Optimizing weight control in diabetes: antidiabetic drug selection

S Kalra1, B Kalra1, AG Unnikrishnan2, N Agrawal3, S Kumar41Bharti Hospital, Karnal; 2Amrita Institute of Medical Science, Kochi; 3Medical College, Gwalior; 4Excel Life Sciences, Noida, IndiaDate of preparation: 18th August 2010Conflict of interest: SK has received speaker fees from Novo Nordisk, sanofi-aventis, MSD, Eli Lilly, BMS, and AstraZeneca.Clinical question: Which antidiabetic drugs provide optimal weight control in patients with type 2 diabetes?Results: Metformin reduces weight gain, and may cause weight loss, when given alone or in combination with other drugs. Pioglitazone and rosiglitazone use is associated with weight gain. Use of the glucagon-like peptide-1 (GLP-1) analogs, liraglutide and exenatide, is associated with weight loss. Dipeptidyl peptidase-4 (DPP-4) inhibitors are considered weight-neutral. Results with insulin therapy are conflicting. Insulin detemir provides weight control along with glycemic control.Implementation: • Weight gain is considered an inevitable part of good glycemic control using conventional modalities of treatment such as sulfonylureas.• Use of metformin, weight-sparing insulin analogs such as insulin detemir, and liraglutide, should be encouraged as monotherapy, or in combination with other drugs.Keywords: weight control, diabete

AmniSure: A Point of Care Diagnostic for Preterm, Term Prelabor Rupture of Membranes

Background: Accurate, early diagnosis, prompt appropriate intervention is essential in the management of rupture of membranes (ROM), especially preterm. Aim: The aim was to determine efficacy of AmniSure rapid immunoassay placental alpha‑microglobulin‑1 test for accurate diagnosis of true ROM in women with watery discharge after 28 weeks gestation, compare with conventional methods. Subjects and Methods: Study was carried out in women presenting with ROM to labor the room of referral rural medical institute in Central India after ethical approval. Prospective study was performed in women presenting with symptoms/signs of ROM after 28 weeks of gestation. Sterile speculum examination was performed to observe pooling of liquor. Nitrazine, ferning tests were done to diagnose ROM. Vaginal examination was performed to determine cervical dilatation, effacement, station of presenting part in term cases. If all or 2 of 3 tests (pooling, ferning, and nitrazine) were positive, provisional diagnosis of ROM was made. Confirmation of ROM was done at birth. However, if 2 of 3 tests were negative, sterile speculum examination was repeated after 30 min of the first test. Test performance was calculated by comparing AmniSure results against final diagnosis at birth. Of 200 patients between 28 and 42 weeks gestation recruited for study, 31.5% (63/200) were preterm, 68.5% (137/200) term. Statistical analysis of data collected in the electronic database using SPSS version (Amnisure International LLC, 30 JFK Street, 4th Floor, Cambridge, MA 02138, USA). Results: AmniSure rapid immunoassay, rapid method for diagnosis of ROM, has 100% specificity, 99.44% sensitivity (one false negative due to meconium and immediate cesarean section). Conclusion: In comparison to nitrazine, pooling, ferning, AmniSure has almost 100% sensitivity, specificity.Keywords: AmniSure, diagnosis, meconium, preterm, term rupture of membrane

Methimazole induced lichenoid eruptions: an unusual case

This is a case report of a 31-year-old male presented to the Endocrinology outpatient department of our hospital with hyperthyroidism and was prescribed tablet methimazole 30mg once daily and tablet propranolol 40mg once daily. After 3 months, the patient complained of violaceous papular lesions on both the extensor aspect of the arms and legs. Physical examination was remarkable for acute onset, raised, itchy, violaceous papular lesions over the defined areas. The drug methimazole was suspected to cause lichenoid drug eruptions and was withdrawn. This case illustrates methimazole otherwise an efficacious and widely used anti thyroid drug is an agent capable of inducing lichenoid eruptions. However in future the monitoring of methimazole is essential for such adverse reaction

Magnetic resonance spectroscopy in ring enhancing lesions

We report a 4 year old girl with ring enhancing lesions in brain CT, initially diagnosed as neurocysticercosis but did not respond to cysticidal therapy. A Magnetic resonance spectropscopy (MRS) revealed lipid peaks suggestive of tuberculoma which was successfully treated with antituberculosis therapy. This report highlights the role of MRS in the diagnosis of ring enhancing lesios

Antibiotics usage, how well we know it? KAP survey among the dentist population in Mumbai

Background: There is a rising concern for antibiotic resistance worldwide, the primary cause of which is overuse and misuse. This study primarily aimed at assessing the knowledge of dental practitioners regarding the current guidelines on use of antibiotics and to identify the shortcomings if any.Methods: Present study was a cross-sectional questionnaire-based study conducted amongst 450 dental practitioners across Mumbai with the help of a self-designed questionnaire. The data was entered into excel sheets and appropriate statistical analysis was done with chi-square test using SPSS version 20.Results: The present study had a response rate of 95%. For the total percentage of patients examined each day that required systemic antibiotics, 36.9% (153) dentists answered 0-5%, followed by 25.3% (105) answered 10-15%. 76.1% (316) dentists came across patients who had self-prescribed antibiotics. 66% (274) dentists had never advised an antibiotic sensitivity/ culture test for their patients. 51.3% (213) dentists came across patients who did not respond to antibiotics. 87.2% (363) dentists were not aware about the ‘AWaRe’ classification of antibiotics given by WHO. 93.3% (383) dentists did not know about antimicrobial stewardship concept.Conclusions: The present study reflected antibiotic overuse and misuse to a certain extent by dental practitioners across Mumbai. Most dentists were unaware about ‘AWaRe’ classification and antimicrobial stewardship. Patient education on ill effects of self-prescription of antibiotics, identification of traits of antibiotic resistance and antibiotic culture tests needs to be prioritized by dentists

Correlation of DNA Ploidy with Progression of Cervical Cancer

The majority of squamous cell carcinomas of cervix are preceded by visible changes in the cervix, most often detected by cervical smear. As cervical cancer is preceded by long precancerous stages, identification of the high-risk population through detection of DNA ploidy may be of importance in effective management of this disease. Here we attempted to correlate aneuploid DNA patterns and their influence on biological behavior of flow-cytometry analysis of DNA ploidy which was carried out in cytologically diagnosed cases of mild (79), moderate (36), and severe (12) dysplasia, as well as “atypical squamous cells of unknown significance (ASCUS)” (57) along with controls (69), in order to understand its importance in malignant progression of disease. Cytologically diagnosed dysplasias, which were employed for DNA ploidy studies, 39 mild, 28 moderate, and 11 severe dysplasia cases were found to be aneuploid. Out of the 69 control subjects, 6 cases showed aneuploidy pattern and the rest 63 subjects were diploid. An aneuploidy pattern was observed in 8 out of 57 cases of cytologically evaluated ASCUS. The results of the followup studies showed that aberrant DNA content reliably predicts the occurrence of squamous cell carcinoma in cervical smear. Flow cytometric analysis of DNA ploidy may provide a strategic diagnostic tool for early detection of carcinoma cervix. Therefore, it is a concept of an HPV screening with reflex cytology in combination with DNA flow cytometry to detect progressive lesions with the greatest possible sensitivity and specificity

Bone mineral parameters in healthy young Indian adults with optimal vitamin D availability

Background: Several recent studies indicate a marked prevalence of vitamin D deficiency in asymptomatic, apparently healthy urban subjects from different socioeconomic groups in north India. Methods: To further examine this trend, we studied 40 men and 50 women, 20–30 years of age, from the Indian paramilitary forces. These individuals consume a nutritious, high-protein diet, have optimal exposure to sunlight and undertake strenuous outdoor physical exercise. Results: The mean serum calcium, phosphorus and alkaline phosphatase levels were normal in both men and women. The mean (SD) serum intact parathyroid hormone and 25-hydroxy-vitamin D3 levels were 19.3 (8.2) pg/ml and 18.4 (5.3) ng/ml in men, and 11.9 (6.6) pg/ml and 25.3 (7.4) ng/ml in women. Bone mineral density estimated in 20 men and 22 women revealed that in comparison with white Caucasians, 35%–50% of men and 14%–32% of women were osteopenic at different sites, while an additional 10% of men had osteoporosis of the lumbar spine. Conclusion: We found that with optimal nutrition, good sunlight exposure and regular physical exercise, healthy young individuals have normal bone and mineral biochemical values. The reasons for the abnormalities detected in bone mineral density in them needs further study. The impact of childhood nutrition on accumulation of peak bone mass may contribute to our findings. There is a need for establishing normative bone mineral density data for Indians

A simple method to estimate the loading effects of Al/Si on the characteristic impedance of multilayer microstrip line

The present study aims to experimentally determine the microwave transmission and reflection properties of aluminum thin film grown on silicon using sputtering. A simple microstrip line based structure has been used for the microwave characterization in the frequency range 10 MHz to 26.5 GHz. Complex S-parameter measurements reveal only small differences on silicon loading and aluminum/silicon loading in comparison to the microstrip line. The characteristic impedance (Z) of the microstrip line loaded with silicon and with aluminum/silicon have been obtained corresponding to the length of the loadings using two port microwave analysis. Comparison of loaded microstrip line with no loading shows large changes in the real part well as imaginary part of the characteristic impedance in the frequency range less than 10 GHz. Percentage changes in the real (Z) and imaginary (Z) have been found as ± 40% and ± 10% in average, respectively, for silicon loading in comparison to the no loading case, whereas these changes have been found to be below ±5% for aluminium/silicon loading, thus these smaller changes suggest the similar responses for aluminium/silicon loading and no loading. The results reveal that the propagation can be restored with the application of aluminum with any semiconductor or dielectric as loading on the microstrip line, which shows its potential to be explored for making an individual microwave component

Dapagliflozin in the Landscape of Type 2 Diabetes Management

As per current statistics, India accounts for more than 74 million individuals living with diabetes. Many of these individualshave associated cardiovascular disease (CVD) and chronic kidney disease (CKD) comorbidities. Optimal glycemic managementis important because uncontrolled glycemia may accelerate the macrovascular and microvascular complications, furtheraggravating the comorbid conditions. Metformin is used as the first-line therapy in most persons. However, there are somewho do not tolerate metformin, are unable to achieve required glycemic targets or require greater efforts for cardiovascular(CV) risk reduction. These patients require an alternative hypoglycemic agent to be used as either monotherapy or ascombination treatment with metformin, respectively. Sodium-glucose cotransporter-2 (SGLT2) inhibitors are one such novelclass of drugs that can be used as either monotherapy or as part of two drug (dual) or three drug (triple) combinations withother oral hypoglycemic agents or insulin. Dapagliflozin is a promising option for managing type 2 diabetes with CV andrenal benefits, weight and blood pressure reducing properties. A low risk of hypoglycemia and drug-drug interactions are theadded advantages. In this article, the authors have reviewed the existing clinical evidences on dapagliflozin and highlightedits place in the diabetes management landscape

Improvement in short-circuited coaxial flange for evaluating microwave superconducting properties at low temperature

5-10In the present study, we have proposed an improvement in terms of the determination of S-parameters of an open flange from its characteristic impedance and propagation constant. With the help of these S-parameters, the actual reflection coefficient of YBCO films deposited on LAO substrate is obtained from the measured reflection coefficient. The surface impedance of three YBCO films is obtained in the range of few ohms in the frequency range from 1 GHz to 40 GHz. The surface resistance of the films reduces at liquid nitrogen temperature, i.e., 77 K, whereas, the surface reactance slightly increases due to kinetic inductance. The conductivity and skin depth are also determined to validate the improvement in the method