Background:The new guidelines issued by the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure (JNC-8) emphasize that aggressive blood pressure (BP) control is essential to reducing morbidity and mortality. Patient non-adherence is a serious obstacle to the effective treatment of many acute and chronic disorders. Successful treatment and outcome of a chronic disease such as hypertension depend on many factors, including resources (e.g., funds, space, and people), avoidance of serious adverse events, patient adherence with treatment plans, and the availability of effective therapies. The aim of this study is to assess the antihypertensive drug prescription patterns and adherence to joint national committee (JNC-8) hypertension (HT) treatment recommendations among hypertensive patients attending a tertiary care teaching hospital. Methods: An observational and cross-sectional prospective prescription audit study was carried over a period of 1 year in ambulatory patients attending medicine OPD. A total of 500 prescriptions prescribed to diagnose HT were analyzed. Drug prescription patterns, and their adherence to JNC-8 report was assessed. Results: Out of 500 patients, 299 (59.8%) were male and 201 (40.2%) were female. Mean age of male and female patients were found to be 57.68±15.32 and 61.29±12.65 years respectively. As per present study, most of the physicians prescribed single drug (monotherapy, 34.6%) to control BP followed by two-drug combination (18.4%), three-drug combination (11.8%) and four-drug combination (3%). Two drugs regimen was prescribed in 18.4% of the hypertensive patients. Angiotensin receptor blocker + diuretic combination (4.4%) was mostly used in two drug combination therapy followed by Angiotensin receptor blockers + Diuretics (3.6%) and Calcium channel blocker + ACEIs combination (2.6%). No combination of ACEIs + ARBs was prescribed in any prescription. The overall rate of adherence was 16.5 % (Pre-hypertension); 87.90% (Stage 1 hypertension); and 68.20% (Stage 2 hypertension). Conclusions:In conclusion, present study demonstrated that physicians are not completely adhering to standard guidelines while treating hypertension with comorbid conditions.

Background: Postoperative sore throat (POST) consider a minor ailment in patients receiving general anesthesia with endotracheal intubation, seen in 21-65% cases but it causes significant distress and increases postoperative morbidity and patient dissatisfaction. This study was done to compare nebulized ketamine and ketamine with clonidine to treat POST.Methods: This was a prospective, randomized, double-blind control clinical study. After approval from institution ethical and scientific committee, study was conducted in between May 2015-April 2016. Written and informed consent was obtained from 100 patients of either sex aged between 20-65 years. ASA I-II, undergoing surgery in supine position lasting up to two hour. Patients were randomized into two groups Group K (n=50) nebulized with 50 mg ketamine (1cc) + 3cc NS =4cc, Group KC (n=50) nebulized with ketamine 50mg (1cc) + clonidine 150µg (1cc) + 2cc NS for 15 min, before general anaesthesia with endotracheal intubation. The POST and hemodynamic variable were monitored before nebulization, after nebulization, before induction, on arrival to PACU and at 4, 8, 12, 24 hours post operatively. POST was graded on 4 point scale (0-3).Results: Overall incidence of POST was 46% (Group K-40%, KC-6%). The Incidence and severity of POST were significantly attenuated in Group KC in comparison to Group K at 4 hours (P= 0.002), 8 hours (P=0.000), 12 hours (P= 0.000) and at 24 hours (P=0.000).Conclusions: Preoperative nebulization with clonidine and ketamine mixture compared to ketamine is more effective in dealing with postoperative sore throat with no adverse effects.

Background: Transverses abdominis plane (TAP) block is a new regional anaesthetic technique for postoperative analgesia in abdominal surgeries, as a part of multimodal analgesia. We evaluated effect of two different doses of clonidine as an adjunct in TAP block in patients underwent unilateral inguinal hernioplasty. Methods: Sixty adult patients undergoing unilateral inguinal hernioplasty were randomized into two groups, Group A (n=30) received bilateral TAP block with bupivacaine 0.25% 38cc + clonidine (1cc) 150 microgram +1cc NS=40cc, Group B (n=30) received bupivacaine 0.25% 38cc+clonidine (2cc) 300 microgram=40cc, at the end of surgery. The postoperative pain was evaluated by visual analog score (VAS) for pain scoring at 2, 4, 6, 12 and at 24 hours. Subjective assessment of duration of analgesia was done. Results: The VAS score in patients who received clonidine 300 microgram Group B as an adjunct was significantly lower than who received 150 microgram Group A. Duration of analgesia was longer in Group B. 2 patients in Group B showed bradycardia treated with atropine. Sedation score was lesser in Group A. Conclusions: Clonidine showed dose dependant analgesia and adverse effect in TAP block for postoperative analgesia. Higher doses of clonidine may be used as an adjunct in TAP block.

Background: Regional anesthesia increasingly used for gynecological surgeries, has advantage of decreased stress response to surgery, decreased cardiorespiratory depression, with improved postoperative analgesia.Methods: This randomized, prospective, double blind study was conducted at Amaltas Institute of Medical Sciences, Banger Dewas in Department of Anesthesia between June 2016-December 2016. Sixty patients who were posted for gynecological surgeries were enrolled and randomly divided into two groups: Group R received 3.5 ml (17.5 mg) 0.5% ropivacaine plain and Group L received 3.5 ml (17.5 mg) 0.5% levobupivacaine plain. The onset and duration of sensory and motor block and any undesirable side effects were noted.Results: Demographic parameters were comparable between the two groups (P >0.05). Onset of sensory and motor block was significantly faster in Group L, duration of motor and sensory block was significantly less in Group R. Patients in group R were hemodynamically stable (P = 0.032) compared to group L.Conclusions: Both ropivacaine and levobupivacaine have the desirable blocking property and can be used in gynecological surgeries. Ropivacaine showed shorter duration of sensory and motor block allowed early mobilization and early recovery of patients.

Introduction: Cardiovascular diseases (CVD) are known as important reasons of the increased morbidity and mortality observed in patients with chronic renal failure (CRF). The association of serum Interlukin-6 , homocysteine as well as other cardiovascular risk factors in relation to existence and cause of CVD were investigated. Method: In this study 200 CRF patients were recruited and further stratified into group with Male and Female as case groups. Those without renal failure were assigned as control group (n=200). Results: The patients with CRF showed a significant increase in plasma levels of Cpk-MB homocysteine and C-reactive protein (CRP) compared to control. The positive association were observed between homocysteine, Urea and Hs-CRP, IL_6 . It shows a significant Association of parameters in CRF . Conclusion: The results demonstrated elevation in plasma values IL-6 , homocysteine and HS-CRP in patients with CRF . However, these modifications may be lead to atherosclerosis and consequence CVD event. These parameters may be important with respect to the high morbidity and mortality of CVD found in patients with CRF.