Amlodipine drug therapeutic failure: a rare case report

Drug Therapeutic failure is a rare condition which is underreported in recent scenario. It is important for the chronic diseases like Hypertension where it could lead to fatal outcome. In our case report elderly male patient taking tablet Amlodipine once daily as antihypertensive medication and had 2 years without any events. Patient came to the emergency department with the complaint of altered sensorium and elevated blood pressure. The mechanism for sudden increase in blood pressure (Decreased Therapeutic Response) in patient with ongoing treatment with amlodipine could be due to sympathetic over activity (e.g. stress), pharmacokinetic variation or counterfeit drug

Amlodipine drug therapeutic failure: a rare case report

Drug Therapeutic failure is a rare condition which is underreported in recent scenario. It is important for the chronic diseases like Hypertension where it could lead to fatal outcome. In our case report elderly male patient taking tablet Amlodipine once daily as antihypertensive medication and had 2 years without any events. Patient came to the emergency department with the complaint of altered sensorium and elevated blood pressure. The mechanism for sudden increase in blood pressure (Decreased Therapeutic Response) in patient with ongoing treatment with amlodipine could be due to sympathetic over activity (e.g. stress), pharmacokinetic variation or counterfeit drug

Anaesthesia for laparoscopic kidney transplantation: Influence of Trendelenburg position and CO 2 pneumoperitoneum on cardiovascular, respiratory and renal function

Background: Laparoscopic donor nephrectomy is a routine practice since 1995. Until now, the recipient has always undergone open surgery for transplantation. In our institute, laparoscopic kidney transplantation (LKT) started in 2010. To facilitate this surgery, the patient must be in steep Trendelenburg position for a long duration. Hence, we decided to study the effect of CO2 pnuemoperitoneum and Trendelenburg position in chronic renal failure (CRF) patients undergoing LKT. Methods: A total of 20 adult CRF patients having mean age of 31.7±10.36 years and body mass index 19.65±3.41 kg/m 2 without significant coronary artery disease were selected for the procedure. Cardiovascular parameters heart rate (HR), mean arterial pressure (MAP), Central venous pressure (CVP) and respiratory parameters (ETCO 2 , peak airway pressure) were noted at the time of induction, after induction, 15 min after creation of pnuemoperitoneum, 30 min after Trendelenburg position, 15 min after decompression of pnuemoperitonuem and after extubation. Arterial blood gas analysis was carried out after induction, 15 min after creation of pnuemoperitoneum, 30 min after Trendelenburg position and 15 min after clamp release. Total duration of surgery, anastomosis time, time for the establishment of urine output and total urine output were noted. Serum creatinine on the 1 st and 7 th post-operative day were recorded. Results: Significant increase in HR was observed after creation of CO 2 pneumoperitoneum and just before extubation. Significant increase in the MAP and CVP was noted after creation of pneumoperitoneum and after giving Trendelenburg position. No significant rise in the ETCO 2 and PaCO 2 was observed. Significant increase in the base deficit was observed after the clamp release, but none of the patients required correction. Conclusion: LKT performed in steep Trendelenburg position with CO 2 pneumoperitoneum significantly influenced cardiovascular and respiratory homeostasis; however, measured parameters remained within clinically acceptable range without affecting early function of the transplanted kidney

The analgesic efficacy of continuous transversus abdominis plane block in renal transplant recipients

Background and Aims: Transversus abdominis plane (TAP) block is suitable for operations where parietal pain is a major cause of pain. Renal transplant recipients are ideally suited to gain maximum benefit from TAP block as the incision classically involves the lower abdomen. This study was conducted to evaluate the analgesic efficacy of continuous TAP block in transplant recipients. Material and Methods: In a prospective double-blind study, 40 chronic renal failure patients undergoing open renal transplant were randomly divided into two groups. At the end of surgery during closure, a multiorifice epidural catheter was placed in TAP plane. Study group (Group S) received Inj bupivacaine bolus 1 mg/kg (0.25%) followed by infusion 0.25 mg/kg (0.125%) through the catheter, whereas control group (Group C) received normal saline through the catheter. Inj pentazocine (0.3 mg/kg) was given as rescue analgesic at visual analogue score (VAS) > 3 in any group at rest or on movement. The analgesic efficacy was judged by VAS, time of first rescue analgesic, and total analgesic consumption in 24 h. Results: Patients in Group S had significant lower VAS scores, longer time to first rescue analgesic (270 ± 347.96 vs. 42.85 ± 32.27 min) and lower pentazocine consumption (9.75 ± 13.95 vs. 56.42 ± 12.46 mg) in 24 h. There was significant sedation in Group C. Conclusion: The TAP catheter technique for postoperative pain control after renal transplant has proved to be effective in relieving the postoperative pain after renal transplant with less pentazocine requirement and less sedation

Developing a Community-Based Screening and Referral Mechanism for Atrial Fibrillation in Low Resource Settings: “Smartphone Monitoring for Atrial Fibrillation in Real-Time – India (SMART-India)”

BACKGROUND: Atrial fibrillation (AF), the world’s most common arrhythmia, often goes undetected and untreated in low-resource communities, including India. Moreover, AF is an important risk factor for stroke, which plagues an estimated 1.6 million Indians annually. As such, early detection of AF and management of high-risk patients is critically important to decrease stroke burden in individuals with AF. OBJECTIVE: The objectives of this study are to evaluate the age- and sex-stratified epidemiology of AF in Anand District, Gujarat India; characterize the profile of individuals who are diagnosed with AF; and determine the performance of two mobile technologies for community-based AF screening. METHODS: We built on findings from our feasibility study and leveraged two novel technologies as well as an existing community health program to screen 2,500 people from 60 villages of Anand District. A single-lead EKG and a pulse-based app was used to screen each individual for AF 3 times over a period of 5 days. Participants with suspected arrhythmias were referred at a local tertiary-care hospital for further evaluation and follow up with a cardiologist. Participants diagnosed with AF were initiated on treatment as deemed appropriate by the cardiologist. ANALYTICAL PLAN: Age- and sex-stratified AF prevalence for AF will be calculated using survey weights to estimate population prevalence. Sociodemographic and clinical factors associated with AF will be evaluated using multivariable regression methods. Performance of each mobile technology in detecting AF will be evaluated by measuring sensitivity, specificity, and discriminative ability while considering a 12-lead EKG interpretation as gold-standard. CONCLUSIONS: Effective approaches for leveraging state-of-the-art technology to develop a screening and referral mechanism for AF in low-resource settings requires active participation with community partners and health workers

Renal angiotensin-converting enzyme is essential for the hypertension induced by nitric oxide synthesis inhibition

The kidney is an important source of angiotensin-converting enzyme (ACE) in many species, including humans. However, the specific effects of local ACE on renal function and, by extension, BP control are not completely understood. We previously showed that mice lacking renal ACE, are resistant to the hypertension induced by angiotensin II infusion. Here, we examined the responses of these mice to the low-systemic angiotensin II hypertensive model of nitric oxide synthesis inhibition with L-NAME. In contrast to wild-type mice, mice without renal ACE did not develop hypertension, had lower renal angiotensin II levels, and enhanced natriuresis in response to L-NAME. During L-NAME treatment, the absence of renal ACE was associated with blunted GFR responses; greater reductions in abundance of proximal tubule Na+/H+ exchanger 3, Na+/Pi co-transporter 2, phosphorylated Na+/K+/Cl- cotransporter, and phosphorylated Na+/Cl- cotransporter; and greater reductions in abundance and processing of the γ isoform of the epithelial Na+ channel. In summary, the presence of ACE in renal tissue facilitates angiotensin II accumulation, GFR reductions, and changes in the expression levels and post-translational modification of sodium transporters that are obligatory for sodium retention and hypertension in response to nitric oxide synthesis inhibition.Fil: Giani, Jorge Fernando. Cedars Sinai Medical Center; Estados Unidos. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Janjulia, Tea. Cedars Sinai Medical Center; Estados UnidosFil: Kamat, Nikhil. University of Southern California; Estados UnidosFil: Seth, Dale M.. University of Tulane; Estados UnidosFil: Blackwell, Wendell-Lamar B.. Cedars Sinai Medical Center; Estados UnidosFil: Shah, Kandarp H.. Cedars Sinai Medical Center; Estados UnidosFil: Shen, Xiao Z.. Cedars Sinai Medical Center; Estados UnidosFil: Fuchs, Sebastien. Western University of Health Sciences; Estados UnidosFil: Delpire, Eric. Vanderbilt University; Estados UnidosFil: Toblli, Jorge Eduardo. Hospital Aleman; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Bernstein, Kenneth E.. Cedars Sinai Medical Center; Estados UnidosFil: McDonough, Alicia A.. University of Southern California; Estados UnidosFil: Gonzalez Villalobos, Romer A.. Cedars Sinai Medical Center; Estados Unido