A clinical study to determine metformin as a cause of serum vitamin B12 decrease and effect of combination of metformin and mecobalamin on serum vitamin B12 levels in type 2 diabetics

Background: Several evidences show metformin decreases vitamin B12. Diabetics are also at the risk of developing neuropathy which is treated with vitamin B12. metformin being initial therapy for diabetic patients, it becomes all the more important to know the extent of this decrease. The study was designed with the objective to compare the levels of vitamin B12 in patients on metformin vis-à-vis on antidiabetic drugs other than metformin and to evaluate the increase in vitamin B12 levels after prescribing a combination of metformin and mecobalamin, in T2DM patients.Methods: Of 500 enrolled, 321 patients completed the study for duration of 6 months, divided in two periods of 3 months each. At the end first period of 3 months the vitamin B12 levels were compared form Metformin vs. that of other antidiabetics. In second period of 3 months a combination of metformin and mecobalamin was given instead of plain metformin and vitamin B12 levels were repeated at the end of this period.Results: There was reduction in vitamin B12 levels with metformin with levels of 272.5pg/ml compared to 714.6pg/ml with other antidiabetics at the end of first period. The levels increased from 272.5pg/ml to 615.9 pg/ml at the end of second period after receiving the combination of metformin and mecobalamin.Conclusions: T2DM patients being treated with metformin had a greater risk of reduction in vitamin B12 levels and addition of vitamin B12 in the form of mecobalamin would decrease the reduction in vitamin B12 levels associated with Metformin therapy

Abstracts of Scientifica 2022

This book contains the abstracts of the papers presented at Scientifica 2022, Organized by the Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India, held on 12–13 March 2022. This conference helps bring researchers together across the globe on one platform to help benefit the young researchers. There were six invited talks from different fields of Physiotherapy and seven panel discussions including over thirty speakers across the globe which made the conference interesting due to the diversity of topics covered during the conference. Conference Title:  Scientifica 2022Conference Date: 12–13 March 2022Conference Location: Sancheti Institute College of PhysiotherapyConference Organizer: Sancheti Institute College of Physiotherapy, Pune, Maharashtra, Indi

Constraints on the CKM angle γ\gamma from B±→Dh±B^\pm\rightarrow Dh^\pm decays using D→h±h′∓π0D\rightarrow h^\pm h^{\prime\mp}\pi^0 final states

A data sample collected with the LHCb detector, corresponding to an integrated luminosity of $9~{\rm fb}^{-1}$, is used to measure $CP$ observables in $B^\pm \to D h^\pm$ decays, where $h^{(\prime)}$ is either a kaon or a pion, and the neutral $D$ meson decay is reconstructed in the three-body final states $K^\pm \pi^\mp \pi^0$, $\pi^\pm \pi^\mp \pi^0$, and $K^\pm K^\mp \pi^0$. The most suppressed of these modes, $B^\pm \to [\pi^\pm K^\mp \pi^0]_D K^\pm$, is observed with a significance greater than seven standard deviations and constraints on the CKM angle $\gamma$ are calculated from the combination of the measurements

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London