ABSTRACT
Background: A group of metabolic diseases is ‘diabetes’ which has become a major global concern is characterized by high blood sugar. In the world about 347 million people have diabetes. Untreated long standing hyperglycemia leads to microvascular complications in newly diagnosed DM. The objective of the study was to find out prevalence of microvascular complications in newly diagnosed Type-2 diabetes mellitus.Methods: The present cross-sectional study was conducted over a period of 6 months involved 200 patients who were diagnosed with T2DM having ≤6 months duration was conducted in the out-patient department of medicine and ophthalmology at a tertiary care hospital. Informed consent was taken from all the participants who were willing to participate. Detailed history, clinical examination and relevant investigations were done to diagnose microvascular complications.Results: Maximum number of studied subjects i.e. 54% were seen in age group of 41-50 yrs. Males were 56% whereas females comprised 44%. Total of 52% of subjects were from rural background. Nephropathy was the most common microvascular complication present in 54% patients followed by neuropathy in 30% and retinopathy in 8% (NPDR in 7% and PDR in 1%) of patients.Conclusions: From the present study it has been concluded that nephropathy is the most common microvascular complication in newly diagnosed T2DM followed by neuropathy and retinopathy. Authors recommend that education of high-risk group regarding diabetes and its complications by electronic and print media is required so that they seek medical consultation at the earliest. Screening for diabetes at a younger age in view of lower average age at presentation and high prevalence of microvascular complications.
ABSTRACT
Post-menopausal women suffer from a plethora of problems like vasomotor symptoms, vulvovaginal atrophy (VVA), bone loss, and all this can be attributed to estrogen deficiency. The conventional treatment till date for these hormone deficient manifestations have been estrogen replacement therapy in hysterectomized female or a combination of estrogen and progesterone therapy in women with an intact uterus. The reason for adding progesterone is to protect the endometrium from estrogenic stimulation. The drawback with the combination therapy was irregular vaginal bleeding and breast discomfort, which led to the discontinuation of this therapy. The United States Food and Drug Administration, has recently approved a novel tissue selective estrogen complex comprising of conjugated estrogen (0.45 mg) and a selective estrogen receptor modulator, bazedoxifene (BZA) (20 mg) for the treatment of moderate to severe vasomotor symptoms and prevention of osteoporosis in nonhysterectomized post-menopausal women. This combination retains the benefits of estrogen on vasomotor symptoms, VVA and bone density along with the protective effect of BZA on endometrium and breast tissue. The results of clinical trials have been promising but what still needs to be evaluated is the long term safety of this pair on venous thromboembolism, stroke, and breast cancer.
ABSTRACT
Linaclotide, a 14 aminoacid peptide is an intestinal secretagogue and works by stimulating guanylate cyclase (GC-C) present in the intestinal epithelium, which leads to improvement in symptoms of irritable bowel syndrome with constipation and chronic constipation in adults. Treatments available currently for these gastrointestinal problems have not been very satisfactory and many new options are therefore being explored to provide relief to these patients. Linaclotide has shown promising results in various clinical trials and hence was approved by US Food and Drug Administration (FDA) in 2012.
ABSTRACT
Multiple myeloma represents a malignant proliferation of plasma cells derived from a single clone. The tumor, its products and the host response to it result in a number of organ dysfunctions and symptoms of bone pain, fracture, anemia, hypercalcemia, susceptibility to infection, neurologic symptoms, clotting abnormalities and manifestations of hyperviscosity. The cause of myeloma remains unexplained but it is associated with few occupations, inflammatory conditions, autoimmune illnesses, viral infections and genetic heterogeneity. Direct interaction between multiple myeloma cells and bone marrow cells activates pleiotropic signalling pathways that mediate growth, survival, migration of multiple myeloma cells and also resistance to chemotherapy. Although myeloma remains incurable, but the use of novel drugs like thalidomide, lenalidomide and bortezomib have resulted in a paradigm change in the therapy of myeloma. Their inclusion in current multiple myeloma treatment regimens have extended median overall survival especially in younger patient population. Recent advances in the molecular genetics have provided opportunities to design highly specific inhibitors of signal transduction pathways that may enhance the efficacy of standard chemotherapy drugs by reducing or altering the pathways associated with cell survival. Despite therapeutic advances, multiple myeloma ultimately relapses and remains an incurable disease. Current research goals are to further increase our knowledge, to identify additional targeted therapies, and to reduce adverse effects and improve response rate. This review focuses on recent clinical advancement in ant myeloma strategies with additional discussion dedicated to emerging drugs that may prove beneficial to patients with this disease.
ABSTRACT
Background: Type 2 Diabetes mellitus (DM) is a heterogeneous group of disorders associated with both microvascular and macrovascular complications. Due to progressive nature of type 2 DM, dual / triple drug therapy produce additive effects, less side effects and allows the use of submaximal doses of individual agents. Therefore, the present study was designed to study the effect of voglibose in comparison to pioglitazone on glycaemic and lipid profile as an add-on drug in patients with DM whose glycaemic status was uncontrolled with glimepiride and metformin. Methods: The present study was open, randomized parallel group comparison of two active treatment groups over a six months period. Sixty patients of either sex in the age group of 30-75 years, suffering from type 2 DM, with FBG> 126 mg/dl and HbA1c between 7- 10 % were selected at random. The effect of voglibose and pioglitazone were observed on various parameters i.e. FBG, PPBG, HbA1c and lipid profile (Total cholesterol, TG, LDL, VLDL). Results: At the end of 6 months it was observed that though both pioglitazone and voglibose reduced FBG, PPBG and HbA1C significantly but pioglitazone caused a significantly greater percentage change in FBG as well as in PPBG whereas the difference in mean percentage change in HbA1C was not significant. Also, fall in total cholesterol, TG, LDL and VLDL was significantly greater with pioglitazone than voglibose. Few side effects were observed with voglibose and not with pioglitazone. Conclusions: Though pioglitazone and voglibose were equally effective in lowering HbA1C levels yet pioglitazone showed better results in improving FBG, PPBG and lipid profile as compared to voglibose. Pioglitazone had minimal side effects as compared to voglibose.
ABSTRACT
Cannabis sativa L preparations have been used therapeutically since many years. Inspite of their medicinal value, the danger of its abusive potential led to the ban on its use in clinical practice in many countries. The recent research and in depth knowledge about the cannabinoid system which throw a light on their disease management potential has paved way for the cannabinoids to become a new therapeutic focus of attention. Cannabinoids are a group of compounds that mediate their effects through cannabinoid receptors which include CB1, predominantly expressed in the brain and CB2 which is primarily found in the cells of the immune system. Despite the addictive properties of cannabis, the therapeutic value of cannabinoids is too high to be put aside. Numerous diseases such as anorexia, pain, inflammation, obesity, cardiovascular disorders, neurodegenerative diseases, cancer, gastrointestinal diseases, hepatic disorders, skin related diseases, respiratory disorders like asthma and eye diseases like glaucoma have suggested cannabinoid agonists/ antagonists/ cannabinoids related compounds as potential treatment options. Developments of new specific ligands for the cannabinoid receptors are now underway and it needs to be seen, if in future, they can prove to be a boon for the medical world. The paper reviews the current understanding of the cannabinoid receptors, their ligands and their possible role in various diseases supported by preclinical and clinical studies.
ABSTRACT
Background and Objectives: Assessment is a matter of continuing concern for medical teacher as it is supposed to steer student learning. Globally there is an increasing trend to move from subjectivity to objectivity. While the universities are custodial for modifying the examinations system as a summative assessment, what is more important for teachers is to mould their formative assessment. University examinations are criticized to be highly subjective and inadequate for covering full range of topics in Pharmacology. Further there is little scope for providing feedback to the students for continuous learning and improvement. In response to this it was decided to introduce multiple choice questions (MCQs) as a tool for formative assessment. Methodology: In the present study, the multiple choice questions were given along with the subjective questionsfrom the same topic to the students. The main aim was to improve the objectivity in students’ assessment by introducing MCQs as a formative assessment tool. To evaluate the affectivity of this pattern of assessment from the student’s viewpoint, we designed a feed back questionnaire which was analyzed. The MCQs were evaluated by doing Item analysis. Results: The overall feedback revealed that 89% of the students were of opinion that MCQs preparation and examination helped them in learning the subject, self studying, reasoning and enhancement of clinical skills. The present study also clearly indicates that MCQs alone are not sufficient to assess learning and should be used along with subjective tests. Conclusion: To make testing and assessment both fair and consequently valid, MCQs should be used strategically to test important subject content and it should be aligned with subjective tests.