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Kovil R, Chawla M, Shah T, Sahoo A, Makkar B, Kesavadev J, Seshadri K, Tiwaskar M, Rajput R, Phatak S, Majumdar S, Gupta S. Sodium-glucose Cotransporter-2 Inhibitors in Primary and Secondary Prevention of Cardiovascular and Renal Outcomes in Patients with Type 2 Diabetes Mellitus: A Meta-analysis. J Assoc Physicians India 2022; 70:11-12. [PMID: 36082726 DOI: 10.5005/japi-11001-0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The available evidence was systematically reviewed to evaluate the effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors (SGLT2i) on cardiovascular (CV) and renal outcomes in people with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) or multiple risk factors (MRF), with or without heart failure (HF), and per estimated glomerular filtration rate (eGFR) rate at baseline. METHODS We comprehensively searched three electronic databases to retrieve publications up to 30th November 2019, which were screened for inclusion. The data extracted for the outcomes according to baseline ASCVD, HF, and eGFR levels were meta-analyzed using fixed effects model. RESULTS Of the 735 screened citations, 15 primary and secondary publications from five CV or renal outcome trials were included. SGLT2is reduced the risk of CV death or hospitalization for HF (HHF), HHF alone, and composite renal-specific outcome, irrespective of ASCVD and HF at baseline. The three-point major adverse cardiovascular events (3P-MACE) risk was reduced by 14% (p<0.001) in patients with ASCVD and by 10% (p = 0.018) in those without baseline HF compared with their counterparts. SGLT2is significantly reduced the risk of MACE (18%) in patients with mild kidney dysfunction (eGFR within the range of 60-<90 mL/min/1.73 m2 and <60 mL/min/1.73 m2 ). CONCLUSION SGLT2is are effective for both secondary and primary prevention of composite CV outcomes, and secondary prevention of MACE. The upcoming evidence may strengthen the primary prevention benefits of SGLT2is.
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Affiliation(s)
- Rajiv Kovil
- Diabetologist, Dr. Kovil's Diabetes Care Centre; Corresponding Author
| | - Manoj Chawla
- Diabetologist, Lina Diabetes Care and Mumbai Diabetes Research Centre
| | - Tejas Shah
- Consultant of Diabetology, iVA Speciality Clinic, Mumbai, Maharashtra
| | - Abhay Sahoo
- Endocrinologist, IMS and SUM Hospital, Bhubaneshwar, Odisha
| | - Brij Makkar
- Senior Diabetologist and Obesity Specialist, Dr. Makkar's Diabetes and Obesity Centre, New Delhi, Delhi
| | | | - Krishna Seshadri
- Senior Consultant-American Board Certified Endocrinology, Diabetes and Metabolism, Chennai Diabetes and Endocrinology Clinic, Chennai, Tamil Nadu
| | | | - Rajesh Rajput
- Senior Professor and Head, Department of Medicine VII and Endocrinology, Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryan
| | - Sanjeev Phatak
- Diabetologist and Metabolic Physician, Vijayratna Diabetes Diagnosis and Treatment Centre, Ahmedabad, Gujarat
| | - Sujoy Majumdar
- Endocrinologist, Department of Diabetes, GD Hospital and Diabetes Institute, Kolkata, West Bengal
| | - Sunil Gupta
- Diabetologist, Sunil's Diabetes Care n' Research Centre, Nagpur, Maharashtra, India
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Kesavadev J, Murthy L, Chaudhury T, Yalamanchi SR, Giri J, Gupta S, Phatak S, Modi K, Chatterjee S, Manjunath A, Revanna M, Bhattacharya A. One-year safety and effectiveness of insulin degludec in patients with diabetes mellitus in routine clinical practice in India—TRUST (Tresiba real-world use study). Metabol Open 2022; 14:100184. [PMID: 35496980 PMCID: PMC9046940 DOI: 10.1016/j.metop.2022.100184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 11/18/2022] Open
Abstract
Objective This post-authorization safety study (PASS) was conducted to evaluate the long-term safety and effectiveness of insulin degludec in patients with diabetes mellitus (DM) requiring insulin therapy in routine clinical practice in India. Methods Data on glycated hemoglobin (HbA1c) and adverse events (AEs) were collected up to 12 months after insulin degludec initiation. Results A total of 1057 adult patients with DM were enrolled, including 60.07% males with the mean duration of 22.2 ± 21.90 years with type 1 DM and 10.1 ± 7.37 years with type 2 DM and the mean HbA1c of 9.6 ± 1.9%. Insulin degludec was prescribed to improve HbA1c and fasting plasma glucose (FPG). Insulin degludec daily dose was increased from 14.8 ± 8.0 U to 18.0 ± 9.46 U over 12 months resulting in a significant decrease of HbA1c by 1.8 ± 1.68% compared with baseline. There were 84 events of confirmed hypoglycemia in 51 patients during the 12-month follow-up period, and 44 AEs were reported in 2.6% of patients, of which 2 AEs were serious and unrelated to the drug. Conclusion Insulin degludec is well tolerated in patients with DM. It improves glycemic control with reduced HbA1c, FPG, and postprandial glucose, with a low risk of hypoglycemia.
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Affiliation(s)
| | | | | | | | - J. Giri
- KG Hospital, Coimbatore, Tamil Nadu, India
| | - Sunil Gupta
- Sunil’s Diabetes Care & Research Centre Pvt. Ltd, Nagpur, Maharashtra, India
| | - Sanjeev Phatak
- Vijayratna Diabetes Diagnostic Treatment Centre, Ahmedabad, Gujarat, India
| | - K.D. Modi
- Care Hospitals, Hyderabad, Telangana, India
| | | | | | | | - Arpandev Bhattacharya
- Manipal Hospital, Bengaluru, Karnataka, India
- Corresponding author. Department of Diabetes and Endocrinology, Manipal Hospital, Bengaluru, Karnataka, India.
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Gupta R, Kesavadev J, Krishnan G, Agarwal S, Saboo B, Shah M, Mittal A, Durani S, Luthra A, Singhal A, Rasheed M, Rao GVS, Tripathi V, Jha A, Ghosh A, Mohan V, Singh AK, Phatak S, Panicker J, Bhadada SK, Joshi S, Pal R, Mithal A, Vikram N, Misra A. COVID-19 associated mucormycosis: A Descriptive Multisite Study from India. Diabetes Metab Syndr 2021; 15:102322. [PMID: 34717135 PMCID: PMC8635309 DOI: 10.1016/j.dsx.2021.102322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Mucormycosis is an invasive fungal infection and carries a significant morbidity and mortality. A number of cases of mucormycosis have been reported in association with COVID-19. In this study, a consortium of clinicians from various parts of India studied clinical profile of COVID-19 associated mucormycosis (CAM) and this analysis is presented here. METHODS Investigators from multiple sites in India were involved in this study. Clinical details included the treatment and severity of COVID-19, associated morbidities, as well as the diagnosis, treatment and prognosis of mucormycosis. These data were collected using google spreadsheet at one centre. Descriptive analysis was done. RESULTS There were 115 patients with CAM. Importantly, all patients had received corticosteroids. Diabetes was present in 85.2% of patients and 13.9% of patients had newly detected diabetes. The most common site of involvement was rhino-orbital. Mortality occurred in 25 (21.7%) patients. On logistic regression analysis, CT scan-based score for severity of lung involvement was associated with mortality. CONCLUSION Universal administration of corticosteroids in our patients is notable. A large majority of patients had diabetes, while mortality was seen in ∼1/5th of patients, lower as compared to recently published data.
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Affiliation(s)
| | | | - Gopika Krishnan
- Jothydev's Diabetes Research Centre, Trivandrum, Kerala, India
| | | | | | | | - Atul Mittal
- Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Suhail Durani
- Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Atul Luthra
- Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Anuj Singhal
- Fortis Escorts Heart Institute, New Delhi, India
| | | | - G V S Rao
- Dr Rao's ENT Centre, Hyderabad, Telangana, India
| | | | - Alka Jha
- Fortis Rajan Dhall Hospital, New Delhi, India
| | | | - V Mohan
- Dr Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, Tamilnadu, India
| | | | | | | | | | | | - Rimesh Pal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Naval Vikram
- All India Institute of Medical Sciences, New Delhi, India
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Saboo B, Phatak S, Jethwani P, Patel R, Hasnani D, Panchal D, Shah S, Raval V, Dave R, Mishra A. Intervention of a personalized low-carbohydrate diet to reduce HbA1c level and weight in patients with Type 2 diabetes using seed-based flour as replacement for high-carbohydrate flour and foods. J Diabetol 2021. [DOI: 10.4103/jod.jod_74_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Gokalani R, Panchal D, Saboo B, Zinzuwadia P, Patel D, Chaudhury R, Chavda V, Phatak S, Prasad R, Dariya SS, Shnakar A, Prajapati A, Chudasama D, Patel N. The extent of use of SGLT2 inhibitors in patients with type 2 diabetes in clinical practice: A study from India. J Diabetol 2021. [DOI: 10.4103/jod.jod_81_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Although insulin delivery devices are widely used by the patients, there is a paucity of published guidelines to help professionals manage their patients in insulin therapies. To provide simple and easily implementable guidelines to health care physicians on the choice of insulin delivery devices in routine clinical practice, experts in diabetes gathered together and discussed the recommendations at the National insulin Summit 2018. An ideal insulin delivery device should accurately deliver the prescribed dose of insulin and be easy to use. Recommendations are: (1) insulin should be initiated by using an insulin device if the patient seems to discontinue insulin therapy. (2) Pen devices offer accurate dosing than a syringe and vial and are associated with cost savings in the long term. (3) Switching over from syringes and vial to disposable pen devices improves adherence. (4) FlexPen® offers better accuracy, and it requires lower dose force and injection force than SoloStar® and KwikPen® (5). Durable delivery pens such as NovoPen® 4 maintain accuracy and low dose force compared with vials and syringes. (6) One pen should be used by only one patient. (7) Regular counseling on the proper use of the pen device is required regularly. This consensus-based recommendation is a useful reference tool for health care practitioners to initiate insulin therapy in patients with diabetes by using the appropriate insulin pen device.
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Affiliation(s)
- Arvind Gupta
- Director and Consultant Physician at Jaipur Diabetes Research Centre, Jaipur, Rajasthan
| | - Sanjeev Phatak
- Founder, Consultant Diabetologist, Vijayratna Diabetes Diagnostic Treatment Centre, Ahmedabad, India
| | - Y Sadashiv Rao
- Consultant Physician and Managing Director, Yalamanchi Hospital and Research Centre Private Limited, Vijayawada
| | - Jayanthy Ramesh
- Department of Endocrinology, Andhra Medical College, Visakhapatnam, India
| | - Debmalya Sanyal
- Consultant Endocrinologist, Department of Endocrinology, G.D. Diabetic Institute, R.N. Tagore Hospital, Kolkata, India
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Ramachandran A, Jain SM, Mukherjee S, Phatak S, Pitale S, Singh SK, Agrawal N, Majumdar A, Deshpande N, Jhulka S, Minakshisundaram S, Chawla M, Lodha S, Maheshwari A, Makkar BM, Rao S, Shah P, Ghosh R, Mohanasundaram S, Menon S, Chodankar D, Kanade V, Trivedi C. Suboptimal glycemic control among subjects with diabetes mellitus in India: a subset analysis of cross-sectional wave-7 (2016) data from the International Diabetes Management Practices Study (IDMPS). Ther Adv Endocrinol Metab 2020; 11:2042018820937217. [PMID: 32647562 PMCID: PMC7325532 DOI: 10.1177/2042018820937217] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 05/03/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To assess the real-world management practices of subjects with type 2 diabetes mellitus (T2DM) and type 1 diabetes mellitus (T1DM) in India. METHODS This cross-sectional study was conducted between 7 March 2016 and 15 May 2016 in India as part of the seventh wave (2016) of the International Diabetes Management Practices Study (IDMPS). Adult subjects with T1DM or T2DM visiting physicians during a 2-week recruitment period were included. RESULTS A total of 55 physicians included 539 subjects who met eligibility criteria. Of 495 subjects with T2DM, 303 were treated with oral glucose lowering drugs (OGLDs) only, 158 were treated with OGLD + insulin, and 27 received insulin only. Among 44 subjects with T1DM receiving insulin, 13 (29.5%) were also treated with OGLD therapy. The most commonly used insulin regimens were basal alone (69/184; 37.5%) and premixed alone (63/184; 34.2%) in subjects with T2DM, and basal + prandial insulin (24/44; 54.5%) in subjects with T1DM. Proportions of subjects achieving glycemic targets were low [glycated haemoglobin (HbA1c) <7%: T1DM = 7.3% (3/44), T2DM = 25.2% (106/495); as targeted by the treating physician: T1DM = 31.8% (14/44), T2DM = 32.1% (59/185); global target: T1DM = 4.8% (2/42) and T2DM = 1.7% (8/482)]. In subjects with T2DM, HbA1c <7% was noted in 11/22 subjects receiving insulin only and 76/260 receiving only OGLDs. Lack of experience in self-managing insulin dosing, poor diabetes education and failure to titrate insulin dosages were the main reasons for non-achievement of glycemic targets. CONCLUSION Timely insulinization, education and empowerment of people with diabetes may help improve glycemic control in India.
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Affiliation(s)
- Ambady Ramachandran
- Department of Diabetology, Dr. Ramachandran’s Diabetes Hospital, No. 28, Marshall’s Road, Egmore, Chennai 600 008, India
| | - Sunil M. Jain
- Department of Endocrinology, TOTALL Diabetes Hormone Institute, Indore, India
| | - Sagarika Mukherjee
- Department of Diabetology, Dr. Sagarika Mukherjee’s Endocrinology Clinic, Kolkata, India
| | - Sanjeev Phatak
- Department of Diabetology, Vijayratna Diabetes Diagnosis and Treatment Centre, Ahmedabad, India
| | - Shailesh Pitale
- Department of Diabetology, Pitale Diabetes and Hormone Centre, Nagpur, India
| | - Shailendra K. Singh
- Department of Diabetology, Dr. Shailendra Kumar Singh’s Clinic, Varanasi, India
| | - Navneet Agrawal
- Department of Diabetology and Obesity, Diabetes, Obesity and Thyroid Centre, Gwalior, India
| | - Anirban Majumdar
- Department of Endocrinology, Anirban’s Diabetes- Obesity-Thyroid & Hormone Clinic, Kolkata, India
| | | | - Sandeep Jhulka
- Department of Diabetology, Radiance the Hormone Health Clinic, Indore, India
| | | | - Manoj Chawla
- Department of Diabetology, Lina Diabetes Care Centre and Mumbai Diabetes Research Centre, Mumbai, India
| | - Sailesh Lodha
- Department of Endocrinology, Dr. Sailesh Lodha Clinic, Rajasthan, India
| | - Anuj Maheshwari
- Department of Diabetology, Shri Hari Kamal Diabetes and Research Clinic, Lucknow, India
| | - Brij Mohan Makkar
- Department of Diabetology and Obesity, Diabetes and Obesity Centre, New Delhi, India
| | - Sadashiva Rao
- Department of Diabetology, Diabetic Care Centre, Vijayawada, India
| | - Parag Shah
- Department of Endocrinology, Gujarat Endocrine Centre, Ahmedabad, India
| | - Romik Ghosh
- Medical Affairs, Sanofi India Limited, Mumbai, Maharashtra, India
| | | | - Shalini Menon
- Medical Affairs, Sanofi India Limited, Mumbai, Maharashtra, India
| | - Deepa Chodankar
- Clinical Study Unit, Sanofi Synthelabo India Limited, Mumbai, Maharashtra, India
| | - Vaishali Kanade
- Clinical Study Unit, Sanofi Synthelabo India Limited, Mumbai, Maharashtra, India
| | - Chirag Trivedi
- Clinical Study Unit, Sanofi Synthelabo India Limited, Mumbai, Maharashtra, India
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Modi KD, Farishta F, Phatak S, Godbole SG, Banzal S. Adherence and Swallowing Experience with a Modified, Smaller-sized Tablet Formulation of Metformin and Glimepiride (SR) in Indian Patients with Type 2 Diabetes Mellitus. J Assoc Physicians India 2019; 67:44-49. [PMID: 31801331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND This study evaluated the adherence and swallowing experience with novel oval-shaped, compact-sized metformin (500 mg/1000 mg)-glimepiride (1mg/2mg) combination, sustained-release tablet (Gluformin G1/Gluformin G2 SR; GM-new-SR) in Indian patients with T2DM, previously treated with conventional metformin-glimepiride combination tablet. METHODS Patients' adherence, swallowing experience, and satisfaction were assessed at baseline and month-3 by Adherence to Refills and Medication Scale (ARMS12; adherent: ARMS12 score=12; nonadherent: ARMS12 score >12) and questionnaire based 5-point Likert scale, respectively. Safety was also assessed. RESULTS Of 1550 patients enrolled, 1547 (99.8%) completed the study. After 3 months of switching to GM-new-SR tablets, adherence rate increased from 4.38% to 91.1%, with concurrent reduction in mean ARMS-12 score by 6.3±4.36 (p<0.0001). Compared to baseline, all glycemic indices, HbA1c, PPG, and FPG, significantly improved (p<0.0001) in the overall population. Reduction in HbA1c levels was significant only in patients who were adherent to therapy as opposed to nonadherent patients (7.8±1.74 to 7.1±0.85, p<0.0001 vs. 7.7±1.39 to 6.7±0.77, p=0.4276). Most patients attributed ease of swallowing of GM-new-SR tablets to its modified shape (95.5%) and size (94.9%). Most patients (90.4%) were satisfied with the new tablet formulation. Size of the tablet was the most common reason for patients' nonadherence with conventional tablets, which was reported to be less frequent with GM-new-SR tablets (2.5% vs 53.4%). CONCLUSION Treatment with GM-new-SR tablets significantly increased adherence and was associated with improvement in glycemic indices, which could be attributed to the compact shape and size of the new tablet formulation.
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Affiliation(s)
- K D Modi
- Dr. Modi's Clinic, Asifnagar, Mehdipatnam, Hyderabad, Telangana , Corresponding Author
| | - Faraz Farishta
- FS Endocrine and Diabetic Center, Santhosh Nagar, Hyderabad, Telangana
| | - Sanjeev Phatak
- Vijayratna Diabetes Diagnosis and Treatment Centre, Paldi, Ahmedabad, Gujarat
| | | | - Subodh Banzal
- Dr. Subodh Banzal Diabetes and Hormone Care Clinic, Vijay Nagar, Indore, Madhya Pradesh
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Kumar KMP, Chawla M, Sanghvi A, Sastry NG, Kotla C, Phatak S, Choudhari S. Adherence, satisfaction, and experience with metformin 500 mg prolonged release formulation in Indian patients with type 2 diabetes mellitus: a postmarketing observational study. Int J Gen Med 2019; 12:147-159. [PMID: 31040711 PMCID: PMC6460999 DOI: 10.2147/ijgm.s179622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
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.
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Affiliation(s)
| | - Manoj Chawla
- Lina Diabetes Care and Mumbai Diabetes Research Centre, Mumbai, Maharashtra, India
| | - Ami Sanghvi
- Sanghvi Eye and Diabetes Care Centre, Mumbai, Maharashtra, India
| | | | - Chaitanya Kotla
- JP Endocrine and Research Institute, Hyderabad, Telangana, India
| | - Sanjeev Phatak
- Vijayratna Diabetes Diagnosis and Treatment, Ahmedabad, India
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Aggarwal A, Phatak S, Srivastava P, Lawrence A, Agarwal V, Misra R. Outcomes in juvenile onset lupus: single center cohort from a developing country. Lupus 2018; 27:1867-1875. [DOI: 10.1177/0961203318791046] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction About 10–20% of systemic lupus erythematosus (SLE) patients have onset in childhood and have more severe organ involvement. Survival of juvenile SLE patients is improving worldwide. Long-term data of childhood onset SLE from developing countries is scarce. Methods Clinical and laboratory data at initial presentation and follow-up visits were retrieved from clinic files, hospital information system and personal interviews. Treatment received, complications, flares, outcomes and death were recorded. Survival was calculated using Kaplan–Meier survival curves and regression analysis was done for predictors of mortality. Results Children with SLE ( n = 273, 250 girls) had a median age at onset of 14 years and duration of illness prior to diagnosis at our hospital of 1 year. Fever and arthritis were the most common presenting manifestations. Renal disease was seen in 60.5% and central nervous system (CNS) disease in 29%. The median follow-up period in 248 patients was 3.5 years. Fourteen children died, and 10 of these had active disease at the time of death. The mean actuarial survival was 24.5 years and survival rates at 1, 5 and 10 years were 97.9%, 95% and 89% respectively. Fever, CNS disease, anti-dsDNA levels and serious infections predicted death on univariate and multivariate analysis. Infections were seen in 72 children (26.3%), and 38 of these infections were serious. One-third of the patients had damage on the last follow-up. Flares were seen in 120 children, the majority being major flares. Conclusion Outcomes of pediatric SLE in North Indian children are similar to those seen in developed countries. Infections pose a major challenge in these patients.
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Affiliation(s)
- A Aggarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - S Phatak
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - P Srivastava
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - A Lawrence
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - V Agarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - R Misra
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Kleinman NJ, Shah A, Shah S, Phatak S, Viswanathan V. Improved Medication Adherence and Frequency of Blood Glucose Self-Testing Using an m-Health Platform Versus Usual Care in a Multisite Randomized Clinical Trial Among People with Type 2 Diabetes in India. Telemed J E Health 2017; 23:733-740. [PMID: 28328396 DOI: 10.1089/tmj.2016.0265] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In 2015, India had an estimated 69.2 million people with diabetes and a national prevalence of 8.7%. Evidence is mounting for the benefits of telemedicine in diabetes care, but remains limited on mobile-health (m-Health) interventions. INTRODUCTION This study assessed the impact of an m-Health diabetes platform on clinical outcomes, patient-reported outcomes, patient and provider satisfaction, and app usage. MATERIALS AND METHODS This open-label, two-arm parallel study enrolled 91 people at 3 sites in India, aged 18-65, with type 2 diabetes, and an A1c between 7.5% and 12.5% (58-113 mmol/mol). Participants were randomly assigned 1:1 to m-Health or usual care and observed for 6 months. All received free visits, laboratory tests, transportation fees, and strips and lancets. Intervention participants received the m-Health app and a mobile phone data stipend. RESULTS A1c change was previously reported as statistically significant. Significantly more participants in intervention than control had improved medication adherence (39.0% vs. 12.8%; p = 0.03) and increased frequency of blood glucose (BG) self-testing (39.0% vs. 10.3%; p = 0.01) at 6 months from baseline. No other outcomes were significantly different. Among m-Health users, 75% of participants actively used the app at week 24. Participants entered 29,668 medications and 2,575 BG readings, sent 497 messages, and received 890 messages. Most participants (80%) were satisfied with all aspects of the app and all seven providers rated the software very acceptable. DISCUSSION Participants assigned to m-Health had increased medication adherence and frequency of BG testing compared with usual care participants. CONCLUSIONS This tool could be an effective way to expand access to quality chronic disease care and improve outcomes.
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Affiliation(s)
- Nora J Kleinman
- 1 Gather Health LLC , Hong Kong .,2 NJK Consulting , Seattle, WA
| | - Avani Shah
- 3 Diabetes Action Centre , Mumbai, India
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Phatak S, Chaurasia S, Mishra SK, Gupta R, Agrawal V, Aggarwal A, Misra R. Urinary B cell activating factor (BAFF) and a proliferation-inducing ligand (APRIL): potential biomarkers of active lupus nephritis. Clin Exp Immunol 2016; 187:376-382. [PMID: 27804111 DOI: 10.1111/cei.12894] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2016] [Indexed: 12/23/2022] Open
Abstract
B cell activating factor (BAFF) and a proliferation-inducing ligand (APRIL) help in B cell activation, maintenance and plasma cell survival. B cell infiltration has been demonstrated in kidneys of patients with lupus nephritis (LN). Serum levels of BAFF and APRIL have shown inconsistent relationships with lupus disease activity. We evaluated urinary levels of BAFF and APRIL as biomarker for LN. Thirty-six patients with proliferative lupus nephritis (AN), 10 with active lupus without nephritis (AL) and 15 healthy controls (HC) were studied. APRIL and BAFF levels were measured in both serum and urine using enzyme-linked immunosorbent assay (ELISA). Urine levels were normalized for urinary creatinine excretion. Urine levels were correlated with conventional disease activity markers and histology. Levels were reassessed in 20 AN patients at 6 months after treatment with cyclophosphamide. Urinary APRIL (uAPRIL) and BAFF (uBAFF) levels were raised significantly in AN. uAPRIL, but not uBAFF, correlated moderately with renal Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) in AN (r = 0·36, P < 0·05). On receiver operator curve (ROC) analysis, uBAFF and uAPRIL showed an area under the curve (AUC) of 0·825 and 0·781, respectively, in differentiating between nephritis and non-nephritis, which performed better than low C3, C4 and raised anti-dsDNA antibodies. There was no correlation of serum levels with uBAFF (r = 0·187, P = 0·261) and uAPRIL (r = 0·114, P = 0·494). uAPRIL levels reduced after treatment (mean 125 pg/mg to 36 pg/mg, P < 0·05). uBAFF levels reduced in 16 responders while two of four non-responders had increase in levels. Thus, uBAFF and uAPRIL are potential biomarkers of proliferative lupus nephritis.
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Affiliation(s)
- S Phatak
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - S Chaurasia
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - S K Mishra
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - R Gupta
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - V Agrawal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - A Aggarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - R Misra
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Kleinman NJ, Shah A, Shah S, Phatak S, Viswanathan V. Impact of the Gather mHealth System on A1C: Primary Results of a Multisite Randomized Clinical Trial Among People With Type 2 Diabetes in India. Diabetes Care 2016; 39:e169-70. [PMID: 27493133 DOI: 10.2337/dc16-0869] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 07/07/2016] [Indexed: 02/03/2023]
Affiliation(s)
| | - Avani Shah
- Diabetes Action Center, Kandivali, Mumbai, India
| | - Sanjiv Shah
- Diabetes Action Center, Kandivali, Mumbai, India
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Contreras K, Cuthbert J, Phatak S, Larson D, Benninghoff A. 0204 Effect of the total Western diet via direct or ancestral exposure on estrous cycling in third-generation offspring in mice. J Anim Sci 2016. [DOI: 10.2527/jam2016-0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Affiliation(s)
- S Phatak
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - L Gupta
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - A Aggarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Bhatt D, Chauhan N, Sharma A, Dhawan D, Bhatt RV, Phatak S, Padh H. Investigating the Role of Plasma Glucose Concentration as a Phenotypic Marker for CYP2C9 Genetic Variants, in the Diabetic Population of Gujarat. Indian J Pharm Sci 2014; 76:72-7. [PMID: 24799741 PMCID: PMC4007258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 12/19/2013] [Accepted: 12/26/2013] [Indexed: 12/02/2022] Open
Abstract
The present study was aimed to investigate the role of plasma glucose concentration as a phenotypic marker and to study the frequency distribution of CYP2C9 genetic variants in Gujarat state diabetic population. One hundred and nine unrelated diabetes mellitus patients treated with sulfonylureas were genotyped for CYP2C9*2 and CYP2C9*3 alleles. Their pre- and posttreatment postprandial blood glucose levels were recorded and mean glucose drop per milligram of drug values were calculated and further used as an index for phenotypic correlation. The frequencies of CYP2C9*1, CYP2C9*2 and CYP2C9*3 alleles in the Gujarat state diabetic population were 0.84, 0.07 and 0.09, respectively. The distribution of CYP2C9*1/*1, CYP2C9*1/*2, CYP2C9*1/*3, CYP2C9*2/*2, CYP2C9*2/*3 and CYP2C9*3/*3 genotypes were 0.73, 0.08, 0.13, 0.0, 0.06 and 0.0, respectively. Patients with CYP2C9*1/*2 genotype did not show any significant difference in the mean glucose drop per milligram of drug values when compared with wild-type patients in glipizide-treatment group. Patients with CYP2C9*1/*3 genotype showed greater mean glucose drop per milligram of drug values than patients with CYP2C9*1/*1 wild-type genotype for both glipizide and glimepiride while patients with CYP2C9*2/*3 genotype showed greater drop than patients with CYP2C9*1/*1 genotype only in the glipizide-treatment group. The presence of CYP2C9*3 allele significantly affected plasma glucose drop per milligram of drug values in patients taking glipizide and glimepiride, while effects of CYP2C9*2 allele were insignificant. Further studies are needed to confirm the effects of CYP2C9*2 allele on plasma glucose drop per milligram of drug values. However, plasma glucose concentration is a complex physiological marker that cannot be used to establish perfect genotype-phenotype correlation. Hence studies exploring robust phenotypic markers must be initiated.
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Affiliation(s)
- D. Bhatt
- Department of Pharmacology, L. M. College of Pharmacy, Navrangpura, Ahmedabad-380 009, India
| | - N. Chauhan
- Departments of Cellular and Molecular Biology, B. V. Patel PERD Centre, Thaltej, Ahmedabad-380 054, India,Address for correspondence: E-mail:
| | - A. Sharma
- Departments of Cellular and Molecular Biology, B. V. Patel PERD Centre, Thaltej, Ahmedabad-380 054, India
| | - D. Dhawan
- Departments of Cellular and Molecular Biology, B. V. Patel PERD Centre, Thaltej, Ahmedabad-380 054, India
| | - R. V. Bhatt
- Department of Pharmacology, L. M. College of Pharmacy, Navrangpura, Ahmedabad-380 009, India
| | - S. Phatak
- Vijayratna Diabetes Clinic, Paldi, Ahmedabad-380 007, India
| | - H. Padh
- Departments of Cellular and Molecular Biology, B. V. Patel PERD Centre, Thaltej, Ahmedabad-380 054, India
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Srivastava A, Shah S, Maseeh A, Vyasa B, Balaji M, Bhatter S, Buch P, Dantara D, Karnani J, Kumar V, Lodha S, Maji D, Moses A, Phatak S, Polarappu S, Shah S, Upadhayay B. A clinical study to compare the efficacy and safety of pregabalin sustained release formulation with pregabalin immediate release formulation in patients of diabetic peripheral neuropathic pain. Indian J Endocrinol Metab 2012; 16:S477-S479. [PMID: 23565472 PMCID: PMC3603120 DOI: 10.4103/2230-8210.104137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the efficacy and safety of sustained release (SR) formulation of pregabalin with immediate release (IR) formulation in patient with diabetic peripheral neuropathic pain. MATERIALS AND METHODS In this open label, randomized, comparative, multicentric study, the primary efficacy measure was reduction in visual analogue scale (VAS) of short form McGill pain questionnaire (SF-MPQ) score from baseline to last visit. The secondary evaluation measures included reduction in SF-MPQ descriptive score and present pain intensity score and change in clinical global impression - improvement of illness (CGI-I) and clinical global impression - severity of illness (CGI-S) from baseline to last visit. Total duration of the study was 12 weeks. Safety evaluation was done by recording treatment emergent adverse events and laboratory investigations at baseline and end of treatment. RESULTS Of 265 randomized patients, 133 received pregabalin SR tablets and 132 pregabalin IR. Patients randomized to both treatments responded to respective treatments. The least square means of VAS score in both the groups were reduced significantly (P <0.01). Reduction in both groups was similar (P = ns). At the end of the trial in both the groups, there was a significant reduction in the SF-MPQ descriptive score (P <0.01), severity of illness as well as clinically significant improvement in the symptoms. Difference between the groups for CGI-I (P = 0.37) and CGI-S (P = 0.41) score was not statistically significant. Treatment in both the groups was found safe and well tolerated. CONCLUSION The study shows that the pregabalin SR is safe and effective in patients of diabetic peripheral neuropathic pain. The results of the study demonstrated that pregabalin SR has comparable efficacy and safety as pregabalin IR.
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Affiliation(s)
- A. Srivastava
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - S. Shah
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - A. Maseeh
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - B. Vyasa
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - M. Balaji
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - S. Bhatter
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - P. Buch
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - D. Dantara
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - J. Karnani
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - V. Kumar
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - S. Lodha
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - D. Maji
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - A. Moses
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - S. Phatak
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - S. Polarappu
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - S. Shah
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
| | - B. Upadhayay
- Torrent Pharmaceuticals Limited, Ahmedabad, Gujarat, India
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Abstract
A case of metallic foreign body getting impacted into maxillary antrum and orbit due to a blast in a furnace, presenting primarily with 20% facial burn & ocular symptoms is presented for its rarity.
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Affiliation(s)
- S Phatak
- Choithram Hospital & Research Centre, 23, Lokmanya Nagar, Indore, 452 009 Indore MP
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Reddy UR, Phatak S, Allen C, Nycum LM, Sulman EP, White PS, Biegel JA. Localization of the human Ror1 gene (NTRKR1) to chromosome 1p31-p32 by fluorescence in situ hybridization and somatic cell hybrid analysis. Genomics 1997; 41:283-5. [PMID: 9143508 DOI: 10.1006/geno.1997.4653] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Ror1 is an orphan cell surface receptor with strong homology to the tyrosine kinase domain of growth factor receptors, in particular the Trk family. Southern blot analysis of genomic DNA from somatic cell hybrids revealed that Ror1 is located on chromosome 1. We have mapped the Ror1 gene to chromosome 1p12-p32 using PCR on a somatic cell hybrid panel that subdivides chromosome 1p. We have further localized the gene to chromosome 1p31-p32 by fluorescence in situ hybridization using a PAC clone that contains the Ror1 gene.
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Affiliation(s)
- U R Reddy
- Division of Neurology Research, Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
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Reddy UR, Phatak S, Pleasure D. Human neural tissues express a truncated Ror1 receptor tyrosine kinase, lacking both extracellular and transmembrane domains. Oncogene 1996; 13:1555-9. [PMID: 8875995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Human heart, lung and kidney express a 6 kb mRNA encoding Ror1, a member of the receptor tyrosine kinase (RTK) family with as yet unknown ligand specificity. We used a Ror1 cDNA probe to screen a cDNA library prepared from the human neuronogenic teratocarcinoma line, NTera2, and cloned a 2373 nucleotide transcript. This transcript contains an open reading frame that encodes a 388 amino acid protein identical with the cytosolic, C-terminal region of ror1 but lacking the ror1 transmembrane and entire extracellular domains. Northern blots demonstrate that mRNA encoding this truncated Ror1 ('t-Rorl') is abundantly expressed in fetal and adult human CNS, in human leukemia, lymphoma cell lines, and in a variety of human cancers derived from neuroectoderm. While previous studies have documented alternative splicing patterns within 5' and 3' regions of mRNAs encoding various RTKs altering their ligand binding specificity or their intracellular signaling, the present report is the first to demonstrate tissue-specific alternative mRNA splicing causing loss of the entire extracellular and transmembrane regions of an RTK.
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Affiliation(s)
- U R Reddy
- Division of Neurology Research, The Children's Hospital of Philadelphia, Pennsylvania 19104, USA
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Phatak S, Rangneker PV. Some observations on the ultrastructure of the sinus gland of the lobster, Palinurus polyphagus (Herbst). Riv Biol 1976; 69:59-76. [PMID: 1013594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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