Journal of the Indian Medical Association
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Blockade of the renin-angiotensin system (RAS) plays an important role in the prevention and correction of cardiovascular diseases. Agents that block the RAS such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are major in this league. There have been numerous clinical trials looking at the use of ACEIs and ARBs in hypertension, heart failure (HF), and other special population who remain at high risk for cardiovascular and cardiometabolic abnormalities. ⋯ Although, there are no data at present to precisely suggest the efficacy differences between all available ACEIs, there are trials which support that ramipril, a long acting ACEI with good tissue penetration, potent long-lasting inhibition of ACE may not be applicable to other available ACEIs. Ramipril also specifically reduces major adverse coronary and cerebrovascular events in post MI patients when compared to other ACEIs or placebo. When clinicians are faced with the choice of using either an ACEI or an ARB in high-risk patients, they should be mindful of the unique differences between each class of medication, particularly with respect to MI and CV death, and also the range of indications, cost and individual convenience.
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Comparative Study
Multidrug-resistant Gram-negative bacteria in postoperative infections.
Gram-negative bacteria are responsible in an important way in hospital-associated infections and their reported resistance to multiple antimicrobials is a matter of grave concern. In this study, Gram-negative bacteria isolated from clinical samples of postoperative infected patients were identified and their antibiotic susceptibility patterns determined. ⋯ Escherichia coli and klebsiella were the most common bacterial isolates. Amongst the 14 antibiotics tested, the percentage sensitivity against the multidrug-resistant Gram-negative isolates was highest for amikacin, meropenem, piperacillin + tazobactam and cefoperazone + sulbactam.