Natural Physiological Changes During Pregnancy.

Pregnancy causes physiological changes that support the growing fetus and get the mother ready for labor and delivery. Some of these modifications affect biochemical levels; they are normally stable, while others could imitate symptoms of illness. It is critical to distinguish between pathology associated with disease and typical physiological changes. This review article focuses on the significant changes that occur throughout a typical pregnancy.

Clinical implications of microbial biofilms in chronic rhinosinusitis and orbital cellulitis.

BACKGROUND: Discovery of sessile mode of microbial existence (Biofilm state) focussed much interest, during the recent years, on the study of biofilms in many recurring and chronic infections. However, the exact role of microbial biofilms in chronic rhinosinusitis and orbital cellulitis were not elucidated earlier. The purpose of the present study was to look for the adherent property and biofilm producing ability of the clinical isolates in chronic rhinosinusitis and orbital cellulitis, and to look for the effects of antimicrobial agents on these biofilms by colorimetric assay and ultrastructural analysis. METHODS: Organisms were isolated and identified from various clinical samples in patients with chronic sinusitis and orbital cellulitis. Antimicrobial sensitivity testing was carried out by the standard protocol. Biofilms were developed; quantified and antimicrobial drug perfusion through the biofilm model was evaluated by the earlier devised procedure. Electronmicroscopic study of the biofilm was performed by the recommended technique. RESULTS: Of the total of 70 clinical samples processed, 48 i.e. 68.5 % grew bacteria and 13 i.e.(18.6 %) fungi. Staphylococcus aureus (20), S epidermidis (16) and Pseudomonas aeruginosa (6) accounted for the majority of the bacterial isolates. Aspergillus flavus (8), however was the commonest amongst the fungi. A total of 40 bacteria and 8 fungi could be tested for biofilm production. Eighteen (45 %) of the 40 bacterial isolates and 4(50 %) out of the 8 A flavus isolates were found to be biofilm producers. In vitro adherence testing revealed that majority i.e. 16 (88.8 %) of the 18 biofilm positive bacteria were adherent to artificial surfaces. Antimicrobial drug perfusion through the biofilm model was poor. Antimicrobial treatment was totally ineffective against strong biofilm producers, whose electron microscopic picture was quite similar to that observed for biofilm producers without any antimicrobial pre-treatment. CONCLUSIONS: Filamentous fungi, like bacteria were capable of forming biofilms, which could be one of the important virulence factors in determining the pathogenic potential of these organisms in causing chronic rhinosinusitis and orbital cellulitis.

Comparison of the Efficacy Between Ultrasound-Guided Paravertebral Block and Erector Spinae Block for Postoperative Analgesia in Percutaneous Nephrolithotomy Using Levobupivacaine: A Prospective and Randomized Study.

Introduction Various techniques have been developed in the current era of regional anesthesia practice. With the advent of ultrasound, the visualization of needle and pleura in real time enables a better outcome with negligible adverse events. This study was designed to compare the efficacy between ultrasound-guided erector spinae plane block (ESPB) and paravertebral block (PVB) in percutaneous nephrolithotomy (PCNL) for the duration of postoperative analgesia with levobupivacaine, a local anesthetic with higher lipid solubility, making it more potent and resulting in a longer duration of action. Methods This prospective randomized single-blinded study enrolled 50 patients of ASA grades I and II, aged between 20 and 60 years, who were scheduled for PCNL under general anesthesia. Patients were divided into two groups of 25 each: group ESPB and group PVB, and 25 mL of 0.25% levobupivacaine was administered to both groups. They were primarily evaluated for the duration of postoperative analgesia. Total rescue analgesic requirements, hemodynamic parameters, and any adverse effects were also assessed. Results Both ESPB and PVB provided a significant duration of analgesia postoperatively. Demographic characteristics in both groups were comparable. The duration of postoperative analgesia in group ESPB was 746 ± 58.6 minutes when compared to group PVB, which is 768 ± 68.6 minutes (p = 0.08). Intravenous (IV) paracetamol was used as a rescue analgesic. The doses used were also comparable in both groups, with the visual analog score (VAS) being high after around 12 hours of surgery. The total rescue analgesic requirement was similar in both groups (group ESPB, 2.0 ± 1.6; group PVB, 2.2 ± 1.4; p = 0.51). There were no significant hemodynamic or other adverse effects in either group. Conclusion We conclude that both ESPB and PVB using isobaric levobupivacaine 0.25% as a local anesthetic are equally efficacious in providing effective postoperative analgesia in patients undergoing PCNL under general anesthesia.

Clinicopathologic review of epithelial tumors of the lacrimal gland.

OBJECTIVE: To study the clinicopathologic features of epithelial tumors of the lacrimal gland diagnosed at a tertiary care center in India during a 10-year period. METHODS: Medical records of cases with histopathologically proven epithelial tumors of the lacrimal gland were reviewed for demographic details and clinical features at the time of presentation. For histopathologic findings, slides with hemotoxylin and eosin-stained sections of the tumors were reviewed. Special stains, including histochemical and immunohistochemical stains, and additional sections were studied, whenever needed. RESULTS: Of 66 cases with epithelial tumors of the lacrimal gland identified during the study period, 50 (76%) cases were benign and 16 (24%) cases were malignant tumors. Histopathologic examination was consistent with the diagnosis of pleomorphic adenoma (PA) in all 50 cases of benign tumors. The mean age at diagnosis in PA cases was 37.7 years. Microscopic examination of PA tumors showed cystic degeneration in 18 (36%) cases, squamous metaplasia in 16 (32%) cases, calcification in 6 (12%) cases, and ossification in 1 (2%) case. Among malignant tumors, adenoid cystic carcinoma (ACC) was the most common tumor (n = 12, 18%), with an average age at diagnosis of 32.4 years. Microscopic examination of ACC revealed that most cases were grade I tumors. Solid areas were noted in 4 (33.3%) cases and perineural invasion was identified in 2 (16.7%) cases. Other malignant tumors included 1 case each of carcinoma ex-PA (1.5%), lacrimal duct carcinoma (1.5%), mucoepidermoid carcinoma (1.5%), and basal cell adenocarcinoma (1.5%). CONCLUSIONS: As far as the authors are aware, this is the largest series on clinicopathologic features of epithelial tumors of the lacrimal gland from South Asia. The incidence of PA was significantly higher in this study than reported in the Caucasian population. Among malignant tumors, ACCs were the most common, although rare tumors were also identified.

Conjunctivodacryocystorhinostomy using a high-density porous polyethylene-coated tear drain tube.

To evaluate the outcome of conjunctivodacryocystorhinostomy using a high-density porous polyethylene (HDPP)-coated tear drain tube. Patients with epiphora due to a proximal lacrimal system block were included in a prospective interventional case study. A total of 22 eyes were treated with lacrimal bypass surgery using the HDPP-coated tube. On follow-up (12-41 months), 21 eyes had a patent well-positioned tube with subjective relief of epiphora. In one eye, a loose sleeve was noted during surgery. The tube dislodged postoperatively and was removed. A high success rate with only a few minor complications is achievable using a HDPP-coated tear drain tube for lacrimal bypass surgery. Long-term follow-up is required to look for tube blockage due to conjunctival or nasal mucosal overgrowth.

Preoperative Ultrasonographic Evaluation of Subclavian Vein and Inferior Vena Cava for Predicting Hypotension Associated with Induction of General Anesthesia.

Introduction: Induction of general anesthesia is often associated with hypotension and is a common scenario faced by anesthesiologists. Intraoperative hypotension can have detrimental effects and cause various adverse effects leading to an extended hospital stay. Patients' preinduction volume status can have an effect on postinduction blood pressure. Ultrasonography is a useful tool for measuring intravascular volume status. We studied the ability of ultrasonographic measurement of subclavian vein (SCV) and inferior vena cava (IVC) diameter, collapsibility index (CI) to predict hypotension after induction of general anesthesia. Materials and Methods: We included 120 patients in our study. SCV measurements during spontaneous and deep inspiration and IVC measurements were taken before induction and postinduction blood pressure was monitored. Patients with mean arterial blood pressure <60 mmHg or with a 30% decrease from baseline were considered to be having hypotension. Results: The CI of IVC with a cutoff 37% showed sensitivity of 94% and specificity of 84% which was statistically significant. The CI of 36% of SCV during deep breathing was found to have high sensitivity and specificity of 90% and 87%. Conclusion: Our study in spontaneously breathing preoperative patients shows that SCV CI in deep breathing and IVC CI is very sensitive and reliable in predicting postinduction hypotension. Bedside ultrasound measurements can be easily done to obtain valuable information to recognize patients who could be at risk from postinduction hypotension.

Phthisis bulbi in retinoblastoma.

BACKGROUND: Phthisis bulbi is a relatively uncommon and atypical clinical presentation of retinoblastoma. DESIGN: Retrospective study conducted at a tertiary care hospital. PARTICIPANTS: Eighteen consecutive retinoblastoma patients with primary phthisis bulbi. METHODS: Retrospective analysis of clinical, imaging and histopathological features of all retinoblastoma patients with primary phthisis bulbi, treated at our centre between January 2005 and December 2009. MAIN OUTCOME MEASURE: Clinical and histopathology features. RESULTS: Eighteen (3.5%) retinoblastoma patients developed primary phthisis bulbi. The median age of presentation was 1.5 years. The median duration of symptoms before presentation was 6 months. In total, 15 out of 18 (83%) cases had bilateral disease. Among these, 80% (12/15) had advanced intraocular disease in the fellow eye. Most common first symptom was white reflex. History of orbital inflammation was present in 12/18 cases. Computed tomographic scan of orbit showed intraocular mass with calcific densities in 16 eyes. In two cases, hyperdense mass was seen without any calcification. On histopathology, residual viable tumour cells with characteristics of poorly differentiated retinoblastoma were found in 67% (12/18) eyes. High-risk factors were present in six cases with microscopic residual disease in three cases. CONCLUSIONS: This is the largest case series of retinoblastoma patients with primary phthisis bulbi. Phthisis bulbi in retinoblastoma may be associated with bilateral disease in most cases and advanced intraocular disease in the fellow eye in a significant number of cases. Regression is incomplete in majority of these cases; therefore, enucleation must definitely be done in all cases of retinoblastoma presenting with phthisis bulbi.

Switching of majority charge carriers by Zn doping in NdNiO3 thin films.

We have studied the effects of Zn doping on the structural and electronic properties of epitaxial NdNiO3 thin films grown on single-crystal LaAlO3 (001) (LAO) substrates by pulsed laser deposition. The films are deposited in two sets, one with variation in Zn doping, and another with variation in thickness for undoped and 2% Zn doping. The experimental investigations show that Zn occupies Ni-site and that the films are grown with an in-plane compressive strain on LAO. All the films show metal-to-insulator transitions with a thermal hysteresis in the temperature-dependent resistivity curves except 5% Zn-doped film, which remains metallic. The theoretical fits show non-Fermi liquid behaviour, which gets influenced by Zn doping. The Hall resistance measurements clearly show that Zn doping causes injection of holes in the system which affects the electronic properties as follows: i) the metallic conduction increases by two factors just by 0.5% Zn doping whereas, 5% doping completely suppresses the insulating state, ii) a reversal of the sign of Hall coefficient of resistance is observed at low temperature.

Endophytic bacteria from Ocimum sanctum and their yield enhancing capabilities.

Endophytes are beneficial microbes that reside intercellularly inside the plants. Interaction of endophytes with the host plants and their function within their host are important to address ecological relevance of endophyte. Four endophytic bacteria OS-9, OS-10, OS-11, and OS-12 were isolated from healthy leaves of Ocimum sanctum. These isolated microbes were screened in dual culture against various phytopathogenic fungi viz. Rhizoctonia solani, Sclerotium rolfsii, Fusarium solani, Alternaria solani, and Colletotrichum lindemuthianum. Of these, strain OS-9 was found to be antagonistic to R. solani, A. solani, F. solani, and C. lindemuthianum while OS-11 was found antagonistic against A. solani only. The growth-promoting benefits of the endophytes were initially evaluated in the glasshouse by inoculated seeds of O. sanctum. Treatment with endophytes OS-10 and OS-11 resulted in significant enhancement of growth as revealed by increase in fresh as well as dry weight. Further, field trials involving two genotypes OS Purple and CIM-Angana were conducted with strains OS-10 and OS-11. The growth-promoting effect was visible on both the genotypes tested as the endophytes significantly enhanced fresh herbage yield (t/ha). Interestingly, these endophytes increased the content of essential oil particularly in cultivar OS Purple and thereby increasing the total oil yields. Molecular characterization of strain OS-11 indicated the strain to be highly related to the type strain of Bacillus subtilis.

Rare etiology of obstructive uropathy: pelvic lipomatosis.

We present a case of a 32-year-old hypertensive and obese male who had bilateral obstructive uropathy, and who was diagnosed as having pelvic lipomatosis on the basis of clinicoradiological findings. Cystoscopy and biopsy revealed cystitis cystica. He was successfully managed with bilateral extravesical modified Lich-Gregoir ureteric reimplantation by intraperitoneal approach. At 5 months follow-up, the patient had normal serum creatinine and was clinically asymptomatic.

Role of internal limiting membrane peeling in the prevention of epiretinal membrane formation following vitrectomy for retinal detachment: a randomised trial.

AIM: To study the role of internal limiting membrane (ILM) peeling in the prevention of macular epiretinal membrane (ERM) formation following pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). METHODS: In a randomised trial, patients with macula-off RRD (duration ≤3 months) with proliferative vitreoretinopathy grade ≤C1 and absence of pre-existing maculopathy were recruited from June 2016 to May 2018. Patients were randomised into two groups: group 1 (conventional treatment) underwent PPV alone, while group 2 underwent PPV with macular ILM peeling. The main outcome measures were macular ERM formation (detected on optical coherence tomography), corrected distance visual acuity (CDVA), retinal attachment and central macular thickness (CMT) at last follow-up (minimum 6 months). RESULTS: Sixty patients (30 in each group) completed the required follow-up. The two groups were comparable in sex distribution, age, duration of RRD, baseline CDVA and duration of follow-up (median 15.5 vs 14 months). Macular ERM developed in 20% (n=6) and 0% of eyes in groups 1 and 2, respectively (p=0.002). Retinal reattachment was attained in all eyes. There was no statistical difference in final CDVA between the groups (p=0.43). Dissociated optic nerve fibre layer (DONFL) was found in 0% and 40% (n=12) of eyes in groups 1 and 2, respectively (p=0.0001). However, DONFL did not significantly affect the final CDVA (p=0.84). The final CMT was 266.0±37.5 µm and 270.0±73.7 µm in groups 1 and 2, respectively, with no statistical difference (p=0.62). CONCLUSIONS: ILM peeling prevents macular ERM formation following PPV for RRD but provides similar visual outcomes as compared with conventional treatment. TRIAL REGISTRATION NUMBER: CTRI2018/04/012978.

Off-Flavours and Unpleasantness Are Cues for the Recognition and Valorization of Organic Wines by Experienced Tasters.

The drivers of consumer acceptance concerning organic wines are not well understood. In particular, among wine professionals, there are anecdotal evidences claiming that consumers accept off-flavours that would not be tolerated if the wines were conventionally produced. Therefore, the aim of this study was to shed further light on this issue by tasting blind wines of both types of production using a tasting panel comprised by experienced individuals of several nationalities. The tasted wines were both conventional and organic and were with and without off-flavours. The same wines were evaluated in three tasting sessions where the given information was: (1) all wines were conventional, (2) all wines were organic, and (3) tasters were asked to guess the mode of production. A group of untrained tasters also rated the same organic wines in an informed session. The results showed that wines were significantly better scored and were given a higher willingness to pay value in the "organic" session. In addition, the experienced tasting panel produced a list of the most frequent sensory descriptors. When tasters were asked to guess the mode of production, wines that were supposed to be organic received a higher citation of off-flavours, such as "oxidized", "reductive", and "animal/undergrowth". Moreover, an overall emotional response of unpleasantness was associated with the recognition of organic wines in the "guess" session. Untrained tasters rated the same organic wines with lower liking scores and were willing to pay less. In conclusion, off-flavours and their unpleasantness worked as a cue to identify wines supposed to be organic by experienced tasters. Their corresponding higher valorization could be explained by the psychological halo effect induced by the organic label. Contrarily, consumers did not show this halo effect, depreciating wines with unpleasant flavours irrespective of their mode of production.

Cellulase production by six Trichoderma spp. fermented on medicinal plant processings.

Capabilities of cellulase production, using delignified bioprocessings of medicinal and aromatic plants, viz. citronella (Cymbopogon winterianus) and Artemisia annua (known as marc of Artemisia) and garden waste (chiefly containing Cynodon dactylon), by the six species of Trichoderma were comparatively evaluated. Among the members of Trichoderma studied, T. citrinoviride was found to be the most efficient producer of cellulases along with a high level of beta-glucosidase (produced 102.4 IU g(-1) on marc of Artemisia; 101.33 IU g(-1) on garden waste; 81.86 IU g(-1) on distillation waste of citronella and 94.77 IU g(-1) on pure cellulose). Although T. virens was noticed to be the minimal enzyme producer fungus, it interestingly could not produce complete cellulase enzyme complex on any test waste or pure cellulose, except on marc of Artemisia, where it produced all three enzymes of the complex. Immediate reduction in pH was also noticed during fermentation in the case of pure polymer (cellulose) by all tested fungi, while it was delayed with delignified agrowastes. The pH profile varied with the substrate used as well as with individual species of Trichoderma. On the other hand, no alteration in pH with any species of Trichoderma was noticed when grown on marc of A. annua, which might be due to the buffering capacity of this marc.

Orbital abscess with unusual features.

PURPOSE: To report a series of 7 cases of orbital abscess with unusual features that may mimic other cystic orbital lesions. METHODS: Retrospective study of all cases of orbital cellulitis/abscess treated at our center, over 1 year, highlighting cases with unusual features. RESULTS: Thirty-one cases were studied, where orbital cellulitis/abscess was the final diagnosis. Of these, 7 patients did not have typical signs and/or symptoms of local infection. At presentation, there was no associated predisposing risk factor, indicating the source of infection. The duration of symptoms, among these 7 patients, ranged from 3 weeks to 6 months. The initial diagnosis was myocysticercosis in 3 cases, orbital dermoid in 1 case, lymphangioma in 1 case, pseudotumor in 1 case, and schwannoma in 1 case. CONCLUSIONS: Unusual presentations of orbital abscess can mimic other conditions of the orbit. Orbital abscess should be considered in the differential diagnosis if a cystic lesion has not responded or partly responded to systemic antibiotics and there are associated signs or symptoms of intermittent or constant low-grade inflammation, even in the absence of predisposing risk factors.

Comparison of ranibizumab alone versus ranibizumab with targeted retinal laser for branch retinal vein occlusion with macular edema.

Purpose: To determine the effect of ultra-widefield fluorescein angiography (UWFFA)-guided targeted retinal photocoagulation (TRP) in branch retinal vein occlusion (BRVO) with macular edema after intravitreal Ranibizumab (RBZ). Methods: 33 eyes of 32 treatment naïve patients diagnosed as BRVO with macular edema were prospectively randomized to 0.5 mg Ranibizumab only (RBZ group) (n = 17) or Ranibizumab with UWFFA-guided laser (RBZ + TRP group) (n = 16). Both groups received three injections at monthly intervals and PRN henceforth. RBZ + TRP group additionally underwent UWFFA-guided TRP of peripheral capillary nonperfusion areas 1 week post injection. Outcome measures included improvement in visual acuity, central subfoveal thickness (CST), and the number of injections required with a minimum follow-up of 9 months. Results: Both groups showed significant improvement in mean BCVA (25.7 ± 8.19 letters, P < 0.001 vs. 23.38 ± 7.56 letters, P < 0.001; in RBZ and RBZ + TRP group, respectively) and reduction in mean central subfoveal thickness (379.12 ± 242.7 µm, P < 0.001 vs. 253.75 ± 137.9 µm, P < 0.001 in RBZ and RBZ + TRP group, respectively) at 9 months. The number of injections in the RBZ group (5.76 ± 1.3) was significantly greater than RBZ + TRP (4.06 ± 0.99) (P < 0.001). Both groups had significant improvement in contrast sensitivity and mean deviation on visual fields; however, the difference between the groups was not significant (P = 0.62 and P = 0.79, respectively). Conclusion: UWFFA-guided TRP reduced the number of injections of Ranibizumab in patients having BRVO with macular edema, while maintaining similar benefits in the improvement of BCVA, central subfoveal thickness without deleterious effect on the visual field, and contrast sensitivity.

Detection and monitoring of subclinical ocular siderosis using multifocal electroretinogram.

BACKGROUND: Although full-field electroretinogram (ffERG) is the gold standard test to detect physiological dysfunction in siderosis, it measures overall retinal function. This study aims to determine if multifocal electroretinogram (mfERG) can detect subclinical siderosis in eyes with an iron intraocular foreign body (IOFB). METHODS: Twenty eyes of 20 patients with retained iron IOFB, clear ocular media and good visual acuity (≥20/120) were enroled in this prospective case-control study. The fellow eyes served as control. These were evaluated with ffERG and mfERG at baseline. Serial mfERG was done till six months after pars plana vitrectomy with IOFB removal. Primary outcomes measures were amplitude and peak time of P1 and N1 wave of mfERG. RESULTS: The median age was 25 years (range 18-55). Most patients (n = 14/20) presented within a month of trauma. Baseline ffERG showed no difference in either 'a' or 'b' wave amplitude or peak time between cases and controls. However, on mfERG, there was a significant decrease in P1 and N1 wave amplitude and delay in P1 wave peak time in <2° retinal ring in cases as compared to controls (p = 0.001, 0.001 and 0.02 respectively) despite variability in results. At 6 months, P1 amplitude showed significant improvement from baseline in cases (p = 0.010). However, P1 peak time did not show significant recovery (p = 0.65). CONCLUSIONS: mfERG may reveal subclinical electrophysiological retinal dysfunction in eyes with iron IOFB in cases with normal ffERG. P1 peak time may serve as an electrophysiological marker for past retinal damage.

Choroidal thickness in normal Indian eyes using swept-source optical coherence tomography.

PURPOSE: The purpose of this study is to provide normative database for subfoveal choroidal thickness in Indian eyes using swept-source optical coherence tomography. METHODS: This is a cross-sectional study based at a tertiary eye care center in Northern India. Two hundred and thirty eight eyes of 119 healthy subjects were examined in terms of axial length, spherical equivalent, and choroidal thickness. Inclusion criteria included age 19-60 years, no retinal or choroidal disorder, and patients with clear media and good fixation. Patients with high hypermetropia (>4 D) or myopia (>6 D) or any systemic disease likely to affect choroidal thickness were excluded. Twelve radial line scans were obtained centered on the fovea that were used to calculate choroidal and retinal thickness in 9 early treatment diabetic retinopathy study (ETDRS) zones. RESULTS: The mean age of all the subjects was 28.70 ± 11.28 years; mean axial length was 23.63 ± 1.96 mm, and mean spherical equivalent was - 0.92 ± 3.08 D. The mean subfoveal choroidal thickness was 299.10 ± 131.2 µ and mean foveal thickness was 239.92 ± 48.16 µ. A negative correlation was found between subfoveal choroidal thickness and age (r = -0.0961, P = 0.1392) and axial length (r = -0.3166, P < 0.001). A statistically significant positive correlation was found between subfoveal choroidal thickness and refractive error (r = 0.2393, P = 0.0002). CONCLUSION: This study provides normative database for subfoveal choroidal thickness and foveal thickness using swept-source optical coherence tomography. The choroidal thickness measured with swept-source platform is slightly higher than that reported with spectral domain platforms.

Electrochemical Properties of Na0.66V4O10 Nanostructures as Cathode Material in Rechargeable Batteries for Energy Storage Applications.

We report the electrochemical performance of nanostructures of Na0.66V4O10 as cathode material for rechargeable batteries. The Rietveld refinement of room-temperature X-ray diffraction pattern shows the monoclinic phase with C2/m space group. The cyclic voltammetry curves of prepared half-cells exhibit redox peaks at 3.1 and 2.6 V, which are due to two-phase transition reaction between V5+/4+ and can be assigned to the single-step deintercalation/intercalation of Na ion. We observe a good cycling stability with specific discharge capacity (measured vs Na+/Na) between 80 (±2) and 30 (±2) mAh g-1 at current densities of 3 and 50 mA g-1, respectively. The electrochemical performance of Na0.66V4O10 electrode was also tested with Li anode, which showed higher capacity but decayed faster than Na. Using density functional theory, we calculate the Na vacancy formation energies: 3.37 eV in the bulk of the material and 2.52 eV on the (100) surface, which underlines the importance of nanostructures.

Effect of vitamin E administration on blood pressure following reperfusion of patients with myocardial infarction.

BACKGROUND: Reperfusion of infarcted myocardium by thrombolysis is the major technique used to restore blood supply. Reperfusion, however, is associated with a burst of oxygen consumption, with the resultant excessive generation of free radicals causing reperfusion injury. OBJECTIVE: In the present study, the effect of vitamin E administration on the status of free radical-mediated injury and blood pressure in post reperfusion hypertensive patients with myocardial infarction is assessed. METHOD: POST REPERFUSION HYPERTENSIVE PATIENTS WERE DIVIDED INTO THREE GROUPS: those not receiving a beta-blocker (group I), those receiving acetylsalicylic acid (ASA) plus a beta-blocker (group II) and those receiving ASA, a beta-blocker and 400 mg vitamin E (group III). Groups II and III were comprised of patients from group I. Levels of malondialdehyde (MDA) and xanthine oxidase (XO) activity in blood were used as an index of oxidative stress. These parameters, along with blood pressure, were monitored in these groups. RESULTS: Patients not receiving a beta-blocker had elevated levels of MDA and XO activity when compared with healthy persons (P<0.0005 both for MDA and XO). Compared with group I, patients receiving a beta-blocker plus ASA (group II) had a significant decrease in the activity of XO (P<0.005) and the levels of MDA (P<0.005). When vitamin E was incorporated in the treatment, there was highly significant decrease in these oxidative stress parameters compared with groups I and II (P<0.0005 for XO and MDA). Use of vitamin E as an adjuvant in hypertensive therapy (group III) resulted in better management of blood pressure (systolic P<0.005, diastolic P>0.05) when compared with group II. CONCLUSION: Inclusion of vitamin E in antihypertensive therapy in post reperfusion hypertensive patients results in better management of blood pressure.