Comparison of Efficacy of Oral and Intravenous Anti-Hypertensive Drugs in Eclampsia- A Randomized Trial.

Eclampsia increases the risk for both mother and foetus. The treatment aims to quickly bring about smooth reduction in blood pressure to levels that are safe for both, but avoiding any sudden drops, that may in themselves cause dizziness or foetal distress. Hence, this study was conducted to compare the efficacy of anti-hypertensive drugs in eclampsia.METHODS80 eclampsia patients were randomized into two groups: one received oral nifedipine and other intra-venous labetalol. Nifedipine group orally received 10 mg initially with repeated doses of 20 mg every 20 minutes up to maximum of 5 doses or until the therapeutic goal was reached. The other group received intravenous labetalol 20 mg initially followed by escalating doses of 40, 80, 80, and then 80 mg every 20 minutes until therapeutic goal was achieved or for a maximum of 5 doses. Once the therapeutic goal was reached, blood pressure was measured every 20 minutes till delivery.RESULTSMean time required to reach therapeutic blood pressure goal in nifedipine, and labetalol group was 45 ± 22.98 and 59.5 ± 25.41 minutes respectively. Total dose requirement was 1.65 ± 0.57 and 2.17 ± 0.74 mg respectively. The differences between two groups were significant. There was difference in urine output between the two groups as well. In the initial two hours, there was increased urine output in nifedipine group though it was statistically not significant. After two hours till 48 hours, this increased urine output in the nifedipine group was significant (p value 0.001).CONCLUSIONSnifedipine achieved the therapeutic blood pressure goal more rapidly than labetalol.

Psychiatric advance directives: cultural reflections.

The article by Sarin et alon the subject of psychiatric advance directives (PADs) raises new problems which are particularly challenging in the Indian context. The debate so far has focused on issues of competence, access, resources and legal dilemmas. What is missing is a discussion on the cultural aspects of mental healthcare for the Indian population.

Mental and Physical Morbidity in Oldage Homes of Lucknow, India.

Purpose: An exceptional increase in the number and proportion of ‘older adults’ in the country, rapid increase in nuclear families and contemporary changes in the psychosocial matrix and values often compel the elderly segment of society to live alone or in oldage homes. These and other factors make the older adults increasingly vulnerable to mental health problems and their undesirable effects. This study assesses mental health problems and associated morbidity amongst inhabitant of oldage homes in Lucknow, India. Methods: It is an exploratory study in which information about available oldage homes at Lucknow were obtained. Out of these, two oldage homes gave the permission to carry out the study. Survey Psychiatric Assessment Schedule, Mini Mental Status Examination, Mood Disorder Questionnaire, and Schedule for Clinical Assessment of Neuropsychiatric Disorder based clinical interviews were carried out. Results: More than half of the inhabitants of oldage homes were suffering from one or other mental health problems, depression being the most common one. The inhabitants suffering from psychiatric illnesses had one or more associated physical morbidity. Many either overtly or covertly tried avoiding giving details related to personal information.Conclusion: The present study was the first of its nature conducted in India to find the prevalence of mental health morbidity in the inhabitants of oldage homes. Findings reveal higher prevalence of mental health morbidity compared to the community prevalence. Future research may allow shedding light on the determinants of such findings.