SGLT-2 Inhibitors: A Novel Mechanism in Targeting Glycemic Control in Type 2 Diabetes Mellitus

OBJECTIVE: To review the chemistry, pharmacology, pharmacodynamics, pharmacokinetics, clinical efficacy, tolerability, dosing, drug interactions, and administration of canagliflozin, dapagliflozin, and empagliflozin, and comparing the benefit and risk aspects of using these agents in the older adult diabetes patient population. DATA SOURCES, STUDY SELECTION, DATA EXTRACTION, AND DATA SYNTHESIS: A search of PubMed using the terms SGLT-2 inhibitors, canagliflozin, dapagliflozin, empagliflozin, efficacy, and tolerability was performed to find relevant primary literature on each of the sodium/glucose cotransporter 2 (SGLT-2) inhibitors currently approved for use in type 2 diabetes. Phase III trials for all agents were included. All English-language articles from 2010 to 2015 appearing in these searches were reviewed for relevance to this paper. In addition, related articles suggested in the PubMed search were also reviewed. The SGLT-2 inhibitors have shown a reduction in hemoglobin A1c values and fasting plasma glucose levels with a low incidence of hypoglycemia. The incidence of mycotic infections is increased in patients taking an SGLT-2 inhibitor. CONCLUSION: SGLT-2 inhibitors may be a viable treatment option for patients not controlled on other oral agents. The risk of hypoglycemia is small. However, the clinical efficacy and tolerability of these agents has not been fully elucidated in older and frail patients

COPD: Optimizing Treatment

A guideline update and an expanded armamentarium have many physicians wondering how best to treat patients with COPD. Chronic obstructive pulmonary disease (COPD) carries a high disease burden. In 2012, it was the 4th leading cause of death worldwide.1,2 In 2015, the World Health Organization updated its Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, classifying patients with COPD based on disease burden as determined by symptoms, airflow obstruction, and exacerbation history.3 These revisions, coupled with expanded therapeutic options within established classes of medications and new combination drugs to treat COPD (TABLE 1),3-6 have led to questions about interclass differences and the best treatment regimen for particular patients

Enhancing Ambulatory Care APPEs by Incorporating Patient-Centered Medical Home Principles

Objective: Incorporation of various clinical activities during ambulatory care APPEs to achieve exposure to the five principals of a patient centered medical home (PCMH) provide Pharm.D. Candidates at the Wegmans School of Pharmacy with a strong foundation for a future practice in patient centered care. Methods: The APPE is designed to engage students in activities involving the five principals of a PCMH practice. Students that are assigned to complete their Ambulatory Care APPE at one of two Level 3 National Committee for Quality Assurance (NCQA) certified PCMH Family Medicine Residency Training Practices are directly involved in engaging patients in decision making and management of chronic disease states, improve communication directly between patients and providers through the use of an electronic medical record, coordinate care with other health professionals through care transitions, and contribute to the transparency of comprehensive evidence based care of patients through patient education. Results: A total of 26 Pharm.D. Candidates have completed the redesigned APPE that emphasizes the role of a pharmacist in delivering care in a PCMH practice. In the 2012-13 academic year three from a total 11 students pursued post-graduated training and acquired a residency to enhance their clinical and research skills. In the 2013-14 academic year a greater percentage of students pursued advanced training. Eight out of a total of 15 students acquired advanced training in a variety of settings including ambulatory care, managed care, and community pharmacy residency programs. One student intends to pursue an additional certification to enrich her future as community practitioner. Implications: The structured experiences at a certified PCMH practice site has displayed the potential to encourage Pharm.D. Candidates to pursue future careers in various settings to enhance their skills in delivering collaborative patient centered care

What is the best management for patients who have a TIA while on aspirin therapy?

Alternative antiplatelet therapy for stroke prevention is indicated for patients who experience transient ischemic attacks (TIAs) while on aspirin therapy (strength of recommendation [SOR]: A, based on 1 meta- analysis and 1 randomized controlled trial). The combination of aspirin and extended- release dipyridamole reduces the risk of stroke following a TIA (SOR: A). Thienopyridines (eg, clopidogrel and ticlopidine) are an alternative for patients at high risk for a cardioembolic event. Ticlopidine reduces the risk of stroke following TIA, specifically showing benefit for patients previously on aspirin (SOR: A). Clopidogrel has not shown significant reduction in reoccurrence of stroke and has not been studied for patients with a previous TIA. Aspirin and a thienopyridine do not provide significant additional reduction in secondary strokes (SOR: A)

Effect of chitosan oligosaccharide and valine on growth, serum hormone levels and meat quality of broilers

Chitosan oligosaccharide (COS) and valine (Val) supplementation will improve growth performance, carcass traits, hormonal profile and meat quality in broilers. To evaluate this hypothesis, based on a 2×4 factorial arrangement, 480 male broilers (Ross 708) were randomly placed in eight treatment groups for two levels of COS (C1: 100 mg/kg, and C2: 150 mg/kg) and four levels of valine (V1: 0.57%, V2: 0.72%, V3: 0.87% and V4: 1.02%) with three replicates (n=24) with 20 birds in each (ni=60; i=1, 2, 3,..., 8.). The results showed that live bodyweight (BW), weight gain (WG), and carcass weight increased, and feed conversion ratio (FCR) decreased with increased supplemental levels of dietary Val at C1 and C2. Abdominal fat reduced linearly for both COS and Val, with a higher reduction response value at C2 and V4. The serum levels of triiodothyronine (T3), thyroxine (T4), testosterone and insulin-like growth factor 1 (IGF-1) presented a linear effect for COS and Val. The proximate composition of breast and leg meat showed that crude fat content decreased linearly for COS and Val with higher reduction response values at V3 for both levels of COS. The ash content rose linearly with increasing concentration of Val at C1, but showed the highest value at V2 when birds were offered C2. There was an interaction between COS and Val for T3, T4, IGF-1, ash content and crude fat. In conclusion, supplementation exerted a significant influence on the growth performance, hormonal profile and meat composition of broilers

Multi-representation Ontology in the Context of Enterprise Information Systems

International audienceIn the last decade, ontologies as shared common vocabulary played a major role in many AI applications and informationintegration for heterogeneous, distributed systems. The problems of integrating and developing information systems anddatabases in heterogeneous, distributed environment have been translated in the technical perspectives as system’sinteroperability. Ontologies, however, are foreseen to play a key role in resolving partially the semantic conflicts anddifferences that exist among systems. Domain ontologies, however, are constructed by capturing a set of concepts and theirlinks according to various criteria such as the abstraction paradigm, the granularity scale, interest of user communities, andthe perception of the ontology developer. Thus, different applications of the same domain end up having severalrepresentations of the same real world phenomenon. Multi-representation ontology is an ontology (or ontologies) thatcharacterizes ontological concept by a variable set of properties (static and dynamic) or attributes in several contexts and/ orin several scales of granularity. This paper introduces the formalism used for defining the paradigm of multi-representationontology and shows the manifestation of this paradigm with Enterprise Information Systems

Effective Use of Team Based Learning in a Flipped Classroom

This roundtable presentation highlighted the components of team based learning activities in a flipped classroom. The instructional techniques to maximize knowledge application and critical thinking are described. Additional student performance and level of satisfaction with this course design in comparison to lecture based course design in previous years is evaluated

A dual strategy to improve psychotic patients\u27 compliance using sustained release quetiapine oral disintegrating tablets

Quetiapine (QT) is a short acting atypical antipsychotic drug effective in schizophrenia and bipolar disorder. This study aims at designing a novel dosage form of sustained release taste-masked QT orally disintegrating tablets (ODTs) based on solid lipid micro-pellets (SLMPs). QT SLMPs were prepared using the hot melt extrusion technique utilizing three lipid carriers: Compritol, Precirol and white beeswax either alone or in mixtures. They showed sustained QT release and a taste masking effect. The selected QT SLMP was further blended with an aqueous solution containing polyvinylpyrollidone (2.5%), croscarmellose sodium (2%) and mannitol (50%); it was then lyophilized into ODT in a mass ratio of 1:2 respectively. ODTs containing QT SLMPs showed: average wetting time (40.92 s), average oral disintegration time (21.49 s), average hardness (16.85 N) and also imparted suitable viscosity to suspend pellets during lyophilization process. In conclusion, lyophilization is a promising technique for the formulation of multiparticulate systems into ODTs

Aggressive Anesthetic Management of a Patient with Severely Dilated Cardiomyopathy for Non Cardiac Surgery

We report a case of a 37 year old man, with history of rhabdomyosarcoma as a child. Patient developed severe dilated cardiomyopathy secondary to the treatment of the cancer. He presented for resection of the small bowel. An intra-aortic balloon pump (IABP) was placed preoperatively for mechanical cardiac support. A combined general/epidural technique was used for the surgery. Transesophageal echocardiogram (TEE) was used to monitor patients cardiac status intraoperatively. Patient remained hemodynamically stable and tolerated the procedure well