Concept learning through question framing in Pharmacology

Background: Framing questions is a skill that requires expertise, knowledge, guidance and mentoring. It provides structure for deep learning, critical thinking and also promotes interaction and communication. Objective of this study is to analyze the question framing skills of fifth semester medical students on a ‘must know’ area in Pharmacology.Methods: A cross-sectional study was done in the Department of Pharmacology of a Government Medical College in Central Kerala. After briefing about the study, each of the participants was instructed to frame a question which were collected after 15 minutes. The data on different aspects of questions was analysed by Statistical Package for the Social Sciences 16.Results: Total 130 students, 79 females and 51 males participated in this study. 7 questions were incomplete and excluded from further analysis. From the rest 123 properly framed questions, 106(86.2%) were correct, 10(8.1%) were partially correct and 7(5.7%) incorrect with regards to the task assigned. In this study knowledge as well as application was tested in 50.4% questions, comprehension in 21.1% and application alone in 22.8%. The knowledge dimension tested was factual in 91(74%) and conceptual in 32(26%). Non-hierarchical classification showed 96(78%) convergent and 27(22%) divergent.Conclusions: In this study majority of the participants framed direct short answer questions which reflects factual knowledge indicating their lower-level cognition. Critical thinking and procurement of higher level cognition can be attained by directing them to frame the right question especially in medical education

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

Tuberous sclerosis complex: a case report

Tuberous Sclerosis Complex is an autosomal dominant phakomatosis. This neurocutaneous disorder usually presents with seizures, facial angiofibroma and mental retardation (Vogt’s triad). Here we report a case where a 25 year old gentleman presented with recurrent seizures, and was diagnosed to have tuberous sclerosis complex

Interferon Tau Alleviates Obesity-Induced Adipose Tissue Inflammation and Insulin Resistance by Regulating Macrophage Polarization

Chronic adipose tissue inflammation is a hallmark of obesity-induced insulin resistance and anti-inflammatory agents can benefit patients with obesity-associated syndromes. Currently available type I interferons for therapeutic immunomodulation are accompanied by high cytotoxicity and therefore in this study we have examined anti-inflammatory effects of interferon tau (IFNT), a member of the type I interferon family with low cellular toxicity even at high doses. Using a diet-induced obesity mouse model, we observed enhanced insulin sensitivity in obese mice administered IFNT compared to control mice, which was accompanied by a significant decrease in secretion of proinflammatory cytokines and elevated anti-inflammatory macrophages (M2) in adipose tissue. Further investigations revealed that IFNT is a potent regulator of macrophage activation that favors anti-inflammatory responses as evidenced by activation of associated surface antigens, production of anti-inflammatory cytokines, and activation of selective cell signaling pathways. Thus, our study demonstrates, for the first time, that IFNT can significantly mitigate obesity-associated systemic insulin resistance and tissue inflammation by controlling macrophage polarization, and thus IFNT can be a novel bio-therapeutic agent for treating obesity-associated syndromes and type 2 diabetes

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

Solution conformation of a tetradecapeptide stabilized by two di-n-propyl glycine residues

The solution conformation of a designed tetradecapeptide Boc-Val-Ala-Leu-Dpg-Val-Ala-Leu-Val-Ala-Leu-Dpg-Val-Ala-Leu-OMe (Dpg-14) containing two di-n-propyl glycine (Dpg) residues has been investigated by 1H NMR and circular dichroism in organic solvents. The peptide aggregates formed at a concentration of 3 mM in the apolar solvent CDCl3 were broken by the addition of 12% v/v of the more polar solvent DMSO-d6. Successive NiH ↔Ni+1H NOEs observed over the entire length of the sequence in this solvent mixture together with the observation of several characteristic medium-range NOEs support a major population of continuous helical conformations for Dpg-14. Majority of the observed coupling constants (3JNHCαH) also support φ values in the helical conformation. Circular dichroism spectra recorded in methanol and propan-2-ol give further support in favor of helical conformation for Dpg-14 and the stability of the helix at higher temperature

Lack of association of mirSNP rs11174811 in AVPR1A gene with arterial blood pressure and hypertension in South Indian population

Epigenetic regulation of arterial blood pressure mediated through mirSNPs in renin–angiotensin aldosterone system (RAAS) genes is a less explored hypothesis. Recently, the mirSNP rs11174811 in the 3’UTR of the AVPR1A gene was associated with higher arterial blood pressure in a large study population from the Study of Myocardial Infarctions Leiden (SMILE). The aim of the present study was to replicate the association of mirSNP rs11174811 with blood pressure outcomes and hypertension in a south Indian population. Four hundred and fifteen hypertensive cases and 416 normotensive controls were genotyped using a 5’ nuclease allelic discrimination assay. Logistic regression was used to test the association of mirSNP rs11174811 with the hypertension phenotype. Censored normal regression was used to test the association of the polymorphism with continuous blood pressure outcomes such as systolic and diastolic blood pressure. The mirSNP rs11174811 did not show any significant association with hypertension. The adjusted odds ratio was 1.02, with 95% CI of 0.72 to 1.45 (p = 0.909). The mean systolic and diastolic blood pressure values were not significantly different across the three genotypic groups, between hypertensives and normotensives, or when stratified by gender. Despite having a similar minor allele frequency (MAF) of 14.5% compared with the SMILE cohort, our results did not support an association of the mirSNP rs11174811 with the hypertension phenotype or with continuous blood pressure outcomes in the south Indian population