A comparative assessment of safety and tolerability of metoprolol versus carvedilol in patients of chronic stable angina

Background: Angina pectoris is a clinical manifestation characterized by chest pain typically in substerum radiating to left arm, jaw, back lasting for 1-5 minutes and is relieved by rest. Beta blockers are one of the drugs indicated in angina. The aim of the study is to compare safety and tolerability of metoprolol and carvedilol in patients of chronic stable angina.Methods: The study done is randomized, open label, parallel type where tablet carvedilol and tab metoprolol is given in a group of 50 patients each. The patients were followed thereafter on 8th, 16th, 24th week to study safety in terms of haematological parameters like complete blood count, liver function tests, renal function tests, serum sodium, serum potassium, fasting blood glucose, 2 hours post prandial blood glucose, HbA1C, and Lipid profile and tolerability in terms of side effects. The study was conducted for one year and the data was assessed by relevant statistical analysis where p value <0.05 was considered significant.Results: It was seen that the disease was most common in the age group of 51-60 years with male preponderance, and carvedilol was found to cause non-significant decrease in Serum Triglyceride with no change in total cholesterol, HDL-C, LDL-C was found. No significant changes were observed in metoprolol group. There was no significant difference observed when blood sugar profile and other haematological parameters were considered. Both drugs were considered to be equally tolerable.Conclusions: Compared with carvedilol and metoprolol in patients of chronic stable angina, carvedilol resulted in better lipid profile whereas metoprolol showed no changes in lipid parameters

Stroke in sickle cell disease: case report

Sickle cell disease is an inherited blood disorder that affects red blood cells. It is characterized by polymerization of haemoglobin, erythrocyte stiffening, and subsequent vaso-occlusions. These can lead to microcirculation obstructions, tissue ischemia, infarction and acute stroke. Transient ischemic attack, Ischaemic stroke, haemorrhagic stroke, silent cerebral infarction, headache, Moyamoya disease, neuropathic pain, and neurocognitive impairment are neurological complications of sickle cell disease. Here we report a case of ischemic stroke in a patient of sickle cell disease. For early diagnosis and proper management of sickle cell disease neurological complications require specialised haematological and neurological expertise. The newly used medications under ongoing research will be the hope to overcome this devastating disease and its complications

Adenosine Deaminase as Inflammatory Marker in Type II Diabetes Mellitus

Objective: To evaluate the enzymatic activity of Adenosine Deaminase in type II diabetes mellitus (T2DM). Methods: This study was conducted on 60 clinically diagnosed type II diabetes mellitus patients, with 60 healthy subjects as the control group. Subjects were enrolled in the study only after their written consent was obtained. The inclusion of diabetes mellitus cases (DM) was conducted as per the WHO guidelines. Estimation of enzymatic activity of serum ADA was performed by Kinetic method using a commercial kit. Result: The observed serum ADA activity in DM patients was 48.34 ± 21.05 U/L, which was significantly higher in comparison to healthy controls (25.02 ± 5.78 U/L). The serum activity raised in about 80% of patients and they had higher values above the reference activity of 30 U/L. The increased activity of ADA among the diabetic subjects indicates inflammatory changes in these individuals. Conclusion: It is possible that in the coming years, a new therapeutic strategy based on anti-inflammatory properties with beneficial effects on diabetic complications can be translated into real clinical treatments

Evaluation of prescribing pattern of antidiabetic drugs in medicine outpatient clinic of a tertiary care teaching hospital

Background: Diabetes is rapidly gaining the status of a potential epidemic in India with more than 62 million diabetics currently diagnosed with the disease. Drug utilization studies are of paramount importance for the optimization of drug therapy and promote rational drug use among health care providers. The aim of this study was to investigate the drug utilization pattern in type-2 diabetic patients. The objective of the study was to analyse the prescribing pattern of anti-diabetic drugs in a tertiary care hospital.Methods: A prospective, cross-sectional study was carried out in medicine outpatient clinic of tertiary care hospital, RIMS Ranchi for a period of 7 months. The data was analysed using WHO core indicators and Microsoft Excel 2013.Results: The total number of encounters surveyed was 94. Avg no of drugs per prescription was 3.04. Percentage of drugs prescribed by generic name was found to be 34.2%. Percentage of prescriptions was a) with antibiotics was 27.6%, b) with insulin was 14.89%, c) from essential drugs list 44.05%. Most common co morbid disease was found to be hypertension present in 27.6% cases.Most commonly use drug was found to be metformin followed by glimepiride.Conclusions: Implementation of WHO core prescribing indicators by the prescribers would help us to reduce the cost, to recognize and prevent potentially dangerous drug- drug interaction and antibiotic resistance

Incentivizing Responsible Small-Dollar Lending in Low-Income Communities

POLICY QUESTION: “Based on results of pilot programs and policies implemented in other parts of the country, how can New York City/State best support and incentivize responsible small-dollar lending in low-income communities?” RECOMMENDATION: Design a borrower’s card system to collect information about consumers’ borrowing and repayment behaviors, to encourage lenders to extend loans to low-income individuals in need, and to incentivize consumers to take ownership of their own financial behavior. PROBLEM STATEMENT: In many states, the payday lending market has operated to meet the strong consumer demand for short-term small-dollar loans. In the realm of small-dollar lending, the payday lending market provides access for low-income individuals who might be classified as higher risk consumers, likely due to blemished credit histories. Lenders compensate for this higher risk by charging a higher interest rate, which would allow for the possibility that the borrower does not repay the loan. However, though the payday lending market is competitive, significant information asymmetries exist for both the lender and the borrower, which leave lenders unable to discern between high-risk and low-risk consumers, and leave borrowers with an unclear understanding of the terms of the loans and often, with increased amounts of debt. The reliance on payday loans poses significant problems for borrowers, however. Research has shown that consumers often are unable to repay within a single pay period and thus have to roll over their loan for another borrowing period, and accrue another fee. Therefore, for many borrowers, what starts off as a short-term loan turns into long-term payments because of rollover and chronic borrowing patterns. Furthermore, within the industry, only a few states seem to have a standardized database housing information on borrowing and repayment history for payday loan consumers. The lack of a centralized system makes it difficult to keep track of where consumers are originating their loans, how often they are taking out payday loans, and their true ability to repay. More responsible loan programs are characterized by a variety of criteria to ensure access to credit without trapping borrowers in additional debt. These characteristics include annual percentage rate caps, extended loan terms, multiple installment payment plans, proper underwriting of loans based on a borrower’s ability to repay, and financial counseling or a savings component. The tension in designing an alternative program is in balancing consumer need and incentive, market failures in information asymmetries, and business profitability concerns in order to meet the demand for these loans while not encouraging or incentivizing unscrupulous or predatory behavior. CRITERIA: 1) Minimize risk associated with consumers’ ability to repay loans: This criterion aims to reduce the risk associated with a consumer’s ability to repay by either better assessing consumer riskiness or ensuring that whatever consumer risk does exist does not prohibit or limit the potential for the loan to be repaid. 2) Provide incentive for lenders to make loans with a positive expected value: A viable alternative will provide the incentive for lenders to rationally extend a loan by reducing consumer risk, allowing lenders to better examine consumer risk, or by guaranteeing that they will be compensated for the risk associated with the population they are serving. 3) Provide incentive for consumers to improve behavior: A viable alternative should provide a mechanism by which consumers choose to improve their own repayment behavior, in order to ensure lenders receive the return on the loans that they make and continue to provide access to the small-dollar loans. 4) Maximize sustainability of program implementation: Any recommended program design should consider factors of sustainability, such as cost considerations, simplicity of implementation, political pushback, or scalability concerns. ALTERNATIVES: The following alternatives provide plausible program designs for a responsible small-dollar lending program. Each alternative is weighted against the specific criteria identified above. 1) Use a referral process to provide loans to approved low-income and/or high-risk consumers. 2) Design a borrower’s card system to collect information about consumers’ borrowing and repayment behaviors. 3) Fund a loan loss reserve pool to back loans made to low-income and/or high-risk consumers

Frequency of diabetic retinopathy in patients with diabetes mellitus and its correlation with duration of diabetes mellitus

Purpose : To evaluate the correlation between diabetic retinopathy (DR) and duration of diabetes mellitus (DM). Materials and Methods : A cross-sectional study was carried out in 500 patients who were reported diabetics or newly diagnosed diabetics referred for screening for DR. Patients with posterior segment disease in whom posterior segment was not visualized were excluded from the study. A detailed evaluation of patients diabetic and hypertensive status was done along with their detailed ophthalmological examination. All patients were investigated for blood sugar levels, urine sugar levels, and HbA 1 C. Grading of DR was done by the ETDRS grading system. Results : Total prevalence of DR is 32%. Among these, non-proliferative diabetic retinopathy (NPDR) is seen in 71.88% and proliferative diabetic retinopathy (PDR) in 28.12% patients. This study shows an increasing prevalence of DR with increasing duration of DM. The prevalence of DR was seen to be 9.44% when duration of diabetes detected was less than 5 years and was 76.47% in patients with diabetes of more than 20 to 25 years. Conclusion : There is an increasing prevalence of DR with increase in duration of DM. All patients having diabetes of more than 25 years were found to have retinopathy