Expert eValuation of Efficacy and Rationality of Vildagliptin "EVER-Vilda": An Indian Perspective

Vildagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor is effective in reducing HbA1c levels in patients with type 2 diabetes (T2DM) when administered as monotherapy, dual or triple combination therapy. In India, Vildagliptin is commonly prescribed in T2DM patients because it reduces mean amplitude of glycemic excursion (MAGE), has lower risk of hypoglycemia and is weight neutral. Early combination therapy with vildagliptin and metformin is effective and well-tolerated in patients with T2DM, regardless of age or ethnicity. In view of already existing data on vildagliptin and the latest emerging clinical evidence, a group of endocrinologists, diabetologists and cardiologists convened for an expert group meeting to discuss the role and various combinations of vildagliptin in T2DM management. This practical document aims to guide Physicians and Specialists regarding the different available strengths and formulations of vildagliptin for the initiation and intensification of T2DM therapy.

Desmoplastic Ameloblastoma-A Case Report

Desmoplastic ameloblastoma (DA) is a rare variant of conventional ameloblastoma. It accounts for only 4%-13% of all ameloblastomas. DA was included in the World Health Organization Classification of Head and Neck Tumors (WHO-2005) as a variant of ameloblastoma with specific clinical, imaging, and histological features. The desmoplastic variant of ameloblastoma usually appears in the anterior and premolar regions as a mixed radiolucent and radiopaque lesion, sometimes resembling a benign fibro-osseous lesion.Ameloblastoma is a locally aggressive tumor that may cause recurrence and in rare cases, malignant transformation with repeated postsurgical recurrences. In this paper, we present a case of a 28-year-old female with swelling in the left upper jaw, a biopsy of which turned out to be DA.

Synthesis, Characterization and In Vitro Anticancer analysis of PEG capped Mn doped TiO2 nanoparticles against Hepatocellular carcinoma cells

In this study, Polyethylene Glycol (PEG) functionalized bare and Mn (2.0, 2.5, and 3.0 wt%) doped TiO2 nanoparticles were synthesised by sol-gel method and their anticancer efficacy was tested against...

Nasoruminal endoscopy of the rumen and reticulum in buffaloes (Bubalus bubalis) - a preliminary study

Twenty apparently healthy buffaloes were withdrawn of feed and water for 48 hours. Buffaloes were administered with fluids and were subjected to endoscopy every 12 hours. Olympus™ [GIF V70] flexible video endoscope was passed through the ventral nasal meatus, the pharynx, oesophagus and then into the reticulo-rumen in physically restrained buffaloes. The entire reticulum and part of the rumen could be visualized, when the animals were off feed and water for at least 48 hours and evacuations of rumen contents were done even after 48 hours of starvation to visualize the rumen in six buffaloes. The reticulum appeared light brown to pink coloured with honeycomb shape and the rumen appeared smooth, shiny pink, with numerous papillae throughout its surface. The procedure was well tolerated by all the buffaloes and satisfactory reticular and ruminal images could be obtained including biopsy.

A scale to measure the perception of veterinarians towards antimicrobial use and resistance

Veterinarians are the primary sourceof knowledge for farmers on how to use antibiotics responsibly in farm animals and how to decrease the risk of antibiotic resistance.Antimicrobial use and resistance is a multidimensional construct that lacks a specific measurement scale. This paper looks into the development of a scale to assess veterinarian perception about antimicrobial use and resistance. Following a thorough literature review, focus group interviews were conducted with selected key informant veterinarians to identify statements.An initial list of 80 statements reflecting positive and negative perception towards antimicrobial use and resistance was prepared. After editing, a final list of 70 statements were arrivedat. Descriptives of antimicrobial use and resistance, consensus regarding antimicrobial use and resistance indicators were arrived at through relevancy rating by a panel of 40 judges in the field of veterinary science based on which 35 statements were selected for item analysis. These 35 statements were subjected to item analysis among 60 veterinarians selected from a non-sample area. Out of the 60 veterinarians to whom the items were administered for item analysis, 15 veterinarians each with the lowest and highest scores were used as the two criterion groups to evaluate individual items. Individual items were selected based on‘t’ value whereinitems that had a t-value of more than 1.75 were selected and incorporated into the final schedule. Based on the calculated‘t’ values, 14 items were finally selected and includedin the final scale. Reliabilityof the scale was tested using Cronbach’s alpha coefficient of reliability test for which a Cronbachalpha of 0.852 was obtained indicating the internal consistancy of the scale.

Glucocrinology of Modern Sulfonylureas: Clinical Evidence and Practice-Based Opinion from an International Expert Group

AIM

The primary objective of this document is to develop practice-based expert group opinion on certain important but less discussed endocrine and metabolic effects of modern sulfonylureas (SUs) and their usage in the management of diabetes mellitus (DM).

BACKGROUND

Modern SUs may be considered a panacea in DM care with their beneficial extra-pancreatic, pleiotropic, and cardiovascular effects. Safe glycemic control with SUs could be achieved with appropriate patient selection, drug and dosage selection, and patient empowerment. Additionally, sulfonylureas also exhibit certain endocrine and metabolic effects, which could be considered beneficial in the management of DM. In this regard, a group of international clinical experts discussed the less known beneficial aspects of SUs and safe and smart prescription of modern SUs in DM care.

RESULTS

The concept of glucocrinology or the relationship of glycemia with the endocrine system was emphasized during the meetings. Clinical experts arrived at a consensus for the usage of modern SUs in the presence of other endocrine dysfunction and the impact of these drugs on endocrine health. The beneficial pleiotropic and cardiovascular effects of modern SUs were also discussed. The key discussion points were considered to develop clinical expert opinions for the use of modern SUs in persons with DM. Clinical expert opinions were developed for indications, pleiotropic benefits, cardiovascular outcomes, adherence, and safe use of modern SUs.

CONCLUSIONS

Appropriate clinical judgement coupled with a patient-centered approach is crucial to achieve the best outcome in persons with DM. Owing to their safety, efficacy, extra-pancreatic benefits including effects on endocrine and metabolic aspects, and low cost of therapy, modern SUs could be considered as drugs/agents of choice for the treatment of diabetes.

FUNDING

Sanofi India.

BE-SMART (Basal Early Strategies to Maximize HbA1c Reduction with Oral Therapy): Expert Opinion

The past three decades have seen a quadruple rise in the number of people affected by diabetes mellitus worldwide, with the disease being the ninth major cause of mortality. Type 2 diabetes mellitus (T2DM) often remains undiagnosed for several years due to its asymptomatic nature during the initial stages. In India, 70% of diagnosed diabetes cases remain uncontrolled. Current guidelines endorse the initiation of insulin early in the course of the disease, specifically in patients with HbA1c > 10%, as the use of oral agents alone is unlikely to achieve glycemic targets. Early insulin initiation and optimization of glycemic control using insulin titration algorithms and patient empowerment can facilitate the effective management of uncontrolled diabetes. Early glucose control has sustained benefits in people with diabetes. However, insulin initiation, dose adjustment, and the need to repeatedly assess blood glucose levels are often perplexing for both physicians and patients, and there are misconceptions and concerns regarding its use. Hence, an early transition to insulin and ideal intensification of treatment may aid in delaying the onset of diabetes complications. This opinion statement was formulated by an expert panel on the basis of existing guidelines, clinical experience, and economic and cultural contexts. The statement stresses the timely and appropriate use of basal insulin in T2DM. It focuses on the seven vital Ts-treatment initiation, timing of administration, transportation and storage, technique of administration, targets for titration, tablets, and tools for monitoring.Funding: Sanofi.

Euthymia in Diabetes: Clinical Evidence and Practice-Based Opinion from an International Expert Group

AIM

To develop an evidence-based expert group opinion on various types of euthymia associated with diabetes mellitus (DM) and its management.

BACKGROUND

Diabetes mellitus is a metabolic syndrome characterized by diverse biomedical and psychosocial features. Emotional health disturbances may lead to psychological and psychiatric dysfunction and may negatively influence glycemic control. Patients with DM may experience diabetes distress (DD) associated with burden of self-care, interpersonal issues, and emotional worries regarding the ability to cope with the illness. Euthymia or a state of positive mental health and psychological well-being should be considered a key outcome of diabetes care. Therefore, to achieve optimal outcomes, the consideration and measurement of psychological and psychiatric aspects along with glycemic levels are very important. A group of multidisciplinary clinical experts came together in an international meeting held in India to develop a workable concept for euthymia in diabetes care. A multidisciplinary approach was suggested to enhance the clinical outcomes and facilitate patient-centered care. During the meeting emphasis was given to the concept of a euthymia model in diabetes care. This model focuses on enhancement of self-care skills in diabetic patients and preventative health awareness among diabetes care providers. Euthymia also encompasses patient-provider communication to aid enhancement of coping skills.

RESULTS

After due discussions and extensive deliberations, the expert group provided several recommendations on implementing the concept of euthymia in DM care.

CONCLUSIONS

Introduction of the concept of euthymia in routine clinical practice is important to improve the quality of life and coping skills in patients with DM. A timely clinical assessment of psychological and psychiatric aspects along with patient-reported outcomes of diabetes contributes to overall health and well-being of affected individuals.

FUNDING

Sanofi India.

Consensus recommendations on exploring effective solutions for the rising cost of diabetes

Diabetes remains asymptomatic for a long period of time and its real burden gets noticed only once the complications set in. The number of individuals affected with the disease is also on the rise and more so in the low income countries. This scenario calls for urgent precautionary measures that need to be undertaken to equip ourselves to fight against this chronic disease. Individuals with financial constraints cannot afford to access even the basic treatment facilities and thus stands the most burdened. The International Diabetes Federation calls for 'Eyes on Diabetes' for the society to focus on early screening and early intervention. The rising cost of diabetes results from delayed and denied treatment. The panel discussion organized as a part of 4th Annual global diabetes convention of Jothydev's Professional Education Forum (JPEF, 2016) facilitated a platform to address diabetes as a serious health concern that needs to be given immediate priority by the policymakers as well as public and also to discuss about the feasible measures that will help achieve cost effective and affordable diabetes treatment. This was followed by in-depth literature search and finally a set of recommendations have been arrived at by the key opinion leaders to realize the dream of affordable diabetes care to all deserving individuals.

Therapeutic management of botulism in dairy cattle

AIM

To report the successful recovery of few dairy cattle from botulism in response to a modified therapeutic strategy.

MATERIALS AND METHODS

Seventy four naturally-occurring clinical cases of bovine botulism encountered during the period of 2012-2014 which were confirmed by mouse lethality test became material for this study. Affected animals were made into three groups based on the treatment modifications made during the course of study.

RESULTS AND DISCUSSION

With the modified therapeutic regimen, 17 animals recovered after 7-10 days of treatment. Clinical recovery took 2-30 days. Animals which were not given intravenous fluid and calcium recovered uneventfully. Cattle which were already treated with intravenous fluids, calcium borogluconate, and antibiotics did not recover. They were either died or slaughtered for salvage.

CONCLUSION

In cattle with botulism, administration of Vitamin AD3E and activated charcoal aid the clinical recovery. Besides, strictly avoiding anti-clostridial antibiotics, fluid therapy, and calcium therapy may facilitate the clinical recovery. Upon fluid administration, the pulmonary congestion existed in the ailing cattle might have worsened the anoxia. Administration of antibiotics like penicillin, aminoglycosides, and tetracyclines further worsen the neuronal paralysis by increasing the availability of botulinum neurotoxin. Cattle in early botulism have fair chances of recovery with the modified therapy.

Biosorption of aniline blue from aqueous solution using a novel biosorbent Zizyphus oenoplia seeds: Modeling studies

This article presents the feasibility for the removal of Aniline Blue dye (AB dye) from aqueous solution using a low cost biosorbent material Zizyphus oenoplia seeds. In this study, a batch mode experiments of the adsorption process were carried out as a function of pH, contact time, concentration of dye, adsorbent dosage and temperature. The experimental data were fitted with Freundlich and Langmuir isotherm equations. The feasibility of the isotherm was evaluated with dimensionless separation factor (RL). The kinetic data of sorption process are evaluated by using pseudo-first order and pseudo-second order equations. The mode of diffusion process was evaluated with intra-particle diffusion model. The thermodynamic parameters like change in enthalpy (ΔHº); change in entropy (ΔSº) and Gibbs free energy change (ΔGº) were calculated using Van’t Hoff plot. The biosorbent material was characterized with Fourier Transform Infrared (FTIR) spectroscopy and the morphology was identified with Scanning Electron Microscope (SEM) in before and after adsorption of AB dye.

Smoking cessation among diabetes patients: results of a pilot randomized controlled trial in Kerala, India

BACKGROUND

India has the second largest diabetic population (61 million) and tobacco users (275 million) in the world. Data on smoking cessation among diabetic patients are limited in low and middle income countries. The objective of the study was to document the effectiveness of diabetic specific smoking cessation counseling by a non-doctor health professional in addition to a cessation advice to quit, delivered by doctors.

METHODS

In our parallel-group randomized controlled trial, we selected 224 adult diabetes patients aged 18 years or older who smoked in the last month, from two diabetes clinics in South India. Using a computer generated random sequence with block size four; the patients were randomized equally into intervention-1 and intervention-2 groups. Patients in both groups were asked and advised to quit smoking by a doctor and distributed diabetes specific education materials. The intervention-2 group received an additional diabetes specific 30 minutes counseling session using the 5As (Ask, Advise, Assess, Assist and Arrange), and 5 Rs (Relevance, Risks, Rewards, Roadblocks and Repetition) from a non-doctor health professional. Follow up data were available for 87.5% of patients at six months. The Quit Tobacco International Project is supported by a grant from the Fogarty International Centre of the US National Institutes of Health (RO1TW005969-01).The primary outcomes were quit rate (seven day smoking abstinence) and harm reduction (reduction of the number of cigarettes / bidis smoked per day > 50% of baseline use) at six months.

RESULTS

In the intention to treat analysis, the odds for quitting was 8.4 [95% confidence interval (CI): 4.1-17.1] for intervention-2 group compared to intervention-1 group. Even among high level smokers the odds of quitting was similar. The odds of harm reduction was 1.9 (CI: 0.8-4.1) for intervention-2 group compared to intervention-1 group.

CONCLUSIONS

The value addition of culturally sensitive diabetic specific cessation counseling sessions delivered by non-doctor health professional was an impressive and efficacious way of preventing smoking related diabetic complications.

TRIAL REGISTRATION

Clinical Trial Registry of India (CTRI/2012/01/002327).

A New Class of P(VdF-HFP)-CeO2-LiClO4-Based Composite Microporous Membrane Electrolytes for Li-Ion Batteries

Composite microporous membranes based on Poly (vinylidene fluoride–co-hexafluoro propylene) P(VdF-co-HFP)-CeO2were prepared by phase inversion and preferential polymer dissolution process. It was then immersed in 1M LiClO4-EC/DMC (v/v=1:1) electrolyte solution to obtain their corresponding composite microporous membrane electrolytes. For comparison, composite membrane electrolytes were also prepared by conventional phase inversion method. The surface morphology of composite membranes obtained by both methods was examined by FE-SEM analysis, and their thermal behaviour was investigated by DSC analysis. It was observed that the preferential polymer dissolution composite membrane electrolytes (PDCMEs) had better properties, such as higher porosity, electrolyte uptake (216 wt%), ionic conductivity (3.84 mS⋅cm−1) and good electrochemical stability (4.9 V), than the phase inversion composite membrane electrolytes (PICMEs). As a result, a cell fabricated with PDCME in between mesocarbon microbead (MCMB) anode and LiCoO2cathode had better cycling performance than a cell fabricated with PICME.

High prevalence of type 2 diabetes mellitus and other metabolic disorders in rural Central Kerala

BACKGROUND

Within India, inter-regional disparities in burden of type 2 diabetes mellitus (DM) are expected because of varying lifestyles and demographic patterns. Hence, to estimate the prevalence of DM and impaired fasting glycaemia (IFG), and to explore the predictors of DM, a study was conducted in rural Kerala.

METHODS

In 2007, a cross-sectional survey was conducted among 1990 adults (women: 1149; men: 841) of two Panchayat Wards in Venmony Panchayat, Chengannur Taluk, Kerala, India. Those who were already on drugs for DM and/or having fasting plasma glucose (FBS) > or = 126 mg/dL were considered as DMs; those with FBS 100 -125 mg/dL were considered as IFGs. Pearson's Chi-Square test and multiple logistic regression were used for statistical analysis.

RESULTS

The response rate was 82.7 percent. The crude- and age-adjusted prevalence of DM was 14.6 percent and 12.5 percent respectively, and that of IFG was 5.1 percent and 4.6 percent respectively. The crude prevalence of hypertension (BP > or = 140/90), hypercholesterolemia (fasting total serum cholesterol > or = 200 mg/dL) and central obesity (WHR > or = 0.80 [women] and > or = 0.90 [men]) was 36.1 percent, 37.0 percent and 85.6 percent respectively. Adjusted for age and sex, DM was significantly associated with positive family history of DM [Odds ratio: 2.81; 95% CI (2.04-3.86)], high socioeconomic status [1.43; (1.04-1.95)], central obesity [3.91; (1.77-8.64)], hypercholesterolemia [1.93; (1.42-2.62)], and hypertension [1.71; (1.24-2.37)].

CONCLUSION

High prevalence of DM even in rural community validates the pandemic trend of DM. The coexistence of other non-communicable diseases amplifies the burden of DM. The impact of socioeconomic transition on the occurrence of DM needs to be explored further.