Dapagliflozin in the Landscape of Type 2 Diabetes Management

As per current statistics, India accounts for more than 74 million individuals living with diabetes. Many of these individuals have associated cardiovascular disease (CVD) and chronic kidney disease (CKD) comorbidities. Optimal glycemic management is important because uncontrolled glycemia may accelerate the macrovascular and microvascular complications, further aggravating the comorbid conditions. Metformin is used as the first-line therapy in most persons. However, there are some who do not tolerate metformin, are unable to achieve required glycemic targets or require greater efforts for cardiovascular (CV) risk reduction. These patients require an alternative hypoglycemic agent to be used as either monotherapy or as combination treatment with metformin, respectively. Sodium-glucose cotransporter-2 (SGLT2) inhibitors are one such novel class of drugs that can be used as either monotherapy or as part of two drug (dual) or three drug (triple) combinations with other oral hypoglycemic agents or insulin. Dapagliflozin is a promising option for managing type 2 diabetes with CV and renal benefits, weight and blood pressure reducing properties. A low risk of hypoglycemia and drug-drug interactions are the added advantages. In this article, the authors have reviewed the existing clinical evidences on dapagliflozin and highlighted its place in the diabetes management landscape

Assessment of core capacities for antimicrobial stewardship practices in indian hospitals: Report from a multicentric initiative of global health security agenda

Introduction: Antimicrobial-resistant HAI (Healthcare associated infection) are a global challenge due to their impact on patient outcome. Implementation of antimicrobial stewardship programmes (AMSP) is needed at institutional and national levels. Assessment of core capacities for AMSP is an important starting point to initiate nationwide AMSP. We conducted an assessment of the core capacities for AMSP in a network of Indian hospitals, which are part of the Global Health Security Agenda-funded work on capacity building for AMR-HAIs. Subjects and Methods: The Centers for Disease Control and Prevention's core assessment checklist was modified as per inputs received from the Indian network. The assessment tool was filled by twenty hospitals as a self-administered questionnaire. The results were entered into a database. The cumulative score for each question was generated as average percentage. The scores generated by the database were then used for analysis. Results and Conclusion: The hospitals included a mix of public and private sector hospitals. The network average of positive responses for leadership support was 45%, for accountability; the score was 53% and for key support for AMSP, 58%. Policies to support optimal antibiotic use were present in 59% of respondents, policies for procurement were present in 79% and broad interventions to improve antibiotic use were scored as 33%. A score of 52% was generated for prescription-specific interventions to improve antibiotic use. Written policies for antibiotic use for hospitalised patients and outpatients were present on an average in 72% and 48% conditions, respectively. Presence of process measures and outcome measures was scored at 40% and 49%, respectively, and feedback and education got a score of 53% and 40%, respectively. Thus, Indian hospitals can start with low-hanging fruits such as developing prescription policies, restricting the usage of high antibiotics, enforcing education and ultimately providing the much-needed leadership support.

Role Of Strain Elastography In The Characterization Of Benign And Malignant Nature Of The Thyroid Nodules.

Elastography is an imaging technique to measure the stiffness of tissues. Images are acquired before and after soft compression of tissues and the deformation is evaluated. Strain ratio -calculated as the ratio of stiffness between nodular tissue and surrounding normal thyroid tissue. With prior verbal and written consent patients were examined on gray-scale ultrasound on transverse images and then using elastographic ultrasonography technique. patients were followed up by fnac findings & postoperative histopathology report in cases of inconclusive FNAC reports. This is prospective study conducted on 200 subjects at Government Medical College, Department of RADIO-DIAGNOSIS, Nagpur from November 2016 to 2018. Regarding sonoelastograph, relation between elastograph scores and thyroid malignancies showing sensitivity, specificity and p value is calculated. The most accurate strain ratio cutoff value among studies calculated. RESULTS: Ultrasound Strain elastography is a promising imaging technique that is useful in the differentiating between benign and malignant thyroid nodules. Further improvements in the technique and the diagnostic criteria are necessary for this examination to provide a useful contribution to diagnosis. The use of Real Time ultrasound strain elastography would lead to low thyroid FNAC’s because of the high elasticity of being strongly associated with a benign cytology.

Cytotoxic activity of methanolic extract of Artocarpus heterophyllus against A549, Hela and MCF-7 cell lines.

Research is focusing on the search for new types of natural chemotherapeutic agents derived from plants which are proving to be excellent sources of new compounds. The present research article was aimed to study the cytotoxic activity of methanolic extracts of Artocarpus heterophyllus plant by various in vitro cytotoxic assays like MTT and SRB against different cell lines like HEK293, A549, HeLa and MCF-7. The IC50 values of methanolic extract of Artocarpus heterophyllus were found 35.26 μgm/ml and 35.27 μgm/ml against A549 cell line by MTT and SRB assay methods respectively whereas this extract was found to be non toxic to normal cells (HEK293), proved that the methanolic extract exhibited significant anti cancer potential with no toxicity on normal cell line. The methanolic extract had no activity against Hela and MCF-7 cell line.

Rapid detection and characterization of chikungunya virus by RT-PCR in febrile patients from Kerala, India.

There has been a resurgence and prevalence of fever with symptoms of Chikungunya (CHIK) and increased death toll in Kerala, the southern-most state of India. The objective of this study was to develop a rapid detection method to determine the presence of CHIK- virus in the serum samples collected from febrile patients in Kerala, India. Serum specimens were analyzed for CHIK viral RNA by RT-PCR using primers specific for nsP1 and E1 genes. Five out of twenty clinical samples were positive for CHIK virus. The partial sequences of the E1 and nsP1 genes of the strain, IndKL01 were highly similar to the Reunion strains and the recently isolated Indian strains. A novel substitution, A148V, was detected in the E1 gene of the isolate, IndKL02. The detection procedure used in this study was simple, sensitive and rapid (less than 4 hr). This result suggests that CHIK viruses similar to the Reunion strains, which had resulted in high morbidity and mortality rates, may have caused the recent Chikungunya outbreak in India. The effect of the variant, E1-A148V, in the virulence and the rate of transmission of the virus deserves further investigation.

Standard guidelines of care: laser and IPL hair reduction.

Laser-assisted hair removal, Laser hair removal, Laser and light-assisted hair removal, Laser and light-assisted, long-term hair reduction, IPL photodepilation, LHE photodepilation; all these are acceptable synonyms. Laser (Ruby, Nd Yag, Alexandrite, Diode), intense pulse light, light and heat energy system are the different light-/Laser-based systems used for hair removal; each have its advantages and disadvantages. The word "LONG-TERM HAIR REDUCTION" should be used rather than permanent hair removal. Patient counseling is essential about the need for multiple sessions. PHYSICIANS' QUALIFICATIONS: Laser hair removal may be practiced by any dermatologist, who has received adequate background training during postgraduation or later at a centre that provides education and training in Lasers or in focused workshops providing such training. The dermatologist should have adequate knowledge of the machines, the parameters and aftercare. The physician may allow the actual procedure to be performed under his/her direct supervision by a trained nurse assistant/junior doctor. However, the final responsibility for the procedure would lie with the physician. FACILITY: The procedure may be performed in the physician's minor procedure room. Investigations to rule out any underlying cause for hair growth are important; concurrent drug therapy may be needed. Laser parameters vary with area, type of hair, and the machine used. Full knowledge about the machine and cooling system is important. Future maintenance treatments may be needed.

Eales' disease: oxidant stress and weak antioxidant defence.

Eales' disease (ED) is an idiopathic retinal periphlebitis characterized by capillary non-perfusion and neovascularization. In addition to the existing system, a new staging system has been proposed by Saxena et al. Immunological, molecular biological and biochemical studies have indicated the role of human leucocyte antigen, retinal S antigen autoimmunity, Mycobacterium tuberculosis genome, free radical damage and possibly hyperhomocysteinemia in its etiopathogenesis, which appears multifactorial. Oxidant stress has been shown by increase in the levels of thiobarbituric acid reactive substances (lipid oxidation) in the vitreous, erythrocytes, platelets and monocytes. A decrease in vitamins E and C both in active and healed vasculitis, superoxide dismutase, glutathione and glutathione peroxidase showed a weakened antioxidant defence. Epiretinal membrane from patients of ED who underwent surgery showed, by immunolocalization, presence of carboxy methyl lysine, an advanced glycation end product formed by glycoxidation and is involved in angiogenesis. OH. free radical accumulation in monocytes has been directly shown by electron spin resonance spectrometry. Free radical damage to DNA and of protein was shown by the accumulation of 8 hydroxy 2 deoxyguanosine (in leucocytes) and nitrotyrosine (in monocytes), respectively. Nitrosative stress was shown by increased expression of inducible nitric oxide synthase in monocytes in which levels of iron and copper were increased while those of zinc decreased. A novel 88 kDa protein was found in serum and vitreous in inflammatory condition and had antioxidant function. Platelet fluidity was also affected. Oral, methotrexate in low dosage (12.5 mg/week for 12 weeks) as well as oral vitamin E (400 IU) and C (500 mg) daily for 8 weeks are reported to have beneficial effects.

Tranexamic acid in paediatric cardiac surgery.

BACKGROUND & OBJECTIVES: Antifibrinolytic agents are used commonly in adult cardiac surgery to reduce postoperative blood loss. Paucity of literature on the use of a newer antifibrinolytic agent tranexamic acid (TA) in children undergoing cardiac surgery promoted us to conduct this study in children with cyanotic heart disease. METHODS: One hundred and twenty consecutive children with cyanotic heart disease were randomised into two groups. Control (group A) (n=24) given no drug while the study (group B, n=96) group was given tranexamic acid 10 mg/kg each after anaesthetic induction, on bypass and after protamine at the end of bypass. Postoperatively, total mediastinal chest tube drainage and blood and blood product usage at 24 h were recorded. Tests of coagulation including activated clotting time, fibrinogen, fibrin degradation products and platelet count were performed at 6 h postoperatively. RESULTS: The two groups were comparable in terms of demographic characteristics such as age, sex, weight, operations performed, and preoperative haematocrit. Postoperatively, group B, had a significantly (P<0.05) lower blood loss, blood and blood product usage, re-exploration rate compared to the control group. There was preservation of fibrinogen and lower levels of fibrin degradation products in group B. INTERPRETATION & CONCLUSION: Tranexamine acid was highly effective in reducing post-operative blood loss, blood and blood product usage in children with congenital cyanotic heart disease undergoing corrective surgery.

Prevalence and characteristics of migraine among adolescents: a questionnaire survey.

A screening questionnaire was distributed to 1000 boys and 1000 girls, studying in classes VI to X (11 to 15 years) in two public schools of Jaipur. Questionnaire A consisted of a single question to parents. "Does your child suffer from recurrent headache?" To those who responded in the affirmative, a detailed questionnaire (B) was distributed Questionnaire B consisted of twenty questions pertaining to characteristics and associations of headache. From questionnaire B a diagnosis of common migraine was made according to IHS criteria (1988). The prevalence of recurrent headache was found to be 18% in boys and 21% in girls, while the prevalence of migraine was 9% in boys and 14% in girls. Among the other causes of recurrent headache tension type headache was seen in 3.6%, eye problems in 0.389% sinusitis in 0.22%, and undetermined etiology in 2.14% children. The clinical characteristics of migraine are described.

Hepatoprotection by Elephantopus scaber Linn. in CCl4-induced liver injury.

The efficacy of the medicinal plant Elephantopus scaber Linn. (Asteraceae), to prevent carbon teterachloride (CCI4)-induced chronic liver dysfunction in the rats was examined by determining different biochemical markers in serum and tissues. In serum, liver function marker enzymes like aspartate aminotrasferase (AST), alanine aminotrasferase (ALT), alkaline phosphatase (ALP) and also protein were evaluated. The concentrations of total lipid, cholesterol and phospholipids were studied in serum and the different tissues. The concentration of serum triglycerides was also studied. The biochemical changes induced by CCI4 in different tissues particularly in the liver tissue improved following treatment with E. scaber Linn. The results suggest the hepatoprotective effect of this medicinal plant.

Insulin receptor tyrosine kinase activity in monocytes of type 2 diabetes mellitus patients receiving oral L-lysine.

The action of lysine as an antidiabetic agent was examined in human volunteers. Eight patients with type 2 DM were orally supplemented with L-lysine hydrochloride 1 g/day in two doses along with antidiabetic tablets (glyciphage or chlorformine), for a period of two months. Periodically their plasma fasting sugar and insulin receptor tyrosine kinase activity was measured in their monocytes. Eight normal healthy volunteers served as controls for comparison of receptor tyrosine kinase activity. Insulin receptor tyrosine kinase was isolated from monocytes by immunoprecipitation and the activity was determined using exogenous substrate poly glu-tyr (4:1) and radioactive ATP. Phosphorylated peptide was separated by electrophoresis and quantified using a liquid scintillation system. The enzyme activity was significantly low (22074 +/- 1728 dpm/ml immunoprecipitate) in subjects with diabetes when compared to non-diabetic control group (50,775 +/- 3597). Lysine treatment enhanced the enzyme activity by 31% in patients with diabetes and decreased their blood sugar by 27%.