INTRODUCTIONHypertension (defined as: systolic B.P.>=130mm Hg; diastolic B.P.>=80mm Hg) is a condition in which arterial B.P. is chronically elevated.1 It is the commonest cardiovascular disorder, posing a major public health challenge, a major risk factor for cardiovascular mortality and accounts for 20-50% of all deaths. 2 Raised blood pressure is responsible for 60% of strokes and 50% of coronary ABSTRACT Background: Hypertension, a common cardiovascular disorder accounts for 20-50% of all deaths. This risk can be greatly ameliorated by creating awareness about disease and its effective treatment alongside regular medical check-ups. Therapeutic failures result from patient non-compliance, manifested as intentional or unintentional errors in dosage or schedule, overuse or underuse of prescribed drugs and early termination of therapy. Adherence is helpful for management of hypertension and cost minimization. Non-adherence to the drug treatment is an important factor for uncontrolled hypertension and its complications. Methods: Patients were interviewed individually after taking informed consent, using pretested, predesigned, self-administered and closed ended questionnaire both before and 4 weeks after creating awareness about hypertension and its complications. Compliance measured by self-reporting in which knowledge of the patient about number of antihypertensive drugs being used, formulations of drugs, frequency of administration, duration of taking the drugs and knowledge of complications due to uncontrolled and untreated hypertension were assigned 1 score each. Patient having score of at least 4 out of total 5 was considered compliant. Results: No significant association of compliance with demographic and other variables like age, sex, marital status, economic status, education, urbanization, duration of treatment and drug procurement were noted. A significant increase in compliance in patients on antihypertensive medication was found 4 weeks after creating awareness about hypertension and its complication. A significant increase in compliance scores was also seen in non-compliant patients showing their shifting from non-compliance to compliance group. Overall compliance increased from 59.38% to 84.38%. A percentage decrease from 58.82% to 25% in patients having uncontrolled hypertension was also observed after the awareness about hypertension. Conclusions: Demographic variables, duration of hypertension and drug procurement have no significant effect on compliance to antihypertensive medication. There is persistence and improvement in compliance to antihypertensive medications after an education of the patients about hypertension and its complications.
Background: It is a well-known fact that drug-induced bleeding causes considerable morbidity and mortality. Drugs that induce bleeding do so by affecting either anti-platelet Function and /or coagulation. By the frequency of their use, anti-platelet, a coagulant, thrombolytic and NSAIDs are the most commonly implicated drugs. Upper gastrointestinal bleeding is commonest adverse drug reaction associated with hospital admission. Significant number of these could be prevented if simple guidelines are followed. Spontaneous cessation of bleeding occurs in as many as 85% of cases. Early intervention is required in those if bleeding does not stop spontaneously. Objective of the study was to determine the pattern of drug induced bleeding in tertiary care hospital setting. Methods: It was a hospital based observational study conducted during one year study dura on ((June 1, 2014 to May 31, 2015) amongst all adult patients admitted to the hospital with drug induced bleeding. Statistical analysis was done by frequency measurement for categorical variables. Chi-square test was used to determine associations. A p-value of<0.05 was taken as statistically significant. Results: A total number of 110 cases with history of bleeding were enrolled. Commonest drug that caused bleeding was a platelet with 29 (26%) cases followed by combination of 2 or more drugs in 25 (23%) cases, then NSAIDs and anticoagulants in 24 (21%) and 23 (20%) cases respectively. Upper gastrointestinal bleeding was the commonest site of bleeding seen in 64 (58%) cases. The commonest drugs causing upper GI bleeding were NSAIDs seen in 24 (37.5%) cases followed by a platelet 22 (34.3%), combined drugs in 09 (14%) cases. (P<0.001) In overall severity most cases of drug induced bleeding had mild bleeding with 61 cases as compared to 38 cases of moderate and 11 cases of severe bleeding. There were significantly higher proportion of mild and moderate bleeding in upper gastrointestinal bleed cases in comparison to other sites of drug induced bleeding in this study (p<0.01). 7 (6.4%) out of 110 patients died and 103 (93.6%) patients recovered and were discharged. Conclusions: Clinical management of bleeds requires careful assessment of the patient, haemodynamic stabilisation, discontinuation of the offending medication and, where appropriate, reversal of the haemorrhagic effects and specific therapies such as endoscopic haemostatic therapy.
Background: Depression, a major common affective disorder which carries excess mortality through suicide. Among various drug classes available SSRI’s are usually a choice, but many patients show inadequate response, residual symptoms or discontinue medication due to intolerable side effects. Disturbances of circadian rhythm function are an etiopathogenic hallmark of depression. The degree of circadian misalignment correlates with the severity of depression and circadian abnormalities may partially be a consequence of alterations in behavior and sleep patterns that accompany depression. Agomelatine an agonist acts on MT1 and MT2 receptors and antagonist of 5HT2c receptors contributes to its resynchronization of circadian rhythms, enhancement of dopaminergic and adrenergic input to the frontal cortex, induction of hippocampal neurogenesis, and ultimately, to its antidepressant effect.Methods: The study was randomized, prospective, comparative and interventional regarding the efficacy of therapy. Hundred consenting patients of MDD attending psychiatry OPD were screened for possible enrollment into group A(Agomelatine) and group B(Sertraline). Patients were assessed by semi-structured case recording form, DSM-IV- TR Criteria for major depressive episode, Hamilton Rating Scale for Depression (HAM-D) and Clinical Global Impressions for severity (CGI-S) at baseline and CGI for improvement (CGI-I), every two weeks interval and final assessment at 8 weeks.Results: Socio-demographic parameters like age and sex distribution, marital status, locality, family type, educational status, occupation and socio-economic class were comparable between two groups. Similarly baseline HAM-D and CGI-S values between the two groups were statistically non-significant. HAM-D, CGI-S and CGI-I values at eight weeks among the two groups were also statistically non-significant but in all three sertraline had decreased the values to a greater extent and showed a trend towards improvement.Conclusions: Both groups had shown significant decrease in scores of all scales i.e. HAM-D, CGI-S, and CGI-I at the end of 8th week as compared to baseline scores, indicating that the uses of agomelatine and sertraline have resulted in significant improvement in symptoms of patients of MDD and reinforcing there efficacy in treatment of MDD. No statistical difference was observed between two groups.
<p class="abstract">A stony hard rigid neck is the typical presentation in the angina of Von Ludwig. Suddenly with excruciating pain generalized severe cellulitis of the neck is noticed. It flares up quickly and extends on either side, in the submandibular, sublingual and submental triangles thereby manifesting as a medical emergency. This necessitates a prompt diagnosis and intervention medical or surgical as the case maybe, lest a life maybe lost. A neck swelling secondary to self-manipulation of a loose dental plate with impacted wire is being reported. This odontogenic infection had accessed the deeper tissues of a neck with elevation of the floor of the mouth obstructing the airway with consequent breathlessness and stridor; with need to regain his airway by emergency tracheostomy. At the same time a cervical fasciotomy was undertaken to drain the potentially involved spaces.</p><p class="abstract"> </p>
Background: Worldwide hypertension is an important public-health challenge because of its high frequency and concomitant risks of cardiovascular, renal, cerebrovascular disease and death. Current guidelines for the management of hypertension mainly recommend the search for preclinical damage to the heart and kidneys. However, extending this search to other organs, for instance the brain, might improve risk stratification, might optimize antihypertensive therapy and might, in the end help to further reduce the burden of disease attributable to hypertension.Methods: 84 consecutive hypertensive patients with no target organ damage were enrolled in study to find out silent brain damage over a period of one year.Results: Mean body mass index (BMI) of the study population was 28.4±2.5 kg/m2 (range 23.2 to 35.3kg/m2). 33 (39.3%) subjects had white matter lesions. 13 (15.47%) study subjects were found to have vascular changes which included micro angiopathic changes, infarcts and reduced/slow blood flow. 33 (39.3%) subjects were found to have normal brain MRI in the study. Early brain MRI was found to be beneficial in patients who had uncontrolled blood pressure either due to lack of treatment or irregular use of anti-hypertensive treatment. This was true for every age group in general and particularly in subjects above the age of 50 years.Conclusions: The screening of hypertensive patients for silent cerebrovascular damage with brain MRI may be useful in stratifying the risk of future cerebrovascular disease.
Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and represents a substantial socioeconomic burden. Co-morbidities are more in COPD patients. Cardiovascular disease is one of the co-morbid conditions in COPD. Arterial stiffness has a strong predictive value for cardiovascular events, which can be assessed non-invasively. Various predictors of arterial stiffness between stable COPD patients and healthy volunteers were measured and compared.Methods: COPD patients attending pulmonary medicine outpatient services were screened for enrolment. It was a prospective case control study with enrolment of fifty COPD stable cases and fifty healthy control, who were matched for their age and sex. All eligible participants were subjected to focused history and physical examination as per structured questionnaire, followed by spirometric examination, periscope test, arterial blood gas analysis and six- minute walk test (6MWT).Results: Increased arterial stiffness was observed in COPD patients over a wide range of severity of airway obstruction. Distance walked in 6MWT and spirometric values were significantly lower in COPD group as compared to healthy group.Conclusions: It was concluded that vascular changes, which are predictive of cardiovascular disease remain as cardiovascular risks in mild or early lung disease. A strong relationship between COPD, systemic inflammation, arterial stiffness and cardiovascular disease had been found which needs to be explored further. It was finally concluded that targeted therapeutic approach has broad aspect in reducing cardiovascular risks and has potential for improved prognosis in COPD.
Background: The demographic profile of patients with frontal sinusitis undergoing surgical intervention in the state of Punjab was analysed. The emphasis was on the age, gender and clinical presentation in this prospective study.Methods: In this prospective study 85 patients of clinically diagnosed frontal sinusitis were randomly selected from the Rhinology clinics of Oto-rhino-laryngology services, Dayanand Medical College and Hospital Ludhiana; in a period of one and a half years (June 2008 to December 2009). All patients were taken up for functional endoscopic sinus surgery with frontal sinusotomy.Results: 3 (3.53%) subjects, with frontal sinusitis were in the pediatric age group, 65 (76.47%) were males 20 (23.53%) females. Males outnumbered females by a ratio of 3.25:1. The age range varied from a minimum of 8 to a maximum of 86 years. 16 (18.8%) had a discharge in the right middle meatus and 21 (24.7%) over the Eustachian tube orifice. Right sided deviation of the nasal septum was in 13 (14.1%) patients, septal spur in 4 (4.7%) and hypertrophy of the inferior turbinate in 7 (8.2%).Conclusions: Frontal sinusitis was seen in all ages with a male predominance. Nasal blockage on the right side rather than frank frontal headache was the primary complaint. Purulent discharge in the middle meatus and over the Eustachian type were the common findings. Pathology on histopathology encountered was mucosal hypertrophy followed by polyp in the sinus. There was no correlation of frontal sinusitis with the weight and height of the patients
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