Treatment outcomes of graded dose of empagliflozin in type-2 diabetes: A real world study.

Background: Costs are important cause of therapeutic noncompliance in type-2 diabetes mellitus (T2DM). Half-tablet empagliflozin (EMPA)-25 mg has lowest monthly cost among all EMPA preparations; data is unavailable on efficacy of half EMPA-25. This study compared real world weight loss and glycaemic outcomes of 10 mg versus 12.5 mg versus 25 mg of EMPA. Methods: Data, retrospectively captured from records of 2 different centresfor patients > 35 years-age having T2DM on EMPA as part of standard pharmacotherapy for T2DM, having > 6 months follow-up data available was analysed. Patients were in 3-groups depending on EMPA dosage: Group 1 on EMPA 10 mg/day (1-tablet EMPA-10), Group-2 on EMPA 12.5 mg/day (half-tablet EMPA-25), and Group 3 on EMPA 25 mg/day (1-tablet EMPA-25). Primary endpoints were glycaemic efficacy and weight-loss. Results: Of 3601 records screened, data from 599 patients (184, 239 and 176 in Group-1, 2 and 3 respectively) was analysed. All 3 groups were comparable with regards to sex, blood pressure, haemoglobin, renal function, medications use. Group-3 were significantly older, had longest diabetes duration, highest HbA1c and lowest body mass index. Glycaemic efficacy was comparable among groups (ΔHbA1c Groups 1-3: -0.9 (-1.9 - 0.0), -1.0 (-1.8 - 0.5) and - 1.0 (-1.5 - 0.22], respectively; P = 0.363). Patients on EMPA 12.5 or 25 mg/d had significantly higher total (-1.4 [-3.0 -0.2] vs. -0.3 [-2.4 - 1.32] kg; P = 0.028) and percent weight-loss (-1.75% [-4.15 - 0.26] vs. -0.44% [-3.11 - 1.39]; P = 0.039), and significantly higherfraction achieving HbA1c < 5.7% (12% vs. 0; P = 0.021), compared to EMPA-10. Conclusion: Half EMPA-25 is the most cost effective way of using EMPA in clinical practice.

Résumé Contexte: Les coûts sont une cause importante de non-conformité thérapeutique dans le diabète sucré de type 2 (DT2). Empagliflozine demi-comprimé (EMPA) -25 mg a le coût mensuel le plus bas parmi toutes les préparations EMPA; les données ne sont pas disponibles sur l'efficacité de la moitié de l'EMPA-25. Cette étude a comparé le monde réel perte de poids et résultats glycémiques de 10 mg contre 12,5 mg contre 25 mg d'EMPA. Méthodes: Données, capturées rétrospectivement à partir d'enregistrements de 2 centres différents pour les patients de plus de 35 ans ayant un DT2 sous AEM dans le cadre de la pharmacothérapie standard pour le DT2, ayant> 6 mois les données de suivi disponibles ont été analysées. Les patients étaient répartis en 3 groupes en fonction de la posologie d'EMPA: Groupe 1 sous EMPA 10 mg / jour (1 comprimé d'EMPA-10), Groupe-2 sur EMPA 12,5 mg / jour (demi-comprimé EMPA-25) et groupe 3 sur EMPA 25 mg / jour (1 comprimé EMPA-25). Les critères d'évaluation principaux étaient glycémiques efficacité et perte de poids. Résultats: sur 3601 enregistrements examinés, les données de 599 patients (184, 239 et 176 dans les groupes 1, 2 et 3 respectivement) étaient analysé. Les 3 groupes étaient comparables en ce qui concerne le sexe, la pression artérielle, l'hémoglobine, la fonction rénale et l'utilisation de médicaments. Groupe-3 étaient significativement plus âgé, avait la plus longue durée de diabète, le plus haut taux d'HbA1c et le plus bas indice de masse corporelle L'efficacité glycémique était comparable entre groupes (ΔHbA1c Groupes 1 à 3: −0,9 (−1,9 - 0,0), −1,0 (−1,8 - 0,5) et - 1,0 (−1,5 - 0,22], respectivement; P = 0,363). Patients sous EMPA 12,5 ou 25 mg / j avaient un total significativement plus élevé (−1,4 [−3,0 ­0,2] contre −0,3 [−2,4 - 1,32] kg; P = 0,028) et un pourcentage de perte de poids (−1,75% [−4,15 - 0,26] contre −0,44% [−3,11 - 1,39]; P = 0,039), et une fraction significativement plus élevée atteignant un taux d'HbA1c <5,7% (12% contre 0; P = 0,021), par rapport à EMPA-10. Conclusion: HalfEMPA-25 est le moyen le plus rentable d'utiliser EMPA dans la pratique clinique. Mots-clés: Diabésité, inversion du diabète, empagliflozine, euglycémie, perte de poids.

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.

The biology of distraction osteogenesis for correction of mandibular and craniomaxillofacial defects: A review.

Limb lengthening by distraction osteogenesis was first described in 1905. The technique did not gain wide acceptance until Gavril Ilizarov identified the physiologic and mechanical factors governing successful regeneration of bone formation. Distraction osteogenesis is a new variation of more traditional orthognathic surgical procedure for the correction of dentofacial deformities. It is most commonly used for the correction of more severe deformities and syndromes of both the maxilla and the mandible and can also be used in children at ages previously untreatable. The basic technique includes surgical fracture of deformed bone, insertion of device, 5-7 days rest, and gradual separation of bony segments by subsequent activation at the rate of 1 mm per day, followed by an 8-12 weeks consolidation phase. This allows surgeons, the lengthening and reshaping of deformed bone. The aim of this paper is to review the principle, technical considerations, applications and limitations of distraction osteogenesis. The application of osteodistraction offers novel solutions for surgical-orthodontic management of developmental anomalies of the craniofacial skeleton as bone may be molded into different shapes along with the soft tissue component gradually thereby resulting in less relapse.

An Immature Type II Dens Invaginatus in a Mandibular Lateral Incisor with Talon's Cusp: A Clinical Dilemma to Confront.

Dens invaginatus (DI) is a malformation of teeth probably resulting from an infolding of the dental papilla during tooth development. DI is classified as type I, II, and III by Oehlers depending on the severity of malformation. The maxillary lateral incisor is the most commonly affected tooth. Structural defects do exist in the depth of the invagination pits, and as a consequence, the early development of caries and the subsequent necrosis of the dental pulp, as well as abscess and cyst formation are clinical implications associated with DI. Occasionally, we can see more than one developmental anomaly occurring in a single tooth. In such cases it becomes important to identify the anomalies and initiate a proper treatment plan for good prognosis. In this paper, an unusual case of DI which clinically presented as a huge talons cusp affecting a mandibular lateral incisor tooth is described. This case report illustrates grinding of the talons cusp followed by nonsurgical endodontic management of dens invaginatus type II with an immature apex and periapical lesions, in which Mineral Trioxide Aggregate (MTA) shows a complete periapical healing with bone formation at the site of the lesions.

Efficacy of aloe vera gel as an adjuvant treatment of oral submucous fibrosis.

OBJECTIVE: Definitive therapy is not defined for the management of oral submucous fibrosis (OSMF). This study evaluated the efficacy of aloe vera gel as an adjuvant treatment of OSMF. STUDY DESIGN: A double-blind, placebo-controlled, parallel-group randomized controlled trial was conducted on 60 subjects with OSMF divided into medicinal treatment (submucosal injection of hyaluronidase and dexamethasone, n = 30) and surgical treatment (n = 30) categories. Each category was randomly divided into groups A (with aloe vera, n = 15 per category) and B (without aloe vera, n = 15 per category). Follow-up assessment for various symptoms was performed, and results were analyzed using paired and unpaired Student t tests. RESULTS: The group receiving aloe vera had a significant improvement in most symptoms of OSMF (P < .01) compared with the non-aloe vera group, in both the medicinal and surgical categories. CONCLUSIONS: Aloe vera gel was effective as an adjuvant in treatment of OSMF.

An epidemiological study on pattern and incidence of mandibular fractures.

Mandible is the second most common facial fracture. There has been a significant increase in the number of cases in recent years with the advent of fast moving automobiles. Mandibular fractures constitute a substantial proportion of maxillofacial trauma cases in Lucknow. This study was undertaken to study mandibular fractures clinicoradiologically with an aim to calculate incidence and study pattern and the commonest site of fractures in population in and around Lucknow. Patient presenting with history of trauma at various centers of maxillofacial surgery in and around Lucknow were included in this study. Detailed case history was recorded followed by thorough clinical examination, and radiological interpretation was done for establishing the diagnosis and the data obtained was analyzed statistically. Out of 66 patients with mandibular fractures, highest percentage was found in 21-30 years of age with male predominance. Road traffic accidents were the most common cause of fracture with parasymphysis being commonest site. Commonest combination was parasymphysis with subcondyle. There was no gender bias in etiology with number of fracture sites. The incidence and causes of mandibular fracture reflect trauma patterns within the community and can provide a guide to the design of programs geared toward prevention and treatment.

A case of unifocal eosinophilic granuloma of the mandible in an adult female: a case report.

Eosinophilic granuloma of bone is a disease with an incidence of one new case per 350,000 to 2 million per year, which is an uncommon disease of maxillofacial region, and presents in more than 90% in children under the age of ten with predominance for males. As a result, eosinophilic granuloma of the jaw is always unconsidered in the differential diagnosis of similar lesions by many clinicians. It is difficult to make a correct diagnosis on it without proof of a pathological diagnosis, which correlates with the diverse clinical and radiographic presentations of eosinophilic granuloma in the jaws. In the present paper we report a rare case of unifocal eosinophilic granuloma of mandible occurring in an adult female.

A huge adenomatoid odontogenic tumor of maxilla.

The adenomatoid odontogenic tumor (AOT) is a benign, nonneoplastic (hamartomatous) lesion with a slow progressing growth. It occurs in both intraosseous and peripheral forms. This paper reports the case of a female aged 16 years who presented with a swelling in anterior maxilla; canine was missing, and a supernumerary tooth was present in the mid line. Radiology revealed a well-defined radiolucent area associated with impacted canine and root resorption of adjacent teeth, which was diagnosed histopathologically as AOT. The patient was treated surgically and later rehabilitated with fixed prosthesis.

The interrelationship of adenomatoid odontogenic tumour and dentigerous cyst: a report of a rare case and review of the literature.

The adenomatoid odontogenic tumor (AOT) is a relatively uncommon lesion which mainly affects females in their second decade of life, exhibiting predilection for the anterior region of the maxilla. The lesion is usually associated with the crown of an enclosed tooth, most commonly the maxillary canine. In this paper we present a case of adenomatoid odontogenic tumor associated with a dentigerous cyst affecting the left maxilla in a 15-year-old female. We also discuss clinical, radiographic, histopathologic, and therapeutic features of the case.