A study of atenolol and nebivolol in prehypertension

Background: Patients with prehypertension have an increased risk of cardiovascular disease. The coexistence of prehypertension with risk factors increases cardiovascular morbidity and mortality. That’s why it is important to treat pre-hypertensive patients having risk factors. The objective was to evaluate the effect of atenolol and nebivolol in pre-hypertensive patients.Methods: Pre-hypertensive patients having risk factors were selected, and non-pharmacological therapy was advised to all patients. Those patients who were not able to follow strictly non-pharmacological guidelines and remained pre-hypertensive were included in this study. Pre-hypertensive patients were divided into three groups. One group received atenolol 50 mg orally, once daily. Second group received nebivolol 5 mg orally, once daily. Third group received placebo orally, once daily. All groups received treatment for 1 month.Results: In the nebivolol group after 1 month of study, the mean reduction in systolic blood pressure (SBP) was 134.2±3.07-118.26±4.66 and mean reduction in diastolic BP (DBP) was 87.13±1.87-80.73±1.99. Reduction in SBP and DBP in the nebivolol group was significant (p≤0.0001). In the placebo, and atenolol group results were not significant.Conclusion: Nebivolol produces a significant reduction in SBP and DBP in pre-hypertensive patients. Atenolol and placebo did not show beneficial results

Understanding of effects of potassium on cardiac tissue by medical students: a critical appraisal

Potassium (K+) is one of the most important ion present in the human body and involved in numerous physiological activities. It mainly affects heart and skeletal muscle but the effects are not confined to theses organs only. The article precisely focuses on the explaining the physiological as well as pathological aspects of potassium on cardiac tissue. This article tends to explain: The cause of difference in extra cellular and Intra cellular concentration of potassium when potassium channels are open in resting conditions, why are Purkinje fibers and ectopic tissue are more sensitive to effect of potassium, mechanisms responsible for increased action potential duration by hypokalemia and decreased action potential duration by hyperkalemia. Hypokalemia generates ectopic activities and hyperkalemia inhibits them, therapeutic effects of potassium administration without causing hyperkalemia. These issues will be discussed and try to be explained with the help of Ohm’s law , Nernst equation and Nernst potential to sort out the complicated actions of potassium on cardiac tissue in a simplified manner. The primary aim of article is to improve understanding of potassium physiology by medical graduates, secondarily, convey message regarding improvement in teaching methodology in Pharmacology for the benefit of new generations

Risk adjustment is crucial in comparing outcomes of various surgical modalities in patients with ileal perforation

<p>Abstract</p> <p>Background</p> <p>Using crude mortality and morbidity rates for comparing outcomes can be misleading. The aim of the present study was to compare the outcome of various surgical modalities without and with risk adjustment using Physiologic and Operative Severity Scoring for the enUmeration of Mortality and morbidity (POSSUM) score in cases of ileal perforations.</p> <p>Methods</p> <p>Prospective study on 125 patients of ileal perforations. Resection anastamosis (Group I) was done in 38 patients, primary repair (Group II) in 42 patients and 45 patients had an ileostomy (Group III). The disease severity was assessed in all patients using POSSUM score. The odds of death without and with risk adjustment using POSSUM mortality score were calculated for all groups</p> <p>Results</p> <p>Seventeen patients (14%) patients died and 99 (79%) developed postoperative complications. Using crude mortality rates Group I appeared to be the best treatment option with only 2 (5%) deaths followed by Group II with 5 (12%) deaths where as Group III had the worst outcome with 10 deaths (22%). However, Group III (ileostomy) patients had higher mean POSSUM mortality and morbidity score (55.55%, 91.33%) than Group I (28%, 75.26%) and Group II (27%, 73.59%). Taking Group I as the reference (odds ratio, OR1) odds of death were greatest in Group III (OR 5.14, p = 0.043) followed by Group II (OR 2.43, p = 0.306). With risk adjustment using POSSUM mortality score the odds of death decreased in Group III (OR 1.16 p = 0.875). For the whole group, there was a significant association between the POSSUM score and postoperative complications and deaths. Mean POSSUM mortality and morbidity score of those who died (63.40 vs.33.68, p = 0.001) and developed complications (66.32 vs.84.20, p = 0.001) was significantly higher. For every percent increase in severity score the risk of postoperative complications and death increased by 1.10 (p = 0.001) and1.06 (p = 0.001) respectively.</p> <p>Conclusion</p> <p>Despite ileostomy patients having highest crude mortality and complication rates, after risk adjustment it was equally safe. Severity of the disease rather than the surgical option had a significant impact on the outcome in patients with ileal perforations.</p

Cost variation among antiretroviral drugs: pharamcoeconomical prospective

Background: Acquired immunodeficiency syndrome (AIDS) is a disorder caused by the human immunodeficiency virus (HIV). Main characteristic feature of AIDS includes severe immunosuppression which leads to opportunistic infections which is a main cause of death and requires a lifelong therapy. There exists wide range of cost variation in antiretroviral drugs that are marketed in India. The current study aims to view the existing situation of antiretroviral drugs, by collecting data about the cost of common antiretroviral drugs available either singly or in combination and to evaluate the difference in cost of different brands of same active drug by calculating percentage cost variation.Methods: Data for calculating cost ratio and percentage price variation of various antiretroviral drugs was obtained from “Current Index of Medical Specialties” October 2017-January2018.Results: Zidovudine 100mg shows maximum cost ratio and price variation followed by Lamivudin 100mg in the single drug therapy. Lamivudine 150mg + Zidovudine 300mg shows maximum price variation in combination drug therapy.Conclusions: Indian market shows wide price variation of different brands of the same generic antiretroviral drug. To decrease the wide cost variation among different brands of antiretroviral drugs; it is time to create awareness among healthcare professionals about impact of cost effectiveness of drug regimen and decrease the financial burden on the patients

Hypermotor seizure presenting with unusual psychiatric symptoms - a case report

We report a case of hypermotor seizure activity. The patient presented behavioural changes with previous reports of normal electroencephalogram (EEG). A prolonged video EEG of this patient showed rare epileptic abnormalities over the left frontocentral region, which ruled out a conversion disorder diagnosis. Management using Antiepileptics proved beneficial in this case

Diversity and status of migratory and resident wetland birds in Haridwar, Uttarakhand, India

Migration is the seasonal habitual movement, exhibited by many avian species along a flyway from breeding to wintering grounds and vice versa all over the world. Migratory birds are very sensitive to even small changes in water level which may be affected by flood or drought on their breeding and wintering grounds. High rains during monsoon season can cause flood conditions in the lower hills and Gangetic plains including Haridwar district. In our study, conducted during last ten years (2009-2018), we covered Bheemgoda Barrage and Missarpur Ganga Ghat of Haridwar, Uttarakhand, where 46 species of Migratory (M) and Resident Migratory (RM) wetland birds were observed. Bird survey indicated that there was a significant increase (p = 0.064, t-test) in the population of certain species such as Bhraminy Shelduck (67%), Black Headed Gull (31%), Gadwall (7%), Northern Pintail (59%), Red Crested Pochard (10%) and Tufted Pochard (47%) in Missarpur Ganga Ghat as compared to Bheemgoda Barrage (based on the average abundance of the species observed during study period). It may be pointed out that after flood and loss of vegetated island, there was significant decrease (p= 0.023, t-test) in the population of species such as Black necked stork (76%), Great crested grebe (56), Pallas gull (47%) at Bheemgoda barrage, while some species such as Bar headed goose, Common pochard did not arrive in Bheemgoda barrage after the flood. The study would help to understand the effect of climatic change on water birds species distribution in natural and man-made wetlands

CASPR2 positive autoimmune encephalitis presenting as delirium in an alcohol dependent patient: a diagnostic dilemma

Delirium, a major psychiatric emergency commonly encountered in alcohol withdrawal state, can have various aetiologies. Here we present a case of protracted delirium in an alcohol dependent patient, which on detailed neurological workup was diagnosed to be autoimmune encephalitis with CASPR2 (contactin-associated protein-like 2) antibodies. Subsequent treatment with immunotherapy and steroids lead to the resolution of symptoms

Cost Estimation Tool for Commercial Software Development Industries

ABSTRACT: As cost associated to the software development is increasing continuously, there is a need to direct attention at better understanding of development process and calibrating previous models and methods making them applicable to existing environment such as proposing hybrid tools using the techniques based on existing models. The main aim of this paper is to improve the cost estimation accuracy of applications at all the phases of a software development lifecycle by calibrating COCOMO using a function point as a size measure instead of SLOC being used in COCOMO model. Here we have discussed the working of proposed software estimation tool that is a hybrid implementation of various software estimation and measurement techniques helping an organization to determine metrics such as Effort, Time and Cost, essential for improving turnaround time. This tool also works towards utilizing these metrics for project planning, scheduling and tracking

Whole-Genome Sequence of Drug-Resistant Mycobacterium tuberculosis Strain S7, Isolated from a Patient with Pulmonary Tuberculosis

Over the past decades, drug-resistant Mycobacterium tuberculosis strains have presented a significant challenge, with inadequate diagnosis of tuberculosis (TB) cases. Here, we report the draft whole-genome sequence of drug-resistant M. tuberculosis strain S7, which was isolated from a patient from Tripura, India, who was diagnosed with pulmonary TB

Accuracy of telepsychiatric assessment of new routine outpatient referrals

<p>Abstract</p> <p>Background</p> <p>Studies on the feasibility of telepsychiatry tend to concentrate only on a subset of clinical parameters. In contrast, this study utilises data from a comprehensive assessment. The main objective of this study is to compare the accuracy of findings from telepsychiatry with those from face to face interviews.</p> <p>Method</p> <p>This is a primary, cross-sectional, single-cluster, balanced crossover, blind study involving new routine psychiatric referrals. Thirty-seven out of forty cases fulfilling the selection criteria went through a complete set of independent face to face and video assessments by the researchers who were blind to each other's findings.</p> <p>Results</p> <p>The accuracy ratio of the pooled results for DSM-IV diagnoses, risk assessment, non-drug and drug interventions were all above 0.76, and the combined overall accuracy ratio was 0.81. There were substantial intermethod agreements for Cohen's kappa on all the major components of evaluation except on the Risk Assessment Scale where there was only weak agreement.</p> <p>Conclusion</p> <p>Telepsychiatric assessment is a dependable method of assessment with a high degree of accuracy and substantial overall intermethod agreement when compared with standard face to face interview for new routine outpatient psychiatric referrals.</p