A prospective study to assess the medication adherence pattern among hypertensives and to evaluate the use of cellular phone text messaging as a tool to improve adherence to medications in a tertiary health-care center.

AIM: The aim of the study was to assess improvement in adherence to medications using mobile phone text messaging (short message services [SMSs] and social media). OBJECTIVES: The objective was to assess the pattern of adherence to medication in hypertensives and to assess the improvement in adherence pattern to antihypertensive medications using mobile phone text messaging as a tool. METHODOLOGY: After obtaining informed consent, the study participants' blood pressure was recorded, and their adherence to medications was graded as high, medium, and low using the Medication Adherence Questionnaire. Then, messages in the form of either SMSs or WhatsApp were sent regularly (once every 3 days) reminding them of the importance of regular medicine intake. After 2 months of follow-up, again blood pressure was recorded and adherence graded. Data were tabulated and statistically analyzed. RESULTS: Majority of study participants in who were initially placed in medium to low grading of adherence (65.2%) moved toward high adherence (88.4%) at follow-up after receiving messages for 2 months. A statistically significant decrease was noted in systolic (8.3 mmHg,P < 0.001) and diastolic blood pressure (2.4 mmHg,P < 0.002) at the end of follow-up. CONCLUSION: Nonadherence to medication is a global phenomenon to be tackled at the earliest. Our study clearly brings out the importance of improving adherence by regular reminders as messages. Hence, there is a wide scope to avail means to improve the adherence pattern and maximize the health benefits.

Effect of oral vitamin D supplementation on glycemic control in patients with type 2 diabetes mellitus with coexisting hypovitaminosis D: A parellel group placebo controlled randomized controlled pilot study.

CONTEXT: Vitamin D supplementation in type 2 diabetes mellitus patients may lead to improved glycemic control by improving insulin secretion and decreasing insulin resistance. AIMS: To investigate effect of oral vitamin D supplementation on glycemic control, in patients with type 2 diabetes mellitus and coexisting hypovitaminosis D. SETTINGS AND DESIGN: Randomized, Parallel Group, Placebo Controlled Trial carried out in a tertiary care hospital of Indian Armed Forces. METHODS AND MATERIAL: Sixty patients with coexisting type 2 diabetes mellitus and hypovitaminosis D were randomized into cases and controls and were supplemented with oral Vitamin D and microcrystalline cellulose respectively for six months. Subjects' HbA1c and vitamin D levels were monitored at the beginning and end of the study, fasting plasma glucose (FPG) & post prandial plasma glucose (PPPG) during monthly OPD visits. STATISTICAL ANALYSIS USED: Intra-group comparison was made by paired t test & unpaired t test was used for inter-group (A v/s B) comparisons. Repeated measures ANOVA was undertaken to compare values over time. RESULTS: The two groups were comparable for all parameters at baseline. Case group showed significant decrease in mean HbA1c levels (7.29% to 7.02%; P = 0.01), mean FPG levels (131.4 to 102.6 mg/dl; P = 0.04) and mean PPPG levels (196.2 to 135.0 mg/dl; P < 0.001). Incidentally, significant improvement in systolic as well as diastolic blood pressure and total cholesterol was also noted in the cases, while for LDL cholesterol improvement tended towards significance (p = 0.05). CONCLUSIONS: We found that oral vitamin D supplementation was associated with improved glycemic control and other metabolic parameters in patients with type 2 diabetes mellitus. Supplementation to achieve normal levels of vitamin D can be a promising adjuvant therapy for T2DM patients & coexisting hypovitaminosis D.

Brittleness of diabetes due to achalasia cardia managed successfully by multiple innovative strategies.

Achalasia cardia is an infrequent disorder of esophageal dysmotility that has failure of the lower end of the esophagus to relax with swallowing as hallmark abnormality. Diabetes mellitus, on the other hand, can afflict the motor activity of gastrointestinal tract by causing autonomic neuropathy. Combination of these diseases can be very distressing to a patient. We present a 45-year-old lady co-affected with both these disorders who presented with severe hypoglycemia and was managed successfully using the multiple strategies to treat achalasia and diabetes.

Botulinum toxin for meralgia paresthetica in type 2 diabetes.

Botulinum toxin has been used for a variety of neuropathic conditions in diabetes mellitus. Meralgia paresthetica is a mononeuropathy of femoral nerve seen in diabetes and obesity with an unclear etiopathogenesis. We studied the role of botulinum toxin in resistant cases of meralgia paresthetica in type 2 diabetes.

Gitelman's syndrome with panhypopituitarism: Reno-endocrine interplay.

Gitelman's syndrome is an inherited tubulopathy affecting thiazide-sensitive sodium chloride cotransporter, which manifests with hypokalemic alkalosis, hypomagnesemia, and hypocalciuria. Recently few cases have been described having an association of Gitelman's syndrome with pituitary abnormalities on imaging, though with normal hormonal status. We describe the first case of an adult patient having Gitelman's syndrome and hypopituitarism with abnormal pituitary imaging. She presented to us with hypotension, hypokalemia, hypomagnesemia with alkalosis, hypothyroidism, hypocortisolism, and hypogonadism. She was treated with replacement of electrolytes and hormones, to which she showed an excellent response.

Simultaneous determination of multi drug components Theophylline, Etofylline, Guaiphenesine and Ambroxol Hydrochloride by validated RP-HPLC method in liquid dosage form.

The RP-HPLC (reverse phase high performance liquid chromatography) method was developed and validated for simultaneous determination of Multi drug components i.e., Theophylline, Etofylline, Guaiphenesine and Ambroxol Hydrochloride in a liquid dosage form. Chromatographic separation of the four drugs was performed on a Hypersil Phenyl BDS (25cmX4.6mm, 5mm). The mobile phase constituted of triethylamine pH 3.0 buffer: methanol (85:15) v/v was delivered at the flow rate 1.5 mL/min. Detection was performed at 235 nm. The peak purity of Theophylline, Etofylline, Guaiphenesine and Ambroxol Hydrochloride were 0.99970, 0.99979, 0.99986 and 0.99949 respectively. Calibration curves were linear with correlation coefficient between 0.99995 to 0.99997 over a concentration range of 5 to 37 microg/mL for Theophylline, 19 to 140 microg/mL for Etofylline, 20 to 149 microg/mL for Guaiphenesine and 6 to 45 microg/mL for Ambroxol hydrochloride. The relative standard deviation (RSD) was found < 2.0%. The percentage recovery was found between the range of 98.6% and 100.5% at three different levels. Robustness and ruggedness were performed and result found within the RSD of 2%. All the parameters of validation were found in the acceptance range of ICH guideline.

Lipid Profile In Transplant Patients: A Clinical Study.

15 renal transplant recipients were studied for their lipid profile. The patients were on regular post transplant follow up and had non clinical or laboratory evidence of graft dysfunction, intercurrent infection or post transplant diabetes mellitus for at least 3 months prior to the study. The mean duration of transplant was 15 ± 9.5 months (range 3-32 months). Majority (86%) were on triple immunosuppression therapy and received a mean prednisolone dose of 10.5 mg. An equal number of healthy subjects were randomly selected and studied for their lipid profile and served as control for the study group. There was no significant change in the HDL-cholesterol level as compared with controls. However, these patients showed a significantly higher LDL-cholesterol and total cholesterol levels. Further, a significant inverse correlation was observed between triglycerides and total cholesterol levels and transplant duration.

Beta2-glycoprotein I dependent anticardiolipin antibodies and lupus anticoagulant in patients with recurrent pregnancy loss.

AIM: The present study was aimed to define the incidence of antiphospholipid antibodies of different types lupus anticoagulant (LAC), venereal disease research laboratory test (VDRL) and Beta2-glycoprotein I dependent anticardiolipin antibodies Beta2 I aCL) in our cohort of population experiencing recurrent pregnancy loss (RPL) from Andhra Pradesh, South India. SETTING AND DESIGN: A referral case-control study at a tertiary centre over a period of 5 years. PARTICIPANTS: 150 couples experiencing 3 or more recurrent pregnancy losses with similar number of matched controls. MATERIAL AND METHODS: LAC activity was measured by the activated partial thromboplastin time (aPTT) according to the method of Proctor and Rapaport with relevant modifications. VDRL analysis was performed by the kit method supplied by Ranbaxy Diagnostics Limited and Beta2 Glycoprotein I dependent anticardiolipin antibodies were estimated by ELISA kit (ORGen Tech, GmbH, Germany) with human Beta2 Glycoprotein I as co-factor. STATISTICAL ANALYSIS: Statistical analysis was performed using Student's t test. RESULTS: LAC activity was found positive in 11 women (10.28%). The mean +/- SE Beta2 I aCL concentration in the study group was 14.53 (micro/ml) +/- 1.79 (range 0 to 90.4 micro/ml) which was higher than the control group with a mean +/- SE of 7.26 (micro/ml) +/- 0.40 (range 0 to 18 u/ml). The binding of the antibodies to the antigen was observed in 40.24% (n=33) of the cases compared to 6.09% (n=5) in controls. VDRL test was positive in 7(2.34%) individuals (3 couples and 1 male partner) and none among controls. CONCLUSIONS: The present study indicates the importance of antiphospholipid antibodies in women experiencing RPL and suggests the usefulness of screening for these antibodies as a mandatory routine for instituting efficient therapeutic regimens for a successful outcome of pregnancy.

Adenosine deaminase in cord blood as an immunoenzyme marker in low birth weight neonates.

Adenosine Deaminase (ADA) levels were estimated in cord blood of 30 neonates born with birth weight less than or equal to 2.5 kg and 30 neonates born with birth weight greater than 2.5 kg. The mean ADA levels in low birth weight (LBW) group was found to be 6.94 U/L and in normal birth weight group the mean ADA levels were 14.37 U/L which was statistically significant. Therefore ADA may be useful in assessing CMI status in low birth weight infants.

Ethylene dibromide poisoning with acute renal failure: first reported case with non-fatal outcome.

Ethylene-di-bromide is a popular fumigant. Delayed long-term effects of this chemical include carcinogenicity and genotoxicity in animals. Only a few cases of acute ethylene-di-bromide toxicity have been reported and all of them have resulted in a fatal outcome. We report the first case of ethylene-di-bromide poisoning presenting with acute renal failure and toxic hepatitis that was managed successfully.

Effect of handwashing agents on bacterial contamination.

In order to assess the effect of handwashing agents like soap and ash on the control of bacterial contamination, the study was carried out in two villages of Rajendranagar mandal of Rangareddy district, Andhra Pradesh. Twenty households belonging to high income group and twenty households belonging to low income group having 1-2 years age children were randomly selected for the study handwash samples. Before feeding the child handwash samples after washing with different agents were collected and analysed for bacterial contamination. The study revealed that use of soap or ash for washing hands before feeding the child reduced hand contamination significantly.

Effect of Lactobacillus supplementation on immune status of malnourished pre-school children.

The present study was undertaken to assess the effect of Lactobacillus supplementation on immune response of pre-school children. Thirty malnourished (grade I and grade II) pre-school (3-5 years old) children were selected for the study. These were further categorized into three groups 'A', 'B' and 'C', each group comprising of 10 individuals. Groups 'A' and 'B' were given lactobacillus supplementation 1.0 x 10(8) million viable spores/day/child and 2.0 x 10(8) million of viable spores/day/child for 90 days respectively. Group 'C' served as control. Serum adenosine deaminase (ADA) which is an important immuno enzyme marker for assessing lymphocyte function and proliferation was determined at different intervals. The results revealed that lactobacillus supplementation at level of 1.0 x 10(8) million viable spores/day/child for 15 days along with regular diet significantly improved the ADA levels of pre-school children indicating therapeutic value of lactobacillus as supplementation to malnourished pre-school children.

Effect of levamisole on the immune status of malnourished children.

Levamisole is known to enhance an impaired immune response. Its function as an immunostimulant was assessed in malnourished children. A total of 26 children suffering from severe protein-calorie malnutrition were selected for the study. Serum immunoglobulins were estimated in these subjects and to assess cell-mediated immunity, enumeration of T lymphocytes and the lymphocyte proliferative response were carried out. The results show an increase in the cell-mediated immunity response in the levamisole-treated group, thereby suggesting that levamisole may help to speed the recovery of malnourished children suffering from various infections.