Comparative evaluation of effects of combined oral anti-diabetic drugs (sulfonylurea plus pioglitazone and sulfonylurea plus metformin) over lipid parameters in type 2 diabetic patients

Background: Type 2 diabetes is associated with significant cardiovascular morbidity and mortality. Dyslipidemia, which affects almost 50% of patients with type 2 diabetes, is a cardiovascular risk factor characterized by elevated triglyceride levels, low high-density lipoprotein (HDL) cholesterol levels, and a preponderance of small, dense, low-density lipoprotein (LDL) particles. In addition to their glucose-lowering properties, oral anti-diabetic agents may have effects on lipid levels, especially triglycerides (TGs), HDL-C, LDL-C and total cholesterol levels.Methods: A prospective, open-labeled, randomized, parallel-group study was carried out in sizable number of patients (n=40) of established type 2 diabetes on combined oral anti-diabetic drugs, to investigate the effects of combined oral anti-diabetic on lipid parameters who was not receiving any hypolipidemic agent in addition.Results: Statistically significant mean reduction of triglycerides (TGs) of 25.1mg/dl (a 15.30% reduction from baseline value) and by 13.5 mg/dl (a 8.94% reduction from baseline value) in the SU (sulfonylurea) plus PIO (pioglitazone) and SU plus MET (metformin) group respectively. Present study also shows improvement in HDL cholesterol with SU plus PIO group by 13.18% which is almost twice that observed in SU plus MET group (8.06%). Present study also shows increase in LDL cholesterol with SU plus PIO group by 2.10%, is just opposite to SU plus MET group (4.92 % decrease). With SU plus PIO group, a statistically significant mean reduction of total cholesterol (TC) of 8.33mg/dl (5.14 % decrease) and by 7.62 mg/dl (4.28% decrease) in the SU plus MET group.Conclusions: Pioglitazone, a thiazolidinedione, has been shown to improve the lipid profile in patients with type 2 diabetes by increasing HDL-C levels and by decreasing triglyceride and total cholesterol levels in monotherapy or combination regimens with sulfonylurea. Metformin also has been shown to reduce LDL-C, TC, and TG levels and increase HDL-C levels in monotherapy and in combination regimens with sulfonylurea. In contrast, LDL cholesterol levels mild increase with pioglitazone monotherapy or with SU combination therapy. Thus the results of this study have demonstrated that SU plus pioglitazone is an effective combination regimen for patients insufficiently treated with SU monotherapy and may provide possible positive effects on other coronary risk factors/ dyslipidemias associated with the type 2 diabetes

A study of the effect of pre-radiation on healing of surgical wounds in the treatment of cancers of the head and neck

Background: Radiation therapy is an established modality in the treatment of head and neck cancer patients. It is used alone or in combination with surgery and chemotherapy. Although radiotherapy is useful to affect tumour death, it also exerts a deleterious effect on surrounding normal tissues. These effects are either acute or can manifest months or years after the treatment. The chronic wounds are a result of impaired wound healing. Compromised wound healing in irradiated tissues is a common and challenging clinical problem.Methods: A prospective observational study was done in a tertiary care teaching institute, Kolkata. The effect of radiation on surgery of cancers of head and neck was studied in 50 patients. The patients were divided into 2 groups of 25 each. The cases in the first group were irradiated prior to surgery and those on the second group were operated upon without any pre-radiation.Results: The highest incidence of wound complications in those patients who were operated upon within 2 weeks to 6 months of completion of RT (83.33%). Patients who had their blood Hb level at or above 11 gm% developed less number of wound complications (34.78%) as compared to those who had their blood Hb level between 8-11 gm% where complication rate was 48.15%. Those patients who had their oral cavity or pharynx opened during surgery had a much higher incidence of wound complications (54.54%) than whose oral cavity or pharynx were not interfered with (17.64%). Wound infection was 36% in the irradiated group and 12% in the non-irradiated group. Separation of wound edges or skin necrosis followed in 28% cases in the pre-radiated group and in 8% cases in the non-pre-radiated group.Conclusions: Radiotherapy is an integral modality of head and neck cancer therapy. Compromised wound healing is an important side effect of radiation therapy. All sorts of local complications as wound infection and necrosis, or ocutaneous fistulae, carotid artery perforation etc. are more pronounced in patients, who received prior radiotherapy. The complication of surgery after radiotherapy was found to be more pronounced between 2 weeks to 6 months in this series

Fermentation Studies for the Production of Dibutyl Phthalate, an Ester Bioactive Compound from Streptomyces albidoflavus MTCC 3662 Using Low-Priced Substrates

Abstract Attempts were made to evaluate the limiting nutritional parameters for production of dibutyl phthalate from Streptomyces albidoflavus MTCC 3662. The compound was found as a broad spectrum bioactive compound that acts as an antimetabolite of proline. Among the carbon and nitrogen sources tested in batch fermentation, glycerol (1.75%) and arginine (0.075%) supported best production. Arginine was replaced with sodium nitrate (0.025%) in the later studied due to its low cost, easy availability and as well as for good production capability. Other limiting nutrients, KH 2 PO 4 0.05%, NaCl 0.15% and MgSO 4 0.03% were found best for production. Effect of trace salts in the basal medium was also tested. Medium supplementation with casein hydrolysate, jaggery and yeast extract (0.001%, each) enhanced the production. Yield enhancement was also observed with Tween-80 (0.2µg/ml). Optimization of nutritional parameters imparts enhancement of production by 2.4 fold, using low cost substrates

Pregnancy outcome in women with gestational diabetes mellitus – a study from Eastern India

Introduction: Hyperglycemia first detected in pregnancy during screening test (often between 24-28 weeks) which does not meet the criteria for overt diabetes is called gestational diabetes mellitus (GDM). The International Association of Diabetes in Pregnancy Study group (IADPSG) recommended a new diagnostic criteria and protocol. Objective: To find out the prevalence, the need for insulin therapy, any short term maternal or fetal adverse effect of metformin therapy and maternal and fetal outcome of gestational diabetes mellitus in eastern part of India.  Methods: This observational study was conducted in a tertiary care semi urban private hospital from October 2018 to September 2019 for a period of twelve months. All women with normal fasting blood sugar at booking underwent oral glucose tolerance test between 24-28 weeks using 75 grams glucose drink. All GDM cases were managed by a multidisciplinary team. Pregnancies complicated with known type 1 or type 2 DM, preexisting hypertension and multiple pregnancies, were excluded from this study. Results: Out of 581 total deliveries 70 cases was GDM (12%). All cases received dietary modifications; metformin was needed in 62 (88.5%) and insulin required in 8 (11.5%) cases. 7 cases (10%) detected to have growth between 50 th and 90 th centile, interestingly 3(4.2%) cases growth was between 5th and 50th centile. 4 patients (5.7. %) delivered between 32 to 34 weeks and 15 (21.4%) between 34-36 weeks. 67 (95.7%) were delivered by caesarean section. There was no perinatal loss. Conclusion: This study indicates that majority of the patients with GDM can be managed without insulin. Metformin use has reduced the need for insulin therapy. Universal screening and proper vigilance can result in optimal outcom

Antibiotic usage pattern among inpatients of a paediatric ward in a tertiary care hospital in Eastern India

Background: The inevitable consequence of the widespread use of antimicrobial agents has been the emergence of antibiotic resistant pathogens. The rising incidence of bacterial resistance to common antibiotics, particularly, multi-drug resistant pneumococci, has prompted the need to use antibiotics judiciously in paediatric practice. The present study thus attempted to understand the antibiotic usage pattern among inpatients in a paediatric ward of a tertiary care hospital.Methods: A cross-sectional study was carried out for three months among the inpatients in the Department of Pediatrics in a tertiary care teaching hospital, Kolkata. The data regarding patient’s demographics and antibiotic use was collected daily in a pre-structured proforma. A descriptive statistical analysis of the data was performed.Results: A total of 124 patients were screened of which males and females represented 58.06% and 41.94% of the cases respectively with age group of 2-14 years presenting in majority. Among various causes of hospitalization, prevalence of respiratory disorders were maximum (25.81%), followed by hematological disorders (25%). Among various categories of prescribed drugs, antibiotics were found to be maximum (39.25%). Beta-lactum antibiotics were prescribed in majority (64.41%) with 56.91% being of cephalosporin group. The preferred route of administration was found to be parenteral (64%). 61.29 % cases were ordered laboratory investigations prior to the antimicrobial therapy initiation.  About 63.16% of the total samples for culture & sensitivity tested were reported positive. 39.58% of these positive cases showed resistance to empirical antibiotic therapy on lab reports.Conclusions: The study enables to obtain information on the antibiotic usage pattern in the pediatric population, focusing on prevalence of antibiotic misuse in our set-up and suggesting strategies of its minimization.

A study of brainstem auditory evoked responses in normal human subjects and normal variations as a function of stimulus and subject characteristics

Background: Brainstem auditory evoked responses (BAERs) are electrophysiological investigations have widespread clinical utility in neurology, audiology, neonatology and anesthesiology. BAER responses exhibit a normal variability due to various non-pathologic factors and age is one of the variables suggested to have considerable influence on normal BAE responses. Aging changes in the auditory system may significantly influence the interpretation of the auditory brainstem responses in comparison with younger adults. The present study was undertaken to study the different parameters of brainstem evoked responses in normal subjects and their variations with changing stimulus and subject characteristics among average Indian people.Methods: The test was conducted on 50 neuro-audiologically normal subjects (age-group of 5-60 years) selected from the OPD of ENT Department. Various audio-vestibular tests they were subjected to brainstem evoked response audiometry and responses were studied regarding various parameters of ABR details. An attempt was made to find out a normal range, normative values of various parameters and their variations with respect of their stimulus intensity and subject characteristics.Results: In the present study it was observed that absolute latencies of all waves decreased with increasing stimulus intensity. The mean absolute latency values of all waves were prolonged in male than those of female subjects. The mean inter-peak latency values of I-III, III-V and I-V were also prolonged in male. Effects of change in stimulus rate on absolute latencies of all waves were observed. There were increases in absolute latencies of all waves with increasing stimulus rate.Conclusions: Increased stimulus intensity caused decrease in latency values of all values. Wave V showed lesser degree of variation than the other components. Increase in stimulus rate caused increase in latency of all waves. Wave V showed lesser degree of variation than the other components. BERA can be performed with a wide range of stimulus variations. But what was clear in conclusion was that 60dB SL was the suitable intensity level. Also a wide variety of stimulus rate can be used in combination with either of the stimulus polarity. So any combination of stimulus intensity, rate and polarity may be used for clinical application of BERA. But essence is that there should be a prior adjustment of parameter norms according to subject and stimulus characteristics

Knowledge, attitudes and practice of adverse drug reaction monitoring among physicians in India

Background: Underreporting of ADRs still remains a major obstacle in the complete success of pharmacovigilance programs. In order to improve ADR monitoring, it is thus imperative to assess the current knowledge, attitude, and practices of doctors. Therefore, the primary objective of this study was to evaluate the knowledge, attitude, and practices (KAP) of the healthcare professionals about pharmacovigilance in various tertiary care government teaching hospital vis-a-vis private clinics in West Bengal.Methods: A cross sectional, questionnaire based survey was conducted among healthcare practitioners in several tertiary care government set-ups and private set-ups in the state of West Bengal (India). The study instrument was a pre-validated structured questionnaire designed to obtain information on the knowledge of the ADRs reporting, the attitudes towards the reporting, and the factors that in practice could hinder the reporting among the doctors.Results: About 89.62% public practitioners correctly spotted the WHO definition for pharmacovigilance, while 77.5% of the private practitioners did the same. Only 19.81% of the public practitioners documented a suspected ADR in any surveillance form, while there were only 3.75% private practitioners who documented it. About 59.43% of the physicians in government hospitals published an ADR case report in any medical journal, while 81.25% private practitioners did no.Conclusions: Study revealed lack of time, incentive less extra work load being major factors responsible for ADR underreporting. In order to improve ADR reporting, continuous medical education, training and proper sensitization of healthcare professionals can help combating the existing scenario and promising an improved tomorrow. The PvPI should be widely publicized in the visual and print media to make health professionals, as well as the general population at large aware of its presence and scope. Pharmacovigilance should be integrated in undergraduate and postgraduate medical courses

A study of histological changes of human placenta in rural population of eastern India

Background: Placenta is essential for maintenance of pregnancy and for promoting normal growth and development of fetus. It forms the morphological record of anatomical condition, intrauterine events and intrapartum events of gestation. Present study has been undertaken to record the data on the morphology and histology of placenta from mothers with hypertension and diabetes.Methods: This study showed several significant morphological and histological differences in the placenta of the mother with GDM and hypertensive placenta. The histological study of the placenta was done under microscope and number of syncytial knots, cytotrophoblastic cellular proliferation, fibrinoid necrosis, endothelial proliferation, calcified and hyalinised villous spots were noted per low power field in the diabetics and hypertensive group in comparison to control group.Results: All other parameters including area, thickness, diameter, and circumference of GDM placenta show a significant increase when compared with normal placenta. The gross anatomic features of placentae e.g infarcted areas, calcified areas and marginal insertion of the umbilical cord in the study group show significant increase in value (p>0.01) in diabetic and hypertensive groups when compared to that of the control or normal group.Conclusions: In present study we found that hypertensive placentae tend to be slightly smaller in size, weight, volume, area, thickness, diameter, circumference and feto-placental ratio than normal placentae but the parameters were found to be significantly greater than that of normal placentae in case of diabetic placentae. No significant differences were found in umbilical cord insertion. In normal pregnancy cases we found several histological findings which were increased in hypertensive and diabetic cases

"The fruits of independence": Satyajit Ray, Indian nationhood and the spectre of empire

Challenging the longstanding consensus that Satyajit Ray's work is largely free of ideological concerns and notable only for its humanistic richness, this article shows with reference to representations of British colonialism and Indian nationhood that Ray's films and stories are marked deeply and consistently by a distinctively Bengali variety of liberalism. Drawn from an ongoing biographical project, it commences with an overview of the nationalist milieu in which Ray grew up and emphasizes the preoccupation with colonialism and nationalism that marked his earliest unfilmed scripts. It then shows with case studies of Kanchanjangha (1962), Charulata (1964), First Class Kamra (First-Class Compartment, 1981), Pratidwandi (The Adversary, 1970), Shatranj ke Khilari (The Chess Players, 1977), Agantuk (The Stranger, 1991) and Robertsoner Ruby (Robertson's Ruby, 1992) how Ray's mature work continued to combine a strongly anti-colonial viewpoint with a shifting perspective on Indian nationhood and an unequivocal commitment to cultural cosmopolitanism. Analysing how Ray articulated his ideological positions through the quintessentially liberal device of complexly staged debates that were apparently free, but in fact closed by the scenarist/director on ideologically specific notes, this article concludes that Ray's reputation as an all-forgiving, ‘everybody-has-his-reasons’ humanist is based on simplistic or even tendentious readings of his work

A study of the effect of pre-radiation on healing of surgical wounds in the treatment of cancers of the head and neck

Background: Radiation therapy is an established modality in the treatment of head and neck cancer patients. It is used alone or in combination with surgery and chemotherapy. Although radiotherapy is useful to affect tumour death, it also exerts a deleterious effect on surrounding normal tissues. These effects are either acute or can manifest months or years after the treatment. The chronic wounds are a result of impaired wound healing. Compromised wound healing in irradiated tissues is a common and challenging clinical problem.Methods: A prospective observational study was done in a tertiary care teaching institute, Kolkata. The effect of radiation on surgery of cancers of head and neck was studied in 50 patients. The patients were divided into 2 groups of 25 each. The cases in the first group were irradiated prior to surgery and those on the second group were operated upon without any pre-radiation.Results: The highest incidence of wound complications in those patients who were operated upon within 2 weeks to 6 months of completion of RT (83.33%). Patients who had their blood Hb level at or above 11 gm% developed less number of wound complications (34.78%) as compared to those who had their blood Hb level between 8-11 gm% where complication rate was 48.15%. Those patients who had their oral cavity or pharynx opened during surgery had a much higher incidence of wound complications (54.54%) than whose oral cavity or pharynx were not interfered with (17.64%). Wound infection was 36% in the irradiated group and 12% in the non-irradiated group. Separation of wound edges or skin necrosis followed in 28% cases in the pre-radiated group and in 8% cases in the non-pre-radiated group.Conclusions: Radiotherapy is an integral modality of head and neck cancer therapy. Compromised wound healing is an important side effect of radiation therapy. All sorts of local complications as wound infection and necrosis, or ocutaneous fistulae, carotid artery perforation etc. are more pronounced in patients, who received prior radiotherapy. The complication of surgery after radiotherapy was found to be more pronounced between 2 weeks to 6 months in this series