Comparative Effect of Agomelatine versus Escitalopram on Glycemic Control and Symptoms of Depression in Patients with Type 2 Diabetes Mellitus and Depression

Kumar K, Salman MT, Shukla V, Ahmad A, Verma V K, Rizvi D A and Kohli A: Comparative Effect of Agomelatine versus Escitalopram on Glycemic Control and Symptoms of Depression in Patients with Type 2 Diabetes Mellitus and Depression). Int J Pharm Sci Res 2015; 6(10): 1000-06.doi: 10.13040/IJPSR.0975-8232.6(10).1000-06.

Introduction: A bidirectional relationship exists between type 2 diabetes mellitus (T2DM) and depression. There is dearth of research on comparative suitability of different antidepressants in people with T2DM and depression.

 Aim: To compare the effects of Escitalopram and Agomelatine on glycemic control and symptoms of depression in patients with T2DM and depression. 

Materials and Methods: We conducted a randomized, open label, parallel groups study. Patients diagnosed as T2DM with moderate to severe depression (Hamilton Depression Rating Scale Score ≥ 14) were randomized to receive either Escitalopram (10 mg daily) or Agomelatine (25 mg daily) along with antidiabetic agents as per American Diabetes Association (ADA), 2013 guidelines. Depression was assessed using HDRS and Montgomery Asberg Depression Rating Scale (MADRS).

Results: Escitalopram group showed a significant reduction in FBG and HbA1Cvalues as compared to Agomelatine group at 1 and 2 months. HDRS scores of Escitalopram group were significantly lower than Agomelatine group at 1 and 2 months (8.85 ± 5.86 and15.6 ± 2.5 respectively). Similarly, Escitalopram group showed significantly lower MADRS scoresthan Agomelatine group at 1 and 2 months (13.6 ± 1.85 and 21.15 ± 2.34 respectively). 

Conclusion: Escitalopram seems to be better than Agomelatinefor glycemic control and ameliorating symptoms of depression in patients of T2DM and depression.

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Neuroprotective effects of Nigella sativa extracts during germination on central nervous system

Islam MH, Ahmad IZ, Salman MT. Neuroprotective effectsof Nigella sativa extracts during germination on central nervous system. Phcog Mag 2015;11:182-9.

Background: Nigella sativa Linn. which has many acclaimed medicinal properties is an indigenous herbaceous plant and belongs to the Ranunculaceae family, which grows in countries bordering the Mediterranean Sea, Pakistan and India. Objective: This study was designed to investigate the effects of N. sativa seed extracts of different germination phases on the central nervous system (CNS) responses in experimental animals. 

Materials and Methods: Anxiolytic, locomotor activity of extracts (1 g/kg of body weight) was evaluated in both stressed and unstressed animal models and antiepileptic effect was evaluated by maximal electroshock seizure model keeping diazepam (20 mg/kg) as a positive control. Antidepressant effect was evaluated by forced swim test and tail suspension test keeping imipramine (15 mg/kg) as a positive control. 

Results: All tested extracts of N. sativa during different phases of germination (especially 5th day germination phase) showed significant (P < 0.001) anxiolytic effect in comparison to control. Diazepam reduced locomotor activity in control (unstressed) rats but did not show affect in stressed rats while N. sativa extracts from germination phases significantly (P < 0.001) reduced locomotor activity in unstressed as well as stressed animals. All the extracts of N. sativa from different germination phases exhibited significant (P < 0.001) reduction in various phases of epileptic seizure on comparison with the reference standard (diazepam). During antidepressant test, N. sativa extracts exhibited a slight reduction in the immobility of rats. 

Conclusion: During germination, especially in 5th day germination extract, N. sativa showed significant CNS depressant activity as compared to whole seeds that possibly may be due higher content of secondary metabolites produced during germination.

Presurgical Antibiotic Prophylaxis Pattern In An Indian Tertiary Care Teaching Hospital

Authors: Rupinder Kaur, Mohd Tariq Salman, Narendra K. Gupta, Uma Gupta, Ali Ahmad, Vinod K. Verma

The present study was performed to study the antibiotic prophylaxis pattern in patients admitted in Surgery and Obstetrics and Gynaecology wards of a Tertiary Care Teaching hospital in North India. It was an observational, non interventional and analytical study used to evaluate the patients undergoing surgery through period of one and half years. Information concerning demographic data, type of surgery, and parameters of antibiotic therapy (selection of antibiotic, dose, route and duration of therapy as well as cost) was collected from case records of 400 patients. Third generation cephalosporins were the most commonly prescribed class of antibiotics. No consistency was noted in the timing of administration of prophylactic antimicrobials agents which were prescribed 30 minutes to 6 hours before surgery. The dose was not repeated during surgery. Majority of antibiotics were prescribed from Essential Medicines List. Surgical prophylaxis was inappropriate in terms of choice of antimicrobial agent, timing of administration as well as the total duration of prescription, in majority of the cases. Interventions are warranted to promote the development, dissemination and adoption of evidence based guidelines for antimicrobial prophylaxis.

JK Science Vol. 17 No. 2, April - June 2015

Atypical Thyrotoxicosis Relapse after Carbimazole Discontinuation: A Case Report with Pharmacological View

authors: Sharique Ahmad, Saeeda Wasim, Mohammed Tariq Salman, Mohammed Aqwam Siddiqui,
Nahid Shabnam, Pragya Khanna

A 15-year-old girl who presented with pyrexia of unknown origin of 3 month’s duration was evaluated and examined. She had two palpable axillary lymph nodes associated with mild hepatosplenomegaly and leukopenia (white blood cell count - 1700/cmm). Later was assessed for systemic infection, hematological malignancies and autoimmune disorders. All investigations showed no cause pertaining leukopenia and fever. There was moderate sized goiter in midline of neck with past history of hyperthyroidism associated with tachycardia, tremors, weight loss and thyroid hormone profi le suggesting hyperthyroidism, which prompted to think about thyrotoxicosis associated autoimmunity leading to lymphadenopathy, hepatosplenomegaly and leukopenia. Patient improved rapidly in 3 days after initiation of anti-thyroid drug. 

Atypical Thyrotoxicosis Relapse after Carbimazole Discontinuation

Challenges faced by males

Challenging Toxic Masculinity

Author Mel Rogers

As a group, men have certain advantages in society, the effects of which can be seen in a wide variety of ways— at all levels of government, for example, the overwhelming majority of positions are held by men, But while it's important to look at ways to redress these imbalances, it's also important to consider the ways in which this kind of society disadvantages and harms men.

The reality of American society is that there's a strict range in terms of what's considered to be acceptable masculine and feminine behavior, and it hurts men as well as women. For boys, this means growing up in a society where men aren't encouraged to show emotions, to ask for help, to back down from confrontation, or to back down from a dare. We teach boys that men don't show pain or fear, or talk about their emotions. As a results, many boys grow up believing that the only emotion they can show is anger, and that violence is an acceptable outlet for anger.

Statistics show that the overwhelming majority of violent crimes are committed by men: 99% of rapes, 98% of mass shootings, 86% of armed robberies, 85% of domestic violence injuries, 77% of aggravated assaults. And it's not because men are inherently criminals, or inherently violent. Many factors contribute to this gendered disparity, but it is at least in part because boys grow up in a society that places limitations on what's considered acceptable masculine behavior.

These expectations that are placed on boys and men are part of what's called toxic masculinity. This phrase refers to the fact that society's ideas and expectations for men and male behavior are often harmful to them, and can cause a great deal of pain. Learn more about this subject with this piece. 

Poor Quality of Sleep and its Relationship with Depression in First Year Medical Students. | . | Advances in Life Science and Technology

Poor Quality of Sleep and its Relationship with Depression in First Year Medical Students. | . | Advances in Life Science and Technology
Abdussalam , Mohammad Tariq Salman, Sushma Gupta, Mohit Trivedi, Mariam Farooqi

Introduction: High incidence of depression has been reported in undergraduate medical students. Sleep disturbance has been associated with depressive symptoms and higher body mass index (BMI). This study evaluated the relationship between sleep disturbance measured by Pittsburgh Sleep Quality Index ( PSQI) and Epworth sleepiness scale (ESS) with BMI and depression measured by Beck Depression Inventory (BDI)  in 1st year  medical students. Method: Following Institutional Ethics Committee approval, 1st year medical students who volunteered for study and gave written informed consent (n=73) were administered PSQI, ESS & BDI questionnaires after seven months of admission. Height and weight were measured by standard method. Scores of PSQI, BDI and BMI were calculated and their interrelationship was measured statically.  Results: Poor quality of sleep (PSQI score greater or equal to five) and depression (BDI score eleven or greater) was seen in majority of students (64 and 60 % respectively). BMI was not significantly correlated with PSQI, ESS or BDI scores .There was significant positive correlation between PSQI and BDI (Pearson correlation, r = 0.410, P < 0.001), higher the BDI scores higher the PSQI scores. Conclusions: Poor sleep quality and depressive symptoms were observed in majority of 1st year medical students. Sleep quality and depressive symptoms were interrelated. Prevention and treatment strategies should target sleep as a factor that can potentially influence the development and course of Depression leading to poor academic performance. There is an urgent need to address this issue.

Keywords: PSQI, BDI, Medical students, college students, adolescent health, freshman, freshers

In vivo Hepatoprotective Potential of Nigella sativa Extract Against Rifampicin Induced Sub-chronic Hepatotoxicity and Altered Redox Status

In vivo Hepatoprotective Potential of Nigella sativa Extract Against Rifampicin Induced Sub-chronic Hepatotoxicity and Altered Redox Status

Journal of Biologically Active Products from Nature

Volume 2, Issue 3, 2012

DOI:

10.1080/22311866.2012.10719124

Devendra Singh kushwah^a, Mohd Tariq Salman^a*, Hemant Kumar Singh^a, Ali Ahmad^a & V.K. verma^a 

pages 167-177

Despite the hepatotoxic effects of Rifampicin (RIF), its use is inevitable in the management of tuberculosis. No satisfactory treatment is available for prevention of this adverse effect. This study was undertaken to evaluate the protective effect of Nigella sativa extract (NSE) against Rifampicin induced sub-chronic hepatotoxicity. Male wistar rats were divided in 4 groups of 8 each and received vehicle, RIF (100 mg/ kg), RIF (100 mg/kg)+NSE (250 mg/kg) or RIF (100 mg/kg)+NSE (500 mg/kg) orally respectively for 28 days. Blood was withdrawn at day 14 and 28 for estimation of circulatory liver markers and anti-oxidant levels. At the end of the experiment histopathological study and estimation of SOD, CAT, GSH and LPO in liver samples was done. Pre-treatment of NSE produced significant hepatoprotection by decreasing the level of serum Alkaline phosphatase (ALP) (p< 0.01), Serum glutamic pyruvic transaminase (SGPT) (p< 0.001), Serum glutamic oxaloacetic transaminase (SGOT) (p<0 .001="" action="" advocate="" against="" along="" and="" another="" architecture="" bilirubin="" bridging="" by="" cat="" changes="" chronic="" degeneration="" degenerative="" drug="" extending="" fatty="" from="" further="" group="" groups="" gsh="" hepatocytes="" hepatoprotective="" hepatotoxicity.="" hepatoxicity.="" histopathology="" in="" increasing="" indicate="" induced="" infiltration="" is="" its="" kg="" level="" levels="" liver="" mda="" mg="" microvesicular="" mononuclear="" near="" necrosis="" needed="" normal="" nse="" of="" one="" p="" persisting="" portal="" possesses="" pre-treatment="" prevention="" regaining="" research="" results="" rif="" serum="" showed="" sod="" span="" steatosis.="" sub="" that="" the="" to="" tract.="" tract="" triditis="" use="" with="">

Black cumin seeds possess analgesic and anti-inflammatory activity comparable to indomethacin.

IN VIVO EVALUATION OF ANTI-INFLAMMATORY AND ANALGESIC ACTIVITIES OF NIGELLA SATIVA SEED DURING GERMINATION

MOHAMMAD HAYATUL ISLAM, IFFAT ZAREEN AHMAD AND MOHAMMAD TARIQ SALMAN

Objective: The medicinal values of Nigella sativa have been mentioned in ancient literature as useful in disorders of inflammation. The present study investigates the anti-inflammatory and analgesic activities of methanol extract of Nigella sativa seed during different phases of its germination on Wistar rats. Methods: Seeds of N. sativa were grown in vitro in glass petri plates using multiple folds of damp filter paper. Complete plantlet with two leaves was obtained in 11 days. The acute anti-inflammatory activity of N. sativa extracts during different phases of germination was measured plethysmographically using kaolin as inflammatory agent, analgesic activity was measured by hot plate method, keeping indomethacin (10mg/kg b.w) as reference standard in both tests.
Results: All tested extracts of N. sativa (1gm/kg b.w) during different phases of germination showed significant reduction in paw oedema in comparison to control (P<0 .001="" 5th="" all="" among="" analgesic="" and="" anti-inflammatory="" day="" during="" effect="" extract="" extracts.="" germination="" hot="" in="" increased="" of="" on="" p="" plate="" reaction="" showed="" significant="" test.="" test="" tested="" the="" time="">
Conclusion: It may be concluded that extracts of N. sativa possess enhanced anti-inflammatory and analgesic activities during germination as compared to seed extract. High metabolic activity and higher contents of secondary metabolites expressed during germination might be responsible for this activity.

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Black Cumin seed (Nigella sativa, Kalonji) protects against Paracetamol induced hepatotoxicity

Protective Effects of Ethanolic Extract of Nigella sativa Seed in Paracetamol Induced Acute Hepatotoxicity In vivo

D.S. Kushwah, M.T. Salman, P. Singh, V.K. Verma and A. Ahmad

Paracetamol overdose causes serious liver necrosis. Hepatoprotective activity of ethanolic extract of Nigella sativa in Paracetamol induced acute hepatotoxicity was investigated in rats. Fasted male Wistar rats were orally treated with Nigella sativa extract in graded doses for 5 days followed by Nigella sativa extract and paracetamol 3 g kg-1 on 6 and 7th day. Circulatory liver markers and reduced glutathione (GSH) levels were estimated and histopathological study of liver performed. Paracetamol caused a significant increase in serum alkaline phosphatase, glutamic oxaloacetic transaminase, glutamic pyruvic transaminase and total Bilirubin and a significant decrease in GSH compared to control. Nigella sativa pretreatment significantly prevented the increase in liver enzymes and total bilirubin and decrease in GSH level as compared to paracetamol group. Liver histopathology showed marked reduction in sinusoidal dilatation, midzonal necrosis, portal triaditis and occasional apoptosis in Nigella sativa extract treated groups as compared to group receiving only paracetamol. Nigella sativa extract possesses hepatoprotective action against paracetamol induced acute hepatoxicity. Further research is needed to advocate its prophylactic use for drug induced hepatotoxicity

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Recent new drug approvals

1. Icosapent ethyl (Vascepa)

• Indication: Adjunct to diet to reduce triglyceride (TG) levels in adult patients with severe (≥500mg/dL) hypertriglyceridemia. 
• Pharmacology: Icosapent ethyl is an ethyl ester of the omega-3 fatty acid eicosapentaenoic acid (EPA).
• Studies suggest that eicosapentaenoic acid reduces hepatic very low-density lipoprotein triglycerides (VLDL-TG) synthesis and/or secretion and enhances TG clearance from circulating VLDL particles.
• Potential mechanisms of action include 
• increased ß-oxidation;
•  inhibition of acyl-CoA:1,2-diacylglycerol acyl­transferase (DGAT); 
• decreased lipogenesis in the liver; and
•  increased plasma lipoprotein lipase activity.

2. Cabozantinib (Cometriq)

• Indication

  :

Treatment of progressive, metastatic medullary thyroid cancer.

• Pharmacology:

• Cabozantinib inhibits the tyrosine kinase activity of RET, MET, VEGFR-1, -2 and -3, KIT, TRKB, FLT-3, AXL, and TIE-2. 
• These receptor tyrosine kinases are involved in both normal cellular function and pathologic processes such as oncogenesis, metastasis, tumor angiogenesis, and maintenance of the tumor microenvironment.

Antibacterial activity of Nigella sativa seed in various germination phases on clinical bacterial strains isolated from human patients

See full text of paper on antimicrobial activity of N. sativa in various germination stages against clinical strains. Nigella sativa is an important spice and flavoring agent which is widely used in various European and Asian cuisines. It harbors an array of medicinal properties as shown by various researches. Germination is a phenomenon during which rapid changes in metabolic activities and the interconversions of metabolites take place. The objective of present study was to evaluate the antibacterial activity of N. sativa seed that are on various germination phases against clinical bacterial strains isolated from pus, urine, ascitic fluid and cerebrospinal fluid of various patients. The minimum inhibitory concentration (MIC) values were determined by using a modified macro-broth dilution technique. The agar well diffusion method was used to test the antimicrobial effects of N. sativa extracts. Some broad spectrum antibiotics were used as positive control. The phytochemical constituents of N. sativa seed were also studied in germination phases. The distilled methanolic extracts of N. sativa showed significant antimicrobial activity against tested clinical strains of Gram-positive Staphylococcus aureus and Gram-negative Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Proteus mirabilis bacteria. Results showed day-dependent and dose-dependent activity and a significant antimicrobial effect was observed as germination proceeded.

Bioethics in India

Knowledge, Attitudes and Practices of Bioethics among Doctors in a Tertiary Care Government Teaching Hospital in India
J Clinic Res Bioeth 2011, 2:118. 0:0, (2011)
http://dx.doi.org/10.4172/2155-9627.1000118

Drugs Update

New drugs approved for marketing in India during November-December 2011

Source: http://cdsco.nic.in

Diazinon Flea Drops Spot on Dogs 30.0% w/w	For dogs infected with fleas.
Cabazitaxel Injection 60mg / 1.5ml	In combination with prednisone for treatment of patients with hormone-refractory metastatic prostrate cancer previously treated with a docetaxel-containing treatment regimen.
Trifluridine Eye Drops 1% w/v	For the treatment of primary keratoconjunctivitis and recurrent epithelial keratitis due to herpes simplex viruses type 1 and 2.
Fosaprepitant (as Dimeglumine) for Injection 150mg.	1. Prevention of acute and delayed nausea and vomiting associated with highly emetogenic cisplatin based cancer chemotherapy in adults. 2. Prevention of nausea and vomiting associated with moderately emetogenic cancer chemotherapy in adults.
Abiraterone Acetate Tablets 250mg	In combination with prednisone for the treatment of patients with metastatic castration-resistant prostrate cancer who have received prior chemotherapy containing docetaxel.
Dabigatran Etexilate( as Mesilate) hard gelatin Capsules 75mg/110mg/150mg	For prevention of stroke, systemic embolism and reduction of vascular mortality in adult patients with atrial fibrillation.
Crizotinib  hard gelatin Capsules 200mg/250mg	For the treatment of patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) that is anaplastic lymphoma kinase (ALK) – positive as detected by an FDA-approved test.

Drugs  banned in India in 2011

Source: http://cdsco.nic.in

1.      Gatifloxacin

2.      Tegaserod

3.      Nimesulide for children below 12 years.

4.      Cisapride

5.      Phenyl propanolamine

6.      Human placental extract

7.      Sibutramine

8.      R-Sibutramine

FDA approvals in January 2012

Source: http://drugs.com

1.      Fentanyl Sublingual Spray

Opioid analgesic sublingual spray formulation indicated for the treatment of breakthrough cancer pain.

2.      Glucarpidase Injection

Carboxypeptidase enzyme indicated for the treatment of toxic plasma methotrexate levels in patients with delayed methotrexate clearance due to impaired renal function.

3.      Ciclesonide Nasal Aerosol

Corticosteroid nasal spray indicated for the treatment of symptoms associated with seasonal and perennial allergic rhinitis.

4.      Ingenol mebutate Topical Gel

Inducer of cell death indicated for the topical treatment of actinic keratosis.

5.      Axitinib Tablets        

Kinase inhibitor indicated for the treatment of advanced renal cell carcinoma

6.      Exenatide Extended-Release Injectable Suspension

Glucagon-like peptide-1 (GLP-1) receptor agonist indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes.

7.      Vismodegib Capsules

Hedgehog pathway inhibitor for the treatment of patients with advanced basal cell carcinoma (BCC).

8.      Ivacaftor Tablets

Cystic fibrosis transmembrane conductance regulator (CFTR) potentiator indicated for the treatment of cystic fibrosis (CF) in patients age 6 years and older who have a G551D mutation in the CFTR gene.

Top News From American Heart Association (AHA) 2010 scientific sessions

The American Heart Association (AHA) 2010 Scientific Sessions took place in Chicago, Illinois, November 13-17, 2010.
Key trials presented at the sessions include:

• ADVANCE: New LVAD equivalent to HeartMate II, nonrandomized study shows
• RAFT: CRT shows survival benefit for patients with class 2 and 3 HF who have low EF and wide QRS
• EMPHASIS-HF: Eplerenone shows large benefits in milder heart failure
• ASCEND HF: Nesiritide safe but of limited dyspnea benefit in acute HF
• ROCKET AF: Rivaroxaban noninferior to warfarin, but superiority analyses at odds
• CLOSURE I: No overall benefit, no reduction in stroke or TIA with PFO closure
• GRAVITAS: No benefit of doubling dose in clopidogrel nonresponders
• P-OM3: Omega-3 PUFA caps don't suppress paroxysmal AF in randomized trial
• BASKET-PROVE: DES as safe as bare-metal stents in larger coronary arteries, with less TVR 
• DEFINE: Large effects on LDL and HDL cholesterol with CETP inhibitor anacetrapib
• SYMPLICITY HTN: Catheter-based renal denervation reduces BP in patients with resistant hypertension
• ASCOT CRP: Analysis fuels debate over JUPITER-based CRP indication for statins
• ACT: No benefit of N-acetylcysteine to reduce contrast-induced nephropathy

Acceptability and safety profile of oral and sublingual misoprostol for uterine evacuation following early fetal demise

Background: It has been established that sublingual (SL) route of misoprostol has a great potential to be developed for medical abortion, but there is dearth of evidence to reveal satisfaction rate and safety profile among patients of oral and SL routes. Thus, this study was conducted to provide an insight into the acceptability and safety profile of the same.
Materials and Methods: A randomized controlled trial was carried out by giving 200 mg mifepristone orally, followed by administration of 600 ΅g misoprostol orally to 50 women and sublingually to 50 women. The primary endpoints of study were measurements of acceptability and safety profile parameters (average blood loss, nausea, vomiting, diarrhea, hot flushes, fever) of both the groups. The secondary endpoints of the study were number of doses required for complete abortion, success rate and the induction to evacuation interval in both the groups.
Results: SL route of administration was more acceptable than the oral route (P = 0.009). Average blood loss was higher in the oral group than in the SL group (P = 0.001). Amongst the side effects, 34% in the SL group and 52% in the oral group had nausea (P = 0.264), 22% in the SL group and 44% in the oral group had vomiting (P = 0.031), 48% in the SL group and 86% in the oral group had diarrhea (P < 0.05), hot flushes were presented by 24% in the SL group and 50% in the oral group (P < 0.05), fever was presented by 20% in the SL group and 44% in the oral group (P < 0.05), and the number of cases aborted with only one dose was higher (86%) in the SL group as compared to 63% in the oral group (P = 0.004). The evacuation (success) rates were 92% in the SL group and 84% in the oral group (P = 0.218) and the mean ± SD induction to evacuation intervals in the SL and oral groups were 5.6 ± 4.54 hours and 9.44 ± 5.61 hours, respectively (P = 0.0002).Conclusion: The SL route had fewer undesirable effects, was more satisfactory, required less number of doses and was more acceptable to the patient compared to the oral route.


Kushwah DS, Kushwah B, Salman MT, Verma VK. Acceptability and safety profile of oral and sublingual misoprostol for uterine evacuation following early fetal demise. Indian J Pharmacol [serial online] 2011 [cited 2011 May 24];43:306-10. Available from: http://www.ijp-online.com/text.asp?2011/43/3/306/81513

Free Business and Tech Magazines and eBooks

Promising Therapies in Diabetes Mellitus

Diabetes mellitus (DM) results from defects in insulin secretion (type 1) or insulin resistance (type 2). Insulin is used to manage type 1 DM, and oral hypoglycemic agents are used to manage type 2 DM. These therapies are inconsistent in maintaining glycemic control and cause some severe adverse effects such as undue weight gain and hypoglycemia. New and appropriate therapies are needed to overcome these problems. Drugs that are in the pipeline include oral insulins for type 1 DM and incretin mimetics, incretin enhancers, gastric inhibitory peptides, amylin analogues, peroxisome proliferator-activated receptor-α/γ ligands, sodium-dependent glucose transporter inhibitors, and fructose 1,6-bisphosphatase inhibitors for type 2 DM.

Free Business and Tech Magazines and eBooks

Measures of Obesity

There are several measures of obesity. Each  has its own strengths and limitations. The gold standard is dual-energy X-ray absorption (DEXA). Body mass index (BMI) is calculated as mass (kg) per height² (m²). Waist circumference is widely thought to be a better indicator of cardiovascular risk than BMI, although some studies have shown them to be equally predictive. Other measures include the waist-to-hip ratio (WHR) and the waist-to-hip-to-height index, which have both been forwarded as potentially better measures of obesity than BMI. Using measurements of hip circumference and height, the new body adiposity index (BAI) can be used to reflect percentage of body fat for adult men and women of differing ethnicities, without numerical correction or assessment of weight. BAI, calculated as (hip circumference/height^1.5)–18, is a good predictor of percent fat and works for men and women.  The BAI also yields the percentage of fat itself, rather than just a correlate (or index) of it, which is what the BMI does. Body fat percentage is estimated from three skinfold thicknesses (biceps, triceps, and subscapular).

Top Ten Health Stories of the Year 2010

The year 2010 saw a lot of ‘hustle and bustle’ in the medical circle. Here are the Top 10 stories as viewed by eMedinewS.

1. Overhauling of Medical Council of India: The major story of the year was the arrest of MCI President Dr. Ketan Desai, dissolution of the MCI; appointment of six out of seven Board of Governors; subsequent release of Dr. Ketan Desai on bail, common entrance exam for MBBS; reduction in forensic faculty requirement; increase in retirement age to seventy and the suspense behind 7th seat of Board of Governors etc.
2. Medical Council of India action against Indian Medical Association: MCI took action against the IMA President and Secretary for violation of MCI Ethics on the ground that IMA should not have endorsed Pepsi products. The IMA had to approach High Court to take a stay. The matter is now in the High Court. Is that a start of MCI actions against ethics violations? Will it act against the cut system?
3. Delhi Bug: A huge controversy arose when British Medical Journal broke a story about NDM1 bug being named after New Delhi. The medical circle in India said that it was unfair and was an attempt to sabotage the medical tourism in India. The new bug is a gram negative bacteria showing resistance to all present antibiotics. New Delhi metallo–beta–lactamase (NDM–1) is an enzyme that makes bacteria resistant to a broad range of beta–lactam antibiotics. These include the antibiotics of the carbapenem family, which are a mainstay for the treatment of antibiotic–resistant bacterial infections. The gene for NDM–1 is one member of a large gene family that encodes beta–lactamase enzymes called carbapenemases. Bacteria that produce carbapenemases are often referred to in the news media as “superbugs” because infections caused by them are difficult to treat. Such bacteria are usually only susceptible to polymyxins and tigecycline. NDM–1 was first detected in a Klebsiella pneumoniae isolate from a Swedish patient of Indian origin in 2008. It was later detected in bacteria in India, Pakistan, the United Kingdom, the United States, Canada, Japan and Brazil. The most common bacteria that make this enzyme are Gram negative such as Escherichia coli and K. pneumoniae, but the gene for NDM–1 can spread from one strain of bacteria to another by horizontal gene transfer.
4. H1N1 havoc: H1N1 created great havoc, but ultimately, proved to be a ‘much hyped’ virus with mortality even lower than the regular human flu virus. Most of the hospitals who had started special H1N1 virus wards, now do not have these wards.
5. Chikungunya epidemic: The latest epidemic in the North India was that of Chikungunya with patients presenting with fever, rash and joint pains. It complicated the pre–existing dengue epidemic in the society.
6. Dengue with a difference: This year dengue was different than other years, came with more GI symptoms, pancreas involvement, dengue hepatopathy and lot of skin reactions. The platelet count dropped to less than 10000 but most required no platelet transfusion.
7. Diabetes diagnosis: The year saw a new advancement where A1C is to be used for diagnosis of diabetes and not fasting sugar. An A1C >6.5% means diabetes.
8. New pill for HIV prevention: A new pill is now available for HIV prevention along with condoms. It is to be used before the act and continues for seven days. In a trial involving nearly 2,500 HIV–negative, but high risk, gay men in six countries, researchers found that a combination antiretroviral pill (tenofovir and emtricitabine) reduced the risk of HIV infection by 44%, compared with placebo. When scientists looked more carefully at the study volunteers who took the medication most faithfully, on a daily basis, they found that the risk of contracting HIV was even lower — 73% lower than the placebo group. More studies will need to confirm the benefit of antiretrovirals in the prevention of HIV, and public health experts warn that even if the results hold up, it would not replace the best method of prophylaxis: safe sex and consistent use of condoms. That’s because the way so–called pre–exposure prophylaxis, or PrEP, works is to load up high–risk people with HIV–disabling antiretroviral drugs before exposure to the virus, which allows the medication to hit HIV as early as possible. But the drugs do not work as a vaccine would, by priming the immune system to actually prevent infection.
9. National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) started in the country:At last, Govt. of India, Ministry of Health and Family Welfare has started the above program.
10. New drug for premature ejaculation: The year ended with the launch of an SOS drug for premature ejaculation. This will be breakthrough for the community. Premature ejaculation, the most common sexual problem apart from erectile dysfunction, has been often found to put marriages under strain. While the existing drugs, which are not specific to treat premature ejaculation, need to be taken regularly, the new pill can be popped just a few hours before intercourse. It works by altering levels of serotonin, a chemical in the brain. The drug, dapoxetine, comes from a family of drugs called selective serotonin reuptake inhibitors, which block the reabsorption of the neurotransmitter serotonin.

Key findings from American Heart Association (AHA) 2010 scientific sessions

The American Heart Association (AHA) 2010 Scientific Sessions took place in Chicago, Illinois, November 13-17, 2010.

Key trials presented at the sessions include:

• ADVANCE: New LVAD equivalent to HeartMate II, nonrandomized study shows
• RAFT: CRT shows survival benefit for patients with class 2 and 3 HF who have low EF and wide QRS
• EMPHASIS-HF: Eplerenone shows large benefits in milder heart failure
• ASCEND HF: Nesiritide safe but of limited dyspnea benefit in acute HF
• ROCKET AF: Rivaroxaban noninferior to warfarin, but superiority analyses at odds
• CLOSURE I: No overall benefit, no reduction in stroke or TIA with PFO closure
• GRAVITAS: No benefit of doubling dose in clopidogrel nonresponders
• P-OM3: Omega-3 PUFA caps don't suppress paroxysmal AF in randomized trial
• BASKET-PROVE: DES as safe as bare-metal stents in larger coronary arteries, with less TVR 
• DEFINE: Large effects on LDL and HDL cholesterol with CETP inhibitor anacetrapib
• SYMPLICITY HTN: Catheter-based renal denervation reduces BP in patients with resistant hypertension
• ASCOT CRP: Analysis fuels debate over JUPITER-based CRP indication for statins
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Some drug interactions

Questioner: Edie
Question: My 85 year old mother has been taking some form of sleeping pills for the past 50 years the last 20 years at least has been restoral she is prescribed 30 mg. (there is times she binges and takes 2 pills a night) She also takes Xanax, Tylenyol with Codeine.  Should someone her age (or any age) be taking this much medication.  She has recently started drinking again.  What are the dangers/risks of her taking this much medication?  I am working with her Dr. to take the administration of the medications out of her hands as she is getting more and more abusive.
Answer: There is risk of major interaction between Tylenol (acetaminophen) and alcohol. Consumption of alcohol may increase the risk of acetaminophen-induced hepatotoxicity. There is moderate risk of interaction between (1) alcohol with codeine, Xanax (alprazolan) and Restoril (Temazepam). CNS depressant effects of these drugs may be potentiated. (2) codeine, alprazolam and Temazepam with each other.  Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.
There is no need for her to take codeine, acetaminophen or alcohol. The are not helpful in getting to sleep. Stopping these three will dramatically reduce risk of adverse effects.