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Muneshwar J N et al., Int J Med Res Health Sci.2013;2(1):19-22

International Journal of Medical Research

&

Health Scienceswww.ijmrhs.com Volu me 2 Issue 1 Jan-Mar 2013 Coden: IJMRHS Copyright @2013 ISSN: 2319-5886

Received: 26th

Oct 2012 Revised: 19th

Nov 2012 Accepted: 23rd

Nov 2012

Original research article

A QUESTIONNAIRE BASED EVALUATION OF TEACHING METHODS AMONGST MBBS

STUDENTS

Muneshwar JN1, *Mirza Shiraz Baig2, Zingade US3, Khan ST4

1Associate Professor, 2Assistant Professor, 4Professor & Head, Department of Physiology, GMC,

Aurangabad, Maharashtra.3Professor & Head, Department of Physiology, BJMC, Pune, Maharashtra.

*Corresponding author e mail: [email protected]

ABSTRACT

Background: The medical education and health care in India are facing serious challenges in content and

competencies. Heightened focus on the quality of teaching in medical college has led to increased use of

student surveys as a means of evaluating teaching. Objectives: A questionnaire based evaluation of 200

students (I MBBS & II MBBS) about teaching methods was conducted at a Govt Medical College &

Hospital, Aurangabad (MS) with intake capacity of 150 students &established since 50 last years. Methods:

200 medical students of I MBBS & II MBBS voluntarily participated in the study. Based on teaching

methods, an objective questionnaire paper was given to the participants to be solved in 1 hour. Results: As a

teaching mode 59% of the students favored group discussion versus didactic lectures (14%). Almost 48%

felt that those didactic lectures fail to create interest & motivation. Around 66% were aware of learning

objectives. Conclusion: Strategies and futuristic plans need to be implemented so that medical education in

India is innovative & creates motivation.

Keywords: Teaching methods, Undergraduate students, Medical education

INTRODUCTION

The Government of India recognizes Health for all

as a national goal and expects medical training to

produce competent “Physicians of First Contact”

towards meeting this goal. However, the medical

education and health care in India are facing

serious challenges in content and competencies1

With the growing awareness of the importance of

teaching and learning in medical education and the

need to move towards evidence-based teaching, it

is important to re-examine the educational teaching

methodology2.

To take care of the huge Indian population India

needs quality doctors and not just quantity.

Heightened focus on the quality of teaching in

medical college has led to increased use of student

surveys as a means of evaluating teaching3.

Good evaluation practices in medical training, at

all levels, enhance both quality and accountability

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of medical education4.In recent a time there is a

growing apathy of students towards attending

lectures and clinics in medical colleges. Present

study tried to evaluate the teaching methods &

changing trends amongst first year and second yearMBBS Students at Govt. Medical College,

Aurangabad (MS).

Aims and objective

Primary To evaluate the teaching methods

practiced in medical education in Ist MBBS & II nd

MBBS medical students

Secondary The strengths and shortcomings in

teaching methods, areas of improvement in

medical teaching: student’s scenario

Study Design: A prospective observational study

MATERIAL AND METHODS

The study was approved by the Institutional

Ethical Committee of Govt. Medical College,

Aurangabad.

Enrolled students were explained all the details of

the study and objectives. The identity of the

students was not allowed. 200 medical students of

I MBBS & II MBBS voluntarily participated in thestudy. Based on teaching methods, an objective

questionnaire paper was given to the participants to

be answered in 1 hour.

The questionnaire consisted of MCQs regarding:

1) Teaching methods

2) The audiovisual aids used in teaching.

3) Evaluation Methods

4) The environment related to studying

RESULTS

A) Teaching Methods: 66% were aware of thelearning objectives, which is a welcome sign. 48%

felt that didactic lectures fail to create interest &

motivation in the subject. 59% of the students

favored group discussion as a teaching mode over

didactic lectures (14%). 87% pointed out that at the

end of the lecture, the student becomes storehouse

of book facts rather than being oriented. 83% were

of the opinion that the current duration of the

MBBS curriculum versus vast syllabus is a major

hurdle in learning process.

B) Audio Visual Aids: 90%Participants were in

favor of using Audio visual aids for

demonstrations with complimentary use of

traditional chalk and blackboard methods.

C) Evaluation Methods: 53%of the students feel

that the current evaluation standards are not

satisfactory considering the competitive

examinations for future. They prefer introduction

of more MCQs.D) Environment related to studies: 90%Students

complained of average sound system quality in

lecture halls, overcrowding in the demonstration

sessions.

Fig: 1 Teaching Methods

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Learning Objectives

achieved

Didatic Lectures

acceptance

Group Discussions

required

Change in Duration of

MBBS Curriculum Required

O b s e r v a t i o n %

Teaching Methods

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Fig. 2: Other Parameters Studied

DISCUSSION AND CONCLUSION

The study is not judgemental. We are just trying to

put forth the facts In front. It is not a complete

picture. The information gained from evaluation

can lead to changes in any aspect of teaching and

evaluation methods. Curricular reforms to

systematically address these issues and develop

strategies to strengthen the medical education andhealth care system are needed at an institutional

level & to be implemented at health universities

who are involved in the curricular programmes.

This will definitely help the Indian Medical

Graduates match or better the international

standards.4-6

Amongst the important suggestions received from

the medical students were to decrease the

generation gap between the student and the

teachers by imparting Group activities in the formof seminars and symposiums. The teaching

standard should be of competitive entrance

examination level right from the basic sciences

itself.

A comprehensive initiative for complete

assessment of teaching methods is urgently

required at a state level involving Medical

education technology units of all concerned

universities for medical education. This will enable

strategies and futuristic plans for proper and

uniform implementations so that medical education

in India becomes innovative, competitive and is

able to prepare undergraduates to perform in the

changing scenario of medical science.

REFERENCES

1. Vision2015-Medical council of India.

Available at www.mciindia.org/tools/announcement/MCI_booklet.pdf. Accessed on

14 Dec 2011.

2. Sybille K L. Evaluation of Teaching and

Learning Strategies. Med Educ Online [serial

online] 2001;6:4.

3. Harden R. AMEE Guide 21: curriculum

mapping: a tool for transparent and authentic

teaching and learning. Evaluating the outcomes

of undergraduate medical education. Medical

Education. 2003; 37: 580 – 81

4. Marton F, Saljo R. Qualitative differences in

learning I-outcome and process. Brit J of Educ

Psych. 1996;46:4-11

5. Second year student’s feedback on teaching

methodologyy and evaluation methods in

pharmacology. Nilesh Chavda, preeti yadav,

mayor Chaudhari, kantharia. National Journal

of Physiology, Pharmacy and Pharmacology

2011;1:23-31.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Audiovisual Aids Acceptance Evaluation Methods Satisfactory Teaching Environment change

required

O b s e r v a t i o n

%

Parameters

21


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6. Learning Habits Evaluation of First M.B.B.S

Students of Bhavnagar Medical College.

Chinmay Shah, Shailesh Patel, Jasmin Diwan,Hemant Mehta. International Journal of

Medical Science and Public Health. 201;’

1(2):81-86

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Kunkulol Rahul et al., Int J Med Res Health Sci.2013;2(1):23-29


&

Health Scienceswww.ijmrhs.com Volume 2 Issue 1 Jan-Mar 2013 Coden: IJMRHS Copyrig ht @2013 ISSN:2319-5886

Received: 4th

Nov 2012 Revised: 3rd

Dec 2012 Accepted: 7th

Dec 2012


EVALUATION OF EFFICACY AND TOLERABILITY OF ACETAMINOPHEN (PARACETAMOL) AND

MEFENAMIC ACID AS ANTIPYRETIC IN PEDIATRIC PATIENTS WITH FEBRILE ILLNESS: A

COMPARATIVE STUDY.

*Kunkulol Rahul R 1

, Sonawane Aishwarya2

, Ashok Kumar Chavva3

1Associate Professor, Department of Pharmacology, Secretary, Research Cell, PIMS-DU, Loni.2UG, Rural Medical College, Loni.3Professor, Department of Pediatrics, Rural Medical College, Loni

*Corresponding author e mail: [email protected]

ABSTRACT

Objectives: With the increase in reports of the failure of Paracetamol as antipyretic in pediatric patients and

the increase in the use of Mefenamic acid, the study was undertaken to recommend best among the both

antipyretics by comparing the efficacy and tolerability of both these drugs.

Methods-It was a prospective, active treatment controlled study with follow up to 72 hours done over a

period of 2 months after the Institutional Ethical committee approval. Total 124 pediatric patients with fever

admitted to Pravara Rural Hospital, Loni having a body temperature >38.5 and fulfilling the inclusion and

exclusion criteria were included. Patients included were categorized into two groups –group A and group B

and administered Paracetamol and Mefenamic acid in the doses 15 mg/kg and 4 mg/kg body weight

respectively. The parameters essential for comparing the efficacy and tolerability were observed and

recorded. The collected data were subjected to ‘paired t test’ of significance and was analyzed statistically.

Results-Both drugs significantly decreased body temperature in pediatric patients with fever. The

antipyretic efficacy of Mefenamic acid was highly significant than Paracetamol (


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regulates the set-point at which the body

temperature is maintained. In fever this

hypothalamus thermostat set point is elevated and

body temperature increases over normal values.

The normal range of body temperature is 36.5 º -

37.5º C.

3

In most clinical situations, fever results from the

presence of the substances called pyrogens.

Various infections, toxins and other mediators

induce production of pyrogens by host

inflammatory cells such as macrophages,

endothelial cells and lymphocytes. Best pyrogens

are endotoxins (Lipopolysaccharides, LPS)

produced by gram negative bacilli. Gram positive bacteria also produce pyrogens as their cell wall

has peptidoglycan and Lipoteichoic acid. The

endogenous pyrogens produced locally or

systemically gain entrance in the circulation and

produce fever .1,4

. The major fever causing

cytokines are various Interleukins (IL) IL-Iβ, IL-lα,

1L-6, TNF-α (Tumor necrosis factor) and INF-α

(interferon). These pyrogenic cytokines directly

stimulate the hypothalamus to produce PGE2

(prostaglandin I2) which then resets thetemperature regulatory set point. IL-1 is an

important pyrogen that on reaching the

hypothalamus induces fever in 8-10 minutes

time1.When the pyrogenic cytokines disappear

from the circulation or inhibition of

cyclooxygenase by the metabolites, the

hypothalamus is again reset downward so now the

heat dissipation mechanisms come into play

causing vasodilation and sweating.

It has been shown beyond doubt that increase in

the temperature of the body puts the child under

threat of convulsions, dehydration, metabolic

acidosis and fever induced stroke. So Antipyresis

is one of the most usual therapeutic interventions

undertaken. 1

The most commonly used antipyretics are

Nonsteroidal Anti Inflammatory Drugs (NSAIDS),

which also have a considerable analgesic effect

which promotes a general feeling of well-being.Antipyretic treatment is now routinely prescribed

to febrile children, though variedly by most

pediatricians.

Antipyresis occurs with different classes of

substance including Acetyl Salicylic Acid (ASA),

Acetaminophen and the other nonsteroidal anti-

inflammatory agents represented by Indomethacin,

Mefenamic acid, Ibuprofen and the latest

Nimesulide. Some antipyretics are anti-

inflammatory. NSAIDs inhibit cyclooxygenase

(COX) which catalyzes the conversion of

arachidonic acid to prostaglandin E2. This

reduction of prostaglandin E2 in the brain is

believed to lower the hypothalamic set point.1, 4

Aspirin, once a preferred drug is no longer used inreducing fever as it has potential to cause Reye's

syndrome. Acetaminophen, Mefenamic acid and

Nimesulide are currently three preferred drugs for

treating fevers in children.

Acetaminophen (paracetamol) antipyretic is in use

for a considerable time. As with ASA, the

antipyretic effect of Paracetamol is believed to be

caused by its ability to decrease prostaglandin

synthesis in the brain. Since Paracetamol does not

inhibit the synthesis of prostaglandins in the periphery, it does not possess any anti-

inflammatory action. Besides its beneficial effects

PCM also has potential side effects and may cause

severe hypersensitivity reactions1,4

. Nimesulide is a

non-steroidal anti-inflammatory drug with

analgesic and antipyretic properties. Its efficacy

has been compared with naproxen, ASA,

paracetamol and Mefenamic acid but it is banned

due to fulminant hepatitis. Mefenamic acid is a

potent inhibitor of cyclooxygenase. It has a central

as well as peripheral analgesic action. The drug is

commonly used in patients with injuries,

osteoarthritis, rheumatoid arthritis and

dysmenorrhea. The pediatric suspension of

Mefenamic acid is recommended 50mg/5ml or

25mg/kg body weight in divided doses.3-6

It is essential to establish a cause for a fever and

then provide effective modern treatment. Judicious

use of the antipyretics needs to be consideredgiving due respect to the body's response to the

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infection in the form of fever. The decision to

choose an antipyretic should be dictated by

efficacy, safety, duration of action, effectiveness

and cost. 1 PCM has always been a dependable

antipyretic and has an additional advantage of

being a cheaper drug and relatively safer

antipyretic. There have been reports of failure of

antipyretic drugs including paracetamol in

controlling fever and trends of increase use of

Mefenamic acid as antipyretic. Moreover there are

no studies comparing efficacy and tolerability of

Acetaminophen and Mefenamic acid. Hence it

was thought prudent to evaluate both these drugs

for better antipyretic efficacy in pediatric patientswith febrile illness.

Aims and objectives

1. To compare the efficacy of Acetaminophen

(Paracetamol) And Mefenamic Acid in

pediatric patients with fever.

2. To compare the tolerability and adverse effect

of Acetaminophen (Paracetamol) And

Mefenamic Acid in pediatric patients with

fever

3. To recommend best antipyretic in pediatric

patients.

MATERIALS AND METHODS

This was a prospective observational clinical study

done in collaboration with the Department of

Pediatrics, Pravara Rural Hospital, Loni. The

Institutional ethical committee approval was

obtained before the initiation of the study.

Patients diagnosed by Department of Pediatricswith febrile illness were enrolled in the study

according to the following inclusion and exclusion

criteria. Written informed consent was taken from

each patient.

Inclusion criteria

1. Patients ready to give informed consent.

2. Hospitalized children having temperature >

99.6 º F

3. Patients 1-12 years.

4.

Patients of either sex.

5. Patients of all types of febrile illness.

Exclusion criteria

1. Uncooperative patients.

2. Patients not following the protocol.

3. Patients above the age of 12 years.

4.

Patients who were hypersensitive to drugs.

5. Patients having any inflammatory illness

6. Severely ill patients suffering from circulatory

collapse, blood dyscrasias, cardiac or hepatic

disease, G-6-PD deficiency or meningitis.

7. Children having collagen vascular diseases or

malignancy as a primary or the underlying cause

of fever and those receiving antimicrobials

and/or corticosteroids within 24 hours preceding

the study.Study conduct

This was a prospective, observational, comparative

study with follow- up till 72 hours. A total of 124

children having temperature > 99.6 º F admitted to

the Pediatrics ward, Pravara Rural Hospital, Loni

were included in the study.

Enrolled patients were categorized into 2 groups

depending on antipyretic treatment given by the

pediatricians:

Group A: Paracetamol treated at a dose of 15mg/kg given as suspension 1, 10

Group B: Mefenamic acid 4 mg/kg given as a

suspension.8

Following parameters were recorded in each group

for:

1. Efficacy evaluation7

Axillary temperature (measured with a mercury

thermometer)

Before drug administration

Every 1 (H1), 4 (H4) and 6 (H6) h after the

first dose.

Maximum temperature

Withdrawal of the patient from the study

Body temperature increases above 104°F or

decreased below 96.5 °C

Occurrence any severe physical event

Withdrawal of the consent of the

parents/guardians.

2. Tolerability evaluation

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Modified Treatment Tolerability Evaluation Score

(MTTES) 7,11:

Vomiting, dislikeness for meals, daytime sleep and

additional medication were assessed and scores

were recorded from 0-3 (absent –severe):

Score 0: Absent - Symptom is not present

Score1: Mild - Symptom is present but is not

annoying or troublesome

Score 2: Moderate - Symptom is frequently

troublesome but would not interfere with normal

daily activity or sleep

Score 3: Severe - Symptom is sufficiently

troublesome to interfere with normal daily activity

or sleep

Symptoms for MTTES: Vomiting, Dislikeness

for meals, Daytime sleeping, Additional

medication

The primary efficacy and tolerability end points

were recorded as changes from the baseline values:

Sample size: 62 patients were included in each

group according to inclusion and exclusion criteria.

(Total sample size: 124 pediatric patients with

fever)

Study period: 2 months starting from the date of

approval of the study by the Institutional Ethical

Committee

Statistical analysis: The data will be collected,

pooled, subjected to appropriate statistical analysisand conclusions were drawn

RESULTS AND OBSERVATIONS

Fig:1. The change in mean values of all parameters from baseline to 6 hours during treatment of patients

included in group A (Paracetamol)

By applying Student’s Paired ‘t’ test there is a

highly significant decrease of body temperature in

treatment group A (Paracetamol) from baseline to

1 hour, 4 hours and 6 hours, 1 hour to 4 hours and

6 hours, (i.e. p


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By applying Student’s Paired ‘t’ test there is a

highly significant decrease of body temperature in

treatment group B (Mefenamic acid) from baseline

to 1 hour, 4 hours and 6 hours, 1 hour to 4 hours

and 6 hours, (i.e. p0.05* P>0.05* P>0.05* P>0.05*

* No significant difference between mean values of MTTES scores between Paracetamol and Mefenamic acid group.

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DISCUSSION

The management of children with fever is based

primarily on the elucidation and treatment of the

underlying cause. The role of antipyretic therapy in

such children is aimed at reducing the ever present

risk of a febrile convulsion. A variety of

pharmacological agents are available for

Antipyresis. The so called superiority of one drug

over the other is marginal and has no therapeutic

significance.3, 12

In our study both Paracetamol and

Mefenamic acid proved to be effective antipyretic

drugs. Antipyresis was achieved within 6 hours of

administration of the dose. In Paracetamol group

the baseline body temperature decreased since

101.81 º to 99.29

ºFat 6hours while in Mefenamic

acid group from 102.12 º to 98.82 ºFat 6hours. Both

the drugs are NSAIDs and act by inhibiting COX

enzyme responsible for generating Prostaglandins

(PGE2). Paracetamol has only central action with

weak anti-inflammatory effect and so has been

reported to be the best antipyretic drug. Mefenamic

acid has central and peripheral action with anti-

inflammatory effect. The fall in temperature at 1 hr

was more in Mefenamic acid group (102.12o

Fto99.5oF)compared with paracetamol group

(101.81oF to 100.32oF).These results show that

Mefenamic acid has better antipyresis at 1 hour

than Mefenamic acid. A rough correlation has been

established between the anti synthetase activities of

many nonsteroidal anti-inflammatory drugs13

including Mefenamic acid in central nervous

system. Our results are in accord with S. Keininen

etal which also states Mefenamic acid to be more

potent and powerful antipyretic drug.8. The

children showed no adverse symptoms or signs in

connection with the antipyretic therapy. There was

no significant difference on Heart rate, BP and

respiratory rate despite a slight fall in all above

was noted.

Mefenamic Acid shows highly significant

decreases in the body temperature baseline to 6th

hour as compared to Paracetamol in paediatric

patients with fever (i.e. P


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efficacy of paracetamol as antipyretic should be

taken up.

ACKNOWLEDGEMENT

We acknowledge all the faculty members of theDepartment of Paediatrics for their help and

cooperation for this study

REFERENCES

1. Jagdish Chandra and Shishir Kumar

Bhatnagarr. Antipyretics in Children. Indian J

Pediatr. 2002; 69 (1) : 69-74

2. Avtar Let al. Antipyretic Effects of

Nimesulide, Paracetamol and Ibuprofen-

Paracetamol. Indian Journal of Paediatrics.2000; 67 (12): 865

3. Alexander KC et al. Fever in childhood.

Canadian Family Physician.1992; 38: 1832-36

4. K. Rajeshwari. Antipyretic Therapy. Indian

Pediatrics. 1997; 34 : 409-411

5. B S David. Fever panic. Sri Lanka Journal of

Child Health, 2000; 29: 97

6. S Balasubramanian, A Sumanth. Mefenamic

acid – Role as Antipyretic. Indian paediatrics.

2010; 47: 453

7. Autret E et al. Evaluation of Ibuprofen versus

aspirin and paracetamol on efficacy and

comfort in children with fever. Eur J Clin

Pharmacol. 1997 ; 51: 367-371

8. S. Keininen et al. Oral Antipyretic Therapy:

Evaluation of the N-Aryl-Anthranilic Acid

Derivatives Mefenamic Acid, Tolfenamic Acid

and Flufenamic Acid. Europ. J. Clin,

Pharmacol. 1978; 13: 331-3449. RP Khubchandani, KN Ghatikar, SS Keny,

NG Usgaonkar. Choice of antipyretic in

children. J. Assoc Physicians India.1995; 43

(9): 614-6

10. Keith R. Powell. Fever (ch.170). Nelson

Textbook of Paediatrics: 16thedition.p738.

11. Bikas Medhi et al. Efficacy of fexofenadine in

the Indian population suffering from allergic

rhinitis and urticarial. JK Science. 2006; 8: 83 -

85.

12. John hunter. Study of antipyretic therapy in

current use. Archives of Disease in

Childhood.1973; 48: 313. -314

13. Praveen Kumar Goyal et al. Double blind

randomized comparative evaluation of

Nimesulide and Paracetamol as antipyretics.

Indian paediatrics. 1998 ; 35: 24-26

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Naveen et al., Int J Med Res Health Sci. 2013;2(1):30-34


&

Health Scienceswww.ijmrhs.com Volume 2 Issue 1 Jan-Mar 2013 Coden: IJMRHS Copyright @2013 ISSN:2319-5886

Received: 5th

Nov 2012 Revised:30th

Nov 2012 Accepted: 7th

Dec 2012


DETECTION OF MALARIAL PARASITE BY BLOOD SMEAR EXAMINATION AND ANTIGEN

DETECTION: A COMPARATIVE STUDY

Erumalla Naveen1, Dimple Arora

2, Vinod Agarwal

3, Neelam sharma

4, Anuradha B

5, Vijay Durga S

6

1

Lecturer,

3

Professor. Triveni Institute of Dental Sciences, Hospital & Research Centre, Bilaspur, Chhattisgarh.2 Asst .Prof. Teerthankar Mahavir Medical College. Moradabad, UP.4 Professor,

5Associate Professor

6Assistant Professor, department of microbiology, Mamata Medical College,

Khammam, A.P

*corresponding author email: [email protected]

ABSTRACT

At present about 100 countries in the world are considered malarious, is thought to kill between 1.1 and 2.7

million people worldwide each year, of which about 1 million are children under the age of 5 years in these

areas. Under ideal circumstances, the clinical suspicion of malaria would be confirmed by a laboratory test

that is simple to perform, rapid, sensitive, specific and expensive. At the present time, no such test exists.

The most common test for malaria diagnosis remains the microscopic examination of giemsa or the fields –

stained blood smears. The test is based on the detection of Plasmodium falciparum specific histidine rich

protein ii (hrp) and a pan malarial species specific enzyme aldolose, produced by the respective parasites

and released into the blood and the test is based on immune chromatography, the test is highly sensitive.

Method: In this study included 100 patients, 60% of patients had history suggestive of malaria, another 40%

gave the history of irregular fever; For each patient peripheral blood sample was collected, thin and thick

smear blood films were made immediately after blood collection, stained with Leishman stain and examined

for malaria parasite by light microscopy. Results: The blood films results indicated that 40 (20%) patients

were infected with malaria and the rest 171 (85.5%) were malaria negative. Among positive patientsPlasmodium vivax was detected in 24 cases (60%) and Plasmodium falciparum in 10 cases (31%) and 6

cases mixed infection (PV + PF) (15%) correspondingly, the Para HIT Test results indicated that 29 (14.5%)

of the patient sample were positive for malaria parasites and 171 (85.5) were malaria negative out 29

patients cases. Infection with Plasmodium vivax accounted for 17 (58.6%) while infection with Plasmodium

falciparum accounted for 9 (25%) and 3 (1.3%) with mixed infection of Plasmodium vivax and Plasmodium

falciparum.

Keywords: Malaria, Blood smear, Para Hit test.

INTRODUCTION

Malaria is a parasitic infection of globalimportance and it remains to be one of the most

significant cause of morbidity and mortality ofhumans, worldwide. The disease is a major health

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problem in the tropics and subtropics regions.

Annually, approximately 500 million people in the

world suffer from malaria and about 1 million

deaths occur due to this infection. Current efforts

to control malaria focus on reducing attributable

morbidity and mortality by prompt diagnosis ofsuspected malarial infection with rapid and

accurate diagnosis for effective therapeutic

intervention.

The protozoan parasite belongs to the genus

Plasmodium. Four species of malaria parasite that

are known to infect humans are Plasmodium

falciparum, Plasmodium vivax, and Plasmodium

ovale and Plasmodium malariae. Plasmodium

falciparum accounts for the majority of infections

that term out to be lethal. While the three other

species cause a less severe form of malaria. The

infection is characterized by intermittent fever with

chills and anemia1-3

.

At present about 100 countries in the world are

considered malaria, about half of which are in sub-

Saharan Africa. Although this number is

considerably less than it was in the mid 1950s,

more than 2.4 billion of the world’s population is

still at risk.Malaria is thought to kill between 1.1 and 2.7

million people worldwide each year, of which

about 1 million are children under the age of 5

years in this areas2-5.

In many developing- world settings, a presumptive

diagnosis of malaria is based upon the presence of

fever alone. While statistically justifiable in sole

regions, such an approach inevitably leads to the

overuse of antimalarial drugs. Under ideal

circumstances, the clinical suspicion of Malaria

would be confirmed by a laboratory test that is

simple to perform, rapid, sensitive, specific and

expensive. At the present time, no such test exists.

The most common test for malaria diagnosis

remain the microscopic examination of Giemsa or

Fields – Stained blood smears. However, the

examination of blood films requires technical

expertise and the availability of a good – quality

microscope. The microscope is also time-

consuming and has limited sensitivity when

parasitemia is low3-5

.

Besides these majorities of Malaria cases occur in

rural areas where there is a little or no access to

reference laboratories and in many areas

microscopy is not available. Keeping all these in astudy was done to compare microscopic

examination of blood films with newly develop

Immuno Chromatography dipstic Test.

The test is based on the detection of Plasmodium

Falciparum specific Histidine Rich protein II (HRP

II) and a Pan Malarial Species specific enzyme

Aldolose, produced by the respective parasites and

released into the blood and the test is based on

Immuno Chromatography. The test is highly

sensitive and specific for the diagnosis of

Plasmodium Falciparum, Plasmodium Vivax,

Plasmodium Ovale and Plasmodium Malarial

Infection.


After approval of the Institutional Ethics

Committee and inform consent form the patient in

this study included 100 patients attending Mamata

General Hospital 60% of patients had historysuggestive of malaria i.e., rigor, chill, rise of high

temperature with profuse sweating. Another 40%

gave the history of irregular fever; Patients that

have been treated for malaria in the previous four

weeks were excluded from this study. For each

patient peripheral blood sample was collected into

a sterile tube containing potassium EDTA. Thin

and thick smear blood films were made

immediately after blood collection, stained with

Leishman stain and examined for malaria parasite by light microscopy. According to standard

practice a thin blood smear was examined for 15

minutes and for a thick blood film 200 fields were

visualized. All the blood sample was tested with

Para HIT total dipstick test according to

manufacturers instruction and results were

compared to those obtained from examination of

thin and thick blood smears.

The test is based on the detection ofPlasmodiumm

falciparum specieshistidinee rick protein II (HRP

31


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II) and a pan malarial species specific enzyme

Aldolase, produced by the respective parasites and

released into the blood.

RESULTS

Positive: Appearance of three magenta red colored bands, one each in the anti falciparum antibody

region, anti malarial antibody region and control

region indicates that the sample is reactive for

Plasmodium falciparum and mixed infection with

another malarial species. (Plasmodium vivax is

most commonly encountered in India).

Negative: Appearance of only one magenta red

colored band in the control region indicates that the

sample is non-reactive for Plasmodium species.

Error: No band observed in control or test region

indicates improper test procedure or deterioration

of reagents. Repeat the test using a fresh test strip.

The magenta red coloured test bands indicate

reactive result representing the binding of antigen

antibody complex to a monoclonal antibody thathas been pre-immobilized on the test strip. In non-

reactive sample no magenta red coloured band is

seen in test region. A reactive procedural control

band is also built into validate the results as well as

proper test performance.

Fig.1: Examined Blood smear report & Para hit report

Table:1. Comparision of blood smear examination and antigen detection

A total of 200 blood samples was tested from the

month of March 2007 to December 2007 for

malaria parasites by the Para HIT method and the

results were compared to those obtained from

examination of thin and thick smear blood films.The blood films results indicated that 40 (20%)

patients were infected with malaria and the rest

171 (85.5%) were malaria negative. Among

positive patients Plasmodium vivax was detected

in 24 cases (60%) and Plasmodium falciparum in

10 cases (31%) and 6 cases mixed infection (PV +PF) (15%) correspondingly, the Para HIT Test

24

13

3

160

Blood Smear

Parameters Blood Smear Para HIT

Positive % Positive %

PF 10 (25%) 9 (31%)

PV 24 (60%) 17 (58.6%)

Mixed 6 (15%) 3 (10.3%)

Total 40 (20%) 29 (14.5%)

2211

3

164

Para HIT

P. vivax

P. falciparum

Both Pf+pv

Negative

32


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results indicated that 29 (14.5%) of the patient

sample were positive for malaria parasites and

171 (85.5) were malaria negative out 29 patients

cases. Infection with Plasmodium vivax

accounted for 17 (58.6%) while infection with

Plasmodium falciparum accounted for 9 (25%)and 3 (1.3%) with mixed infection of Plasmodium

vivax and Plasmodium falciparum.

The blood film examination identified 7

Plasmodium vivax positive samples that were not

detected by the Para HIT Test and 1 Plasmodium

falciparum case identified by blood film

examination and not detected by the para HIT test.

However there was 100% agreement between

blood film results and Para HIT results for the

other 29 cases.

DISCUSSION

The resurgence of malaria has renewed interest in

developing not only preventive measures, but also

rapid diagnostic techniques. A multitude of

factors has contributed to the reemergence of

malaria, including

(i) Insecticide resistance in the Anopheles

Mosquito.(ii) Social instability resulting in movements of

unexposed non immune individuals in areas

where malaria is endemic, and

(iii)The failure to develop an effective malaria

vaccine.

Compounding the problems of malaria’s

geographical expansion and of increasing

morbidity and mortality are the emergence and

rapid spread of antimalarial drug resistance.

Which necessitate the use of more expensive and

sometimes toxic antimalarial drugs and longer

treatment courses? In addition, the cyclic

recurrence of malaria epidemics has a tremendous

impact on the health infrastructure in developing

countries and adversely affects local economics,

since infected individuals are often too debilitated

to work.

One of the most pronounced problems in

controlling the morbidity and mortality caused by

malaria is limited access to effective diagnosis

and treatment in areas where malaria is endemic.

Clinical diagnosis of infection with the malaria

parasite requires microscopic observation of

parasites on a Giemsa – stained blood smear.

Microscopic examination of blood smears

requires highly skilled people to perform orinterpret results.

Several methods have been developed to

supplement and replace the conventional

microscopic method. The most promising new

malaria diagnostics are the serological Antigen

detection tests. Para HIT is one amongst them.

We employed this test and compared it with a

conventional smear examination for diagnosis of

Plasmodium falciparum and Plasmodium vivax

infection6-8.

The antigen detection test identified (14%) as

malaria positive while the blood film identified

(20) to be malaria positive. Some malaria

infections detected by blood film were not

detected by the Para HIT test. This may be

explained by the fact that increased awareness of

malaria among the general public has led to a

rampant misuse of antimalarial drugs in

inadequate doses empirically for any fever. SincePara HIT detects PLDH which is produced only

by living parasites, the blood samples judged

negative by Para HIT may have been dead

parasites and not yet cleared from the host. Two

cases of Plasmodium vivax detected by blood film

were not detected by Para HIT. This may be due

to insufficient enzyme production which occurs

during early malarial infection or the patient blood

samples contained parasites at concentrations

below the Para HIT tests detection level eight

blood samples in which Para HIT detected

Plasmodium falciparum band were found to be

negative in the blood smear examination. This

may be explained by the fact that Plasmodium

falciparum can sometimes sequester and may not

be present in circulating blood.9,10

This test has the added advantage that it can detect

all fouPlasmodiumum species and can be used to

follow the efficiency of drug therapy since itdetects on enzyme produced only by living

33


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parasites. Although it has got a number of

advantages one needs to keep in mind the cost of

the test which may not be affordable by many.

The high cost of the test may prevent its regular

and routine we in many of the laboratories.

However, it was a valuable adjunct at the time ofemergency for rapid diagnosis, although

microscopy remains the mainstay for the

diagnosis of malaria for routine use in countries

like India.

REFERENCES

1. Momar Ndao, Etienne B, Evelyne K, Theresa

WG, Dick MacLean , Brian J W. Comparison

of Blood Smear, Antigen Detection, and Nested-PCR Methods for Screening Refugees

from Regions Where Malaria Is Endemic after

a Malaria Outbreak in Quebec, Canada. J Clin

Microbiol. 2004; 42 (6): 2694–2700.

2. Manjunath PS, Preeti BM, Basavaraj VP.

Comparative Study of Peripheral Blood

Smear, QBC and Antigen Detection in

Malaria Diagnosis. Journal of Clinical and

Diagnostic Research. 2011;5 (5): 967-9.

3. Cooke AH, Chiodini PL, Doherty T, Moody

AH, Ries J, Pinder M. Comparison of a

parasite lactate dehydrogenase-based immune

chromatographic antigen detection assay

(OptiMAL) with microscopy for the detection

of malaria parasites in human blood samples.

Am J Trop Med Hyg. 1999; 60(2):173-6.

4. DK Mendiratta , Bhutada K, Narang R,

Narang P. Evaluation of different methods

for diagnosis of P. Falciparum malaria. IndianJournal of Medical Microbiology, (2006) 24

(1):49-51

5. Parija SC, Dhodapkar R, Subashini

Elangovan, DR Chaya. A comparative study

of blood smear, QBC and antigen detection

for diagnosis of malaria. 2009; 52(2):200-2

6. Bhat Sandhya K, Sastry S, Nagaraj ER,

Sharadadevi Mannur, Sastry AS. Laboratory

diagnosis of malaria by conventional

peripheral blood smears examined with

Quantitative Buffy Coat (QBC) and Rapid

Diagnostic Tests (RDT) - A comparativestudy. International Journal of Collaborative

Research on Internal Medicine & Public

Health. 2012; 4(10): 1746-55

7. Hovette P, Aubron C, Perrier-Gros-Claude

JD, Schieman R, N'Dir MC, Camara P. Value

of Quantitative Buffy Coat (QBC) in

borreliasis-malaria co-infection] Med Trop

(Mars). 2001; 61(2):196-7.

8. Carol JP, John FL, Winslow IK, Jose AQ,

Rina Kaminsky, Marianna KB, Arba LA.

Evaluation of the OptiMAL Test for Rapid

Diagnosis of Plasmodium vivax and

Plasmodium falciparum Malaria. Journal of

Clinical Microbiology. 1998; 36 (1) 203–6

9. Beatriz EF, Iveth J González, Fanny de

Carvajal, Gloria I Palma, Nancy G Saravia

Mem Inst Oswaldo Cruz, Rio de Janeiro,

Performance of OptiMAL in the Diagnosis

of Plasmodium vivax and Plasmodiumfalciparum Infections in a Malaria Referral

Center in Colombia.2012; 97 (5) 731-35

10. Kakkilaya BS. Rapid Diagnosis of

Malaria. Lab Medicine. 2003;8(34):602-08

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Afshan Afroz et al., Int J Med Res Health Sci. 2013;2(1):35-39


&

Health Scienceswww.ijmrhs.com Volume 2 Issue 1 Jan-Mar 2013 Coden: IJMRHS Copyr ight @2013 ISSN:2319-5886

Received: 15th

Nov 2012 Revised: 13th

Dec 2012 Accepted: 19th

Dec 2012


A COMPARATIVE STUDY AMONG THE THREE WHEELER AUTOMOBILE DRIVERS ON

PULMONARY FUNCTION TESTS IN ADULT MALES OF GULBARGA CITY

*Afshan Afroz1, Salgar Veeresh B2, Sugoor Manjushree3, Swati I Amrutha

1

Department of Physiology, KIMS, Amlapuram,2

Dept of Gen. Medicine, KBNIMS, Gulbarga,3

Dept ofBiochemistry, KBNIMS, Gulbarga,

4Department of Com. Medicine, KBNIMS, Gulbarga.

*Corresponding author email: [email protected]

ABSTRACT

Background: Development of our country has led to rapid urbanization and there is increasing use of

automobiles that is aggravating environmental pollution. Occupational exposure to automobile exhaust

and industrial smokes has been shown to affect functioning of different systems of the body. The present

study was taken up to assess the Pulmonary Function Tests (PFT) in auto rickshaw drivers of Gulbarga

city. Methods: Fifty non –smoker male auto drivers in the age group of 20–50 years for more than 5

years of auto driving experience formed the study group. Age and sex matched individuals not exposed to

auto rickshaw driving [administrative staff] formed the control group. Pulmonary function parameters

FVC, FEV1, FEV1%, PEFR, PIFR, FEF25-75, FEF50 and MVV were assessed using a computerized Spiro

meter during their working hours and were statistically analyzed. Results: There was a highly significant

decrease in FVC and FEV1 in the study group compared to control group. The decrease in FEV1%, PIFR,

FEF25-75 and FEF50 were statistically significant but the decrease in PEFR and MVV were statistically non-

significant. Conclusion: Our findings point towards the adverse effects of vehicle exhaust on lung

functions, mainly on lower airways with restrictive pattern of disease.

Keywords: Automobiles, Auto drivers, Pulmonary function tests.

INTRODUCTION

The development of our country has brought

many changes that include increased

industrialization, improved transportation

facilities, jobs in various fields. Modern lifestyles

have certain adverse effects on our surroundings.

Rapid urbanization led to increased use of

automobiles that is aggravating environmental pollution. Experimental studies indicate that

airborne contaminants lead to injury to the

airways and lung parenchyma in subjects who are

exposed to it (1,2)

. Occupational exposure to

automobile exhaust and industrial smokes has

been shown to affect functioning of different

systems of the body. Numerous epidemiological

studies have documented decrements in

pulmonary function and various other health

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problems associated with long term air pollution

exposure(3-7)

.Health effects of occupational

exposure to petroleum vapors and air pollution

from vehicular sources is relatively unexplored

among auto rickshaw drivers. There is limited

published data regarding the pulmonary functiontest abnormalities in auto-rickshaw drivers. Hence

we undertook this study.

To meet the present day requirement, there is an

increase automobile use and because of the

predominant role of gasoline [petrol] as a motor

vehicle fuel, the effects of gasoline engine

emissions are potentially even greater problems.

In the persons exposed to these pollutants,

pulmonary function tests are used as screening

tests to determine their effects8 .Therefore, the

present study is taken up to evaluate the changes

in Pulmonary Function Tests (PFTs) like Forced

Vital Capacity (FVC), Forced Expiratory Volume

in the first second (FEV1), FEV1/FVC ratio, Peak

Expiratory Flow Rate (PEFR), Peak Inspiratory

Flow Rate (PIFR), Forced Expiratory Flow in 25-

75% of vital capacity( FEF25-75), Forced

Expiratory Flow at 50% of vital capacity (FEF50 )

and Maximum Voluntary Ventilation (MVV) ofauto rickshaw drivers in Gulbarga city.


The present study was conducted in Salgar

hospital in Gulbarga city. Gulbarga is located in

the north Karnataka region of South India. Ethical

clearance was taken from the Institutional Ethical

Committee and each subject gave the consent.

The study group consisted of 50 males in the age

group of 20–50 year, who was driving auto

rickshaw for 8 hours per day for more than 5

years in Gulbarga city. The control group

consisted of 50 males of the same age group from

administrative post, who were not exposed to auto

rickshaw driving. The subjects in the study group

and the control group had certain inclusion and

exclusion criteria.Inclusion criteria

Male subjects of age between 20-50 years and

subjects with no history of allergic disorders,

respiratory disorders like asthma, or any systemic

disease, no history of smoking, chewing tobacco

and intake of alcohol.

Exclusion criteria

Subjects with age less than 20 years and more

than 50 years of age, alcoholics, persons with

systemic diseases, smokers who had chest wall

deformities, neuromuscular disease, severe

obesity, previous thoracic surgery and females

were excluded from the study.

Age, height, and weight were recorded. All the

Pulmonary functions were tested during day time

using computerized Spirometer [MEDSPIROR].

The subjects were familiarized with the

instrument. All the tests were carried out at the

same time of the day, between 10-11 AM. All thesubjects were in sitting position and wearing nose

clips9. The subjects were asked to breathe

forcefully following deep inspiration into the

mouthpiece attached to the pneumatachometer. 3

readings of maximal Inspiratory and expiratory

efforts were recorded and the best reading was

taken for statistical analysis. Statistical methods

used in our study was a student’s unpaired t test

using SPSS-16. The P< 0.05 was considered

statistically significant and P< 0.001 was

considered highly statistically significant.

RESULTS

Table:1. Comparison of mean values of the age, height and weight of the subjects and the controls

Parameters Study group Control group

Age [years] 36.4±7.40 34.8±3.76

Height [cm] 170.40 ± 3.39 174.60 ± 4.15

Weight [kg] 72.60 ± 7.56 74.40 ± 8.24

The subjects and controls did not differ significantly on above parameters.

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Table: 2. Comparison of lung volumes and capacities between study and control groups

Parameter Study group (n=50) Control group (n=50) p-value

FVC (L) 2.77±0.41 3.33±0.50 0.001**

FEV1 (L) 2.67±0.46 3.11±0.33 0.001**

FEV1% 88.25±13.34 90.31±10.12 0.050*

MVV

(L/min)

110.80±18.63 130.16±26.89 0.059

*P value


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irritant gas such as NO2 results in greater damage

to the lung than when exposed to either

substance individually11

.In combination with

particulate pollutants, SO2 and NO2 have a

greater chance to reach the deeper parts of the

lungs. The gaseous pollutants may also alter the properties and concentration of surfactant and

contribute to the early closure of small airways.

Much of the terminal bronchioles may be

compromised before other pulmonary function

tests such as FEV1 are affected 12

.

Few histopathological studies have provided

evidence that the small airways are the site of

damage in people living in areas of high air

pollution13

. The particles generated from diesel

exhaust are extremely small and are present in

the nuclei or accumulation modes with a

diameter of 0.02 ηm and 0.2 ηm respectively.

These small sized particles, by virtue of their

greater surface area to mass ratio, can carry a

much larger fraction of toxic compounds, such as

hydrocarbons and metals on their surface.

Importantly they can remain airborne for long

periods of time and get deposited in greater

numbers and deeper into the lungs than largersized particles. Hence chronic exposure to them

can lead to chronic inflammation of respiratory

tract and lung parenchyma. These would

contribute to the substantial decrease in lung

functions in the form of a restrictive pattern as

indicated in the present study.

Rajkumar studied the effect of air pollution on

the respiratory system of the auto rickshaw

drivers in Delhi. The study found that (19%)

drivers showed normal Pulmonary Function Test

(PFT). (80%) showed mild and moderate to

severe obstruction, of which (48%) were non-

smokers and (52%) were smokers and the result

concludes that auto rickshaw drivers have a high

respiratory morbidity due to exposure to

pollution.14

In a study, reduced mechanical

properties of breathing were attributed to

exposure to benzene in the vapors of petrol15.

Bijendra Kumar et al examined the pulmonaryfunction test in three wheeler diesel taxi drivers

in Bikaner city. They found restrictive

impairment in 87% of the study group, of which

50% were smokers and 37% were non-smokers,

mixed pattern (both restrictive and early

obstructive impairment) was found in only 13%

of the study group, of which 7% were smokersand 5% non-smoker. So they concluded that

when all the five parameters (FVC, FEV1,

FEV1/FVC, FEF 25–75% and PEFR) were taken

together they were indicative of mixed pattern

(obstructive and restrictive) lung impairments16

.

Chattopadhyay et al conducted a study on garage

workers, drivers and conductors of Kolkata city

to assess the pulmonary function status of these

workers and found that FEV1, FEV1% and flow

rates, FEF 02-121, FEF25%-75% values showed

a gradual decrement as age and duration of

exposure increased 17.

CONCLUSION

From the present study it was concluded that

respiratory functions of the auto rickshaw drivers

who are continuously exposed to emissions from

vehicles, petrol vapor and dust were significantly

reduced as compared to respiratory functions of

age, weight and height matched control groups.

To prevent the respiratory dysfunction among auto

drivers, medical observation and periodic checkups

for pulmonary function tests should be performed.

Control strategies should be adopted to reduce the

vapor concentration in the air, like vapor

adsorbents and to reduce the benzene concentration

in the ambient air. Personal protective equipment

must be worn by auto rickshaw drivers. Imparting

health education to auto rickshaw drivers will prevent respiratory morbidity. Further long term

perspective studies on auto rickshaw drivers will

help in getting a comprehensive picture of long

term effects.

ACKNOWLEDGEMENT

This research paper is made possible by the

support from the participants of our study. We

dedicate our acknowledgment of gratitude

towards Mr.Shaik.Meera and Dr. Rashmi.C.G as

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they kindly read our paper and offered valuable

detailed advices on grammar, organization, and

theme of the paper. Finally, we sincerely thank

almighty, family and friends, who provided

financial support and timely advice.

REFERENCES

1. Lewis TR, Moorman WJ, Yang YY, Stara JF.

Long term exposure to auto exhaust and other

pollutant mixture. Arch Env Health 1974;

21:102–06

2. Chhabra SK. Air pollution and health. Indian

J Chest Dis Allied Sci 2002; 44: 9–11.

3. Mayank Singhal et al “pulmonary functions

in petrol pump workers: A preliminarystudy” IJPP; 2007; 51 (3)244-248.

4. Gamble J, Jones W, Minshall S.

Epidemiological- Environmental study of

Diesel Bus Garage workers: Acute effects of

NO2 and respirable particulate on the

respiratory system. Environ Research 1987;

42: 201–214.

5. Nakai S, Maeda K, Crest JST. Respiratory

health associated with exposure to

automobile exhaust. III. Results of a cross

sectional study in 1987, and repeated

pulmonary function tests from 1987 to 1990.

Arch Environ Health 1999; 54: 26–32.

6. Chabra SK, Chabra P, Rajpal S, Gupta RK.

Ambient air pollution and chronic respiratory

morbidity in Delhi. Arch Environ Health

2001; 56: 58–63.

7. Ware JH, Spengler JD, Neas LM, Samet JM,

Wagner GR, Coultas D et al. Respiratory andirritant health effects of ambient volatile

organic compounds. The Kanawa county

health study. Am J Epidemiol 1993; 137:

1287–1301.

8. Kamat SR et al. Prospective 3 year study of

health morbidity in relation to air pollution in

Bombay India; Methodology and early

results up to 2 years. Lung India, 2, 1984, 1-

20.

9. Standardisation of spirometry 1994 Update.

American Thoracic Society. Am J Respir

Crit Car Med 1995; 152 (3) :1107–36.

10. Chawla A, Lavania AK. Air pollution and

fuel vapour induced changes in lung

functions: Are fuel handlers safe? IJPP 2008;52 (3) :255–61.

11. Boren HG. Pathophysiology of air pollutants.

Environ Res 1967; 1:178.

12. Cotes JE. Lung function assessment and

application in medicine. 5th ed. Oxford

Blackwell Scientific Publications, 1993.

p122.

13. Souza MB, Saldiva PHN, Pope CA,

Capelozzi VL. Respiratory changes due to

long term exposures to urban levels of air

pollution. Chest 1998; 113:1312–18.

14. Rajkumar. Effect of air pollution on

respiratory system of auto rickshaw drivers in

Delhi. Indian Journal of Occupational and

Environmental Medicine. 1999 Oct-Dec.; 3

(4) :171-73.

15. Kesavachandran C, Mathur N, Anand M,

Dhawan A. Lung function abnormalities

among petrol pump workers of Lucknow, North India. Current Science 2006; 90:1177–

78.

16. Binawara BK, Gahlot S, Kamlesh Chandra

Mathur, Ashok kakwar, Reshu Gupta,

Rajnee. Pulmonary function tests in three

wheeler diesel taxi drivers in Bikaner city.

Pak J Physiol 2010; 6 (1):28-31.

17. Chattopadhyay BP, Alam J, Roychowdhury

A. Pulmonary function abnormalities

associated with exposure to automobile

exhaust in a diesel bus garage and roads.

Lung India, 2003, 181 (5), 291-302.

18. Madhuri BA,ChandrashekharM, Ambareesha

Kondam. A study on pulmonary function test

in petrol pump workers in Kanchipuram

Population. IJBMR. 2012;3(2):1712-14

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Manjula et al., Int J Med Res Health Sci.2013;2(1):40-46


&

Health Scienceswww.ijmrhs.com Volume 2 Issue 1 Jan-Mar 2013 Coden: IJMRHS Copyright @2013 ISSN:2319-5886

Received: 1st Dec 2012 Revised: 15

th Dec 2012 Accepted: 20

th Dec 2012


AN ETHNOBOTANICAL SURVEY OF MEDICINAL PLANTS USED BY TRADITIONAL

HEALERS OF THADVAI, WARANGAL DISTRICT, ANDHRA PRADESH, INDIA.

Soma Manjula , *Estari Mamidala

Infectious Diseases & Metabolic Disorders Research Lab, Department of Zoology, Kakatiya University,

Warangal, Andhra Pradesh, India

*Correspondence author email : [email protected]

ABSTRACT

Since ancient times, plants have been used as medicine, foods, Agrochemicals and pharmaceuticals by large

number of tribes, rural and urban people. India has more than 300 tribal communities. The tribal region of

Andhra Pradesh has not received proper attention of ethnomedicinal researchers. Therefore, a survey of

ethnomedicinal plants used by Koya tribes of Medaram and Narlapura villages which are on the south of the

Godavari River, Thadvai Mandal, Warangal District; Andhra Pradesh, India was undertaken. The

information on plants was collected by interviewing the local tribal traditional practitioners. The

present study revealed that the plants which are used in traditional systems are mostly collected from

the wild resources. A total of 36 plant species (belonging to 24 families) of ethno botanical interest upon

inquiries from these tribal informants’ between the age of 35-78 were reported. They have been using these

parts in the form of paste, powder, decoction, juice, infusion and also in crude form, with other additives

like honey, curd, and urine and cow milk to get relief from different ailments like diabetes, inflammations,

wounds, skin diseases, headache, indigestion, urinary infections, fever, snake bites, cough, and dental

problems. This study therefore concludes, it is necessary that suitability requirements are needed in order to

protect the traditional knowledge in a particular area with reference to medicinal plant utilization. The plantsneed to be evaluated through phytochemical investigation to discover potentiality as drugs.

Keywords: Ethnomedicine, Koyas, Warangal

INTRODUCTION

Traditional medical practices are an important part

of the primary health care system is the developing

World.1 The ethno botanical survey can bring out

many different clues for the Development of drugs

to treat human diseases. Now-a-days, a trend in the

study of medicinal plants and their use in

traditional medicine has been drawing the attention

of different medical practitioners throughout the

world. People have become health cautious; the

phototherapy is more safe and effective in curing

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ailments without any side effects. 2

Ethnic groups

of various regions of the world are the real

custodians of nature’s wealth and experts in herbal

medicine.3 The traditional indigenous knowledge

transferred orally for centuries is fast disappearing

because of the technological developments and

changing culture of ethnic groups.2

It is for this

reason the study of ethnomedicine and its

restoration have been taking place.

In many countries of Africa, Asia and Latin

America people depend on traditional knowledge

and medicinal plants to meet some of their primary

health care needs. For instance in Africa up to 80%

of the population use traditional medicine for primary health care.4 Likewise, many Ethiopian

communities are dependent on local plant

resources for medicine. Moreover, the people in

ethnic tribes are averse to change the mode of their

life and traditions. But this traditional medical

knowledge is slowly diminishing, so it is to be

procured and preserved in various forms for future

generations. Thus, this study aimed to ascertain the

detailed information on the use of plants and their

therapeutic medical practices popular among Koya

tribes of Thadvai Mandal, Warangal district,

Andhra Pradesh.


Study Area

Warangal is a city and a municipal corporation in

Warangal district in the Indian state of Andhra

Pradesh. Warangal is located 148 kilometers

northeast of the state capital of Hyderabad and is

the administrative headquarter Hyderabad,

Warangal District. Warangal is located at 18.0°N79.58°E. It has an average elevation of 302 meters

(990 feet). As of 2011 India census5, Warangal had

a population of 759,594. Males constitute 51% of

the population and females 49%. Warangal has an

average literacy rate of 84.16%, higher than the

national average of 74.04%: male literacy is

91.54%, and female literacy is 76.79%.

Fig:1. Study area location

Ethno botanical Survey

The ethnomedicinal information was collected

from knowledgeable local aged people, herdsmen

and local healers of Medaram and Narlapur

villages of Warangal district, Andhra Pradesh aged

between 35-78 years. The information on

ethnomedicine was collected during August 2011

to September 2012 through interviews and

discussions. The collected information includes

useful plant species with local names, parts of the

plant used for curing different diseases. The plant

specimens collected with the help of the

inhabitants of surveyed villages. The scientific

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names of plant species their families were

identified with the help of a senior taxonomist of

Department of Botany, Kakatiya University,

Warangal. The data collected from different

sources of ethnic community consists of 36 plant

species whose different parts are used for curing

different diseases.

RESULTS AND DISCUSSION

The present study includes 36 numbers of plant

species of Angiosperms belonging to 24 families

are reported. The alphabetical order of scientific

name of the plants, their families local names,

diseases, parts used, mode of administration with

duration and doses are furnished with table-1. The

information provided in the table is collected from

local healers through interviews and discussions.

They have good knowledge about the use of plants

for curing various ailments and also believe in

supernatural powers which are also a part of their

healing methods. The diagnosis of different

pathologies is the first step in phyto cure treatment

which can be known by one's nose, ear, hands, and

eyes and is interesting.

Table. 1: List of medicinal plant used by Koyas of Thadvai Mandal, Warangal District, Andhra

Pradesh, India.

S.No Botanical & family name Common

Name

Part used & Mode to use Medicinal uses

1 Andrographis Parculata

(Acanthaceae)

Nelavemu Leaf crush or Powder with

honey mixture

Control Diabetes

2 Acassia auriculata (Caesapinaceae)

Thangedu All parts in same quantity

and add the water or

honey.

Diabetics and Urinary

puss

3 Tinospora Cordifalia

(Menispermaceae).

Thippa Teega. Creepers and Leafs

Dry powder or 1 teaspoon

Juice

Diabetics

4 Emblica aphicinalis,

(Euphorbiaceac)

Usiri Powder of dry fruit is

mixed with turmeric

powder along with

thangedu leafs

Diabetics

5 Mymosa Peudica,

(Mimosoidae)

Athipathi. Leaf powder with water Blood purification,

nose bleeding, and

jaundice. Respiratory

diseases, heart disease.

Removing water fromthe body

6 Eugeniajambolana(myrtaceae or

myrluscuceius)

Neredu Seed, Dried and poweredmixed with and taken

before meals

Diabetes

7 Aclupta alba (asteraceae, Guntagalagara

.

Leaves, Dried under shade

and finally powered this is

boiled with oil and applies

to white hair for about 40

days

Grey hair

8 Partheniunhisteroporouse

(asteraceae)

Nagkesaralu. Flower, Powered and

mixed with buttermilk.

Hyper urination

9 Aerva lenata

(Amaranthaceae)

Pindi kura. Whole plant Boiled with

water.

Kidney pains or

kidney stones

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10 Tectonegrandis

(Verbenaceae)

Teaku Flower, Flower is grinded

with water and made into paste now this paste is

layered below the stomach

Urine flow will be

cleared

11 Dolichas biflorous

(Fabaceae)

Blackuluvalu Seed, Soak in water and

grind into a paste and place

on the anus

Piles can be controlled

12 Bombox ceiba

(Bombacaceae) Burugu

chekka

Bark, Grind the bark and

mixed with water

Body heat regulations

13 Phyllonthus niruri

(Euphorbiaceae) Nela usiri Creepers are grinded and

mixed with waterJaundice

14 Parteinsonia ariculata

(Caesalpinacea)

Giluku Cekka. Roots, Grinded form Regulation of Body

temperature

15 Casiafistula,

(Caesalpinaceae),

Raala kaya. Fruit

Direct intake

Fids legs scrams

16 Hardwictia binata,

(Caeselpinacaae)

Narepa Bark, Directly layer on the

leg or hand fracture

Pains can be

controlled

17 Odinaoodier

(Anacardiaceae) Dhumpudu Bark, Directly applied on

woundsThe wound will behealed quickly.

18 Litseasebifera

(Lauraceae) Narre mamedi Bark, Juice of bark Is

mixed with waterDiabetes

19 Holoptaliaintegricelia

(Urgicaceae) Namelinara Bark, Fresh juice of the

bark is mixed with curd

and taken

Abdominal pain

20 Leucasaspera(Lamiaceae)

Thumikuru, Root, Mix the grind rootsand peppers and then mix

with boiling water and take

through orally

asthmatic problem

21 Menordica

(cucurbitaceae) Kakara chettu, Leaf and unripe.

The leaf extract is poured

into nostril

Migraine

22 Sphaeranthus indicus Linn

(Asteraceae)

Bodasaram Leaf. The leaves are

grinded with pepper and adose of spoon extract is

orally

Sexual stimulation.

Body pains andDiabetic

23 Soymida febrifuga A. Juss.( Meliaceae)

Somi Bark. The bark soakedwater

Diarrhea.

24 Solanum xanthocarpus

Schard. & Wendl

( Solanaceae)

Nelamulaka Root. The aqueous extractof the root with a dose of 1

spoon per day is orally

fever and cough, cold

25 Streblus asper Lour

( Moraceae)

Barinka, Pakki Latex, The latex in

combination with turmericapplied on head

Cold relief

26 Bryophyllum

(Crusulaceae)

Ranapala Leaves. Grind the leaf and

applied to wounds

Wounds healing

27 Cyperus rotandus

(Cyperaceae)

Garika Leafs Applied to the

wounds

Wounds healing

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28 Datura metal

(Solanaceae)

Nalla

Ummetta

Leaf and Bark Skin allergy

29 Madhuca indica

(Convolvunaceae)

Ippa Flower and seeds Blood purification

30 Riccinus communis(Euphorbiaceae)

Amudam leafs Control body pains

31 Strichnus nuxvimoca

(Loganiaceae) Vishamushti Bark and fruit juice. Leprosy

32 Lowsina (Lytrhoceae) Gorinta Leaves Jaundice

33 Centella aciatica

(Mackinlayaceae)

Saraswthi Leaves. leaf is grinded &

mixed with honey

Improve

Memory power

34 Plumbago zeylancia

(Plambaginaceae)

Chitramala Root, bark and leaves Relief body pain

35 Nona squmosa

(Annonaceae)

Seetapalam Leaves. Grained the leaf

and applied to the tumor

Tumours can be

controlled

36 Ocimumtenuifloram(Lamiaceae)

Tulasi Leaves. Juice of leaves Cold and cough

The tribal healer’s preparations are either based on

single plant part or combination of several plant

species parts. The mode of ethnomedicine usage

for different diseases is in various forms, such as

aqueous extract, paste and oil. In addition, milk,

ginger, pepper, oil, turmeric and jiggery etc. are

used as ingredients in the administration of

ethnomedicine. The ethnic tribe (Koya) of these

villages is healthy and not suffering from common

problems like depression, blood pressure and

diabetes which are common in urban people. List

of medicinal plant used by Koyas of Thadvai

Mandal, Warangal District, Andhra Pradesh, India.

Conversely, the same ethnic tribe occupying

different vegetation habitats is to be studied ethno

botanically.6

Among 36 plants belongs to 24 Families, 31% of

leaves, 21% Bark, 14% roots, 12 % Flowers, 12%

Seeds and 5% Fruits are used for various diseases.

The most widely sought after plant parts in the

preparation of remedies in the study area are the

leaves (31%) and stem bark (21%) (Figure 2).

Fig: 2. Parts using from the Different Plants

Leaf, 31%

Flower,12%

Fruit,5%

Bark,21%

Seed,12%

Root,14%

Creaper,5%

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These plant species are used for the treatment and

prevention of many ailments and diseases grouped

under 10 ailment categories (Figure 3). The main

ailments in the study area were cold, cough, wound

healing, urinary disorders, body pains, stomach

pain, jaundice, diarrhea, kidney diseases, neural and

other diseases. The largest number of medicinal

plant species are available for the treatment of skin

diseases, body pains and stomachache. Half of the

remedies for the above ailments are taken orally,

followed by external application. Generally, fresh

part of the plant is used for the preparation of

medicine. To improve the acceptability of certain

oral remedies, additives are frequently used. Most

of the reported preparations in the area are drawn

from a single plant; combinations are used in twelve

cases. In other parts of the country, the use of

mixtures of plant species in treating a particular

ailment is fairly common.7,8

Fig: 3. The different elements of study area grouped under different ailment categories

The present study revealed that the local traditional

healers of Khammam district, Andhra Pradesh are

rich in ethnomedicinal knowledge and the majority

of people rely on plant based remedies for common

health problems like headache, body ache,

constipation, indigestion, cold, fever, diarrhea,

dysentery, wounds, skin diseases, urinary troubles,

etc. The survey also revealed that all the traditional

healers have strong faith on ethno-medicines

although they were less conscious about the

documentation and preservation of ethno medicinal

folklore and medicinal plants. The group

discussion and personal interviews show that

youngsters of the Koya tribal community are less

aware about the use of ethnomedicines; our

findings are similar to reports from India [9]. On the

other hand, traditional healers who are the main

repository of ethno medicinal knowledge claim

extreme secrecy over their ethnomedicinal

knowledge. The traditional healers have strong

believe that if they disclose the secrecy about the

medicinal properties of particular plant all the

medicinal potentialities of the plant will be lost and

the remedy will not work properly.

The study concluded that the local and tribal

people of the Warangal district have very good

knowledge on the use of medicinal plants. But

such knowledge of medicinal plants is restricted to

a few persons in rural area. Therefore it is

necessary that suitability requirements are needed

in order to protect the traditional knowledge in a

particular area with reference to medicinal plant

utilization and it was found that traditional ethno-

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medicine still persists among the tribal’s in

Thadvai Mandal, Warangal district.

ACKNOWLEDGEMENTS

The authors acknowledge the kindness and

cooperation of the informants and local

administrators in the study area, and the support of

the Department of Botany, Kakatiya University,

and Warangal for identification of the plant

species. My thanks also to tribal people in study

area.

REFERENCES

1.

Sheldon JW., Balick MJ and Laird SA.

Medicinal Plants: Can utilization and

Conservation co-exist. New York Botanical

Garden Press Department, New York, 1997;

104.

2. Ganesan S, Suresh N and Kesavan L.

Ethnomedicinal Survey of Lower Palani Hills

of Tamilnadu, I.J. Trad. Knowledge, 2004;3

(3): 299-304.

3.

Burmol KS and Naidu TS. National seminar on“Tribal medicinal System and its

Contemporary Relevance. Forest flora of

Hyderabad state. 2007.

4. Samy RP, Ignacimuthu S, Raja DP.

Preliminary screening of ethnomedicinal plants

from India. J Ethnopharmacol. 1999;66:235-

240.

5. Census of India. Household Schedule - Side

Government of India. 2011.

6.

Ravisankar T, Henry AN. Ethnobotany of

Adilabad district Andhra Pradesh,

India.Ethnob.1992; 4:45-52.

7. Ayyanar, M; Ignacimuthu, S. Traditional

Knowledge of Kani tribals in Kouthalai of

Tirunelveli hills, Tamil Nadu, India. J.

Ethnophar. 2005;102:246–255.

8. Jain. SK. Dictionary of Indian Folk medicine

and Ethnobotany. Deep Publications, Paschim

Vihar, New Delhi. 1991.

9. Uniyal SK, Sharma S, Jamwal P. Folk

Medicinal Practices in Kangra District of

Himachal Pradesh, Western Himalaya. Human

Ecol. 2011;39:479-488.

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Bavane DS et al., Int J Med Res Health Sci.2013;2(1):47-51


&

Health Scienceswww.ijmrhs.com Volume 2 Issue 1 Jan-Mar 2013 Coden: IJMRHS Copyright @2013 ISSN: 2319-5886

Received: 1st Dec 2012 Revised: 20

th Dec 2012 Accepted: 23

rd Dec 2012


BENEFICIAL EFFECT OF LOW DOSE AMLODIPINE VS NIFEDIPINE ON SERUM

CHOLESTEROL PROFILE OF RABBITS RECEIVING STANDARD DIET.

*Bavane DS, Rajesh CS, Gurudatta Moharir, Bharatha Ambadasu

Department of Pharmacology, Shri. B. M. Patil Medical College & Research Centre, BLDE University

Bijapur- Karnataka

*Corresponding author e-mail: [email protected]

ABSTRACT

Objective: To investigate the effect of low dose amlodipine v/s nifedipine on serum cholesterol profile of

rabbits receiving standard diet. Methods: Fourty Newzealand rabbits were selected for the study. Their

cholesterol profile was estimated at the beginning of the study. Rabbits were grouped into 4 groups

receiving standard diet (control group), standard diet + vehicle propylene glycol, standard diet + nifedipinedissolved in propylene glycol and standard diet + amlodipine dissolved in propylene glycol. Along with

standard diet they were treated with respective drugs for ten weeks. At the end of ten weeks serum

cholesterol profile was estimated. Results: The cholesterol profile was estimated at the beginning and at the

end of ten weeks. Total cholesterol in the amlodipine group decreased from 97±4.06 mg/dl to 90±4.2 mg/dl

and HDL-Cholesterol increased from 32.01±4.40 mg/dl to 37±4.60 mg/dl after 10 week treatment but these

changes were not significant. LDL cholesterol decreased significantly in rabbits with low dose of

amlodipine from 55.42±3.32 mg/dl to 32.40±3.22 mg/dl and. In the nifedipine group there was a slight

increase in total cholesterol from 102.49±5.16 mg/dl to 106±5.39 mg/dl, HDL cholesterol from 34.10±2.80

to 35.16±2.82 mg/dl and LDL cholesterol also increased from 56.20±2.20 mg/dl to 59.00±2.20 mg/dl after

10 week treatment. Conclusion: The study shows amlodipine produces favorable alterations in serum

cholesterol profile.

Key words: Cholesterol profile, Standard diet, Amlodipine, Nifedipine

INTRODUCTION

Hyperlipidaemia and hypertension are often two

co-existing risk factors for coronary artery disease.

Among different cholesterol high serum levels of

total cholesterol and low density lipoprotein

cholesterol favours coronary artery disease. A

report by the National cholesterol education

program11 has focused attention on the necessity

for managing lipid disorders. Serum cholesterol

plays a central role in the atherosclerotic process,

in particular, abnormal levels of total cholesterol

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and low – density lipoprotein cholesterol. High

density lipoprotein particles function in the

opposite way from low density lipoprotein, they

act as a scavenger of free cholesterol and enhance

the rate of clearance of cholesterol from the

arteries.3 It has been reported in a large number of

animal and human experimental studies that

various classes of antihypertensive agents have

either adverse or significant, effect on plasma lipid

& lipoprotein levels.1,4,5 Beta-blockers without

partial intrinsic sympathomimetic activity increase

serum triglycerides and tend to lower high-density

lipoprotein cholesterol.9 Recently there has been an

epidemical increase in hypertensive cases resultingin coronary artery disease and abnormal lipid

profile. Therefore we planned in this study to see

whether amlodipine versus nifedipine to test if this

drug having antihypertensive effect in human, has

any effect on serum cholesterol profile of rabbits

fed on standard diet.

MATERIALS AND METHOD

Fourty healthy male Newzealand rabbits weighing

between 2-3 Kg was selected and placed underideal conditions. Animals were maintained on the

routine standard feed and acclimatized for seven

days prior to start of the experiment. Nifedipine

(Pfizer Ltd): A solution of 5 mg/40ml in propylene

glycol prepared and administered orally in a dose

of 2ml/kg i.e. 0.25 mg/kg orally. Amlodipine

(Pfizer Ltd): A solution of 2.5mg/40 ml in

propylene glycol prepared and administered orally

in a dose of 2ml/kg i.e. 0.125 mg/kg orally.

Estimations of serum total cholesterol and serum

high and low density lipoprotein cholesterol were

done at the beginning of the study and after 10

weeks of administration of the study drugs.

Study design

The rabbits were divided into four groups

containing 10 rabbits each. The groups were

treated as follows:

Group I Standard diet (control group)

Group II Standard diet+ vehicle propylene glycol

2ml/kg/day

Group III Standard diet +Nifedipine

(0.25mg/kg/day)Group IV Standard diet +Amlodipine

0.125mg/kg/day orally

A routine diet containing bread, milk and vegetable

on an average of 100gm/rabbit was given to the

rabbits during the study period with water given

ad-libitum. The animals were treated in this

manner for 10 weeks. For analysis of cholesterol

profile i.e. total cholesterol, HDL-cholesterol and

LDL-cholesterol 1ml blood samples were collected

from the marginal ear vein of rabbit after anovernight fast at the beginning before starting the

drug administration and then after ten weeks of the

drug administration. Readings were taken on a

photo colorimeter. The data were analyzed using

students paired ‘t’ test for the same group and

students unpaired t test for between the groups.

Table: 1. Cholesterol profile in the rabbits baseline values (Pretreatment)

Sr.

No

Group Total Cholesterol (mg/dl) HDL-cholesterol (mg/dl) LDL-cholesterol (mg/dl)

1. Group I 95.00± 1.28 32.16± 2.08 56.55±3.72

2. Group II 97.00± 1.28 34.01± 3.20 54.20± 5.20

3. Group III 102.49± 5.16 34.10± 2.80 56.20± 2.20

4. Group IV 97.00± 4.06 32.01± 4.40 55.42± 3.32*

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Table: 2. Cholesterol profile in rabbits after 10 weeks of drug administration

Sr.

No

Group Total Cholesterol (mg/dl) HDL-cholesterol (mg/dl) LDL-cholesterol (mg/dl)

1. Group I 99.00± 1.28 31.02± 2.08 53.12± 3.72

2. Group II 100.00± 1.28 34.00± 3.20 55.00± 5.20

3. Group III 106.00± 5.19 35.16± 2.82 59.00± 2.20

4. Group IV 90.00± 4.06 37.00± 460. 32.40± 3.32*

The data were analyzed by paired ‘t’ test (p


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satisfactorily. Increased uptake and degradation of

low density lipoprotein by skin fibroblasts, aortic

endothelial cells, smooth muscle cell, induction of

denovo synthesis of apoproteins and inhibition of

cholesterol synthesis and reduction of cholesterol

ester accumulation in smooth muscle cells are

thought to be the possible mechanisms. Many

studies have demonstrated that arterial compliance

is improved by antihypertensive drugs that induce

vasodilation in the large peripheral arteries, e.g.

calcium an

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