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

A comparative study on perception and use of generic drugs between public and private health practitioners

Context: The perception of generic drugs may vary significantly between government and private doctors because physicians in the private sector have more prescribing choices and flexibility. Hence, this study was undertaken to analyse the knowledge, attitude and perception (KAP) of government and private physicians on generic drugs. Materials and Methods: This was a questionnaire-based cross-sectional study conducted among physicians working in public and private health sectors. The questionnaire had 25 closed-ended questions related to the KAP of generic medicine. The overall scores were categorised using Bloom's cut-off point. The Chi-square or Mann–Whitney U-test was used to compare the differences between the two groups. Results: About 80% of the participants in both groups agreed that generic medicines contain the same active ingredients as brand-name drugs, are less expensive and are available in the Indian market. Nearly 84% of government physicians and only 64% of private physicians believed that generic medicines are just as effective and secure as branded medicines (P - 0.003). The majority of physicians from both groups concurred that there is a lack of quality check in generic drug manufacturing, and they require more information about bioequivalence studies. In both categories, about 75% of participants preferred generic medications for their patients. However, in both groups, more than 50% of physicians were concerned about therapeutic failure and expressed reluctance to prescribe generic medications in life-threatening situations. Conclusions: Knowledge and acceptance of generic drugs regarding efficacy, safety, bioequivalence and therapeutic failure are low among both government and private physicians

Adherence to weekly iron folic acid supplementation and associated factors among adolescent girls – A mixed-method study

Context: Despite the Weekly Iron folic acid supplementation (WIFS) program, the prevalence of anaemia among adolescent girls remains high. Phase 1 Indian Council of Medical Research (ICMR) task force study conducted in 2016 in Kallur showed that the IFA provision rate for adolescent girls was 72% but the consumption rate was only 15% in the Kallur area. The present study was done to identify the gaps for the difference between provision and consumption rate of weekly IFA tablets among adolescent girls using the WHO conceptual framework in home-based settings. Materials and Methods: This crosssectional study with a mixedmethod design was conducted from October 2020 to December 2021. Quantitative data were collected from 972 adolescent girls and their parents using a structured pretested questionnaire, whereas qualitative exploration was done by focus group discussions. Descriptive analysis and bivariate analysis were used to analyse the quantitative data. Qualitative data were analysed and integrated with quantitative results. Results: The overall number of girls who were aware of Iron Folic acid therapy (IFAT) was 704 (72%). However, only 132 (13%) adolescent girls were found to be adherent to IFA therapy. Multivariable regression analysis revealed that side effects encountered on intake of IFAT (Odds ratio (OR) =0.5, P = 0.009) were associated with higher rates of nonadherence, whereas regular supply (OR = 13.6, P = 0.000), health education to parents (OR = 2.76, P = 0.002), and experiencing benefits (OR = 1.72, P = 0.006) were associated with higher rates of adherence. These were substantiated by qualitative findings. Conclusions: Ignorance on the impact of anaemia on adolescent health, fear of side effects, unpleasant effects experienced on intake of Iron folic acid (IFA), and inadequate counselling determines the adherence to weekly IFA supplements among adolescent girls