Adherence, satisfaction, and experience with metformin 500 mg prolonged release formulation in Indian patients with type 2 diabetes mellitus: a postmarketing observational study

Purpose

The aim of this study was to understand patient adherence, satisfaction, and experience with the smaller sized metformin 500 mg prolonged release (PR) tablet that has been manufactured with the help of technological advancement (Gluformin I 500 mg), in comparison with metformin 500 mg extended-release (ER) tablet, in patients with type 2 diabetes mellitus (T2DM).

Patients and methods

In this postmarketing observational study, T2DM patients who were on a stable dose of metformin 500 mg PR tablet for at least 1 month and had previously received metformin 500 mg ER tablet were recruited from 50 sites in India. The medication adherence and patients’ experience, satisfaction, and perception with metformin 500 mg PR tablets were compared with metformin 500 mg ER tablets. The patients’ experience was determined based on the external appearance of tablet, ease of swallowing, the presence of gastrointestinal discomfort, and ghost pill effect.

Results

A total of 1,000 patients were enrolled. The majority had medium adherence to metformin 500 mg PR tablet (54%) and did not report swallowing difficulties (66.2%) due to its small size (64.4%) and oval shape (64.3%). The PR formulation of metformin was more acceptable than ER formulation due to no aftertaste (63%). The ghost pill effect was reported in 0.7% of patients with metformin 500 mg PR tablet against 8.5% with ER tablet. More than 60% of patients were “comfortable” (67.9%), had “much effect on their well-being” (61.8%), and were “satisfied” (69%) with metformin 500 mg PR tablet compared with ER tablet. Patient’s dissatisfaction (42.7%) and taste (24.9%) were the common reasons cited by physicians and patients, respectively, for changing the treatment from metformin 500 mg ER to metformin 500 mg PR formulation. A total of 10 adverse events (nonserious) were reported, and all of them were resolved.

Conclusion

The technologically advanced formulation of metformin 500 mg PR tablets is more effective than that of metformin 500 mg ER tablets in improving adherence, compliance, satisfaction, and perception to medication in Indian patients with T2DM.

Dynamics of silver elution from functionalised antimicrobial nanofiltration membranes

In an effort to mitigate biofouling on thin film composite membranes such as nanofiltration and reverse osmosis, a myriad of different surface modification strategies has been published. The use of silver nanoparticles (Ag-NPs) has emerged as being particularly promising. Nevertheless, the stability of these surface modifications is still poorly understood, particularly under permeate flux conditions. Leaching or elution of Ag-NPs from the membrane surface can not only affect the antimicrobial characteristics of the membrane, but could also potentially present an environmental liability when applied in industrial-scale systems. This study sought to investigate the dynamics of silver elution and the bactericidal effect of an Ag-NP functionalised NF270 membrane. Inductively coupled plasma-atomic emission spectroscopy was used to show that the bulk of leached silver occurred at the start of experimental runs, and was found to be independent of salt or permeate conditions used. Cumulative amounts of leached silver did, however, stabilise following the initial release, and were shown to have maintained the biocidal characteristics of the modified membrane, as observed by a higher fraction of structurally damaged Pseudomonas fluorescens cells. These results highlight the need to comprehensively assess the time-dependent nature of bactericidal membranes.

Pyogenic granuloma - report of three cases in rare sites

Pyogenic granuloma is a benign, localized mass of exuberant granulation tissue produced in response to various stimuli. It is inflammatory hyperplasia of oral cavity commonly seen on gingival area and rarely on other parts of oral cavity such as lips, tongue, palate and buccal mucosa. It is seen predominantly in 2nd to 3rd decade of life in young females. Clinically manifesting as small red erythematous exophytic lesion, it must be biopsied to rule out other serious conditions. This article aims to present three cases of extra gingival pyogenic granulomas occurring in rare sites such as buccal mucosa, anterior hard palate and alveolar mucosa of completely edentulous ridge in maxilla. Pyogenic granuloma on buccal mucosa and anterior hard palate were seen in female patients with age of 40 years and 34 years respectively and pyogenic granuloma on alveolar mucosa of edentulous ridge in maxilla was noted in 70 years old male patient. Surgical excision was performed for all the lesion and follow up of one year did not show any recurrence. Please add little description of patient + treatment + followup results. DOI: http://dx.doi.org/10.3329/bjms.v12i4.16667 Bangladesh Journal of Medical Science Vol. 12 No. 04 October ’13 Page 445-448

Electrical Maintenance of IIT Bombay Hostels

The Electrical Maintenance Department (EMD) of the Indian Institute of Technology Bombay (IIT Bombay) is responsible for the electrical maintenance of all hostels on campus. At present, EMD activity is outsourced to Chintamani Electrical on an annual contract. The latter puts up its resources to operate EMD. The EMD supervisor Vijay Bhogale is concerned about the productivity of the electricians because his boss, the owner of Chintamani Electrical, has pushed him several times to improve it.

This case on electrical maintenance of IIT Bombay hostels explains the functioning of EMD along with relevant data to apply operations management techniques such as simulation and capacity analysis. The first step for using these techniques is to understand the situation by mapping its processes; hence, the initial part of the case throws light on this. The latter part of the case emphasizes relevant and precise data collection to apply the appropriate operations management technique. This case creates a stimulating environment for class discussion on key data, the underlying notion in the application of simulation and/or queuing model for a given situation.