Comparative study of amlodipine versus ramipril and their effects on markers of renal disease in type 2 diabetes mellitus

Background: Diabetes mellitus is a chronic metabolic condition and patients require long treatment for it. The aim of the study was to evaluate the effects of amlodipine and ramipril on the blood pressure and markers of renal disease (viz. serum creatinine, albuminuria and eGFR) in type 2 diabetes mellitus.Methods: This was a randomized, open labelled, parallel study conducted to assess the effect of Amlodipine (2.5-10 mg) and Ramipril (2.5-10 mg) daily for 24 weeks in T2DM patients (n=103). Patients were recruited from department of Medicine OPD/Ward in the GGS Hospital and Medical College, Faridkot. Subjects in the age group of 30- 80 years who had T2DM with or without hypertension were enrolled and randomly divided into two groups viz. Group A (n=51, amlodipine 2.5 to 10 mg/day) and Group B (n=52, ramipril 2.5 to 10mg/day). Patients were evaluated at day 0 and then at 12 and 24 weeks for Blood pressure, S. Creatinine, albuminuria, eGFR and other routine investigations.Results: At 24 weeks SBP, DBP and MAP values were decreased significantly in both the groups (p 0.05) in Ramipril group. eGFR was decreased (9.73%, p <0.01) in Amlodipine group while increased in Ramipril group (10.29%, p<0.01 %).Conclusions: Both amlodipine and ramipril are equally efficacious in improving SBP, DBP and MAP in T2DM patients. Whereas, ramipril is also improves the markers/predictors of renal disease (viz. serum creatinine, albumin level in urine and eGFR) in T2DM patients, furthermore, it is having renoprotective action in an addition to lowering raised blood pressure which is useful to treat diabetic nephropathy cases

Study of Patients’ awareness and their perspective about diabetic disorder in T2DM patients: A descriptive study

Introduction: Type 2 Diabetes mellitus, a metabolic disorder is mostly related to the sedentary life style of subjects. Awareness of diabetes disorder among diabetics plays a crucial role in its management. Aims &amp; Objectives: To study the awareness of diabetes disorder, its complications and management among T2DM patients. Materials and Methods: This was a cross-sectional and descriptive study done among T2DM patients who visited the OPD of department of Medicine at GGS Hospital, Faridkot (in a rural area of Punjab-India). A pretested proforma contained questionnaire related to the awareness/ knowledge to diabetic disorders, its complications and management was distributed among 300 subjects and their response was analyzed. Results: 235 patients responded (78.33%) to the pretested proforma. Males and females were 48.08% and 51.92% respectively. 25.53% subjects were illiterate. Lack of knowledge about diabetic disorders in 79.57%, duration of treatment in 73.61%, their complications in 74.89%, modification of diet in 40%, their body care/cleanliness in 62.55% and leaving of medication in 76.17% were seen. A habit of taking other indigenous / complimentary medicines was also seen in 40.43% of cases along with conventional antidiabetic therapy. Conclusion: Most of the diabetic patients had lack of knowledge about diabetic disorders, its complications and management. They also left the medicine in midway of treatment and had developed signs &amp; symptoms of hyperglycemia. A good number of patients also took indigenous products to treat their disease. They also didn’t follow the life style modification measures appropriately. Therefore, adequate awareness/knowledge should be provided to all the diabetic patients to manage diabetic disorder in a better way. Keywords: Knowledge, Perspectives, Complications, Life style modification, Complementary &amp; Alternative medicine (CAM), Medication compliance &amp; Adherence

2016 United Kingdom national guideline on the sexual health care of men who have sex with men.

This guideline is intended for use in UK Genitourinary medicine clinics and sexual health services but is likely to be of relevance in all sexual health settings, including general practice and Contraception and Sexual Health (CASH) services, where men who have sex with men (MSM) seek sexual health care or where addressing the sexual health needs of MSM may have public health benefits. For the purposes of this document, MSM includes all gay, bisexual and all other males who have sex with other males and both cis and trans men. This document does not provide guidance on the treatment of particular conditions where this is covered in other British Association for Sexual Health and HIV (BASHH) Guidelines but outlines best practice in multiple aspects of the sexual health care of MSM. Where prevention of sexually transmitted infections including HIV can be addressed as an integral part of clinical care, this is consistent with the concept of combination prevention and is included. The document is designed primarily to provide guidance on the direct clinical care of MSM but also makes reference to the design and delivery of services with the aim of supporting clinicians and commissioners in providing effective services. Methodology This document was produced in accordance with the guidance set out in the BASHH CEG's document 'Framework for guideline development and assessment' published in 2010 at http://www.bashh.org/guidelines and with reference to the Agree II instrument. Following the production of the updated framework in April 2015, the GRADE system for assessing evidence was adopted and the draft recommendations were regraded. Search strategy (see also Appendix 1) Ovid Medline 1946 to December 2014, Medline daily update, Embase 1974 to December 2014, Pubmed NeLH Guidelines Database, Cochrane library from 2000 to December 2014. Search language English only. The search for Section 3 was conducted on PubMed to December 2014. Priority was given to peer-reviewed papers published in scientific journals, although for many issues evidence includes conference abstracts listed on the Embase database. In addition, for 'Identification of problematic recreational drug and alcohol use' section and 'Sexual problems and dysfunctions in MSM' section, searches included PsycINFO. Methods Article titles and abstracts were reviewed and if relevant the full text article was obtained. Priority was given to randomised controlled trial and systematic review evidence, and recommendations made and graded on the basis of best available evidence. Piloting and feedback The first draft of the guideline was circulated to the writing group and to a small group of relevant experts, third sector partners and patient representatives who were invited to comment on the whole document and specifically on particular sections. The revised draft was reviewed by the CEG and then reviewed by the BASHH patient/public panel and posted on the BASHH website for public consultation. The final draft was piloted before publication. Guideline update The guidelines will be reviewed and revised in five years' time, 2022

How should a District General Hospital immunology service screen for antinuclear antibodies?:An "in the field" audit

Anti-nuclear antibody (ANA) testing assists in the diagnosis of several immune-mediated disorders. The gold standard method for detection of these antibodies is by indirect immunofluorescence testing on human epidermoid laryngeal carcinoma (HEp-2) cells. However, many laboratories test for these antibodies using solid-phase assays such as enzyme-linked immunosorbent assay (ELISA), which allows for higher throughput testing at reduced cost. In this study, we have audited the performance of a previously established ELISA assay to screen for ANA, making comparison with the gold standard HEp-2 immunofluorescence test. A prospective and unselected sample of 89 consecutive ANA test requests by consultant rheumatologists were evaluated in parallel over a period of 10 months using both tests. ELISA and HEp-2 screening assays yielded 40 (45%) and 72 (81%) positive test results, respectively, demonstrating lack of concordance between test methods. Using standard and clinical samples, it was demonstrated that the ELISA method did not detect several ANA with nucleolar, homogeneous and speckled immunofluorescence patterns. None of these ELISA(NEG) HEp-2(POS) ANA were reactive with a panel of six extractable nuclear antigens or with double-stranded DNA. Nonetheless, 13 of these samples (15%) originated from patients with recognized ANA-associated disease (n = 7) or Raynaud's phenomenon (n = 6). We conclude that ELISA screening may fail to detect clinically relevant ANA that lack defined specificity for antigen