Expert Opinion on Novel Fixed Drug Combination of Metformin Sustained Release and Vildagliptin Immediate Release for Type 2 Diabetes Mellitus Management in India

Type 2 Diabetes Mellitus (T2DM) is a highly prevalent cardiometabolic disorder in India and is further projected to rise (10.4% by 2030). In newly diagnosed patients, maintaining HbA1c 6.5-7.0% and minimizing glycaemic exposure, particularly during the first year following diagnosis, may be crucial for preventing complications. Early treatment initiation with a synergistic combination of vildagliptin and metformin is one of the many possible combinations to manage type 2 diabetes mellitus. In view of emerging clinical evidence on early initiation of combination therapy than monotherapy with metformin, there is a need for expert consensus on the use of the current approved Fixed Dose Combination (FDC) of Metformin SR + Vildagliptin IR in newly diagnosed diabetic patients. Experts framed final consensus statements based on available scientiûc evidence, experience and collective clinical judgment from practical experience this FDC.

Hashimoto‘S Encephalopathy Case Reports Of Hashimoto‘S Encephalopathy In Tertiary Care Hospital

Hashimoto's encephalopathy (HE) is an uncommon syndrome and rare disease, associated with Hashimoto thyroiditis. It is characterized by a acute to chronic loss of cognitive dysfunction ,subacute onset of confusion with altered level of consciousness, stroke like episodes , neuropsychiatric manifestations ,seizures, and myoclonus. HE is believed to be an immune-mediated disorder rather than representing the direct effect of an altered thyroid state on the central nervous system. Hashimoto encephalopathy or Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT) and a more general term, nonvasculitic autoimmune meningoencephalitis, are also used to describe this condition. Here we are reporting 3 cases of hashimoto encephalopathy in the tertiary care centre who presented with acute to chronic memory loss , neuropsychiatric disturbances, complex parital seizures visual hallucinations and myoclonus and responded to steroids. A negative microbiological screen of the CSF and serum along with raised CSF protein, elevated serum antithyroid antibodies, characteristic EEG and neuroimaging findings yielded the diagnosis

Surface, thermal and hemocompatible properties of novel single stage electrospun nanocomposites comprising polyurethane blended with bio oilTM

ABSTRACT In this work, the physicochemical and blood compatibility properties of prepared PU/Bio oil nanocomposites were investigated. Scanning electron microscope (SEM) studies revealed the reduction of mean fiber diameter (709 ± 211 nm) compared to the pristine PU (969 nm ± 217 nm). Fourier transform infrared spectroscopy (FTIR) analysis exposed the characteristic peaks of pristine PU. Composite peak intensities were decreased insinuating the interaction of the bio oilTM with the PU. Contact angle analysis portrayed the hydrophobic nature of the fabricated patch compared to pristine PU. Thermal gravimetric analysis (TGA) depicted the better thermal stability of the novel nanocomposite patch and its different thermal behavior in contrast with the pristine PU. Atomic force microscopy (AFM) analysis revealed the increase in the surface roughness of the composite patch. Activated partial thromboplastin time (APTT) and prothrombin time (PT) signified the novel nanocomposite patch ability in reducing the thrombogenicity and promoting the anticoagulant nature. Finally the hemolytic percentage of the fabricated composite was in the acceptable range revealing its safety and compatibility with the red blood cells. To reinstate, the fabricated patch renders promising physicochemical and blood compatible nature making it a new putative candidate for wound healing application.

Spectrum of systemic bacterial infections during febrile neutropenia in pediatric oncology patients in tertiary care pediatric center.

BACKGROUND: Outcome of pediatric cancers has significantly improved with modern chemotherapy and good supportive care. However, febrile neutropenia remains one of the important limiting factors in these patients especially with the emergence of resistant organisms. Choosing appropriate antimicrobials is possible only if we understand the local microbial spectrum and their sensitivity pattern. AIMS: To study the likely etiologic agents and their antibiotic sensitivity pattern among systemic infections in children with cancer. SETTINGS AND DESIGN: This is a prospective study. MATERIALS AND METHODS: The study was conducted at a tertiary care center for pediatrics, in which culture samples representing blood stream infections and others like urinary tract infections sent from the Oncology services of the Hospital during the year of 2013 were analyzed. The microbiological profile and antibiotic sensitivity pattern of these isolates were studied. RESULTS: There were 89 isolates that represented blood and urinary tract infections in neutropenic patients with cancer.Out of 89 positive cultures 76 were gram negative isolates. The most common gram negative bacterial isolates were Escherichia coli 33 (37%), followed by Pseudomonas 21 (23.5%). Acinetobacter grew in 2 patients (2.2%). Extended spectrum beta‑lactamases (ESBL’s), carbepenem resistant and pan‑resistant organisms seen in 28 (31.4%), 5 (5.6%) and 2 cases (2.3%) respectively. Over all Gram‑positive organisms were 13/89 (12.3%). Staphylococcus was the most common Gram‑positive organism and methicillin resistant Staphylococcus aureus seen in 5each. CONCLUSION: Gram‑negative organism is a common isolate in cancer children with febrile neutropenia, which is resistant to first‑line antibiotic cefepime. Meropenem is most sensitive antibiotic and ESBL’s are sensitive to piperacillin–tazobactam.

Adrenal insufficiency in patients with stable non-cystic fibrosis bronchiectasis.

Background & objectives: Suppressed adrenal responses associated with inhaled steroid use have been reported in patients with bronchiectasis and have been shown to be associated with poor quality of life. This study was undertaken to examine the prevalence of suppressed cortisol responses in stable bronchiectasis and determine their correlation with the use of inhaled corticosteroids, radiologic severity of bronchiectasis and quality of life (QOL) scores. Methods: In this case-control study, cases were patients with bronchiectasis and suppressed cortisol responses and controls were healthy volunteers, and patients with bronchiectasis without suppressed cortisol responses. Symptoms, lung function test values, exercise capacity, HRCT severity scores for bronchiectasis, exacerbations, inhaled corticosteroid use and quality of life scores were compared between patients with and without suppressed cortisol values. Results: Forty consecutive patients with bronchiectasis and 40 matched controls underwent 1-μg cosyntropin testing. Baseline cortisol (mean difference -2.0 μg/dl, P=0.04) and 30-minute stimulated cortisol (mean difference -3.73 μg/dl, P=0.001) were significantly lower in patients with bronchiectasis. One patient had absolute adrenal insufficiency and 39.5 per cent (15/38) patients with bronchiectasis had impaired stimulated responses. Baseline and stimulated cortisol responses were unaffected by inhaled steroids (O.R 1.03, P=0.96). SGRQ scores were negatively correlated with body mass (r= -0.51, P=0.001) and bronchiectasis severity (r=0.37, P=0.019), but not related to baseline or stimulated cortisol responses. Interpretation & conclusions: Our results showed that the impaired adrenal responses to 1-μg cosyntropin were common in patients with bronchiectasis. This was not associated with the use of inhaled steroids or severity of bronchiectasis. Poor health status was associated with advanced disease and not with cortisol responses to the 1-μg cosyntropin test.

Bilateral gonadoblastomas with a left sided dysgerminoma in a true hermaphrodite (disorder of sexual differentiation) with 46, XY karyotype.

Ovotesticular DSD is not an uncommon disorder. The presence of Y chromosome confers a high risk of neoplastic transformation in dysgenetic gonads. The neoplastic development in these patients is associated with the presence of Y chromosome and intra abdominal location of the abnormal gonad. We report histogenetic details of a rare occurrence of bilateral gonadoblastomas and left sided dysgerminoma in a XY ovotestes DSD (disorder of sexual differentiation) in an 18 year old with a female phenotype.

A comparison of three media for isolation of Nocardia species from clinical specimens.

The study was carried out to compare the efficacy of three media namely Modified Thayer Martin medium, McClung's carbon free broth with paraffin bait and paraffin agar in isolating Nocardia species from clinical specimens. Two hundred and seventy six clinical specimens from 245 cases were studied which included cases of bronchopulmonary and systemic infections and cases of mycetoma. Paraffin agar was found to be an inexpensive and selective medium for isolation of Nocardia species when compared with Modified Thayer Martin medium and paraffin bait techniques.