Drug utilization study in patients affected with COVID-19 in a dedicated COVID hospital

Background: There exists a treatment dilemma regarding the optimal and effective use of therapeutic drugs (hydroxychloroquine/chloroquine/azithromycin) for COVID-19. Furthermore, with changing guidelines, the data on drug utilization patterns across India are limited. Hence, this study was conducted to assess the prescription pattern and drug utilization trends in COVID-19 patients with the aim to study the drug utilization pattern in patients affected with COVID-19 in a dedicated COVID-19 hospital. Aims and Objectives: The objectives of the study are as follows: (1) To study drug utilization patterns according to the severity of the disease. (2) To study the prevalence of adverse drug reactions (ADRs). Materials and Methods: Data were collected retrospectively from 100 medical records of patients ?18 years irrespective of sex admitted in the COVID ward and ICU of a dedicated COVID hospital from May to August 2020. Pregnant and lactating women were excluded from the study. ADRs reported were also analyzed. Results: About 71% were mild in this study, 18% were moderate, and 11% were severe COVID-19 patients. Overall, the most common drugs prescribed were multivitamins, followed by pantoprazole, paracetamol, and azithromycin. Hydroxychloroquine was prescribed in 22%, favipiravir in 7%, and remdesivir in 3% of cases. The majority of moderate COVID patients received injectables piperacillin-tazobactam, methylprednisolone, and enoxaparin. The mean number of medications, duration of admission, and number of days on oxygen were higher and significant in moderate compared to mild and severe COVID patients. Overall, ADRs were encountered in 9% of cases. Conclusion: The prescribed pattern of drugs was by the national standard guidelines. Multivitamins, followed by pantoprazole, paracetamol, and azithromycin dominated the prescription pattern. Polypharmacy was encountered, which needs to be addressed for the rational use of drugs.

Ventilatory Strategies in Traumatic Cervical Spinal Cord Injury: Controversies and Current Updates

Ventilatory management of patients with traumatic cervical spinal cord injury (CSCI) is a complex and controversial area of critical care medicine. Despite significant advances in our understanding of the pathophysiology of CSCI and the development of novel interventions, there remains a lack of consensus about the optimal approach to ventilatory management in these patients. Some of the key controversies in CSCI ventilatory management include timing of tracheal intubation, non-invasive ventilation versus invasive ventilation, high versus low tidal volume, and early versus late tracheostomy. The objective of this review is to discuss the existing controversies and provide an insight on the current evidence.

Histological Variants of Leiomyoma: A Great Impersonator posing a Diagnostic Challenge - Three year Study in Delhi NCR

Background: Objectives: Uterine smooth muscle tumours are diagnostically challenging as well as scientifically intriguing with leiomyoma being the most common. On review of literature there are numerous studies on audit of hysterectomy specimens worldwide, however, studies focusing on detailed histopathologi cal analysis of leiomyomas are limited. Thereby, this study was conducted to identify the secondary changes as well as histological variants of leiomyoma, their frequency of occurrence and other associated clinicopathological factors Methods: A retrospecti ve audit of all the hysterectomy and myomectomy specimens was conducted over a period of 3 years (Jan 2016 to Dec 2018) comprising of a total of 155 cases with 388 leiomyomas (LM). The clinical details were retrieved, and histopathological slides reviewed for cellularity, mitosis, atypia, necrosis, any secondary changes or specific variants. Results: On histopathology, 19.1% LM showed degenerative changes and histologic variants were observed in 6.18% LM. Hyaline change was the most frequent degenerative ph enomenon in 82.43% (60/74) while cellular leiomyoma was the most common variant in 37.5% (9/24) LM. Conclusion: Certain histological variants make the differentiation from malignant tumors challenging. A thorough tissue sampling and strict adherence to histologic criteria coupled with a ncillary techniques like immunohistochemistry can help in excluding malignancy in most of the cases. Awareness regarding these is very important amongst youn g pathologists to avoid misdiagnosis and overtreatment leading to unwarranted stress to the patient.

COVID-19 infection in patients with haematological disease - A tertiary centre experience from north India

This retrospective study was aimed to understand the clinical, laboratory, radiological parameters and the outcome of COVID-19 patients with underlying haematological disease. All patients with known haematological disease admitted with COVID-19-positive status from April to August 2020 in the COVID-19 facility of a tertiary care centre in north India, were included. Their medical records were analyzed for outcome and mortality risk factors. Fifty four patients, 37 males, were included in the study. Of these, 36 patients had haematological malignancy and 18 had benign disorder. Fever (95.5%), cough (59.2%) and dyspnoea (31.4%) were the most common symptoms. Nine patients had severe disease at diagnosis, mostly malignant disorders. Overall mortality rate was 37.0 per cent, with high mortality seen in patients with aplastic anaemia (50.0%), acute myeloid (46.7%) and lymphoblastic leukaemia (40.0%). On univariate analysis, Eastern Cooperative Oncology Group performance status >2 [odd ratio (OR) 11.6], COVID-19 severity (OR 8.2), dyspnoea (OR 5.7) and blood product transfusion (OR 6.4) were the predictors of mortality. However, the presence of moderate or severe COVID-19 (OR 16.6, confidence interval 3.8-72.8) was found significant on multivariate analysis. The results showed that patients with haematological malignancies and aplastic anaemia might be at increased risk of getting severe COVID-19 infection and mortality as compared to the general population

Best Practice Guidelines for Breast Imaging, Breast Imaging Society, India: Part—2

Breast imaging is a prerequisite for providing high quality breast health care. Choosing the appropriate investigation is central to diagnosing breast disease in patients who present to health professionals for treatment. These patients present to doctors of different subspecialties as well as to general practitioners in our country. It is important, therefore, to provide uniform guidance to doctors in different healthcare setups of our country, urban and rural, government and private, for optimal management of breast diseases. These guidelines framed by the task group set up by the Breast Imaging Society, India, have been formulated focusing primarily on the Indian patients and health care infrastructures. They aim to provide a framework for the referring doctors and practicing radiologists to enable them to choose the appropriate investigation for patients with breast symptoms and signs. The aim has been to keep this framework simple and practical so that it can guide not only subspecialists in breast care but also help doctors who do not routinely deal with breast diseases, so that breast cancer is not missed. Overall, the aim of this document is to provide a holistic approach to standardize breast care imaging services in India. Part 2 of these guidelines focuses on the best practice principles for breast interventions and provides algorithms for the investigation of specific common breast symptoms and signs. Ultrasound is the preferred imaging modality for image-guided breast interventions due to real-time needle visualization, easy availability, patient comfort and absence of radiation. Stereotactic mammography guided procedures are performed if the lesion is visualized on mammography but not visualized on ultrasound. 14-gauge automated core biopsy device is preferred for breast biopsies although vacuum assisted biopsy devices are useful for biopsy of certain abnormalities as well as for imaging guided excision of some pathologies. MRI guided biopsy is reserved for suspicious lesions seen only on MRI. Algorithms for investigation of patients presenting with mastalgia, breast lumps, suspicious nipple discharge, infections and inflammation of the breast have been provided. For early breast cancers routine use of investigations to detect occult distant metastasis is not advised. Metastatic work up for advanced breast cancer is required for selection of appropriate treatment options.

Best Practice Guidelines for Breast Imaging, Breast Imaging Society, India: Part—1

Breast imaging is one of the prerequisites for providing high quality breast health care. Choosing the appropriate investigation is central to diagnosing breast disease in women and men who present to health professionals for treatment. Patients with breast disease present to doctors of different subspecialties as well as general practitioners in our country. It is important therefore to provide uniform guidance to doctors in different health care setups of our country, urban and rural, government and private, for breast diseases to be diagnosed and treated optimally. These guidelines framed by the task group set up by the Breast Imaging Society, India have been formulated focusing primarily on the Indian patients and health care infrastructures. These guidelines aim to provide a framework for the referring doctors and practicing radiologists, to enable them to choose the appropriate investigation for patients with breast symptoms and signs. The aim has been to keep this framework simple and practical so that it can guide not only subspecialists in breast care but also help doctors who do not routinely deal with breast diseases, so that breast cancer is not missed. Overall, the aim of this document is to provide a holistic approach to standardize breast care imaging services in India. Part 1 of these guidelines focuses on the best practice principles for mammography, breast ultrasound and breast magnetic resonance imaging. In the absence of a population-based screening program in India, the guidelines to be followed for those women who wish to be screened by mammography have been provided. The key points of these guidelines include the recommendations that mammography is the modality of choice for breast screening and investigation of symptomatic women aged over forty years. Screening is advised annually from the age of forty. Ultrasound is the investigation of choice for pregnant and lactating women and women less than thirty years of age. For women between thirty to thirty-nine years of age, ultrasound can be used initially followed by mammography in presence of clinical or sonographic suspicion of breast cancer. All women diagnosed with breast cancer should have ultrasound and mammography. Breast MRI is useful for assessment of disease extent, problem solving, evaluation of response to neo-adjuvant chemotherapy, identifying occult breast primary and evaluation of augmented breasts.

Cingulum bundle integrity in schizophrenia with auditory verbal hallucinations: A diffusion tensor imaging tractographic study

Background & objectives: Cingulum bundle (CB) is frequently implicated in schizophrenia; however, its role in specific symptoms of schizophrenia such as auditory verbal hallucinations (AVHs) is less explored. Few studies have reported association between reduced integrity of CB and severity of AVH. Using a symptom-based approach, this diffusion tensor imaging (DTI) tractographic study was aimed to assess and compare the integrity of CB in schizophrenia with AVH, schizophrenia without AVH and healthy controls. Methods: A total of 92 right-handed adult individuals (aged 18-50 yr) were recruited across three study groups. Those with Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) diagnosis of schizophrenia with AVH (group I; n=30) were compared to those with DSM-5 schizophrenia without lifetime AVH (group II; n=32) and healthy controls (group III; n=30; screened using Mini International Neuropsychiatric Interview version-7.0.0. and negative family history). Clinical assessments (groups I and II) included scale for assessment of positive symptoms, scale for assessment of negative symptoms, clinical global impression-schizophrenia and psychotic symptom rating scale. All participants underwent DTI, and quantitative tract-based measurements of fractional anisotropy (FA) were obtained for images using DTI studio version-3.0. Results: All groups were comparable for age, gender, education and severity of illness. Group I had significantly lower FA values in the cingulate gyrus (CG) part of the left CB compared to groups II and III. No significant difference was found between groups II and III. Interpretation & conclusions: The findings of this study suggest that the disruption in the left CB appears to be specific for AVH-positive schizophrenia. The finding is, however, preliminary subject to replication in future studies. Further investigations are needed to understand its relevance in the context of AVH-positive schizophrenia.

COMPARATIVE EVALUATION OF MARGINAL SEALING ABILITY OF POSTERIOR PACKABLE COMPOSITE WITH OR WITHOUT LINERS USING DYE PENETRATION METHOD- AN INVITRO STUDY.

Condensable” or “packable” composites (Surefil) were introduced as an alternative to dental amalgam. However, concerns have been raised related to the ability of these stiffer materials to adequately adapt to internal surfaces. To offset this problem, low viscosity fiowable liners walls are recommended under packable composites. This study aimed at evaluating the effect of SDR and Ketac N100 liners on marginal sealing ability of High Density Surefil posterior packable composite. Methodology: Sixty permanent extracted molars were mounted in a modelling wax and box only Class II cavities were prepared on the mesial side with gingival seat 1mm above CEJ. Teeth were divided into 3 groups: Group (i) Surefil with SDR; Group (ii) Surefil with Ketac N 100; and Group (iii) Surefil without liner. After restoration, the teeth were immersed in Methylene blue dye, sectioned mesiodistally and then evaluated for leakage under Stereomicroscope. Results: None of the groups were free of microleakage. Surefil without liner (1.2±0.696) exhibited maximum microleakage followed by Ketac N100 group (0.9±0.718) and SDR group (0.8±0.523) showed least microleakage. Conclusion: Posterior packable composites should be lined by a resin based liner at the gingival margin to allow better seal

Exploring the Association of Fibrinogen and CRP with the Clinical Spectrum of CAD and Periprocedural Outcomes in Patients Undergoing Percutaneous Coronary Interventions

Background:The pathophysiology of an atherosclerotic plaque is mediated by the mechanisms involving thrombus formation and systemic inflammation. While C-reactive protein (CRP) levels are useful in predicting a cardiovascular event in intermediate risk population, the usefulness of routinely measuring fibrinogen in patients with acute coronary syndrome (ACS) is debatable. Also, data on the association of these markers with periprocedural outcomes in patients undergoing percutaneous coronary interventions (PCI) is scarce. Aims: The study aimed to determine whether the levels of fibrinogen and CRP vary across the different spectra of CAD and whether they have any correlation with cardiac Troponin I levels. Materials and Methods: A total of 284 patients with coronary artery disease undergoing percutaneous coronary intervention were included in the study. Complete blood count, serum lipid profile, serum CRP, fibrinogen, and troponin I were measured for all patients. Results: Patients with STEMI had significantly higher levels of CRP as compared to those with unstable angina (USA) and chronic stable angina (CSA). Patients presenting with ACS had significantly higher baseline fibrinogen as compared to those with CSA. A significant positive correlation between CRP and admission Troponin I (r = 0.50; P < 0.05) as well as fibrinogen and admission troponin I (r = 0.30; P < 0.05) was observed. The CRP levels were significantly higher in 15 patients with periprocedural MI as compared to those who did not develop periprocedural MI. Conclusions: The levels of the markers of inflammation and atherothrombosis vary with presentation across varied spectra of CAD with generally higher levels in acute presentation and in those who develop periprocedural MI.

Body temperature in assessment of 7th day outcome in acute stroke patients – A hospital-based study

Background: Worldwide stroke is accounted as the second leading cause of death and third cause of disability. Changes in physiological variables such as temperature, blood pressure, blood glucose levels, and their deleterious effect in terms of mortality and morbidity are of major concerns for the treating physicians. Aim and Objectives: The aim of the study was to study changes in temperature and its relation to 7th day outcome in acute stroke patient. Materials and Methods: A prospective hospital-based study was conducted, after approval of Institutional Ethical committee, recruiting 150 acute stroke patients presenting within 6 h of developing symptoms. Temperature was recorded every 8 h for 48 h and stroke severity was assessed using modified Rankin scale on admission and on the 7th day after admission. Results: Categorical variables were analyzed using Chi-square analysis and means of continuous variables were compared using analysis of variance. For any significant difference in mean temperature at two consecutive readings, paired sample t-test was used. Multinomial logistic regression analysis was done to predict outcome in acute stroke patients. The difference in the mean temperature at 8 h, 16 h and 40 h after admission was significant between male and female patients. Temperature at 16th h of admission was found to be significant for improved, status quo, and worsened comparison. Temperature at 24th h of admission was also found to have significant value but only for status quo and worsened outcome. Conclusion: The authors conclude that the mean temperature of the patients remained within the normal range in the first 48 h. The temperature at various intervals may not consistently predict the 7th day outcome in acute stroke patients.

Comparison of Propofol and Ketofol on Transcranial Motor Evoked Potentials in Patients Undergoing Thoracolumbar Spine Surgery

Methods@#Amplitude and latency of TcMEPs were recorded bilaterally from the abductor pollicis brevis (APB) and abductor hallucis (AH) muscles in 38 adult American Society of Anesthesiologists I and II patients undergoing thoracolumbar spine surgery. Baseline recordings of TcMEPs in both groups were recorded under propofol infusion. Group X patients then received propofol and fentanyl (1 mcg/kg/hr), and group Y patients received ketofol and fentanyl (1 mcg/kg/hr). Bispectral index was maintained at 40–60 in both groups. Amplitude and latency were recorded at 30 minutes intervals for 2 hours. @*Results@#Propofol caused no significant changes in amplitude and latency in any muscle. In contrast, amplitude increased significantly at all time points in the bilateral APB muscles and 60, 90, and 120 minutes in the left AH muscle without changes in latency in response to ketofol. When the two groups were compared, ketofol induced significantly higher amplitudes at 60, 90, and 120 minutes in the (left) APB, at all time points in the (right) APB, and at 120 minutes in both AH muscles, compared with propofol. Blood pressures were lower and fluid and vasopressor requirements were higher in group X. Muscle power was similar between the two groups. @*Conclusions@#Ketofol facilitates TcMEP amplitudes without affecting latency. Use of ketofol resulted in a better and more stable hemodynamic profile than did use of propofol.

Comparison Of In-Hospital Mortality Of COVID-19 Patients Between Those Who Were Vaccinated And Who Were Not

Background:We compared the mortality rate of patients with moderate to severe COVID-19 who were vaccinated and who were not. Material And Methods:In this retrospective observational study, we collected data of patients who were admitted with moderate to severe COVID-19.The vaccination status and co morbidities of the patients were documented. The incidence and in-hospital mortality of COVID-19 patients was assessed.Univariate analysis was performed to determine the risk factors of in-hospital mortality.Result:Of 294 patients, 5.1% (n=15) received Covaxin™and 26.5% (n=78) received Covishield™;68.4%(n=201) patientswere unvaccinated.Of patientswho were vaccinated and contracted COVID-19, 24.8%(n=73) had taken the first dose and 6.8%(n=20) had taken the second dose of either vaccine.The in-hospital mortality rate was 13.6% (n=40). No significant association was found with the type of vaccine and the in-hospital mortality (p=0.23). Significant associations with in-hospital mortality were found with the interval before COVID-19 disease andvaccination (OR, 3.02; p=0.01); and the presence ofdiabetes mellitus (OR, 2.13; p=0.02), cardiovascular diseases (OR, 2.11; p<0.001), and malignancy (OR: 2.33; p=0.0325).Conclusion:The mortality rate of unvaccinated patients with moderate to severe COVID-19 was high. There was no significant difference in the effectiveness of Covaxin™ and Covishield™ in terms of the incidence of COVID-19 and in-hospital mortality. Diabetes mellitus, cardiovascular diseases, and malignancies had a significant association with in-hospital mortality in patients with moderate to severe COVID-19.

Comparative evaluation of effect of two relaxation breathing exercises on anxiety during buccal infiltration anesthesia in children aged 6-12 years A randomized clinical study

Background: Dental procedures, especially local anesthetic administration, are a source of great anxiety to children. Diaphragmatic breathing is defined as an efficient integrative body–mind training for dealing with stress and psychosomatic conditions. Pinwheel exercise is also a highly effective technique of “play therapy.” Aim: This study aimed to compare dental anxiety using pinwheel breathing exercise and diaphragmatic breathing exercise during buccal infiltration anesthesia. Methodology: Sixty children in the age group of 6–12 years with Frankel's behavior rating score of 3 who required buccal infiltration local anesthesia were selected. Subjects were divided randomly into two groups, i.e., Group A: children who performed pinwheel breathing exercise and Group B: children who performed diaphragmatic breathing exercise. The level of anxiety of the patients was recorded using an animated emoji scale. The data were analyzed using IBM SPSS version 20 software with paired t-test and Chi-square test. Results: There was a significant reduction in dental anxiety score from score 1 (before the anesthetic procedure) to score 2 (after the anesthetic procedure) in both the groups. On intergroup analysis, children who performed pinwheel breathing exercise (Group A) showed higher values than children who performed deep breathing exercise without pinwheel (Group B) with a t value of 1.42 but was not statistically significant with a P value of 0.161. Conclusion: Pinwheel breathing exercise as well as diaphragmatic breathing exercise proved to be significantly effective in reducing dental anxiety during local anesthesia.

Diagnostic and therapeutic endonasal rhinologic procedures generating aerosol during COVID-19 pandemic: a systematized review / Procedimentos endonasais de rinologia diagnósticos e terapêuticos geradores de aerossóis durante a pandemia de Covid-19: uma revisão sistematizada,

Abstract Introduction Most rhinologic procedures, particularly endoscopic sinonasal procedures, are liable to produce aerosols. The severe acute respiratory syndrome coronavirus 2 (SARS-Co V-2) transmits via respiratory droplets, but the degree of its spread through airborne routes by aerosol is unclear. Objective The aim of this article is to counsel rhinologists on how to modify their conventional practice during the COVID-19 pandemic by prioritising the need of procedures, identifying aerosol- generating procedures and using precise personal protection equipment for various endonasal procedures. Methods We did a review of articles indexed for MEDLINE on PubMed, ENT Cochrane, DOAJ and Web of Science databases using the keywords nasal endoscopy, SARS-CoV-2, COVID-19, aerosol generating medical procedures and rhinology to formulate guidelines for the safety of healthcare workers. Results The review included evidence from 28 articles from the otorhinolaryngology, surgery, infectious disease, head and neck surgery and cancer biology literature. We have provided recommendations and relevant information for rhinologists during the COVID-19 pandemic, based on the available studies and data, to warrant high-quality patient care and requisite levels of infection prevention during rhinology procedures. Conclusion In rhinology, marked care is advised during nasal packing, electrocauterisation and use of high-speed rotating devices in potentially infected tissue as they are considerable aerosol- producing procedures. The choice of personal protective equipment is based on the risk of exposure and possible modes of aerosol generation.

Resumo Introdução A maioria dos procedimentos rinológicos, principalmente os procedimentos endoscópicos nasossinusais, é suscetível à produção de aerossóis. A síndrome respiratória aguda grave coronavírus-2 (SARS-CoV-2) é transmitida através de gotículas respiratórias, mas o grau de sua disseminação através de aerossóis por via aérea não é claro. Objetivos Orientar os rinologistas sobre como modificar sua prática convencional durante a pandemia de Covid-19, priorizar a necessidade de procedimentos, identificar procedimentos geradores de aerossol e usar equipamento de proteção individual de precisão para vários procedimentos endonasais. Método Fizemos uma revisão de artigos indexados na Medline por meio das bases de dados PubMed, ENT Cochrane, DOAJ e Web of Science, com as palavras-chave nasal endoscopy, SARS-CoV-2, Covid-19, aerosol-generating medical procedures e rhinology para formular diretrizes para a segurança dos profissionais de saúde. Resultados A revisão incluiu evidências de 28 artigos de otorrinolaringologia, cirurgia, doenças infecciosas, cirurgia de cabeça e pescoço e biologia do câncer. Fornecemos recomendações e informações relevantes para rinologistas durante a pandemia de Covid-19, com base nos estudos e dados disponíveis, para garantir atendimento de alta qualidade ao paciente e níveis necessários de prevenção da infecção durante procedimentos de rinologia. Conclusões Em rinologia, recomenda-se cuidado acentuado durante o tamponamento nasal, eletrocauterização e uso de dispositivos rotativos de alta velocidade em tecidos potencialmente infectados, pois esses procedimentos são consideráveis produtores de aerossóis. A escolha do equipamento de proteção individual é baseada no risco de exposição e nos possíveis modos de geração de aerossol.

Efficacy and Safety of the Novel Dipeptidyl Peptidase-4 Inhibitor Gemigliptin in the Management of Type 2 Diabetes: A Meta-Analysis

Background@#No meta-analysis has holistically analysed and summarised the efficacy and safety of gemigliptin in type 2 diabetes. The meta-analysis addresses this knowledge gap. @*Methods@#Electronic databases were searched for randomised controlled trials (RCTs) involving diabetes patients receiving gemigliptin in the intervention arm and placebo/active comparator in the control arm. The primary outcome was change in haemoglobin A1c (HbA1c). The secondary outcomes were alterations in glucose, glycaemic targets, lipids, insulin resistance, and adverse events. @*Results@#Data from 10 RCTs involving 1,792 patients were analysed. Four had an active control group (ACG), with metformin/dapagliflozin/sitagliptin/glimepiride as the active comparator; six had a passive control group (PCG), with placebo/rosuvastatin as controls. HbA1c reduction by gemigliptin at 24 weeks was comparable to ACG (mean difference [MD], 0.09%; 95% confidence interval [CI], –0.06 to 0.23; P=0.24; I2=0%; moderate certainty of evidence [MCE]), but superior to PCG (MD, –0.91%; 95% CI, –1.18 to –0.63); P<0.01; I2=89%; high certainty of evidence [HCE]). Gemigliptin was superior to PCG regarding achieving HbA1c <7% (12 weeks: odds ratio [OR], 5.91; 95% CI, 1.34 to 26.08; P=0.02; I2=74%; 24 weeks: OR, 4.48; 95% CI, 2.09 to 9.60; P<0.01; I2=69%; HCE). Gemigliptin was comparable to ACG regarding achieving HbA1c <7% after 24 weeks (OR, 0.92; 95% CI, 0.52 to 1.63; P=0.77; I2=66%; MCE). Adverse events were similar between the gemigliptin and control groups (risk ratio [RR], 1.06; 95% CI, 0.82 to 1.36; P=0.66; I2=35%; HCE). The gemigliptin group did not have increased hypoglycaemia (RR, 1.19; 95% CI, 0.62 to 2.28; P=0.61; I2=19%; HCE). @*Conclusion@#Gemigliptin has good glycaemic efficacy and is well-tolerated over 6 months of use.

Efficacy and Safety of the Novel Dipeptidyl Peptidase-4 Inhibitor Gemigliptin in the Management of Type 2 Diabetes: A Meta-Analysis

Background@#No meta-analysis has holistically analysed and summarised the efficacy and safety of gemigliptin in type 2 diabetes. The meta-analysis addresses this knowledge gap. @*Methods@#Electronic databases were searched for randomised controlled trials (RCTs) involving diabetes patients receiving gemigliptin in the intervention arm and placebo/active comparator in the control arm. The primary outcome was change in haemoglobin A1c (HbA1c). The secondary outcomes were alterations in glucose, glycaemic targets, lipids, insulin resistance, and adverse events. @*Results@#Data from 10 RCTs involving 1,792 patients were analysed. Four had an active control group (ACG), with metformin/dapagliflozin/sitagliptin/glimepiride as the active comparator; six had a passive control group (PCG), with placebo/rosuvastatin as controls. HbA1c reduction by gemigliptin at 24 weeks was comparable to ACG (mean difference [MD], 0.09%; 95% confidence interval [CI], –0.06 to 0.23; P=0.24; I2=0%; moderate certainty of evidence [MCE]), but superior to PCG (MD, –0.91%; 95% CI, –1.18 to –0.63); P<0.01; I2=89%; high certainty of evidence [HCE]). Gemigliptin was superior to PCG regarding achieving HbA1c <7% (12 weeks: odds ratio [OR], 5.91; 95% CI, 1.34 to 26.08; P=0.02; I2=74%; 24 weeks: OR, 4.48; 95% CI, 2.09 to 9.60; P<0.01; I2=69%; HCE). Gemigliptin was comparable to ACG regarding achieving HbA1c <7% after 24 weeks (OR, 0.92; 95% CI, 0.52 to 1.63; P=0.77; I2=66%; MCE). Adverse events were similar between the gemigliptin and control groups (risk ratio [RR], 1.06; 95% CI, 0.82 to 1.36; P=0.66; I2=35%; HCE). The gemigliptin group did not have increased hypoglycaemia (RR, 1.19; 95% CI, 0.62 to 2.28; P=0.61; I2=19%; HCE). @*Conclusion@#Gemigliptin has good glycaemic efficacy and is well-tolerated over 6 months of use.

A Comparative Evaluation of Antimicrobial Activity of Septilin, Calcium Hydroxide and 2 % Chlorhexidine as an Intracanal Medicament - An In Vitro Study

One of the most important objectives of root canal treatment is elimination of microorganisms in the root canals. The use of intra-canal medicament may be helpful in eliminating remaining bacteria that survived inside the root canals after complete chemo-mechanical preparation. This study aims to evaluate and compare the antimicrobial activity of Septilin, chlorhexidine and calcium hydroxide against Enterococcus faecalis and Streptococcus mutans. Intra-canal medicament helps in eliminating remaining bacteria that survived inside root canals after complete chemo-mechanical preparation. MethodsThe well variant of agar diffusion test using brain heart infusion agar was used for evaluating the antimicrobial activity of the intra-canal medicaments. McFarland 0.5 turbidity standard was taken as reference to adjust the turbidity of bacterial suspensions. The wells were prepared and filled with of Septilin, chlorhexidine and calcium hydroxide. This was done for both the test organisms and plates were incubated in an incubator for 24 hrs. at 37 °C. After incubation, antimicrobial effectiveness was determined using digital caliper (mm) by measuring zone of inhibition. ResultsThe mean zone of inhibition for chlorhexidine, calcium hydroxide, and Septilin were 29.50 ± 0.58, 25.00 ± 0.00, 20.00 ± 0.82 for E. faecalis and 28.50 ± 1.00, 24.25 ± 0.96, 19.50 ± 1.29 for S. mutans respectively. ConclusionsSeptilin showed significant inhibition against E. faecalis and S. mutans but its antibacterial activity is less compared to that of calcium hydroxide and chlorhexidine. Moreover, the dark colour of the material might cause tooth discoloration.

Silent Thecoma of Ovary - A Rare Case.

Theca cell tumours are benign ovarian tumours. These tumours are of stromal origin. Most commonly they are seen in premenopausal and postmenopausal women. Usually they are asymptomatic and are found incidentally. Ovarian cancers can be of benign and malignant type. According to WHO classification, they are classified as epithelial, germ cell, sex cord stromal tumours and others.1 Among them epithelial ovarian cancer are most common, and the least common variety is of sex cord stromal tumours. About 1% of ovarian cancers are thecoma.2 These tumours are most commonly found in postmenopausal women however about 2% of stromal tumours occur in young girls.3 Theca cell tumours are also known as hormone producing tumours as they produce oestrogen hormone. Usually the patient presents with complaint of post-menopausal bleeding because of the oestrogen which is secreted by theca cell tumours. Imaging modalities (ultrasonography and CT scan) are of little help in differentiating thecoma from other types of ovarian tumours, because of radiological close resemblance to other tumours.4 Here we enlightened the symptomless presentation of such a huge thecoma which was diagnosed incidentally.

Vesicouterine fistula: a case report

Vesicouterine fistula represents a rare urogenital fistula, accounting for approximately 1-4% of genitourinary fistulas. Iatrogenic reasons have been shown to be most common cause. Surgical excision is the mainstay of treatment. Less than 5% patients respond to conservative management. Authors report a case of successful conservative management of vesicouterine fistula.

Combating the Hypersensitive Gag Reflex in Patients Undergoing Dental Treatment – A Review

Gag reflex is a complex physiologic reflex which can leadto a compromised dental treatment and can prove a barrierfor optimal patient care and management. This gag reflexis protective in nature, but can present a bewildering,annoying and frustrating problem during various dentalprocedures. The aim of this article is to review normal gagreflex, neurophysiology of gag reflex, factors associated withetiology of gagging and role of different methods to managegagging during routine dental procedures.