Management of Hypertension in Patients with Diabetes: A Comprehensive Review of the Perceptions and Practices of Health Care Providers in India

Objectives: This study evaluated the perception and practices of health care providers (physicians, diabetologists, and endocrinologists) regarding the treatment of hypertension in patients with diabetes in India. Methods: Health care providers throughout India who treated patients with diabetes and hypertension were invited to participate in an online survey and periodic 21 virtual meetings. They were questioned about their perception and practices in managing these patients, and strategies to improve blood pressure (BP). Results: The online survey was completed by 2,513 health care providers, and 344 participated in virtual meetings. More than 50% reported that 31–50% of their patients with diabetes also had hypertension. Home BP monitoring was recommended by 88%, and lifestyle modifications were consistently recommended. Choice of antihypertensive treatment varied based on comorbidities, and a renin–angiotensin system blocker plus a calcium channel blocker (CCB) was the most common combination for dual antihypertensive therapy. Suggested strategies to improve BP control included patient awareness/education, lifestyle modifications, better follow-up/monitoring, and optimization of therapy. Conclusion: Indian health care providers were aware of clinical recommendations and practices regarding treatment of patients with diabetes and hypertension, and generally make clinical decisions consistent with current guidelines. Optimization of care for these patients is essential to reduce cardiovascular disease risk and improve patient outcomes.

A randomized, double-blind, placebo-controlled trial of ormeloxifene in breast pain and nodularity.

Background. Breast pain and non-discrete breast nodularity are common in women. Methods. We did a randomized, double-blind, placebocontrolled trial of oral ormeloxifene 30 mg, a selective oestrogen receptor modulator (SERM) or placebo twice a week for 3 months in 20–50-year-old women with breast pain with or without lumpiness. Women with a discrete benign lump or cancer were excluded from the study. Serial assessments of pain on a visual analogue scale and nodularity grade on a 5-point ordinal Lucknow–Cardiff scale were done. A total of 151 patients were randomly allocated to two interventions using a block size of 4. Results. Of the 151 patients, 121 (active 57, placebo 64) were available for efficacy analysis. The mean pain level showed a systematic downward trend over five visits (F=105.23, p<0.0001) that significantly reduced in the active group compared to that in the placebo group (F=18.66, p<0.0001). The patterns of variation in pain over time for the individual groups differ from the overall mean pattern for the two groups and thus from one another (F=44.43, p<0.0001). Cumulative frequencies of breast nodularity grades during successive visits showed significant improvement (p=0.001) compared to placebo at the end of the third month. The effect of the active drug persisted till the completion (6 months) of treatment (p<0.001). At the last visit, 93.3% of women in the active group had grade 2 or lower nodularity as compared to 71.1% in the placebo group. Oligomenorrhoea alone was reported by 12 patients. Conclusion. Ormeloxifene showed significant efficacy for treating breast pain and nodularity.

End-of-life care of terminally ill geriatric cancer patients in northern India.

BACKGROUND: The geriatric population in India is increasing, and so is the prevalence of cancer. We aimed to study the knowledge, attitude and practices of end-of-life care issues of terminally ill geriatric cancer patients in our region. METHODS: A pilot cross-sectional qualitative study using case studies, focus group discussions on providers and recipients of palliative care, an open-ended, interviewer administered questionnaire on specialist doctors and practitioners (50), geriatric cancer patients (20) and healthy family members of patients (30), was done in Lucknow, the capital of Uttar Pradesh, India. RESULTS: Only 14 physicians (28%) could enumerate more than 3 important technical elements of end-of-life care. Two physicians (4%) utilized palliative care services but none had received training themselves. The explanations and counselling provided by physicians were mostly inadequate, incomplete and did not fully satisfy the patients and their relatives. Of the cancer patients, 19 (95%) desired to use special services but were unaware of such facilities. There was only one charitable organization for needy geriatric cancer patients in Lucknow. No specific health scheme existed in the programme of the Government of Uttar Pradesh. CONCLUSION: The knowledge and practices of physicians and specialists were not up to the expectations and requirements of terminally ill cancer patients. Curriculum-based learning or organized teaching of end-of-life care issues was non-existent. Western countries have well-organized subspecialty facilities for end-of-life needs; such facilities are lacking in India. Capacity building for the care of terminally ill geriatric cancer patients is urgently required in north India.

A Randomised Comparison of Oral and Vaginal Misoprostol for Medical Management of First Trimester Missed Abortion

The present study was done to compare the safety and efficacy of misoprostol administered orally and vaginally for medical management of first trimester missed abortion. 100 women with diagnosed missed abortion were taken for this prospective study. Group A comprised of 50 women who were given oral misoprostol and another 50 in-group B were administered vaginal misoprostol. Clinical outcome, time taken for expulsion, number of doses required, side effects and cervical permeability were compared in two groups. Eighty percent in group B and 36% in group A had successful clinical outcome (p=0.000008). 16.6% in group A and 22.5% in group B expelled with a single dose while 50% and 77.5% expelled with complete schedule. Mean duration of expulsion was significantly higher in group A as compared to group B. Nearly ninety percent of women in both groups had good cervical permeability. Side effects were more common in group A. Hence vaginal misoprostol was found to be more effective and safer as compared to oral misoprostol.

Hodgkins disease in relapse presenting as bone tumor.

A 10-year-old male child presented with multiple lymph node swellings. A diagnosis of Hodgkins disease was made on histopathological examination. The patient developed relapse six months after his last chemotherapy as a solitary bone tumor, which is rare. Immunohistochemical evaluation helped for the correct typing of Hodgkins disease.