Glycemic and Non-Glycemic Effects of Teneligliptin

The gut enzymes are released in response to intake of meal, those are GLP-I (glucagon link peptide-I) & GIP (glucose-dependent insulin tropic polypeptide) along with DPP-4(Dipeptidylpeptidase-4). GLP-I has vital role in control of glucose levels and it may also has capacity reduce body weight and it can manage some micro & macro-vascular complications. Unfortunately it has very shorter half-life 1-2 min, and eventually it was degraded by DPP-4 enzyme. Therefore GLP-I has ineffective to perform its tasks. To overcome this incidence essential to inhibit DPP-4 enzyme is benefited in diabetics and in non diabetics suffering with micro, macro vascular complications. Ubiquitous Dipeptidyl peptidase (DPP) -4 has pleiotropic effects because it is widely distributed other than intestine. DPP-4 enzyme inhibition has a promising effect on glycemic control. DPP-4 inhibition is also involved in the improvement of non-glycemic effects as directly or indirectly the DPP-4 enzyme is linked with some pathological conditions of particular organs, such as DPP-4 is linked with the intestinal secretion of triglycerides, and DPP-4 is expressed in the glomerulus in uncontrolled diabetics which in turn leads to nephritis. DPP-4 release strongly correlates with adipocyte size, potentially representing an important source of DPP-4 in obesity. DPP-4 inhibition produces an anti-inflammatory activity because the activity of DPP-4 results in reduced production of cytokines including interleukins and interferon-G. All these anti-inflammatory agents are inhibited by the DPP-4 enzyme which can lead to pathogenesis of cardiovascular diseases and provokes atherosclerosis & psoriasis. Serum sodium and brain natriuretic peptide (BNP) levels are also regulated by inhibition of the DPP-4 enzyme and which can produce vascular protection & regulates blood pressure. Teneligliptin is a recently developed oral DPP-4 inhibitor indicated for the management of T2DM in adults along with diet and exercise. Teneligliptin is recently available in India and is also available in combination with other oral hypoglycemic agents at affordable prices. This review is aimed at exploring the status of teneligliptin with emphasis on its glycemic effects and non-glycemic clinical benefits associated with increasing GLP-1 & GIP

Analysis Of Applicability Of Tools Of Inventory Control And Knowledge Of Hospital Pharmacists On Methods Of Inventory In The Central Pharmacy Of A Tertiary Care Hospital

Objective: A study was conducted to analyse the applicability of the tools of inventory control of drugs, and the awareness of hospital pharmacists on the inventory tools in the central pharmacy of a tertiary care hospital. Methods: Always Better Control (ABC) and High Moderate Low (HML) analysis were carried out for 4057 drugs purchased in the central pharmacy during the financial year of 2017-2018. The drugs were classified as A, B and C category based on their annual usage value and as Category High (H), Moderate (M) and low (L) drugs based on their unit price respectively. The knowledge of the 80 hospital pharmacists on the tools of inventory control was assessed using a structured questionnaire. Results: Based on ABC analysis, of 4057 drugs, 330 drugs were classified under “A” category accounting to 8.13% of the total number of drugs purchased which was 70.91 % of total annual consumption in money value. The category “B” consisted of 667 drugs accounting to 16.44% of the total number of drugs which was 20.01% of total annual money consumption. Category “C” had 3060 drugs which accounted to 75.42% of the total number of drugs purchased which reflected on 9.01% of annual money consumption. Based on HML analysis, 440 drugs (10%) had a unit price above Rs. 500 and were classified under ‘H’ category. The drugs with unit price between Rs.500 and Rs.100 were grouped as ‘M’ items. There were 695 drugs (17.13%) in ‘M’ category. The ‘L’ category consisted of 2922 drugs (72.02%) with their unit price below Rs.100. Of 80 pharmacists, 84 % had good overall knowledge on the inventory control tools and 59 participants were willing to acquire additional training on inventory control techniques. Conclusion: The study explained the need for the application of ABC and HML analysis, and the involvement of hospital pharmacists in the regular implementation of inventory analysis towards effective management of Pharmacy stores in a hospital setting.

A Study on Metabolic Syndrome in the South Indian Population with Coronary Artery Disease Proven By Angiography.

Background: The prevalence of metabolic syndrome is increasing in Indian population, predisposing an increased risk for the development of diabetes mellitus and cardiovascular diseases. Methods: A case control study was conducted to assess the prevalence of MS and the association between the components of MS in 250 patients, diagnosed by angiography to have CAD (125 patients) as cases and no CAD (125 patients) as control group. MS was diagnosed based on the modified ATP III guidelines, if three or more of the following were present: abdominal obesity, hypertension, glucose intolerance, hypertriglyceridemia or low HDL-C levels. SPSS Version 15 was used for statistical analysis and Chi-square analysis was used to estimate the prevalence of MS with respect to the severity of CAD, family history of CAD and smoking history. The association between individual risk factor and outcome was estimated using univariate logistic regression. The multivariate logistic regression analysis was used to estimate the components of MS as a risk factor for CAD, controlling the other confounders. A P value of <0.05 was considered as statistically significant. Results: The prevalence of MS was higher in CAD (70.4%) than in subjects without CAD (66.4%). Diabetic subjects with (88.24%) and without (87.93%) CAD had significantly higher % of MS when compared with non-diabetic subjects with CAD (49.12%) and without CAD (47.76%) (P < 0.001). Of 125 patients with CAD, 3% patients had no functional markers of MS; 11.2 % had an expression of one; 20 % had two; 32 % had three and 33.8% had four functional markers of MS. The level of MS mounted high with the increasing severity of CAD when compared with normal coronary arteries but was not statistically significant (P=0.176). The percentage of MS was higher in patients with family history of CAD (78.18%) which was statistically significant (P<0.001) and was comparatively lower in non-smokers (46.7%) and ex-smokers (62.2%) than smokers (65.2%). Conclusion: A higher prevalence of MS was observed in diabetics with and without CAD. This is suggestive of an increased risk of CAD in diabetic patients with MS than in non-diabetic patients.

Seroprevalence of Scrub typhus at a tertiary care hospital in Andhra Pradesh.

Introduction: Scrub typhus is a rickettsial infection which is caused by Orientia tsutsugamushi and transmitted by the bite of the chigger of a mite. Delay in diagnosis can be fatal otherwise the treatment is simple, doxycycline being the drug of choice. Indirect immunofl urescence is considered gold standard but it is not used in India as it is costly and also not available. There is need for rapid, economic and simple test for the diagnosis of scrub typhus. This study was taken up to study the seroprevalence of scrub typhus in Andhra Pradesh and to compare two commonly used serological methods; rapid test and IgM ELISA. Materials and methods: This is a prospective study in which 100 serum samples from clinically suspected cases collected over a period of 3 months were processed for the detection of IgM antibodies for scrub typhus by ELISA and Rapid test. Samples were also tested for leptospirosis and dengue fever which the other common causes of fever prevalent in this region. Results: Total number of samples processed was 100 of which 52 were males and 48 females. Among the hundred samples 39 were seropositive. Positivity was higher in the age group of patients between 16 and 30 yrs of age. There was 97% correlation between ELISA and rapid method. Of the 100 samples only three samples positive by ELISA were negative by rapid method. Fever was the most common manifestation and there was no eschar and no mortality reported. Conclusion: Scrub typhus should be included in the differential diagnosis of fever of unknown origin along with dengue, malaria and leptospirosis which are the other common endemic infections in this part of the country.

A Rare Clinical Presentation of Primary Pulmonary Hypoplasia with Tuberculous Pleural Effusion.

Primary pulmonary hypoplasia is rare in adulthood. It is characterized by decreased number or size of bronchi, vessels and alveoli. We present a case of unilateral pulmonary hypoplasia in 44-old-year male smoker who presented with right pleural effusion. His chest X-ray revealed an inhomogenous opacity on the left side with bronchiectatic changes and right minimal pleural effusion. Fiberoptic bronchoscopy revealed blind end bronchi in left upper lobe and computed tomography pulmonary angiography revealed hypoplastic lung with cystic bronchiectasis on the left side and hypoplastic left pulmonary artery. It was not associated with any other congenital anomalies. In addition to symptomatic management, he was started on anti-tuberculous treatment for tuberculous pleural effusion and kept under follow-up.

Validation of Assay Indicating Method Development of Simvastatin in Bulk and its Tablet Dosage form by RP-HPLC.

A novel, simple and economic reverse phase high performance liquid chromatography (RP-HPLC) method has been developed for the estimation of Simvastatin in bulk and tablet dosage form with greater precision and accuracy. Separation was achieved on Develosil ODS HG-5 RP C18, (150cmx4.6mm i.d. 5m) column in isocratic mode with mobile phase consisting of acetonitrile :phosphate buffer(pH 3.0) (85:15) with a flow rate of 1 mL/min. The detection was carried out at 236 nm. The retention time of Simvastatin was found to be 5.84 min. The method was validated as per ICH guidelines.Linearity was established for Simvastatin in the range 10 – 100 μg / ml with R2 value 0.99. The percentage recovery of Simvastatin was found to be in the range 99.19-99.67 %. The high recovery and low relative standard deviation confirm the suitability of the proposed method for the estimation of the drug in bulk and tablet dosage forms. The LOD and LOQ were found to be 0.341 and 1.023 μg/ml respectively.Validation studies demonstrated that the proposed RP-HPLC method is simple, specific, rapid, reliable and reproducible for the determination of Simvastatin for Quality Control level.

Gliptins - The Novel Players in Glucose Homeostasis.

Type 2 diabetes mellitus is a chronic metabolic disorder that results from defects in both insulin secretion and insulin action. Tight glycemic control is considered to be important in the therapy of type 2 diabetes mellitus, but treatment with a single agent is not sufficient to achieve this for the majority of patients. So, there is a need for new antidiabetic agents with favorable side effect profiles to use in combination therapy. The gliptins, an emerging new class of oral drugs for type 2 diabetes mellitus, lower blood glucose levels by a novel mechanism of inhibiting the enzyme dipeptidyl peptidase-4 (DPP-4) that inactivates incretin, released from the intestine following a meal to increase pancreatic insulin secretion. Gliptins enhance the circulating levels of incretin hormones glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) and improve glycemic control. This therapeutic approach carries a low-risk of interprandial hypoglycemia, does not cause weight gain and is well-tolerated. The first gliptin, sitagliptin (Januvia), was introduced in the UK in April 2007 as add-on therapy for patients with type 2 diabetes inadequately controlled with oral hypoglycemic agents. Other gliptins, notably vildagliptin (Galvus), saxagliptin and melogliptin are advanced in clinical development. This article reviews the current evidence on the effectiveness of gliptins and suggests several ways in which these agents could be used in diabetes treatment.

Risk Assessment for Congestive Heart Failure in a South Indian Population: A Clinical Pharmacist’s Perspective.

Congestive heart failure (CHF) is becoming an increasingly prevalent healthcare problem. Hypertension (HT) is a major risk factor for CHF and it commonly coexists with other cardiovascular risk factors. The quality of risk that HT represents has to be thoroughly compared with other risk factors. This could have significant implications for primary prevention strategies including drug treatment. A study was conducted in 137 heart failure patients, to assess the contribution of cardiovascular risk factors like age, sex, obesity, HT, diabetes, dyslipidemia, alcohol, smoking and family history, individually and in combination, in the progression of CHF using multivariate logistic regression analysis and odds ratio (OR) (95% confidence interval). Of the various individual factors, HT showed 3.8 times greater risk (p = 0.003; OR-3.773) for heart failure; dyslipidemia exhibited 2.5 times risk (p = 0.07; OR-2.49), followed by others. Patients with HT, but no diabetes or dyslipidemia had 1.2 times risk (OR-1.17) for CHF; patients with hypertension and diabetes had 1.7 times risk (OR-1.69) and patients with HT, diabetes and dyslipidemia had two times greater risk (OR-1.87). Though, the present study emphasizes that HT is the most common risk factor in the progression of heart failure, the risk is high when it coexists with other risk factors like diabetes and dyslipidemia. A clinical pharmacist can work in collaboration with healthcare team in achieving the goal of long-term control of hypertension and other cardiovascular risk factors in millions of patients, by providing services ranging from monitoring drug therapy and improving patients compliance to drug therapy, to, health maintenance care such as ordering screening procedures and counseling regarding lifestyle modification.

Optimal protein extraction methods from diverse sample types for protein profiling by using Two-Dimensional Electrophoresis (2DE)

There is a great diversity of protein samples types and origins, therefore the optimal procedure for each sample type must be determined empirically. In order to obtain a reproducible and complete sample presentation which view as many proteins as possible on the desired 2DE gel, it is critical to perform additional sample preparation steps to improve the quality of the final results, yet without selectively losing the proteins. To address this, we developed a general method that is suitable for diverse sample types based on phenolchloroform extraction method (represented by TRI reagent). This method was found to yield good results when used to analyze human breast cancer cell line (MCF-7), Vibrio cholerae, Cryptocaryon irritans cyst and liver abscess fat tissue. These types represent cell line, bacteria, parasite cyst and pus respectively. For each type of samples, several attempts were made to methodically compare protein isolation methods using TRI-reagent Kit, EasyBlue Kit, PRO-PREPTM Protein Extraction Solution and lysis buffer. The most useful protocol allows the extraction and separation of a wide diversity of protein samples that is reproducible among repeated experiments. Our results demonstrated that the modified TRI-reagent Kit had the highest protein yield as well as the greatest number of total proteins spots count for all type of samples. Distinctive differences in spot patterns were also observed in the 2DE gel of different extraction methods used for each type of sample.

A giant syphilitic aneurysm in a young human immunodeficiency virus sero-positive individual.

A 35-year-old, human immunodeficiency virus sero-positive male presented with huge mediastinal mass for evaluation. After contrast enhanced computed tomography (CECT) angiogram, aneurysm of arch of aorta was diagnosed. The patient also proved to be co-infected with syphilis, which is the aetiological cause of aneurysm in this case. The present report highlights the need to suspect, diagnose and treat dual infections in individuals with high risk behaviour.

Increase in ovarian blood volume during ovulation in adult cyclic rats.

Ovarian blood volume was quantified by measuring optical density (414 nm) of haemoglobin in ovarian extracts and comparing it with that of known amounts of whole blood in the cyclic mature female rats during estrous cycle and periovulatory period. Haemoglobin in ovarian extracts had the same peak absorbance of 414 nm characteristic of oxyhaemoglobin in whole blood taken by cardiac puncture of the rats. There was a linear relationship between the absorbance and volume of whole blood in the sample. The ovarian blood volume was lowest on the day of metestrus and slightly increased on the day of diestrus. On the night of proestrus, the blood volume significantly increased and showed a gradual increase during preovulatory period from 0030 hrs to 0230 hrs and then started decreasing and reached a preovulatory level on the morning of estrus. Ovulation had occurred only in the rats sacrificed after 0230 hrs. Treatment of rats with indomethacin and propranolol significantly reduced the ovarian blood volume observed during the ovulatory period. Epinephrine and norepinephrine did not affect the ovarian blood volume. The results show that the ovarian blood volume changes significantly during the estrous cycle and reaches at maximum level at the time of ovulation which perhaps reflect vasodilatation and hyperemia associated with this process.

Pregnancy associated anemia and iron: a pilot study.

Iron deficiency occurs when the rate of loss of utilization exceeds its assimilation. Treatment is based on iron supplementation but due to side effects compliance to iron therapy is poor. A double blind comparative study was done using a novel time release preparation of ferrous sulphate (Code A) v.s. sustained release ferrous sulphate preparation (Code B) on 60 pregnant women in mid or late pregnancy with anaemia. The amount of ferrous sulphate in Code A was less than half of Code B. The patients were sequentially randomised as Code A or Code B recipient. The non compliance rate was 33%, and for both Code A & Code B. The mean improvement in hemoglobin after 4 weeks of therapy was 2.01 gm% for Code A and 2.3 gm% for Code B. Iron absorption as evidenced by improvement in S. Iron, TIBC and ferritin levels was better with Code A. The improvement in subjective symptoms of anaemia was better than average in Code B preparation. Code A group had comparatively more side effects both major and minor, this may have been the reason for a slightly higher drop out rate in this group. In conclusion the timed release preparation has a comparable haematological response and better absorption with significantly lower doses as compared to the sustained release preparation.

Effect of Santhi Kriya on certain psychophysiological parameters: a preliminary study.

Santhi Kriya is a mixture of combined yogic practices of breathing and relaxation. Preliminary attempts were made to determine the effect of Santhi Kriya on certain psychophysiological parameters. Eight healthy male volunteers of the age group 25.9 +/- 3 (SD) years were subjected to Santhi Kriya practice daily for 50 minutes for 30 days. The volunteer's body weight, blood pressure, oral temperature, pulse rate, respiration, ECG and EEG were recorded before and after the practice on the 1st day and subsequently on 10th, 20th and 30th day of their practice. They were also given a perceptual acuity test to know their cognitive level on the 1st day and also at the end of the study i.e., on the 30th day. Results indicate a gradual and significant decrease in the body weight from 1st to 30th day (P less than 0.001) and an increase in alpha activity of the brain (P less than 0.001) during the course of 30 days of Santhi Kriya practice. Increase of alpha activity both in occipital and pre-frontal areas of both the hemispheres of the brain denotes an increase of calmness. This study also revealed that Santhi Kriya practice increases oral temperature by 3 degrees F and decreases respiratory rate significantly (P less than 0.05) on all practice days. Other parameters were not found to be altered significantly. It is concluded that the Santhi Kriya practice for 30 days reduces body weight and increases calmness.