British Journal of Medical and Health Research

Both Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin Receptor Blockers (ARBs) are recommended first-line agents for hypertension in patients with Type 2 Diabetes Mellitus (T2DM). However, treatment adherence is frequently compromised by class-specific adverse drug reactions (ADRs). This study compares the safety profiles, tolerability, blood pressure control, and short-term renal outcomes of ACEIs versus ARBs in a clinical setting. Methods: A prospective, observational study was conducted over 12 months in a tertiary care teaching hospital. One hundred adult patients ($N=100$) with T2DM and essential hypertension initiating monotherapy with either an ACEI ($n=50$, e.g., enalapril) or an ARB ($n=50$, e.g., losartan) were enrolled. Baseline demographic, clinical, and laboratory safety markers (serum potassium, serum creatinine, and eGFR) were recorded. Safety endpoints included the incidence of dry cough, hyperkalemia, acute kidney injury (eGFR decline greater than 30%), and therapy discontinuation rates. Efficacy was assessed via blood pressure (BP) and urinary albumin excretion rates. Results: Both groups achieved comparable, statistically significant reductions in systolic and diastolic BP, as well as urinary albumin excretion at 12 months ($p > 0.05$ for inter-group comparisons). However, the ARB group demonstrated a significantly superior safety and tolerability profile. Dry cough was reported in 16% of the ACEI group compared to 0% in the ARB group ($p < 0.01$), leading to a therapy discontinuation rate of 10% in the ACEI cohort. Mild hyperkalemia (serum $K^+ > 5.0 \text{ mEq/L}$) occurred in both groups (ACEI: 8% vs. ARB: 6%; $p > 0.05$) without any severe hyperkalemic events or acute kidney injury. Conclusion: While ACEIs and ARBs provide equivalent blood pressure control and renal protection, ARBs offer a significantly superior safety profile with a lower incidence of dry cough and lower treatment discontinuation rates. ARBs may be preferred as a first-line option to optimize long-term treatment adherence in patients with T2DM and hypertension.

Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder affecting women of reproductive age, frequently complicated by anovulatory infertility and insulin resistance. Clomiphene citrate (CC) is the established first-line agent for ovulation induction, but a subset of women exhibits clomiphene resistance. Metformin, an insulin-sensitizing agent, has been proposed as an adjunct to improve ovulatory response in these patients. To compare the safety and efficacy of metformin combined with clomiphene citrate versus clomiphene citrate alone in the management of PCOS. This prospective comparative study was conducted in the Department of Obstetrics and Gynaecology, Coimbatore Medical College Hospital, from July 2025 to December 2025. Forty-two women diagnosed with PCOS were allocated to two groups (n=21 each): Group A received CC alone, and Group B received metformin plus CC. Outcomes assessed included ovulation rate, menstrual cycle regularity, conception rate, adverse effects, and metabolic parameters. Baseline demographic, hormonal, and metabolic parameters were comparable between groups (p>0.05). Ovulation, menstrual regularity, and conception rates were significantly higher in the metformin + CC group compared to CC alone (p<0.05 for all outcomes). Gastrointestinal adverse effects — loss of appetite (60%) and nausea/vomiting (18%) — occurred exclusively in the metformin + CC group but did not lead to treatment discontinuation. No cases of ovarian hyperstimulation syndrome, multiple pregnancy, or teratogenicity were observed in either group. Combination therapy with metformin and clomiphene citrate was more effective than clomiphene citrate alone in inducing ovulation, restoring menstrual regularity, and achieving conception in women with PCOS, with a manageable and non-limiting adverse effect profile. Metformin + CC may be considered a preferable first-line option, particularly in women with insulin resistance. Polycystic ovary syndrome, metformin, clomiphene citrate, ovulation induction, insulin resistance.

Clear aligner therapy (CAT) has evolved as a viable orthodontic treatment approach as digital technology, biomaterials, and biomechanical principles have advanced over time.It was originally used for mild malocclusions, but improvements in aligner design, attachments and digital treatment planning have led to its use in more complex orthodontic situations. This review will present biomechanical principles that define force delivery and tooth movement control and their clinical implications in challenging patients treated with the use of clear aligners. The effects of aligner material properties, thickness, stress relaxation, staging protocols, and attachment design on the magnitude, direction, and predictability of force are discussed. The biomechanical properties of different tooth movements, such as tipping, bodily movement, rotation, intrusion, extrusion, torque and arch expansion are evaluated, highlighting limitations and opportunities for improving treatment outcomes. KEY WORDS:Clear aligner therapy (CAT) ,Orthodontic biomechanics ,Force delivery