Hypertension is an important medical and public health issue all over the world. It is one of the most prevalent conditions seen today by clinicians in both developed and developing countries. Depending upon progression of systolic and diastolic blood pressure it is classified into stage 1, 2 and 3 hypertension. Life style modifications may be helpful in initial stage but pharmacological treatment is necessary when it become difficult to control it. In routine practice, pharmacological treatment is being selected from diuretics, β-blockers, calcium channel blockers and renin angiotensin system inhibitors either alone or in combination for both initial and maintenance therapy. Choice of drug depends upon favourable effects in specific clinical setting. Thiazide type diuretics are being preferred for most patients with uncomplicated hypertension whereas β-blockers show strong benefits in patients with a variety of cardiovascular complications. ACE-Inhibitors and ARBs are superior to other class in patients with multiple risk factors like obesity, insulin resistance or diabetes. CCBs compared with other class of hypertensive drugs demonstrate similar blood pressure lowering effects and similar reductions in cardiovascular morbidity and mortality but higher incidence of heart failure and fatal myocardial infarction in some patients. Despite the continued decrease in mortality and morbidity rate by these antihypertensive drugs, some documented increasing prevalence of cardiac failure and end stage renal disease remains to be explained.
{"title":"Clinical Perspective on the Management of Hypertension","authors":"M. Iqbal","doi":"10.4137/IJCM.S5475","DOIUrl":"https://doi.org/10.4137/IJCM.S5475","url":null,"abstract":"Hypertension is an important medical and public health issue all over the world. It is one of the most prevalent conditions seen today by clinicians in both developed and developing countries. Depending upon progression of systolic and diastolic blood pressure it is classified into stage 1, 2 and 3 hypertension. Life style modifications may be helpful in initial stage but pharmacological treatment is necessary when it become difficult to control it. In routine practice, pharmacological treatment is being selected from diuretics, β-blockers, calcium channel blockers and renin angiotensin system inhibitors either alone or in combination for both initial and maintenance therapy. Choice of drug depends upon favourable effects in specific clinical setting. Thiazide type diuretics are being preferred for most patients with uncomplicated hypertension whereas β-blockers show strong benefits in patients with a variety of cardiovascular complications. ACE-Inhibitors and ARBs are superior to other class in patients with multiple risk factors like obesity, insulin resistance or diabetes. CCBs compared with other class of hypertensive drugs demonstrate similar blood pressure lowering effects and similar reductions in cardiovascular morbidity and mortality but higher incidence of heart failure and fatal myocardial infarction in some patients. Despite the continued decrease in mortality and morbidity rate by these antihypertensive drugs, some documented increasing prevalence of cardiac failure and end stage renal disease remains to be explained.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82889583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-01-01DOI: 10.1177/117739361000100002
K. Gayatri, J. Kumar, B. B. Kumar
Objective To compare the effects of Metformin with N-acetyl cysteine in polycystic ovarian syndrome (PCOS). Methods A prospective, randomised controlled study was conducted in the Department of Obstetrics and Gynaecology in a Medical College and General Hospital. Total 115 cases of polycystic ovarian syndrome presenting with different complaints were selected for the study. Fifty nine cases were treated with Metformin (Group-M) and other 56 with N-acetyl cysteine (Group-N). Primary outcome measures are improvement in clinical features and biochemical profile, where as secondary outcome measures are improvement in hormonal profile and ultrasonographic findings. Statistical analysis was done by Z test and Chi square test. Results From each group, 50 patients were ultimately evaluated. There was significant improvement in some of the clinical features like weight gain, acne and hirsutism in group-N (P < 0.05), but there was no significant change in other features like oligomenorrhea, amenorrhoea and infertility. The biochemical markers of insulin resistance like fasting insulin, fasting glucose/insulin ratio and HOMA-IR were significantly reduced in group-N. Hormone levels like serum LH, FSH, TT and LH/FSH ratio was significantly decreased in group-N, but FT, FT/TT ratio and SHBG were similar in both the groups. Ultrasonographic findings were similar in both the groups. Conclusion N-acetyl Cysteine had better improvement in clinical, biochemical and hormonal profile than Metformin in PCOS patients. It can be used as a substitute for insulin reducing medications in treatment of PCOS patients, considering its limited adverse effects.
{"title":"Metformin and N-acetyl Cysteine in Polycystic Ovarian Syndrome–-A Comparative Study","authors":"K. Gayatri, J. Kumar, B. B. Kumar","doi":"10.1177/117739361000100002","DOIUrl":"https://doi.org/10.1177/117739361000100002","url":null,"abstract":"Objective To compare the effects of Metformin with N-acetyl cysteine in polycystic ovarian syndrome (PCOS). Methods A prospective, randomised controlled study was conducted in the Department of Obstetrics and Gynaecology in a Medical College and General Hospital. Total 115 cases of polycystic ovarian syndrome presenting with different complaints were selected for the study. Fifty nine cases were treated with Metformin (Group-M) and other 56 with N-acetyl cysteine (Group-N). Primary outcome measures are improvement in clinical features and biochemical profile, where as secondary outcome measures are improvement in hormonal profile and ultrasonographic findings. Statistical analysis was done by Z test and Chi square test. Results From each group, 50 patients were ultimately evaluated. There was significant improvement in some of the clinical features like weight gain, acne and hirsutism in group-N (P < 0.05), but there was no significant change in other features like oligomenorrhea, amenorrhoea and infertility. The biochemical markers of insulin resistance like fasting insulin, fasting glucose/insulin ratio and HOMA-IR were significantly reduced in group-N. Hormone levels like serum LH, FSH, TT and LH/FSH ratio was significantly decreased in group-N, but FT, FT/TT ratio and SHBG were similar in both the groups. Ultrasonographic findings were similar in both the groups. Conclusion N-acetyl Cysteine had better improvement in clinical, biochemical and hormonal profile than Metformin in PCOS patients. It can be used as a substitute for insulin reducing medications in treatment of PCOS patients, considering its limited adverse effects.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84564498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We present the case of a 67-year-old man with a three month history of right sided facial nerve palsy reporting to our clinic for evaluation of a recently seen suspicious mass in the right lung. Subsequently he was diagnosed with advanced NSCLC right lung and started on palliative chemotherapy. Furthermore, temporal bone metastasis was discovered on radiological imaging while investigating symptoms of acute mastoiditis and persisting facial neuralgia, a symptom completely overlooked at first as Idiopathic Bell's palsy. This presentation is exceptionally unique, although temporal bone metastasis arising from established primary lung or other malignancies is itself rare, and predilect to a later onset in the natural history of the disease, as reported in the literature. None of the published literature report neither addresses the optimal management course nor its subsequent impact on quality of life of patients with temporal bone metastasis.
{"title":"Non-small Cell Lung Cancer (NSCLC) Presenting as Isolated Facial Nerve Palsy from Metastasis to Temporal Bone: A Report Discussing Unique Presentation and Evolution with Diagnostic and Management Dilemmas","authors":"M. Tiwana, S. Rathod, T. Gupta, J. Agarwal","doi":"10.4137/IJCM.S4894","DOIUrl":"https://doi.org/10.4137/IJCM.S4894","url":null,"abstract":"We present the case of a 67-year-old man with a three month history of right sided facial nerve palsy reporting to our clinic for evaluation of a recently seen suspicious mass in the right lung. Subsequently he was diagnosed with advanced NSCLC right lung and started on palliative chemotherapy. Furthermore, temporal bone metastasis was discovered on radiological imaging while investigating symptoms of acute mastoiditis and persisting facial neuralgia, a symptom completely overlooked at first as Idiopathic Bell's palsy. This presentation is exceptionally unique, although temporal bone metastasis arising from established primary lung or other malignancies is itself rare, and predilect to a later onset in the natural history of the disease, as reported in the literature. None of the published literature report neither addresses the optimal management course nor its subsequent impact on quality of life of patients with temporal bone metastasis.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79470740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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