Post percutaneous coronary intervention antiplatelet therapy: Current perceptions, prospects and perplexity

Dual antiplatelet therapy (DAT) has become standard care for patients undergoing percutaneous coronary intervention (PCI). Following balloon injury and stent placement, the intima at the site is distressed, resulting in the activation of coagulation cascade and platelets. In the case of bare metal stents (BMS), it takes six to eight weeks for the stent surface to be covered with neointima. However, in the case of a drug-eluting stent (DES), the process of healing is delayed and neointima may not form for months or even years. To prevent the formation of platelet thrombi, dual antiplatelet therapy is given as a combination of aspirin and clopidogrel for three months in a case of BMS and for a minimum of one year in a case of DES. A prolonged duration of therapy is often required for a subset of patients who are highly prone to thrombus formation. During most non-cardiac surgeries, dual antiplatelet therapy should be continued if bleeding can be directly controlled and excessive bleeding will have no adverse effect on the outcome of surgery. Prasugrel, another thienopyridine, is more potent and faster acting than clopidogrel, and is therefore of great value in cases of acute coronary syndrome during PCI, particularly in diabetics. Triple drug therapy, by adding cilastozol, is reserved for some selected thrombotic lesions. Ticagrelor and cangrelor are two new antiplatelet agents undergoing various clinical trials. (Cardiol J 2011; 18, 6: 712–717

Tobacco Use during Pregnancy and Its Associated Factors in a Mountain District of Eastern Nepal: A Cross-Sectional Questionnaire Survey

BackgroundTobacco using among women is more prevalent in Nepal as compared to other South-East Asian countries. The effect of its use is seen not only on the pregnant women, but also health of the growing fetus is compromised. Currently, little is known about the tobacco use among women especially during pregnancy in Nepal. This study explored the tobacco use prevalence and its associated factors during pregnancy.Materials and methodsA cross-sectional study was conducted in Sankhuwasabha, a mountain district of eastern Nepal. Representative sample of 436 women of reproductive age group with infant were selected by stratified simple random sampling. Data were collected by face-to-face interviews of selected participants. Data were analyzed with SPSS version 16.0. Binary logistic regression was used to analyze the relationship among variables.ResultsThe study revealed that the prevalence of tobacco use during pregnancy was 17.2%. Only one fifth of the research participants were asked to quit tobacco by health workers during last pregnancy. Multivariable analyses revealed that illiteracy (AOR: 2.31, CI: 1.18–4.52), more than two parity (AOR: 2.45, CI: 1.19–5.07), alcohol use during last pregnancy (AOR: 3.99, CI: 1.65–9.68), and having tobacco user within family (AOR: 2.05, CI: 1.11–3.78) are more likely to use tobacco during pregnancy.ConclusionTobacco use during pregnancy was widely prevalent. Tobacco-focused interventions are required for antenatal women to promote cessation among user and prevent initiation with focus on overcoming problems like illiteracy, high parity, alcohol use, and having other tobacco user family members in family

Hypertension in the elderly: Are we all on the same wavelength?

Hypertension is of frequent occurrence in the elderly population. Isolated systolic hypertension (ISH) accounts for the majority of cases of hypertension in the elderly. ISH is associated with a 2-4-fold increase in the risk of myocardial infarction, left ventricular hypertrophy, renal dysfunction, stroke, and cardiovascular mortality. There have been many studies to determine the optimal treatment for hypertension in the elderly. Why, when and how to treat hypertension in the elderly was the scope of the majority of these trials. Despite countless efforts many aspects remain obscure. While a number of novel drugs are being developed, the issue of whether all antihypertensive drugs bestow parallel benefits or whether some agents offer a therapeutic advantage beyond blood pressure control remains of crucial importance. Furthermore, the response of the elderly to different antihypertensive agents also differs from that of younger patients and may explain some of the disparities in outcomes of trials conducted in elderly patients with hypertension

Preliminary Study on the Antibacterial Activities and Antibacterial Guided Fractionation of Some Common Medicinal Plants Practices in Itum Bahal, Kathmandu Valley of Nepal

The aim of this study was to evaluate the antibacterial activities of selected medicinal plant practices by a traditional healer of the Newar community in Itum Bahal, Kathmandu, Nepal. The antibacterial activities of the methanolic extract (1 mg/disc) of fifteen medicinal plants were screened against two Gram-positive bacteria (Staphylococcus aureus ATCC 25923 and Bacillus subtilis ATCC 6633) and two Gram-negative bacteria (Escherichia coli ATCC 25922 and Salmonella typhi CCM 5445) using the disc diffusion method. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were calculated for the different fractions (hexane, chloroform, ethyl acetate, acetonitrile, and acetone) of the plants having a significant antimicrobial effect. Only Quercus infectoria G. Olivier (galls) and Mallotus repandus (Willd.) Müll.Arg. (seeds) exhibited prominent antibacterial effects. The acetone fraction from Q. infectoria had the strongest antibacterial effect, with a 41.00 mm inhibition zone against S. aureus. In contrast, the ethyl acetate fraction in M. repandus exhibited the highest efficacy, producing a 29.00 mm inhibition zone against S. typhi. In a similar manner, in the case of Q. infectoria, the acetoe fraction depicted the lowest MIC (0.19 mg/mL) and MBC (0.98 mg/mL) values against S. aureus, whereas the ethyl acetate fraction of M. repandus was most significant, showing the lowest MIC and MBC of 0.25 and 0.53 mg/mL, respectively, against S. typhi. This study suggested that the acetone extract of Q. infectoria galls can be used as a potential source against Gram-positive bacteria, whereas the ethyl acetate extract of M. repandus seeds could serve as a useful source to inhibit Gram-negative bacteria. Furthermore, extensive scientific investigation is mandatory to ensure the proper use of folk medicines