Poly(ether-sulfone)/MWCNT nanocomposites manufactured by powder metallurgy route and their dynamic mechanical properties

Dynamic mechanical properties of the poly(ether-sulfone) (PES)/multi-walled carbon nanotube (MWCNT) nanocomposites manufactured by powder metallurgical route was discussed for the first time. The structural investigation of the nanocomposites was analysed by x-ray diffraction. At room temperature, both storage modulus and microhardness of the nanocomposites increased by more than 60% while the strengthening efficiency at higher temperatures is several-folds compared to that of neat PES. The nanocomposites exhibited better damping behaviour compared to neat PES. The Cole-Cole plot indicated a good interaction between the PES and the MWCNT. Moreover, the coefficient of reinforcement decreased by 42% while the degree of entanglement increased.

High electromagnetic interference shielding of poly(ether-sulfone)/multi-walled carbon nanotube nanocomposites fabricated by an eco-friendly route

High-performance polymer matrix nanocomposites based on poly(ether-sulfone) (PES) matrix reinforced with multi-walled carbon nanotubes (MWCNTs) were fabricated using planetary ball mill followed by hot pressing. Their electrical properties and the electromagnetic interference shielding effectiveness (EMI-SE) were investigated and discussed. A percolation threshold of about 0.65 vol% MWCNT was obtained. The electrical conductivity was increased by more than ten orders of magnitude at the percolation threshold and to approximately 0.01 S cm^-1 at 6.67 vol% (or 10 wt%) MWCNT. This is a significant improvement. The highest EMI-SE of about 29-30 dB (both in the X-band and K_u-band) was obtained for the 6.67 vol% MWCNT filled nanocomposites with a thickness of 0.9 mm. The specific EMI-SE of these nanocomposites were found to be higher than the literature values. The thermal stability and the char yield (measured at 900 °C) of the nanocomposites were found to be more than 470 °C and 40.6%, respectively.

Long-term follow-up of IPEX syndrome patients after different therapeutic strategies: An international multicenter retrospective study

Background

Immunodysregulation polyendocrinopathy enteropathy x-linked(IPEX) syndromeis a monogenic autoimmune disease caused by FOXP3 mutations. Because it is a rare disease, the natural history and response to treatments, including allogeneic hematopoietic stem cell transplantation (HSCT) and immunosuppression (IS), have not been thoroughly examined.

Objective

This analysis sought to evaluate disease onset, progression, and long-term outcome of the 2 main treatments in long-term IPEX survivors.

Methods

Clinical histories of 96 patients with a genetically proven IPEX syndrome were collected from 38 institutions worldwide and retrospectively analyzed. To investigate possible factors suitable to predict the outcome, an organ involvement (OI) scoring system was developed.

Results

We confirm neonatal onset with enteropathy, type 1 diabetes, and eczema. In addition, we found less common manifestations in delayed onset patients or during disease evolution. There is no correlation between the site of mutation and the disease course or outcome, and the same genotype can present with variable phenotypes. HSCT patients (n = 58) had a median follow-up of 2.7 years (range, 1 week-15 years). Patients receiving chronic IS (n = 34) had a median follow-up of 4 years (range, 2 months-25 years). The overall survival after HSCT was 73.2% (95% CI, 59.4-83.0) and after IS was 65.1% (95% CI, 62.8-95.8). The pretreatment OI score was the only significant predictor of overall survival after transplant (P = .035) but not under IS.

Conclusions

Patients receiving chronic IS were hampered by disease recurrence or complications, impacting long-term disease-free survival. When performed in patients with a low OI score, HSCT resulted in disease resolution with better quality of life, independent of age, donor source, or conditioning regimen.

Abstract P5-08-18: Treatment patterns and resource utilization among patients with HR+/HER2– metastatic breast cancer in a privately insured US population

Background

Hormone receptor positive (HR+)/HER2– tumors are the most common subtype among patients with metastatic breast cancer (MBC). Several newer therapeutic options have become available over the last decade, but little is known about the real-world treatment patterns and health care resource use (HCRU) in privately insured women with HR+/HER2– MBC.

Methods

An analysis of Truven MarketScan databases containing medical and drug utilization and productivity data from nearly 350 US payers was conducted. Patients aged 18-64 years with an ICD-9 diagnosis code of breast cancer along with ≥2 claims for secondary malignancy between 2007 and 2013 were selected. HR+/HER2– patients were identified based on receipt of endocrine therapy (ET) and absence of HER2-targeted therapies. Use of cancer-directed treatments following MBC diagnosis was analyzed. Treatment characteristics were examined by line of therapy (LOT). Average monthly all-cause and MBC-related HCRU were descriptively assessed.

Results

A total of 5,563 women with HR+/HER2– MBC (mean [SD] age, 54 [7.8] yrs) met the selection criteria. Overall, 97% of the total sample received ≥1 cancer-directed treatment. The most common treatment was ET (85%), followed by chemotherapy (CT) (70%), radiation (62%), and surgery (11%). Treatment patterns for CT alone and ET alone, including the top regimens by LOT, are presented in Table 1. Among those receiving a second LOT, nearly 44% switched to CT in the second line after having received ET alone in the first line. During the study follow-up, 56% of patients had ≥1 all-cause inpatient admission, 49% had ≥1 all-cause emergency department visit, and 9% had a hospice admission.

Table 1. Treatment patterns by LOT in patients with HR+/HER2- MBCLine 1 Line 2 Line 3 Line 4 n=5,179 (93%)* n=2,900 (52%)* n=1,608 (29%)* n=882 (16%)*  n (%) n (%) n (%) n (%)ET Alone3265 (63)ET Alone1468 (51)ET Alone534 (33)ET Alone217 (25)Anastrozole895 (27)Fulvestrant354 (24)Fulvestrant138 (26)Fulvestrant65 (30)Letrozole782 (24)Tamoxifen258 (18)Exemestane89 (17)Exemestane44 (20)Tamoxifen577 (18)Exemestane239 (16)Letrozole82 (15)Tamoxifen25 (12)Fulvestrant428 (13)Anastrozole239 (16)Tamoxifen82 (15)Letrozole20 (9)Exemestane299 (9)Letrozole197 (13)Anastrozole65 (12)Anastrozole14 (6)CT Alone1533 (30)CT Alone1057 (36)CT Alone818 (51)CT Alone505 (57)Paclitaxel413 (27)Capecitabine331 (31)Capecitabine265 (32)Capecitabine140 (28)Capecitabine286 (19)Paclitaxel224 (21)Paclitaxel156 (19)Paclitaxel93 (18)Cyclophosphamide-Doxorubicin → Taxane93 (6)Gemcitabine63 (6)Gemcitabine70 (9)Vinorelbine55 (11)Cyclophosphamide-Docetaxel82 (5)Docetaxel46 (4)Vinorelbine54 (7)Gemcitabine52 (10)Carboplatin-Paclitaxel77 (5)Vinorelbine46 (4)Doxorubicin45 (6)Doxorubicin34 (7)*Out of total 5,563 patients. Only top CT and ET regimens are listed.

Conclusions

A substantial decrease in the use of ET, with simultaneous increase in the use of CT, was observed as patients progressed to subsequent LOTs. Nearly half of those receiving ET alone in the first LOT switched to CT in the second LOT, suggesting a need for more effective non-CT treatments to bridge unmet therapeutic needs in this patient population.

Citation Format: Goyal RK, Carter GC, Nagar SN, Smyth EN, Price GL, Huang Y-J, Bromund JL, Li L, Schilder JM, Davis KL, Kaye JA. Treatment patterns and resource utilization among patients with HR+/HER2– metastatic breast cancer in a privately insured US population [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-08-18.

Abstract P5-08-19: Treatment patterns and resource utilization among elderly Medicare patients with HR+/HER2– metastatic breast cancer

Background

Therapeutic advances in metastatic breast cancer (MBC) over the last decade have led to several novel agents for the treatment of patients with hormone receptor positive (HR+)/HER2– MBC. However, current literature has little data on real-world treatment patterns and health care resource use, particularly among elderly women with HR+/HER2– MBC in the United States Medicare population.

Methods

A retrospective analysis of patients aged ≥66 years diagnosed with MBC during 2007 to 2011 was conducted using the SEER-Medicare database. Patients' HR and HER2 status was obtained from the SEER registry data. For patients with no HER2 data available, HER2− disease was determined based on the absence of HER2-targeted therapies within 12 months of diagnosis. Health care utilization and treatment patterns after MBC diagnosis were examined. Use of cancer-directed therapies, including chemotherapy (CT) and endocrine therapy (ET), were descriptively analyzed by line of therapy (LOT).

Results

A total of 3,622 women with HR+/HER2– MBC (mean [SD] age, 77 [7.3] years) were included. Over 90% of women received ≥1 cancer-directed treatment after MBC diagnosis, with ET being the most common (77%), followed by CT (50%), radiation (48%), and surgery (19%). Treatment with ET alone trended downward across LOTs, from 74% in the first LOT to 36% in the fourth LOT, with a corresponding increase in treatment with CT alone from 21% to 46% (Table 1). Among those receiving a second LOT, nearly 26% switched to CT in the second line after having received ET alone in the first line.

Table 1. Pharmaceutical treatment patterns by line of therapy among patients diagnosed with HR+/HER2– MBC (n = 3622)First-Line Second-Line Third-Line Fourth-Line N = 2,981 (82%)* N = 1,449 (40%)* N = 750 (21%)* N = 356 (10%)*  n (%) n (%) n (%) n (%)ET Alone2215 (74)ET Alone973 (67)ET Alone381 (51)ET Alone127 (36)Anastrozole893 (40)Fulvestrant282 (29)Fulvestrant99 (26)Fulvestrant38 (30)Letrozole602 (27)Exemestane190 (20)Exemestane76 (20)Tamoxifen27 (21)Tamoxifen253 (11)Anastrozole162 (17)Tamoxifen71 (19)Exemestane25 (20)Fulvestrant243 (11)Tamoxifen152 (16)Anastrozole46 (12)Anastrozole13 (10)Exemestane156 (7)Letrozole107 (11)Letrozole38 (10)Exemestane-FulvestrantN/ACT Alone639 (21)CT Alone336 (23)CT Alone264 (35)CT Alone165 (46)Paclitaxel136 (21)Paclitaxel76 (23)Paclitaxel78 (30)Paclitaxel39 (24)Cyclophosphamide-Docetaxel72 (11)Gemcitabine57 (17)Gemcitabine46 (17)Gemcitabine32 (19)Cyclophosphamide-Doxorubicin → Taxane69 (11)Docetaxel28 (8)Vinorelbine31 (12)Vinorelbine21 (13)Carboplatin-Paclitaxel43 (7)Vinorelbine27 (8)Docetaxel22 (8)Doxorubicin17 (10)Docetaxel39 (6)Doxorubicin21 (6)Doxorubicin21 (8)DocetaxelN/AN/A = not available (in accordance with the SEER-Medicare data use agreement, data for categories with cell size less than 11 are suppressed). *Out of total 3,622 patients. Note: Percentages do not add up to 100% as only the top CT and ET regimens are listed.

Conclusions

ET was the most common first-line treatment for elderly women with HR+/HER2– MBC in this study period. However, as patients progressed from first to fourth LOT, the proportion of patients treated with ET decreased substantially.

Citation Format: Goyal RK, Carter GC, Nagar SN, Smyth EN, Price GL, Huang Y-J, Bromund JL, Li L, Schilder JM, Davis KL, Kaye JA. Treatment patterns and resource utilization among elderly Medicare patients with HR+/HER2– metastatic breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-08-19.

Senior Loken Syndrome

Senior Loken Syndrome (SLS) is a rare genetic disorder having juvenile nephronophthisis and retinal degeneration progressing to blindness and end stage renal disease. The present case report is about two sisters who presented with decreased visual acuity and end stage renal disease. Both had decreased vision, pallor, deranged renal function test and chronic malnutrition. Investigations revealed anaemia, uraemia, raised creatinine, low Glomerular Filteration Rate (GFR). Ophthalmology examination revealed nystagmus, retinal examination depicted pale optic disc and pigmentary changes in the retina. Renal ultrasound showed grade III renal parenchymal changes and bilateral cortico-medullary cysts. These cases are presented to highlight the importance of timely recognition of renal derangement in patients with retinal disease to delay end stage renal disease.

Novel HLA-DP region susceptibility loci associated with severe acute GvHD

Despite HLA allele matching, significant acute GvHD remains a major barrier to successful unrelated donor BMT. We conducted a genome-wide association study (GWAS) to identify recipient and donor genes associated with the risk of acute GvHD. A case-control design (grade III-IV versus no acute GvHD) and pooled GWA approach was used to study European-American recipients with hematological malignancies who received myeloablative conditioning non-T-cell-depleted first transplantation from HLA-A, -B, -C, -DRB1, -DQB1 allele level (10/10) matched unrelated donors. DNA samples were divided into three pools and tested in triplicate using the Affymetrix Genome-wide SNP Array 6.0. We identified three novel susceptibility loci in the HLA-DP region of recipient genomes that were associated with III-IV acute GvHD (rs9277378, P=1.58E-09; rs9277542, P=1.548E-06 and rs9277341, P=7.718E-05). Of these three single nucleotide polymorphisms (SNPs), rs9277378 and rs9277542 are located in non-coding regions of the HLA-DPB1 gene and the two are in strong linkage disequilibrium with two other published SNPs associated with acute GvHD, rs2281389 and rs9277535. Eighteen other recipient SNPs and 3 donor SNPs with a high level of significance (8E-07 or lower) were found. Our report contributes to emerging data showing clinical significance of the HLA-DP region genetic markers beyond structural matching of DPB1 alleles.

Risk factors and timing of relapse after allogeneic transplantation in pediatric ALL: for whom and when should interventions be tested?

We previously showed that minimal residual disease (MRD) detection pre-hematopoietic cell transplant (HCT) and acute GvHD (aGvHD) independently predicted risk of relapse in pediatric ALL. In this study we further define risk by assessing timing of relapse and the effects of leukemia risk category and post-HCT MRD. By multivariate analysis, pre-HCT MRD <0.1% and aGvHD by day +55 were associated with decreased relapse and improved event-free survival (EFS). Intermediate leukemia risk status predicted decreased relapse, and improved EFS and overall survival (OS). Patients with pre-HCT MRD ⩾0.1% who did not develop aGvHD compared with those with MRD <0.1% who did develop aGvHD had much worse survival (2 years EFS 18% vs 71%; P=0.001, 2 years OS 46 vs 74%; P=0.04). Patients with pre-HCT MRD <0.1% who did not experience aGvHD had higher rates of relapse than those who did develop aGvHD (40% vs 13%; P= 0.008). Post-HCT MRD led to a substantial increase in relapse risk (HR=4.5, P<0.01). Patients at high risk of relapse can be defined after transplant using leukemia risk category, presence of MRD pre or post HCT, and occurrence of aGvHD. An optimal window to initiate intervention to prevent relapse occurs between day +55 and +200 after HCT.

Effect of aqueous extract of Tephrosia purpurea on cardiovascular complications and cataract associated with streptozotocin-induced diabetes in rats

Tephrosia purpurea has been reported to possess antidiabetic activity, however, its effects on cardiovascular complications and cataract associated with diabetes have not been studied. The objective of the present study was to investigate the effects of aqueous extract of Tephrosia purpurea on cardiovascular complications and cataract associated with streptozotocin-induced diabetes in rats. Sprague Dawley rats of either sex were made diabetic with streptozotocin (45 mg/kg, i.v.). Treatment of aqueous extract of Tephrosia purpurea was given in the dose of 300 and 500 mg/kg/day, p.o for 8 weeks. Various hemodynamic (blood pressure, heart rate, +dp/dt, -dp/dt) and biochemical (serum glucose, cholesterol, triglycerides, creatinine, urea, lactate dehydrogenase and creatinine kinase) parameters were recorded after 8 weeks of the treatment. To evaluate cataract, various biochemical estimations were done in eye lens. Streptozotocin produced hyperglycemia; hypoinsulinemia; hyperlipidemia; increased blood pressure; increased creatinine, cardiac enzymes, reduction in heart rate and cardiac hypertrophy in rats and all these changes were prevented by the treatment with aqueous extract of Tephrosia purpurea in both the doses. Streptozotocin also produced decrease in soluble protein and reduced glutathione in lens of rats that was prevented by aqueous extract of Tephrosia purpurea. Our data suggest that aqueous extract of Tephrosia purpurea prevents not only the streptozotocin-induced metabolic abnormalities but also cardiovascular complications as well as reduce the risk of development of cataract.

Fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures

PURPOSE

To review the outcomes of fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures.

METHODS

44 men and 28 women aged 17 to 50 years with neglected femoral neck fractures of the subcapital (n=12), transcervical (n=57), or basal (n=3) types underwent closed (n=39) or open (n=33) reduction and fixation with a single cancellous screw with double fibular strut grafts (n=24) or fixation with double cancellous screws with a single fibular strut graft (n=48). The mean time from injury to surgery was 10 weeks; the delay was 22 to 35 days in 43 patients and >35 days in 29 patients. Double fibular strut grafts were used for 18 patients with longer delay and resorption of the femoral neck, and 18 patients with posterior comminution of the femoral neck. The outcome was assessed using the Harris hip score.

RESULTS

Patients were followed up for a mean of 3 years. The time to bone union was 3 to 4 months in 48 patients, 4 to 5 months in 15, and 5 to 6 months in 5; nonunion was noted in 4 patients. In 18 patients with resorption of the femoral neck, bone union took a longer time. The Harris hip score was excellent (90-100) in 30 patients, good (80-89) in 20, fair (70-79) in 15, and poor (<70) in 7. Of the latter, 4 had nonunion and 3 developed avascular necrosis of the femoral head; they had persistent pain and restriction of hip joint movement.

CONCLUSION

Fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures is cost-effective and technically less demanding, and associated with good outcomes.

Genomic evolution in Barrett's adenocarcinoma cells: critical roles of elevated hsRAD51, homologous recombination and Alu sequences in the genome

A prominent feature of most cancers including Barrett's adenocarcinoma (BAC) is genetic instability, which is associated with development and progression of disease. In this study, we investigated the role of recombinase (hsRAD51), a key component of homologous recombination (HR)/repair, in evolving genomic changes and growth of BAC cells. We show that the expression of RAD51 is elevated in BAC cell lines and tissue specimens, relative to normal cells. HR activity is also elevated and significantly correlates with RAD51 expression in BAC cells. The suppression of RAD51 expression, by short hairpin RNA (shRNA) specifically targeting this gene, significantly prevented BAC cells from acquiring genomic changes to either copy number or heterozygosity (P<0.02) in several independent experiments employing single-nucleotide polymorphism arrays. The reduction in copy-number changes, following shRNA treatment, was confirmed by Comparative Genome Hybridization analyses of the same DNA samples. Moreover, the chromosomal distributions of mutations correlated strongly with frequencies and locations of Alu interspersed repetitive elements on individual chromosomes. We conclude that the hsRAD51 protein level is systematically elevated in BAC, contributes significantly to genomic evolution during serial propagation of these cells and correlates with disease progression. Alu sequences may serve as substrates for elevated HR during cell proliferation in vitro, as they have been reported to do during the evolution of species, and thus may provide additional targets for prevention or treatment of this disease.

Thermal, mechanical, and dielectric properties of high performance PEEK/AIN nanocomposites

The mechanical, thermal, and dielectric properties of novel high performance poly(ether-ether-ketone) (PEEK)/AIN nanocomposites were discussed. The stiffness of the nanocomposites was significantly improved in the glassy state as well as rubbery state. The coefficient of thermal expansion (CTE) of the nanocomposites was found substantially lower than that of pure PEEK. The glass transition temperature and melting temperature of the nanocomposites were increased significantly. The thermal stability and dielectric constant of the nanocomposites were increased slightly with AIN content. The significant improvement in the properties of the nanocomposites was attributed to the good adhesion between the AIN nanoparticles and the polymer matrix. The fabricated nanocomposite is very promising for use in electronics packaging substrate as an alternative substrate owing to its good thermal, mechanical and dielectric properties.

Glucagon like peptides-1 modulators as newer target for diabetes

Diabetes mellitus (DM) has been recognized as a growing world-wide epidemic by many health advocacy groups including the World Health Organization (WHO). DM affects about 6% of the North American population. A recent report estimated that 8.2% of adult population worldwide has impaired glucose tolerance. Current treatment approaches include diet, exercise, and a variety of pharmacological agents including insulin, biguanides, sulfonylureas and thiazolidinediones. New therapies are still needed to control metabolic abnormalities, and also to preserve beta-cell mass and to prevent loss of beta-cell function. In many cases monotherapy gradually fails to improve blood glucose control and combination therapy is employed. The long-term success of these treatments varies substantially. Thus, there is an imperative need for novel therapeutic approaches for glycemic control that can complement existing therapies and possibly attempt to preserve normal physiological response to meal intake. Glucagon-like peptide 1 (GLP-1) is a drug candidate which potentially fulfils these conditions. Glucoregulatory actions of GLP-1 include glucose-dependent enhancement of insulin secretion, inhibition of glucagon secretion, slowing of gastric emptying and reduction of food intake. GLP-1 is rapidly inactivated by amino peptidase, Dipeptidyl Peptidase-IV (DPP-IV) and the utility of DPP-IV inhibitors are also under investigation. There is a recent upsurge in the development of GLP-1 mimetics and DPP-IV inhibitors as potential antidiabetic agents. The present review summarizes the concepts of GLP-1 based therapy for type 2 diabetes and the current preclinical and clinical development in GLP-1 modulators.

Unreamed intramedullary nailing with oblique proximal and biplanar distal interlocking screws for proximal third tibial fractures

PURPOSE

To assess the outcome of unreamed intramedullary nailing through the lateralised entry point using oblique proximal and biplanar distal interlocking screws.

METHODS

15 men and 3 women aged 25 to 58 (mean, 37) years underwent unreamed intramedullary nailing with oblique proximal and biplanar distal interlocking screws for proximal third metaphyseal tibial fractures. The entry point was kept proximal to the tibial tuberosity and slightly lateral to midline. Proximal locking was at 45 degrees to the coronal and sagittal planes. Biplanar distal locking was in the coronal and sagittal planes.

RESULTS

16 patients had bone union within 20 (mean, 17; range, 14-27) weeks; 2 underwent dynamisation for delayed union. Three patients had valgus angulation of less than 5 degrees; 2 had a loss of terminal knee flexion; 3 had a loss of ankle dorsiflexion; and 3 had shortening of more than 0.5 cm. Functional outcomes were excellent in 13, good in 4, and fair in one patient. No patient endured neurovascular injury, compartment syndrome or implant failure.

CONCLUSION

Unreamed intramedullary nailing with oblique proximal and biplanar distal interlocking screws for proximal third tibial fractures was effective in preventing malalignment.

Current status of the regulation for medical devices

In the light of escalating use of medical devices, stringent regulatory standards are required to ensure that the devices are safe, well studied and have least adverse reactions. Recently introduced guidelines and the amendment in the law will provide adequate guidance for both the manufacturers and competent authorities to manage cases efficiently and appropriately. India has emerged as one of the leaders in pharmaceutical industry. Like many other amendments in Drugs and Cosmetics Act that have boosted the global confidence in pharmaceutical industry in India, guidelines for devices will encourage the much needed research in medical devices. Pharmacy personnel can certainly play an important role in the regulation of medical devices. Safety, risks, effectiveness and performance of the medial devices need to be well established and regulated properly. It is hoped that the guidelines are implemented and regulated properly with effective outcome.

Hepatoprotective activity of Hemidesmus indicus R. br. in rats

Treatment of rats with paracetamol and CCl4 produced a significant increase in the levels of serum glutamate pyruvate transaminase (SGPT), serum glutamate oxaloacetate transaminase (SGOT), alkaline phosphatase (ALP), total and direct bilirubin. Rats pretreated with methanolic extract of roots of H. indicus (100-500 mg/kg body weight, po) exhibited rise in the levels of these enzymes but it was significantly less as compared to those treated with paracetamol or CCl4 alone. The results of methanolic extract of H. indicus were comparable with the standard hepatoprotective agent silymarin (100 mg/kg). Maximum hepatoprotective effect was found to be at the dose of 250 mg/kg body weight in case of CCl4 induced hepatic damage while 500 mg/kg body weight in case of paracetamol induced hepatic damage. The results suggest that methanolic extract of H. indicus roots possesses a potential antihepatotoxic activity.

The safety and efficacy of combined phacoemulsification and trabeculectomy with releasable sutures

AIM

To evaluate the combined phacoemulsification with acrylic intraocular lens implantation and trabeculectomy with releasable sutures, without the use of antimetabolites, performed by one surgeon.

METHODS

A retrospective analysis was performed on 251 eyes of 198 patients after a combined phaco/trabeculectomy procedure, followed up for an average of 16 months for vision, intraocular pressure (IOP), and number of glaucoma medications. Cox proportional hazard regression analysis provided measures of relative risk (RR) or hazards ratios and 95% confidence intervals (CIs) associated with the occurrence of several conditions or complications of surgery.

RESULTS

Mean preoperative variables were best corrected vision, 0.6 (SD 0.4) logMAR (20/80 Snellen); IOP, 18.7 (4.9) mm Hg; and number of glaucoma medications, 1.7 (0.8). Mean postoperative results were best corrected vision, 0.2 (0.4) logMAR (20/32 Snellen); IOP, 15.1 (3.2) mm Hg; and number of glaucoma medications, 0.3 (0.6). Postoperatively, the mean decreases from baseline were 19.2% for IOP and 84.1% for number of glaucoma medications; 85% of eyes required fewer glaucoma medications and 78% of eyes were medication free, with IOP control. There were no significant operative or postoperative complications.

CONCLUSION

Combined phacoemulsification and trabeculectomy with releasable sutures, in the absence of antimetabolites, is a safe, effective, and stable alternative for patients with cataracts and glaucoma.

Nutritional attributes of agaricus Bisporus and Pleurotus sajor caju mushrooms

Agaricus bisporus and Pleurotus sajor caju mushrooms were procured from the Department of Plant Pathology, CCS Haryana Agricultural University, Hisar (INDIA) and analysed for various nutritional attributes. The fat and ash content were significantly higher in Agaricus bisporus, whereas, crude fibre and crude protein contents were significantly higher in Pleurotus sajor caju. Total and protein nitrogen was significantly higher in Pleurotus sajor caju than Agaricus bisporus mushroom as a result its true protein content was also significantly higher. No significant differences were found in the energy, carbohydrates and non-protein nitrogen contents of both the varieties of mushroom. Both varieties contained low phytic acid and oxalate however, it was significantly higher in Pleurotus sajor caju mushroom. The in vitro protein digestibility of both was not differing significantly.

Effect of coenzyme Q10 on catalase activity and other antioxidant parameters in streptozotocin-induced diabetic rats

Although coenzyme Q10 (CoQ10) is a component of the oxidative phosphorylation process in mitochondria that converts the energy in carbohydrates and fatty acids into ATP to drive cellular machinery and synthesis, its effect in type I diabetes is not clear. We have studied the effect of 4 wk of treatment with CoQ10 (10 mg/kg, ip, daily) in streptozotocin (STZ)-induced (40 mg/kg, iv in adult rats) type I diabetes rat models. Treatment with CoQ10 produced a significant decrease in elevated levels of glucose, cholesterol, triglycerides, very-low-density lipoprotein, low-density lipoprotein, and atherogenic index and increased high-density lipoprotein cholesterol levels in diabetic rats. CoQ10 treatment significantly decreased the area under the curve over 120 min for glucose in diabetic rats, without affecting serum insulin levels and the area under the curve over 120 min for insulin in diabetic rats. CoQ10 treatment also reduced lipid peroxidation and increased antioxidant parameters like superoxide dismutase, catalase, and glutathione in the liver homogenates of diabetic rats. CoQ10 also lowered the elevated blood pressure in diabetic rats. In conclusion, CoQ10 treatment significantly improved deranged carbohydrate and lipid metabolism of experimental chemically induced diabetes in rats. The mechanism of its beneficial effect appears to be its antioxidant property.

Spotted dermopathy in a diabetic patient due to insulin allergy

A rare case of diabetic patient who developed multiple cutaneous hyperpigmented spots following bovine isophane (NPH) insulin injection is described here.

Effect of chromium picolinate on histopathological alterations in STZ and neonatal STZ diabetic rats

Earlier studies from our laboratory have indicated insulin sensitizing action of chromium picolinate as the mechanism of its anti-diabetic activity in experimental models of type I and type II diabetes. In the present investigation, we have evaluated the effects of chronic administration of chromium picolinate on the functional and histological alterations of streptozotocin (STZ)-induced diabetes in rats. Type I diabetes was induced by intravenous injection of STZ (40 mg/kg) in adult rats, whereas, type II diabetes was induced by intraperitoneal injection of STZ (90 mg/kg) in 2-day old rat pups which in adulthood develop abnormalities resembling type II diabetes. Chromium picolinate was administered at 8 microg/ml in drinking water for 6 weeks and was found to improve glucose tolerance and increase insulin sensitivity of STZ-diabetic rats. This treatment decrease elevated serum creatinine and urea levels as well as elevated serum levels of hepatic enzymes of both groups of diabetic rats. Histopathological studies of kidney and liver show decrease in the intensity and incidence of vacuolations, cellular infiltration and hypertrophy of STZ and nSTZ (neonatal STZ) diabetic rats. Chronic treatment with chromium picolinate however, did not alter the normal function or morphology of control rats. Chronic chromium picolinate at the therapeutic doses that improved glucose tolerance, was observed to have no hepatotoxic or nephrotoxic potential. It was rather found to improve renal and hepatic function and to reduce abnormalities associated with STZ-diabetes. Chromium picolinate could play an important role in the long term management of diabetes mellitus.

Superiority of DAT over ELISA as a diagnostic and seroepidemiological tool for the diagnosis of Indian Kala-azar

The aim of this study was to evaluate two methods for the diagnosis of Kala-azar. The sera of 160 individuals were evaluated by ELISA using soluble antigen and direct agglutination test (DAT) for Kala-azar. These were categorized as 100 cases of clinically and parasitologically confirmed Kala-azar and 60 controls. The controls included clinically suspected but parasitologically not confirmed Kala-azar patients (10), endemic normals (15), non-endemic normals (19), typhoid fever (10) and malaria (15). The positivity rate amongst the clinically and parasitologically confirmed Kala-azar patients by ELISA and DAT were 93% and 98% respectively. Out of 10 clinically suspected Kala-azar cases three showed positive reaction in ELISA and two in DAT. Of the endemic normals, one case was found positive by both the tests whereas ELISA was found positive in one additional case. DAT did not show any cross reactivity with malaria while ELISA was found positive in one case. Both endemic normals and typhoid fever cases showed no reaction by both tests. ELISA showed a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 93%, 90%, 93% and 90% respectively while for DAT these values were 98%, 95%, 98 and 95% respectively. The diagnostic accuracy for ELISA and DAT was found to be 91.9% and 96.9%, respectively. The present study shows that DAT is a simple, sensitive, specific and cost effective test with high PPV and NPV along with approximately 97% diagnostic accuracy and is comparable to ELISA. It may be applied for the routine diagnosis as well as seroepidemiological study of Kala-azar.

Asparagus racemosus--an update

Asparagus racemosus (Shatavari) is recommended in Ayurvedic texts for prevention and treatment of gastric ulcers, dyspepsia and as a galactogogue. A. racemosus has also been used successfully by some Ayurvedic practitioners for nervous disorders, inflammation, liver diseases and certain infectious diseases. However, no scientific proof justifying aforementioned uses of root extract of A. racemosus is available so far. Recently few reports are available demonstrating beneficial effects of alcoholic and water extracts of the root of A. racemosus in some clinical conditions and experimentally induced diseases, e.g. galactogogue effect, antihepatotoxic and immunomodulatory activities. The present article includes the detailed exploration of pharmacological properties of the root extract of A. racemosus reported so far.

Effect of chronic treatment with Enicostemma littorale in non-insulin-dependent diabetic (NIDDM) rats

We have studied the effect of aqueous extract of Enicostemma. littorale (2 g/kg p.o.) daily for 6 weeks in neonatal non-insulin-dependent diabetes mellitus (NIDDM) rats. To induce NIDDM a single dose injection of STZ (70 mg/kg; i.p.) was given to the 5-day-old pups. After 3 months of STZ injection when animals were confirmed as diabetic, E. littorale was administered for 6 weeks. Fasting and fed glucose and insulin levels in NIDDM were significantly (P<0.05) higher than control rats and they were significantly decreased by the treatment with E. littorale. Results of the oral glucose tolerance test (OGTT) showed a significant (P<0.05) decrease in both AUC(glucose) and AUC(insulin) values in NIDDM treated group. Insulin sensitivity (K(ITT)) index of NIDDM control was significantly lower as compared with Wistar control and this was significantly (P<0.05) increased after treatment with E. littorale. Treatment with E. littorale also decreased the elevated cholesterol, triglyceride and creatinine levels observed in NIDDM rats. Our data suggest that aqueous extract of E. littorale is a potent herbal antidiabetic. It produces an increase in insulin sensitivity, normalizes dyslipidaemia and provides nephroprotection in diabetic rats.

Myopathy secondary to simvastatin in a type 2 diabetic patient

The most important but rare adverse effect of simvastatin is myopathy. In megatrials with simvastatin, the overall incidence of myopathy is 0.025%. We present a case of myopathy presenting as proximal muscle weakness in both upper limbs secondary to simvastatin which reversed spontaneously after cessation of the drug.

Effect of chronic treatment with losartan on streptozotocin induced diabetic rats

Treatment of rats with streptozotocin (STZ, 45mg/kg, i.v.,single dose) produced cardinal symptoms of diabetes mellitus including hyperglycemia, hypoinsulinemia and increase in blood pressure. Treatment with losartan--an angiotensin (AT1) receptor antagonist, 2 mg/kg, po for 6 weeks decreased the blood glucose levels by 16.5%. There was 190% increase in AUCglucose and 59.4% decrease in AUCinsulin in STZ-diabetic rats as compared to control rats. Treatment with losartan caused slight decrease in AUCglucose and slight increase in AUCinsulin. There was no significant difference in insulin sensitivity (K(ITT)) index of STZ-diabetic group as compared to control. Losartan treatment failed to alter these levels significantly. Serum cholesterol and creatinine levels were found to be increased significantly in STZ-diabetic rats. Treatment with losartan significantly prevented the rise in cholesterol and creatinine levels by 20.1 and 81% respectively. The results suggest that losartan produces some beneficial effects in STZ-diabetic rats.

Neural circuits in swallowing and abdominal vagal afferent-mediated lower esophageal sphincter relaxation

The purpose of this review is to identify the medullary subnuclei that house neural circuits for lower esophageal sphincter (LES) relaxation. LES relaxation may occur as a component of primary peristalsis elicited by superior laryngeal nerve (SLN) afferent stimulation, secondary peristalsis elicited by esophageal distention or as a component of belch reflex, and transient LES relaxation elicited by gastric vagal afferent stimulation. In mice, SLN stimulation at 10 Hz elicited complete swallowing reflex, including pharyngeal and esophageal peristalsis, and LES relaxation. SLN stimulation at 5 Hz elicited pharyngeal contractions and isolated LES relaxation, which is not accompanied by esophageal peristalsis. Electric stimulation of afferents in the ventral branch of the subdiaphragmatic vagus (vSDV) at 10 Hz also elicited isolated LES relaxation. Using these defined stimuli, c-fos expression was examined in the entire craniocaudal extent of the medullary nuclei. SLN stimulation at 10 Hz induced c-fos expression in neurons in: (1) interstitial (SolI), intermediate (SolIM), central (SolCe), occasional medial (SolM), and dorsomedial (SolDM) solitary subnuclei; (2) motor neurons in the nucleus ambiguus, including its semicompact (NAsc), loose (NAl), and compact (NAc) formations; and (3) dorsal motor nucleus of vagus, including its rostral (DMVr) and caudal (DMVc) parts. The activated neurons represent neurons involved with afferent SLN-mediated reflexes, including swallowing. SLN stimulation at 5 Hz evoked c-fos expression in neurons in SolI, SolIM, SolM, and SolDM but not in SolCe; and motor neurons in NAsc, NAl, and DMVc but not in NAc or DMVr. Stimulation of vSDV induced c-fos expression in neurons in SolM and SolDM and in motoneurons in DMVc. When considered with published reports in other animal species, these data support the speculation that (1) swallow-evoked primary peristalsis involves the following neural circuits: SolI/SolIM --> NAsc/NAl for pharyngeal and SolCe --> NAc for esophageal (striated muscle) peristalsis, SolM/SolDM --> preganglionic neurons in DMVc and DMVr and nitrergic and cholinergic neurons in myenteric plexus for esophageal (smooth muscle) peristalsis, and SolM/SolDM --> preganglionic neurons in DMVc --> postganglionic nitrergic neurons in the myenteric plexus for LES relaxation; and (2) abdominal vagus-stimulated isolated LES relaxation may involve neurons in SolM and SolDM --> preganglionic motor neurons in DMVc --> postganglionic nitrergic neurons in the myenteric plexus.

Blackwater fever treated with artemether

Blackwater fever is a rare manifestation of falciparum malaria characterized by sudden intravascular hemolysis followed by fever and hemoglobinuria. We present a case of blackwater fever, having occurred after administration of quinine, which was treated successfully with artemether.

Improvement in insulin sensitivity by losartan in non-insulin-dependent diabetic (NIDDM) rats

The present investigation was undertaken to study the effects of chronic treatment with losartan (2 mg kg(-1)/ day P.O) in neonatal non-insulin-dependent diabetes mellitus (NIDDM) rats. To induce NIDDM single-dose injection of STZ (70 mg kg(-1); i.p.) was given to 5 day old pups. The animals were weaned at 30 days and after a period of 3 months, they were checked for fasting and fed glucose levels to confirm the status of NIDDM. Losartan (2 mg kg(-1); p.o.) was administered for 6 weeks into the confirmed diabetic rats. A group of control animals were also maintained and this group received saline 5 days after birth. Fasting and fed glucose levels in NIDDM rats were significantly higher than control rats. Treatment with losartan in the NIDDM rats caused a significant decrease in insulin levels and reduction in elevated fasting and fed glucose levels. Results of the oral glucose tolerance test (OGTT) showed a significant increase in AUC(glucose)and AUC(insulin)values in NIDDM control rats. Losartan treatment significantly decreased both AUC(glucose)and AUC(insulin)values. Insulin sensitivity (K(ITT)) index of NIDDM control was significantly low as compared to Wistar control animals followed by significant increase in T(1/2)glucose value. Losartan treatment significantly reversed both K(ITT)and T(1/2)glucose value. Our data indicates that losartan increases insulin sensitivity in NIDDM rats.

Effect of chronic treatment with losartan on streptozotocin induced diabetic nephropathy

Angiotensin converting enzyme (ACE) inhibitors produce a number of beneficial effects in a condition where diabetes - mellitus and hypertension co-exist. The present investigation was undertaken to study the effect of chronic treatment with losartan (2mg/kg, p.o.) on streptozotocin (STZ)-induced (45mg/kg, single dose, tail vein) diabetic nephropathy in rats. Treatment of rats with STZ produced a significant loss of body weight, polyuria. polydipsia, hypoinsulinemia, hyperglycemia and increase in blood pressure. There was a significant increase in blood glucose levels in STZ-diabetic rats. Serum cholesterol, creatinine, urea and blood urea nitrogen (BUN) levels were found to be increased significantly in the STZ group diabetic rats. Treatment with losartan significantly prevented the raise in cholesterol, creatinine, urea and blood urea nitrogen levels. Creatinine clearance was significantly less in STZ-diabetic rats as compared to control animals and treatment with losartan significantly increased creatinine clearence. Our data suggest a beneficial effect of losartan in STZ-induced nephropathy in rats.

Coronary risk and dyslipidemia in type 2 diabetic patients

OBJECTIVES

A prospective study was carried out to find out the percentage of dyslipidemia in type 2 diabetics, to study the pattern of dyslipidemia, categorize the levels of LDL, HDL and triglycerides into higher, borderline and lower risk of developing coronary heart disease in type 2 diabetics and to compare the lipid profile with non-diabetics.

MATERIAL AND METHODS

Five hundred patients of type 2 diabetes mellitus and 150 age, sex and BMI matched non-diabetic healthy individuals were studied. The labelling of dyslipidemia and the categorization of risk for developing coronary heart disease (CHD) was done according to the guidelines of American Diabetes Association (ADA, 1998).

RESULTS

Dyslpidemia was present in 89% of diabetic patients with LDL hyperlipoproteinemia (LDL > 100 mg%) in 76%, HDL dyslipidemia (HDL < 35 mg%) in 58%, hypertriglyceridemia (TG > 200 mg%) in 22% patients. On analysing CHD risk based on lipid profile, it was revealed that in LDL moiety 48% fell in higher risk of CHD (LDL > 130 mg%), 28% in borderline risk (LDL 100-130 mg%) and 24% (LDL < 100 mg%) in lower risk. For HDL 18.5% fell in higher risk (HDL < 35 mg%) and TG only 0.5% fell in higher risk (TG > 400 mg%). The lipid profile was significantly altered in diabetic patients as compared to non diabetics.

CONCLUSIONS

The major concern which our study highlights is the high percentage of LDL dyslipidemia majority of whom fell in higher risk of developing CHD. Triglyceride and HDL levels were of lesser significance when newer ADA (1998) criteria for dyslipidemia were applied.

Effect of chronic treatment with Bis(maltolato)oxovanadium (IV) in rat model of non-insulin-dependent-diabetes

Effect of chronic treatment with Bis(maltolato)oxovanadium (IV) (BMOV) was studied in streptozotocin (STZ)-induced neonatal non-insulin-dependent-diabetic (NIDDM) rats. Intraperitoneal injection of STZ (90 mg kg(-1)) in Wistar rat pups (day 2 old) produced mild hyperglycemia, impaired glucose tolerance and insulin resistance at the age of 3 months. Treatment with BMOV (0.23 mM kg(-1)) in drinking water for 6 weeks produced a significant decrease in elevated serum glucose levels without any significant change in serum insulin levels in diabetic rats. BMOV treatment significantly decreased integrated area under the glucose curve without any significant change in integrated area under the insulin curve indicating improved glucose tolerance. Treatment also significantly increased K(ITT) value of diabetic rats indicating increased insulin sensitivity. BMOV treatment significantly reduced hypercholesterolemia in diabetic rats. Treatment also significantly decreased serum triglyceride levels in both diabetic and non-diabetic rats. The data suggest that chronic BMOV treatment improves glucose and lipid homeostasis. These effects appear to be due to the insulin sensitizing action of vanadium.

Toxic epidermal necrolysis secondary to carbamazepine in a patient with human immunodeficiency virus infection

Toxic epidermal necrolysis (TEN) is a rare but very serious dermatologic disorder and is seen more commonly in human immunodeficiency virus (HIV) infected patients. We present a case of TEN in HIV infected person secondary to carbamazepine who responded favourably to corticosteroids.

Lower esophageal sphincter is achalasic in nNOS(-/-) and hypotensive in W/W(v) mutant mice

BACKGROUND AND AIMS

It has been proposed that nitrergic nerves mediate lower esophageal sphincter (LES) relaxation with intramuscular interstitial cells of Cajal (ICC-IM) as an intermediary. Dysfunction of the nitrergic pathway has been shown to cause LES hypertension and impaired relaxation in achalasia. We determined whether mice with neuronal nitric oxide synthase gene disruption (nNOS(-/-)) and W/W(v) mice lacking ICC-IM have achalasia-like LES dysfunction.

METHODS

Intraluminal manometry using a customized micro-sized catheter assembly was performed in anesthetized mice. Basal LES pressure and swallow- and vagal-evoked LES relaxations were quantified in wild-type, Nomega-nitro-L-arginine methyl ester HCl salt (L-NAME)-treated, nNOS(-/-), and W/W(v) mice.

RESULTS

Wild-type mouse LES maintained a basal pressure (24 +/- 3 mm Hg; N = 8) and relaxed normally to swallow (87% +/- 3%; N = 8) and vagal stimulation (91% +/- 4% mm Hg; N = 6). Pretreatment with L-NAME (100 mg/kg, intravenously) attenuated LES relaxation to both stimuli (P < 0.05). The LES in nNOS(-/-) was significantly hypertensive (36 +/- 5 mm Hg; N = 10; P < 0.05) with a markedly impaired relaxation (P < 0.05). In contrast, W/W(v) mouse LES was significantly hypotensive (11 +/- 2 mm Hg; N = 6; P < 0.05) with normal relaxation that was blocked by L-NAME.

CONCLUSIONS

nNOS(-/-) mice have LES hypertension with impaired relaxation resembling achalasia. In contrast, W/W(v) mice have hypotensive LES with unimpaired relaxation, suggesting that ICC-IM do not play a role in nitrergic neurotransmission.

Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow-up of a randomized controlled trial

CONTEXT

Severe gastroesophageal reflux disease (GERD) is a lifelong problem that can be complicated by peptic esophageal stricture and adenocarcinoma of the esophagus.

OBJECTIVE

To determine the long-term outcome of medical and surgical therapies for GERD.

DESIGN AND SETTING

Follow-up study conducted from October 1997 through October 1999 of a prospective randomized trial of medical and surgical antireflux treatments in patients with complicated GERD. Mean (median) duration of follow-up was 10.6 years (7.3 years) for medical patients and 9.1 years (6.3 years) for surgical patients.

PARTICIPANTS

Two hundred thirty-nine (97%) of the original 247 study patients were found (79 were confirmed dead). Among the 160 survivors (157 men and 3 women; mean [SD] age, 67 [12] years), 129 (91 in the medical treatment group and 38 in the surgical treatment group) participated in the follow-up.

MAIN OUTCOME MEASURES

Use of antireflux medication, Gastroesophageal Reflux Disease Activity Index (GRACI) scores, grade of esophagitis, frequency of treatment of esophageal stricture, frequency of subsequent antireflux operations, 36-item Short Form health survey (SF-36) scores, satisfaction with antireflux therapy, survival, and incidence of esophageal adenocarcinoma, compared between the medical antireflux therapy group and the fundoplication surgery group. Information on cause of death was obtained from autopsy results, hospital records, and death certificates.

RESULTS

Eighty-three (92%) of 90 medical patients and 23 (62%) of 37 surgical patients reported that they used antireflux medications regularly (P<.001). During a 1-week period after discontinuation of medication, mean (SD) GRACI symptom scores were significantly lower in the surgical treatment group (82.6 [17.5] vs 96.7 [21.4] in the medical treatment group; P =.003). However, no significant differences between the groups were found in grade of esophagitis, frequency of treatment of esophageal stricture and subsequent antireflux operations, SF-36 standardized physical and mental component scale scores, and overall satisfaction with antireflux therapy. Survival during a period of 140 months was decreased significantly in the surgical vs the medical treatment group (relative risk of death in the medical group, 1.57; 95% confidence interval, 1.01-2.46; P =.047), largely because of excess deaths from heart disease. Patients with Barrett esophagus at baseline developed esophageal adenocarcinomas at an annual rate of 0.4%, whereas these cancers developed in patients without Barrett esophagus at an annual rate of only 0.07%. There was no significant difference between groups in incidence of esophageal cancer.

CONCLUSION

This study suggests that antireflux surgery should not be advised with the expectation that patients with GERD will no longer need to take antisecretory medications or that the procedure will prevent esophageal cancer among those with GERD and Barrett esophagus.

Clofazimine enteropathy in a pediatric bone marrow transplant recipient

Clofazimine, previously used in the treatment of leprosy, is now used for treatment of Mycobacterium avium complex infection in patients with acquired immune deficiency syndrome, dermatologic disorders, and graft-versus-host disease. An 11-year-old boy developed a severe enteropathy 2 years after initiation of clofazimine treatment for graft-versus-host disease. Clofazimine enteropathy caused by crystal deposition can be life-threatening.

Lipid-lowering effect of simvastatin in patients of type 2 diabetes mellitus

BACKGROUND

Dyslipidemia is an important factor in causation of macrovascular disease in type 2 diabetics. The role of simvastatin in the management of dyslipidemia in patients with type 2 diabetes mellitus is not very well elucidated, particularly in the context of the recent American Diabetes Association criteria 2001. The American Diabetes Association suggests that aggressive therapy of diabetic dyslipidemia will reduce the risk of coronary heart disease in diabetics and that optimal levels are serum low-density lipoprotein cholesterol <2.60 mmol/L (< 100 mg/dl), high-density lipoprotein cholesterol >1.1 5 mmol/L (>45 mg/dl) and triglycerides <2.30 mmol/L, (<200 mg/dl). This study was planned to compare the effect of simvastatin together with behavioral modification and behavioral modification alone, in age, sex and body mass index matched patients with type 2 diabetes mellitus with dyslipidemia, in reaching the target levels of various lipids as suggested by the American Diabetes Association criteria 2001.

METHODS AND RESULTS

An open-label, prospective study was conducted on 80 patients with type 2 diabetes mellitus, who had fair to moderate glycemic control with a total glycated hemoglobin < 10%. The patients in the control group (n=40) were treated with only behavioral modifications like calorie control and daily walking for 30 minutes, and no lipid-lowering agent was given. The lipid profile was re-evaluated after 6 and 12 weeks. The patients in the test group (n=40) were advised behavioral modification and given simvastatin. The starting dose was 10 mg at bed time. After 6 weeks of simvastatin therapy, a lipid profile was done. If the goal of low-density lipoprotein cholesterol < 100 mg/dl and/or triglycerides <200 mg/dl and/or high-density lipoprotein cholesterol >45 mg/dl was not achieved, the dose of simvastatin was increased to 20 mg at bedtime for another 6 weeks. It was observed that low-density lipoprotein dyslipidemia was most prevalent. In the control group, a favorable alteration in lipid levels was brought about but none was statistically significant and the American Diabetes Association goals were not achieved in any of the patients. In the test group, there was a significant and favorable alteration in all lipid moieties, and the target levels were achieved in 80% of patients after 12 weeks. There was no significant alteration in glycemic control and liver functions. Myopathy and epigastric pain were seen in 1 patient in each group.

CONCLUSIONS

In our study, behavioral modification alone did not achieve the target levels of various lipids in diabetic dyslipidemia as per the American Diabetes Association guidelines. Hence, pharmacological therapy with statins should be resorted to in patients with type 2 diabetes mellitus who carry a high risk of coronary heart disease. Simvastatin is a safe and efficacious lipid-lowering drug.