COMPARATIVE STUDY OF LOSARTAN WITH ENALAPRIL IN MILD TOMODERATE HYPERTENSION
Posted by on Thursday, 22nd July 2010
AIMS AND OBJECTIVES:
To study the efficacy, beneficial and adverse effects of losartan in comparison to enalapril in cases of mild to moderate hypertension during the period of January 2003 to January 2005.
MATERIALS AND METHODS:
In the present study 48 patients of stage 1 and II hypertension without any other complications were included from the Department of General Medicine. They are divided into two groups 'A' & 'B'. The group 'A' was subjected to losartan potassium 50 - 100'nig/day and group 'B' to enalapril maleate 5-10 mg/day to maintain the BP below 140/90 mmHg.
All the patients were subjected to detailed history and clinical examination at the time of presentation. Baseline investigations like nemogram, urine for albumin, sugar and microscopic examination, FBS, serum urea, creatinine, sodium, potassium , uric acid, total cholesterol and HDL cholesterol, LFT, ECG, X-ray chest and USG abdomen were done. All cases were critically evaluated at the time of discharge and were followed up fortnightly for 3 months. During each visit patient is enquired for any adverse effect, BP measured and was investigated for FBS, serum urea, creatinine , sodium , potassium and cholesterol. At the end of 3 months all investigation were repeated.
OBSERVATION:
In the present study it was observed that response rate to BP control is 90.9% with losartan group and 86.5% with enalapril group. Higher doses were required in 20% cases of losarton group and 30% cases of enalapril group. BP reduction was more .with losartan group.
There was no significant alteration in FBS, serum urea, creatinine, sodium and potassium, lipid profile, LFT and hemogram.
In losartan treated group a significant reduction in uric acid level (from 4.75±0.7 mg% to 3.24±0,48 mg%) in comparison to enalapril (4.5±0.71 mf% to 4.03 ±0,47 mg%) was seen.
No serious side effects were seen in both groups. However 10% cases of enalapril group developed dry cough. Overall incidence of adverse effects like weakness, dizziness were less with losartan (15%) than enalapril (25%). However due to small number of cases included in the present study the incidence of adverse effects may not represent the true incidence.
CONCLUSION:
The present study shows that losartan is a potent, safe antihypertensive agent along with uric acid lowering effect and is an useful adjunct to the antihypertensive therapeutic armamentarium.
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CATION (CALCIUM & MAGNESIUM) STATUS IN ESSENTIAL HYPERTENSION AND RESPONSE TO
Posted by on Thursday, 22nd July 2010
AIM:
1. To study the divalent cation status in essential hypertension and to observe the response to different antihypertensive drugs based on divalent cation status.
2. To emphasize the importance of calcium and magnesium status in essential hypertension to serve as surrogate markers of plasma rennin activity and to initiate antihypertensive drugs accordingly as close as physiological antidote.
MATERIALS AND METHODS:
The present study was conducted among essential hypertensive patients, aged >18years with SBP  140 mmHg and DBP  90 mmHg after exclusion of severe essential hypertension and secondary hypertensions in the department of Medicine. V.S.S. Medical College & Hospital, Burla from January 2004 to January 2006. There were 50 patients included in the study without any complication or morbidity. Detailed clinical and laboratory examination were performed. Patients with serum ionized calcium values were grouped into three groups i.e., Group 1 with 2.09  0.03, Group 2 with 2.24  0.03 and Group 3 with 2.34 0.03 mEq/L of ionized calcium and similarly three groups of patients with serum magnesium values i.e., Group 1 with 2.07 0.03 , Group 2 with 1.94 0.03 and Group 3 with 1.830.02 mEq/L magnesium according to Laragh et al. These groups represent surrogate of low rennin, normal rennin and high rennin activity status of essential hypertension respectively. Again these patients were divided into two groups i.e, Group A having surrogate of low renin and normal renin activity - surrogate (LREH/NREH) and constituted 40 patients and Group B surrogate of high rennin activity status of essential hypertension (HREH) and constituted 10 patients. Initially Group A patients were treated with Amlodipine and the cross over to Ramipril for 12 weeks with a washout interval of one month between the two treatments. Group B patients were similarly initially treated with Ramipril and the cross over to Amlodipine after a washout period of one month for 12 weeks respectively.
OBSERVATION:
1. By using the divalent cation status as surrogate of rennin activity incidence of low renin, normal renin and high renin essential hypertension was 36%, 44% and 20% respectively.
2. Incidence of low renin essential hypertension (LREH) was 55% in females and high renin essential hypertension (HREH) was 80% in males.
3. Most patients in Group –A (LREH) were in the age group between 56-60 years while in Group –B (HREH) the average age were between 42-45 years.
4. 82.5%(33) cases of Group A responded well to a dose of 5mg of Amoldipine, while 17.5% (7) responded well to 10mg. In comparison with Ramipril 95% (38) cases responded well to 5mg of Ramipril and 5%(2) cases with 2.5 mg of Ramipril.
5. In Group B 90% patients responded to 2.5 mg Ramipril, 10%(1) cases responded to 5 mg Ramipril. In comparison of response to Amlodipine 80% patients required 10 mg dose of Amlodipine.
6. Average SBP, DBP, MAP fall of the end of 12 weeks in Group–A with Amlodipine was 19.8, 13.7 and 15.8 mmHg respectively. While with Ramipril the average falls were 16.45, 7.79 and 10.72 mmHg respectively.
7. The average fall of SBP, DBP, MAP and Ramipril in Group–B were 18, 15.79 and 15.98 mmHg & 14.6, 8.8 and 10.23 mmHg respectively with Amlodipine.
CONCLUSION:
Measurement of serum ionized calcium and serum magnesium levels and according to their level which serve as surrogate marker of plasma renin activity can be classified into low renin, normal renin and high renin status of essential hypertension patients. From the above study, the low renin status patients best responded to calcium channel blocker Amlodipine, while high renin status patients best responded to ACE inhibitor Ramipril. This new innovative approach can help initiate antihypertensive drugs like a physiological antidote in the treatment of essential hypertension and may help to control hypertension and retard or prevent complications in the absence of costly, bothersome and non-availability of plasma renin activity study. SBP- Systolic Blood Pressure, DBP- Diastolic Blood Pressure, MAP- Mean Arterial Pressure, LREH- Low Renin Essential Hypertension, HREH- High Renin Essential Hypertension, NREH- Normal Renin Essential Hypertension.
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STUDY OF L-ARGININE THERAPY IN SICKLE CELL DISEASE PATIENTS
Posted by on Thursday, 22nd July 2010
Objective of the Study :
To study the effect of L-Arginine in sickle cell pain crises.
Methodology:
Sixty consecutive known patients of sickle cell disease (ss) with vasoocclusive pain crisis admitted to general medical ward were taken into study. Routine relevant haematological and other study were done for every patients. L-Arginine 8 gm/day in divided doses 8 hourly was given orally to 30 patients of trial group with consent of patients or their relatives along with current therapy of controlled gentle hydration. Oxygen and analgesic. Control group patients were managed with same current conservative therapy but without L-Arginine . Rating of pain scale was done daily 8 hourly.
Observation:
There were 22 male and 8 females on trial group and 24 male and 6 female in control group. Age range was between 15-35 years. 17 cases (56.7%) were age range between 15-20 years in trial group and 18 cases (60%) in control group. At presentation patients were classified in 3 group according to pain scale (0-10) into mild, moderate and severe pain . Trial group has mild pain in 2 cases (6.6%), moderate pain in 14 cases (46.7%), severe pain in 14 Cases (46.7%) and in control group mild pain in 2 cases (6.6%), moderate pain in 15 (50%) and severe pain in 13 cases (43.4%). There was no adverse effects due to L-arginine in this study in short term.
Resolution of pain after giving L-arginine in trial group with mild , moderate and severe pain was 48 hours , 60 hours and 88 hours respectively in comparison to control group with mild moderate and severe pain, which was 72, 96 and 128 hours respectively. There was a difference of decreased pain duration in trial group by 24 hour , 36 hours and 40 hours respectively.
Conclusion:
From this study it is concluded that administration of L-arginine in sickle cell pain crisis along with conventional conservative therapy can lessen the duration of pain crisis in comparison to conservative therapy alone. Patients having severe pain at the time of admission took longer time to pain resolution in both groups. However randomized double blind placebo controlled intention to treat trial should be done in large number of patients in multicentre to conclude its effectiveness.
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AN OBSERVATION ON NEUROCYSTICECOSIS
Posted by on Thursday, 22nd July 2010
AIMS AND OBJECTIVES:
The study has been undertaken to identify the incidence, clinical presentation and response to treatment of nerurocysticercosis (NC) in Western Orissa.
MATERIALS AND METHODS:
150 patients presenting with convulsion were investigated for NC with CT scan and ELISA and confirmed cases of NC were given albendazole, steroid and anticonvulsant and were followed up at regular interval for 3 months.
RESULT:
Out o f150 patients with convulsion 40(26.6%) were diagnosed to have NC. Out of 40 patients of NC 8 (20%) were vegetarian and 32(80%) were non-vegetarian including 5 pork eaters. 24 (60%) cases had presented with focal convulsion. In 32 (80%) cases CT showed single ring enhancing lesion (SSEL) and 8 (20%) showed multiple enhancing and non-enhancing lesions.
The common site of lesion is in parenchyma. In 30(75%) cases the lesion were found in the parietal lobe, ELISA for IgG NC was found 32(80%) and 24(60%) cases in CSF and serum respectively. Repeat CT Scan 3 month after treatment with albendazole (15 mg/kg/day fro 28 days) steroid and anticonvulsant, showed complete resolution in 36 (90%) cases. Remaining 4 (10%) cases those not resolved were calcified lesion.
CONCLUSION:
NC is a common cause of late onset focal convulsion in this part of country. As very few 5(12.5%) cases consumed pork, transmission fo NC through raw vegetable is a strong possibility, which may be due to contamination through the bio-fertilizer commonly used in this part of the country
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STUDY OF THYROID FUNCTION STATUS IN PATIENTS OF CHRONIC RENAL FAILURE
Posted by on Thursday, 22nd July 2010
AIMS OF THE STUDY:
To estimate Serum T3, T4TSH in patients of Chronic Renal failure with special reference to (a) Biochemcial abnormalities of thyroid functions in CRF(b) To correlate between severity of CRF and alteration of thyroid indices (c) Effect of conservative management vs haemodialysis on thyroid indices.
MATERIALS AND METHODS:
Twenty cases of CRF patients admitted to Department of Medicine and Nephrology, V.S.S. Medical College Hospital Burla from January 2003-December 2003 were taken for the study. CRF was diagnosed by the criteria given by “Harrison’s Principles of Internal Medicine, Edn 15th. Individuals with known thyroid disease and those on antithyroid drugs, iodine intake were not included in the study. Serum T3, T4, TSH and free T3, T4 was done in all patients on admission and repeated at 3rd , 6th and 12th months during follow up and results were compared. Severity of renal failure was grouped according to GFR and the value of T3, T4, TSH was compared between groups.
OBSERVATION:
Out of 20 CRF patients in this study, male (80%) commonest presenting features anorexia (80%), puffiness on face (70%), oliguria (50%). All patients were anaemic , 70% had hypertension. Commonest vause of CRF was diabetes (50%), hypertension (20%), chronic glomerulonephritis (10%), chronic pylonephritis (5%). No cause found in 15%. TSH was normal in 17 cases. Only 3 cases had increased TSH. 16 cases had low T3, 13 cases normal T4, only 7 cases had increased T4. No significant improvement in T3, T4, TSH was seen in aptietns receiving conservative management. However haemodialysis reverted the abnormality partially. Severity of renal failure and thyroid dysfunction with respect to T3 was found to be significant.
CONCLUSION:
From the study it can be presumed that, there occurs a state of biochemical hypothyroidism in patients of CRF and extent of thyroid dysfunction depends upon the severity of renal failure. The low T3 is not due to increased T3 degradation or decreased T3 secretion, but as a result of impaired extrathyroidal T4 to T3 conversion. The reduction in T4 s due to presence of circulating inhibitors which impair binding of T4 to thyroxin binding globulin. Conservative management does not improve thyroid status through haemodilysis partially reverts back the abnormality.
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