Cost implications of the use of basal insulin glargine in people with early dysglycemia: the ORIGIN trial

AIMS

The cost implications of the Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial were evaluated using a prespecified analysis plan.

METHODS

Purchasing power parity-adjusted country-specific costs were applied to consumed healthcare resources by participants from each country. Subgroup analyses were conducted on subgroups based on baseline metabolic status and diabetes duration.

RESULTS

The total undiscounted cost per participant in the insulin glargine arm was $13,491 ($13,080 to $14,254) versus $11,189 ($10,568 to $12,147) for standard care, an increase of $2303 ($1370 to $3235; p < 0.0001); the discounted increase was $2099 ($1276 to $2923; P < 0.0001). The greater number of mainly generic oral anti-diabetic agents in the standard group partially offset the higher cost of basal insulin glargine. As the trial progressed and the standard group required more anti-diabetic medications, the annual cost difference decreased, reaching $68 (-$160 to $295) in the last year. The subgroup whose baseline diabetes duration was ≥ 6 years achieved cost-savings during the trial.

CONCLUSIONS

From a global perspective basal insulin glargine use in ORIGIN incurred greater costs than standard care using older generic drugs. Nevertheless, the cost difference fell with time such that the intervention was cost-neutral by the last year.

Effect of TiO2 on the photocatalytic properties of bismuth oxide

Bi2-xTixO3+x/2 (x = 0.05, 0.10 and 0.15) photocatalysts are prepared by solid-state technique. The band gap of the prepared sample was estimated from the onset of UV-Vis absorption spectra. The photocatalytic activities of as prepared samples are investigated under UV light irradiation for the decomposition of methyl orange (MO). It has been observed that the rate of decomposition of MO increased with increasing Ti4+ content in the present samples. Moreover, it shows better photocatalytic activity than undoped Bi2O3 and TiO2. The lowest band gap is observed for x = 0.15 sample, i.e. 2.55 eV, which also showed the highest photocatalytic activity in the present sample.

A reentrant phenomenon in magnetic and dielectric properties of Dy2BaNiO5 and an intriguing influence of external magnetic field

We report that the spin-chain compound Dy2BaNiO5, recently proven by us to exhibit magnetoelectric coupling below its Néel temperature (TN) of 58 K, exhibits strong frequency-dependent behavior in ac magnetic susceptibility and complex dielectric properties at low temperatures (<10 K), mimicking the 'reentrant' multiglass phenomenon. Such a behavior is not known among undoped compounds. A new finding in the field of multiferroics is that the characteristic magnetic feature at low temperatures moves towards higher temperatures in the presence of a magnetic field (H), whereas the corresponding dielectric feature shifts towards lower temperatures with H, unlike the situation near TN. This observation indicates that the alignment of spins by external magnetic fields tends to inhibit glassy-like slow electric-dipole dynamics, at least in this system, possibly arising from peculiarities in the magnetic structure.

Role of oxidative stress & antioxidant defence in ulcerative colitis patients from north India

BACKGROUND & OBJECTIVES

Oxidative stress contributes to severity of ulcerative colitis (UC) but the status of erythrocyte antioxidant defence remains unknown. The present study was aimed to study the role of oxidative stress and antioxidant levels in erythrocytes of UC patients from north India.

METHODS

A total of 81 adult UC patients and 85 age and sex matched apparently healthy controls were included in this study. Levels of lipid peroxidation (LPO), reduced glutathione (GSH), catalase and superoxide dismutase (SOD) were measured in erythrocytes.

RESULTS

Mean age of UC patients was 43.5 yr (range 18-64 yr) while in the control group this was 45.3 yr (range 20-64 yr). LPO, catalase and SOD levels in UC patients were significantly increased (P< 0.05) compared to healthy controls, while GSH levels in UC patients were significantly decreased (P< 0.05) compared to healthy controls Ulcerative colitis activity score (UCAI) was 157.4±27.6 in UC patients.

INTERPRETATION & CONCLUSIONS

Increased levels of LPO, SOD, catalase and a decreased level of GSH represent that oxidative stress plays a significant role in pathophysiology of UC. Further, the levels of LPO, GSH, catalase and SOD remained same during different UCAI.

Age-related macular degeneration and protective effect of HMG Co-A reductase inhibitors (statins): results from the National Health and Nutrition Examination Survey 2005-2008

PURPOSE

To determine the association of hydroxymethylglutarylcoenzyme A (HMG Co-A) reductase inhibitor (statin) use with the prevalence of age-related macular degeneration (AMD).

METHODS

This cross-sectional study included 5604 participants in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2008, ≥ 40 years of age, who were ascertained with regard to the diagnosis of AMD, the use of statins, and comorbidities and health-related behaviors such as smoking.

RESULTS

The mean age of participants denying or confirming a history of AMD was 68 (SEM 0.90) and 55 (SEM 0.36) years, respectively. Individuals 68 years of age or older who were classified as long-term users of statins had statistically significant less self-reported AMD (odds ratio (OR) 0.64, 95% confidence interval (CI) 0.49-0.84; P=0.002), after adjusting for potential confounding variables. No significant association was found between the prevalence of AMD and statin consumption among subjects between 40 and 67 years of age (OR 1.61, 95% CI 0.85-3.03; P=0.137).

CONCLUSIONS

Our results suggest a possible beneficial effect of statin intake for the prevention of AMD in individuals 68 years of age or older.

Association of the gonadotrophin-regulated testicular RNA helicase gene polymorphism with human male infertility

Gonadotrophin-regulated testicular RNA helicase (GRTH) plays an important role in RNA functions including nuclear transcription, pre-mRNA splicing and it regulates the translation of specific genes required for the progression of spermatogenesis. In this study, we analysed the association of GRTH gene IVS6+55G/T and c.852C/T polymorphisms with human male infertility. The study showed c.852 T allele was associated with an increased risk of male infertility (OR: 3.16, P = 0.008), whereas IVS6+55G/T allele conferred no risk. In Indian population, this is the first report on association of GRTH gene SNP polymorphism and male infertility and it underscores the significance of GRTH genotypes in modulating the risk of male infertility.

Pro-inflammatory and anti-inflammatory cytokine response in diarrhoea-predominant irritable bowel syndrome patients

BACKGROUND AND AIM

Irritable bowel syndrome (IBS) is referred to as a functional bowel disorder which is diagnosed by a number of characteristic symptoms (Rome II criteria) in the absence of detectable structural abnormalities. Low-grade inflammation of the intestine may be one of the reasons for development of diarrhoea-predominant IBS (IBS-D). We undertook this study to estimate the serum levels of pro-inflammatory (IL-6, TNF-alpha) and anti-inflammatory (IL-10) cytokines in IBS-D patients.

METHODS

A total of 108 diarrhoea patients were screened. Out of these only 63 adult IBS-D patients were enrolled. Age and sex matched 62 apparently healthy controls with no GI symptoms were also recruited. Out of 63 IBS-D patients, 37 were males while there were 32 males among the controls. The patients with IBS-D were diagnosed according to the Rome II criteria. Levels of serum IL-6, TNF-alpha and IL-10 were measured in all subjects using ELISA.

RESULTS

Mean (+/- SD) age of IBS-D patients (42.6 +/- 19.5 years) was comparable (p = 0.64) to that of controls (43.5 +/- 18.7 years). The mean (+/- SD) levels of IL-6 in IBS-D patients (32.2 +/- 12.01 pg/ml) was significantly higher (p < 0.001) than in controls (7.48 +/- 2.55 pg/ml). The levels of TNF-alpha in IBS-D patients (16.3 +/- 5.2 pg/ml) were also significantly higher (p < 0.05) than in controls (7.94 +/- 2.19 pg/ml). There was no significant difference in the serum levels of IL-10 (p = 0.23) between IBS-D patients (5.75 +/- 2.1 pg/ml) and controls (5.84 +/- 1.9 pg/ml).

CONCLUSION

Our results indicate that mild inflammation is involved in IBS-D patients as proinflammatory cytokines were increased although no difference in anti-inflammatory cytokine was observed.

Small intestinal bacterial overgrowth and orocecal transit time in patients of inflammatory bowel disease

BACKGROUND

Inflammatory bowel disease (IBD) consists of Ulcerative colitis (UC) and Crohn's disease (CD). These two conditions share many common features-diarrhea, bloody stools, weight loss, abdominal pain, fever and fatigue. Small intestinal bacterial overgrowth (SIBO) is frequent in patients with CD but it has not been studied in UC Indian patients.

AIM

The study was planned to measure orocecal transit time (OCTT) and SIBO in UC and CD patients.

METHODS

One hundred thirty-seven patients of IBD (95 UC and 42 CD) and 115 healthy controls were enrolled. OCTT and SIBO were measured by lactulose and glucose hydrogen breath test respectively. Concentration of hydrogen and methane were measured by SC microlyser from Quintron, USA.

RESULTS

Mean±standard deviation (SD) of OCTT in patients of IBD was significantly higher as compared to controls. Furthermore, OCTT was significantly higher in CD patients as compared to UC patients. It was also observed that occurrence of SIBO was significantly higher in IBD patients as compared to controls. The occurrence of SIBO in CD (45.2%) was significantly higher as compared to patients in UC (17.8%) group. Percentage of methane positive IBD patients (2.9%) was significantly lower as compared to methane positive controls (24.4%).

CONCLUSION

OCTT was significantly delayed in IBD patients as compared to controls and in CD patients as compared to UC patients. OCTT was significantly higher in SIBO positive IBD patients as compared to SIBO negative patients. Thus, we can suggest that delayed OCTT would have been the cause of increased SIBO in these patients.

Paraphenylenediamine poisoning

Hair dye containing paraphenylenediamine (PPD) is widely used in India because of its free availability and low cost. PPD produces local as well as systemic toxic effects when applied topically and/or ingested. It is highly toxic when taken by mouth and the outcome depends mainly on the dose taken. Important clinical manifestations are angioedema leading to dysphasia and respiratory distress, rhabdomyolysis, intravascular hemolysis, acute renal failure and hepatic necrosis. Myocarditis or fatal arrhythmia may also occur in PPD poisoning. Mainstay of management is early recognition and supportive measures as there is no specific antidote. We hereby report a young female who presented to us with features of angioedema, cardiac manifestation and hepatic dysfunction after ingesting PPD, which was treated successfully. In the absence of laboratory facilities, clinical features like angioedema and chocolate brown-colored urine could be suggestive of PPD poisoning.

Recurrent takotsubo cardiomyopathy : variable pattern of ventricular involvement

BACKGROUND

Takotsubo cardiomyopathy (TTC) is a transient left ventricular (LV) dysfunction that predominantly affects older women and has three main variants: apical, mid-ventricular, and basal. The recurrence rate of TTC is roughly around 11 % at 4-year follow-up. The pathogenesis of TTC is not clear and various theories have been proposed without concrete evidence.

CASE SERIES

We present a case series of 3 patients with recurrent TTC involving a different region of the ventricle during recurrence. All the patients presented with acute coronary syndrome (ACS) during the initial and recurrent episode. At the initial presentation, all the patients underwent selective coronary angiography (CA), transthoracic echocardiography (TTE), and cardiac magnetic resonance imaging (CMR) evaluation. However, the recurrent episodes were diagnosed without the need of CA, except in 1 patient who presented with ST-segment elevation myocardial infarction.

CONCLUSION

Recurrence of TTC is common and can be diagnosed without CA in some cases. During recurrence, the regional involvement of the left ventricle can vary in the same person. Variable regional involvement in the same patient rules out some of the proposed theories on the pathogenesis such as: beta-receptor gradient, wrap-around left anterior descending, and coronary artery spasm.

Magneto-elastic buckling of an Euler beam

We consider nonlinear elastic deformations of a magneto-elastic beam, using a combined experimental and theoretical approach. In the experiments, a beam had one end clamped with a magnet attached at its free end. When it was placed in an external magnetic field, it was susceptible to Euler beam buckling. However, the classic supercritical bifurcation associated with this buckling became subcritical when an attracting magnet was introduced in close proximity to the beam. To understand these experiments, we develop a model that couples the Euler elastica and dipole magnetic interactions with a uniform external field. The numerical model captures the observed behaviour well and shows that the supercritical magnetic field strength depends almost exclusively on elastic properties of the beam and strength of the permanent magnet, whereas the subcritical behaviour also depends on the separation distance between the attracting pair of magnets. We examine the bifurcation behaviour of the nonlinear system and show that for sufficiently small inter-magnet separation distances, other buckled states coexist with the fundamental mode.

Management of children with severe acute malnutrition: experience of Nutrition Rehabilitation Centers in Uttar Pradesh, India

OBJECTIVE

To assess the effectiveness of facility-based care for children with severe acute malnutrition (SAM) in Nutrition Rehabilitation Centers (NRC).

DESIGN

Review of data.

SETTING

12 NRCs in Uttar Pradesh, India.

PARTICIPANTS

Children admitted to NRCs (Jan 1, 2010 - Dec 31, 2011).

INTERVENTION

Detection and treatment of SAM with locally-adapted protocols.

OUTCOMES

Survival, default, discharge, and recovery rates.

RESULTS

54.6% of the total 1,229 children admitted were boys, 81.6% were in the age group 6-23 months old, 86% belonged to scheduled tribes, scheduled castes, or other backward castes, and 42% had edema or medical complications. Of the 1,181 program exits, 14 (1.2%) children died, 657 (47.2%) children defaulted, and 610 (51.7%) children were discharged The average (SD) weight gain was 12.1 (7.3)g/kg body weight/day and the average (SD) length of stay was 13.2 (5.6) days. 206 (46.8%) children were discharged after recovery (weight gain >15%) while 324 (53.2%) were discharged, non-recovered (weight gain <15%).

CONCLUSIONS

NRCs provide life-saving care for children with SAM; however, the protocols and therapeutic foods currently used need to be improved to ensure the full recovery of all children admitted.

Pituitary tuberculoma

Tuberculosis of pituitary gland is rare. We report a case of tuberculosis of pituitary gland in a 68-year-old male presented with holocranial headache of four months duration with left temporal hemianopia, with visual acuity of 6/6, without any localizing sign. Magnetic resonance imaging showed a sellar ring enhancing mass with suprasellar extension. Patient was taken up for surgery and put on antitubercular treatment and hormone replacement therapy.

BECN1 and BIM interactions with MCL-1 determine fludarabine resistance in leukemic B cells

The purine analog fludarabine (Fd) is an essential therapeutic for chronic lymphocytic leukemia (CLL). Innate or acquired resistance to Fd is a significant clinical problem and is largely mediated by increased expression of BCL-2 family members. The antiapoptotic BCL-2 family proteins inhibit both apoptosis and autophagy, therefore, downregulation of antiapoptotic BCL-2 family proteins and enhanced autophagy must coexist in cells dying in response to an apoptosis inducing therapeutic. However, in the drug-resistant cells that have an increased dependence on antiapoptotic proteins, whether autophagy is also inhibited remains unclear. Here, we examined the role of the BCL-2 family in regulating cell death and autophagy in leukemic cell lines and their derivative isogenic Fd-resistant (FdR) cells. MCL-1 degradation following Fd treatment freed the proapoptotic effectors BIM and BECN1, thus leading to cell death-associated autophagy in Fd-sensitive cells. However, in FdR cells, low BIM expression and BECN1 sequestration by MCL-1 prevented cell death. Consistently, in sensitive cells inhibition of apoptosis using siBIM and of both the early-phase autophagy nucleation steps by siBECN1, shATG7 or 3-methyladenine and the late-phase autophagy by shLAMP2, significantly reduced Fd-induced cell death. Paradoxically, FdR cells were addicted to basal autophagy, which was dependent on AMP-activated protein kinase (AMPK) but not BECN1. Moreover, in FdR cells, inhibition of autophagy by shLAMP2, but not siBECN1, enhanced cell death. The BH3-mimetic obatoclax released BIM and BECN1 from MCL-1 in Fd-sensitive and BECN1 from MCL-1 in FdR cells, and was effective at killing both Fd-sensitive and - resistant leukemic cells, including primary CLL cells. Therefore, a differential regulation of autophagy through BECN1 and AMPK signaling in Fd-sensitive and - resistant cells determines the different possible outcomes of autophagy inhibition. These findings suggest effective means to overcome Fd resistance by induction of BIM-dependent apoptosis and activation of BECN1-dependent autophagy.

High prevalence of human papillomavirus in esophageal squamous cell carcinoma: a study in paired samples

Esophageal squamous cell carcinoma (ESCC) is one of the common cancers with a poor prognosis. Incidences of human papillomavirus (HPV) infection range from 0 to 67% in different parts of the world. It has been frequently associated with high-risk HPV genotypes 16 and 18. The present study analyzes the prevalence of HPV infection in ESCC tumor and adjoining mucosa. Fresh tissue samples were obtained from ESCC tumor (group I) and adjoining mucosa (group II). Aliquots of DNA extracts were used. There were 23 patients with paired samples, 19 (83%) were male. HPV was positive in 20/23 (87%). Mean age of HPV positive in group I was 56.63 ± 6.96 and in group II 54.31 ± 7.13 years (P > 0.05). Majority had more than one viral type. HPV52 was the most common observed in 14 (61%) males and two (9%) females. Other common viruses were HPV55, 39, and 59. Smoking had a significant association with viral positivity. p63 and p16 oncoproteins correlated with degree of tumor differentiation but not with viral status. We documented high prevalence of high-risk HPV in ESCC. Our observations support the concept of persistent infection by an oncogenic HPV in cancer development. Our study highlights importance of documenting viral genotype in a defined geographic area.

Association of Interleukin 1 beta (IL-1B) gene polymorphism with early pregnancy loss risk in the North Indian population

C+3953T IL-1 B single-nucleotide polymorphism (SNP) genotyping was carried out in 140 unrelated early pregnancy loss (EPL) patients and in 198 fertile healthy control women and in chorionic villous samples by PCR-RFLP. In Indian population, this is the first report on association of IL-1 B SNP C+3953T polymorphism and EPL.

Neonatal sepsis in a tertiary care center in central India: microbiological profile, antimicrobial sensitivity pattern and outcome

INTRODUCTION

Neonatal mortality is increasingly recognized as an important global public health challenge. The spectrum of organisms that cause neonatal sepsis changes over time and varies from region to another. This study was conducted to determine the profile, antibiotic sensitivity pattern of bacterial isolates and outcome of confirmed neonatal sepsis in a tertiary care center.

STUDY DESIGN

All blood culture reports (n = 285), obtained during the study period (January 2012-September 2012) from the neonatal intensive care unit were analyzed.

RESULTS

Blood culture positivity rate was 22.1% (67/285). Seventy-three percent babies were outborn. Sixty-two percent babies were preterm and 80% were low birth weight. Thirty-six (57%) babies had early onset and remaining 27 (43%) had late onset neonatal sepsis. Blood culture isolates included Gram-negative bacilli (38/67, 56.7%), Gram-positive cocci (20/67, 29.8%), and Candida species (9/67, 13.4%). Staphylococci and Klebsiellae were the most common organisms responsible for infections, accounting for 25.4% (17/67) and 19.4% (13/67) of the isolates, respectively. All Gram positive isolates were sensitive to vancomycin, while 50-65% Gram negative isolates were sensitive to amikacin, ciprofloxacin and meropenem. Fifty-eight percent babies were discharged after completion of the antibiotic therapy, while 28.6% babies expired.

CONCLUSION

Multidrug resistant Gram negative isolates pose serious challenge, particularly in setting of emerging resistance to fluoroquinolones and carbepenems.

Knotted nasoenteric feeding tube in an infant

This is a case report, with review of the literature, of an infant in the neonatal intensive care unit (NICU) with the complication of a nasoenteric weighted feeding tube that assumed an overhand knot configuration. Knotting of the feeding tube is a rare occurrence related to the use of feeding tubes, and should be considered if the tube becomes nonfunctional, if there are clinical factors that might lead to displacement or malposition of the tube, or if there is excessive resistance or sudden onset of respiratory distress in association with attempted removal.

Inhibition of P. falciparum PFATP6 by curcumin and its derivatives: a bioinformatic study

Curcumin, a yellow spice has been shown to have many pathological uses including cancer and malaria. Recent experimental data have shown the inhibitory effect of curcumin and its two derivatives on the growth of Plasmodium falciparum in cell culture at low micromolar concentrations. Previous studies have suggested that Ca(2+)—ATPase (PfATP6) of P. falciparum is the target of many antimalarial drugs. However, the mechanism of inhibition of Ca(2+)—ATPase (PfATP6) is not known. In addition, it is not clear which specific isomeric form of curcumin is the most potent inhibitor of P. falciparum. Here we address this issue using bioinformatics tools. We generated a molecular model of Ca(2+)—ATPase (PfATP6) of P. falciparum and carried out molecular docking of all curcumin analogues of Zinc database of compounds (zinc.docking.org). Two molecular docking programs Glide and FlexX were used to determine binding feasibility of 351 analogues of curcumin. The comparison of docking parameters showed, more than 20 analogues are better ligands of PfATP6 than curcumin itself. . The binding of curcumin and its analogues to PFATP6 is mediated by both hydrophobic and polar interactions. Our results suggest that curcumin analogues are promising lead compounds for the development of antimalarial drugs.