Comparison of teneligliptin with sitagliptin as an add on to metformin in patients of type 2 diabetes mellitus: an observational study

Background: Teneligliptin is a new dipeptidyl peptidase-4 (DPP-4) inhibitor, available in India. It has been widely prescribed in type 2 diabetes mellitus (T2 DM) due to its low cost. However, there are few studies comparing it with other DPP-4 inhibitors. The objective of this study is to compare the efficacy of teneligliptin with sitagliptin in patients of T2 DM.Methods: Patients of T2 DM, attending the OPD of a hospital during the period of January to August 2017 were scrutinized. Those uncontrolled on metformin monotherapy (1 g/day) were selected and were administered either sitagliptin (100 mg/day) or teneligliptin (20 mg/day) in addition to metformin. Base-line clinical features (age, sex, body-weight, BP, pulse rate etc.) and laboratory parameters (hemogram, fasting blood sugar and postprandial blood sugar, HbA1c, serum creatinine etc.) were recorded initially and at the end of three months. Side effects were assessed with the help of a questionnaire. The data obtained were analyzed by student’s t-test. P<0.05 was considered as statistically significant.Results: 35 and 32 patients received sitagliptin and teneligliptin respectively. After 12 weeks of therapy, FBS, PPBS and HbA1c significantly reduced in both the groups as compared to base-line values. Both drugs were well tolerated. There was no significant difference in the glycemic parameters between the two groups at the end of the study.Conclusions: Teneligliptin significantly improved glycemic control in patients with T2 DM when prescribed as an add on to metformin. It was equally effective when compared to sitagliptin. As teneligliptin is less costly than other gliptins, it may be considered as a good cost-effective option as an add on to patients of T2 DM uncontrolled on metformin monotherapy.

Antidiabetic activity of Coriandrum sativum in streptozotocin induced diabetic rats

Background: Diabetes mellitus (DM) can be defined as chronic hyperglycemia due to lack in insulin secretion and/or action. This study was designed to compare the antidiabetic activity of Coriandrum sativum L. with the standard antidiabetic drug, Metformin in Streptozotocin induced diabetic rats.Methods: Streptozotocin (STZ) was used to induce diabetes in the rats. Standard drug was metformin and test drug were Coriandrum sativum seed extract. 4 groups of 8 rats each were taken (normal control, diabetic control, streptozotocin + Coriandrum sativum and streptozotocin + metformin). Blood Sugar Levels (BSL) and HbA1C levels were estimated on day 0, 14 and 28 and day 28 respectively.Results: Streptozotocin administration resulted in significant rise in BSL. This rise was reduced with the administration of CS seed extract, but the reduction was more with chronic administration. It also reduced the HbA1C levels but couldn’t attain total normoglycemia. However, the reduction of BSL was superior with Metformin compared to the test drug.Conclusions: Oral administration of Coriandrum sativum seed extract at a dose of 40 mg/kg has shown antihyperglycemic activity in streptozotocin induced diabetic rats. Thus, Coriandrum sativum may have considerable therapeutic benefit as an antidiabetic agent and can be suggested as a potential dietary add on

Khinchin theorem for integral points on quadratic varieties

We prove an analogue the Khinchin theorem for the Diophantine approximation by integer vectors lying on a quadratic variety. The proof is based on the study of a dynamical system on a homogeneous space of the orthogonal group. We show that in this system, generic trajectories visit a family of shrinking subsets infinitely often.Comment: 19 page

Current pattern of adverse drug reactions to anti-retroviral therapy in an antiretroviral therapy centre attached to a government medical college of Maharashtra, India: a retrospective study

Background: Antiretroviral drug therapy (ART) has brought a ray of hope to people living with HIV/AIDS. Adverse drug reactions (ADRs) can often cause significant morbidity among individuals on ART, occasionally leading to mortality. The present study was conducted to assess the nature, causality, severity of ADRs to ART, and to identify risk factors for ADRs in HIV-positive patients receiving ART in India.Methods: A total of 109 patients reported with ADRs to ART during July 2015-December 2015 were randomly included in a retrospective observational study conducted at an ART center attached to a government medical college of Maharashtra. Causality and severity assessment of ADRs was done by using Naranjo’s ADR Causality scale and Modified Hartwig and Siegel scale respectively. The data was computed using MS Excel and descriptive results were expressed as counts and percentages. The study was approved by Institutional Ethics Committee.Results: Among 109 patients, females (60.55%) had higher prevalence of ADRs than males (39.45%). A total of 132 ADRs were reported. Anemia (76.52%) was the commonest ADR reported followed by skin rash (11.36%) and raised renal function tests (6.06%). Zidovudine + Lamivudine + Nevirapine (ZLN) were the commonest ART regimen causing anemia as ADR.Conclusions: Reporting of ADRs is a very inefficient system in detecting drug-related conditions, leading to underestimation of the burden due to ADRs in India. A well-structured, efficient pharmacovigilance systems, which assesses and monitor safety profile and impact of antiretroviral medicines is very much needed at present in India

A Randomized Experiment of the Split Benefit Health Insurance Reform to Reduce High-Cost, Low-Value Consumption

Traditional cost sharing for health care is stymied by limited patient wealth. The “split benefit” is a new way to reduce consumption of high-cost, low-value treatments for which the risk/benefit ratio is uncertain. When a physician prescribes a costly unproven procedure, the insurer could pay a portion of the benefit directly to the patient, creating a decision opportunity for the patient. The insurer saves the remainder, unless the patient consumes. In this paper, a vignette-based randomized controlled experiment with 1,800 respondents sought to test the potential efficacy of the split benefit. The intervention reduced the odds of consumption by about half. It did so regardless of scenario (cancer or cardiac stent), type of split (rebate, prepay, or health savings account), or amount of split (US$5,000 or US$15,000). Respondents viewed the insurer that paid a split as behaving fairly, as it preserved access and choice. Three-quarters of respondents supported such use in Medicare, which did not depend on political party affiliation. The reform is promising for further testing since it has the potential to decrease spending on low-value interventions, and thereby increase the value of the health care dollar

A study of adverse drug reactions in patients receiving treatment for multi-drug resistant tuberculosis

Background: A high frequency of adverse drug reactions (ADRs) is one of the major challenges in the treatment of Multi-drug resistant tuberculosis (MDR-TB). Patients may refuse to continue treatment if ADRs are not properly addressed, drugs may be stopped unnecessarily and treatment may be terminated prematurely by inexperienced health workers, resulting in a high proportion of failure.Methods: Patients diagnosed for MDR-TB and registered in Drug Resistant TB centre (DR-TB) of tertiary care hospital during period of July 2014 to June 2015 were enrolled in the study. Data of patients hospitalized for the complaints of ADR in DR-TB centre during study period was collected.Results: Out of 468 patients, 60 (12.82%) patients developed at least one adverse reaction and were hospitalised for the same. Among 109 reported ADRs, Gastrointestinal upset was the most common ADR reported (5.98%) followed by psychosis (4.91%) and ototoxicity (2.99%).Conclusions: The health providers, the patients and their relatives should be sensitised about these ADRs for early detection and treatment. It can also be suggested that the setup of DR-TB centre should be integrated with psychiatry and ENT specialities, with all the provisions of early detection of ADR and treatment

Serum lipid profile in non-polycystic ovary syndrome and polycystic ovary syndrome women: a comparative and correlational study

Background: Polycystic ovary syndrome (PCOS), in addition to impaired ovulation, also affects metabolic pathways. Dyslipidemia, occurring in PCOS women leads to cardiovascular diseases in them. The purpose of the present study was to compare lipid profile and its correlation with biochemical and hormonal parameters in PCOS and non PCOS women, to analyse the correlation of lipid profile with hirsutism and body mass index (BMI) in PCOS women.Methods: The present study includes 68 women divided into non PCOS groups (n=30) and PCOS (n=38) as defined by Rotterdam criteria. PCOS group further divided into overweight / obese (n=23) and normal weight subgroups (n=15). Lipid profile, fasting blood glucose and hormonal profile were done in all the groups.Results: TG and TC/HDL ratio were significantly high in PCOS group. Hirsute patients had raised LDL levels as compared to non-hirsute. LDL showed positive significant correlation with insulin, HOMA, testosterone in PCOS group. TC was significantly positively correlated with insulin and HOMA in PCOS group. In both normal weight and overweight / obese PCOS subgroups, LDL had positive and significant correlation with testosterone. TC showed positive and significant correlation with HOMA in overweight/obese subgroup. HDL showed positive and highly significant correlation with FSH in normal weight PCOS.Conclusions: Hyperandrogenism in PCOS may be additionally marked by raised LDL. Overweight/obese PCOS subgroup may be prone to dyslipidemia as well as deranged glucose homeostasis, thereby making it an important therapeutic target

Drug utilization study in a neonatal intensive care unit of a government tertiary care hospital in Western Maharashtra

Background: Presently drug utilization studies (DUS) are in an evolving era. Current literature search has shown paucity of epidemiological studies in the field of paediatric pharmacology. Hence the present study was designed to assess the drug utilization pattern in neonatal intensive care unit to improvise the current prescription practices, if required and to determine areas in neonatal pharmacology in need of further research.Methods: A prospective, observational study spanned for a period of one year from January 2015 to December 2015 was conducted at the neonatal intensive care unit (NICU), Government teaching tertiary care hospital, Maharashtra. Data of prescribed drugs was collected. WHO prescribing indicators were used for evaluating DUS. Assessment of exposure rates of different class of drugs in different gestational age groups was done. Data were analysed using descriptive studies.Results: Data of 205 neonates, showed male preponderance (53.17%) over female neonates (46.83%). With regard to the gestational age, 47.31% were term, 52.68% preterm. Average number of drugs per encounter was 6.69. 76.29% drugs were prescribed by generic name and 69.80 % drugs were from IAP list of essential medicines for children. Mean drug use was 6.23±3.34 per patient. Most common class of drug to which neonates were exposed was antibiotics (96.10%) and amikacin topped the list with exposure rate of 91.22%.Conclusions: The present study substantiates the need for implementation of institutional antibiotic policies, awareness regarding IAP list of essential drugs for children, prescription by generic name and rational drug use

The VIMOS Ultra Deep Survey: Lyα\alpha Emission and Stellar Populations of Star-Forming Galaxies at 2<z<2.5

The aim of this paper is to investigate spectral and photometric properties of 854 faint ($i_{AB}$<~25 mag) star-forming galaxies (SFGs) at 2<z<2.5 using the VIMOS Ultra-Deep Survey (VUDS) spectroscopic data and deep multi-wavelength photometric data in three extensively studied extragalactic fields (ECDFS, VVDS, COSMOS). These SFGs were targeted for spectroscopy based on their photometric redshifts. The VUDS spectra are used to measure the UV spectral slopes ($\beta$) as well as Ly$\alpha$ equivalent widths (EW). On average, the spectroscopically measured $\beta$ (-1.36$\pm$0.02), is comparable to the photometrically measured $\beta$ (-1.32$\pm$0.02), and has smaller measurement uncertainties. The positive correlation of $\beta$ with the Spectral Energy Distribution (SED)-based measurement of dust extinction, E$_{\rm s}$(B-V), emphasizes the importance of $\beta$ as an alternative dust indicator at high redshifts. To make a proper comparison, we divide these SFGs into three subgroups based on their rest-frame Ly$\alpha$ EW: SFGs with no Ly$\alpha$ emission (SFG$_{\rm N}$; EW$\le$0\AA), SFGs with Ly$\alpha$ emission (SFG$_{\rm L}$; EW$>$0\AA), and Ly$\alpha$ emitters (LAEs; EW$\ge$20\AA). The fraction of LAEs at these redshifts is $\sim$10%, which is consistent with previous observations. We compared best-fit SED-estimated stellar parameters of the SFG$_{\rm N}$, SFG$_{\rm L}$ and LAE samples. For the luminosities probed here ($\sim$L$^*$), we find that galaxies with and without Ly$\alpha$ in emission have small but significant differences in their SED-based properties. We find that LAEs have less dust, and lower star-formation rates (SFR) compared to non-LAEs. We also find that LAEs are less massive compared to non-LAEs, though the difference is smaller and less significant compared to the SFR and E$_{\rm s}$(B-V). [abridged]Comment: Accepted for publication in A&A, 19 pages, 10 figures, 1 tabl

Trial of Selective Early Treatment of Patent Ductus Arteriosus with Ibuprofen

BACKGROUND: The cyclooxygenase inhibitor ibuprofen may be used to treat patent ductus arteriosus (PDA) in preterm infants. Whether selective early treatment of large PDAs with ibuprofen would improve short-term outcomes is not known. METHODS: We conducted a multicenter, randomized, double-blind, placebo-controlled trial evaluating early treatment (≤72 hours after birth) with ibuprofen for a large PDA (diameter of ≥1.5 mm with pulsatile flow) in extremely preterm infants (born between 23 weeks 0 days' and 28 weeks 6 days' gestation). The primary outcome was a composite of death or moderate or severe bronchopulmonary dysplasia evaluated at 36 weeks of postmenstrual age. RESULTS: A total of 326 infants were assigned to receive ibuprofen and 327 to receive placebo; 324 and 322, respectively, had data available for outcome analyses. A primary-outcome event occurred in 220 of 318 infants (69.2%) in the ibuprofen group and 202 of 318 infants (63.5%) in the placebo group (adjusted risk ratio, 1.09; 95% confidence interval [CI], 0.98 to 1.20; P = 0.10). A total of 44 of 323 infants (13.6%) in the ibuprofen group and 33 of 321 infants (10.3%) in the placebo group died (adjusted risk ratio, 1.32; 95% CI, 0.92 to 1.90). Among the infants who survived to 36 weeks of postmenstrual age, moderate or severe bronchopulmonary dysplasia occurred in 176 of 274 (64.2%) in the ibuprofen group and 169 of 285 (59.3%) in the placebo group (adjusted risk ratio, 1.09; 95% CI, 0.96 to 1.23). Two unforeseeable serious adverse events occurred that were possibly related to ibuprofen. CONCLUSIONS: The risk of death or moderate or severe bronchopulmonary dysplasia at 36 weeks of postmenstrual age was not significantly lower among infants who received early treatment with ibuprofen than among those who received placebo. (Funded by the National Institute for Health Research Health Technology Assessment Programme; Baby-OSCAR ISRCTN Registry number, ISRCTN84264977.)