Atrial fibrillation is the most common type of tachyarrhythmia caused by multiple re-entrant wave forms within the atria and bombarding the atrioventricular node several times making it beat in a rapid, disorganized fashion termed "fibrillation". In atrial fibrillation, atria beat more than 300 times per minute. The arrhythmatous condition needs to be controlled, as humans cannot withstand this rapid and chaotic beating of the heart. New investigational drugs like Dronedarone ® are being used. Dronedarone is the most recent antiarrhythmic drugs. It was approved by US-FDA on July 2nd 2009 and is available in the USA as Multaq tablets (400 mg). Dronedarone falls under the category of multiple ion channel blocker. It mainly targets the repolarization currents, making them less active and hence prolonging the action potential duration (APD). Dronedarone also exhibits antiadrenergic activity, thus reducing the pace of the pacemaker. Dronedarone has been proven to be a safer and efficacious AAD, evidenced by both animal and human studies. These studies showed that there was prolongation of the APD and absence of QT interval prolongation with long term administration of the drug. Also there was reduced thyroid hormone receptor expression. Dronedarone is significantly safer and effective in maintaining the sinus rhythm and reducing the ventricular proarrhythmias, justifying it for the long term treatment of atrial fibrillation compared to other antiarrhythmic drugs.

Background: Dermatological adverse drug reactions (ADRs) are easily detected by patients and that precludes further usage of drugs. So, decided to study the pattern, causative drugs, severity of adverse drug reactions and their causality in tertiary care hospital.Methods: It was prospective non inventional cross sectional study. Patients attending OPD or admitted to IPD of all age group and both gender with suspected dermatological ADRs following drug intake were included and the ADRS were recorded on CDSCO’s Pharmacovigilance form. Collected data was analyzed for assessment of causality using WHO-UMC scale, for severity by using Modified Hartwig and Siegel. Morphological pattern, drug groups, gender and age distribution was analyzed.Results: 231 dermatological ADRs were recorded and analyzed. Maximum cases were found in 21-30 years age group (74 cases). Dermatological ADRs were found in 143 females and in 88 males. Three major classes of drugs found responsible for causing dermatological ADRs were -oral Antimicrobials-41 (17.75%) and Injectable Antimicrobials-40 (17.32%), NSAID's-40 (17.32%.) and Topical Betnovate-36 (15.58%.). Regarding the type, 95 cases were of maculopapular rashes (41.12%), steroid damaged face in 42 (18.18%) andacute urticaria in 20 (8.65%). In terms of Severity assessment, authors found 23 cases (9.95%) as Mild, 176 cases (76.19%) of moderate severity and 32 cases (13.85%) of Severe category. In terms of causality assessment: 3 cases as Certain, 68 cases as Probable and 160 cases as Possible.Conclusions: From this study, it was found maximum Dermatological ADRs of moderate severity and few cases of causality category as “Certain”.

Background: The majority of the patients with chronic kidney disease stage V on hemodialysis have been found to have hypertension and many studies have recommended that hypertension should be essentially controlled in these patients for better clinical outcome. But till now no study analyzing the relationship between antihypertensive medication and the demographics of the patient has been done, so with this objective in mind the present study was carried out. Aim and objectives were to analyse the types of antihypertensive being used in CKD stage V patients on hemodialysis and their relationship with the demographic variables.Methods: The present observational cross-sectional study was conducted in Sri Aurobindo Institute of Medical Sciences, Indore (M.P.) from 01 January 2018 to 31 March 2018 on patients with chronic kidney disease stage V on hemodialysis. The demographic variables evaluated were age, sex, basic disease and duration of dialysis. The relationship with type of antihypertensive being used and these demographic variables was calculated using Pearson Chi-square test. A p value of<0.05 was taken as statistically significant.Results: Diabetic nephropathy, CIN-CKD 5d, CGN-CKD 5d and hypertensive nephropathy were the commonest basic diseases in our study. Calcium channel blockers, beta blockers, ATRB, centrally acting antihypertensive, ACE inhibitors were the commonest antihypertensive used. Statistically significant relationship was seen between antihypertensive and basic disease (p<0.05).Conclusions: The study revealed that all the antihypertensive medications are prescribed on the basis of basic disease while other demographic variables do not play a vital role prescribing antihypertensive in patients with CKD stage V on haemodialysis. And the prescription of antihypertensive medications also matches with the actual clinical practice.

Background: All the patients with diabetic nephropathy have inherent hypertension and uncontrolled hypertension leads to deterioration in the kidney disease speedily. Aims and objectives were to analyze the prescription of antihypertensive agents in the treatment of hypertension in diabetic nephropathy patients on hemodialysis.Methods: The study was conducted on diabetic nephropathy patients on maintenance hemodialysis, in Sri Aurobindo Institute of Medical Sciences, Indore (M.P.). We had included 73 diabetic nephropathy patients on maintenance hemodialysis, who provided their consent for participation in the study. Pearson coefficient of correlation was used for finding the correlation. Unpaired ‘t’ test was applied for intergroup mean comparison. A p value of<0.05 was taken as statistically significant.Results: Total 73 diabetic nephropathy patients were included, with 80.8% being males. Mean age was 57.74±8.44 years. Mean duration of dialysis was 32.06±35.84 months. Calcium channel blockers was given in 91.8% patients, followed by beta blockers in 61.6%. Other antihypertensives used had lower prevalence. 65.8% patients required combination of 1-3 antihypertensives, 24.7% required 4-5 antihypertensives for control of hypertension. The mean number of antihypertensive medications was comparable between the two genders (p>0.05). An inverse and statistically not significant correlation was seen between duration of dialysis; age and use of multiple antihypertensive medications (p>0.05).Conclusions: A strong association has been reported by many between hypertension and diabetic nephropathy. It is imperative that hypertension is well controlled in all the patients of diabetic nephropathy. This will slow down the progression of kidney disease and improve the quality of life in patients with diabetic nephropathy.

Background: India is experiencing a rapid health transition and is projected to become a major reservoir of chronic diseases like Diabetes and Hypertension and 25 to 40% of these subjects may develop chronic kidney disease and end stage renal disease. Aim and objective of the study was to analyze utilization pattern of antihypertensive drugs in chronic kidney disease patients in a tertiary care hospital.Methods: The present observational cross-sectional study was conducted in Sri Aurobindo Institute of Medical Sciences, Indore (M.P.) from 01.01.2018 to 31.03.2018 on patients with chronic kidney disease stage 5. The drug utilization pattern was studied with respect to age, sex, basic disease, duration of dialysis, type of antihypertensive used, etc. Comparison of mean between gender and dialysis / not on dialysis was done using unpaired ‘t’ test. A p value of < 0.05 was taken as statistically significant.Results: Of 198 patients, 63 (31.8%) were females and 135 (68.2%) were males, showing a male preponderance. Majority of the patients (54%) belonged to the age group 41-60 years. Majority of the patients were having diabetic nephropathy (40.9%), followed by CGN-CKD 5d (18.7%) and CIN-CKD 5d (17.2%). 11.6% patients were not on dialysis, while 88.4% were on dialysis with a mean duration of dialysis of 31.45±34.57 months. Calcium channel blockers were given in 87.4% patients, followed by centrally acting drugs in 56.1% patients, beta blockers in 51.0% and alpha blockers in 39.9%. 93.9% patients were on multidrug antihypertensive therapy. Mean number of antihypertensives required in patients on dialysis was lower than those not on dialysis (2.69±1.44 vs. 3.48±1.16, p <0.05), similarly mean number of antihypertensives use in males was higher than females (2.99±1.41 vs. 2.32±1.37, p <0.05).Conclusions: In order to treat CKD, it is important to treat hypertension as hypertension and CKD are related to each other. Treatment of hypertension will help in controlling future development of comorbidities. Calcium channel blockers and centrally acting drugs are the treatment of choice in patients with CKD stage 5D with hypertension. Multi-drug antihypertensive therapy is a better choice than mono/single-drug antihypertensive therapy.