Glycemic control and cost-effectiveness attained by the drug utilization of oral antidiabetic agents in a tertiary care hospital in South India

Background: Diabetes mellitus require lifelong intervention and Kerala has high prevalence. New expensive agents require comparison with existing regimens for cost-effectiveness.Methods: Socio-demographic, anthropometric, FPG and HbA1C (baseline and post treatment) of 150 patients (73 men; 77 women) were obtained from records using standard case report forms in our retrospective study. ANOVA and paired t test were used for between groups and within group comparison.Results: Metformin was maximum utilized (DDD/1000/day-252.39). All treatment regimens produced significant reduction in FPG (except metformin monotherapy) and HbA1C (except metformin sulfonylurea α-glucosidase inhibitor DPP-4 inhibitor combination). When compared to metformin sulfonylurea pioglitazone combination (best therapy), other regimens were less cost effective in reducing FPG and metformin sulfonylurea α-glucosidase inhibitor DPP-4 inhibitor was more effective and expensive in reducing HbA1C.Conclusions: High prescription rates of metformin were due to its action on insulin resistance and weight. Addition of pioglitazone was cost effective and DPP-4 inhibitor was expensive but effective

Discriminatory Photoactivation of Diastereomeric RAFT Agents

Copyright © 2019 American Chemical Society. Reversible deactivation radical polymerization (RDRP) techniques regulate free radical polymerization through a process of reversible activation/deactivation of propagating radicals, which thus provides dormant polymer chains with unique capping moieties (alkoxyamine, halogen, thiocarbonylthio, etc.) as chain ends. The dormant chain ends are the reactive sites of initiation, propagation, and termination, and therefore their chemical structures are crucial for the mechanism and kinetics of RDRP. The investigation of stereochemical effects of dormant chain ends is challenging due to limited models that are highly accessible and able to represent long polymer chains. Herein, we employ a single unit monomer insertion (SUMI) technology to prepare ideal models (oligomeric macro-RAFT agents) for the investigation of the stereochemical effect on their photoactivation. Two diastereomeric macro-RAFT agents were prepared in high yield by SUMI, which were then photoactivated for photoinduced electron/energy transfer-reversible addition- fragmentation chain-transfer (PET-RAFT) polymerization under visible light. Discriminatory activation kinetics was observed with one diastereomer much faster than the other. The mechanistic explanation of such interesting behavior was suggested with the aid of quantum chemical calculations. Higher C-S bond dissociation energy and greater stability contributed to slower photoactivation of one of diastereomeric RAFT agents as compared to the other

TRENDS IN THE DIAGNOSIS OF HUMAN IMMUNODEFICIENCY VIRUS

Ever since the first HIV case reported, there is a dramatic increase in the prevalence of HIV infection which urged the need for an effective diagnostic method.  There are several improvements in diagnostic methods employing various technologies to screen for HIV infection using enzyme immunoassays and rapid diagnostic tests which simultaneously detect antigen and antibody with significantly reduced window period.  Further, western blot or immunofluorescence methods are used to confirm the results. Nucleic acid amplification tests, though sensitive, are expensive and hence not employed for screening but instead used to monitor the antiretroviral drug response. In spite of appreciable advancements in the sensitivity and specificity of the detection techniques, the algorithms are still the method of choice for ensuring the accuracy of test results

Development and evaluation of one step single tube multiplex RT-PCR for rapid detection and typing of dengue viruses

<p>Abstract</p> <p>Background</p> <p>Dengue is emerging as a major public health concern in many parts of the world. The development of a one-step, single tube, rapid, and multiplex reverse transcription polymerase chain reaction (M-RT-PCR) for simultaneous detection and typing of dengue virus using serotype specific primers during acute phase of illness is reported.</p> <p>Results</p> <p>An optimal assay condition with zero background was established having no cross-reaction with closely related members of flavivirus (Japanese encephalitis, West Nile, Yellow fever) and alphavirus (Chikungunya). The feasibility of M-RT-PCR assay for clinical diagnosis was validated with 620 acute phase dengue patient sera samples of recent epidemics in India. The comparative evaluation <it>vis a vis </it>conventional virus isolation revealed higher sensitivity. None of the forty healthy serum samples screened in the present study revealed any amplification, thereby establishing specificity of the reported assay for dengue virus only.</p> <p>Conclusion</p> <p>These findings clearly suggested that M-RT-PCR assay reported in the present study is the rapid and cost-effective method for simultaneous detection as well as typing of the dengue virus in acute phase patient serum samples. Thus, the M-RT-PCR assay developed in this study will serve as a very useful tool for rapid diagnosis and typing of dengue infections in endemic areas.</p

The effect of protein mutations on drug binding suggests ensuing personalised drug selection

The advent of personalised medicine promises a deeper understanding of mechanisms and therefore therapies. However, the connection between genomic sequences and clinical treatments is often unclear. We studied 50 breast cancer patients belonging to a population-cohort in the state of Qatar. From Sanger sequencing, we identified several new deleterious mutations in the estrogen receptor 1 gene (ESR1). The effect of these mutations on drug treatment in the protein target encoded by ESR1, namely the estrogen receptor, was achieved via rapid and accurate protein-ligand binding affinity interaction studies which were performed for the selected drugs and the natural ligand estrogen. Four nonsynonymous mutations in the ligand-binding domain were subjected to molecular dynamics simulation using absolute and relative binding free energy methods, leading to the ranking of the efficacy of six selected drugs for patients with the mutations. Our study shows that a personalised clinical decision system can be created by integrating an individual patient's genomic data at the molecular level within a computational pipeline which ranks the efficacy of binding of particular drugs to variant proteins

Prosthodontic rehabilitation of a mucormycosis patient: a case report

Maxillofacial defects can result from congenital disabilities, cancer surgery, trauma, infection, or disease. Facial deformities can affect how a person looks, feels about themselves, and interacts with others. It can significantly impair phonetics, mastication, and deglutition and cause facial deformation. Maxillectomy due to mucormycosis is one such maxillofacial defect and it becomes essential to rehabilitate these cases with modified techniques based on the extension of intraoral defect, the severity, the degree of resection, the type of mucormycosis, the stability of lesions over time, the presence of contiguous disease, the accessibility of dental and prosthetic resources, and patient expectations. The prosthetic reconstruction with a maxillofacial prosthesis can restore function and appearance, comfort, and quality of life. The prosthesis should be simple to handle, easy to maintain, biocompatible, light in weight, and convenient for future adjustments. The maxillofacial surgeon, oncologist, and reconstructive dentist should work together to develop a treatment plan based on these considerations. This case report provides the current treatment options for these patients and rehabilitation of the defect. It also discusses the issues that need to be addressed during the planning of prosthetic treatment and highlights some challenges the clinicians face in providing prosthetic treatment for mucormycosis patients

Phytosociological observations on tree species diversity of an urban tropical dry deciduous forest of central India

We analyzed phytosociological characteristics of a tropical dry deciduous forest located in an urban environment of Indian Institute of Forest Management (IIFM) Campus in the capital city of Bhopal of Madhya Pradesh state, Central India. A Comparison has been made among the tree community characteristics during the years 1988, 2002 and 2020 in terms of tree species composition, stem density, basal area and Importance Value Index (IVI). At the time of establishment of the institute in 1988, the forest area resembleda degraded dry scrubland. Due to continuous care/protection, plantation activities, degraded forest recovered remarkably, ecological processes evolved favorably with canopy cover reaching over 60% in some patches and about 50% in general over most part of the campus. During last two decades, tree density increased from 319 to 525 stem ha-1 indicating an increase of 64% whereas basal area increased from 18470.79 cm2 ha-1 to 29782.31 cm2 ha-1,an increase of about 61%. Leguminaceae family represented 26.4% of the tree community followed by Combretaceae (11.76%). Shannon-Weiner index (1.31), Simpson index (0.93) and evenness index (0.85) are within the reported ranges for similar forest type of dry deciduous nature in India. Theresults of the presentstudy will help forest managers in conservation planning of urban tropical forest ecosystem of central India

Phylogenetic studies reveal existence of multiple lineages of a single genotype of DENV-1 (genotype III) in India during 1956–2007

<p>Abstract</p> <p>Background</p> <p>Dengue virus type 1 (DENV-1) have been mostly circulating silently with dominant serotypes DENV-2 and DENV-3 in India. However recent times have marked an increase in DENV-1 circulation in yearly outbreaks. Many studies have not been carried out on this virus type, leaving a lacunae pertaining to the circulating genotypes, since its earliest report in India. In the present study, we sequenced CprM gene junction of 13 DENV-1 isolated from Delhi and Gwalior (North India) between 2001–2007 and one 1956 Vellore isolate as reference. For comparison, we retrieved 11 other Indian and 70 global reference sequences from NCBI database, making sure that Indian and global isolates from all decades are available for comparative analysis.</p> <p>Results</p> <p>The region was found to be AT rich with no insertion or deletion. Majority of the nucleotide substitutions were silent, except 3 non-conservative amino acid changes (I → T, A → T and L → S at amino acid positions 59,114 and 155 respectively) in the Indian DENV-1 sequences, sequenced in this study. Except two 1997–98 Delhi isolates, which group in genotype I; all other Indian isolates group in genotype III. All Indian genotype III DENV-1 exhibited diversity among them, giving rise to at least 4 distinct lineages (India 1–4) showing proximity to isolates from diverse geographic locations.</p> <p>Conclusion</p> <p>The extensive phylogenetic analysis revealed consistent existence of multiple lineages of DENV-1 genotype III during the last 5 decades in India.</p