Background: Cardiovascular cause is the leading cause of mortality in RA and this has been attributed to accelerated atherosclerosis. Indirect evidence of accelerated atherosclerosis in RA comes from studies using carotid artery intima media thickness (CIMT) as a marker of atherosclerotic burden and cardiovascular risk. Aims: To assess carotid intimamedia thickness in patients with rheumatoid arthritis by using Doppler ultrasound and to study the correlation between carotid intima-media thickness and the duration and severity of rheumatoid arthritis. Materials and Methods: A total of 30 rheumatoid arthritis patients were enrolled during 2 year study. Patients satisfying the modified American Rheumatology Association criteria (1987) were included. Those with hypertension, cardiac disease, and diabetes mellitus were excluded. Subjects were divided into three groups (each group consist of 10 patients) based on disease duration. For measurement of carotid intimal medial thickness B-mode USG scan using 7.5 MHz probe is used. Results: The mean value of common carotid intima media thickness (CCIMT) was significantly higher in the study group (0.8 mm) when compared to control group (0.59 mm) (p value < 0.001). Total carotid intima media thickness (i.e., mean of total CIMT of CCA, ICA, and ECA) was significantly higher in the study group (0.76 mm) when compared to control group (0.57mm) (p value < 0.001). Conclusion: The study shows a significant directly proportional relation between carotid intima media thickness to longer duration of disease.
Introduction: Intravenous Thrombolysis is approved upto 4½ hrs and Endovascular Therapy upto 24 hrs in eligible Acute Ischemic Stroke (AIS) patients with Large Vessel Occlusion. There are still substantial number of AIS patients where there is no effective treatment available. In this Study we aim to test the safety and Efficacy of the reversible gp IIb/IIIa receptor inhibitor antagonist Tirofiban in AIS beyond 4 ½ hrs and within 24 hrs. Methodology: Among a total of 750 AIS patients admitted in our Stroke Unit, from July 2019 to March 2020, 100 Consecutive patients were included in this study and received Intravenous tirofiban as an initial bolus followed by infusion. Inclusion criteria were Age 18-80yrs, Window Period 4 ½ to 24 hrs. National Institute of health Stroke Scale score (NIHSS) between 5-20, No contraindication for lytic drugs. CT Brain excluding Hemorrhage or > 1/3 rd infarct. Cardioembolic strokes were excluded. Efficacy Assessments: NIHSS and modified Rankin scale (mRS) performed at baseline, within 48hrs, Day-7 and Day-90. The good outcome was defined as mRS 0-1 at 3 months. The safety outcomes were assessed by the incidence of Symptomatic Intracerebral hemorrhage (SICH), Systemic Bleeding and any mortality. Results: There were 74 males, 26 females with median Age of 56 yrs (range from 18 to 80yrs). The Median NIHSS is 10 (range from 5-20), Majority (87%) had anterior circulation strokes and 13% were in Posterior circulation. One patient (1%) developed symptomatic parenchymal Hemorrhage, 4 patients (4%) had mild haemorrhagic transformation within infarct, 8 patients (8%) had nonfatal systemic bleed in the form of Hematuria. Total Mortality - 2 patients (2%), one patient died in the hospital due to cardiac arrest and another patient died at home after discharge. At 3 months, 62 patients (62%) had good outcome (mRS 0-1) and 33 patients (33%) had favourable outcome (mRS 2-3). Conclusion: In this Observational Study we found that Intravenous Tirofiban is not only safe, but effective in AIS patients with extended window period. However, Randomized Clinical Trials are needed to further clarify our observation.
In worldwide 25% of population is suffering with Hypertension. As it is an instrumental disease, asymptomatic in nature, it was named as Silent killer. The causative factors of Essential hypertension were Genetic predisposition and environmental factors but these factors are triggered by stress hence it comes under stress related psycho-somatic disorder. In Hypertensive patients, Decrease in 5mm of Hg in SBP and DBP results in decrease in cardiovascular risk, stroke which decreases mortality rate worldwide. The management aspect of modern medical science remains symptomatic with troublesome side effects. The Joint National Committee (JNC 8) guideline advise higher blood pressure goals, less use of several types of antihypertensive medications and suggests lifestyle modification and relaxation are the best initial therapy. In Ayurveda, Shirodhara is one of the panchakarma therapy meant for relaxation and stress reducing procedure mentioned in Dharakalpaas a preventive and curative treatment for many stress related disorders. So, Present study is planned as “A Comparative clinical evaluation of Shirodhara with Sukhos̩n̩ajala, Tila tailam and Brahmitailamin the management of mild to moderate essential hypertension”was selected. This paper is going to describe about conclusion drawn from the study i.e. effect of three types of dhara on Objective parameters SBP, DBP, PP, and MAP.
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