An Open-label, Prospective, Multicentric, Cohort Study of Nimesulide/Paracetamol Fixed Drug Combination for Acute Pain Management: Sub-group Analysis.

OBJECTIVE: Nimesulide has been evaluated in numerous clinical studies in the management of a variety of acute painful conditions. However, there is limited Indian data available on the nimesulide/paracetamol fixed drug combination (FDC). Hence, an open-label prospective multicentric study was conducted to evaluate the safety and efficacy of this FDC in the management of acute painful conditions in real-world settings. MATERIALS AND METHODS: A prospective, open-label, and multicenter study conducted at 24 centers across Indian patients with acute painful conditions due to trauma, tendinitis, myalgia, low backache, sprains, pulled muscle, soft tissue injury, dental pain, and dental procedure/surgery. Nimesulide/paracetamol FDC was prescribed by clinicians as a part of routine practice. The effectiveness was evaluated on the numerical rating scale (NRS), that is, pain intensity at rest and movement, and the physician/patient global assessment scale (GAS) among the subgroups of acute painful conditions like myalgia, dental pain, low backache, etc. Hepatic safety was also evaluated among the subgroups at the end of treatment. RESULT: A total of 464 patients were included in the study. The reduction in NRS score at rest and movement during treatment duration across different types of pain was statistically significant (p < 0.001). Pain reduction was evident as per patient and physician GAS at the end of treatment in all indications. No clinically significant difference was found in liver parameters at the end of the study. Nimesulide/paracetamol (FDC) was well tolerated across all the subgroups. CONCLUSION: Nimesulide/paracetamol FDC was found to be well-tolerated and effective in pain management across all acute painful conditions in a real-world setting without any hepatic safety concerns.

May Measurement Month Blood Pressure Screening Program: A Pan India Study.

Background: High blood pressure (BP) is the largest contributor to the global burden of disease and mortality. This Blood Pressure screening program was initiated in conjunction with the May Measurement Month to increase the awareness of the importance of BP and also designed to understand the problems of real time clinical situations. Methodology: This was a cross sectional, multicentric, non-interventional, observational and single visit study. The study was conducted in the Outpatient department of many clinics/ institutions. The convenience sampling technique was used to select the centers in this study and obtain the geographical distribution of India. Results: A total of 1,36,095 BP screening forms were considered for analysis. A total of 37,017 subjects (27.2%) had BP of >130/80 mm Hg. Among participants, 44.5% of men in age group of 51 ­ 60 years had high BP. 31.2 % of the women in the age group of 41-50 years had high BP. Among 37017 subjects, 14066 subjects (38%) were newly diagnosed subjects with hypertension. In the subset (N=22,951) of known cases of hypertension, Men were 14, 127 (Urban, N=7488 and Rural, N=6639) and 8824 were women (Urban, N=4588 and Rural, N=4236). The common comorbidities were dyslipidemia, cardiovascular disorders and diabetes. Conclusion: Despite the advances in hypertension management and emphasis on patient education, our study shows that hypertension continues to be a significant health burden. Improving patient compliance to lifestyle modifications, medication and regular follow-up clinic visits by imparting patient education and awareness can provide better results in Hypertension management.

Significance of BP Control in Reducing Stroke Events: Role of Amlodipine in an Indian Perspective.

While the incidence and prevalence of stroke is gradually decreasing in the western world, a parallel increase is seen in the developing world. It is a matter of special concern to us as approximately 20-30% of stroke occur in people younger than 45 years in India. Indians are prone to higher stroke risk because of urbanization, diabetes, cigarette smoking and high incidence of hypertension. Unfortunately, there is an inadequate awareness about the risk of stroke with hypertension among general public. Hypertension is considered to be the most important risk factor for stroke, and all forms of hypertension are associated with an increased risk of both ischemic and haemorrhagic stroke. The presence of hypertension also worsens mortality in stroke. Recently, it has been increasingly observed that controlling blood pressure variability (BPV) is equally important as achieving BP reduction, and an increased BPV has been shown to increase stroke risk. Thus, effective treatment option for stroke prevention should include drugs which can reduce BPV as well. The landmark ASCOT-BPLA trial reported that the calcium channel blocker amlodipine decreases stroke risk in hypertensive patients, and attributed this beneficial effect to its effective lowering of BPV. Such beneficial effects of amlodipine were replicated in other trials as well and thus it becomes an important drug from an Indian perspective. In this review, we analyse published literature and present a picture on the effect of amlodipine in the stroke prevention in hypertensive patients.

Consensus evidence-based guidelines for management of hyperglycaemia in patients undergoing coronary artery bypass grafting in patients with diabetes in India.

Diabetes is associated with a significant risk of cardiovascular diseases (CVDs). Patients with diabetes are known to suffer from a disproportionately large burden of CVDs, in terms of higher risk, worse prognosis and more adverse outcomes. Acute coronary syndromes, including coronary artery disease, represent a large proportion of this burden and conventionally coronary artery bypass grafting (CABG) has been the mainstay of facilitating reperfusion in patients with diabetes. However, hyperglycaemia is an important factor which affects the outcomes of CABG and shows a grave impact on patients' well-being. Thus, it is important to appropriately manage hyperglycaemia in the peri-and intra-operative periods to assure the best possible outcomes in patients with diabetes. There is scant evidence to show that oral antidiabetic drugs (OADs) or non-insulin based therapies show considerable benefit in patients undergoing CABG. Even with the use of insulin-based therapies, appropriate glycaemic targets, accurately designed algorithm to achieve such targets and specific recommendations to facilitate the appropriate use of such algorithm are important considerations. However, current international guidelines are either country-specific or fail to address context-specific needs in individual countries. In view of the growing incidence of cardiovascular diseases and diabetes in India, as a result of changing lifestyles, it is imperative upon clinicians to formulate India-specific guidelines for effective management of (CVDs). It is the endeavour of the current guideline to present recommendations based on a firm evidentiary foundation coupled with context-specific inputs from experts' consensus opinion. These recommendations represent an effort to address the urgent need for such an exercise both in the academic as well as the clinical realm.

The Chennai Declaration: a roadmap to tackle the challenge of antimicrobial resistance.

"A Roadmap to Tackle the Challenge of Antimicrobial Resistance - A Joint meeting of Medical Societies in India" was organized as a pre-conference symposium of the 2 nd annual conference of the Clinical Infectious Disease Society (CIDSCON 2012) at Chennai on 24 th August. This was the first ever meeting of medical societies in India on issue of tackling resistance, with a plan to formulate a road map to tackle the global challenge of antimicrobial resistance from the Indian perspective. We had representatives from most medical societies in India, eminent policy makers from both central and state governments, representatives of World Health Organization, National Accreditation Board of Hospitals, Medical Council of India, Drug Controller General of India, and Indian Council of Medical Research along with well-known dignitaries in the Indian medical field. The meeting was attended by a large gathering of health care professionals. The meeting consisted of plenary and interactive discussion sessions designed to seek experience and views from a large range of health care professionals and included six international experts who shared action plans in their respective regions. The intention was to gain a broad consensus and range of opinions to guide formation of the road map. The ethos of the meeting was very much not to look back but rather to look forward and make joint efforts to tackle the menace of antibiotic resistance. The Chennai Declaration will be submitted to all stake holders.

Obesity and weight management in primary care.

It is traditional to define obesity in reference to one individuals's body mass index. It is an important health problem in India. There are multiple conditions causing obesity eg, genetic, cultural, socioeconomic, behavioural, situational, metabolic and physiological. There are a number of comorbid conditions of obesity which have an impact on morbidity. Management in clinical practice should always be a patient oriented approach. The management consists of the following approaches: Evidence that reducing weight decreases disease risk, changing patient's expectations and goals, dietary management, physical activity--some general guidelines, behavioural therapy, selection of patient, centrally acting anorexiant medications, peripherally acting medications, the endocannabinoid system, surgery, etc.