Thiazolidinediones--the new insulin enhancers.

Insulin resistance, characterized by reduced responsiveness to normal circulating levels of insulin, leads to hyperglycemia and hyperinsulinemia resulting in a deadly quartet of non-insulin dependent diabetes mellitus, obesity, hypertension and dyslipidemia These complications, also referred to as 'Syndrome X' have been associated with an increased risk of coronary heart disease. A number of non-pharmacological and pharmacological interventions are available for prevention and treatment of insulin resistance. However, introduction of thiazolidinediones, the new orally active class of drug, has proved to be a major breakthrough in this field. These agents have been shown to reduce insulin resistance by a novel mechanism of action. By interacting with a family of nuclear receptors known as peroxisome proliferator activated receptors thiazolidinediones are thought to enhance the actions of insulin, thereby increasing insulin dependent glucose disposal and reducing hepatic glucose output. A series of animal and clinical studies in patients with impaired Glucose Tolerance and NIDDM have demonstrated the safety and effect of various thiazolidinediones including ciglitazone, pioglitazone and troglitazone. Thus, thiazolidinediones by unlocking insulin resistance act as a key to glycemic control and hence are likely to prove a useful and rational therapy in NIDDM and possibly other disorders resulting from insulin resistance.

Attrition of the Zeigarnik effect: role of subjects' expectancy aroused by placebos.

The present paper describes the effect for 45 medical students and interns of "placebo" treatment on the Zeigarnik effect. Attrition of the Zeigarnik effect caused by placebo was resistant to caffeine and diazepam (ns = 58 and 28).

Double-blind comparison of the safety and efficacy of famotidine with ranitidine in patients with endoscopically diagnosed peptic ulcer.

In a double-blind randomised trial, 40 patients with active gastric or duodenal ulcer were treated with a single nocturnal dose of famotidine 40 mg or ranitidine 300 mg for 4 to 8 weeks. Antacid tablets were allowed as additional treatment, only if needed, for pain relief. Endoscopy was repeated after 4 weeks, and if the ulcer had not healed at 6 and/or 8 weeks. Relief of upper gastro intestinal symptoms with which the patient presented and the number of antacid tablets consumed, if any, were recorded on weekly basis. Two patients in famotidine group and 5 patients in ranitidine group did not complete the therapy and were considered dropouts. At the end of therapy, ulcers in 100% of the patients receiving famotidine & 93% of patients receiving ranitidine were healed. This difference was not statistically significant. Relief from ulcer related symptoms was rapid in both the groups. None of the patients in either group reported side effects. Overall opinion of investigator was comparable for both the treatments; however, significantly (P = 0.0334) larger proportion (100%) of patients from famotidine group rated it as an excellent therapy compared to only 73% from ranitidine group. Famotidine provides excellent healing of ulcers and early relief of upper gastrointestinal symptoms in Indian patients with peptic ulcer.

Double-blind clinical trial of nefopam in comparison with pentazocine in surgical patients.

A double-blind clinical study comparing a new non-narcotic analgesic, nefopam, with pentazocine was carried out on 50 Indian patients. Forty patients had undergone surgical procedures, and the remaining 10 had musculoskeletal or traumatic disorders. There were 25 patients in each group. It was observed that both drugs were capable of relieving post-surgical pain which was either very severe (score 4) or severe (score 3). Their efficacy was comparable. In patients who had an initial pain score of 4, a significant (p less than 0.05) fall in the sum of pain intensity scores (SPIS) occurred in two days. For an initial pain score of 3, a correspondingly significant fall in SPIS took three days. These results were statistically significant (p less than 0.01). Nefopam had a significantly better side effect profile than pentazocine. In the nefopam group, 4/25 patients had side effects, as opposed to 10/25 in the pentazocine group (p less than 0.05, Fisher's exact probability test). It was also noted that the incidence of side effects was greater in the pentazocine group (61) than the nefopam group (22), the difference being statistically highly significant (p less than 0.001, chi 2-test). A few patients (score 4) in both groups required additional morphine as relief analgesic on the first day of therapy. Thus the non-narcotic nefopam is equally effective as the narcotic pentazocine and has less side effects.

Phase IV evaluation of piroxicam in acute and chronic painful inflammatory disorders: an Indian study.

We report the first phase-IV computerized study on Piroxicam in Indian patients. Comprehensive subject record sheets were distributed to 1,000 doctors. Piroxicam at 20 mg/day was given to patients categorized as suffering from rheumatoid arthritis (RA), osteoarthritis (OA), cervical spondylitis (CS), ankylosing spondylosis (AS), soft-tissue & other pains (ST) for up to 12 weeks. Assessments of pain, tenderness, swelling, range of movements, morning stiffness as well as the grip test and walking test, were made at 24 and 72 h, and 1, 4 and 8 weeks after therapy. All side-effects were noted. Data entry and statistical analysis (95% confidence interval) for proportions expressed as percentages) were handled by computer. A total of 174 doctors (17.4%) co-operated by giving data for 844 patients, consisting of the following cases: RA (306), OA (253), AS (52), CS (113) and ST (120). Piroxicam was found to be uniformly effective in the above disorders, a favourable response to the treatment being obtained in 82%-96% of the patients. The overall response rates (with 95% confidence interval in brackets) were 93% (91-95%) in pain, 93% (91-95%) in tenderness, 90% (80-93%) in swelling, 90% (87-92%) in range of movements and 86% (83-89%) in morning stiffness. The average duration of therapy ranged from 22 to 42 days. A total of 88 (10.4%) patients reported 224 incidences of side-effects, 91% of them being gastrointestinal, but no patient had ulcer or GI bleeding. In 1.9% of the patients, therapy was stopped due to an adverse reaction.(ABSTRACT TRUNCATED AT 250 WORDS)