A young woman presented with recurrent pericardial effusion, she had previously been treated with antitubercular medications. She had clinical features of systemic sclerosis (SSc) which was subsequently confirmed on further workup. She was also found to be profoundly hypothyroid. Cardiac tamponade is uncommon in both SSc as well as hypothyroidism, unlike in our patient who was found to have both of these disorders. In her case, the pericardial involvement probably ante-dated the other features of SSc.

Introduction:The geriatric population assumes great significance in terms of both preventive and curative health care services utilized. The patho-physio-psychological changes associated with ageing make their problems unique. In the geriatric population, hypertension accounts for a huge proportion of cardiovascular and all cause mortality and morbidity. We conducted a study to describe the patterns of antihypertensive drug use in the geriatric population, compare it to the current recommendations and conduct an analysis using the WHO-INRUD drug use indicators. Methods: A prospective cross sectional drug utilization study of 100 prescriptions of hypertensive patients (as per JNC 7) of either sex and ≥60 years was undertaken as per the WHO -DUS and the STROBE guidelines. Results: Statistically significant relation was found between BP control, and addictions and CIRS-G score. The 100 prescriptions contained 344 drugs, out of which, 171 were antihypertensive drugs. Three percent of antihypertensive drugs were prescribed by generic names. Seventy nine Original Research Articlepercent of antihypertensive drugs were prescribed from the 'hospital drug schedule'. Amlodipine, Hydrochlorothiazide, Losartan and Telmisartan were prescribed to 79%, 24%, 11%, 11% respectively. The combination of ARB (Angiotensin Receptor Blocker) + Diuretic was prescribed to 36% and that of ARB + CCB (Calcium Channel Blocker) was prescribed to 21%. The PDD/DDD ratios of Carvedilol, Losartan, Furosemide and Telmisartan were 0.7, 0.8,1 and1.2, respectively. Conclusion: Creating awareness regarding the role of addiction in BP control and advocating lifestyle changes is paramount in HTN management. Overall, the principles of rational prescribing were followed. The prescription pattern observed was as per current recommendations.

Purpose To analyze the risk factors and comorbidities among the young Indian adults with hypertension. Patients and Methods This was a retrospective, multicentric real-world study which included patients diagnosed with and receiving treatment for hypertension. Data were collected from the medical records of clinics/hospitals across 623 study sites in India. Patients of either sex and aged 18–45 years were included. Demographic details (age, sex, anthropometric measurement), medical and family history, sedentary lifestyle, smoking status and alcohol consumption data were extracted. Descriptive and comparative analysis (Mann–Whitney U and chi-squared test) was done. Results Out of 15,006 young patients diagnosed with hypertension (men=63.6%), 65.7% belonged to the age group of >35–45 years. The median body mass index was 27.0 kg/m 2 . Patients diagnosed with only hypertension were 29.1% while other predominant comorbidities with hypertension were diabetes mellitus (42.4%) and dyslipidemia (7.8%). Hypertension with diabetes mellitus were prevalent in the age group of >35–45 years (43.8%). More than half of the patients with hypertension (n=7656) had a sedentary lifestyle. Overall, 35.6%, 47.3%, and 56.7% of the patients were alcoholic, smokers (present and former), and had a family history of hypertension, respectively. Conclusion The results showed that among the young population, hypertension was common in the age group of >35–45 years and diabetes mellitus and dyslipidemia were common comorbidities. Family history, sedentary lifestyle, smoking, alcohol consumption, and body mass index may also contribute to hypertension.

IntroductIonThe Pharmacology curriculum for undergraduate medical students is designed to empower the graduating students to use the knowledge regarding common and essential drugs judiciously while making decisions in clinical settings. However, the present curriculum gives more emphasis on providing factual information about drugs rather than any hands-on exposure to skills required for patient care. The traditional teaching methods include lectures, tutorials, and practicals, but the teaching is mostly directed toward information dissemination rather than active learning by the students. As a result, the students perceive the subject as a volatile bundle of facts. [1] A change in approach is needed to impart certain pharmacotherapeutic skills to the students. Such skills would help to reduce the stress and anxiety of students during patient encounters. It may be ideal to allow supervised patient encounters or use standardized patients to provide experiential learning, but due to various logistic reasons, such interactions may not be feasible. Hence, to enhance the skill training of the students, help of appropriate techniques and technologies needs to be sought.Simulation-based supportive tools, namely, mannequins, robots, audio recordings, and videotapes are in use to impart skill training. [2] Videos are commonly used in lectures and practicals to demonstrate certain techniques. It has been shown that they sustain the interest of students. Students are Objective: To evaluate the effect of online videos along with traditional teaching on learning pharmacotherapeutic skills. Materials and Methods: Eight videos illustrating skills required for drug administration by parenteral and inhalational routes were developed and uploaded along with additional resource materials on a dedicated website. Following an online pretest, two practicals on routes of drug administration were conducted for 181 II MBBS students. They were then allowed to voluntarily watch the videos. Video usage, change in knowledge (pre-and post-video observation test score), and performance (Objective Structured Clinical Examination [OSCE] scores of two internal assessments) and perceptions (using prevalidated questionnaire) were recorded. Results: The average number of videos watched/student was 7.50 ± 1.30, whereas the average number of times each video watched was 1.50 ± 0.094. Only 39 students watched the videos before the first internal assessment were found to have statistically higher OSCE score compared to others who failed to watch (P = 0.006). The latter group watched the videos subsequently and showed improvement in their OSCE scores in the second internal assessment as compared to the first one (14.28 ± 3.26; P = 0.001). Students (93.10%) perceived the online videos as useful teaching tools, which helped them to understand and retain the sequence of procedural steps of the skills better. Conclusion: Drug administration skills when taught using a blend of traditional teaching methods and online videos, improved the performance with added...

Background: Combined presence of diabetes and hypertension increases the chances of various complications manifold than individually. Together, they accelerate the development of left ventricular hypertrophy, coronary artery disease, renal dysfunction, diabetic retinopathy and cerebrovascular diseases. Methods: After ethical considerations this observational study was carried out to identify the clinical, laboratory and end-organ profile of Hypertensive subjects who also had Diabetes; this cohort was also compared with subjects who had hypertension only. Results: The prevalence of hypertensive subjects with diabetes as co-morbidity was 10.26%. 26.4% subjects had family history of diabetes and 20.4% had family history of hypertension. The mean diastolic blood pressure (83.66±12.0) was significantly higher in hypertensive diabetes group, than the subjects with hypertension only (76.98±6.46) and the difference was statistically significant (p <0.0001). 51.9% of hypertensive females with diabetes had significantly higher (p 0.0003) central obesity. Macrovascular damage was slightly more common in females and microvascular damage was common in male hypertensive diabetic subjects. Out of 102 patients having end organ damage 37.25% had single organ involvement and 62.75% had multiple organ involvement. Retinopathy (33.2%) was commonest followed by renal (27.6%), cardiovascular (16.2%) and cerebrovascular (14.8%). Hypertensive diabetic patients had higher occurrence of end organ damage reflecting the impact of diabetes-hypertension co-morbidity on target organs. Conclusions: Given the increasing rates of coronary artery disease among Indians, especially at a younger age, 5understanding and successfully managing this deadly duo may hold the key to reducing cardiovascular mortality in India.