Comparison between antiproteinuric effects of cilnidipine and amlodipine as add on therapy in hypertensive patients with chronic renal disease.

To compare the efficacy and safety of cilnidipine and amlodipine as add on therapy in chronic kidney disease patients who are on losartan (Angiotensin receptor blocker) for > 2 months. METHODS: In this prospective, single centered, open labeled, randomized study, the antiproteinuric effects of cilnidipine (L/N type calcium channel blockrer) and amlodipine (L type calcium channel blocker) were examined in diabetic chronic renal disease patients with hypertension (BP ≥ 130/80 mmHg) who are already under treatment with T. Losartan 50 mg OD. Antiproteinuric effects were assessed by reduction in spot urine protein creatinine ratio from baseline. RESULTS: Patients received cilnidipine (n=46) or amlodpine (n=50) for 6 months. Cilnidipine and amlodipine reduced systolic and diastolic blood pressure equally. The spot urine protein creatinine ratio values for cilnidipine and amlodipine were 1.94±1.22 g/g and 1.38±0.98 g/g respectively before treatment and 1.09±0.72 g/g and 1.40±0.65 g/g respectively after treatment. The mean serum creatinine concentration gradually increased in both the groups and attained statistical significance at the end of 6 months. Estimated GFR was maintained by both the drugs throughout the study period. Distribution of CKD stages were also similar between the two groups before and after treatment. None of the produced reflex tachycardia. CONCLUSION: In conclusion, cilnidipine has antihypertensive effect equivalent to amlodipine but addition of cilnidipine rather than amlodipine to losartan decreased urine protein excretion in diabetic chronic kidney disease patients. Therefore combination therapy with cilnidipine and RAS inhibitor may be more beneficial and renoprotective in patients with diabetic chronic kidney disease

Antiproteinuric effects of cilnidipine and amlodipine as add on therapy in hypertensive patients with chronic renal disease: a comparative study

Background: Cilnidipine is a dual blocker of L type and N type calcium channel and dilates both afferent and efferent arterioles. Hence it increases renal blood flow and reduces glomerular pressure ultimately reducing proteinuria. Thus, it may exert renoprotective effects. The present study was designed to compare the antiproteinuric effects of cilnidipine and amlodipine in hypertensive patients with chronic kidney disease as add on therapy to patients on losartan.Methods: This is a randomized, open label, prospective, parallel group study conducted in the out patient Department of Nephrology. The trial enrolled Diabetic CKD patients with hypertension and with spot urine protein creatinine ratio (PCR) ≥0.2 who were being treated with T. Losartan 50mg/day for >2 months. The subjects were then randomly assigned to 2 groups to receive either cilnidipine 10-20mg/day (Group A-46) or amlodipine 5-10mg/day (Group B- 50). The drugs were given for a duration of 6 months for each patient. The dose of losartan (50mg/day) was not adjusted throughout the study.Results: After 6 months, a significant reduction in systolic and diastolic blood pressure was seen in both the groups. The decrease in urinary protein creatinine ratio was significantly higher in cilnidipine group rather than amlodipine group. Thus, cilnidipine exerted greater antiproteinuric effect than amlodipine.Conclusions: Cilnidipine has antihypertensive effect equivalent to amlodipine but addition of cilnidipine rather than amlodipine to losartan decreased urine protein excretion in diabetic chronic kidney disease patients

Impact and Perception of Virtual Team-based Learning in Comparison to Online Lectures in Pharmacology- A Randomised Crossover Interventional Study

Introduction: Competency-based Medical Education (CBME) emphasizes small group teaching; henceforth, more innovative educational strategies are needed to stimulate student learning. Team-based Learning (TBL) is structured small-group teaching featuring student preparation out of class to acquire critical concepts. In the current study, TBL was carried out on a virtual platform using commonly available web applications. Aim: To evaluate the impact and perception of virtual TBL compared to online lectures in Pharmacology. Materials and Methods: The randomised crossover study was conducted from September 2021 to January 2022, in the Pharmacology department of Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India. The students were assigned into two groups in the ratio of 1:1 by simple random sampling. Students in group A attended TBL sessions, whereas group B attended lectures on the same topic via Google classroom for the first session. A crossover of groups was done for the second session. At the end of both sessions, a questionnaire with Multiple Choice Questions (MCQs) to assess knowledge recall and Short Answer Questions (SAQs) to assess critical analysis was sent to both groups in Google forms, and responses were collected and evaluated. A validated 33 item TBL Student Assessment Instrument (TBL-SAI) was used to determine the student perceptions. An unpaired t-test was used to compare the scores of both groups to assess performance. Mann-Whitney U test was used to compare the student accountability, preference, and satisfaction scales of TBL-SAI. Results: Out of 130 students, 125 were taken up for analysis as five failed to attend the sessions or complete the questionnaire. TBL group scored significantly better than the lecture group in MCQs {(15.8±2.2 vs 12±2.6) and (12.7±3.5 vs 6.4±2.2)} and SAQs {(5.4±2.1 vs 2.3±1.4) and (6.1±2.0 vs 3.3±1.9)} in sessions 1 and 2, respectively. TBL-SAI subscale and total scores were higher than neutral scores in both groups, indicating a positive attitude toward virtual TBL. Conclusion: Implementation of virtual TBL in synchronous setting in Pharmacology course established proof of high student accountability and satisfaction. Students preferred online TBL to online lectures. Virtual TBL sessions were more effective than online lectures