A comparative study of efficacy of tadalafil and alfuzosin regimens in patients of benign prostate hyperplasia

Background: Aim of the study was to compare efficacy of Tadalafil and Alfuzosin regimens in patients of Benign Prostate Hyperplasia.Methods: It was a comparative, prospective, observational, non-invasive, parallel and randomised study conducted at the Outpatient Department of Urology, Rajindra Hospital, Patiala. 60 patients diagnosed with Benign Prostate Hyperplasia along with Lower Urinary Tract Symptoms, out which, 30 patients, consuming Tadalafil and 30 patients consuming Alfuzosin were considered. History regarding the concerned disease and the compliance of treatment was taken. Symptom scores were assessed with the help of International Prostate Symptom Score, Quality of Lifestyle Score and Erectile Dysfunction Score. Physical examination consisting of Focused Neurological Examination along with Digital Rectal Examination were conducted. Parameters like Renal Function Test, Urine analysis, Ultrasound of Prostate and uroflowmetry were also considered.Results: The mean age selected for study was 64 years for Tadalafil and Alfuzosin group. The mean level of IPS Score, Qol Score and ED Score at the first day of inclusion of patients were 23.96±4.49, 4±0.78, and 25.33±4.02 respectively for Tadalafil group and regarding Alfuzosin group they were 25.23±4.84, 3.56±0.81, and 26.1±4.04 respectively. Follow ups were conducted at 15 days, 1 month and 3 months for both the groups which were found to be statistically significant after 3 months and Alfuzosin showed a favourable result.Conclusions: Alfuzosin 10mg given at daily dose was found to have higher efficacy than Tadalafil (5mg).

To establish the reference range of glycated hemoglobin.

Background: Diabetes mellitus (DM) has emerged as a major healthcare problem in India. There were an estimated 40 million persons with DM in India in 2007 and this number is predicted to rise to almost 70 million by 2025. It is estimated that every fifth person with diabetes will be an Indian. The objective of the present investigation was to establish the reference range for glycated hemoglobin (HbA1C) in healthy non-diabetic subjects in our hospital laboratory and compare it with the values reported by standard laboratories. Methods: The study was conducted in the Department of Biochemistry, MMIMSR, Mullana (Ambala, Haryana). Total number of subjects was 50 (25 males, 25 females), aged 30 to 70 years. 2 ml of blood was collected from antecubital vein under aseptic conditions from each subject and put in EDTA vials. Hemolysed blood was estimated by semiautoanalyzer for HbA1C. Results: In females, the levels were 6.50 ± 0.74 % while in males the levels were 6.27 ± 0.94 %. The overall range in females was 4.8 - 7.56 % while in males it was 4.2 to 7.56 %. The values were comparable (p>0.05) with those reported by standard laboratories, e.g. Dr. Lal PathLabs (<6%), Charak diagnostic (4.5-6.3%) and Mayo Clinic (6.5-7%). Conclusion: Our laboratory levels of HbA1C are comparable with the reference range of different laboratories and hence suitable to be used as cut-offs while interpreting the results of patients with DM.

Molecular insights into diabetic cardiomyopathy.

Diabetes mellitus affects the heart in 3 ways: (1) coronary artery disease (CAD) due to accelerated atherosclerosis; (2) cardiac autonomic neuropathy (CAN); and (3) diabetic cardiomyopathy (DbCM). Although there is high awareness among clinicians about the first two entities, DbCM is poorly recognized by most physicians and diabetologists. DbCM, first described by Rubler et al. in 1972, is defined as myocardial dysfunction occurring in patients with diabetes in the absence of CAD, hypertension, or valvular heart disease. The development of DbCM is multi-factorial including autonomic dysfunction, metabolic derangements, abnormalities in ion homeostasis, alteration in structural proteins, and interstitial fibrosis. Chronic hyperglycemia is thought to play a central role in the development of DbCM. The main metabolic abnormalities in diabetes are hyperglycemia, hyperlipidemia and inflammation, all of which stimulate generation of reactive oxygen/nitrogen species which result in reduction of myocardial contractility and acceleration of fibrosis besides cellular DNA damage and cardiomyocyte apoptosis. In addition, advanced glycation end products (AGEs) indirectly exert their detrimental effect on the myocardium by interacting and up-regulating their receptors, including receptors of AGE and galectin-3. This results in activation of transcription factors, such as nuclear factor-kB (NF-kB). The NF-kB dependent genes, in turn, trigger several pathways that induce production of pro-inflammatory cytokines and cause myocardial damage. All these molecular events are potential therapeutic targets in DbCM.

Duxorubicin-induced cardiotoxicity.

The survival rate of cancer patients has greatly increased over the last 20 years. However, to achieve this result, a considerable price has been paid in terms of the side-effects associated with the intensive anticancer treatment. Cardiotoxicity of anticancer drugs is a serious problem. It is defined, by the National Cancer Institute, as the “toxicity that affects the heart.” This definition not only includes a direct effect of the drug on the heart, but also an indirect effect due to enhancement of hemodynamic flow alterations or due to thrombotic events. Cardiotoxicity can develop in a subacute, acute, or chronic manner. The risk for such effects depends upon: cumulative dose, rate of drug administration, mediastinal radiation, advanced age, younger age, female gender, pre-existing heart disease and hypertension. Anthracyclines, such as doxorubicin (DOX), cause serious cardiac side-effects. Acute tachyarrhythmias and acute heart failure (HF) may occur after high doses, but these reactions are now rare due to changed dosage schemes (e.g. slower infusion) with the aim to prevent this. However, the sub-acute or chronic cardiac effects of anthracyclines remain a clinical problem. Clinically, anthracycline induced cardiotoxicity manifests itself as left ventricular failure, which develops insidiously over months to years after completion of the anthracycline based chemotherapy and may result in congestive HF. The mechanism of anthracyclin induced cardiotoxicity is not totally unraveled. It is likely that the decline in myocardial function is related to apoptosis of cardiac myocytes that occurs apparently at random in the myocardium. Anthracyclin induced formation of reactive oxygen species (ROS) in the presence of intracellular iron, impaired homeostasis of intracellular iron and calcium (that may facilitate the apoptosis induced by the ROS) have been put forward as mechanisms. Cardiac protection can be achieved by limitation of the cumulative dose. Further, addition of the antioxidant and iron chelator dexrazoxane to anthracycline therapy has shown to be effective in lowering the incidence of anthracycline induced cardiotoxicity.

Triple composite tumor of stomach: A rare combination of alpha fetoprotein positive hepatoid adenocarcinoma, tubular adenocarcinoma and large cell neuroendocrine carcinoma.

A 50-year-old male patient presented with pain abdomen of 6 months duration. Computed tomography scan revealed a large mass in the stomach occluding the lumen. Histopathology revealed a triple composite tumor comprising of tubular adenocarcinoma arising on a background of high-grade dysplasia, hepatoid adenocarcinoma (positive for Hep Par-1 and alpha fetoprotein) and large cell neuroendocrine carcinoma (positive for synaptophysin and chromogranin) with nodal metastasis.Triple composite tumors are distinctly rare with few reports in literature.

Osteoporosis: Current Management Guidelines.

Osteoporosis is a multifactorial progressive skeletal disorder characterized by reduced bone mass and deterioration of bone microarchitecture. Fragility fractures, the consequence of osteoporosis, are responsible for excess mortality, morbidity, chronic pain, admission to hospitals and economic costs. Approximately 1.6 million hip fractures occur each year worldwide and the incidence is set to increase to 6.3 million by 2050. Preventive measures should be started at an early age and should include smoking cessation and weight-bearing exercises. Pharmacologic prevention methods include calcium supplementation and administration of raloxifene or bisphosphonates. No treatment can completely reverse established osteoporosis. Early intervention can prevent osteoporosis in most people. For patients with established osteoporosis, medical intervention can halt its progression. Currently available therapies include bisphosphonates, selective estrogen receptor modulators (SERMs), hormone replacement therapy (HRT), denosumab, teriparatide, calcitonin and strontium ranelate. Cathepsin K inhibitors (balicatib and odanacatib) are among recent drugs under development. Saracatinib, a novel orally available competitive inhibitor of Src kinase has been shown to inhibit bone resorption in vitro. Lasofoxifene, bazedoxifene and arzoxifene are new SERMs in late-stage treatment trials. Nonpharmacological measures are required when patients experience adverse effects because of drug therapy, when symptoms are not controlled by drug therapy alone or when patient is not willing to take drugs for a prolonged duration.

Serum Magnesium Levels: A Key Issue For Diabetes Mellitus.

The global burden of diabetes mellitus is expected to increase by 42% (from 51 million in year 1995 to 72 million by 2025) and by 172% (from 84 to 288 million) in the developed countries. The disease leads to many complications and one of them is electrolyte imbalance which has been an ignored subject. Amongst the electrolytes, magnesium merits special attention. The aim of the present study was to assess serum magnesium levels in Type 2 diabetics. A hospital based cross- sectional study was performed on 50 diabetic patients attending the OPD of medicine department from January 2011 to July 2011, M.M. Institute of Medical Sciences and Research, Mullana (Ambala). Thirty age-matched healthy controls were also selected for the sake of comparison. Blood was withdrawn and serum magnesium levels were estimated by colorimetric method using Xylidyl blue dye. The results were analyzed using Student's unpaired 't'test. Serum magnesium levels among normal healthy controls (n=30) ranged between 1.8-3.0 mg /dl (mean ±SD = 2.33±0.37 mg/dl), while the levels of serum magnesium in diabetic patients (n=50) ranged between 0.2-2.25 mg/dl (mean ±SD = 1.62±0.47). The difference was statistically significant (p<0.001). Levels of serum magnesium were significantly lower in diabetic patients as compared to normal healthy controls. Therefore, hypomagnesaemia is a key issue in diabetes which, if corrected, is expected to result in a better management of the disease.