Effect of α-blockers on Handgrip Test Response of Diastolic Blood Pressure in Hypertensive, Benign Hypertrophy of Prostate Patients in a Therapeutics Clinic, Kolkata: A Cross-sectional Study.

BACKGROUND: The isometric handgrip (IHG) test is commonly used to detect sympathetic autonomic dysfunction. Tamsulosin, approved for the management of symptomatic benign prostatic hyperplasia (BPH), acts as an antagonist for α1-adrenergic receptors (α1-AR), whereas prazosin, an α1 receptor blocker, being less selective than tamsulosin, is used as an antihypertensive agent clinically. Our objective was to investigate if there is a distinction in blood pressure (BP) increase during IHG exercise between individuals with essential hypertension taking tamsulosin compared to those taking prazosin. MATERIALS AND METHODS: A cross-sectional observational study was performed on 50 subjects receiving tablet prazosin and 47 subjects receiving tamsulosin, who were asked to undergo an IHG test. Pre- and posttest BP was recorded for both the groups, and the difference in diastolic BP (DBP) (delta DBP) was compared between the groups and to their respective baseline values. RESULTS: Post-IHG test, mean DBP was found to be 93.98 ± 9.13 mm Hg in the prazosin group and 101.00 ± 12.05 mm Hg in the tamsulosin group, respectively. The change of delta DBP in the tamsulosin group was significant, but the prazosin group showed an insignificant rise in DBP. CONCLUSION: Prazosin, being less selective than tamsulosin in terms of α1 receptor antagonism, showed suppression of BP during IHG. Tamsulosin demonstrates high selectivity for prostatic receptors while showing minimal affinity for vascular receptors. As a result, its impact on BP is expected to be minimal.

Cp2TiCl-Promoted Endo-Trig Radical Cyclization to Six- and Seven-Membered Carbocycles: Synthesis of (±)-Isoclavukerin A.

A systematic study is undertaken to investigate the less explored endo-trig radical cyclization in activated olefin-appended epoxides using Cp2TiCl. The radical generated by the Ti(III)-promoted reductive opening of the epoxy ring promptly underwent endo-trig cyclization, giving access to differently 1,3-disubstituted six- and seven-membered carbocycles in good yields and diastereoselectivity. This protocol was successfully employed in the construction of 5,7- and 6,7-fused bicyclic frameworks entailing a de novo synthesis of (±)-isoclavukerin A belonging to tri-nor-guaiane class of sesquiterpene natural products in eight simple steps from commercially available starting materials. Besides the Ti(III)-mediated reaction serving as a key step in the synthesis, a sequential [2,3]-sigmatropic rearrangement/syn-elimination of an allyl sulfenate intermediate successfully rendered the highly constrained diene moiety in the hydroazulene core of the target molecule.

Cp2TiCl-Mediated Reductive Cyclization: Total Synthesis of Pestalotiolactone A, Myrotheciumone A, and Scabrol A.

The first stereoselective total syntheses of fungal secondary metabolites monoterpenoid (+)-pestalotiolactone A, meroterpenoid (-)-myrotheciumone A, and iridoid lactone (+)-scabrol A have been accomplished in an expedient unified approach starting from d-(+)-malic acid employing an epoxide opening-radical cyclization protocol initiated by Cp2Ti(III)Cl as a key step to assemble the core bicyclic lactone moieties of these molecules with complete diastereoselective control. Finally, the deoxygenation and methylation delivered the target natural products.

A questionnaire-based survey to ascertain the views of clinicians regarding rational use of antibiotics in teaching hospitals of Kolkata.

OBJECTIVES: The objective was to assess the views of clinicians in teaching hospitals of Kolkata regarding the use of antibiotics in their own hospitals, focusing on perceived misuse, reasons behind such misuse and feasible remedial measures. MATERIALS AND METHODS: A total of 200 clinicians from core clinical disciplines was approached in six teaching hospitals of Kolkata through purposive sampling. A structured, validated questionnaire adopted from published studies and modified to suit the responding population was completed by consenting respondents through face-to-face interaction with a single interviewer. Respondents were free to leave out questions they did not wish to answer. RESULTS: Among 130 participating clinicians (65% of approached), all felt that antibiotic misuse occurs in various hospital settings; 72 (55.4% of the respondents) felt it was a frequent occurrence and needed major rectification. Cough and cold (78.5%), fever (65.4%), and diarrhea (62.3%) were perceived to be the commonest conditions of antibiotic misuse. About half (50.76%) felt that oral preparations were more misused compared to injectable or topical ones. Among oral antibiotics, co-amoxiclav (66.9%) and cefpodoxime (63.07%) whereas among parenteral ones, ceftriaxone and other third generation cephalosporins (74.6%) followed by piperacillin-tazobactam (61.5%) were selected as the most misused ones. Deficient training in rational use of medicines (70.7%) and absence of institutional antibiotic policy (67.7%) were listed as the two most important predisposing factors. Training of medical students and interns in rational antibiotic use (78.5%), implementation of antibiotic policy (76.9%), improvement in microbiology support (70.7%), and regular surveillance on this issue (64.6%) were cited as the principal remedial measures. CONCLUSIONS: Clinicians acknowledge that the misuse of antibiotics is an important problem in their hospitals. A system of clinical audit of antibiotic usage, improved microbiology support and implementation of antibiotic policy can help to promote rational use of antimicrobial agents.

Impact of increased rate of caesarean section on perinatal outcome: sociolegal evaluation.

Sharp rise in the caesarean section rate, over the past years has been causing lot of concerns. It is to be evaluated whether the decrease in perinatal mortality rate is due to the rising rate of caesarean section. Five hundred consecutive patients were selected on whom caesarean section had been performed. Both mother and baby were followed till they are discharged from the hospital. Foetal distress was the commonest indication in primigravidae who underwent caesarean section. The other indications of caesarean section in this study were breech, severe pre-eclampsia, eclampsia, cord prolapse, elderly primi, postdated, premature rupture of membrane, twin, compound presentation, meconium stained liquor. The occurrence of perinatal morbidity in caesarean section was 10% compared to 12% in vaginal delivery. Common causes of perinatal morbidity were asphyxia, prematurity, diarrhoea, septicaemia, jaundice, conjunctivitis and scalp injury. The occurrence of perinatal mortality in caesarean section was 3.8% compared to 3% in vaginal delivery. Causes of perinatal mortality were stillbirth, meconium aspiration syndrome, hypoxic ischaemic encephalopathy, prematurity and congenital malformation. In spite of safety of vaginal birth after caesarean section it continues to be underutilised. Good perinatal care proper screening and use of newer effective pharmacological agents improve the maternal progress as well as perinatal outcome without increasing the caesarean section rate.

Trends to access internet among medical students of a government medical college in West Bengal.

The use of computer and information technology is on an escalation. The internet, one of the key developments in this field, provides instant access to latest medical information. The present study was conducted (i) to estimate the extent and purpose of internet usage among undergraduate (UG) and postgraduate (PG) medical students, (ii) to identify factors that encourage the students to use internet for medical information, (iii) to assess the need for incorporating computer education in medical curriculum. A prospective, cross-sectional, questionnaire-based study was conducted on 150 students of Burdwan Medical College and Hospital between June 2009 and December 2009. Majority of the students accessed internet from their home PC (42% UGs and 52% PGs).Common search engines browsed commonly by both UGs and PGs include Google and yahoo. Regarding principles of telemedicine and evidence-based medicine, majority of the PGs are well versed while UGs are not (p-value 0.0001). Almost all students agreed to incorporate computer education in medical curriculum. Primary source of medical information was textbook for UGs (62%) and internet for the PGs (48%). Majority of UGs (48%) used internet as a ready source of information thus saving time while PGs (68%) primarily relied on internet for recent advances in their disciplines. The primary purposes of internet use are educational for both UGs and PGs. The data obtained indicates that majority of the medical students participating in the present study embrace and use internet to access medical information. It also justifies the need to incorporate internet and associated information technology into existing medical curriculum.