Advertising of Pre-Packaged Foods in India: A Qualitative Analysis

Objective: We examined the ‘nutrients of concern’ in pre-packaged food products that are commonly advertised, as per WHO standards and Nova Classification. Methods: This was a qualitative study, using a convenience sampling method, to identify advertisements of prepackaged food products. We also analyzed their content from information on the packets, and their compliance with applicable Indian laws. Results: We found that all the advertisements of the food products in this study did not provide important information about the amount of nutrients of concern i.e., total fat, sodium, and total sugars. These advertisements mostly targeted children, made health claims, and used endorsements of celebrities. All the food products were also found to be ultra-processed in nature and high in one or more nutrients of concern. Conclusion: Most of the advertisements are misleading, needing effective monitoring. Health warnings on the front-of- pack label and restrictions on marketing of such food products may go a long way in reducing non-communicable diseases.

A Case for Horizontal Distribution of Activities between General Surgery and Surgical Super Specialties

Under the current practice in organizing surgical services, proportionate representation of disciplines is provided in the curricular planning and in corresponding clinical functions. This is based on the level of competence expected by the end of training period. The disciplines as a “whole” are placed in general surgery or super specialty. The system of vertical arrangement has some serious concerns. Paradoxically, patients with diseases of simple and routine nature of discipline categorized as super specialty are neglected. Super specialist is unable to attend on account of preoccupation with serious challenging problems. The general surgeon hesitates because of privileging issues, fear of allegations of negligence and litigation. The system of vertical division is based on premise that some disciplines deal with complex procedures and others with only simple and routine nature. This premise is incorrect. Each discipline is a mix of simple and complex cases requiring specialized treatment. Alternate modified organization of surgical service is proposed. Activities of all disciplines are scrutinized according to the level of expected competence by the end of training. Categorization is shifted from the “discipline' to “activities.” Criteria applied for classification of activities are as follows: on completion, the trainee is capable to assume full responsibility-category 1; has gained sufficient experience-category 2; and is conversant with broad understanding of management-category 3. Activities of category 1 from all disciplines are assigned to general surgery and those of category 3 from all disciplines are assigned to respective super specialty. Those in the middle, comprising difficult cases but not requiring specialized training or heavy inputs in equipment, are in category 2. They are assigned to general surgery as additional/optional items, or super specialty, guided by local factors. The scope and practice of general surgery are broadened with a shift from “residual” to “comprehensive” discipline. Advantages, concerns, collateral issues of horizontal distribution of activities, its positive impact on research and education are discussed. It is concluded that the proposed organization of surgical services is a rational, logical, and practical strategy for good-quality surgical care in the society. The super specialists need to be convinced that “taking load off” is good for the specialty.

Role of computed tomography angiography in the evaluation of haemoptysis in children: Decoding the abnormal vessels

Background & objectives: Haemoptysis in children is potentially life-threatening. In most cases, the bleeding arises from the systemic circulation, and in 5-10 per cent of cases, it arises from the pulmonary circulation. The role of computed tomography angiography (CTA) in this setting is important. This study was undertaken (i) to study the role of single-phase split-bolus dual energy contrast-enhanced multidetector row CTA (DECTA) in the evaluation of haemoptysis in children; (ii) to analyze the patterns of abnormal vascular supply in the various aetiologies encountered. Methods: A retrospective study of 86 patients who underwent split bolus DECTA for the evaluation of haemoptysis was performed. Final diagnoses were categorized as normal computed tomography, active tuberculosis (TB), post-infectious sequelae, non-TB active infection, cystic fibrosis (CF), non-CF bronchiectasis, congenital heart disease (CHD), interstitial lung disease, vasculitis, pulmonary thromboembolism and idiopathic pulmonary haemosiderosis. Abnormal bronchial arteries (BAs) and non-bronchial systemic collateral arteries (NBSCs) were assessed for number and site and their correlation with underlying aetiologies. Results: A total of 86 patients (45 males, age from 0.3 to 18 yr, mean 13.88 yr) were included in the study; among these only two patients were less than five years of age. The most common cause of haemoptysis was active infection (n=30), followed by bronchiectasis (n=18), post-infectious sequelae (n=17) and CHD (n=7). One hundred and sixty five abnormal arteries were identified (108 BA and 57 NBSC), and were more marked in bronchiectasis group. Interpretation & conclusions: Active infections and bronchiectasis are the most common causes of haemoptysis in children. While post-infectious sequelae are less common, in patients with haemoptysis, the presence of any abnormal arteries correlates with a more frequent diagnosis of bronchiectasis. NBSCs are more common in post-infectious sequelae and CHD

A Prospective Study on Mycology of Eye Infection in a Tertiary Care Teaching Hospital

Background: Objectives: Fungi are commonly found in the environment and most of them are either commensals or nonpathogenic. Eye infections are caused by bacteria, viruses and less commonly by fungi, therefore not given much attention by the practitioners and also by ophthalmolog ists. In the last one - decade incidence of fungal eye infections has increased due to increase in the number of patients with poor immunity. Common conditions which impair the immunity are prolonged use of steroids and antibacterial broad - spectrum antibioti cs, use of immunosuppressive drugs in cancer patients, in patients with organ transplant and some infections like AIDS. Candida, Fusarium and Aspergillus are the fungi frequently found to be associated with fungal eye infections. Trauma is the most signifi cant predisposing factor particularly when accompanied by contamination with vegetable matter. Methods: Samples such as corneal scrapings, Conjunctival swab, Vitreous & Aqueous aspirates were collected aseptically and sent to microbiology laboratory for KO H wet mount examination and fungal culture. KOH preparation was examined directly under microscope and culture were done on SDA, incubated at 25° c for three weeks. Results: Males were more commonly infected (66.5%) as compared to females (33.5%) The overall positivity in direct microscopy ( KOH preparation) was 32% while positivity in culture was 51%.The most frequently isolated fungus was Fusarium (16) followed by A. flavus ( 07), A. fumigatus (06), Candida sp.(06) and Curvalaria (03) Conclusion: If medical therapy fails to control the infection, surgery should be considered to save the eye visual function before the progression of disease.

A Prospective Study to Improve the Yield of Esophagogastroduodenoscopy at a Tertiary Hospital in India

Background: Esophagogastroduodenoscopy (EGD)is an efficient tool for diagnosis, screening and therapy. However, it must be used efficiently, to maximize value for costs and reduce complications. Many centers have adopted an open-access referral policy, resulting in increased costs, waiting times and clinical workload. When EGD is used for screening of common symptoms like dyspepsia by medical and paramedical personnel, the yield is less than 50%.We planned a study to differentiate disease from non-diseased findings and improve the diagnostic yield of EGD. Methods: The clinical history and examination of 150 patients of a tertiary care hospital in north India over 2 years wasrecorded. EGD when indicated by any clinician or desired by a patient was performed by a consultant, using topical anaesthesia.The outcome of the endoscopy was categorized as positive, if there was significant finding. Less severe and equivocal findings such as gastritis, duodenitis were not considered positive for the purpose of this study. Logistic regression (forward LR score) was used; the coefficient of regressionwas used to assign a score for each symptom. Results: Pain was the most common symptom; in 110 patients (77.3%) the endoscopy showed no significant findings. Significant findings were seen in 34 patients giving a diagnostic yield of 22.7%. Clinical features like weight loss, hematemesis, melena, dysphagia, anemia, abdominal distention, ascites, and abdominal lump significantly discriminated and pointed towards a positive endoscopic finding. Pain was not a good discriminating factor; dysphagia, presence of ascites and the presence of abdominal lump independently predict significant endoscopic findings. At a total score of 4 or less endoscopy could be avoided in 75 (50%) of the patients. A score of 5 yielded a sensitivity of 82% and specificity of 71%. For picking up a positive finding. All 11 patients with malignancy had a score >5. Conclusions: Our findings suggest selection of patients for EGD can be improved based on a scoring system. It also provides a basis for prospective studies which can lead to better use of resources in future.

Comparing the efficacy of nano crystalline silver dressing versus betadine dressing in management of diabetic foot ulcer

Background: The incidence of diabetes and its complications is rising as a result of the lifestyle changes. The foot is most frequent site for complication in patients with diabetes. Dressings have a vital part to play in the management of wounds. The ideal antiseptic is one that is lethal to all forms of bacteria, has no deleterious effect on healing tissues, delineates the operative areas, easily applied and has wide spectrum of activity and absence of acquired bacterial resistance. Nanotechnology makes it possible to expand the surface area of silver particles markedly to nanoscale. They expand the surface area of silver particles increasing their contact with bacteria.Methods: In the proposed study, over a period of 18 months, 60 cases (30-30 in 2 groups) of diabetic foot ulcers were studied with respect to response (healing) to nano silver dressing and betadine dressing after dividing them randomly. Assessment was based on various parameters like size reduction, healthy granulation tissue, etc.Results: It was seen that percentage reduction in size, was more in nano silver group as compared to betadine group. Wounds were managed successfully, early in nano silver group and wound healing was better in nano silver group as compared to betadine group. Also, nano silver was better antimicrobial.Conclusions: The prospective study showed nano silver gel is safe and effective in wound management and gives better efficacy and faster response as compared to traditional betadine dressing.

Diagnosis of Non-Neoplastic Haematological Disorders using Bone Marrow Aspiration and Trephine Biopsy

Introduction: Proper diagnosis of various hematologicaland non-hematological disorders is important in the fieldof haematology. Bone marrow examination is consideredas valuable diagnostic tool for evaluation and diagnosis ofvarious hematological and non-hematological disorders.Therefore present study aimed to diagnose non-neoplastichaematological disease through bone marrow aspiration orbiopsy and also to explain the prognosis of different diseases.Material and method: Present study was conducted indepartment of pathology, GSVM Medical College, Kanpur,on 30 patients suffering from chronic haematological disease.The relevant history of patients was recorded and informedconsent was taken. Patients were investigated for completeblood count, coagulation profile, reticulocyte count andperipheral blood film (PBF) examination. Bone marrowaspiration and Bone marrow biopsy were done under asepticprecautions.Results: Out of 30 cases, 11 (36.66%) are having nonneoplastic haematological diseases and most common diseaseis iron deficiency anaemia. In iron deficiency and megaloblasticanaemia, bone marrow aspiration findings are more useful anddiagnostic. In aplastic anaemia, final conclusive diagnosis wasmade by bone marrow biopsy.Conclusion: In some haematological disease, Bone marrowaspiration study alone fails to demonstrate disease processes,therefore trephine biopsy is essential. Hypocellular marrow,unexplained pancytopenias and marrow fibrosis are alsostrong indications for Bone marrow biopsy.

Skilled Counseling in Enhancing Early and Exclusive Breastfeeding Rates: An Experimental Study in an Urban Population in India

Objectives: The study was conducted to evaluate the effect ofbreastfeeding counseling and breastfeeding support by trainedcounselors during the ante-natal period at health facility and post-natal period at home on breastfeeding practices during the first sixmonths of life.Design: This was a randomized controlled study that comparedthe effect of counseling on breastfeeding during the first 6 monthsof life.Setting: study was done in a government medical college innorthern India, which is situated in an urban area.Participants: 300 healthy pregnant women from an urbanpopulation attending the antenatal clinic at Jawaharlal NehruMedical College, Aligarh Muslim University were recruited for thestudy.Intervention: Subjects were equally assigned randomly to theintervention (2 antenatal and 8 postpartum home counseling visitsby the counselors) and control (non-counseling) group.Main Outcome Measures: Infant feeding practices includingrates of initiation of the breastfeeding within one hour of birth;exclusive breastfeeding and bottle-feeding during the first 6months of life.Results: Initiation of breastfeeding within one hour of birth was73.4% in intervention group as compared to 33.6% in controlgroup (P=0.001). More mothers in the intervention group (88.1%)were able to sustain exclusive breastfeeding rates at 6 months ofage in comparison to the control group (50%) (OR 7.44, 95% CI3.98-13.92).Conclusions: This study substantiates positive role of skilledcounseling by a trained dedicated breastfeeding counselorduring the antenatal and post-natal periods on breastfeedingpractices during the first six months of life.

Efficacy Of Panchkarma Treatment In Ankylosing Spondylitis- A Case Study

Ankylosing spondylitis is a chronic inflammatory disease primarily affecting the spine and sacroiliac joint. Many patients are suffering from this disease from a long time but do not find any authentic treatment. This case illustrates the potential of ayurvedic medications and panchkarma therapies in the management of ankylosing spondylitis. A48 year old man consulted in OPD of CBPACS, with complaints of gradually progressive lowerback pain alongwith stiffness in neck, unable to move neck and rolling himself on the bed & prediagnosed case of ankylosing spondylitis. Treatment was done with ayurvedic medications and panchkarma procedures in two phases. In 1st phase Abhyang, Patrapindpottalisvedana and Nadisvedan for 15 days, in 2nd phase Greevabasti, Patrapindpottalisvedana and Sarvang Vashpasveda were given for 18 days. According to BASFI patient got 30% functional improvement and 16.66% anatomical improvement after first phase and 45% functional improvement and 38.88 % anatomical improvement after second phase treatment

Management Of Sciatica Through Ayurveda: A Case Study

In India low back ache is one of the most common emerging diseases which are affecting day to day life of people physically as well as psychologically. Low back ache is the second most common disorder causing disability. Among its various causes the most commonly appearing one is Sciatica. Sciatica is a condition in which pain starts from low back and radiates to leg mostly unilateral but in some, it may be bilateral also. In Ayurvedic perspective its features resemble to those of Gridhrasi. In Ayurvedic classics two types of Gridhrasi have been described namely Vataja and Vata-kaphaja. The case study being presented is of a 44yr old male patient suffering from Vataja gridharsi. Basti karma is the choice of treatment in cases of Gridhrasi where as Snehana/ Snigdha svedana is choice of treatment for any Vataja disorder. So, Panchakarma therapy in this case includes Patrapindasveda, Sarvang vashpasveda and Basti therapy along with oral medication assessed on the basis of Oswestry disability index. The results indicate that the patient improved in presenting features up to 68.75% as well as day to day activities were also performed effectively by him.

Evaluation of antioxidant, immunostimulatory and antifatigue properties of Dashmularishta using in vitro and in vivo assays

Dashmularishta is an Ayurvedic formulation used widely as a health tonic. Since the mode of action of Dashmularishta has not been explored much in detail so far, we investigated its potential effects on antioxidant, antifatigue and immunostimulatory properties using in vitro as well as in vivo assays. The antioxidant potential was assessed by free radical scavenging (ABTS based) assay. Antifatigue potential was elucidated by DNA super coiling assay and swim endurance test model. Immunostimulatory effect on Natural Killer (NK) cells activity was evaluated using mouse splenocytes and YAC-1 based assay. Dashmularishta exhibited in vitro antioxidant and antifatigue potential and in vivo anti-fatigue properties in Swiss albino mice. Further, it also enhanced the in vitro NK cells activity at noncytotoxic concentrations.

Feasibility study of a novel intraosseous device in adult human cadavers.

Background & objectives: Intraosseous (IO) access is an alternative to difficult intravenous (iv) access during emergency clinical situations. Existing IO solutions are expensive, require power supply and trained manpower; limiting their use in resource constrained settings. To address these limitations, a novel IO device has been developed. The objectives of this study were to evaluate functionality and safety of this device in adult human cadavers. Methods: The ability of the IO device to penetrate the proximal and/or distal tibia was evaluated in three adult cadavers. Subjective parameters of loss of resistance, stable needle hold, easy needle withdrawal and any damage to the device were evaluated during the study. The insertion time was the objective parameter measured. Four sets of radiographs per insertion confirmed the position of the needle and identified complications. Results: A single physician performed 12 IO access procedures using the same device. Penetration of proximal and/or distal tibia was achieved in all instances. It was successful in the first attempt in eight (66.7%) and during second attempt in the remaining. The mean time to insertion was 4.1 ± 3.1 sec. Appropriate insertion of needle in the intra-medullary space of bone was confirmed with radiological examination in 10 (83.3%) insertions. In two occasions after penetrating the cortical layer of bone, the device overshot the intra-medullary space, as detected by radiological examination. Device got bent during insertion in one instance. There was no evidence of needle breakage or bone fracture. The needle could be withdrawn effortlessly in all instances. Interpretation & conclusions: The novel IO device could successfully penetrate the adult cadaver bones in most cases. Further studies are needed to confirm these results on a large sample.

Sustainable Management of Keratin Waste Biomass: Applications and Future Perspectives

Keratin is a durable, fibrous protein which is mainly present in higher vertebrates (mammals, birds and reptiles) and humans epithelial cells. Food industry especially the meat market, slaughter house and wool industry produces million of tons of keratin containing biomass. These industries are constantly growing and the major producers include USA, Brazil and China, account for more than 40 million tons per year. These proteins constitute keratin by-products have from 15 to 18% nitrogen, 2-5% sulphur, 3.20% mineral elements and 1.27% fat and 90% of proteins. The organic waste rich in keratin can be utilized as a natural source using chemical and mechanical methods. The natural keratin obtained by biomass does not contain any harmful chemical and can be used directly to produce variety of cosmetics, creams, shampoos, hair conditioners and biomedical products. The natural protein is more compatible to use or apply on human skin and hairs. The monomeric units of natural keratin can penetrate in the skin and hair cuticle and able to nourish the skin without any side effects. In the present review various strategies for the purification and separation of keratin from the organic waste have been described and use of natural keratin in cosmetics and pharmaceutical industry has also been explored.

Conflict of interest in public health: should there be a law to prevent it.

“Conflict of interest”, now being commonly cited, is a set of circumstances that creates a risk that professional judgement or actions regarding a primary interest will be unduly influenced by a secondary interest. Conflict of interest situations can be institutional or personal, and can stem from financial or other interests including post-employment opportunities or during public -private partnerships. Conflicts of interest in the creation of public policy, especially health or nutrition related policies such as the vaccine policy, tobacco control, and research related to health, can have negative impact on the lives of millions of people. While the UN Convention Against Corruption, to which India is a signatory, identifies conflict of interest as often being a precursor to corruption, there is no serious action being taken in this direction by the Indian government, in spite of the fact there are instances of serious nature coming to light that affect our peoples lives. If conflict of interest situations are allowed to continue especially in health policy it could be detrimental to millions of people; therefore, it would be in public interest that India enacts a law to prevent conflict of interest in the making of public policies, comprehensive enough to include financial and institutional conflicts of interest.

Evaluation of immunostimulatory activity of Chyawanprash using in vitro assays.

Chyawanprash is an ayurvedic formulation used in Indian traditional medicinal system for its beneficial effect on human health. We investigated the immunostimulatory effects of Chyawanprash (CHY) using in vitro assays evaluating the secretion of cytokines such as Tumor Necrosis Factor-alpha (TNF-α), Interleukin-1beta (IL-1β) and Macrophage Inflammatory Protein-1-alpha (MIP-1-α) from murine bone marrow derived Dendritic Cells (DC) which play pivotal role in immunostimulation. The effects of CHY on phagocytosis in murine macrophages (RAW264.7) and Natural Killer (NK) cell activity were also investigated. At non-cytotoxic concentrations (20–500 µg/ml), CHY enhanced the secretion of all the three cytokines from DC. CHY also stimulated both, macrophage (RAW264.7) as well as NK cell activity, in vitro. In conclusion, the data substantiates the immunoprotective role of CHY at cellular level mediated by immunostimulation in key immune cells viz. dendritic Cells, macrophages and NK cells.

Transarterial chemoembolization in unresectable hepatocellular carcinoma with portal vein thrombosis: a perspective on survival

Portal vein thrombosis is considered a relative contraindication for transarterial chemoembolization [TACE] in hepatocellular carcinoma. The purpose of our study was to evaluate the efficacy of TACE treatment in patients with hepatocellular carcinoma with portal vein [PV] thrombosis. From April 2011 to June 2013, 17 patients with unresectable hepatocellular carcinoma with PV thrombosis were studied. Patients were assessed for tumor response by imaging at regular intervals and the data compared with the baseline laboratory and imaging characteristics obtained before treatment. Univariate analysis was used to assess the treatments impact on patient survival. Survival analysis was performed using Kaplan-Meier estimations. Overall survival rates at three, six and 12 months were 82%, 71%, and 47%, respectively, with a median of 10 months. Patients in Child-Pugh class A had a median survival of 15 months compared to five months for those patients in Child-Pugh class B. The median survival period of patients responsive to treatment was 13 months while that of non-responders was five months. Patients with ascites at the time of presentation had median survival period of six months while those who did not had a median survival period of 13 months. In univariate analysis, response to chemoembolization [p < 0.001], ascites [p < 0.050] and Child-Pugh class at diagnosis [p < 0.050] were found to be significant prognostic factors. TACE is a promising procedure in unresectable hepatocellular carcinoma with PV thrombosis. Response to chemoembolization, ascites and Child-Pugh class were the most important determining factors of survival

Manejo anestésico de un paciente hemofílico con trombofilia / Anaesthetic management of a haemophiliac patient with thrombophilia

Haemophiliac patient are known to have increased mortality and morbidity in the past due to previous non existence of practice of blood banking. Mainly morbidity increased due to the complications arises such as recurrent bleeding episodes, painful haemarthroses and permanent disability secondary to ankylosed joints. This case enlightens the role and impact of undetected changes in Hemophilia A patient with Buerger’s disease, highlighting the importance of vigilance on the part of the anesthesiologist, who must ensure the adequacy of hemostatic monitoring in these patients. The clinical presentation of Haemophilia A disease with Buerger’s disease is a rare entity and can be challangeable for practicing anaesthesiology.

En el pasado, los pacientes hemofílicos han tenido una mortalidad y morbilidad aumentada debido a la inexistencia de los bancos de sangre. La morbilidadaumentada está dada principalmente porlas complicaciones como episodios de sangrados recurrentes, hemartrosis dolorosas y discapacidad permanente secundaria a articulaciones anquilosadas. Este caso ilustra el rol y el impacto de los cambios no detectados en un paciente con hemofilia A que cursa también con enfermedadde Buerger, lo que enfatiza la importancia de la vigilancia por parte del anestesiólogo quien debe garantizar una monitoría adecuada de la hemostasia en estos pacientes. La aparición clínica de un caso de hemofilia A asociado a la enfermedad de Buerger es muy infrecuente y es un reto parael anestesiólogo.

Atenuación de la respuesta presora a la laringoscopia e intubación entre diltiazem y esmolol en pacientes hipertensos controlados / Attenuation of the pressor response to laryngoscopy and tracheal intubation with intravenous diltiazem and esmolol intravenous in controlled hypertensive surgical patients

Introduction. Tachycardia and hypertension are well documented sequels of laryngoscopy and endotracheal intubation which is transient, highly variable and is generally well tolerated in healthy patients. In hypertensive patients, cardiovascular response to laryngoscopy and intubation is exaggerated. The aim of this study intended to find a better alternative by comparision amongst diltiazem and esmolol to attenuate the pressor response to laryngoscopy and intubation in Kasmiri Population. Materials & Methods. Randomized placebo controlled double blind study. One hundred fifty hypertensive patients of both sexes (ASA II), controlled on antihypertensive drugs, between age hinrange of 40-60 years scheduled for routine surgical procedures were divided into 3 groups Group A (10 ml of 5 % Dextrose), Group B (Diltiazem 0.2 mg/Kg) and Group C (Esmolol 1.5 mg/Kg). Baseline parameters, i.e. heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and rate pressure product were noted at baseline level, at 1 min., 3min. and 5min after tracheal intubation. Results. Both Esmolol and Diltiazem showed statistically significant attenuation of rise in systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and rate pressure product when compared to control. However Diltiazem failed to attenuate rise in heart rate. Conclusions. We conclude that Esmolol is a very effective agent in attenuating the pressor response to laryngoscopy and intubation in controlled hypertensive patients.

Introducción. La taquicardia e hipertensión son efectos bien documentados de la laringoscopia e intubación orotraqueal que son transitorios, muy variables y generalmente bien toleradas en los pacientes sanos. Sin embargo, en los pacientes hipertensos, la respuesta cardíaca a la laringoscopia e intubación es exagerada. El objetivo de este estudio es encontrar la mejor alternativa entre diltiazem y esmolol para atenuar la respuesta presora a la laringoscopia e intubación en una población de Cachemira. Materiales y métodos. Estudio aleatorizado controlado doble ciego. Ciento cincuenta pacientes hipertensos de ambos sexos (ASA II), controlados con drogas antihipertensivas con edades entre los 40 y 60 años programados para cirugías rutinarias fueron divididos en tres grupos, grupo A (10 ml de dextrosa al 5 %), grupo B (diltiazem 0,2 mg por kilo), y grupo C (esmolol 1,5 mg por kilo). Los parámetros de base como frecuencia cardíaca, presión arterial sistólica, presión arterial diastólica, presión arterial media y doble producto, fueron anotados al inicio al minuto 1 al minuto 3 y al minuto 5 después de la intubación traqueal. Resultados. Tanto el esmolol como el diltiazem demostraron atenuación estadísticamente significativa de la presión arterial sistólica, diastólica y media, y del doble producto, cuando se compararon al control. Sin embargo el diltiazem no pudo evitar un aumento de la frecuencia cardíaca. Conclusiones. Concluimos que el esmolol es un agente muy efectivo para atenuar la respuesta presora a la laringoscopia e intubación en pacientes hipertensos controlados.