Drug utilization study of anti-diabetic drugs in patients attending medicine outpatient department at a tertiary care hospital in Western Maharashtra

Background: Studies on antidiabetic drug utilization are important for the optimization of drug therapy and rational prescription of drugs. The aim of the present study was to understand the trends in prescription pattern of oral anti-diabetic drugs among type 2 diabetes mellitus (T2DM) patients attending medicine outpatient department of tertiary care hospital of Western Maharashtra. Methods: A prospective observational study was conducted at Medicine OPD of Government Medical College and Hospital, Miraj. All adult patients (≥18 years) diagnosed with T2DM and willing to give informed consent to participate in the study, were enrolled. The study was approved by Institutional Ethics Committee. The data was computed using MS excel and results were expressed as counts and percentages. Results: Out of 72 T2DM patients enrolled, male population (58.33%) had higher prevalence than females (41.67%). Biguanides (63.16%) were the most commonly prescribed class of oral antidiabetic drugs followed by sulfonylureas (35.09%). Metformin (63.16%) was the most commonly prescribed oral antidiabetic drug followed by glimepiride (30.70%). Combination of oral antidiabetic drugs (OADs) were prescribed in 52.78% and 47.22% patients were prescribed single drug. ‘Metformin and glimepiride’ was the most commonly prescribed combination. Conclusions: In a chronic disease like diabetes mellitus, constant follow up for successful management is a must. It also demands active participation by the patients. Continuing education for the clinicians to keep themselves abreast of the latest development will also contribute in the effective management of diabetes mellitus and rational prescription of antidiabetic drugs

The Na/K-ATPase Oxidant Amplification Loop Regulates Aging

As aging involves oxidant injury, we examined the role of the recently described Na/K-ATPase oxidant amplification loop (NKAL). First, C57Bl6 old mice were given a western diet to stimulate oxidant injury or pNaKtide to antagonize the NKAL. The western diet accelerated functional and morphological evidence for aging whereas pNaKtide attenuated these changes. Next, human dermal fibroblasts (HDFs) were exposed to different types of oxidant stress in vitro each of which increased expression of senescence markers, cell-injury, and apoptosis as well as stimulated the NKAL. Further stimulation of the NKAL with ouabain augmented cellular senescence whereas treatment with pNaKtide attenuated it. Although N-Acetyl Cysteine and Vitamin E also ameliorated overall oxidant stress to a similar degree as pNaKtide, the pNaKtide produced protection against senescence that was substantially greater than that seen with either antioxidant. In particular, pNaKtide appeared to specifically ameliorate nuclear oxidant stress to a greater degree. These data demonstrate that the NKAL is intimately involved in the aging process and may serve as a target for anti-aging interventions

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

“MYCO SYNTHESIS OF SILVER NANOPARTICLES USING GLIOCLADIUM ROSEUM (CLONOSTACHYS ROSEA (LINK) SCHROERS, SAMUELS) AND ITS ANTIMICROBIAL EFFICACY AGAINST SELECTED PATHOGENS”

Objective: Antimicrobial efficacy of silver nanoparticles from Gliocladium roseum, culture filtrate (C. F.) and mycelial mat extract (M. E.) against selected pathogens. Methods: Culture filtrate (C. F.) and Mycelial mat extract (M. E.) of Gliocladium roseum were subjected to 10 Mm silver nitrate solution for the synthesis of silver nanoparticles. Formed silver nanoparticles were evaluated via UV-vis spectroscopy and the structural elucidation was done by FT-IR and TEM. Antimicrobial efficacy was tested against bacterial (Salmonella typhi and Klebsiella pneumonia) and fungal (Cladosporium cladosporioides and Alternaria alternata) pathogens. Different nanoparticle concentrations-50, 100, 150 and 200 µl were checked via disc diffusion method. Results: Gliocladium roseum (C. F. and M. E.) on interaction with silver nitrate solution effectively reduced metallic silver exhibiting a colour change from yellow to dark brown within 24 h due to the formation of silver nanoparticles. The UV-vis spectrum of C. F. and M. E. showed maximum absorption peaks at 350-400 nm and 400-450 nm respectively and FT-IR and TEM showed strong N-H bonding and spherical shaped silver nanoparticles with the size of 11-19 nm (C. F.) and 25-38 nm (M. E.). Antimicrobial analysis resulted in efficient inhibitory activity against Salmonella typhi, Klebsiella pneumonia and also showed moderate inhibitory activity against Alternaria alternata and Cladosporium cladopsorioides. Conclusion: The synthesis of silver nanoparticles from fungus Gliocladium roseum is simple, cheap, safe and eco-friendly thus emphasising on large scale scientific application

The clinico pathological features and survival in serous endometrial cancers

Background & Introduction: Serous cancers are a biologically aggressive variety of endometrial cancer (EC) with a high rate of recurrence and mortality among all the subtypes. Herein we describe our experience with serous endometrial cancer. Objective: This study was conducted to identify the clinicopathological characteristics, treatment modalities and survival outcomes in women diagnosed with serous endometrial malignancies. Methods: This was a retrospective descriptive analysis of data on patients diagnosed with serous endometrial tumours between January 2010 to September 2019 in our institute collected from electronic medical records. Descriptive statistics such as proportions, means and standard deviations and Cox regression hazards model on risk factors were performed. Survival was plotted by Kaplan-Meier curves. Results: During the study period, 32 (5.7%) patients out of 564 diagnosed cases of endometrial cancer had serous histology. The mean age at diagnosis was 62.5 years (SD 7.6) while mean BMI was 26.4 kg/m2 (SD 4.6). Staging laparotomy was done in 27(84%) of the patients. Advanced stages (III and IV) were detected in 16 patients (50%) at primary surgery.Adjuvant chemo therapy and radiation was received by 21(65.6%) patients therapy. Out of 32 patients, 13 (40%) developed recurrence while another 13 expired. Stage at diagnosis and type of adjuvant therapy were important factors in determining the outcome. Median recurrence free and overall survival was 22(95% CI 1.4–42) and 36 months (95% CI 10.1–61.8) respectively. Conclusion: Serous endometrial cancers are an intrusive subtype of EC. Comprehensive surgical staging with optimal cytoreduction should be aimed at. Adequate upfront molecular categorization of these tumors is mandated. Adjuvant therapy with chemotherapy and radiation is given in postoperative setting. Targeted therapies and immunotherapy could be considered in recurrences

Comparison of Dipolar, H‑Bonding, and Dispersive Interactions on Gelation Efficiency of Positional Isomers of Keto and Hydroxy Substituted Octadecanoic Acids

A systematic study of the importance of functional group position and type on the gelator efficiencies of structurally simple, low molecular-mass gelators is reported. Thus, the gelation abilities of a series of positional isomers of ketooctadecanoic acid (<i>n</i>-KSA) are compared in a wide range of liquids. The gelation abilities of the <i>n</i>-KSA as a function of <i>n</i>, the keto group position along the chain, are characterized by several structural, thermal, and rheological techniques and are compared with those of the corresponding hydroxyoctadecanoic acid isomers (<i>n</i>-HSA) and the parent molecule, octadecanoic acid (SA). Analyses of the gels according to the strengths of functional group interactions along the alkyl chain in terms of group position and type are made. The conclusions derived from the study indicate that gel stability is enhanced when the functional group is located relatively far from the carboxylic headgroup and when group–group interactions are stronger (i.e., hydrogen-bonding interactions are stronger in the <i>n</i>-HSA than dipole interactions in the <i>n</i>-KSA, which are stronger than the London dispersion interactions in SA). Co-crystals of the keto- and hydroxy-substituted octadecanoic acids are found to be less efficient gelators than even the ketooctadecanoic acids, due to molecular packing and limited group interactions within the gelator networks