A Study On Impact Of Goods And Service Tax On Small Traders With Reference Mysuru District, Karnataka

The study investigates the impact of Goods and Services Taxes on small businesses. Tax policies have such a big impact on the economy in terms of both efficiencies and equity. For Indian government small traders and medium traders are one of the pillars. Here small traders can fill the registration through online itself. In VAT the tax payment where differed from state to state in some states we have earn 10 lakhs we should pay VAT but for some states if its 5 lakhs itself we need to pay VAT. So it leads to confusion and its not much effective. So compare to that in GST we have one nation one tax. So that small and medium traders can go anywhere and can expand there revenue and business anywhere in India. This study is based on both primary data and secondary data. For collecting of primary data from sample respondents used structured questionnaire. Statistical tools like Garrett ranking method and chi-squre test, ANOVA are used for analysis of data

Correlation of fasting blood, salivary glucose and malondialdehyde in subjects with & without type 2 diabetes

Oxidative stress is identified as the common pathogenic factor that leads to insulin resistance in diabetics. Malondialdehyde is a product of lipid peroxidation. Aim: The aim of this study was to determine the variation in the Salivary malondialdehyde (MDA) among subjects with and without T2DM in comparison to the fasting blood and Salivary glucose. Methods: This study involved 29 healthy participants as Controls (group I) and 29 participants with Type 2 Diabetes Mellitus as Cases (group II). Salivary Glucose was analysed by glucose oxidase end-point assay. Thiobarbituric acid (TBA) assay method was considered for estimation of MDA in fasting saliva. Data was Statistically analysed using SPSS20. Parametric test was performed to analyse the data. Results: The correlation calculated between FBG with FSG level was found to be highly significant. A positive correlation between MDA levels with FBG was found. The relationship between FBG and FSG (r = 0.7815, p < 0.05), FBG and MDA (r =0.3678, p < 0.05) and FSG and MDA (r = 0.2869, p < 0.05) were found to be positively significant. Conclusion: Saliva as a unique body fluid can serve as a medium for biochemical analysis only in standard settings and with multiple measures to be used as a diagnostic tool in par with the gold standard serum. Salivary MDA levels can be considered as one of the oxidative stress markers in Type 2 Diabetic condition

Erroneous reduction of HbA1c levels in patients with type 2 diabetes mellitus on dapsone treatment for Hansen’s disease - a single-center retrospective cohort study

Background: Dapsone treatment may reduce HbA1c levels in patients with diabetes. Aims: To assess the prevalence and characteristics of dapsone associated reduction of HbA1c in patients with Hansen’s disease. Methods: A retrospective data review of outpatient and inpatient charts of consecutive patients with Hansen’s disease and type 2 diabetes mellitus was conducted over two years from January 2014 to January 2016 at the Department of Dermatology, CMC Vellore, India. Results: Of the 245 patients with a confirmed diagnosis of Hansen’s disease who were on oral dapsone 100 mg/day as part of their treatment regimen, 49 patients had diabetes and were eligible for the study as per predetermined inclusion criteria. Of these, 35 subjects (71%) had an HbA1c discordantly lower than the corresponding mean plasma glucose levels. Patients with discordant HbA1c levels were more likely to be male and to have a higher RBC mean corpuscular volume (MCV). A greater reduction in HbA1c levels was seen during the initial 3 months of therapy of dapsone treatment. Limitations: The small sample size and retrospective design were limitations of this study. Also, we did not analyze the role of methemoglobinemia or the utility of alternative measures of glycemic control in these patients. Conclusion: We describe a high prevalence of dapsone associated inappropriate HbA1c lowering in type 2 diabetes mellitus patients. This may have serious implications for the management of diabetes in patients on therapy with dapsone.

Comparative and correlative study of computerized tomographic scan findings and intra-operative findings in patients with inflammatory sinonasal diseases

Background: Inflammatory sinonasal diseases (ISD) refer to a group of disorders characterized by inflammation of the mucosa of the PNS. Acute ISD are defined as sudden in onset and duration less than 3 weeks. Recurrent acute infections are defined as four or more attacks per year lasting greater than 7-10 days. Chronic is defined as duration of symptoms more than 12 weeks. Materials and methods: The present prospective study was conducted in the department of ENT JSS Medical College and Hospital. The study was conducted from a period of November 2012 to June 2014. The study included a total of 50 patients with clinically proven inflammatory sinonasal diseases not responding to medical line of treatment. A complete detail about their signs and symptoms was also recorded in a tabulated form. Data was expressed as percentage of the total information and analysis was done using SPSS software. Results: The present study enrolled 50 subjects, out of these; there were 21 females and 29 males. 56% were diagnosed as with chronic sinusitis, 30% with ethmoid polyposis and 14% with antrochonal polyp in this study. The specificity of CT was found to be best for posterior ethmoid, hiatus semilunaris, sphenoethmoid recess, uncinate process, frontal recess, inferior turbinate. The values were 97%, 89%, 95%, 93.5%, 89.5% and 88.5% respectively. CT was relatively less sensitive for anterior ethmoid, infundibulum, bulla ethmoidalisad maxillary sinus. The values were 86%, 85%, 71%, 66%. Conclusion: CT is effective in demonstrating predisposing cause of Inflammatory Sino nasal diseases (e.g. Anatomical variants) and provides guidance for therapeutic endoscopic instrumentation. CT with its excellent capability for displaying bone and soft tissue is the current diagnostic modality of choice for evaluation of osteomeatal complex. CT scan has to be done, to know sino nasal anatomy and anatomical variations and to plan for FESS.CT scan provides findings which helps in management and acts as Road Map to the surgeons if FESS is indicated.

Redrawing vitreoretinal surgical training program in the COVID-19 era: Experiences of a tertiary care institute in North India

Purpose: The COVID?19 pandemic has brought medical and surgical training to a standstill across the medical sub?specialties. Closure of outpatient services and postponement of elective surgical procedures have dried up opportunities for training vitreoretinal trainees across the country. This “loss” has adversely impacted trainees’ morale and mental health, leading to feelings of uncertainty and anxiety. Therefore, there is an urgent need to redraw the surgical training program. We aimed to describe a systematic stepwise approach to vitreoretinal surgical training. Methods: We introduced a three?pronged approach to vitreoretinal surgical training comprising learn from home, wet lab and simulator training, and hands?on transfer of surgical skills in the operating room in our institute. Results: Encouraging results were obtained as evaluated by feedback from the trainees about the usefulness of this three?pronged approach in developing surgical skills and building their confidence. Conclusion: The disruption caused by the COVID?19 global pandemic should be used as an opportunity to evolve and reformulate surgical training programs to produce competent vitreoretinal surgeons of the future.

Evaluation of stress in three different fiber posts with two-dimensional finite element analysis

Introduction: The primary function of corono-radicular post is to provide retention for the core and to reinforce and to replace the remaining coronal tooth structure. There is considerable controversy regarding optimal choice of the material. An ideal post system should exhibit fracture resistance higher than the average masticatory forces. Finite elemental analysis (FEA) method facilitates precise analysis of the distribution and magnitude of stresses at any point of complex and irregular structures. Thus, this FEA study has been undertaken to evaluate the fracture stress distribution patterns in three fiber posts, viz., carbon, glass fiber, and everStick with an FEA. Materials and Methods: The FE stress analysis was performed with the FE software program (CATIA). Three two-dimensional FEA models of central incisor were simulated, and elastic moduli and Poisson's ratio of all the materials were fed to the software. For all the models, a 200 N vertical force was applied on the lingual surface of the tooth at an angle of 45°. Stress concentration and distribution were evaluated and noted down for all the models. To evaluate the stresses within the restored tooth, the modified von Mises failure criterion was used. The equivalent stresses found in the tested models were compared with the tensile strength of the respective materials. Contact stresses in the luting cement–dentin interface were calculated. Results: Finite element method revealed that maximum stress concentration was at the point of stress application. The stress value was highest in carbon fiber post followed by glass fiber post and least stresses found in everStick post. Maximum stress was observed at the labial surfaces of crown. However, the stress values and distribution were more homogenous in everStick post. Conclusion: The present findings suggest that everStick post has uniform stress distribution within tooth structure.

Synthesis, antibacterial, and antioxidant studies of 7-amino-3-(4-fluorobenzoyl)indolizine-1-carboxylate derivatives

In the present work, the quaternary salts of 4-aminopyridine, i.e., 4-amino-1-[2-(4-bromophenyl)-2-oxoethyl]pyridin-1-iumbromides were obtained by stirring 4-aminopyridine with phenacyl bromides in acetone at room temperature separately.These quaternary salts of 4-aminopyridine were treated with acetylenes (electron deficient), in the presence of anhydrouspossium carbonate in N,N-dimethylformamide solvent to get indolizine derivatives. The structures of newly synthesisedcompounds have been confirmed by spectroscopic techniques, such as liquid chromatography mass spectrometry,1H-NMR, and elemental analysis. Synthesized all compounds were screened for antibacterial and antioxidant activity.The compounds 2e, 2g, and 2j shows inhibition zone against bacteria and compounds 2a and 2f moderately active againstbacteria. All compounds 2a to 2j show 1,1-diphenyl-2-picrylhydrazide radical free radical scavenging activity, NitricOxide free radical scavenging activity, Reducing power scavenging activity, and Lipid peroxidation inhibition activity.

Ayurveda management of Guillain-Barre syndrome: A case report

Guillain-Barre syndrome (GBS) is a severe acute paralytic neuropathy with rapid progression usuallyoccurring post infections. Inspite of the active medications it is associated with severe weakness,incomplete recovery and pain. Long disease course can cause autonomic dysfunction or deterioration ingeneral health and life threatening complications like respiratory failures. Current case was diagnosed asGBS with motor, sensory & sphincter disturbance. Ayurveda diagnosis of Sarvangavata was made andcustomized treatment strategy was planned. First part of Kapha pitta samrushtavata (Vatadosha associated with Kapha and Pitta dosha) and then vatahara chikitsa were followed. Treatments were Koshtashodhana (gut cleansing), Abhyanga (massage of whole body with medicated oil), Ksheera parisheka(dripping of medicated milk over body), Shastikashali panda sweda (Rubbing of medicated rice poulticeover body), Anna lepa (application of medicated rice over the body), Shirotalam (trans cranial drugadministration by applying medicines over scalp), Basti (trans rectal administration of medicines) andOral medicaments. Panchakarma treatments were for 14 days followed by oral medications for next 151days. Intervention period of 165 days showed complete recovery of all the motor, sensory & sphincterdeficits however follow up of the patient was maintained for 437 days looking in to the sustainability ofthe outcomes.© 2018 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

A cross-sectional study on preference of tubectomy over vasectomy among eligible couples in Bengaluru, Karnataka

Background: Population policies, family planning and welfare programmes undertaken by the Government of India, have led to continuous decrease in the fertility rate but sustainability and target of net reproduction rate 1 is not yet achieved. With increase trend of adopting the permanent method of contraception by eligible couples, the preferences of tubectomy over vasectomy is still remarkable. Hence, the present study is taken up to find Knowledge, Attitude and Practice regarding sterilization and factors influencing it.Methods: A cross-sectional study is conducted in the year 2017 among eligible couples who have completed their family size or pregnant women who came for second confinement to Vydehi Institute of Medical Sciences and Research Centre and Shreyas Maternity Home, Hoskote and Shreyas maternity home are included. An institutional ethics committee (IEC) is given on vasectomy, the better method of sterilization and responses are recorded.Results: A total 92.6% couples were aware of permanent family planning methods. Among them only 30.6% couples are aware of vasectomy. There is a significant association between number of children in a family and to undergo sterilization (p=0.02) method. Reason for not choosing vasectomy are unawareness (49.3%) and social stigma (38%) mainly. 11 couples (7.3%) changed their opinion to undergo vasectomy after giving an IEC.Conclusions: Many couples were knowledgeable about tubectomies and opted for it. Only a small number of couples changed their opinion from tubectomy to vasectomy after being given an IEC.

Spasm, stenosis and shelves:balloon-assisted tracking techniquesin endovascular interventions

The technique of balloon-assisted tracking (BAT) has been demonstrated in transradialcardio-angiographic procedures. Using three commonly encountered clinicalscenarios, we outline the technical details of BAT for managing peripheral and cerebralinterventions with challenging vascular access. We describe methods used toovercome vasospasm, stenosis and vascular shelves during interventions for acuteischemic stroke, but these issues are not unique to neuroendovascular cases and thetechniques can be applied across all endovascular interventions. We present threeacute stroke interventions where anatomic challenges were overcome with the useof endovascular BAT. This article describes a novel application for BAT techniques inendovascular interventions to assist with access in peripheral, cervical and intracranialvessels. These methods can also be used to improve access during diagnosticcerebral angiography. BAT is a useful adjunct when navigating catheters throughvasospasm, tortuous anatomy, vascular step-offs or intraluminal plaques.

Management of rectal prolapse (Guda Bhramsa) through Kshara Karma (chemical cauterisation): a case study / Manejo do prolapso retal (Guda Bhramsa) usando Kshara Karma(cauterização química): um estudo de caso

Abstract Rectal Prolapse is a condition where the rectum protrudes beyond the anus. The explanation of this condition can be traced back to ancient Ayurveda text like Susruta Samhita, Ebers Pappyrus of 1500 B.C., etc. The exact cause of rectal prolapse is unclear but it is predominant on female gender and on people having constipation, previous anorectal surgeries etc. Both partial and complete varieties of rectal prolapse are extremely debilitating because of the discomfort of the prolapsing mass and variety of symptoms like rectal bleed, intermittent constipation or fecal incontinence. Although, diverse modalities of surgical management of rectal prolapse are present, no single optimal procedure is proved and the choice of operation is determined by the patient's age, sex, degree of incontinence, operative risk, as well as by the surgeon's experience. In Ayurveda, Guda Bhramsa (Rectal prolapse) is explained by Acharya Susruta under Kshudra Rogas (chapter of minor diseases) and has elaborated it's conservative management very beautifully. In this case, a female with partial rectal prolapse was treated with Kshara application and managed without complications. So, Kshara application can be a safe and effective alternative for the management of rectal prolapse.

Resumo O prolapso retal é uma condição em que o reto se projeta para além do ânus. A explicação desta condição foi relatada em antigos textos Ayurveda como Susruta Samhita e Ebers Pappyrus, datados de 1500 aC. A causa exata do prolapso retal não é clara, mas essa condição é predominante no sexo feminino e nas pessoas com constipação e histórico de cirurgias anorretais anteriores. Tanto o prolapso retal parcial quanto total são extremamente debilitantes devido ao desconforto da massa prolapsante e da variedade de sintomas como sangramento retal, constipação intermitente ou incontinência fecal. Embora diversas modalidades de tratamento cirúrgico para corrigir o prolapso retal tenham sido relatadas na literatura, nenhum procedimento é consensual; a escolha da operação é determinada pela idade, sexo, grau de incontinência, risco operatório e experiência do cirurgião. Na Ayurveda, Guda Bhramsa (prolapso retal) é explicado por Acharya Susruta no Kshudra Rogas (capítulo de doenças menores) e seu manejo conservador é descrito de forma bastante completa. No presente caso, uma paciente do sexo feminino com prolapso retal parcial foi tratada com aplicação de Kshara e administrada sem complicações. Assim, a aplicação de Kshara pode ser uma alternativa segura e eficaz para o manejo do prolapso retal.

Sequential imaging of a case of choroidal osteoma using swept-source OCT and optical coherence tomography angiography: A 4-year follow-up study

A 33-year-old gentleman was presented with metamorphopsia in the left eye due to choroidal osteoma (CO) complicated by choroidal neovascular membrane (CNVM). Optical coherence tomography angiography (OCTA) proved to be a valuable, noninvasive tool in monitoring treatment response of CNVM. The tumor subsequently underwent decalcification over a period of 4 years. In addition, SS-OCT scans were instrumental in documenting the natural course of the tumor and focal choroidal excavations (FCE), which were found in correspondence with tumor decalcification. Close follow-up is warranted in FCE, secondary to decalcification of CO, as CNVM has been documented to occur on the slope or bottom of eyes with FCE.

Effect of Brahmi vati and Sarpagandha Ghana vati in management of essential hypertension – A randomized, double blind, clinical study

Background: Essential hypertension (EHTN) is emerging as one of the most prevalent disorder with highrate of complications, morbidity and mortality. Brahmi vati, an Ayurvedic medicine is explored for itsefficacy in the management of EHTN.Objective: To evaluate the efficacy of Brahmi vati and sarpagandha Ghana vati in the management ofEHTN.Methods: Total 68 patients meeting the JNC 7 criteria of EHTN of age group 20 to 60 years of either sexparticipated in the study. They were randomly divided into two groups, group A received capsule Brahmi vati500 mg and group B capsule Sarpagandha Ghana vati 500 mg respectively twice a day for 30 days. Assessmentswere done through various variables like systolic blood pressure (SBP), diastolic blood pressure (DBP), meanarterial pressure (MAP), lipid profiles, Hamilton anxiety rating scale, 2 weeks sleep diary, serum creatinine,hemoglobin, total leukocyte count and erythrocyte sedimentation rate. Follow up visit was on every 15th day.Results: Study showed that both Brahmi vati and Sarpagandha Ghana vati produced improvement in mostof the variables and were comparable. Improvements were seen in various variables like SBP, DBP, MAP,Hamilton anxiety rating scale, subjective sleep profiles and total cholesterol. However Brahmi vatishowed increase in weight and Body Mass Index (BMI). Sarpagandha Ghana vati produced reduction intotal cholesterol and LDL. Both groups showed good safety profile evaluated through the assessment ofserum creatinine levels.Conclusion: Clinical efficacy of Sarpagandha Ghana vati and Brahmi vati on EHTN showed that both wereeffective, safe and comparable.© 2017 The Authors. Published by Elsevier B.V. on behalf of Institute of Transdisciplinary Health Sciencesand Technology and World Ayurveda Foundation. This is an open access article under the CC BY-NC-NDlicense (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Comparison of safety pattern of drugs used in chronic obstructive pulmonary disease patients in a tertiary care hospital

Background: As per GOLD (Global initiative for chronic obstructive lung disease) guidelines bronchodilators are required for symptomatic treatment of chronic obstructive pulmonary disease (COPD) patients. Currently there is no evidence to say about the safety of fixed dose combinations used in COPD patients. Since the drugs are to be taken for longer period, it is essential to know the safety aspects of these drugs. Moreover we don’t have adequate studies and documentation to say that a particular drug combination is better and safer for COPD patients.Methods: Prospective, open labelled, randomized, comparative, interventional clinical study conducted by the Departments of Pharmacology and Pulmonary Medicine of Basaveshwara Medical College and Hospital, Chitradurga in 40 COPD patients.Results: The fixed dose combinations of drugs used in both the treatment groups i.e. salmeterol/fluticasone and tiotropium/formoterol were equally safer and well tolerated. Some side effects noticed during the course of treatment were statistically significant when compared between the 2 groups, however they were milder and predictable adverse drug reactions.Conclusions: Systemic and severe adverse drug reactions were not observed during 8 week treatment period and the local side effects observed were mild in both the treatment groups. Hence the fixed dose combinations of salmeterol or fluticasone and tiotropium or formoterol are found to be safer for maintenance therapy in COPD patients.

Cardiovascular profile of patients with chronic kidney disease

Background: Frequency of fatal and nonfatal cardiovascular events increase even in early stages of chronic kidney disease (CKD). This study was aimed to understand the cardiovascular profile of patients with CKD.Methods: This observational study was conducted on patients who were admitted with chronic kidney disease in Sri Venkateswara Rama Narayan RUIA Government General Hospital, Tirupati. Patients were classified according to their severity of CKD. All patients had an electrocardiogram and echocardiogram. Results of various biochemical investigations, electrocardiogram and echocardiogram were compared between patients with mild, moderate and severe CKD.Results: Combined diabetes mellitus and hypertension was found to be the most common case of CKD in Authors patient population (43%), followed by diabetes mellitus alone (37%). Serum creatinine and blood urea nitrogen were found to be significantly higher and creatinine clearance and haemoglobin were significantly lower among patients with severe CKD. Electrocardiography revealed 50% had left ventricular hypertrophy (LVH), 30% had tall ‘T’ waves and 15 % had ST-segment changes. Mean inter-ventricular septal end diastole thickness and mean left ventricular mass was found to be significantly in patients with severe CKD as compared to mild CKD.Conclusions: Extensive cardiovascular evaluation of patients with CKD is warranted even if the classical symptoms are not absent and early cardiovascular rehabilitation should be instituted in such patients.

The comparison of apache II and apache IV score to predict mortality in intensive care unit in a tertiary care hospital

Background: The prognostication of critically ill patients, in a systematic way, based on definite objective data is an integral part of the quality of care in Intensive Care Unit (ICU). Acute physiology and chronic health evaluation (APACHE) scoring systems provide an objective means of mortality prediction in Intensive Care Unit (ICU). The aims of this study were to compare the performance of APACHE II and APACHE IV in predicting mortality in our intensive care unit (ICU).Methods: A prospective observational study was conducted in a 13 bedded intensive care unit (ICU) of a tertiary level teaching hospital. All the patients above the age of 12 years, irrespective of diagnosis managed in ICU for >24hours were enrolled. APACHE II and APACHE IV scores were calculated based on the worst values in the first 24hours of admission. All enrolled patients were followed up, and outcome was recorded as survivors or non survivors. Observed mortality rates were compared with predicted mortality rates for both the APACHE II and APACHE IV. Receiver operator characteristic curves (ROC) were used to compare accuracy of the two scores.Results: APACHE II score of the patients ranged from 1 to 32 and APACHE IV score of the patients ranged from 25 to 142. There was good correlation between APACHE II and APACHE IV scores with the spearman’s rho value of 0.776 (P<0.01). Discrimination for APACHE II and APACHE IV models were good with area under ROC curve of 0.805 and 0.832 respectively. APACHE IV was more accurate than APACHE II in this regard. The cut-off point with best Youden index for APACHE II was 17 and for APACHE IV were 72 respectively for predicting mortality.Conclusions: Discrimination was better for APACHE IV than APACHE II model however Calibration was better for APACHE II than APACHE IV model in present study. There was good correlation between the two models observed in present study.

Synthesis and characterization of novel 1,6-dihydropyrimidine derivatives for their pharmacological properties

The present research work involves the use of commercially available thiophene-2-carbaldehyde as a starting materialto construct novel pyrimidine compounds. Synthesis of pyrimidine derivatives has been done by the trimolecularBiginelli condensation reaction, which involves the use of thiophene-2-carbaldehyde with cyano ethylacetate andthiourea to yield 4-oxo-6-(thiophen-2-yl)-2-thioxo-1,2,3,4-tetrahydropyrimidine-5-carbonitrile (1). The intermediate 1was methylated using methyl iodide and K2CO3 in dimethylformamide (DMF) which afforded dimethylated derivative1-methyl-2-(methylthio)-6-oxo-4-(thiophen-2-yl)-1,6-dihydropyrimidine-5-carbonitrile (2). The intermediatecompound 2 when refluxed with hydrazine hydrate in ethanol as a solvent led to the formation of the parent compound2-hydrazineyl-1-methyl-6-oxo-4-(thiophen-2-yl)-1,6-dihydropyrimidine-5-carbonitrile (3), the parent compound 3was used for the synthesis of carboxamides of N′-(5-cyano-1-methyl-6-oxo-4-(thiophen-2-yl)-1,6-dihydropyrimidin2-yl)substituted benzohydrazide (4a–d) and Schiff bases of (E)-2-(2-substituted benzylidenehydrazineyl)-1-methyl6-oxo-4-(thiophen-2-yl)-1,6-dihydropyrimidine-5-carbonitrile (5a–g). Selected title compounds are screened forantibacterial, analgesic, and antifungal activities.

Drug utilization pattern in type II diabetes mellitus patients attending non-communicable disease clinic in a tertiary care hospital

Background: Diabetes mellitus is a metabolic disorder. Early institution of treatment is necessary to prevent complications. Since treatment of diabetes requires lifetime therapy; this study is designed to understand the prescription trends at Non Communicable Disease clinic set up and to provide rationale.Methods: This cross-sectional, observational study was conducted over a period of 2 months (May 2017- June 2017). Details of demographic data, duration and family history of diabetes, antidiabetic medications prescribed, history of comorbid diseases and drugs prescribed by physician for the treatment of comorbid diseases were collected in a structured format. Height and weight were recorded, and body mass index was calculated.Results: Study population included 294 patients and patients in the age groups of 40-59 years formed the bulk. 39% patients were overweight and 19.39% were obese. 93.20% patients were prescribed with metformin. 37 patients received insulin injection. 64.29% received more than one antidiabetic drug. Hypertension (82.05%) was the most common comorbid disease. Amlodipine was the most commonly prescribed antihypertensive drug.Conclusions: Metformin was the most commonly prescribed antidiabetic drug. Utilization of newer antidiabetic drug is inferior. Use of rationale fixed dose combination improves patient compliance.

Comparative study of two different doses of nalbuphine attenuating hemodynamic response to laryngoscopy and intubation in patients undergoing general anesthesia

Background: Various anaesthetic agents have been tried to attenuate pressor response to laryngoscopy and intubation. Among the recommended groups intravenous nalbuphine satisfies without much undesired effects. The objective was to study efficacy of two different doses of nalbuphine to attenuate pressor response to laryngoscopy and intubation.Methods: This was hospital based comparative study was carried out at Karnataka institute of Medical Sciences Hospital, Hubli, India. Patients were divided into two groups of 50 each randomly. First group was named as N1 and the second group was named as N2. Patients in N1 were given 0.1mg/kg Nalbuphine in 10ml of normal saline and patients in N2 were given 0.2-0.1mg/kg Nalbuphine in 10ml of normal saline. Appropriated statistical tests were applied like t test, ANOVA. P value if found less than 0.05 was recorded as statistically significant.Results: There was marked increase in HR, SBP, DBP and MAP immediately following laryngoscopy and intubation in the both the groups. Intravenous Nalbuphine given 5 minutes before intubation in the dose of 0.2mgkg-1 body weight effectively attenuated the hemodynamic response after laryngoscopy and intubation. However, there was a rise in HR, SBP, DBP and MAP immediately following intubation in group N2 which was clinically not significant though statistically significant. Side effects like nausea, vomiting, respiratory depression and sedation was not observed in both study groups.Conclusions: Authors concluded that 0.2mg/kg body weight dose of Nalbuphine was found to be more effective than 0.1mg/kg body weight dose of nalbuphine in maintaining the haemodynamics of the patients.