Cardioprotective role of insulin: Advantage analogues.

AIM: Type II diabetes mellitus (DM) increases the risk of cardiovascular disease. Treatment with insulin substantially reduces C - reactive protein (CRP) because of its anti-atherosclerotic action. This study was designed to explore and compare the cardio protective role of regular human insulin (RHI), aspart and lispro insulin in type II DM. MATERIALS AND METHODS: A randomized, open, parallel group, comparative clinical study was conducted on 90 patients of type II DM. After baseline clinical assessment and investigations, RHI was prescribed to 30 patients, aspart insulin to 30 patients and lispro insulin to another 30 patients for 12 weeks. The efficacy variables were change in blood pressure, glycemic control, lipid profile, serum potassium, high-sensitivity CRP (hsCRP) and UKPDS 10-year CHD risk scoring over 12 weeks. At the end of the study, the patients were followed up and changes in variables from baseline were analyzed by statistical tools. RESULTS: Systolic blood pressure decreased significantly in aspart group (P = 0.008) whereas diastolic blood pressure was decreased significantly both in aspart (P < 0.001) and lispro group (P = 0.01). Fasting, postprandial blood glucose and HbA1c were decreased in all three groups significantly but change in aspart group was superior (P = 0.01). Triglyceride was significantly better controlled by lispro (P < 0.01) whereas aspart insulin was superior to decrease total cholesterol and LDL (P < 0.05). The extent of potassium loss was significantly more with RHI (P = 0.004) than others. CRP-lowering effect (P = 0.017) and decrease in UKPDS risk scoring (P = 0.019) in aspart and lispro group was superior to RHI group. CONCLUSION: Short acting insulin analogues, especially aspart insulin have been found to have a better cardio protective role than RHI in type II DM.

Rupatadine and levocetirizine in chronic idiopathic urticaria: a comparative study of efficacy and safety.

BACKGROUND: Chronic Idiopathic Urticaria is difficult to treat due to its persistent debilitating symptoms. New generation anti-histaminics are first line treatment for this condition. The aim of this study is to compare efficacy and safety of rupatadine and levocetirizine in chronic idiopathic urticaria. METHODS: A randomized, single blinded, single-centred, parallel group outdoor based clinical study was conducted in 70 patients of CIU to compare the two drugs. After initial clinical assessment and baseline investigations, rupatadine was prescribed to 35 patients and levocetirizine to another 35 patients for 4 weeks. At follow-up, the patients were re-evaluated and then compared using different statistical tools. Main outcome measures were DC eosinophil, Absolute Eosinophil Count (AEC), serum IgE, Total Symptom Score, Aerius Quality of Life Questionnaire score, and Global efficacy score. RESULTS: Rupatadine significantly improved patients' clinical condition including symptom score from baseline to day 28. In rupatadine group, there was 27.9 percent decrease (P=0.027) in DC eosinophil, 35.6 percent decrease (P=0.036) in AEC, 15.3 percent decrease (P=0.024) in serum IgE, 28.2 percent decrease (P=0.02) in Total Symptom Scoring, and 27.3 percent decrease (P=0.006) in Aerius Quality of Life Questionnaire score. Global efficacy score of rupatadine was found to be significantly greater (P=0.009) than levocetirizine. The overall incidence of adverse drug reactions was also found to be less in rupatadine group. CONCLUSION: Rupatadine is a better choice in CIU in comparison to levocetirizine due to better efficacy and safety profile.

Racemic salbutamol and levosalbutamol in mild persistent asthma: A comparative study of efficacy and safety.

AIM: The effect of monotherapy with racemic salbutamol and levosalbutamol on symptoms, quality of life, and pulmonary function has been assessed and compared in mild persistent asthma. MATERIALS AND METHODS: A randomized, open, parallel clinical study was conducted on 60 patients of mild persistent asthma. After baseline assessments, salbutamol was prescribed to 30 patients and levosalbutamol to another 30 for 4 weeks. The efficacy variables were change in asthma symptom scoring, pulmonary function test, and Mini Asthma Quality of Life Questionnaire (MiniAQLQ) scoring. At follow-up, the patients were re-evaluated and analyzed by statistical tools. RESULTS: Shortness of breath (P<0.001), chest tightness (P=0.033), wheeze (P=0.01), cough (P=0.024), and overall asthma symptom score (P<0.001) were significantly decreased in the levosalbutamol group in comparison to the salbutamol group. Results of MiniAQLQ revealed that improvement in symptoms (P=0.018), activity limitations (P=0.03), environmental stimuli (P=0.013)-related scoring and overall MiniAQLQ scoring (P<0.001) was statistically significant in the levosalbutamol group. Percentage reversibility of forced expiratory volume at one second (P=0.034), forced vital capacity (P=0.029), peak expiratory flow rate (P=0.0003) was found to be superior in the levosalbutamol group. CONCLUSION: Levosalbutamol was found to be superior compared to recemic salbutamol in mild persistent asthma.

Olopatadine hydrochloride and rupatadine fumarate in seasonal allergic rhinitis: A comparative study of efficacy and safety.

OBJECTIVE: To compare the efficacy and safety of olopatadine and rupatadine in seasonal allergic rhinitis (SAR). MATERIALS AND METHODS: A 2-week, single-centered, randomized, open, parallel group comparative clinical study was conducted on patients with SAR. Following inclusion and exclusion criteria, 70 patients were recruited and were randomized to two treatment groups and received the respective drugs for 2 weeks. At follow-up, clinical improvement was assessed in terms of change in total and differential count of leucocytes, serum Immunoglobulin E (IgE) level, Total Nasal Symptom Score (TNSS) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scoring. RESULTS: Both the drugs significantly reduced the differential count (P<0.001) and absolute eosinophil count (P<0.001), but olopatadine was found to be superior. In olopatadine group, there was significantly higher reduction in serum IgE (P=0.01), TNSS (P<0.001) and RQLQ score (P=0.015) than that of rupatadine. Incidence of adverse effects was found to be less in olopatadine group when compared with rupatadine group. CONCLUSIONS: Olopatadine is a better choice in SAR in comparison to rupatadine due to its better efficacy and safety profile.

Rabeprazole and esomeprazole in mild-to-moderate erosive gastroesophageal reflux disease: A comparative study of efficacy and safety.

OBJECTIVE: To compare the efficacy and safety of rabeprazole and esomeprazole in mild-to-moderate erosive gastroesophageal reflux disease (GERD). MATERIALS AND METHODS: A randomized, single-blinded, outdoor-based clinical study was conducted on 60 patients of mild-to-moderate erosive GERD. After baseline clinical assessment and investigations, rabeprazole (40 mg) was prescribed to 30 patients and esomeprazole (40 mg) to another 30 patients for 4 weeks. The efficacy variables were change in GERD symptom scoring, endoscopic findings, and Quality of Life in Reflux and Dyspepsia (QOLRAD) scoring over 4 weeks. RESULT: Heartburn, acid regurgitation, and overall GERD symptom scoring (P = 0.01) were significantly decreased with rabeprazole in comparison to esomeprazole. The comparative study of all five domains of the QOLARD questionnaire including overall scoring revealed a statistically significant improvement in the rabeprazole group. Endoscopic findings in the rabeprazole group showed an absolute improvement of 30% and relative improvement of 55% over esomeprazole. Both the drugs were well tolerated having no significant difference in the incidence of adverse effects. CONCLUSION: Rabeprazole (40 mg) is a better choice for mild-to-moderate GERD compared with esomeprazole (40 mg) because of its better efficacy and safety profile.

Rupatadine and levocetirizine for seasonal allergic rhinitis: a comparative study of efficacy and safety.

OBJECTIVE: To determine the better agent among rupatadine fumarate and levocetirizine dihydrochloride for seasonal allergic rhinitis. Although treating and ensuring a decent quality of life to patients is challenging, an increasing understanding of pathomechanisms has revealed the potentiality of new-generation antihistamines in the treatment of seasonal allergic rhinitis. DESIGN: A 2-week, single-center, randomized, open, parallel group comparative clinical study between rupatadine and levocetirizine in patients with seasonal allergic rhinitis. SETTING: A tertiary care center. PATIENTS: Following inclusion and exclusion criteria, 60 patients were assigned to either the rupatadine or levocetirizine group. INTERVENTIONS: Two-week treatment with rupatadine or levocetirizine. MAIN OUTCOME MEASURES: After 2 weeks, all postdrug symptoms were listed, baseline laboratory investigations (total and differential leukocyte count and IgE level) were repeated, and clinical improvement was assessed in terms of change in Total Nasal Symptom Score, Rhinoconjunctivitis Quality of Life Questionnaire score, and laboratory parameters. RESULTS: Differential count (P = .01) and absolute eosinophil count (P = .009) was significantly lowered by both drugs, but rupatadine was found to be superior. In the rupatadine group there was a significantly higher reduction (P = .004) in IgE level and Total Nasal Symptom Score (P < .001) compared with the levocetirizine group. There was a decrease of 18.08% (P = .02) in Rhinoconjunctivitis Quality of Life Questionnaire score in the rupatadine group, which was significantly greater compared with the levocetirizine group. Incidence of adverse effects was less in the rupatadine group compared with the levocetirizine group. CONCLUSION: Rupatadine is a better choice for seasonal allergic rhinitis compared with levocetirizine because of its better efficacy and safety profile.