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.

A Preliminary Study on Prevalence of Non-Communicable Diseases and their Association with Physical activity among the Urban Geriatric Population

Background: India is experiencing a rapid health transition with a rising burden of Non-Communicable Diseases (NCDs) and inappropriate lifestyle is the most remarkable risk factor associated to NCDs. Aims & Objectives: To assess the prevalence of NCDs and their association with physical activity among urban elderly. Material and methods: A community based cross-sectional study was conducted among 112 geriatric population (≥60 years) in cities of Hyderabad and Secunderabad. The data on medical history, lifestyle, diet and physical activity was obtained using a pre-tested questionnaire. Anthropometric measurements such as weight, height and waist circumference were measured. Intravenous blood samples were collected to estimate the biochemical parameters. Result: About 64.3 % of elderly have been practicing physical activity i.e. predominantly walking, while 35.7% were sedentary. The prevalence of hypertension (87.5%), diabetes (65.3%), central obesity (77.8%) and metabolic syndrome (59.7%) was higher among walkers as compared to non-walkers and the prevalence of metabolic syndrome was significantly (p<0.005) high among the elderly suffering from Cardio Vascular Diseases (CVDs). Conclusion: In general, the prevalence of non-communicable diseases was high among urban geriatric population. Therefore, primordial and primary preventive measures should be adopted during adolescence and early adulthood for the prevention and control of NCDs.

Scleredema of Buschke: a rare post-streptococcal complication.

A 19-year male presented with acute onset, gradually progressive symmetric indurations involving the skin over the face, neck, shoulders and upper part of chest following an upper respiratory tract infection. Detailed history and examination did not reveal evidence of Raynauds' phenomenon, nail changes, digital ulcers, pigmentation or any systemic involvement. Autoantibodies for systemic sclerosis were absent. Histopathology of skin biopsy documented scleredema. Antistreptolysin O (ASO) titer was elevated. We diagnosed a case of Scleredema adultorum of Buschke following a streptococcal throat infection. We report this case to highlight the importance of clinically differentiating this relatively benign, self-limiting disorder from systemic sclerosis.

Caudal anesthesia in pediatric surgical practice.

Prospective study was carried out on 100 patients since May 2005 in my private practice and in the department of pediatric surgery of MMCH. Under caudal anesthesia along with or without ketaminie induction and gas inhalation all the patients underwent different surgical procedure namely anorectal surgery (eg. anoplasty, rectal polyp), urogenital surgery (Circumcision, hypospadias, meatotomy), groin surgery (hernia, hydrocele) and foot & leg surgery. Calculated dose schedule of drugs used in anesthesia and volume were maintained. Time of giving anesthesia and time of starting analgesia were recorded. Per-operative and postoperative analgesia were evaluated. Every parent was explained regarding the merit of caudal anesthesia calculated and compared with that of general anesthesia. Application of caudal anesthesia with or without ketamine & diazepam induction can be used safely and cost effectively and may be put into protocol in many of the pediatric surgical practice both in institute and also in private practice.

Diverse manifestation of arrhythmogenic right ventricular dysplasia in a family.

Arrhythmogenic right ventricular dysplasia (ARVD) is a cardiomyopathy of unknown cause associated with life-threatening arrhythmias. The purpose of this case report is two-fold: (i) To highlight the utility of a definite set of diagnostic criteria encompassing structural, histologic, electrocardiographic, arrhythmic and genetic factors in establishing diagnosis of ARVD in institutions like ours which are handicapped by lack of magnetic resonance imaging (MRI) and endomyocardial biopsy facilities, (ii) to present diverse arrhythmic manifestations in a single family.

Recurrent respiratory papillomatosis: a study of 24 cases.

24 cases of recurrent respiratory papillomatosis (RRP) in children were treated by surgical removal with cup forceps and followed up for variable periods between 1990-95. Most of the patients required multiple operations due to recurrence. No anaesthetic death or complication was recorded. Voice changes of different degrees were noted. Four patients has glottic web formation. The findings suggest that recurrence of RRP is very common & needs multiple session of surgery. For children with persistent and progressive voice change/cry, the necessity of precise & comprehensive endoscopic examination of the upper aerodigestive tract under general anesthesia (GA) is emphasized.

Effect of short-term dermal toxicity of fenvalerate on residue, cell architecture and biochemical profiles in broiler chicks.

Effect of fenvalerate on cell architecture, tissue biochemical parameters and its residual concentration was studied in broiler chicks following dermal application at 0.1 and 1% in ethanol once daily for 31 days. It did neither produce loss of body weight nor clinical signs of toxicity. Kidney contained maximal residue followed by heart, fat, liver and brain after 0.1%; and fat contained maximal residue followed by kidney, heart, liver and brain after 1% application. Fenvalerate (0.1%) increased the aspartate aminotransferase (AST) (except brain), alanine aminotransferase (ALT), alkaline phosphatase (AP), acid phosphatase (AcP) (only brain) activities, glycogen level (only liver) in liver, kidney, heart and brain tissues; and 1% increased the AST (except brain), ALT, AcP (except liver and kidney), AP (only heart), glycogen (only liver) and decreased AP (except heart), AcP (only kidney), cholesterol (except liver and heart), and acetylcholinesterase (AChE) (liver and brain) of liver, kidney, heart and brain tissue homogenates respectively. Histopathological examination in general showed aggregation of mononuclear cells in liver, around the kidney tubules and cardiac muscle fibre. In addition, fibrosis in the periportal area of liver, proliferation of ureter and tubular degeneration, and congestion of endocardial vessels were also observed. The intensity of cellular changes was more marked after 1% dermal application.

Jaundice in new born and erythrocyte and plasma antioxidant defence system.

Alteration in the antioxidant defence mechanism of erythrocytes with rise in serum unconjugated bilirubin level in neonates has been observed. The cellular glutathione level was found to be significantly low. The activity of glutathione reductase in erythrocyte increased to combat the cellular loss of reduced glutathione in neonatal jaundice. In plasma fraction the level of glutathione (reduced) was found to be significantly higher with lowering of glutathione reductase level. Glutathione peroxidase was reduced in cellular level whereas an increase was observed in plasma fraction. Gamma glutamyl transpeptidase level was barely detectable in erythrocyte whereas an increase was observed in plasma fraction. In all the cases erythrocyte G-6-PDH activity level was found within normal limits.

Subacute toxicity of fenvalerate in broiler chicks: concentration, cytotoxicity and biochemical profiles.

Subacute toxicity study of fenvalerate was carried out in broiler chicks after oral administration @ 525.6 mg/kg once daily for 28 days. The blood concentration of fenvalerate following 1 day post-administration (pd) was 39.65 +/- 2.67 micrograms/ml and maintained plateau thereafter up to day 21 pd, and then declined (18.46 +/- 1.47 micrograms/ml) on day 28 pd. Intestine contained maximum residue (7.46 +/- 1.96 micrograms/g) followed by fat (5.95 +/- 1.16 micrograms/g), brain (5.06 +/- 0.96 micrograms/g), liver (3.93 +/- 0.51 micrograms/g), kidney (3.79 +/- 0.72 micrograms/g) and heart (1.72 +/- 0.35 micrograms/g). Histopathological examinations showed focal areas of necrosis in liver, proliferation and fibrosis of bile duct, larger size of glomeruli, glomerular and tubular necrosis in treated birds. Fenvalerate significantly increased the cholesterol level in brain, GPT activity in liver and heart, GOT activity in heart, and alkaline phosphatase activity in heart and brain tissue. It significantly decreased the glycogen content in liver and heart, GOT activity in brain and acid phosphatase activity in all the tissues analyzed. It appears that comparatively fowl is resistant to fenvalerate toxicity.

Remote sensing system to study rodent behaviour.

The instrumental system assembled consists of video monitors which projects signals from remotely placed video camera in the rat pen with pan and tilt arrangement and all operations are done through control-room. Signals obtained from the camera will pass through the monitor and then fed into VCR system which records the behavioural events. Studies carried out with the above system has revealed that all the characteristic behaviour of gerbils (Meriones hurricane Jerdon) which is significantly superior (P < 0.001) over the direct observation method. The integrated sensing system is an ideal instrumental set up for viewing and recording the behaviour of rodents as well as other animals in the experimental pen throughout the year under varying weather and light conditions.