Trends in antidiabetic drug utilization in Type 2 diabetes patients in a diabetes clinic of a tertiary care teaching hospital in India

Background: The treatment of Type 2 diabetes mellitus (T2DM) requires many classes of drugs, combination of old and new drugs is usually recommended for intensification of therapies. Antidiabetic drug (ADD) utilization study promotes rational use of ADDs and reveals the recent trends in use. Aims and Objectives: The objective of the study was to analyze drug utilization pattern with particular attention to initiation and intensification of the treatment options in T2DM patients of a diabetes clinic run by endocrinology department of a tertiary care teaching hospital in Eastern India. Materials and Methods: This was a cross-sectional and observational study conducted at the diabetes clinic of a tertiary care Medical College and Hospital of West Bengal over a period of 12 months. After obtaining informed consent, diagnosed adult Type 2 diabetes patients receiving any ADD were included in the study. Demographic, clinical, and laboratory data, proportion of each class of ADDs, and WHO core drug use indicators were analyzed. Results: A total of 298 patients ([167, 56%] males and [131, 44%] females) were enrolled. The mean age of the patients was 52.33 ± 9.91. Metformin (287/298, 96%) was the most commonly prescribed drug, followed by glimepiride (168/298, 56.38%), insulins (116/298, 38.93%), DPP4 inhibitors (108/298, 36.24%), and pioglitazone (99/298, 33.22%). Metformin, glimepiride (53/109, 48.62%) and metformin, glimepiride, and pioglitazone (36/113, 31.86%) were the common dual and triple drug combinations. Conclusion: In Type 2 diabetes, metformin was the preferred agent for initiation of the treatment; glimepiride, insulin, DPP-4is, and pioglitazone were used in combination of metformin for intensification of therapy, consistent with current clinical practice guidelines.

Renal pathological changes in poisonous snake bite.

There are more than 3000 species of snakes in the world but only about 350 are venomous. With approximately 10000 deaths occurring annually in India, a large proportion of snake bites occur when people work barefoot in the fields or while walking at night or early morning through fields or along roads. Although, nearly all snakes with medical relevance can induce nephropathy, leading to Acute Renal Failure (ARF), it is unusual except with bites by Russell‟s Viper, E. Carinatus and members of the genera Crotalus and Bothrops. In India, ARF is mostly associated with Russell‟s Viper and E. Carinatus bites. The incidence of ARF following Russell‟s Viper or E. Carinatus bites is 13-32% in India. A histopathological study was conducted on renal autopsy specimens from those subjects who were admitted to IPGME&R and SNP Hospital, Kolkata as a result of development of acute renal failure following poisonous snake bite. Acute tubular necrosis (100%) and Acute cortical necrosis (25%) were the most significant renal histopathological changes. Glomerular lesions were also present in 30% of cases.

Oxidative stress in liver of mice exposed to arsenic-contaminated water.

BACKGROUND: Oxidative stress has been implicated in the initiation of hepatic damage caused by various agents. Not much data on oxidative stress in liver in chronic arsenic exposure are available in the literature. We therefore studied this aspect in a murine model. METHODS: BALB/c mice were given arsenic-contaminated (3.2 mg/L) or arsenic-free (< 0.01 mg/L, control) drinking water ad libitum. Batches of mice were sacrificed after 2 and 4 months, and blood samples and liver tissue were collected. Liver histology was examined and levels of hepatic reduced glutathione (GSH), malondialdehyde, and enzymes of the antioxidant defense system in the liver tissue were determined. Arsenic content in liver tissues obtained at 4 months was estimated. RESULTS: Two-month exposure to arsenic caused significant elevation of hepatic GSH (11.4 [0.8] micrograms/mg protein) compared to control mice (9.3 [0.4]; p < 0.01). Levels of enzymes related to GSH homeostasis were also elevated. At 4 months, hepatic GSH was significantly reduced (8.4 [0.5] micrograms/mg protein) when compared to control mice (9.3 [0.4]; p < 0.01). Arsenic content in the liver tissue after 4 months of exposure was significantly higher (0.40 [0.05] microgram/g) as compared to control mice (0.04 [0.04]; p < 0.01). CONCLUSION: The results suggest that the antioxidant defense system in the liver of mice is activated after exposure to arsenic for 2 months. However, prolonged exposure to arsenic probably causes overuse failure of this system, which might result in initiation of biochemical injury to the liver.

Influences of vestibulo-cerebellum on kindling in the cat.

The development of amygdaloid kindling was assessed under conditions of pharmacological depression of the nodular areas of vestibulocerebellum and also following vestibular stimulation in chronically prepared cats. The results demonstrated that a single intra-nodular micro-injection of procaine hydrochlorides could significantly facilitate such epileptogenesis for at least several days. The number of kindling trials required to reach the first generalized convulsions was significantly increased by natural vestibular stimulation in comparison with control kindled animals. The intensity of fit, development of amygdaloid seizures and the convulsions were reduced markedly within a week by pre-conditioning the kindled animals with daily vestibular stimulation for 15-30 min. In addition, analysis of the behaviour of sleep-wake cycle indicated a significant increase in total sleep time and in the percentage of rapid eye movement (REM) sleep. These findings suggest that the natural rotational vestibular stimulation may result in a durable modification of brain function through development of enduring focal sensitization of catecholamine-mediated inhibitory mechanisms, reflecting the tonic inhibitory influences of the vestibulo-cerebellum in regulating the development and attenuation of epileptic states.