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Background: Intravenous calcium channel blockers or beta-blockers are the preferred rate control medications for hemodynamically stable patients with atrial fibrillation with rapid ventricular rate (AFRVR) in the emergency department. Objectives: To compare the efficacy of intravenous diltiazem and metoprolol for rate control and safety with respect to development of hypotension and bradycardia in patients with AF-RVR. Methods: For this systematic review and meta-analysis, we searched PubMed, Embase, Cochrane databases, and the clinicaltrials.gov registry between database inception and 30th May 2021. Articles were included if they compared efficacy and safety of diltiazem versus metoprolol in critically ill adult patients hospitalized with AF-RVR. Outcome measures were achievement of rate control, development of new hypotension, and bradycardia after drug administration. Results: Of 86 records identified, 14 were eligible, all of which had a low to moderate risk of overall bias. The meta-analysis (Mantel-Haenszel, random-effects model) showed that diltiazem use was associated with increased achievement of rate control target compared to metoprolol [14 studies, n ¼ 1732, Odds Ratio (OR): 1.92; 95% Confidence Intervals (CI):1.26 to 2.90; I2 ¼ 61%]. In the pooled analysis, no differences were seen in hypotension using diltiazem vs metoprolol [12 studies, n ¼ 1477, OR: 0.96; 95% CI:0.61 to 1.52; I2 ¼ 35%] or bradycardia [9 studies, n ¼ 1203, OR: 2.44; 95% CI: 0.82 to 7.31; I2 ¼ 48%]. Conclusions: Intravenous diltiazem is associated with increased achievement of rate control target in patients with AF-RVR compared to metoprolol, while both medications are associated with similar incidence of hypotension and bradycardia.
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Introduction:Anal fissures or anal ulcers are considered one of the commonest causes of severe analpain. Surgical techniques like manual anal(lords) dilatation or lateral internalsphincterotomy, effectively heal most fissures within a few weeks, but mayresult in permanently impaired anal continence. This has led to the research foralternative non-surgical treatmentAIMS AND OBJECTIVES:The present study comprises the comparative study of 2% Diltiazem gel,0.2% Glyceryl Nitrate,2%lignocaine jelly application and need of surgical intervention in the treatment of chronic fissure inano.MATERIALS AND METHODS: This is a prospective study of fissure in ano during the period from September 2020 to September2021 in Sheth Lallubhai Gordhandas Municipal General Hospital, Ahmedabad. Clinical Data ofadmitted patient were collected by their detail history after stabilizing the patient, clinicalexamination with appropriate investigations.OBSERVATION AND DISCUSSION:Anal fissure is a very common problem across the world. It causes considerablemorbidity and adversely affects the quality of life. Therefore appropriate treatment ismandatory.In this study the commonest age group affected was 31-40 years agegroup (40%) and least affected were 51-60 years age groupThe incidence of fissure in males was slightly greater than females with MaleFemale ratio being 2.2: 1 in our study.CONCLUSION:Propper clinical examination and appropriate investigations helps in management of patient eitheroperative or non-operative which leads successful treatment in these patients.
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Abstract Stroke is one of the most important health concerns worldwide. Calcium ions accumulation in the nerve cells and increase in the catecholamines level of the brain following cerebral ischemia/reperfusion (I/R) are accompanied by damaging effects. Therefore, the present study aimed to evaluate the effects of diltiazem, as a calcium channel blocker, and metoprolol, as a β-adrenoceptors antagonist, on I/R injury. In this study, 30 male Wistar rats were divided into control, I/R, metoprolol, diltiazem, and metoprolol plus diltiazem groups (n=6 in each). Metoprolol (1 mg/kg/day) and diltiazem (5 mg/kg/day) were injected intraperitoneally (i.p.) for 7 days before I/R induction. On day 8, the animals underwent ischemia by bilateral common carotid arteries occlusion for 20 min. Histopathological analysis showed a significant reduction in leukocyte infiltration in diltiazem, metoprolol, and diltiazem plus metoprolol treated rats compared with the I/R group (P<0.05, P<0.01, P<0.01, respectively). In addition, in all treated groups, myeloperoxidase activity and malondialdehyde levels in the brain tissue significantly declined compared with the I/R group (P<0.001). Furthermore, pre-treatment with diltiazem and metoprolol alone or in co-administration remarkably reduced infarct size following I/R (P<0.001). Overall, the results indicate the considerable neuroprotective effects of metoprolol and diltiazem in cerebral I/R.
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Abstract Objective: To detect and to compare the apoptotic effects of intraoperatively topically applied diltiazem, papaverine, and nitroprusside. Methods: Internal thoracic artery segments of ten patients were obtained during coronary bypass grafting surgery. Each internal thoracic artery segment was divided into four pieces and immersed into four different solutions containing separately saline (Group S), diltiazem (Group D), papaverine (Group P), and nitroprusside (Group N). Each segment was examined with both hematoxylin-eosin and the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) method in order to determine and quantify apoptosis. Results: Apoptotic cells were counted in 50 microscopic areas of each segment. No significant difference was observed among the four groups according to hematoxylin-eosin staining. However, the TUNEL method revealed a significant increase in mean apoptotic cells in the diltiazem group when compared with the other three groups (Group S=4.25±1.4; Group D=13.31±2.8; Group N=9.48±2.09; Group P=10.75±2.37). The differences between groups were significant (P=0.0001). No difference was observed between the samples of the diabetic and non-diabetic patients in any of the study groups. Conclusion: The benefit of topically applied vasodilator drugs must outweigh the potential adverse effects. In terms of apoptosis, diltiazem was found to have the most deleterious effects on internal thoracic artery graft segments. Of the analyzed medical agents, nitroprusside was found to have the least apoptotic activity, followed by papaverine. Diabetes did not have significant effect on the occurrence of apoptosis in left internal thoracic artery grafts.
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Humans , Papaverine/therapeutic use , Vasodilator Agents/therapeutic use , Nitroprusside/therapeutic use , Diltiazem/therapeutic use , Mammary Arteries , Papaverine/pharmacology , Vasodilator Agents/pharmacology , Nitroprusside/pharmacology , Diltiazem/pharmacologyABSTRACT
Not many studies have compared more than two drugs in attenuating pressor responses to laryngoscopy and intubation. This study compares four groups of considerable size. The present study compared intravenous esmolol, diltiazem, and lignocaine, for their efficacy to abate pressure response to laryngoscopy and intubation. METHODSThis is a prospective, randomized, double-blinded, controlled clinical study conducted among 220 patients of ASA grade I/II (age 18–60 years), undergoing elective surgical procedure requiring general anaesthesia with endotracheal intubation over a period of 15 months at a tertiary hospital setup. Study subjects were categorised as Groups D, E, L, and N that received diltiazem (0.2 mg/Kg IV), esmolol (2 mg/Kg IV), lignocaine (1.5 mg/Kg IV), and normal saline, respectively; each group had 55 patients. Haemodynamic parameters were recorded at baseline, after drug administration, immediately after intubation, and at 1-, 3-, and 5-minutes after intubation. Data entry and analysis were performed using MS Excel and SPSS-PC-17 version, respectively. One-way ANOVA and the chi-square test were used to evaluate the difference. P < 0.05 was considered significant. RESULTSA maximum increase in haemodynamic parameters occurred immediately after intubation. The increase in heart rate and rate pressure product were significantly lower in Group E (+2.93% & +15.31%), whereas the increase in blood pressure was lower in Group D (8.51%). CONCLUSIONSHaemodynamic stability during laryngoscopy and endotracheal intubation is an integral and essential goal of any anaesthetic management plan and was more effectively maintained with esmolol and diltiazem than with lignocaine.
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Background: Anal fissures are often encountered in surgical practice with surgery the gold standard management for chronic anal fissures. Recently the widespread use of pharmacologic agents for chronic fissures has increased. In our study we compare topical 2% diltiazem with lateral sphincterotomy with respect to symptoms such as relief of pain, ulcer healing, and side effects of treatments.Methods: A prospective comparative study, a total of 80 patients were randomized into 2 groups 40 each. Group A patients were subjected to open internal lateral sphincterotomy and group B to 2% topical diltiazem. The patients in both groups were followed up at 1st, 4th, 14th weeks and 6 months in OPD and were assessed for pain, sphincter tone and complications.Results: In group A (lateral anal sphincterotomy), patients achieved a good pain relief with a mean pain score of 1.98 by one week post procedure whereas group B (2% diltiazem) had taken 14 weeks to achieve similar pain relief (pain score of 1.5). At the end of 6 months, healing of fissure was noted in 100% of group A and in 90% of group B. 4 patients (10%) had recurrences in group B. Flatus incontinence was reported in 2 patients (5%) in group A although transient.Conclusions: Lateral anal sphincterotomy is superior to 2% diltiazem especially in healing of fissure, pain relief, quality of life and recurrence. Pharmacologic agents should be reserved for patients who are unfit or unwilling for surgery or can be used as a bridge therapy till sphincterotomy can be planned.
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Anal fissures are often encountered in surgical practice in both sexes. It is a distressing disease impacting quality of life and causes profound morbidity among those affected. If left untreated, it may lead onto perianal abscess or even malignancy in long standing cases. Surgery is the gold standard management for chronic anal fissures. Recently the widespread use of pharmacologic agents for chronic fissures has increased. The management of chronic anal fissures has migrated to an era of multifaceted approach. This narrative review looks into various studies spanning over a period of 16 years. Various articles were shortlisted and analyzed for efficacy of various treatment methods, their impact in hospital stay, quality of life improvement, recurrence rate and complications among various treatment methods. We concluded from this review, that open lateral internal sphincterotomy is still the gold standard method of treatment for chronic anal fissure. Among pharmacological agents, 2% diltiazem has the best effectiveness with good compliance rate. Modern surgical techniques like VY plasty can be reserved for special situations. We do not recommend the practice of manual anal dilatation.
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Background:Endotracheal extubation is one of the frequently performed procedure in the practice of anaesthesia.This study was done to observe the haemodynamic responses during tracheal extubation and to compare the efficacy of IV diltiazem 0.2mg/kg versusIV lidocaine 1mg/kg in attenuating the hemodynamic response to tracheal extubation.Methods:90 patients aged 20 to 60 yrs, belonging to ASA I and II, normotensive were included in the study and they were randomly allocated into 3 groups of 30each. Group I received normal saline and served as control. Group II received0.2mg/kg of IV diltiazem 2 min before extubation. Group III received 1mg/kg of lidocaine IV 2 min before extubation. At the end of the surgery, heart rate (HR), systolic blood pressure (SBP)and diastolic blood pressure(DBP)were recorded served as base line values.Results:After tracheal extubation, all the haemodynamic parameters increase from the basal level in the control group and decreased in the study group. The change in HR, SBP and DBP were significantly less in group II and group III compared to group I. The change in HR, SBP and DBP were significantly less in group II compared to group III. Conclusions: Diltiazem hydrochloride, a calcium channel blocker belongs to the benzothiazepine group given in dose of 0.2mg/kg IV 2 min before tracheal extubation in ASA grade I andgrade II patients is a simple, effective and practical method of blunting cardiovascular responses to tracheal extubation. This suppressive effect of diltiazem was comparable to or even more potent than that of lignocaine 1mg/kg IV 2 min before tracheal extubation
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An understanding of the thermodynamics of the complexation process utilized in sustaining drug release in clay matrices is of great importance. Several characterisation techniques as well as isothermal calo-rimetry were utilized in investigating the adsorption process of a model cationic drug (diltiazem hy-drochloride, DIL) onto a pharmaceutical clay system (magnesium aluminium silicate, MAS). X-ray powder diffraction (XRPD), attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR) and optical microscopy confirmed the successful formation of the DIL-MAS complexes. Drug quantification from the complexes demonstrated variable behaviour in the differing media used with DIL degrading to desacetyl diltiazem hydrochloride (DC-DIL) in the 2 M HCl media. Here also, the authors report for the first time two binding processes that occurred for DIL and MAS. A competitor binding model was thus proposed and the thermodynamics obtained suggested their binding processes to be enthalpy driven and entropically unfavourable. This information is of great importance for a formulator as care and consideration should be given with appropriate media selection as well as the nature of binding in complexes.
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Background: Calcium channel blockers are being used in the treatment of hypertension, ischemic heart disease, cardiac arrhythmias etc. They act by blocking the slow calcium channels. Influx of calcium is an essential step in the release of histamine and 5HT from mast cells and in the synthesis and release of prostaglandins. They are the main mediators in the process of inflammation. The aim of the present study was to compare anti-inflammatory properties of calcium channel blockers and aspirin in albino rats.Methods: Present study was prospective intervention study carried out to compare anti-inflammatory properties of calcium channel blockers and aspirin in albino rats. Total 30 albino rats were used, and they were divided into 5 groups of 6 each. First group of rats was control group where normal saline was used. Second group was standard group where aspirin was used. Remaining three groups were test groups and given nifedipine, amlodipine and diltiazem respectively. Effects were observed and compared between the groups.Results: In carrageenan method, the anti-inflammatory response of Aspirin was significantly higher. Nifedipine response was <aspirin but >diltiazem. The response of amlodipine was not significantly > that of control percent inhibition. In histamine method, the anti-inflammatory response of aspirin was significantly highest. Anti-inflammatory response of nifedipine was < aspirin but > diltiazem. Diltiazem response was < nifedipine but > amlodipine. In formaldehyde method, aspirin inhibition was highest at 96.2% followed by nifedipine (90.7%), diltiazem (75.9%) and amlodipine (3.7%). In cotton wool pellet granuloma, the mean dry granuloma weight was least for aspirin and percent anti-inflammatory activity was significantly high.Conclusions: Calcium channel blockers (nifedipine, diltiazem) have shown comparable anti-inflammatory property with that of aspirin. Further clinical studies are required for confirmation.
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Objective: To observe the clinical efficacy and safety of tacrolimus (TAC) combined with low dose of corticosteroids in the treatment of the children with refractory nephrotic syndrome (RNS), and to investigate the effect of diltiazem on the blood concentration of TAC. Methods: A total of 16 hospitalized children with refractory nephrotic syndrome (RNS) were selected. All patients were treated with TAC (0. 10-0. 15 mg · kg-1 · d-1) combined with low dose of corticosteroids (1. 0-2. 0 mg · kg-1 · d-1). The concentrations of TAC of the children during the treatment process were monitored. The 24 h urine protein quantitative (UP), plasma albumin (Alb), creatinine and other 6 indexes were recorded before treatment and 2, 4, 8, 12 and 24 weeks after treatment. Results: In 16 cases, 9 cases were completely relieved, 5 cases were partially relieved, and 2 cases were invalid; the total efficiency was 94%. The 24 h UP of 16 children at 24 weeks after treatment was significantly decreased compared with before treatment (Z= - 3. 516, P<0. 01); the plasma Alb level of the children was significantly increased compared with before treatment (Z= - 3.516, P<0. 01). The total cholesterol and triglyceride levels at 2 weeks after treatment were decreased significantly compared with before treatment (Z = - 2. 223, P<0. 05; Z= - 3. 464, P<0. 01). Eight patients had low blood concentration of TAC, and it was increased to an effective concentration after treated with diltiazem. In the course of treatment, creatinine, urea nitrogen and other indexes of the patients were fluctuated in a normal range. Conclusion: TAC combined with low dose of corticosteroids for treatment of RNS is safe and effective, and diltiazem can effectively increase the blood concentration of TAC.
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Background: Anal fissure is condition in which there are cut or tear in the distal anal cavity that associated with the spasm of the muscle of the internal anal sphincter. Simply anal fissure can be treated with simple measures through increase fibers intakes, laxatives, in addition to having a lots of drinks and in cases that not respond to these measures we use some topical preparations include CCBs, steroids, anesthetics. Aim: Topical CCBs mostly given for treatment of chronic anal fissures as it consider effective nonsurgical treatment for anal fissure and there are more than one CCBs including diltiazem and nifedipine to be used in treatment of anal fissure therefore this study was done in order to compare between these two drugs in term of their efficacy and tolerability. Method: In this study there are 65 patients was selected and interviewed during their visits to consultation clinics in Thi-Qar and distributed randomly between the two groups (Diltiazem group) and (Nifedipine group) as they use the drugs for 2 months topically for the perianal region the end point of this study was the healing within the predetermined period (3 months) and also made comparison for the tolerability between the 2 groups. Results: The healing rate with Nifedipine topical was higher significantly when compared with Diltiazem topical while in term of tolerability was there are no significant differences between the two groups the most common adverse effects that founded in the two group was perianal itching and burning sensation in the anal area. Conclusion: Availability of more than one topical from of CCBs for treatment of anal fissure needed to be investigated and according to the above results show that superiority for the topical nifedipine over diltiazem in treatment of anal fissure due to the higher rate of healing while in term of tolerability was no significant differences between them.
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OBJECTIVE:To observe therapeutic efficacies and safety of diltiazem combined with ciclosporine in the treatment of nephrotic syndrome complicated with acute renal injury. METHODS:A total of 66 patients with nephrotic syndrome and cute kid-ney injury were randomly divided into control group(30 cases)and observation group(36 cases). Control group was given routine treatment;observation group was additionally given Diltiazem hydrochloride tablet 5 mg orally,twice a day,and Ciclosporin soft capsules 1.5 mg/(kg·d)orally,twice a day. Treatment course of 2 groups lasted for 20 d. Clinical efficacies of 2 groups were ob-served. The serum creatinine and kidney injury molecule 1(KIM-1),24 h urine volume,24 h urine protein levels,AKI classifica-tion,follow-up and recurrence were observed before and after treatment as well as the occurrence of ADR. RESULTS:The remis-sion rate of observation group was significantly higher than that of control group,and recurrence rate was significantly lower than control group,with statistical significance(P0.05). After 2 weeks and 1 month of treatment of observatiom groups,and after 1 month of treatment of control group,serum creatinine levels,KIM-1 and 24 h urine protein of observation group were significantly lower than before treatment,and the observation group was significantly lower than the control group;24 h urine and the ratio of gradeⅠby AKI classification were significantly more than before treatment,and the observation group was significantly more than the control group,with statistical significance(P0.05). CONCLUSIONS:Based on routine treatment,diltiazem combined with ciclosporin shows significant therapeutic efficacy in the treatment of nephrotic syn-drome and acute renal injury with good safety.
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Objective:To explore influence of tanshinone injection combined diltiazem on vascular endothelial function in patients with hypertension.Methods:A total of 136 inpatients with essential hypertension were selected from our hospital. According to random number table,they were randomly and equally divided into diltiazem group and combined treatment group (received tanshinone injection combined diltiazem).Blood pressure,endothelium dependent dilation (EDD)were compared between two groups before,two weeks and one month after treatment.Results:Compared with before treatment [combined treatmant group: (168.25 ± 12.54)/ (112.47 ±6.28)mmHg;diltiazem group: (168.37 ± 1174.16)/(112.49±7.13)mmHg],there was significant reduction in blood pressure in two groups on two weeks and one month af-ter treatment;compared with diltiazem group on two weeks and one month after treatment,there was significant reduction in blood pressure [two weeks:(151.36±6.16)/ (109.17±4.76)mmHg vs.(142.37±2.43)/ (100.43±5.19)mm-Hg,one month:(142.34±6.28)/ (94.16±6.28)mmHg vs.(126.71 ±8.17)/ (87.49±5.37)mmHg]in combined treatment group,P <0.01 all.Compared with before treatment [Combined treatmant group:(4.78±2.30)%;diltiazem group:(4.74±2.28)%],there was significant rise in EDD in two groups on two weeks and one month after treatment;compared with diltiazem group on one month after treatment,there was significant rise in EDD [(6.69 ±4.60)% vs. (8.43±4.73)%]in combined treatment group,P <0.05 or <0.01. Conclusion:Diltiazem combined tanshinone injection can help to improve vascular endothelial function in patients with hypertension.
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Objective To investigate the effect of diltiazem injection on the blood pressure and heart rate of patients with carotid artery stent implantation. Methods 60 patients with carotid artery stent implantation from February 2015 to March 2017 were divided into control group and observation group, with 30 cases in each group. The control group was given conventional medication, the observation group was treated with diltiazem on the basis of routine medication in the control group. The mean arterial pressure (MAP) and heart rate (HR) were measured at 72 hours after operation. The number of patients with low blood pressure was measured. Results The stenosis rate of the two groups was significantly lower than that of the control group, while the observation group was significantly lower than the control group (P<0.05). The blood pressure of the observation group was lower than that of the control group at 72 h after operation, but there was no statistical significance. There was no significant difference between the two groups in the rate of hypotension. Conclusion Application of diltiazem injection can help stabilize the carotid artery stent implantation in patients with blood pressure and heart rate, to avoid the occurrence of accidents.
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Objective:To explore influence of tanshinone injection combined diltiazem on vascular endothelial function in patients with hypertension.Methods:A total of 136 inpatients with essential hypertension were selected from our hospital. According to random number table,they were randomly and equally divided into diltiazem group and combined treatment group (received tanshinone injection combined diltiazem).Blood pressure,endothelium dependent dilation (EDD)were compared between two groups before,two weeks and one month after treatment.Results:Compared with before treatment [combined treatmant group: (168.25 ± 12.54)/ (112.47 ±6.28)mmHg;diltiazem group: (168.37 ± 1174.16)/(112.49±7.13)mmHg],there was significant reduction in blood pressure in two groups on two weeks and one month af-ter treatment;compared with diltiazem group on two weeks and one month after treatment,there was significant reduction in blood pressure [two weeks:(151.36±6.16)/ (109.17±4.76)mmHg vs.(142.37±2.43)/ (100.43±5.19)mm-Hg,one month:(142.34±6.28)/ (94.16±6.28)mmHg vs.(126.71 ±8.17)/ (87.49±5.37)mmHg]in combined treatment group,P <0.01 all.Compared with before treatment [Combined treatmant group:(4.78±2.30)%;diltiazem group:(4.74±2.28)%],there was significant rise in EDD in two groups on two weeks and one month after treatment;compared with diltiazem group on one month after treatment,there was significant rise in EDD [(6.69 ±4.60)% vs. (8.43±4.73)%]in combined treatment group,P <0.05 or <0.01. Conclusion:Diltiazem combined tanshinone injection can help to improve vascular endothelial function in patients with hypertension.
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Objective To investigate the effect of diltiazem injection on the blood pressure and heart rate of patients with carotid artery stent implantation. Methods 60 patients with carotid artery stent implantation from February 2015 to March 2017 were divided into control group and observation group, with 30 cases in each group. The control group was given conventional medication, the observation group was treated with diltiazem on the basis of routine medication in the control group. The mean arterial pressure (MAP) and heart rate (HR) were measured at 72 hours after operation. The number of patients with low blood pressure was measured. Results The stenosis rate of the two groups was significantly lower than that of the control group, while the observation group was significantly lower than the control group (P<0.05). The blood pressure of the observation group was lower than that of the control group at 72 h after operation, but there was no statistical significance. There was no significant difference between the two groups in the rate of hypotension. Conclusion Application of diltiazem injection can help stabilize the carotid artery stent implantation in patients with blood pressure and heart rate, to avoid the occurrence of accidents.
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Background: Pericardial effusion in clinical practice is commonly under diagnosed or missed especially minimal to moderate effusion. Aim and objectives: To study the clinical and etiological profile of pericardial effusion and to recognize radiological, electrocardiographic and echocardiographic features that are characteristic of pericardial effusion and to analyze pericardial fluid in various etiologies. Materials and methods: It was prospective study in patients presenting with pericardial effusion in department of Medicine and Cardiology. Total of 30 patients who presented with pericardial effusion based on clinical criteria and confirmed by echocardiography were included in the study. Results: The causes of pericardial effusion in this study were Tuberculosis (33.33%), Uremia (20%), Viral /Idiopathic (16.67%), Bacterial (10%), Malignancy (10%), Hypothyroidism (3.33%), and post MI with ischemic cardiomyopathy (3.33%), SLE (3.33%). 3 cases (10%) were HIV positive among viral causes,1 patient had tuberculous pericarditis. ECG findings of low voltage complexes were present in 90% of patients and electrical alternans was seen mainly in tamponade cases. Chest X-ray finding of cardiomegaly was present in 90% patients with pleural effusion in 13.3% patients. ADA levels elevated in all 10 patients of tuberculous effusion with 100% sensitivity and among them smear for AFB was positive in 3 patients. Increased levels of ADA>60U/L was associated with increased incidence of effusive constrictive pericarditis in TB effusion. Pericardial fluid IFN-ᵞ increased greater than 200 pg/L, tuberculous etiology showed 100% sensitivity and specificity. In all 10 patients of M Manjusha, B. Manoj Kumar, N. Venkat Rajaiah, P. Narayana. Study of characteristic of pericardial effusion and to analyze pericardial fluid in various etiologies. IAIM, 2017; 4(10): 221-229. Page 222 2Dimensional echocardiographic findings of right atrial, right ventricular collapse and left atrial collapse was seen predominantly in tamponade cases. Pericardiocentesis showed hemorrhagic effusion in malignancy and uremia, serous and serofibrinous in tuberculosis and purulent in pyogenic effusion. In 3 cases of pyogenic effusion, culture revealed Staphylococcus aureus in 2 patients and Klebsiella pneumonia in 1 patient. Among 3 cases of HIV, one patient had ADA >40 and smear for AFB positive suggesting tuberculous etiology and other 2 cases were directly due to HIV. In HIV with tubercular effusion the patient presented with cardiac tamponade. Conclusions: ADA>40U/L is diagnostic of tuberculous effusion which showed 100% sensitivity and specificity. Increase of ADA>60 U/L is associated with effusive constrictive pericarditis which has poor prognosis. IFN-ᵞ is increased >200pg/l in all patients of tuberculous etiology showing 100% sensitivity and specificity
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Background: In contributing the patient care, Anaesthesia and endotracheal intubation have become a core part of anaesthesiologists. Via nose or mouth, the trans-laryngeal placement of endotracheal tube into the trachea is called endotracheal intubation. Aim: To compare responses of lignocaine and diltiazem and combination of both on cardiovascular endotracheal intubation in healthy, normotensive patients. Materials and methods: This was a prospective randomised study, 80 patients were scheduled for tubectomy, cholecystectomy, appendectomy, abdominal and vaginal hysterectomy. These patients were divided into four groups, 20 in each group. Group I received normal saline, Group II received lignocaine and normal saline, Group III received diltiazem and normal saline, Group IV received diltiazem and lignocaine. Results: Males were 12, 60% and females were 8, 40% in group I, males were 12, 60% and females were 8, 40% in group II, males were 12, 60% and females were 8, 40% in group III and males were 10, 50% and females were 10, 50% in group II. Most of patients were aged between 21-40 years, group I (90%), Group II (82%), Group III (86%) and Group IV (75%). The mean age of group I was 33.98±8.05, group II was 38.78±9.26, group III was 31.87±5.29 and group IV was 35.68±7.89. The attenuation was maximum in Group IV followed by group II and group III, with respect to heart rate and systolic blood pressure. P V Praveen Kumar, P. Archana. Comparative clinical study of attenuation of cardiovascular responses to laryngoscopy intubation diltiazem, lignocaine and combination of diltiazem and lignocaine. IAIM, 2017; 4(10): 8-13. Page 9 Conclusion: In normotensive patients, the combination of diltiazem and lignocaine were more effective than when they were administered diltiazem and lignocaine individually for attenuating hemodynamic changes to laryngoscopy and tracheal intubation.
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ABSTRACT A stability indicating HPLC method to determine diltiazem hydrochloride (DTZ) in tablets and compounded capsules was developed and validated according to Brazilian and the International Conference on Harmonization (ICH) guidelines. The separation was carried out on a Purospher Star® C18 (150 x 4.6 mm i.d., 5 µm particle size, Merck Millipore) analytical column. The mobile phase consisted of a 0.05% (v/v) trifluoroacetic acid aqueous solution and a 0.05% trifluoroacetic acid methanolic solution (44:56, v/v). The flow rate was 1.0 mL.min-1 with a run time of 14 minutes. The detection of DTZ and degradation products (DP) was performed at 240 nm, using a diode array detector. The method proved to be linear, precise, accurate, selective, and robust, and was adequate for stability studies and routine quality control analyses of DTZ in tablets and compounded capsules.