Sitagliptin in Achieving Better Glycemic Control as added Drug Therapy in Type 2 Diabetes Mellitus

Introduction: Type 2 diabetes mellitus is progressive loss ofglycemic control over a period of time. So the purpose of thepresent study was to evaluate the effectiveness and safety ofthe Sitagliptin as an ‘add-on’ to the ongoing drug therapy inpatients with Type 2 Diabetes Mellitus (T2DM).Material and Methods: It was a randomized, retrospectivepopulation based cohort study done in 259 patients for 36weeks from July’12 – March’13. Patients were randomlydivided into 2 groups. In 1st group, sitagliptin was added andno ongoing drug was withdrawn while in 2nd group sitagliptinwas added and dose of ongoing therapy was reduced to half.Results: The primary efficacy endpoint was reduction inglycated haemoglobin (HbA1C), fasting blood sugar, and 2hour post prandial blood sugar evaluated after 4, 8, 12, 18 and36 weeks. A better glycemic control was observed in 1st groupthan 2nd. Sitagliptin was well tolerated without side effects.Conclusion: Addition of Sitagliptin 100mg once daily as‘add-on’ drug therapy was well tolerated with significantglycemic control in T2DM after 36 weeks.

Depression and Routine Biochemical Markers: A Cross Sectional Study

Background: Today, globally up to 6–12% of the adult population suffered mental disorder and recurrent depression. The prevalence of depression in India was reported as 4.5% by WHO. Currently the diagnosis of major depression is carried out through symptom-based assessment process, which has limitation of the development of personalised treatment plans. Objective: To determine the association between various biochemical markers of the inflammation, lipid profile, BMI, thyroid profile and depression among the patients attending department of psychiatry in a tertiary care centre. Methods: A cross-sectional study conducted among 50 patients attending the psychiatry department at S.N. Medical college, Agra and diagnosed as Depression disorder, during April 2012 to December 2012. Hamilton rating scale (HAM-D) was used to assess the severity of depression. The patients were also assessed for their vitals, lipid profile, thyroid profile, ESR, CRP and BMI. Results: 19 (38%) study subjects were in the age group of 18yrs to 30 yrs with mean age as 34.2 ±14.57 years. 36(72%) were of normal weight or under-weight and14 (28%) were pre-obese. Among 14 pre-obese and obese study subjects, 2(15.4%) had mild, 4(18.2%) had moderate and 8(53.3%) had severe type of depression(p=0.03). ESR is more in severe depression as compared to mild and moderate depression. (p=<0.001%). C-reactive protein is statistically more in severe depression (T =2.25; P= < 0.001). Conclusions: There is a positive and significant relationship between the severity of depression and ESR, CRP and BMI among the patients attending department of psychiatry.

Expression of CD 68, CD 45 and human leukocyte antigen‑DR in central and peripheral giant cell granuloma, giant cell tumor of long bones, and tuberculous granuloma: An immunohistochemical study.

Background: Multinucleated giant cells (MNCs) form an integral part of numerous bone and soft tissue tumors, tumor‑like lesions and are often associated with granulomas of immunological and nonimmunological origin. The presence of various types of giant cells depends on the lesions in which they are present which are difficult to be diagnosed under routine histological techniques. Immunohistochemistry can be used for a better diagnosis and understanding of the origin of various giant cells using various markers of immune response like human leukocyte antigen‑DR (HLA‑DR) and those expressed on monocytes and macrophages like CD 68 and leukocyte common antigen (LCA). Materials and Methods: The study group consisted of 10 cases of giant cell tumor (GCT) of long bones, tuberculous granuloma, and giant cell granuloma to evaluate and analyze the expression pattern of LCA, CD 68, and HLA‑DR in various giant cell lesions. Results: Strong expression of CD 68 was observed in 80% of the lesions, strong and moderate expression of CD 45 observed in 70% of the lesions among and within the groups. In contrast, HLA‑DR demonstrated negative expression in 80% of cases except for tuberculous granuloma where all the 10 cases showed moderate to strong immunoreactivity. Conclusion: CD 68 and CD 45 expression was found in central giant cell granuloma, peripheral giant cell granuloma and GCT, suggesting the origin from mononuclear phagocyte system and considering their clinical behavior of osteoclast type. High expressivity of HLA‑DR in tuberculous granulomas which is an essential factor for presentation of the microbial antigen to CD 4 helper cells thus reassuring the fact that they are up‑regulated in response to infection.

Clinical profile of amoebic colitis and its association with malabsorption.

Background: The amoebiasis is a very common problem of tropical countries like India. The association of malabsorption with amoebic colitis was studied in the present study from 1978 to 1980 in the tertiary care centre of Western Uttar Pradesh (India). Aims & Objective: The study was done with the aim of studying the clinical profile of chronic amoebic colitis and the incidence of malabsorption for fats, carbohydrates and proteins in cases of chronic amoebic infection of the intestine. Material and Methods: The study was carried out in 102 cases of chronic amoebic colitis and 25 age and sex matched controls. For the evidence of malabsorption, faecal fat excretion, D – Xylose excretion, total seum protein and albumin were estimated in all the cases. The patients who showed malabsorption were subjected to jejuna biopsy to know the histopathological findings. Results: Majority of cases (74%) were in the age groups of 21 – 40 years with decreasing incidence on either side. Pain in abdomen (98%) whether localised or diffuse was the commonest symptom followed by altered bowel habits (84%). Othe common symptoms were tenesmus (44%), increased gastro colic reflex (41%) and gaseous dyspepsia (19%). Among the physical signs palpable sigmoid colon was the commonest. Faecal fat excretion was less than 6gm/24 hours in majority (94.12%) of cases and malabsorption was found only in 5.88% of cases. D – Xylose excretion was more than 5 gm in majority (97.06%) and excretion less than 5 gm (malabsorption) was found in only 2.94% cases. Total serum proteins and albumin were between 6.1 to 7 gm and 3.1 to 4 gm respectively in majority (76.4% and 74.5%). Conclusion: Pain in abdomen was the most common symptom in amoebiasis. Amoebiasis does not cause significant malabsorption. Protein absorption was not affected much in amoebiasis.

Level of glycaemic control in type 2 diabetes mellitus in Bareilly region (India).

Background: Diabetes mellitus has emerged as a major health care problem of India. The real burden of diabetes is due to its associated complications which lead to increased morbidity and mortality. An accurate diagnosis of diabetes and level of glycaemic control in known diabetics is recommended for the treatment and prevention of complication in the population. Aims & Objective: To identify the pattern of glycaemic control in type 2 diabetes mellitus using glycosylated haemoglobin (HbA1C) in Bareilly region, India. Material and Methods: The present cross sectional study was conducted in one of the tertiary care hospital of Bareilly district. The respondents were the 1000 type 2 diabetics of 35 to 60 years of age group. Glycosylated haemoglobin A1C (HbA1C) was done in all subjects by ion exchange chromatography and results were categorized as normal, good, average and poor diabetes control. The statistical analysis was Analysis of variance (ANOVA) using SPSS software. Results: Out of 1000 individuals, 120 had good, 469 had fair and 411 had poor glycaemic control on the basis of their HbA1C status. Age was similar for all 3 groups and was insignificantly related to glycaemic control (p-0.663). Out of 1000 individuals, 703(70.30%) had normal BMI while 297 (29.7%) were overweight. Conclusion: Measurement of glycosylated haemoglobin levels should be used in monitoring the treatment and long term glycaemic control of diabetes in a population and the assessment of body mass index should be done for the need of life style intervention in a population.

Prevalence and severity of periodontal diseases in type 2 diabetes mellitus of Bareilly region (India).

Background: Periodontal disease and diabetes share a two way relationship because of common pathways of disease progression. Aims & Objective: Extensive study on various population worldwide were carried out but there is a limited data for Indian population, Hence, the present study was done to evaluate the prevalence and severity of periodontitis in type 2 diabetes mellitus of Bareilly region of Uttar Pradesh (INDIA). Material and Methods: 1000 individuals of type 2 diabetes mellitus were categorized as good, average and poor glycaemic control on the basis of glycosylated hemoglobinA1C(HbA1C). Periodontal examination was done by recording oral hygiene index simplified, clinical attachment loss and gingival bleeding index. This periodontal result was correlated with glycaemic status and duration of diabetes since diagnosis. Results: Results showed a 91.7% prevalence of periodontitis, predominating with 41.3% cases of moderate periodontitis followed by 26.2% of severe and 24.2% of slight and 8.3% of gingivitis cases. In poor oral hygiene strata; the amount of severe periodontitis cases increased from 0% to 26.2% and up to 73.8%; as the glycaemic control deteriorated from good to average to poor. Similar results were reported for good and fair oral hygiene strata. Conclusion: Results of present study demonstrated that with worsening of glycaemic control, severity of periodontitis significantly increases even when examined for similar oral hygiene status.

Effects of drop acceleration and deceleration on particle capture in a cross-flow gravity tower at intermediate drop Reynolds numbers.

Cross-flow gravity towers are particle scrubbing devices in which water is sprayed from the top into particle-laden flow moving horizontally. Models for predicting particle capture assume drops traveling at terminal velocity and potential flow (ReD > 1000) around it, however, Reynolds numbers in the intermediate range of 1 to 1000 are common in gravity towers. Drops are usually injected at velocities greater than their terminal velocities (as in nozzles) or from near rest (perforated tray) and they accelerate/decelerate to their terminal velocity in the tower. Also, the effects of intermediate drop Reynolds number on capture efficiency have been simulated for (a) drops at their terminal velocity and (b) drops accelerating/decelerating to their terminal velocity. Tower efficiency based on potential flow about the drop is 40%-50% greater than for 200 mm drops traveling at their terminal velocity. The corresponding values for 500 mm drops are about 10%-20%. The drop injection velocity is important operating parameter. Increase in tower efficiency by about 40% for particles smaller than 5 mm is observed for increase in injection velocity from 0 to 20 m/s for 200 and 500mm drops.

Ipsilateral Fracture of Femur and Tibia, Treatment and Functional Outcome

We reviewed forty patients with forty-two extremities having ipsilateral fracture of femur and tibia at Christian Medical College Ludhiana. Patients were grouped according to type of injury and the method of treatment Three percent femoral and ten percent tibial fractures developed delayed union out of which bone grafting was done in two femoral and seven tibial fractures. Three(7.2%) tibial fractures developed infected gap non union which were subsequently managed by distraction osteoneogenisis. Eight (29.1%) patients had stiffness of knee with range of movement less than 90 degree. Bad results were found in patients having compound injuries and in juxta articular involvement of both fractures. In our study external fixator was the mainstay of treatment in operative group comprising of ten(23%) femoral and twentythree( 55%) tibial fractures because of compound nature of injury and many limbs were salvaged which otherwise could have amputated. Patients in whom rigid internal fixation was used to treat both fractures produced excellent results.