Comparative study of efficacy and adverse effects profile of telmisartan vs enalapril maleate in patients of essential hypertension and diabetic hypertensives

Background: Hypertension is the most common cardiovascular disease and is one of the leading causes of morbidity and mortality. Hypertension when associated with Diabetes mellitus increases this risk. To prevent this, we need appropriate antihypertensive agents with better compliance.  By virtue of selective inhibition of angiotensin II type 1 receptor, telmisartan reduces blood pressure throughout the day with high tolerability.Methods: A longitudinal and interventional study was undertaken including both male and female patients within the age group of 25-55yrs with clinically diagnosed Essential hypertension and essential hypertension associated with type II diabetes mellitus.  Totally 80 patients were enrolled in this study.  They were divided into 2 groups i.e., Essential hypertension group as A and hypertension associated with diabetes group as B with 40 patients in each group. Again A group was divided into 2 sub-groups (A1 & A2) and B into (B1& B2) with 20 patients in each group. A1and B1 sub groups received Tab. Telmisartan 40mg once a day. A2 and B2 sub groups received tab. Enalapril maleate 5mg once daily. The total period of the study was 3 months.Results: In this study, both telmisartan and enalapril maleate reduced systolic and diastolic blood pressures in A and B groups at 2 weeks, 6 weeks, and 12 weeks almost equally with no statistical significance. But in terms of adverse effect profile, persistent dry cough and rash was observed more in A2 and B2 group than A1 and B1 subgroups.Conclusions: Telmisartan is effective, better tolerated than enalapril for the treatment of hypertension

A study of efficacy and safety of intravenous iron sucrose for the treatment of moderate anaemia in antenatal women in South India

Background: Iron deficiency anaemia in pregnancy is a common medical problem throughout India with the burden of disease impacting on both mother and the newborn. The WHO technical group working on the prevention and treatment of anaemia has documented that parenteral iron therapy has produced a rapid and better correction of iron deficiency anaemia.Methods: A total of 61 antenatal women in the age group of 18-25yrs were enrolled and randomly assigned into study group. For a period of 4 weeks, study group received iron sucrose intravenously. The results were noted, tabulated, analysed and expressed as descriptive statistics. Student's ‘t’ test and percentages were compared using chi square test. P -value, <0.001 was considered significant. The results were analysed by using SPSS V-21 software.Results: Mean rise of Hb was 2.51±0.44 with IV iron sucrose this was highly significant (HS). Mean rise of MCV was 8.02±6.72 with IV iron sucrose this was not significant (NS). Mean rise of PCV was5.7±2.77 with IV iron sucrose. These findings showed improvement in Hb and PCV which were statistically highly significant (HS). Adverse effects were 14% in the group.Conclusions: The present study proved that iron sucrose when given intravenously there was a rapid improvement in anaemia. IV iron sucrose was proved to be safe with minimal side effects

A study on disease burden and treatment among patients attending teleconsultation during lockdown period

Background: Covid-19 has been announced as a pandemic by the World Health Organization. To maintain social distancing effectively, the Government of India announced a complete lockdown on March 25th, 2020. As there are no proper transport facilities for patients who need health care services, the Government of Andhra Pradesh started 104 sevakendram as a helpline. Medical services were also provided by this 104 sevakendram through teleconsultation with doctors. The aim and objectives of the study were to study the disease pattern and treatment given to patients attending teleconsultations, to analyze the disease burden among the patients attending teleconsultation, to study the treatment given to the patients attending teleconsultation.Methods: It is a retrospective, observational, and analytical study. After prior IEC clearance and permission from teleconsultation authority, we did the study at Dr.YSR Aarogyasri health care trust, Guntur. Data regarding all calls connected to 104 was collected. Detailed information of the calls related to the Medical officer about the age, gender, disease pattern, and treatment given to the patient was collected. Statistical analysis was done using MS excel software.Results: On average, 104 sevakendram received two hundred valid teleconsultations per day. Most of the calls are related to anxiety and these calls constitute twenty four percent. Treatment given was according to probable diagnosis, mostly symptomatic and continuation of the same treatment.Conclusions: 104 sevakendram has played a vital role in meeting the medical and health requirements of the people suffering from different diseases during the lockdown period.

A comparative study of intrathecal ropivacaine with fentanyl and L-bupivacaine with fentanyl in lower abdominal and lower limb surgeries

Background: Subarachnoid block (SAB) is the anesthesia of choice and is the gold standard for lower abdominal and lower limb surgeries. SAB, a popular and common anesthetic procedure practiced worldwide. Today heavy bupivacaine, 0.5% is most commonly used for spinal anesthesia. Levo-bupivacaine, new long-acting local anesthetic, has a pharmacological activity very similar to that of racemic bupivacaine. Due to lesser cardiovascular side-effects and central nervous system toxicity, use of levo-bupivacaine, a pure S (−) enantiomer of bupivacaine has progressively increased. Ropivacaine has a less systemic toxicity, especially cardio toxic profile than both racemic and levo-bupivacaine. Though less potent, even 50% higher dose is still less toxic than bupivacaine. So, intrathecal ropivacaine may prove useful than that of bupivacaine or levo-bupivacaine when anesthesia of a similar quality and shorter duration is desired.Methods: This study was conducted in 60 adult patients aged between 18 and 60 years, who underwent elective lower abdominal and lower limb surgeries under spinal anesthesia. They were distributed in two groups. Group R: 30 patients were given injection ropivacaine 3 ml (0.75%) + injection fentanyl 0.5 ml (25 µg). Group L: 30 patients were given injection L-bupivacaine 3 ml (0.5%) + injection fentanyl 0.5 ml (25 µg). Hemodynamic parameters such as pulse rate, blood pressure, and respiratory rate, sensory and motor blockade were assessed at 0, 5, 10, 15, 30, 45, 60, 90, and 120 mins following the block. Thereafter, observation was continued at 30 mins intervals until the motor block regressed completely as defined by modified Bromage score. Time of two segment regression, duration of complete and effective analgesia, and time to first analgesic dose, side effects, and complications were studied.Results: Statistical analysis was done using SPSS software 16.0. Data obtained is tabulated in the excel sheet and analyzed. Chi-square test for proportion and t-test for quantitative data were done. Block characteristics were compared using Mann–Whitney U-test. Both the groups were comparable with respect to age, sex, height, weight, body mass index, level of SAB, American Society of Anesthesiologist score (p>0.05). The mean time for onset of sensory block with p=0.49 which was clinically and statistically not significant for both groups. The mean time for onset of motor block (Bromage 3) with p=0.16 was clinically and statistically not significant. The time taken for two segment regression of sensory block was p=0.22 statistically not significant. There was no clinical or statistical significance in the incidence of side effects in both groups.Conclusion: This study revealed that the intrathecal ropivacaine with fentanyl provided adequate anesthesia for lower abdominal and lower limb surgeries. Ropivacaine achieved a shorter duration of sensory and motor blockade, and a lesser degree of motor blockade when compared to L-bupivacaine. Thus, ropivacaine was justified for short duration ambulatory surgeries of lower abdominal and lower limb surgeries. Furthermore, fentanyl as an adjuvant to both ropivacaine and L-bupivacaine enhanced the duration of the sensory block. Hence, ropivacaine with fentanyl in spinal anesthesia for lower abdominal and lower limb surgeries is a better alternative compared to L-bupivacaine with fentanyl favoring day care ambulatory surgeries