Objectives:Terlipressin improves renal function in hepatorenal syndrome (HRS) is a known fact. However the reason for lack of its long-term survival benefits despite improvement in renal function remains unclear. The aim of this study was to analyze the survival benefits of terlipressin in HRS and to address the issue of non-responder state to terlipressin.Materials and Methods:Electronic databases and relevant articles were searched for all types of studies related to HRS and use of terlipressin in HRS. Reduction in all-cause mortality rate was the primary outcome measure. Reduction in mortality rate due to HRS and other causes of death were also analyzed.Results:With total 377 patients analyzed from eight eligible studies; terlipressin reduced all-cause mortality rate by 15% (Risk Difference: -0.15%, 95% CI:-0.26 to -0.03). Reduction in the mortality rate due to HRS at three months was 9% (Risk Difference:-0.09%, 95% CI:-0.18 to 0.00).Conclusion:Terlipressin has long term survival benefits perhaps at least up to three months but only with HRS as a cause of death not for other causes of death. Benefits and role of antioxidants like N- Acetylcysteine (NAC) in non-responder patients’ needs to be studied further. Long-term use of low dose terlipressin (<4mg/d) plus albumin and addition of antioxidant NAC to this regimen may help in improving both HRS reversal rate and survival rate in non-responders to terlipressin.

Objective:To analyze the role of calcium in anxiety and its effect on anxiolytic activity of diazepam and verapamil.Materials and Methods:Study was conducted using female albino rats in light and dark arena; a nonconflicting animal experimental model for anxiety. Animals were divided into six groups with six animals in each group. Test drugs, calcium gluconate (10 mg/kg), diazepam (1 mg/kg), verapamil (5 mg/kg), calcium + diazepam, and calcium + verapamil were administered intraperitoneally. Percentage of time spent in light arena and number of entries into light arena were the two parameters observed for 5 min after 30 min of drug administration. ANOVA test was used for statistical analysis.Results:Compared to the control group, diazepam group, and calcium group, only calcium + diazepam group showed considerable increase in mean percentage of time spent in light arena. However, this increase was statistically insignificant. In the case of total number of entries into light arena, animals in calcium + diazepam group showed statistically significant increase in total number of entries into light arena when compared to calcium group and diazepam group.Conclusion:Results of the study suggest that calcium may enhance the anxiolytic activity of diazepam, but has no effect on anxiolytic activity of verapamil.

Background: Hypertension leads to vascular damage due to high pressure exerted on arteriolar wall and also promotes atherothrombosis in large and medium sized blood vessels. Thrombosis is an extension of haemostasis and platelets have a crucial role in the formation of atherothrombosis. Increased platelet activity is a risk factor in hypertensive patients and leads to cardio-and cerebrovascular events and target organ damage. Anti-platelet aggregatory treatment in these high risk patients have become a crucial step in their treatment. Recent data indicate that angiotensin II type 1 blockers or AT1 receptor blockers (ARBs) like Losartan and dihydropyridine class of L-type calcium channel antagonist like Amlodipine have anti-platelet activity. These two classes of drugs are frequently administered in hypertensive either alone and in combinations. This study aims to compare the anti-platelet activity of Losartan and Amlodipine. Anti-platelet activity in addition to anti-hypertensive activity of these drugs would be beneficial in treating hypertensive who are at high risk of atherosclerosis and atherothrombosis, if they are selectively prescribed these agents. Methods: This was an observational study. Sixty (n=60) patients diagnosed with essential hypertension, attending medicine outpatient department of a tertiary care hospital were enrolled in the study. Out of them thirty (n=30) were patients who were prescribed losartan. Rest of the patients (n=30) were ones prescribed amlodipine. It was ensured that the patients of both the groups were on respective medication for at least one month. Another thirty (n=30) normotensive subjects acted as control. The bleeding time was evaluated for all three groups using Duke method of bleeding time estimation. Results: Data was analysed using SPSS software version 20. One way ANOVA was used to analyse the data. This was followed by post hoc Tukey's test. The mean bleeding time(in minutes) of Losartan group was 2.583±0.263 SD, Amlodipine group was 2.214±0155 SD and control group was 1.998±0.198 SD. Statistically significant p value of <0.001 was observed in losartan and amlodipine groups. Conclusions: Our study shows that the mean bleeding time of Losartan group and amlodipine group were significantly higher than that of Control group. It was further observed that the mean bleeding time of losartan was higher than that of amlodipine group indicating a better antiplatelet action by losartan than amlodipine. Additional antiplatelet activity could be desirable to treat hypertensive patients with high atherothrombotic and/or thromboembolic risk.