Place of sulfonylureas in the management of type 2 diabetes mellitus in South Asia: A consensus statement.

Since their introduction in clinical practice in the 1950's, Sulfonylureas (SUs) have remained the main-stay of pharmacotherapy in the management of type 2 diabetes. Despite their well-established benefits, their place in therapy is inappropriately being overshadowed by newer therapies. Many of the clinical issues associated with the use of SUs are agent-specific, and do not pertain to the class as such. Modern SUs (glimepiride, gliclazide MR) are backed by a large body of evidence, experience, and most importantly, outcome data, which supports their role in managing patients with diabetes. Person-centred care, i.e., careful choice of SU, appropriate dosage, timing of administration, and adequate patient counseling, will ensure that deserving patients are not deprived of the advantages of this well-established class of anti-diabetic agents. Considering their efficacy, safety, pleiotropic benefits, and low cost of therapy, SUs should be considered as recommended therapy for the treatment of diabetes in South Asia. This initiative by SAFES aims to encourage rational, safe and smart prescription of SUs, and includes appropriate medication counseling.

High blood glucose level and increased risk of mortality in critically ill patients.

102 patients, 38 from ICU and 64 from postoperative ward were evaluated. Out of these, 49 of the patients had random blood glucose level < 100 mg/dl, 46 had in the range 100 to 140 mg/dl and 7 had > 140 mg/dl. The mean random blood glucose level in medical patients was 146 mg/dl with a standard deviation of 20 and that in the post operative patients was 94.3 mg/dl with a standard deviation of 10. There was an overall mortality of 13.7% (14 patients), of which medical patients were 78.6% (11 patients) and surgical patients were 21.4% (3 patients). Amongst the dead, 81.8% had random blood glucose level > 110 mg/dl and all were medical patients. However all 3 deaths (18.2%) in surgical patients had their random blood glucose level < 110 mg/dl. Higher blood glucose level was observed in critically ill medical patients and mortality was higher among patients with random blood glucose level > 110 mg/dl.

Dysphagia as a presenting symptom in a case of dermatomyositis and occult gastric malignancy.

A case of dermatomyositis in a 64 yrs old male with occult gastric malignancy is presented along with a brief review of literature.

Study of prevalence of hypertension in Chronic Obstructive Pulmonary Disease patients admitted at Nepal Medical College and Teaching Hospital.

A retrospective study of 237 cases of Chronic Obstructive Pulmonary Disease (COPD) patients admitted in medical ward of Nepal Medical College Teaching Hospital (NMCTH) was performed to find out the prevalence of hypertension in such COPD subjects. The prevalence of COPD amongst the total number of patients admitted at NMCTH medical ward was 17.3%. Prevalence of COPD was more after the onset of middle age, the peak was found to be at the age of 60-69 years. Out of these COPD subjects, 98 patients (37 patients were known case of hypertension) had hypertension. Thus prevalence of hypertension was 41.3% in COPD subjects studied. Prevalence increased with age after the age of 50 years and the highest prevalence was at the age of 60-69 years which directly correlates with the prevalence of COPD. The prevalence of hypertension in COPD patients was significantly higher than the normal population that may reflect COPD itself as a risk factor for developing hypertension. A larger and detailed study is needed to confirm such finding.

Study of cases of hypertension admitted at Nepal Medical College Teaching Hospital.

Hundred cases of hypertension admitted to medical ward at Nepal Medical College and Teaching Hospital were studied and analysed. They constituted 9.4% of the total admitted patients in the medical ward. Association of hypertension with other diseases is highlighted. Thirty two percent of these hypertensives were diabetic and 22.0% of hypertensives also had Chronic obstructive airway disease (COAD). Different types of complications of hypertension seen in the studied subjects are mentioned. Only 19.0% of hypertensives had their blood pressure controlled and the rest were uncontrolled hypertensives.

Study of type 2 diabetes mellitus cases at Nepal Medical College Teaching Hospital.

A total of 110 cases attending diabetic clinic at Nepal Medical College Teaching Hospital were studied. Associated risk factors and co-morbid conditions were analyzed. Among them 63.6% have systolic BP more than 130 mm of Hg and 24.5% have diastolic BP more than 85 mm of Hg reflecting hypertension as most common co-morbid condition. Various complications of diabetes in studied subjects are highlighted. Eighty percent of patients have fasting blood sugar more than 110 mg% and 93.0% have post-prandial blood sugar more than 140 mg% reflecting poor overall glycemic control despite the use of medication.