Azilsartan medoxomil: Angiotensin receptor blocker in the treatment of hypertension.

Hypertension is an important risk factor for cardiovascular and renal disease. It’s early detection and control is critically important as it is an important attributable cause of stroke, coronary artery disease, heart failure, atrial fibrillation and ESRD. Recent data indicates increasing prevalence of hypertension amongst various populations. This reflects the importance of having a variety of treatment options for the management of this condition. Angiotensin receptor blockers are highly effective at reducing blood pressure, have excellent tolerability and renoprotective properties, hence they remain a useful choice in the management of hypertension. Azilsartan medoxomil has recently been approved by the FDA for the oral treatment of hypertension making it the eighth Angiotensin receptor blocker to be approved for this indication.

Changing trends of services used as first contact by patients with mental health problems.

Background. In the past, traditional faith healers and practitioners of alternative medicine have often been reported to be the first source of contact for Indian patients with mental health problems. However, over the past few decades, this trend seems to be changing. Method. Using a semi-structured questionnaire, we assessed 200 new patients at a psychiatric outpatient service in a general hospital for the first service contact used by them for their mental health problems. Results. Psychiatrists, non-psychiatric physicians, traditional faith healers and practitioners of alternative medicine were the first service contact for 91 (45.5%), 88 (44%), 16 (8%) and 5 (2.5%) patients, respectively. Patients suffering from severe mental illnesses were more likely to choose a psychiatrist as the first contact, whereas those with neurotic, stress-related and organic mental disorders contacted a non-psychiatric physician. Conclusion. In the current scenario, psychiatrists and nonpsychiatric physicians serve as the first service contact for most patients with mental health problems in India, though traditional faith healers and practitioners of alternative medicine are contacted by a minority.

Patterns of various modes of delivery in relation to presence of different risk factors in term pregnant mothers--a case-control study.

A case-control study, was carried out, which aimed to determine whether a relation exists between risk factors present in mother and the mode of delivery i.e., outcome. Cases were those mothers who had one or more risk factors present during pregnancy (namely, short stature, malpresentation, antepartum haemorrhage, pre-eclamptic toxaemia/eclampsia, anaemia-haemoglobin less than 10 g/dl, twins, bad obstetric history, prolonged pregnancy, history of previous caesarean section and instrumental delivery, pregnancy associated with general diseases, prolonged difficult labour and RH-iso-immunisation). Controls were those mothers who did not have any of the above mentioned risk factors. Total of 250 cases and 250 controls were taken. Results showed that surgical and instrumental deliveries were strongly associated with presence of risk factors (odd's ratio: 5.94; attributable risks: 72%). Out of risk factors among cases, most common indication of caesarean section, was previous caesarean section followed by malpresentation, prolonged difficult labour and short statured mothers in descending order.

Role of hysteroscopy in infertile women.

The diagnostic accuracy and therapeutic value of hysteroscopy were evaluated in 32 infertile women aged 21-35 years who underwent the procedure as part of their infertility evaluation. In 19 cases (59.4%) visually recognisable abnormalities were detected on hysteroscopy. These included intra-uterine adhesion (25%), submucous fibroid (9.4%), endometrial atrophy (9.4%), uterine septum (6.1%) and muellerian fusion defect (6.1%). The results of hysterosalpingography corresponded with hysteroscopy in 56.2% cases with a false positive of 30.7% for hysterosalpingography over hysteroscopy, and a false negative of 52.6%. Adhesion, fibroid and uterine septum accurately diagnosed were treated under hysteroscopic visualisation in the same sitting.

Early neonatal morbidity and mortality in 'at-risk' and 'normal' term pregnancies.

It is a universally known fact that maternal well-being is related to neonatal health. This case-control study aims to assess the pattern and strength of association of neonatal morbidity and mortality (in first 7 days of life) in relation to the presence of obstetric & medical risk factors in the mother (indicating maternal ill-health). In 250 cases (at-risk pregnancies), 75 (30%) developed neonatal illnesses while 17 (6.8%) perinatal deaths occurred in first seven days. In the same number of controls (uncomplicated pregnancies) there were only two perinatal deaths and lesser number of newborns (45/250, 16.4%) developed neonatal diseases in the first 7 days. Perinatal deaths, (still births and early neonatal deaths), (OR = 9.05; AR = 88.2%) and neonatal illnesses (OR = 2.2 and AR = 45) were strongly associated with presence of maternal risk factors. This study supports the fact that 'at risk' pregnancies have highly significant chances of developing early (first 7 days) neonatal morbidity (p < 0.001) and mortality (p < 0.001). Still births also occurred significantly more (p < 0.005) in number among 'at risk' (cases) than normal term pregnancies (controls).

Towards a safer motherhood.

One hundred cases each, in induced and spontaneous labour, were analysed to compare which group could achieve safer motherhood. It was observed that induced group with controlled labour has many maternal and foetal advantages like undisturbed domestic arrangements, avoidance of fatigue of patients and her relations, short duration of labour and minimal exposure to stress of labour, lower incidence of caesarean section and minimised perinatal morbidity and mortality.

Role of screening tests for gestational carbohydrate intolerance.

A variety of tests are available to screen gestational diabetes mellitus but there is disagreement about the value of these tests in screening it. One hundred-pregnant patients were selected at random for sequential gestational carbohydrate intolerance test (GCIT) with the purpose of identifying gestational diabetes mellitus (GDM) at its earliest. Patients with values of GCIT above 120 mg% were advised to undergo glucose tolerance test (GTT). GCIT at random is a great strain on hospital resources. But GCIT can identify the patients who need a GTT for diagnosing GDM. In many cases of abnormal GCIT, GTT may be normal.

Taurodontism and pyramidal molars.

The present study was conducted to investigate the occurrence of taurodontism and pyramidal molars in Goa children, hitherto considered rare in Indians. Radiographs of 300 children of 9 to 13 years were evaluated. The criteria of Keene (1966) was used to designate taurodonts. Ten children showed taurodontism: involving mandibular second molars in eight cases, maxillary first molars in three cases; and pyramidal molars in three cases, four cases showed associated findings. Hypodontia of one to fourteen teeth was observed in all four cases. In addition one case showed thinning of maxillary central incisors, rotation of lateral incisors, impacted supernumerary and a canine and polydactyly of hands and feet. The condition does not appear rare in this population group.

Neural tubal defects in an east Delhi hospital.

A high incidence of congenital neural tube defects was suspected among the babies born in East Delhi. The hospital data of 30 months was reviewed to find out the incidence and to evaluate the prenatal diagnosis in these disorders. An incidence of 7/1000 births was found to be correct in all cases of anencephaly and hydrocephalus. However, spina bifida and encephalocele were missed in 25% of cases. All patients were diagnosed late during pregnancy mainly because of late booking. Early booking and a high index of suspicion are desirable for early prenatal diagnosis.

Perinatal mortality and morbidity in caesarean section.

The study was conducted on 350 babies born by caesarean section. There were 29 perinatal deaths among 350 births giving a gross perinatal mortality rate of 8.3 per 1000 live births. Corrected perinatal mortality rate was 7.1%. The stillbirth rate was 2%. It was high for cases of abruptio placentae, transverse lie and cord prolapse. Septicaemia was the commonest cause of perinatal death followed by asphyxia and prematurity. Birth weight played an important role in the survival of babies. There was no foetal loss among babies in weight group of 3501-4000 g. Perinatal morbidity was mainly due to asphyxia, septicaemia, prematurity and cord infection.