Comparison of efficacy of azilsartan with olmesartan in patients of hypertension: randomized controlled trial

Background: Azilsartan and olmesartan are members of ARBs, used in the management of hypertension. Objective was to evaluate efficacy of azilsartan with olmesartan in patients of hypertension. Methods: A randomized, prospective, open label, comparative study was carried out in Pharmacology and Medicine department at Dr. RPGMC Kangra at Tanda, HP. The study stretched over one year and blood pressure was monitored at first, third and sixth month. Out of 69 patients, 35 patients in group A were prescribed tablet azilsartan 40 mg/day and 34 patients in group B patients were prescribed tablet olmesartan 20 mg/day. Tablet chlorthalidone 12.5 mg/day was add on in both the groups. Data was presented as mean+SD. Student’s t test was used and p value <0.05 was considered significant. Results: In group A, systolic blood pressure (SBP) values improved from baseline of 153±10 mmHg to 111±18 mmHg (p<0.001) at 3 months and 109±6.1 mmHg (p<0.001) at 6 months and diastolic blood pressure (DBP) values from baseline of 87±7 mmHg to 67.1±4.6 mmHg (p<0.001) at 3 months and 67.6±2.5 mmHg (p < 0.001) at 6 months. In group B, SBP values improved from baseline of 154±8.5 mmHg to 127±3.6 mmHg (p<0.001) at 3 months and 123±4 mmHg (p<0.001) at 6 months and DBP values from baseline of 85±6.5mm Hg to 75.7±3.3 mmHg (p<0.001) at 3 months and 73±3.3 mmHg (p<0.001) at 6 months. On intergroup comparison improvement in hypertension was better in azilsartan group (p<0.001). Conclusions: The study concluded that azilsartan is significantly better than olmesartan in controlling the hypertension.

Navigation-guided optic canal decompression for traumatic optic neuropathy: Two case reports

Two cases of traumatic optic neuropathy presented with profound loss of vision. Both cases received a course of intravenous corticosteroids elsewhere but did not improve. They underwent Navigation guided optic canal decompression via external transcaruncular approach, following which both cases showed visual improvement. Postoperative Visual Evoked Potential and optical coherence technology of Retinal nerve fibre layer showed improvement. These case reports emphasize on the role of stereotactic navigation technology for optic canal decompression in cases of traumatic optic neuropathy.

Autologous transfusion in a patient with life threatening traumatic haemothorax: Case Report.

Penetrating thoracic injuries frequently presents a challenge to the clinicians. The situation may become more deleterious owing to the unavailability of adequate blood of required group. We discuss the acute management of a patient with life threatening traumatic haemothorax following penetrating thoracic injury. In this patient, autologous transfusion of patient blood collected in chest drain was performed during intraoperative period using an indigenous technique with successful outcome.

Maturation of permanent teeth in different facial types: A comparative study.

Background: Accurate diagnosis of dental maturation help in diagnosis, treatment planning, and timing in orthodontics and dentofacial orthopedics. Aim and Objective: The present study is undertaken to compare and correlate chronological age and dental age of patients with average, vertical, and horizontal facial types, and to find out any sex difference in dental age in different growth patterns and to evaluated the reliability of Willem's method in Indian population. Materials and Methods: Subjects in the age group of 8-10 years were screened from Out Patients Department of Orthodontics and Dentofacial Orthopedics and from the various school of the City, were subjected to cephalometric radiography and orthopentomograms. Angular and linear measurements used included;-SN Go-Gn angle, J.R. (Jarabak ratio) and LAFH (lower anterior facial height), to group total sample of 150 children. Group 1 (average grower), Group 2 (vertical grower), and Group 3 (horizontal grower). Then dental age for each child in different group was calculated from OPG of each subject and compared with chronological age using Student t-test. Results: The results suggest a difference in dental age in subject with vertical and horizontal growers. Vertical grower showed earlier maturation compared to horizontal growth patterns. There was insignificant difference present when vertical grower and horizontal grower were compared with average growth pattern. Insignificant difference was found in dental age between males and females when compared to same growth pattern. Conclusion: Subjects with vertical growth pattern matured early than having the horizontal growth pattern in the same chronological age.

Diagnosis of spontaneous bacterial peritonitis: Role of tween 80 and triton X in ascitic fluid cultures.

A patient with alcoholic cirrhosis of the liver, portal hypertension with hepatic encephalopathy and spontaneous bacterial peritonitis (SBP) was admitted in an obtunded condition. Attempts at delineating the aetiology of the SBP using conventional cultures as well as automated systems were not successful. The use of non-anionic surfactant agents such as Tween 80-incorporated blood agar and Triton X treatment of the specimens facilitated the growth of Klebsiella pneumoniae from the ascitic fluid, which otherwise would have been concluded to represent culture-negative neutrocytic ascites. Thus, the use of the aforementioned agents could be explored in elucidating the aetiology of body cavity infections when conventional methods fail.

Affinity purification and partial characterization of IgM-like immunoglobulins of African catfish, Clarias gariepinus (Burchell, 1822).

IgM like macroglobulin from bovine serum albumin (BSA)-immunized African catfish C. gariepinus was purified by affinity chromatography and partially characterized. The molecular weight of this macroglobulin was 840 kDa, as estimated by gel filtration chromatography. Purified macroglobulin was analyzed using SDS-PAGE under reducing and non-reducing conditions. The molecular weight (MW) of heavy and light chain was 74.8 kDa and 27.2 kDa respectively, in presence of a reducing agent. In non-reducing SDS-PAGE, a single high MW band was observed representing tetrameric form.

Photographic appraisal of crystal lattice growth technique.

Concept of creating mechanical retention for bonding through crystal growth has been successfully achieved in the present study. By using polyacrylic acid, sulphated with sulphuric acid as etchant, abundant crystal growth was demonstrated. Keeping in view the obvious benefits of crystal growth technique, the present SEM study was aimed to observe and compare the changes brought about by different etching agents (phosphoric acid, polyacrylic acid and polyacrylic acid sulphated) and to evaluate their advantages and disadvantages in an attempt to reduce iatrogenic trauma caused due to surface enamel alteration. Control and experimental groups were made of 24 and 30 premolars, respectively, for scanning electron microscopic appraisal of normal unetched and etched enamel surface and fracture site and finished surface evaluation. When compared with conventional phosphoric acid and weaker polyacrylic acid, investigations indicated that crystal growth treatment on enamel surface caused minimal iatrogenic trauma and surface alteration were restored to the original untreated condition to a large extent.

Linear assessment of anteroposterior jaw relationship.

Three Linear methods of establishing the sagittal relationship of the maxillary and mandibular apical bases were compared using Lateral skull radiographs of thirty individuals having Class II div. 1 malocclusion. Statistical evaluation was done for wit appraisal, AD' distance, and Wylie analysis. The A-D' distance is recommended for use during sagittal apical base relationship.

Maxillo- mandibular relationship--a cephalometric study.

An accurate assessment of apical base relationships using cephalometrics has been a perennial problem in orthodontics. The currently available literature suggests that reference points and planes are subject to change with treatment. Hence, an assessment of sagittal jaw relationship was done using five angular measurements and an attempt was made to determine the one which is statistically more accurate.

Seroprevalence of hepatitis A virus antibody in patients with chronic liver disease--experience from a tertiary care hospital in north India.

Patients with chronic liver disease of any etiology are at a high risk for a more severe outcome when superinfected with hepatitis A virus (HAV). Prevention of hepatitis A, by inactivated vaccine has been shown to be safe and effective in this subgroup of patients. Most countries in the West recommend prophylaxis against hepatitis A virus for patients with chronic liver disease. However, hepatitis A virus is endemic in India. Before advocating a uniform prophylaxis against hepatitis A for chronic liver disease patients in India, we prospectively evaluated the seroprevalence of hepatitis A virus antibody (Anti HAV) among the patients with cirrhosis of liver registered at our hospital, using a commercial enzyme-immunoassay (ELISA). Prevalence of protective antibody against HAV among the 42 Cirrhotic patients included in the study was documented to be 97.6% (41/42). Therefore, vaccination against hepatitis A virus infection may not be needed among patients with chronic liver disease in our population. However, further studies including adequate sample size is needed to confirm the observation encountered in the present study.

High seroprevalence and clinical significance of hepatitis B and C infection in hospitalized patients with alcoholic cirrhosis.

OBJECTIVES: Patients with alcoholic cirrhosis (AC) are frequently infected with hepatotropic viruses which could alter the clinical spectrum of the disease. We studied the seroprevalence of hepatitis B (HBV) and hepatitis C virus (HCV) and their impact on the clinical profile of patients with AC. METHODS: Two hundred and ten hospitalized patients of AC were studied and screened for markers of HBV and HCV infection. Clinical, biochemical and virological correlation was done. RESULTS: One hundred and forty (66.6%) patients had no viral infection Group I, 50 (23.8%) were positive for HBsAg Group II and 20 (9.5%) for anti-HCV Group III. All patients were males with comparable ages (43.9 years, 44 years and 45.9 years respectively). The amount of alcohol consumed by patients in Group III (130 +/- 115 g/d) was significantly less than Group II (204 +/- 130 g/d, P < 0.05) and Group I (281 +/- 188 g/d, p < 0.001). The duration of alcohol abuse was shorter in Group II and III, although not statistically significant. Presentation as jaundice was common in Group II and III (p < 0.05). The AST and ALT values (IU/L) were significantly higher in Group II (239 +/- 351, 197 +/- 266) and III (157 +/- 170, 86 +/- 52) than Group I (89 +/- 78, 66 +/- 54) (P < 0.05). The serum alkaline phosphatase (IU/L) was higher in Group III (349 +/- 223) as compared to Group II (263 +/- 186) and Group I (162 +/- 62) (P < 0.05). There was however, no difference in Child's grade or the discriminant function between the three groups of patients. CONCLUSIONS: (i) One-third of the hospitalized patients with AC are infected with HBV or HCV infection, (ii) these infections hasten clinical presentation of patients with alcoholic liver disease, with lesser amount of alcohol consumption and (iii) jaundice, raised ALT/AST and alkaline phosphatase are more common with superadded viral infection.

Cephalometric evaluation of Class II malocclusions in transitional dentition.

Studying malocclusion during active growth period is important because this period has the maximum impact on dentofacial structures. The present study comprises of computerised cephalometric evaluation of 100 North Indian children in the age group of 9-12 years, with 50 children in normal occlusion group. The samples were segregated according to sex with 25 females and 25 males in each group. It was concluded from the study that changes or deviations in SNB, Saddle, Articular and Gonial angles are the potential indicative factors in the development of a class II malocclusion and that class II pattern is associated with short and posteriorly placed mandible in relation to the cranial base.

Age prediction based on skeletal morphology.

Treatment plan for a child requires a complete diagnosis with monitoring of the skeleto-dental morphological changes during active period of growth. Growth modifications are done while the forces of growth are still at the peak of activity in a developing child. This study was undertaken on lateral cephalograms of 100 North Indian samples in the age group of 9-12 years consisting of 50 males and 50 females divided into normal occlusion and malocclusion groups, to predict and assess age by evaluating the skeleto-dental morphology in developing normal children having flush terminal plane molar relationship and children with developing class II pattern. It was concluded that based on measurements used in the study of dentofacial morphology, the age of a child could be statistically determined.

Blood transfusion practices in India: results of a national survey.

BACKGROUND: Blood transfusion may lead to serious clinical consequences for the recipient, if the transfused blood is not safe. To assess the functioning of the blood banks in India, a nation-wide, questionnaire-based study was conducted between November 1995 and November 1996 under the auspices of the Indian Association for Study of the Liver. METHODS: Of 604 blood banks in 31 states and union territories to whom the questionnaires were sent, responses wereobtained from 78 (13%) blood banks in 17 (54.8%) states, providing information on 275,000 donors. RESULTS: A majority (58%) of donors in these blood banks were replacement donors, followed by voluntary (39.3%) donors. About 87% of the respondent blood banks screen blood for hepatitis B, 95% for HIV, 94% for syphilis, 67% for malaria, and only 6% for hepatitis C. Marked heterogeneity in the test methods was observed with only 13% using ELISA kits for HBsAg. Only 21% of the blood banks prepare blood-derived components. Feedback to the blood banks on the occurrence of transfusion-associated hepatitis is given on less than 40% of occasions. CONCLUSIONS: Testing for transfusion-transmitted infections is unsatisfactory and poorly regulated in India. Reporting of adverse events after transfusion is poor and no stringent donor deferral system exists.

Effect of fiberoptic bronchoscopy on arterial blood gases and cardiac rhythm at a moderate altitude of 2250 meters.

OBJECTIVES: To study the effects of fiberoptic bronchoscopy (FOB) at an altitude of 2250 m on arterial blood gases (ABG) and cardiac rhythm abnormality. METHODS: Fifty consecutive patients undergoing fiberoptic bronchoscopy were evaluated for the arterial blood gases and cardiac rhythm changes at Shimla (a moderate altitude of 2250 m), where there is a state of ambient hypoxia. RESULTS: The changes were noted in five stages ranging from the levels before the procedure till 15 minutes after the completion of the procedure. The mean fall in PaO2 levels in this study was 8 +/- 2.45 mm Hg and the fall was maximum at the end of procedure. Both smokers and nonsmokers showed a significant fall but the fall was more severe in smokers. The mean fall in SaO2 in this study was 3%. The increase in heart rate and blood pressure during FOB was significant as compared to baseline levels. There was no significant change in PH, PaCO2, HCO3. The commonest rhythm abnormality noted was sinus tachycardia which was well tolerated. No major cardiac arrhythmia was noted. It was further seen that the duration of the procedure and type of special procedure undertaken did not effect the levels significantly. Cyanosis was the commonest complication encountered (36%) and was seen more frequently in smokers and those with age more than 40 years. It was observed during the induction of bronchoscope and also during the further negotiation of the bronchoscope into the smaller branches of bronchial tree. CONCLUSION: The changes in ABG and cardiac rhythm are comparable to the studies at sea level except the increased incidence of cyanosis.