Evaluation of losartan plus hydrochlorothiazide combination therapy against amlodipine monotherapy in patients of hypertension

Background: Microalbuminuria has been shown to predict cardiovascular disease (CVD) in patients with hypertension. Recently the FDC of losartan and hydrochlorothiazide (HCTZ) has been reported to be effective for achieving a target BP level and also improvement in cardiovascular prognosis. The present study was conducted to compare effect of losartan plus hydrochlorothiazide combination therapy and high dose amlodipine monotherapy on blood pressure and microalbuminuria.Methods: Total 184 patients with hypertension were randomly allocated to two groups. The patients in group 1 received Amlodipine 5 mg orally for first 4 weeks. The patients from group 2 received losartan 50 mg orally for first 4 weeks. Patients in group 1 were titrated to amlodipine 10 mg orally for next 4 weeks. The patients in group 2 were titrated to FDC of losartan (50 mg) plus HCTZ (12.5 mg) for next 4 weeks. Follow杣p visits were scheduled at 4 weeks and 8 weeks. Pulse rate, sSBP and sDBP were estimated at each follow杣p. Microalbuminuria was estimated at 8 weeks.Results: There was no significant difference in mean change in sSBP, sDBP and pulse rate between two treatment groups (p>0.05). There was greater reduction in microalbuminuria in group 2 patients (p<0.0001). The adverse effects such as flushing and lower extremity oedema were significantly more in amlodipine group (p<0.05).Conclusions: Losartan plus HCTZ has similar effect on BP, better safety profile and superior effect on microalbuminuria level reduction.

Observational study to assess demographic, clinical profile and outcome of acute kidney injury due to acute gastroenteritis during monsoon season

Background: Worldwide incidence and causes of acute kidney injury (AKI) are variable and even more in developed and developing countries. At least 80% of AKI in tropics is community acquired. Acute gastroenteritis (AGE) is a common problem in developing countries. Present study concentrates on AGE as cause of AKI during monsoon period. It presents in epidemic proportion during monsoon and is preventable with timely intervention.Methods: The study was carried out prospectively in tertiary care hospital in Mumbai during monsoon season of 2012 and 2013. AKI was staged as per AKIN criteria. Patients were treated for primary disease and AKI, initially conservatively and dialysis if indicated. Patients were followed during the hospital stay.Results: Two hundred and thirty patients had AKI due to infectious disease during monsoon. Incidence of AKI due to diarrhea was 23%, and affecting males predominantly in 4th decade. Diarrhea and vomiting were the most common presenting complaints. 32% patients required dialysis. Mortality rate was 3.8%.Conclusions: AKI secondary to AGE is common in tropics. Treatment of primary disease and hemodynamic optimization at the earliest helps to prevent AKI. Presents with less severe AKI and has better outcome. Multiorgan involvement and need for supportive lifesaving therapies were risk factors for AKI.

Determinants of Prakriti, the Human Constitution Types of Indian Traditional Medicine and its Correlation with Contemporary Science.

Background: Constitutional type of an individual or prakriti is the basic clinical denominator in Ayurveda, which defines physical, physiological, and psychological traits of an individual and is the template for individualized diet, lifestyle counseling, and treatment. The large number of phenotype description by prakriti determination is based on the knowledge and experience of the assessor, and hence subject to inherent variations and interpretations. Objective: In this study we have attempted to relate dominant prakriti attribute to body mass index (BMI) of individuals by assessing an acceptable tool to provide the quantitative measure to the currently qualitative ayurvedic prakriti determination. Materials and Methods: The study is cross sectional, multicentered, and prakriti assessment of a total of 3416 subjects was undertaken. Healthy male, nonsmoking, nonalcoholic volunteers between the age group of 20-30 were screened for their prakriti after obtaining written consent to participate in the study. The prakriti was determined on the phenotype description of ayurvedic texts and simultaneously by the use of a computer‑aided prakriti assessment tool. Kappa statistical analysis was employed to validate the prakriti assessment and Chi‑square, Cramer’s V test to determine the relatedness in the dominant prakriti to various attributes. Results: We found 80% concordance between ayurvedic physician and software in predicting the prakriti of an individual. The kappa value of 0.77 showed moderate agreement in prakriti assessment. We observed a significant correlations of dominant prakriti to place of birth and BMI with Chi‑square, P < 0.01 (Cramer’s V‑value of 0.156 and 0.368, respectively). Conclusion: The present study attempts to integrate knowledge of traditional ayurvedic concepts with the contemporary science. We have demonstrated analysis of prakriti classification and its association with BMI and place of birth with the implications to one of the ways for human classification.

Docosahexaenoic acid content is signifi cantly higher in ghrita prepared by traditional Ayurvedic method.

Background: Ghee (clarifi ed butter) also known as ghrita, has been utilized for thousands of years in Ayurveda. Ghee is mostly prepared by traditional method in Indian households or by direct cream method at industry level. Ayurvedic classics mention that ghrita made from cow milk is superior. However, there is no scientifi c comparison available on preparation methods and essential fatty acids content of ghrita. Objective: To investigate fatty acid composition of ghrita prepared by traditional/Ayurvedic method and commercial method (direct cream method). Materials and Methods: Fatty Acid Methyl Esters (FAME) extracted from ghrita samples were analysed on Gas Chromatography (GC) Shimadzu B using capillary column BPX70 (0.32 mm*60 m, ID of 0.25 mm). The fatty acids in the samples were identifi ed by comparing peaks with the external standard 68A (Nu-Chek-Prep, Inc.USA). Signifi cant differences between the experimental groups were assessed by analysis of variance. Results: Distribution of fatty acids was compared in ghrita samples prepared by traditional method and direct cream method which is commercially used. Saturated fatty acids were predominant in both the groups. Mono unsaturated fatty acids and poly unsaturated fatty acids were in the range of 17-18% and 3-6% respectively. DHA content was signifi cantly higher in ghee prepared by traditional method using curd starter fermentation. Conclusion: The fi ndings suggested that ghrita prepared by traditional ayurvedic methods contains higher amount of DHA; Omega-3 long-chain polyunsaturated fatty acids, which is a major component of retinal and brain tissues and remains important in prevention of various diseases.

Pulmonary Infection by Rapidly Growing Mycobacterium in an Immunocompetent Child.

Background: Pulmonary infections by rapidly growing mycobacteria are rare in immunocompetent children. Case characteristics: A 2-year-old boy with persistent right upper lobe pneumonia. Observation: Bronchoalveolar lavage culture demonstrated growth of Mycobacterium atocessus. Outcome: Complete resolution of disease with multidrug chemotherapy with imipenam, clarithromycin and amikacin. Message: Persistent upper lobe cavitory lesions can rarely be caused by rapidly growing mycobacteria.

Insights from Ayurveda for translational stem cell research.

Ayurveda, the traditional Indian system of medicine has given great emphasis to the promotion of health. Ayurveda therapies are based on restoration of body balance and nourishment of dhatus or tissues. Rasayana concept of Ayurveda explains tissue regeneration and cell renewal. The drugs and therapies explained as rasayana provide research opportunities for biology of regeneration. Specific rasayana stimulate and nourish respective dhatus. Interpretation of this description offers clues for specific differentiation of stem cells with appropriate extract. The preliminary experiments on Medhya drugs suggest neuronal stem cells differentiation. Authors highlight the potential of Ayurveda and its possible contributions in regenerative medicine. Authors propose a protocol based on integrative approach derived from Ayurveda concepts and current understanding of regenerative medicine. The advanced understanding about adult and embryonic stem cells along with concepts of regeneration in Ayurveda has immense potential in the development of regenerative medicine.

Analgesic efficacy of peritubal infiltration of ropivacaine versus ropivacaine and morphine in percutaneous nephrolithotomy under ultrasonic guidance

Percutaneous nephrolithotomy is a safe and effective endourologic procedure which is less morbid than open surgery. However, pain around a nephrostomy tube requires good post-operative analgesia. We hypothesize that infiltration of local anesthetic with opioid from the renal capsule to the skin around the nephrostomy tract under ultrasonic guidance would alleviate the postoperative pain for a long period. A total of 60 ASA physical status I to II patients were selected for a prospective randomized double-blind controlled study in percutaneous nephrolithotomy surgeries. Patients were divided into group R [n=30] and group RM [n=30]. Balanced general anesthesia was given. After completion of the surgical procedure, a 23-gauze spinal needle was inserted at 6 and 12 O'clock position under ultrasonic guidance up to renal capsule along the nephrostomy tube. A 10 ml drug solution was infiltrated in each tract while withdrawing from renal capsule to the skin. After extubation, the patient was shifted to the post-anesthesia care unit for 24 hours. Post-operative pain was assessed using the visual analog scale [VAS] and dynamic visual analog scale [DVAS] [during deep breathing and coughing] rating 0-10 for initial 24 hours. Rescue analgesia was given in the form of injection tramadol 1.0 mg/kg intravenously when VAS >/= 4 and maximum up to 400 mg in 24 hours. Time to 1[st] rescue analgesic, number of doses of tramadol and total consumption of tramadol required in initial 24 hours were noted. Patients were observed for any side effect and treated accordingly. Time to 1[st] rescue analgesic, i.e., duration of analgesia in group RM is more prolonged than group R [P=0.0004]. The number of doses of tramadol in 24 hours in group R were higher as compared to group RM [P=0.0003]. The total amount of tramadol in 24 hours in group R was more than in group RM [P=0.0013]. Side effects like nausea and vomiting and sedation were comparable in both the groups. Addition of morphine to ropivacaine for nephrostomy tract infiltration significantly prolonged the duration of post-operative analgesia and reduced the number of doses and total consumption of rescue analgesic in initial 24 hours in percutaneous nephrolithotomy surgery

analgesic efficacy of ultrasound-guided transversus abdominis plane block for retroperitoneoscopic donor nephrectomy: a randomized controlled study

Transversus abdominis plane [TAP] block is suitable for lower abdominal surgeries. Blind TAP block has many complications and uncertainty of its effects. Use of ultrasonography increases the safety and efficacy. This study was conducted to evaluate the analgesic efficacy of ultrasound [USG]-guided TAP block for retroperitoneoscopic donor nephrectomy [RDN]. In a prospective randomized double-blind study, 60 patients undergoing laparoscopic donor nephrectomy were randomly divided into two groups by closed envelope method. At the end of surgery, USG-guided TAP block was given to the patients of both the groups. Study group [group S] received inj. Bupivacaine [0.375%], whereas control group [group C] received normal saline. Inj. Tramadol [1 mg/kg] was given as rescue analgesic at visual analog scale [VAS] more than 3 in any group at rest or on movement. The analgesic efficacy was judged by VAS both at rest and on movement, time to first dose of rescue analgesic, cumulative dose of tramadol, sedation score, and nausea score, which were also noted at 30 min, 2, 4, 6, 12, 18, and 24 h postoperatively. Total tramadol consumption at 24 h was also assessed. Patients in group S had significantly lower VAS score, longer time to first dose of rescue analgesic [547.13 +/- 266.96 min vs. 49.17 +/- 24.95 min] and lower tramadol consumption [103.8 +/- 32.18 mg vs. 235.8 +/- 47.5 mg] in 24 h. The USG-guided TAP block is easy to perform and effective as a postoperative analgesic regimen in RDN, with opioids-sparing effect and without any complications

Microbiological Analysis of Sachet Drinking Water Marketed at Two Sites in Aliero; Kebbi State; Nigeria

Sachet drinking water; often called as 'pure water' is generally accepted safe for consumption. Ten brands of sachet water are mainly marketed at Kebbi State University of Science et Technology (KSUST) campus and Onion Market of Aliero (AOM). Seven of these are NAFDAC registered. Bacteriological analysis of 50 samples of each of the sachet drinking water samples was carried out to determine the potability of the sampled water. Standard conventional methods were employed for the detection of coliforms (viable count; presumptive coliform count by multiple tube method and confirm coliforms count) and other bacteria. Biochemical analysis as well as microscopic examination was performed for sediments and other debris and/or bacteria; protozoa and other fungal hyphae. Bacteriological analysis of the samples from both sites revealed the presence of pathogens (log 10cfu/ml) viz. Shigella spp. (3.41; 3.31); Salmonella spp. (2.10; 2.05); Staphylococcus aureus (5.04; 5.09); Streptococcus spp. (4.76; 4.80); Bacillus spp. (5.12; 5.10); E. coli (2.0; 1.93) and Yeasts (3.13; 4.00). Most of the sachet water brands fell below WHO drinking water standards and are therefore; of doubtful quality. Out of the ten brand samples tested; four samples showed the presence of contamination in the form of high number of coliforms and occurrence of intestinal pathogens.This indicates that the 'pure water' available in the University campus and Onion market are unfit for human consumption due to their inability to meet up with NAFDAC (2010) and WHO (2011) standard. Efforts need to be intensified in the monitoring of activities in this rapidly expanding industry with a view to raising standards

Tracheobronchomalacia Presenting as Infantile Wheeze.

We report six months old infant with a history of recurrent wheeze, admitted for foreign body aspiration like presentation, where fibreoptic bronchoscopy revealed the diagnosis of tracheobronchomalacia.

Lower airway anomalies in infants with laryngomalacia.

Objective. To study the prevalence of associated airway anomalies in infants presenting with moderate to severe laryngomalacia. Methods. Eighty three symptomatic infants with recurrent respiratory symptoms including wheeze and cough diagnosed as moderate to severe laryngomalacia based on their clinical and direct laryngoscopic findings were subjected to fiberoptic bronchoscopy (FOB) during the period March 2007 to February 2009 in the Department of Pulmonology, Institute of Child Health and Hospital for Children, Chennai, India. Analysis of the clinical features, radiological findings and associated lower airway anomalies by FOB was done. Results. Lower airway anomalies were demonstrated in 40 (48%) infants of the study population. Tracheomalacia was the most common lower airway anomaly 24(29%) followed by bronchomalacia 8(10%) and tracheobronchomalacia 6 (7%). (4:1:1). Conclusion. Infants with moderate and severe laryngomalacia should be evaluated with flexible fibreoptic bronchoscopy to rule out associated lower airway lesions.

Nattrassia mangiferae causing fungal keratitis.

We report a case of fungal keratitis caused by the coelomycetous fungus Nattrassia mangiferae in a 70 year old gentleman, agriculturist by occupation, with a history of injury to his right eye. The scraping showed narrow septate fungal hyphae on a KOH mount, isolation of a fast growing black mould, which demonstrated hyphae and arthroconidia of varying widths typical of the Scytalidium synanamorph (S. dimidiatum). The formation of the pycnidia, which at maturity, expressed conidia. The patient was started on topical itraconazole one hourly and topical atropine thrice a day. The patient was lost to follow up hence we are not able to comment on the final outcome of the patient.

Biochemical studies on hypoglycemic effect of Aavirai kudineer: a herbal formulation in alloxan diabetic rats.

Aavirai Kudineer (AK) is an herbal decoction of seven botanical drugs, cited in the Gunapadam; a Tamil Siddha medical text. The anti-diabetic efficacy of this formulation was evaluated using alloxan-induced diabetic and normal rats. Glucose tolerance was observed within 1 hr in AK-treated rats (10 ml/kg body ) as compared to control. A significant decrease in the severe hyperglycemia characteristic of alloxan diabetes was noted after 15 days of AK treatment. Further AK treatment reversed the elevated urea, creatinine, cholesterol and decreased protein values to near normal levels. Assay of glycogen content and chief carbohydrate-metabolizing enzymes, viz. hexokinase, glucose-6-phosphatase and fructose 1,6 diphosphatase in the liver of diabetic and AK-treated diabetic rats clearly ascertains the hypoglycemic efficacy of this formulation. The mode of action of this herbal formulation remains to be elucidated.