mentha arvensis. Internodal segments excised from the in vitro raised shoots were inoculated on the MS medium supplemented with combinations of 5 concentrations of l-napthalene acetic acid (NAA) and 3 concentrations of 6-benzyl amino purine (BAP). The media containing 2 Ilg ml-1 NAA, 10 Ilg ml-1 BAP and I Ilg ml-1 NAA, 5 Ilg ml-1 BAP proved best for shoot regeneration and growth responses on cv Himalaya and cv Kalka explants, respectively. In 12 weeks time, on average one explant of cv Himalaya produced about 200 shoots and that of cv Kalka produced about 180 shoots. The Himalaya explants required higher concentrations of NAA and BAP for high efficiency proliferation as compared to the Kalka explants. The experiments demonstrated that internodal tissue in Mentha arvensis can be induced to obtain direct shoot regenerants with high efficiency. The analysis of the RAPD profiles of 100 regenerated plantlets each of cv Himalaya and Kalka showed more than 99.9% homogeneity in bands with respect to the parents.