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Bandyopadhyay S, Das S, Samajdar SS, Joshi SR. Role of semaglutide in the treatment of nonalcoholic fatty liver disease or non-alcoholic steatohepatitis: A systematic review and meta-analysis. Diabetes Metab Syndr 2023; 17:102849. [PMID: 37717295 DOI: 10.1016/j.dsx.2023.102849] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 09/19/2023]
Abstract
AIM This systematic review and meta-analysis was conducted to evaluate the efficacy and safety of 24 weeks of semaglutide treatment in patients with non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH). METHODS PubMed, Embase, Scopus, Cochrane CENTRAL, and ClinicalTrials.gov databases were searched for relevant studies. The primary outcome was the change in the serum alanine transaminase level. The secondary outcomes were changes in liver stiffness, liver function test parameters, metabolic parameters, and safety. Pooled mean differences and relative risks were calculated using random-effects models. RESULTS Six hundred studies were screened and eight were included (n = 2413). Semaglutide treatment showed a reduction in serum alanine transaminase [mean difference: 14.07 U/L (95% CI: 19.39 to -8.75); p < 0.001] and aspartate transaminase [mean difference: 6.89 U/L (95% CI: 9.14 to -4.63); p < 0.001] levels. There was a significant improvement in liver fat content [mean difference: 4.97% (95% CI: 6.65 to -3.29); p < 0.001] and liver stiffness [mean difference: 0.96 kPa (95% CI: 1.87 to -0.04); p = 0.04]. There were significant improvements in the glycated hemoglobin level and the lipid profile. However, the risk of serious adverse events [relative risk: 1.54 (95% CI: 1.02 to 2.34); p = 0.04] was high following semaglutide treatment as compared to placebo; the most common ones were gastrointestinal (nausea and vomiting, dyspepsia, decreased appetite, constipation, and diarrhea) and gallbladder-related diseases. CONCLUSION Treatment with 24 weeks of semaglutide could significantly improve liver enzymes, reduce liver stiffness, and improve metabolic parameters in patients with NAFLD/NASH. However, the gastrointestinal adverse effects could be a major concern.
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Affiliation(s)
| | - Saibal Das
- Indian Council of Medical Research - Centre for Ageing and Mental Health, Kolkata, India; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Shambo Samrat Samajdar
- Department of Clinical and Experimental Pharmacology, Calcutta School of Tropical Medicine, Kolkata, India
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Klonoff DC, Wang J, Rodbard D, Kohn MA, Li C, Liepmann D, Kerr D, Ahn D, Peters AL, Umpierrez GE, Seley JJ, Xu NY, Nguyen KT, Simonson G, Agus MSD, Al-Sofiani ME, Armaiz-Pena G, Bailey TS, Basu A, Battelino T, Bekele SY, Benhamou PY, Bequette BW, Blevins T, Breton MD, Castle JR, Chase JG, Chen KY, Choudhary P, Clements MA, Close KL, Cook CB, Danne T, Doyle FJ, Drincic A, Dungan KM, Edelman SV, Ejskjaer N, Espinoza JC, Fleming GA, Forlenza GP, Freckmann G, Galindo RJ, Gomez AM, Gutow HA, Heinemann L, Hirsch IB, Hoang TD, Hovorka R, Jendle JH, Ji L, Joshi SR, Joubert M, Koliwad SK, Lal RA, Lansang MC, Lee WA(A, Leelarathna L, Leiter LA, Lind M, Litchman ML, Mader JK, Mahoney KM, Mankovsky B, Masharani U, Mathioudakis NN, Mayorov A, Messler J, Miller JD, Mohan V, Nichols JH, Nørgaard K, O’Neal DN, Pasquel FJ, Philis-Tsimikas A, Pieber T, Phillip M, Polonsky WH, Pop-Busui R, Rayman G, Rhee EJ, Russell SJ, Shah VN, Sherr JL, Sode K, Spanakis EK, Wake DJ, Waki K, Wallia A, Weinberg ME, Wolpert H, Wright EE, Zilbermint M, Kovatchev B. A Glycemia Risk Index (GRI) of Hypoglycemia and Hyperglycemia for Continuous Glucose Monitoring Validated by Clinician Ratings. J Diabetes Sci Technol 2023; 17:1226-1242. [PMID: 35348391 PMCID: PMC10563532 DOI: 10.1177/19322968221085273] [Citation(s) in RCA: 53] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND A composite metric for the quality of glycemia from continuous glucose monitor (CGM) tracings could be useful for assisting with basic clinical interpretation of CGM data. METHODS We assembled a data set of 14-day CGM tracings from 225 insulin-treated adults with diabetes. Using a balanced incomplete block design, 330 clinicians who were highly experienced with CGM analysis and interpretation ranked the CGM tracings from best to worst quality of glycemia. We used principal component analysis and multiple regressions to develop a model to predict the clinician ranking based on seven standard metrics in an Ambulatory Glucose Profile: very low-glucose and low-glucose hypoglycemia; very high-glucose and high-glucose hyperglycemia; time in range; mean glucose; and coefficient of variation. RESULTS The analysis showed that clinician rankings depend on two components, one related to hypoglycemia that gives more weight to very low-glucose than to low-glucose and the other related to hyperglycemia that likewise gives greater weight to very high-glucose than to high-glucose. These two components should be calculated and displayed separately, but they can also be combined into a single Glycemia Risk Index (GRI) that corresponds closely to the clinician rankings of the overall quality of glycemia (r = 0.95). The GRI can be displayed graphically on a GRI Grid with the hypoglycemia component on the horizontal axis and the hyperglycemia component on the vertical axis. Diagonal lines divide the graph into five zones (quintiles) corresponding to the best (0th to 20th percentile) to worst (81st to 100th percentile) overall quality of glycemia. The GRI Grid enables users to track sequential changes within an individual over time and compare groups of individuals. CONCLUSION The GRI is a single-number summary of the quality of glycemia. Its hypoglycemia and hyperglycemia components provide actionable scores and a graphical display (the GRI Grid) that can be used by clinicians and researchers to determine the glycemic effects of prescribed and investigational treatments.
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Affiliation(s)
- David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
| | - Jing Wang
- Florida State University College of Nursing, Tallahassee, FL, USA
| | - David Rodbard
- Biomedical Informatics Consultants LLC, Potomac, MD, USA
| | - Michael A. Kohn
- University of California, San Francisco, San Francisco, CA, USA
| | - Chengdong Li
- Florida State University College of Nursing, Tallahassee, FL, USA
| | | | - David Kerr
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
| | - David Ahn
- Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA
| | | | | | | | - Nicole Y. Xu
- Diabetes Technology Society, Burlingame, CA, USA
| | | | | | | | | | | | | | - Ananda Basu
- University of Virginia, Charlottesville, VA, USA
| | - Tadej Battelino
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | | | | | | | | | | | | | - Kong Y. Chen
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | | | | | | | | | - Thomas Danne
- Diabetes Center Auf der Bult, Hannover Medical School, Hannover, Germany
| | | | | | | | | | - Niels Ejskjaer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Juan C. Espinoza
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | | | | | | | | | | | | | | | | | - Thanh D. Hoang
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | | | - Linong Ji
- Peking University People’s Hospital, Peking University Diabetes Center, Beijing, China
| | | | | | | | | | - M. Cecilia Lansang
- Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Wei-An (Andy) Lee
- LAC + USC Medical Center, Los Angeles County Department of Health Service, Los Angeles, CA, USA
| | - Lalantha Leelarathna
- Manchester University NHS Foundation Trust and The University of Manchester, Manchester, UK
| | - Lawrence A. Leiter
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital and University of Toronto, Toronto, ON, Canada
| | - Marcus Lind
- University of Gothenburg, Gothenburg, Sweden
| | | | | | | | | | - Umesh Masharani
- University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Viswanathan Mohan
- Dr. Mohan’s Diabetes Specialities Centre, Chennai, India
- Madras Diabetes Research Foundation, Chennai, India
| | | | | | | | | | | | | | - Moshe Phillip
- Institute for Endocrinology and Diabetes, Schneider Children’s Medical Center of Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | | | | | - Gerry Rayman
- Ipswich Hospital, East Suffolk and North Essex Foundation Trust and University of East Anglia, Ipswich, UK
| | - Eun-Jung Rhee
- Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Korea
| | - Steven J. Russell
- Massachusetts General Hospital Diabetes Research Center, Boston, MA, USA
| | - Viral N. Shah
- Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO, USA
| | | | - Koji Sode
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- North Carolina State University, Raleigh, NC, USA
| | | | | | - Kayo Waki
- The University of Tokyo, Tokyo, Japan
| | | | | | | | | | - Mihail Zilbermint
- Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Community Physicians, Bethesda, MD, USA
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Godhamgaonkar AA, Wadhwani NS, Randhir KN, Selukar SS, Dalvi S, Dangat K, Wagh GN, Lalwani S, Chandhiok N, Kulkarni B, Fall C, Sachdev HPS, Gupte S, Joshi SR. Erythrocyte fatty acids and desaturase indices in early pregnancy are associated with risk of preeclampsia. Prostaglandins Leukot Essent Fatty Acids 2023; 196:102583. [PMID: 37531787 DOI: 10.1016/j.plefa.2023.102583] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023]
Abstract
Preeclampsia (PE) is a pregnancy disorder that may be associated with inadequate maternal nutrition. Fatty acids are vital for placental and fetal growth. Fatty acid desaturases, key enzymes influencing the metabolism of polyunsaturated fatty acids, are reported to be associated with cardiometabolic risk. Any imbalance in the levels of omega-3 and omega-6 fatty acids can result in increased inflammatory response. The current study reports the levels of erythrocyte fatty acids and desaturase index across gestation in women who develop PE (n = 108) and compares them with non-PE women (n = 216). Maternal erythrocyte fatty acids were measured at 4 time points during pregnancy (i.e., 11-14, 18-22, 26-28 weeks and at delivery) using gas chromatography. Maternal total erythrocyte saturated fatty acids and omega-6/omega-3 fatty acid ratio was higher in the PE group as compared to the non-PE group at 11-14 weeks and 18-22 weeks respectively. Maternal Δ5 desaturase index was lower while Δ6 desaturase index was higher in the PE group at 11-14 and 18-22 weeks. Maternal stearoyl CoA desaturase-18 (SCD-18) index was lower at 11-14 weeks and at delivery. These changes were mainly observed in the early onset PE (EOP) group. Δ6 desaturase index at 11-14 weeks predicted the risk of EOP. Imbalance in fatty acid levels and desaturase indices predate the clinical diagnosis of PE, indicating their role in its pathophysiology. Measurement of fatty acids and desaturase indices in early pregnancy merits evaluation as predictors of risk of PE.
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Affiliation(s)
- A A Godhamgaonkar
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, 411043, India
| | - N S Wadhwani
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, 411043, India
| | - K N Randhir
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, 411043, India
| | - S S Selukar
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, 411043, India
| | - S Dalvi
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, 411043, India
| | - K Dangat
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, 411043, India
| | - G N Wagh
- Department of Obstetrics and Gynaecology, Bharati Medical College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune, 411043, India
| | - S Lalwani
- Department of Obstetrics and Gynaecology, Bharati Medical College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune, 411043, India
| | - N Chandhiok
- Division of Reproductive, Biology, Maternal and Child Health (RBMCH) and Nutrition, Indian Council of Medical Research - Headquarters, New Delhi, India
| | - B Kulkarni
- Division of Reproductive, Biology, Maternal and Child Health (RBMCH) and Nutrition, Indian Council of Medical Research - Headquarters, New Delhi, India
| | - C Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - H P S Sachdev
- Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - S Gupte
- Gupte Hospital and Research Centre, Pune, 411004, India
| | - S R Joshi
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, 411043, India.
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Singh AK, Singh A, Singh R, Joshi SR, Misra A. Non-sugar sweeteners and health outcomes in adults without diabetes: deciphering the WHO recommendations in the Indian context. Diabetes Metab Syndr 2023; 17:102829. [PMID: 37451112 DOI: 10.1016/j.dsx.2023.102829] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 06/30/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND AND AIMS A systematic review and meta-analysis conducted by the World Health Organization (WHO) assessed the health outcomes of non-sugar sweeteners (NSS) in randomized controlled trials (RCTs) and prospective cohort studies (PCSs) and reported conflicting findings. We aim to decipher these conflicting findings in RCTs and PCSs by critically reviewing their results, comparing them with previous meta-analyses, and providing a simplified interpretation including the Indian perspective. METHODS We critically reviewed the 210-page dossier of WHO including the full text of most of the key studies of NSS included in this meta-analysis and subsequently compared it with previous meta-analyses to identify similarities and differences to address a few key questions pertaining to health outcomes associated with NSS use in adults. RESULTS Poor health outcomes are often associated with excess sugar intake. While NSS are typically consumed as a sugar replacement, benefits are conflicting. While RCTs found some benefits in the short term, PCSs found harm associated with NSS use in the long term. CONCLUSION The 2022 WHO meta-analysis that assessed the health outcomes of NSS is the most robust and critically analyzed document available to date. Despite the absence of any strong conclusion that suggests NSS consumption increases the risk of cardio-metabolic disorders, no firm evidence also rejects this statement. NSS could be an attractive replacement for sugar in overweight/obese people in the short term, but long-term harm cannot be fully ruled out. We suggest avoiding consuming sugar and restricting NSS intake wherever possible until long-term studies confirm or refute these findings.
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Affiliation(s)
- Awadhesh Kumar Singh
- G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India; Sun Valley Hospital & Diabetes Research Centre, Guwahati, Assam, India; Horizon Lifeline Multi-specialty Hospital, Kolkata, West Bengal, India.
| | - Akriti Singh
- Jawaharlal Nehru Medical College & Hospital, Kalyani, West Bengal, India
| | - Ritu Singh
- G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India; Horizon Lifeline Multi-specialty Hospital, Kolkata, West Bengal, India
| | | | - Anoop Misra
- Fortis C-DOC Hospital for Diabetes & Allied Sciences, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India; Diabetes Foundation (India), New Delhi, India
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Joshi SR, Mittra S, Raj P, Suvarna VR, Athalye SN. Biosimilars and interchangeable biosimilars: facts every prescriber, payor, and patient should know. Insulins perspective. Expert Opin Biol Ther 2023; 23:693-704. [PMID: 35993301 DOI: 10.1080/14712598.2022.2112664] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/09/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION For many of the 537 million adults living now with diabetes, the cost of insulin is becoming prohibitive as the insulin prices have tripled between 2002-2013. Globally, the direct annual cost of healthcare expenditure due to diabetes will soon be US$1 Trillion. Biosimilars provide access to high-quality, affordable biologic therapy that is otherwise inaccessible due to the high costs of original biologics. AREAS COVERED A primer to the development of biosimilars shows comparable structural and analytical characterization to the original biologics (e.g. insulins), with no clinically significant or meaningful differences in efficacy and safety. 'Interchangeability' status, a regulatory designation by the US FDA, bestowed to some biosimilars, enables confidence in high-quality, bio-equivalent biosimilar of insulin with key global approvals. This can allow rapid uptake of biosimilars by the prescribers, formulary decision-makers, and payors. Biocon-Viatris's biosimilar Insulin Glargine (Semglee®) is the first interchangeable biosimilar insulin approved by the US FDA. EXPERT OPINION The 'interchangeable' status can prompt faster and wider uptake of insulin biosimilars and keep the insulin expenditure under control, especially for patients who otherwise practice non-adherence or rationing of life-saving insulin. Education, support, and awareness can ensure that interchangeable biosimilars gain wider acceptance.
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Affiliation(s)
- Shashank R Joshi
- Department of Diabetology and Endocrinology, Lilavati Hospital and Research Center, Mumbai, India
| | - Shivani Mittra
- Clinical Development and Medical Affairs, Biocon Biologics Ltd, Bengaluru, India
| | - Praveen Raj
- Clinical Development and Medical Affairs, Biocon Biologics Ltd, Bengaluru, India
| | - Viraj Ramesh Suvarna
- Clinical Development and Medical Affairs, Biocon Biologics Ltd, Bengaluru, India
| | - Sandeep N Athalye
- Clinical Development and Medical Affairs, Biocon Biologics Ltd, Bengaluru, India
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Joshi SR, Chowdhury S, Dharmalingam M, Bhandari S, Deshmukh V, Cruz MD, Farishta F. Prevalence of Pancreatic Exocrine Insufficiency among Patients with Diabetes Mellitus in India. J Assoc Physicians India 2023; 71:11-12. [PMID: 37449690 DOI: 10.59556/japi.71.0316] [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: 07/18/2023]
Abstract
AIMS We aimed to assess the prevalence of pancreatic exocrine insufficiency (PEI) in Indian patients with type 1 diabetes (T1D) or type 2 diabetes (T2D) using a unique diagnostic criterion. METHODS This multicenter study included patients aged ≥18 years with diabetes for at least 5 years. The sociodemographic characteristics, lifestyle habits, and clinical characteristics of patients were assessed. Patients were administered the PEI questionnaire (PEI-Q), and fecal elastase-1 (FE) concentration was measured. Patients were diagnosed to have PEI if they satisfied any two of the following three criteria: (a) a PEI-Q total symptom score of ≥0.60; (b) presence of malnutrition using the European Society of Clinical Nutrition and Metabolism diagnostic criteria for malnutrition; or (c) FE concentration <100 μg/gm stool. RESULTS This multicenter study included patients aged ≥18 years with diabetes for at least 5 years. The sociodemographic characteristics, lifestyle habits, and clinical characteristics of patients were assessed. Patients were administered the PEI questionnaire (PEI-Q), and fecal elastase-1 (FE) concentration was measured. Patients were diagnosed to have PEI if they satisfied any two of the following three criteria: (a) a PEI-Q total symptom score of ≥0.60; (b) presence of malnutrition using the European Society of Clinical Nutrition and Metabolism diagnostic criteria for malnutrition; or (c) FE concentration <100 μg/gm stool. CONCLUSIONS Pancreatic exocrine insufficiency (PEI) was found to be prevalent in nearly one-fourth of Indian patients with diabetes, using composite diagnostic criteria.
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Affiliation(s)
- Shashank R Joshi
- MBBS, MD, DM (Endocrinology), Joshi Clinic and Department of Diabetology and Endocrinology, Lilavati Hospital, Mumbai, Maharashtra; Corresponding Author
| | - Subhankar Chowdhury
- MBBS, DTM, DM (Endocrinology), MRCP (UK), Department of Endocrinology, Calcutta Medical Centre, Kolkata, West Bengal
| | - Mala Dharmalingam
- MBBS, Bangalore Endocrinology and Diabetes Research Center and Laboratory, Bengaluru, Karnataka
| | - Sudhir Bhandari
- MBBS, MD, DNB, MNAMS, AFICA (USA), FISC, Bhandari Clinic and Research Centre, Jaipur, Rajasthan
| | - Vaishali Deshmukh
- MD, DNB (General Medicine), DM (Endocrinology), Deshmukh Clinic & Research Centre, Pune, Maharashtra
| | - Mary D Cruz
- MBBS, MD (Internal Medicine), Dr Mary D Cruz's Clinic, Kolkata, West Bengal
| | - Faraz Farishta
- MBBS, DNB, MMSc, PG DIP (Endocrinology), Department of Endocrinology Diabetes & Metabolism, F. S. Endocrine & Diabetes Center, Hyderabad, Telangana, India
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Das S, Samajdar SS, Mukherjee S, Sarkar S, Sen S, Pathak A, Lundborg CS, Selvarajan S, Tripathi SK, Pal J, Chatterjee N, Joshi SR. Ten clinical pharmacological interventions in routine care to ensure better treatment outcomes. Int J Pharm Pract 2023:7146135. [PMID: 37105526 DOI: 10.1093/ijpp/riad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Saibal Das
- Indian Council of Medical Research, Centre for Ageing and Mental Health, Kolkata, India
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Shambo Samrat Samajdar
- Department of Clinical and Experimental Pharmacology, Calcutta School of Tropical Medicine, Kolkata, India
| | - Shatavisa Mukherjee
- Department of Clinical and Experimental Pharmacology, Calcutta School of Tropical Medicine, Kolkata, India
| | - Sougata Sarkar
- Department of Clinical and Experimental Pharmacology, Calcutta School of Tropical Medicine, Kolkata, India
| | - Sumalya Sen
- Department of Clinical and Experimental Pharmacology, Calcutta School of Tropical Medicine, Kolkata, India
| | - Ashish Pathak
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatrics, RD Gardi Medical College, Ujjain, India
| | | | - Sandhiya Selvarajan
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Jyotirmoy Pal
- Department of Medicine, RG Kar College and Hospital, Kolkata, India
| | - Nandini Chatterjee
- Department of Medicine, Institute of Postgraduate Medical Education and Research and SSKM Hospital, Kolkata, India
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Joshi SR, Singh G, Marwah A, Mittra S, Suvarna VR, Athalye SN. Comparative clinical efficacy and safety of insulin glargine 300 U/ml (Toujeo) versus insulin glargine 100 U/ml in type 2 diabetes and type 1 diabetes: A systematic literature review and meta-analysis. Diabetes Obes Metab 2023; 25:1589-1606. [PMID: 36748186 DOI: 10.1111/dom.15007] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023]
Abstract
AIM To compare the clinical efficacy and safety of glargine-U100 (Lantus/Gla-100) with glargine-U300 (Toujeo/Gla-300) in adult patients with type 2 diabetes (T2D) and type 1 diabetes (T1D). MATERIALS AND METHODS A literature search on Gla-300/Gla-100 in diabetes management was conducted using the MEDLINE/Embase/Cochrane databases from inception to 10 January 2021. Eligible studies considered for inclusion were parallel-design, randomized controlled trials (RCTs). The Cochrane risk-of-bias tool was used to evaluate the quality of the included studies. The random-effects model was applied for interpretation of the results. RESULTS Of 5348 records screened, 592 were assessed for eligibility and 15 RCTs were considered for data extraction and meta-analysis (T2D [N = 10; n = 7082]; T1D [N = 5; n = 2222]). In patients with T1D, all safety parameters were comparable between Gla-100 and Gla-300. In T2D, statistically significant differences were observed in favour of Gla-300 over Gla-100 for nocturnal and total hypoglycaemia. For efficacy parameters, a statistically and clinically significant difference favouring Gla-100 in basal insulin dose requirement was observed for both T2D and T1D. Change in HbA1c showed a statistically but not clinically significant reduction with Gla-100 compared with Gla-300 in T1D. Statistically significant but clinically less relevant differences favoured Gla-300 for control of body weight in T1D and T2D and Gla-100 for fasting blood glucose in T2D. CONCLUSIONS Gla-100 and Gla-300 had comparable efficacy and safety profiles in both T1D and T2D populations. Gla-300 showed a lower risk of nocturnal and total hypoglycaemia, significant in insulin-experienced/exposed patients with T2D. Patients on Gla-300 required significantly more units of insulin daily than the Gla-100 group to achieve equivalent efficacy.
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Affiliation(s)
- Shashank R Joshi
- Department of Diabetology and Endocrinology, Lilavati Hospital and Research Center, Mumbai, India
| | - Gursharan Singh
- Clinical Development and Medical Affairs, Biocon Biologics India Ltd., Bengaluru, India
| | - Ashwani Marwah
- Clinical Development and Medical Affairs, Biocon Biologics India Ltd., Bengaluru, India
| | - Shivani Mittra
- Clinical Development and Medical Affairs, Biocon Biologics India Ltd., Bengaluru, India
| | - Viraj R Suvarna
- Clinical Development and Medical Affairs, Biocon Biologics India Ltd., Bengaluru, India
| | - Sandeep N Athalye
- Clinical Development and Medical Affairs, Biocon Biologics India Ltd., Bengaluru, India
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Joshi SR, Das S, Xaviar S, Samajdar SS, Saha I, Sarkar S, Mukherjee S, Tripathi SK, Pal J, Chatterjee N. Efficacy and safety of lobeglitazone, a new Thiazolidinedione, as compared to the standard of care in type 2 diabetes mellitus: A systematic review and meta-analysis. Diabetes Metab Syndr 2023; 17:102703. [PMID: 36634469 DOI: 10.1016/j.dsx.2022.102703] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/29/2022] [Accepted: 12/31/2022] [Indexed: 01/04/2023]
Abstract
AIM This systematic review and meta-analysis was conducted to evaluate the efficacy and safety of lobeglitazone as compared to the standard of care (SOC) in patients with type 2 diabetes mellitus (T2DM). METHODS Databases were searched for relevant randomized controlled trials. The primary outcome was the comparison of the glycated hemoglobin (HbA1C) level after 24 weeks. Pooled mean differences and odds ratios were calculated using random-effects models. RESULTS Of 267 studies that were screened, four were included. Treatment with adjunct lobeglitazone showed a reduction in the HbA1C level [mean difference: -0.23% (95% CI: -0.62 to 0.16); p = 0.24; i2: 87%; moderate GRADE (Grading of Recommendations Assessment, Development and. Evaluation) of evidence], fasting blood glucose level [mean difference: -7.12 mg/dl (95% CI: -20.09 to 5.85); p = 0.28; i2: 87%; moderate GRADE of evidence], and lipid profile as compared to those following treatment with the SOC; however, the changes were not statistically significant. The risk of hypoglycemia was significantly lower [odds ratio: 0.24 (95% CI: 0.08 to 0.70); p < 0.05; i2: 0%; moderate GRADE of evidence] without any significant difference in the risk of drug-related adverse events [odds ratio: 1.59 (95% CI: 0.87 to 2.93); p = 0.13; i2: 0%; moderate GRADE of evidence] following treatment with lobeglitazone as compared to those following treatment with the SOC. CONCLUSION Treatment with adjunct lobeglitazone showed changes in the blood glycemic status and lipid profile similar to SOC in patients with T2DM, and the results were not statistically significant. Lobeglitazone was well tolerated; its safety profile was comparable to SOC.
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Affiliation(s)
| | - Saibal Das
- Indian Council of Medical Research - Centre for Ageing and Mental Health, Kolkata, India; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Suja Xaviar
- Department of Pharmacology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Shambo Samrat Samajdar
- Department of Clinical and Experimental Pharmacology, Calcutta School of Tropical Medicine, Kolkata, India.
| | - Indranil Saha
- Indian Council of Medical Research - Centre for Ageing and Mental Health, Kolkata, India
| | - Sougata Sarkar
- Department of Clinical and Experimental Pharmacology, Calcutta School of Tropical Medicine, Kolkata, India
| | - Shatavisa Mukherjee
- Department of Clinical and Experimental Pharmacology, Calcutta School of Tropical Medicine, Kolkata, India
| | | | - Jyotirmoy Pal
- Department of Medicine, RG Kar College and Hospital, Kolkata, India
| | - Nandini Chatterjee
- Department of Medicine, Institute of Postgraduate Medical Education and Research and SSKM Hospital, Kolkata, India
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10
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Joshi SR. COVID 19 are we at the End of the Road in India - Pandemic to Endemic Journey. J Assoc Physicians India 2022; 69:11-12. [PMID: 35057585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Shashank R Joshi
- Consultant Endocrinologist, Lilavati Hospital and Joshi Clinic, Mumbai, Maharashtra; Member, Maharashtra COVID-19 Task Force
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11
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Anjana RM, Srinivasan S, Sudha V, Joshi SR, Saboo B, Tandon N, Das AK, Jabbar PK, Madhu SV, Gupta A, Bajaj S, Chowdhury S, Kalra S, Gayathri R, Abirami K, Manasa VS, Padmapritha T, Lakshmipriya N, Geetha G, Deepa M, Pradeepa R, Unnikrishnan R, Kurpad AV, Krishnaswamy K, Kaur T, Dhaliwal RS, Mohan V. Macronutrient Recommendations for Remission and Prevention of Diabetes in Asian Indians Based on a Data-Driven Optimization Model: The ICMR-INDIAB National Study. Diabetes Care 2022; 45:dc220627. [PMID: 36350789 DOI: 10.2337/dc22-0627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/05/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To derive macronutrient recommendations for remission and prevention of type 2 diabetes (T2D) in Asian Indians using a data-driven optimization approach. RESEARCH DESIGN AND METHODS Dietary, behavioral, and demographic assessments were performed on 18,090 adults participating in the nationally representative, population-based Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study. Fasting and 2-h postglucose challenge capillary blood glucose and glycosylated hemoglobin (HbA1c) were estimated. With HbA1c as the outcome, a linear regression model was first obtained for various glycemic categories: newly diagnosed diabetes (NDD), prediabetes (PD), and normal glucose tolerance (NGT). Macronutrient recommendations were formulated as a constrained quadratic programming problem (QPP) to compute optimal macronutrient compositions that would reduce the sum of the difference between the estimated HbA1c from the linear regression model and the targets for remission (6.4% for NDD and 5.6% for PD) and prevention of progression in T2D in PD and NGT groups. RESULTS Four macronutrient recommendations (%E- Energy) emerged for 1) diabetes remission in NDD: carbohydrate, 49-54%; protein, 19-20%; and fat, 21-26%; 2) PD remission to NGT: carbohydrate, 50-56%; protein,18-20%; fat, 21-27%; 3 and 4) prevention of progression to T2D in PD and NGT: carbohydrate, 54-57% and 56-60%; protein, 16-20% and 14-17%, respectively; and fat 20-24% for PD and NGT. CONCLUSIONS We recommend reduction in carbohydrates (%E) and an increase in protein (%E) for both T2D remission and for prevention of progression to T2D in PD and NGT groups. Our results underline the need for new dietary guidelines that recommend appropriate changes in macronutrient composition for reducing the burden due to diabetes in South Asia.
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Affiliation(s)
- Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Seshadhri Srinivasan
- International Research Centre, Kalasalingam Academy of Research and Education, Srivilliputhur, Tamil Nadu, India
| | - Vasudevan Sudha
- Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Shashank R Joshi
- Department of Diabetology and Endocrinology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Banshi Saboo
- Dia Care-Diabetes Care & Hormone Clinic, Ahmedabad, Gujarat, India
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi - National Capital, India
| | - Ashok Kumar Das
- Department of General Medicine & Endocrinology, Pondicherry Institute of Medical Sciences, Pudcherry - Union Territory, India
| | | | - Sri Venkata Madhu
- Department of Endocrinology, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Arvind Gupta
- Department of Diabetes, Obesity and Metabolic Disorders, Rajasthan Hospital, Jaipur, Rajasthan, India
| | - Sarita Bajaj
- Department of Medicine, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Subhankar Chowdhury
- Department of Endocrinology & Metabolism, Institute of Post Graduate Medical Education & Research (IPGMER) & SSKM Hospital, Kolkata, West Bengal, India
| | | | - Rajagopal Gayathri
- Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Kuzhandaivelu Abirami
- Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Valangaiman Sriram Manasa
- Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Thamotharan Padmapritha
- Department of Instrumentation and Control Engineering, Kalasalingam Academy of Research and Education, Srivilliputhur, Tamil Nadu, India
| | - Nagarajan Lakshmipriya
- Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Gunasekaran Geetha
- Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Mohan Deepa
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Rajendra Pradeepa
- Department of Research Operations, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Ranjit Unnikrishnan
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | | | - Kamala Krishnaswamy
- Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Tanvir Kaur
- Non-Communicable Diseases Division, Indian Council of Medical Research, New Delhi, India
| | | | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
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Joshi SR, Rajput R, Chowdhury S, Singh AK, Bantwal G, Das AK, Unnikrishnan AG, Saboo BD, Kesavadev J, Ghosal S, Mohan V. The role of oral semaglutide in managing type 2 diabetes in Indian clinical settings: Addressing the unmet needs. Diabetes Metab Syndr 2022; 16:102508. [PMID: 35653929 DOI: 10.1016/j.dsx.2022.102508] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
AIMS Despite their established benefits, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) remain underutilized for type 2 diabetes mellitus (T2DM) management, which indicates that subcutaneous injection is an unfavorable mode of delivery from the patient's perspective. This review summarizes existing challenges related to medication adherence and the use of antihyperglycemia injectables, revisits the established safety and efficacy of oral semaglutide, and explores its features and considerations for use among the Indian T2DM population. METHODS We performed a literature search using MEDLINE and the National Institutes of Health Clinical Trials Registry from July 1, 2016, to July 1, 2021, to identify publications on oral semaglutide approval, T2DM treatment guidelines, and clinical evidence for oral drug formulation. RESULTS Oral semaglutide is the first oral GLP-1 RA approved for T2DM patients based on phase 3, randomized PIONEER trials. The multitargeted action of this drug offers glycemic control, weight control, and cardiovascular, renal, and additional benefits, including patient convenience and enhanced medication adherence. In addition to achieving glycemic control, the cost of semaglutide is reported to be lower than other GLP-1 RA in the West, thus potentially mitigating the economic burden that appears to be high among the Indian population. CONCLUSIONS Currently, there is no data available on oral semaglutide in Indian clinical settings. However, significant improvements in glycemic control, cardiac and renal benefits, as well as weight loss across clinical trials should encourage clinicians to prioritize oral semaglutide over other antidiabetic agents.
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Affiliation(s)
- Shashank R Joshi
- Grant Medical College and Consulting Endocrinologist, Lilavati Hospital, Mumbai, India.
| | - Rajesh Rajput
- Department of Endocrinology, PGIMS, Rohtak, Haryana, India.
| | | | - Awadhesh K Singh
- G. D. Hospital & Diabetes Institute, Kolkata, West Bengal, India.
| | | | - Ashok K Das
- Department of General Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India.
| | | | | | | | | | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialties Centre & Madras Diabetes Research Foundation, Chennai, India.
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13
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Joshi SR, Wangnoo SK, Chowdhury S, Chandalia HB, Sethi B, Unnikrishnan AG, Zargar AH, Das AK, Kumar A, Kalra S, Mohan V. Indian Reality of Clinical Practice and Patient Profile in Diabetes Care: Lessons from the IMPACT survey. J Assoc Physicians India 2022; 70:11-12. [PMID: 35598134] [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: 06/15/2023]
Abstract
UNLABELLED India shoulders a heavy burden of diabetes mellitus (DM), the management of which is suboptimal globally.& Objectives: Insulin Management: Practical Aspects in Choice of Therapy (IMPACT) survey was designed to gain insight into the ground (in-clinic) reality of DM management by physicians in India. METHODS A survey consisting of 12 multiple-choice questions was conducted by SurveyMonkey® , focusing on practice profile, patient profile, and other aspects of DM management. RESULTS The survey included 2424 physicians. Majority of them were general physicians (58.5%) followed by diabetologists (31.1%). Most (49.2%) of the respondents specified that the ideal time for a DM consultation is 15 min. However, 73.4% of them provided consultation of <10& min because of heavy patient load. Nearly half of the respondents reported that their patients consumed a diet with carbohydrate content of 60% to 80%, and 79.4% of them admitted that <50% of their patients adhered to dietary advice. About 73.5% of the respondents believed controlling fasting plasma glucose (FPG) level alone would not adequately control postprandial plasma glucose (PPG) level, and 93.0% of them preferred an insulin therapy at the initiation that controls both FPG and PPG levels. CONCLUSION Limited consultation time, high-carbohydrate diet, and a need for choosing insulin regimens that provide control for both PPG and FPG levels are some ground realities of DM management in India. These realities need to be factored in while choosing treatment options to achieve the desired glycemic control and improve the status of diabetes care.
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Affiliation(s)
- Shashank R Joshi
- Lilavati Hospital and Research Centre, Mumbai, Maharashtra; Corresponding Author
| | | | | | | | | | | | - Abdul Hamid Zargar
- Advanced Centre for Diabetes and Endocrine Care, Srinagar, Jammu and Kashmir
| | | | - Ajay Kumar
- Diabetes Care and Research Centre, Patna, Bihar
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14
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Chettri U, Joshi SR. A first calibration of culturable bacterial diversity and their dual resistance to heavy metals and antibiotics along altitudinal zonation of the Teesta River. Arch Microbiol 2022; 204:241. [PMID: 35378604 DOI: 10.1007/s00203-022-02858-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 11/25/2022]
Abstract
Culturable bacterial diversity and co-occurrence of heavy metal and antibiotic resistance were investigated from the water and sediments along the course of the Teesta River, in the Eastern Himalayas. Water and sediment samples collected from six sampling points during the monsoon and winter seasons were subjected to analysis of physico-chemical parameters, heavy metal contamination and antibiotic tolerance. The culturable bacterial diversity established by application of bacterial culture and 16S rRNA gene sequencing, ascertained the majority belonged to Proteobacteria, Actinobacteria, Firmicutes, Bacteroidetes and Deinococcus-Thermus. Among the 5 phyla, Proteobacteria and Actinobacteria were the dominant phyla present in both water and sediment samples, whereas Bacteroidetes, Firmicutes and Deinococcus-Thermus were unique to particular sites. The Shannon index indicated that the bacterial richness was more in the water column as compared to sediment. From the total of 245 isolates, 69 genera were identified. Heavy metal tolerance and antibiotic resistance profiles showed some isolates to be tolerant to high levels of heavy metals and multiple antibiotics indicating a major concern in terms of river ecosystem serving as a pool for dissemination of such resistant genes. The antibiotic resistance and heavy metal contamination diversified along the human-impacted downstream sites, endorsing the contribution of anthropogenic factors. The present report on bacterial diversity and the associated metal and antibiotics tolerance among bacteria is the first of its kind on Teesta River, the only major river system flowing through the state of Sikkim and parts of North Bengal.
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Affiliation(s)
- Upashna Chettri
- Microbiology Laboratory, Department of Biotechnology and Bioinformatics, North-Eastern Hill University, Shillong, Meghalaya, 793022, India
| | - S R Joshi
- Microbiology Laboratory, Department of Biotechnology and Bioinformatics, North-Eastern Hill University, Shillong, Meghalaya, 793022, India.
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15
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Anjana RM, Siddiqui MK, Jebarani S, Vignesh MA, Kamal Raj N, Unnikrishnan R, Pradeepa R, Panikar VK, Kesavadev J, Saboo B, Gupta S, Sosale AR, Seshadri KG, Deshpande N, Chawla M, Chawla P, Das S, Behera M, Chawla R, Nigam A, Gupta A, Kovil R, Joshi SR, Agarwal S, Bajaj S, Pearson ER, Doney ASF, Palmer CNA, Mohan V. Prescribing Patterns and Response to Antihyperglycemic Agents Among Novel Clusters of Type 2 Diabetes in Asian Indians. Diabetes Technol Ther 2022; 24:190-200. [PMID: 34609928 DOI: 10.1089/dia.2021.0277] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Aim: To assess the prescribing patterns and response to different classes of antihyperglycemic agents in novel clusters of type 2 diabetes (T2D) described in India. Materials and Methods: We attempted to replicate the earlier described clusters of T2D, in 32,867 individuals with new-onset T2D (within 2 years of diagnosis) registered between October 2013 and December 2020 at 15 diabetes clinics located across India, by means of k-means clustering utilizing 6 clinically relevant variables. Individuals who had follow-up glycated hemoglobin (HbA1c) up to 2 years were included for the drug response analysis (n = 13,247). Results: Among the 32,867 participants included in the study, 20,779 (63.2%) were males. The average age at diagnosis was 45 years and mean HbA1c at baseline was 8.9%. The same four clusters described in India earlier were replicated. Forty percent of the study participants belonged to the mild age-related diabetes cluster, followed by insulin-resistant obese diabetes (27%), severe insulin-deficient diabetes (21%), and combined insulin-resistant and insulin-deficient diabetes (12%) clusters. The most frequently used antihyperglycemic agents were sulfonylureas, metformin, and dipeptidyl peptidase-4 inhibitors apart from insulin. While there were significant differences in HbA1c reduction between drugs across clusters, these were largely driven by differences in the baseline (pretreatment) HbA1c. Conclusions: In this new cohort, we were able to reliably replicate the four subtypes of T2D earlier described in Asian Indians. Prescribing patterns show limited usage of newer antihyperglycemic agents across all clusters. Randomized clinical trials are required to establish differential drug responses between clusters.
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Affiliation(s)
- Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Moneeza Kalhan Siddiqui
- Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Saravanan Jebarani
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Mani Arun Vignesh
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Nithyanantham Kamal Raj
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ranjit Unnikrishnan
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Rajendra Pradeepa
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Vijay K Panikar
- Department of Diabetology, Dr. Panikars Speciality Care Centre, Mumbai, Maharashtra, India
| | - Jothydev Kesavadev
- Department of Diabetology, Jothydev's Diabetes and Research Centre, Kerala, India
| | - Banshi Saboo
- Department of Diabetology, Diabetes Care & Hormone Clinic, Ahemedabad, Gujarat, India
| | - Sunil Gupta
- Department of Diabetology, Sunil's Diabetic Care & Research Center, Nagpur, Maharashtra, India
| | - Aravind R Sosale
- Department of Diabetology, Diacon Hospital, Bangalore, Karnataka, India
| | - Krishna G Seshadri
- Department of Endocrinology, Chennai Diabetes and Endocrine Clinic, Chennai, Tamilnadu, India
| | - Neeta Deshpande
- Department of Diabetology, Belgaum Diabetes Centre, Belgaum, Karnataka, India
| | - Manoj Chawla
- Department of Diabetology, Lina Diabetes Care, Mumbai, Maharashtra, India
| | - Purvi Chawla
- Department of Diabetology, Lina Diabetes Care, Mumbai, Maharashtra, India
| | - Sidhartha Das
- Department of Diabetology, Prof.S.Das Clinic, Cuttack, Odisha, India
| | - Manoranjan Behera
- Department of General Medicine, SCB Medical College, Cuttack, Odisha, India
| | - Rajeev Chawla
- Department of Diabetology, North Delhi Diabetes Centre, Delhi, India
| | - Anant Nigam
- Department of Diabetology, Nigam Diabetes Centre, Jaipur, Rajasthan, India
| | - Arvind Gupta
- Department of Diabetology, Rajasthan Hospital, Jaipur, Rajasthan, India
| | - Rajiv Kovil
- Department of Diabetology, Dr. Kovil's Diabetes Care Centre, Mumbai, Maharashtra, India
| | - Shashank R Joshi
- Department of Diabetology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Sanjay Agarwal
- Department of Medicine Aegle Clinic-Diabetes Care, Pune, Maharashtra, India
| | - Sarita Bajaj
- Department of Medicine, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - Ewan R Pearson
- Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Alexander S F Doney
- Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Colin N A Palmer
- Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
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16
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Kesavadev J, Misra A, Saboo B, Agarwal S, Sosale A, Joshi SR, Hussain A, Somasundaram N, Basit A, Choudhary P, Soegondo S. Time-in-range and frequency of continuous glucose monitoring: Recommendations for South Asia. Diabetes Metab Syndr 2022; 16:102345. [PMID: 34920199 DOI: 10.1016/j.dsx.2021.102345] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIM The prevalence of diabetes is on its rise and South Asia bears a huge burden. Several factors such as heterogeneity in genetics, socio-economic factors, diet, and sedentary behavior contribute to the heightened risk of developing diabetes, its rapid progression, and the development of complications in this region. Even though there have been considerable advances in glucose monitoring technologies, diabetes treatments and therapeutics, glycemic control in South Asia remains suboptimal. The successful implementation of treatment interventions and metrics for the attainment of glycemic goals depends on appropriate guidelines that accord with the characteristics of the diabetes population. METHOD The data were collected from studies published for more than the last ten years in the electronic databases PubMed and Google Scholar on the various challenges in the assessment and achievement of recommended TIR targets in the SA population using the keywords: Blood glucose, TIR, TAR, TBR, HbA1c, hypoglycemia, CGM, Gestational diabetes mellitus (GDM), and diabetes. RESULTS The objective of this recommendation is to discuss the limitations in considering the IC-TIR Expert panel recommendations targets and to propose some modifications in the lower limit of TIR in older/high-risk population, upper limit of TAR, and flexibility in the percentage of time spent in TAR for pregnant women (GDM, T2DM) for the South Asian population. CONCLUSION The review sheds insights into some of the major concerns in implementing the IC-TIR recommendations in South Asian population where the prevalence of diabetes and its complications are significantly higher and modifications to the existing guidelines for use in routine clinical practice.
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Affiliation(s)
| | - Anoop Misra
- Chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chairman, National Diabetes, Obesity and Cholesterol Foundation (N-DOC) President, Diabetes Foundation, (DFI), India.
| | - Banshi Saboo
- Chairman and Chief Diabetologist, Diacare, Diabetes Care & Hormone Clinic, Ahmedabad, India.
| | - Sanjay Agarwal
- Diabetologist, Dr. Sanjay Agarwal's Aegle Clinic in Dhole Patil Road, Pune, India.
| | | | - Shashank R Joshi
- Department of Diabetology and Endocrinology, Lilavati Hospital & Research Centre, Bandra (W), Mumbai, India.
| | - Akhtar Hussain
- Faculty of Health Sciences, Chronic Disease-Diabetes, NORD University, Stjørdal, Norway; Faculty of Medicine, Federal University of Ceara, Brazil.
| | - Noel Somasundaram
- Consultant Endocrinologist, National Hospital of Sri Lanka: Colombo, Western, LK, Sri Lanka.
| | - Abdul Basit
- Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Pakistan.
| | - Pratik Choudhary
- Senior Lecturer and Consultant in Diabetes, Department of Diabetes, King's College Hospital, London, UK.
| | - Sidartawan Soegondo
- Internist, Consultant Endocrinologist, Department of Internal Medicine, University of Indonesia, Indonesia.
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Joshi SR, Senjaliya SB, Maru HD, Kshirsagar PD, Kulkarni SS, Shrivastava P. A unique approach to screen for blood donors lacking high-prevalence antigen In b of the Indian blood group system. Immunohematology 2021; 37:126-130. [PMID: 34591380 DOI: 10.21307/immunohematology-2021-019] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Inb antigen of the Indian blood group system is a high-prevalence antigen. The presence of alloanti-Inb in a recipient may pose a problem in finding compatible blood for transfusion. The aim of this study was to screen blood donors for Inb and to include individuals found to be In(b-) in our rare donor registry. To save resources, a unique study design was constructed. Blood group O donors were tested for Inb because their red blood cell (RBC) units could serve recipients across all ABO groups. EDTA blood samples were used for serologic and genomic testing. These samples were first tested serologically for Ina, and samples typed as In(a+) were then tested both serologically and molecularly for Ina and Inb to find homozygous IN*01/01 [i.e., the predicted In(b-) phenotype]. A cost-conservative approach in using recycling of antibody was adopted to economize available resources. Of 6300 donors, 196 donor samples typed as In(a+) and were also found to be In(b+) when tested by serologic and genomic methods. Although none of the donors typed as In(b-), the statistical analysis suggests the expected prevalence for this rare phenotype to be 0.02 percent among the total number of donors tested. In conclusion, this report presents a unique cost-conservative approach using limited reagents to screen a large number of donors for the rare In(b-) phenotype. The Inb antigen of the Indian blood group system is a high-prevalence antigen. The presence of alloanti-Inb in a recipient may pose a problem in finding compatible blood for transfusion. The aim of this study was to screen blood donors for Inb and to include individuals found to be In(b–) in our rare donor registry. To save resources, a unique study design was constructed. Blood group O donors were tested for Inb because their red blood cell (RBC) units could serve recipients across all ABO groups. EDTA blood samples were used for serologic and genomic testing. These samples were first tested serologically for Ina, and samples typed as In(a+) were then tested both serologically and molecularly for Ina and Inb to find homozygous IN*01/01 [i.e., the predicted In(b–) phenotype]. A cost-conservative approach in using recycling of antibody was adopted to economize available resources. Of 6300 donors, 196 donor samples typed as In(a+) and were also found to be In(b+) when tested by serologic and genomic methods. Although none of the donors typed as In(b–), the statistical analysis suggests the expected prevalence for this rare phenotype to be 0.02 percent among the total number of donors tested. In conclusion, this report presents a unique cost-conservative approach using limited reagents to screen a large number of donors for the rare In(b–) phenotype.
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Affiliation(s)
- S R Joshi
- Lok Samarpan Regional Blood Center , Surat, Minibazar, Varachha Road, Surat-395006, Gujarat State , India
| | | | - H D Maru
- ICMR-National Institute of Immunohaematology , Mumbai , India
| | - P D Kshirsagar
- ICMR-National Institute of Immunohaematology , Mumbai , India
| | - S S Kulkarni
- ICMR-National Institute of Immunohaematology , Mumbai , India
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18
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Nanditha A, Raghavan A, Misra A, Saboo B, Singh AK, Joshi SR, Agarwal S, Tandon N, Tiwaskar M, Aravind SR, Ramachandran A. Management of Hyperglycemia in COVID-19 and Post-COVID-19 Syndrome - Proposed Guidelines for India. J Assoc Physicians India 2021; 69:11-12. [PMID: 34585892 DOI: pmid/34585892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
SARS-CoV-2 virus spread rapidly all over the globe in 2020 and the second wave has taken our nation, India by storm. The pandemic has posed unique challenges in people with metabolic disorders, including diabetes, hypertension, obesity, pulmonary, cardiovascular, kidney and non-alcoholic fatty liver disease. Uncontrolled diabetes, in conjunction with endocrine, inflammatory and metabolic effects of the infection itself has made management of hyperglycemia in COVID-19 infection particularly challenging. Furthermore, the post-COVID-19 syndrome has also emerged as a sequela in COVID-19 survivors, increasing the risk of death, complications and adding further burden on the health care system. With more than a year of experience, we have gained substantial insight; and now provide practical recommendations on the management of hyperglycemia in COVID-19 as well as post COVID-19 syndrome.
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Affiliation(s)
- Arun Nanditha
- Director, Consultant Diabetologist, India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, Tamil Nadu
| | - Arun Raghavan
- Director, Consultant Diabetologist, India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, Tamil Nadu
| | - Anoop Misra
- Chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chairman, National Diabetes, Obesity and Cholesterol Foundation (N-DOC), President, Diabetes Foundation (India) (DFI), New Delhi
| | - Banshi Saboo
- Chief Diabetologist Chairman, Diabetes Care Hormone Clinic, Ahmedabad, Gujarat
| | - Awadhesh Kumar Singh
- Senior Consultant Endocrinologist, G.D Hospital Diabetes Institute, Kolkata, West Bengal
| | - Shashank R Joshi
- Senior Consultant Endocrinologist, Lilavati Hospital and Medical Research Centre, Mumbai, Maharashtra
| | - Sanjay Agarwal
- Director - Aegle Clinic for Diabetes Care, Head of Dept. Medicine Diabetes, Ruby Hall Clinic. Senior Consultant Diabetes Medicine, Jehangir Hospital, Pune, Maharashtra
| | - Nikhil Tandon
- Professor Head, Department of Endocrinology Metabolism, All India Institute of Medical Sciences, New Delhi
| | - Mangesh Tiwaskar
- Consultant Physician Diabetologist, Shilpa Medical Research Centre, Mumbai, Maharashtra
| | - Sosale R Aravind
- Director, Diacon Hospital, Bangalore, Karnataka; 10President, India Diabetes Research Foundation, Chairman, Dr. A. Ramachandran's Diabetes Hospitals, Chennai, Tamil Nadu
| | - Ambady Ramachandran
- President, India Diabetes Research Foundation, Chairman, Dr. A. Ramachandran's Diabetes Hospitals, Chennai, Tamil Nadu
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Joshi SR. Polycystic Ovary Syndrome and COVID-19: An Emerging Risk Factor. J Hum Reprod Sci 2021; 14:211-212. [PMID: 34316241 PMCID: PMC8279055 DOI: 10.4103/jhrs.jhrs_79_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
- Shashank R Joshi
- Endocrinologist Joshi Clinic and Lilavati Hospital, Mumbai, India
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Abstract
BACKGROUND AND AIMS There are increasing case reports of rhino-orbital mucormycosis in people with coronavirus disease 2019 (COVID-19), especially from India. Diabetes mellitus (DM) is an independent risk factor for both severe COVID-19 and mucormycosis. We aim to conduct a systematic review of literature to find out the patient's characteristics having mucormycosis and COVID-19. METHODS We searched the electronic database of PubMed and Google Scholar from inception until May 13, 2021 using keywords. We retrieved all the granular details of case reports/series of patients with mucormycosis, and COVID-19 reported world-wide. Subsequently we analyzed the patient characteristics, associated comorbidities, location of mucormycosis, use of steroids and its outcome in people with COVID-19. RESULTS Overall, 101 cases of mucormycosis in people with COVID-19 have been reported, of which 82 cases were from India and 19 from the rest of the world. Mucormycosis was predominantly seen in males (78.9%), both in people who were active (59.4%) or recovered (40.6%) from COVID-19. Pre-existing diabetes mellitus (DM) was present in 80% of cases, while concomitant diabetic ketoacidosis (DKA) was present in 14.9%. Corticosteroid intake for the treatment of COVID-19 was recorded in 76.3% of cases. Mucormycosis involving nose and sinuses (88.9%) was most common followed by rhino-orbital (56.7%). Mortality was noted in 30.7% of the cases. CONCLUSION An unholy trinity of diabetes, rampant use of corticosteroid in a background of COVID-19 appears to increase mucormycosis. All efforts should be made to maintain optimal glucose and only judicious use of corticosteroids in patients with COVID-19.
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Affiliation(s)
- Awadhesh Kumar Singh
- Department of Diabetes & Endocrinology, G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India.
| | - Ritu Singh
- Department of Diabetes & Endocrinology, G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India
| | - Shashank R Joshi
- Department of Diabetes & Endocrinology, Lilavati Hospital & Joshi Clinic, Mumbai, Maharashtra, India
| | - Anoop Misra
- Fortis C-DOC Hospital for Diabetes & Allied Sciences, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India; Diabetes Foundation (India), New Delhi, India
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21
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Affiliation(s)
- Shashank R Joshi
- Joshi Clinic, Lilavati Hospital, Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India,
| | - Rahul Pandit
- Director, Critical Care, Fortis, Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India,
| | - Purvish Parikh
- Chief Advisor, Mumbai Oncocare Clinics, Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India,
| | - Ashish Gulia
- Professor, Orthopedic Oncology, Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India,
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22
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Kumar S, De Souza R, Nadkar M, Guleria R, Trikha A, Joshi SR, Loganathan S, Vaidyanathan S, Marwah A, Athalye SN. A two-arm, randomized, controlled, multi-centric, open-label phase-2 study to evaluate the efficacy and safety of Itolizumab in moderate to severe ARDS patients due to COVID-19. Expert Opin Biol Ther 2021; 21:675-686. [PMID: 33835886 PMCID: PMC8040494 DOI: 10.1080/14712598.2021.1905794] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/16/2021] [Indexed: 12/15/2022]
Abstract
Objective: Efficacy and safety of Itolizumab, an immunomodulatory mAb, in treating moderate-to-severe acute respiratory distress syndrome (ARDS) due to cytokine release in COVID-19 patients was evaluated in a multi-centric, open-label, two-arm, controlled, randomized, phase-2 study.Methods: Patients were randomized (2:1) to Arm-A (best supportive care [BSC]+Itolizumab) and Arm-B (BSC). Primary outcome of interest was reduction in mortality 30-days after enrollment.Results: Thirty-six patients were screened, five treated as first-dose-sentinels and rest randomized, while four patients were screen-failures. Two patients in Arm-A discontinued prior to receiving one complete infusion and were replaced. At end of 1-month, there were three deaths in Arm-B, and none in Arm-A (p = 0.0296; 95% CI = -0.3 [-0.61, -0.08]). At end of study, more patients in Arm-A had improved SpO2 without increasing FiO2 (p = 0.0296), improved PaO2 (p = 0.0296), and reduction in IL-6 (43 vs 212 pg/ml; p = 0.0296) and tumor necrotic factor-α (9 vs 39 pg/ml; p = 0.0253) levels. Transient lymphopenia (Arm-A: 11 patients) and infusion reactions (7 patients) were commonly reported treatment-related safety events.Conclusion: Itolizumab is a promising, safe and effective immunomodulatory therapy for treatment of ARDS due to cytokine release in COVID-19 patients, with survival and recovery-benefit.
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Affiliation(s)
- Suresh Kumar
- MAMC Medical College and Lok Nayak Jai Prakash Narayan Hospital, New Delhi, India
| | - Rosemarie De Souza
- Topiwala National Medical College & B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Milind Nadkar
- Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | | | - Anjan Trikha
- All India Institute of Medical Sciences, New Delhi, India
| | - Shashank R. Joshi
- Indian College of Physicians and Lilavati Hospital, Mumbai, Maharashtra, India
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23
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Joshi SR. COVID 19 in India: Waves, Variants of Concern, Airborne Transmission. J Assoc Physicians India 2021; 69:11-13. [PMID: 34189878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Shashank R Joshi
- Member, Maharashtra Covid-19 Task Force, Consultant Endocrinologist, Lilavati Hospital, Mumbai, Maharashtra
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24
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Nair T, Joshi SR. Do we need to change the Patient Indications for Trimetazidine after ATPCI? J Assoc Physicians India 2021; 69:11-12. [PMID: 34470192] [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: 06/13/2023]
Abstract
The results of the ATPCI (efficAcy and safety of Trimetazidine in patients with angina pectoris treated by Percutaneous Coronary Intervention) study showed no significant difference in the incidence of primary endpoint events between trimetazidine and the placebo group in angina patients who recently underwent percutaneous coronary intervention. The study had limitations specific to the design and selection of the target patient population. However, safety outcomes for trimetazidine were reconfirmed in this study. In this article, we discuss the limitations of study design, patient inclusion criteria and their implications in routine practice. We have also dissected the evidence to tweeze out patient groups who are likely to benefit from trimetazidine treatment.
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Affiliation(s)
- Tiny Nair
- Head, Department of Cardiology, PRS Hospital, Trivandrum, Kerala
| | - Shashank R Joshi
- Consultant Endocrinologist, Department of Endocrinology, Lilavati Hospital, Mumbai, Maharashtra
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25
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Shylla L, Barik SK, Joshi SR. Characterization and bioremediation potential of native heavy-metal tolerant bacteria isolated from rat-hole coal mine environment. Arch Microbiol 2021; 203:2379-2392. [PMID: 33665708 DOI: 10.1007/s00203-021-02218-5] [Citation(s) in RCA: 10] [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] [Received: 10/03/2020] [Revised: 01/29/2021] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
Identification and characterization of endogenous and stress adapted bacterial species, from rat-hole coal mines in Meghalaya, amplify the ambit of bioremediation for eco-restoration. 52 native bacterial isolates, drawn from soil and water samples of these mines, were analysed for bioremediation potential, based on growth and metal tolerance parameters. 12 of these isolates were metal tolerant with Bacillus spp. being the most promising taxon. Three isolates, namely, Serratia marcescens KH-CC, Bacillus altitudinis KH-16F and Bacillus siamensis KH-12A, exhibited high Maximum Tolerable Concentration (MTC) against Fe (500 ppm), Mn (830 ppm) and Pb (1400 ppm). B. siamensis showed highest Fe remediation with 48.34% removal capacity, while maximum removal for Mn and Pb was exhibited by Serratia marcescens at 72.5 and 83%, respectively. The growth profile of the isolates indicated their ability to survive under pH, temperature and salt stress conditions. In vitro growth kinetics studies of the isolates revealed their ability to decrease the acidity of growth media and improve alkalinity from an initial of pH 4.8-5.2 to an alkaline level of pH 8.5-9. These native bacteria, extracted from the stressed coal mine habitat, are potential germane applicants for rehabilitation and eco-restoration of ecologically degraded mine sites.
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Affiliation(s)
- L Shylla
- Department of Biotechnology and Bioinformatics, North Eastern Hill University, Shillong, 793022, India
| | - S K Barik
- CSIR-National Botanical Research Institute, Lucknow, Uttar Pradesh, 226001, India
| | - S R Joshi
- Department of Biotechnology and Bioinformatics, North Eastern Hill University, Shillong, 793022, India.
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26
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Anjana RM, Pradeepa R, Unnikrishnan R, Tiwaskar M, Aravind SR, Saboo B, Joshi SR, Mohan V. New and Unique Clusters of Type 2 Diabetes Identified in Indians. J Assoc Physicians India 2021; 69:58-61. [PMID: 33527813] [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: 06/12/2023]
Abstract
Type 2 diabetes (T2D), the most common form of diabetes, is recognized as being a heterogenous disorder, and presents a universal threat to health. In T2D, the pathophysiology and phenotype differ significantly by ethnicity, particularly among Asian Indians, who are known to have the 'Asian Indian phenotype', which makes them more susceptible to develop T2D than white Caucasians. The recent subclassification of T2D into different subtypes or clusters, which behave differently with respect to clinical presentation and risk of developing complications is a remarkable development. Five unique "clusters" of individuals with diabetes were described in the Scandinavian population [Severe Autoimmune Diabetes (SAID), Severe Insulin Deficient Diabetes (SIDD), Severe Insulin Resistant Diabetes (SIRD), Mild Obesity-related Diabetes (MOD) and Mild Age-Related Diabetes (MARD)]. For the first time in India, identification of clusters of diabetes was done on 19,084 individuals with T2D, using 8 clinically relevant variables (age at diagnosis, BMI, waist circumference, HbA1c, triglycerides, HDL cholesterol and fasting and stimulated C-peptide). Four replicable clusters were identified [SIDD, MARD, IROD (Insulin Resistant Obese Diabetes) and CIRDD (Combined Insulin Resistant and Deficient Diabetes)], two of which were unique to the Indian population (IROD and CIRDD). Clustering of T2D helps i) to accurately subclassify diabetes into different subtypes, ii) plan therapies based on the pathophysiology, iii) predict prognosis and prevent diabetic complications and iv) helps in our approach to precision diabetes. Further studies would help us to refine the usefulness of these clusters of T2D particularly in the Indian population, with respect to selection of appropriate therapies and hopefully in the prevention of complications of diabetes.
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Affiliation(s)
- Ranjit Mohan Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu
| | - Rajendra Pradeepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu
| | - Ranjit Unnikrishnan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu
| | | | | | | | - Shashank R Joshi
- Lilavati Hospital and Medical Research Centre, Mumbai, Maharashtra
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu
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27
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Joshi SR. COVID-19 Immunity to Vaccination in India. J Assoc Physicians India 2021; 69:11-12. [PMID: 34227767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Shashank R Joshi
- Dean, Indian College of Physicians, Mumbai, Maharashtra; Joshi Clinic, Lilavati Hospital and Bhatia Hospital, Mumbai, Maharashtra
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28
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Joshi SR. COVID-19 Care in India: Evolving Paradigms from Public Health to Critical Care. J Assoc Physicians India 2020; 68:56-58. [PMID: 32978927] [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: 06/11/2023]
Abstract
Covid-19 pandemic in India has rapidly grown though we have a low case fatality rate, high recovery rate and large population is asymptomatic or presymptomatic. Public health measures to close the tap across the country need hypervigilance and follow simple dictum of aggressive testing, tracing and isolation. The covid cases need an early diagnosis with treat and care model. Most can be managed with home isolation under telemedicine supervision with oxygen saturation screening by a simple six minute walk test. Hospitalised cases have emerging evidence in different therapies from antivirals, steroids, immunologic to heparins but high flow oxygen, prone position and supportive care remains the cornerstone in critical care with nursing and nutrition. Vaccine research is ongoing but currently only social vaccine can mitigate the pandemic. Covid appropriate behaviour of Masking, sanitisation and physical distancing with immune modulating behaviour like adequate sleep, digital detox for two hour and clean well ventilated environment is the key with breathing exercises including yoga and positive mental health and avoidance of crowds the only vaccine to live with covid -19 today.
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Affiliation(s)
- Shashank R Joshi
- Dean, Indian College of Physicians; Consultant Endocrinologist, Lilavati Hospital and Research Centre and Bhatia Hospital, Mumbai, Maharashtra
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29
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Samajdar SS, Sam PA, Moitra S, Ray Y, Pal J, Joshi SR, Tripathi SK. Risk Benefit Analysis in Reference to use of LMWH in COVID-19. J Assoc Physicians India 2020; 68:52-61. [PMID: 32798346] [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: 06/11/2023]
Abstract
Venous thromboembolism (VTE) and disseminated intravascular coagulation (DIC) are frequent cardiovascular and/or respiratory complications among hospitalized patients of COVID-19 infection. A relatively high mortality of severe coronavirus disease 2019 (COVID-19) is worrying, and the application of heparin in COVID-19 has been assessed and recommended with some expert consensus because of the risk of DIC and venous thromboembolism. However, "Risk Benefit Analysis" on the aspect of safety in using low molecular weight heparin (LMWH) in COVID-19 patients for thrombosis prophylaxis has been explained below with a few case studies and detailed information from various clinical evidence. COVID-19 infection has been associated with inflammation and a prothrombotic state, with increase in fibrin, fibrin degradation products, fibrinogen, and D-dimers. Heparin treatment including unfractionated and low molecular weight heparin appears to be associated with better prognosis in severe COVID-19 patients with coagulopathy. Major studies since the onset of this pandemic, found better prognosis in severe COVID-19 patients meeting SIC criteria or with markedly elevated D-dimer, by approaching thrombosis prophylaxis with LMWH.
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Affiliation(s)
| | | | - Saibal Moitra
- Adjunct Professor and Senior Consultant, Department of Allergy and Immunology, Apollo Gleneagles Hospital, Kolkata
| | - Yogiraj Ray
- Assistant Professor Tropical Medicine, School of Tropical Medicine, Kolkata and COVID CCU in charge ID and BG Hospital
| | - Jyotirmoy Pal
- Professor, Department of Internal Medicine, R G Kar Medical College and Hospital, Kolkata
| | | | - Santanu K Tripathi
- Professor and Head, Department of Clinical and Experimental Pharmacology, School of Tropical Medicine, Kolkata
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31
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Loganathan S, Athalye SN, Joshi SR. Itolizumab, an anti-CD6 monoclonal antibody, as a potential treatment for COVID-19 complications. Expert Opin Biol Ther 2020; 20:1025-1031. [DOI: 10.1080/14712598.2020.1798399] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Subramanian Loganathan
- Clinical Sciences, Clinical Development and Medical Affairs, Biocon Biologics India Ltd, Bengaluru, India
| | - Sandeep N. Athalye
- Clinical Sciences, Clinical Development and Medical Affairs, Biocon Biologics India Ltd, Bengaluru, India
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32
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Udwadia ZF, Tripathi AR, Nanda VJ, Joshi SR. Prognostic Factors for Adverse Outcomes in COVID-19 Infection. J Assoc Physicians India 2020; 68:62-66. [PMID: 32602683] [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: 06/11/2023]
Abstract
Whilst COVID-19 infection generally run a mild course in up to 80% of those affected, a number of pre-existing co-morbidities determine the severity of infection and the outcome in an individual patient. The most important of these co-morbidities that have consistently emerged in studies from across the globe, are the patients age and sex. Other important co-morbidities that adversely affect outcomes include pre-existing diabetes, obesity, hypertension, chronic lung disease and malignancy. This comprehensive review discusses the impact of these co-morbidities and the role of laboratory predictors of poor patient outcomes.
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Affiliation(s)
- Zarir F Udwadia
- Consultant Pulmonologist, PD Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra
| | - Awatansh R Tripathi
- DNB Trainee Pulmonary Medicine, PD Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra
| | - Viral J Nanda
- DNB Trainee Pulmonary Medicine, PD Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra
| | - Shashank R Joshi
- Consultant Endriconologist, Lilavati Hospital and Medical Research Centre, Mumbai, Maharashtra
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33
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Mohan V, Mithal A, Joshi SR, Aravind SR, Chowdhury S. Remogliflozin Etabonate in the Treatment of Type 2 Diabetes: Design, Development, and Place in Therapy. Drug Des Devel Ther 2020; 14:2487-2501. [PMID: 32612352 PMCID: PMC7322139 DOI: 10.2147/dddt.s221093] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 05/15/2020] [Indexed: 01/01/2023]
Abstract
Type 2 diabetes mellitus (T2DM) is an emerging epidemic in Asian countries, especially in India. With the advent of the SGLT2 inhibitor class of drugs demonstrating benefits beyond glycemic control, viz. weight loss, blood pressure reduction, and cardiovascular and renal protection, the management of T2DM has taken a quantum leap. Remogliflozin etabonate (RE) is the latest addition to the SGLT2 inhibitor class of drugs that have been recently approved in India for the management of T2DM. RE is a potent and selective inhibitor of SGLT2 with the unique distinction of being administered as a prodrug, existence of active metabolites, and short half-life necessitating twice-daily dosing. The Phase III study of RE demonstrated it to be an efficacious and safe agent and non-inferior to the currently available SGLT2 inhibitors. This paper reviews not only the pharmacokinetics, pharmacodynamics, clinical efficacy, and safety profile of RE but also its molecular and clinical development program. This review has taken into consideration all available published as well as unpublished literature on RE and discusses the individual studies performed during its development for characterization of pharmacological profile.
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Affiliation(s)
- Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, Chennai, Tamil Nadu, India
| | - Ambrish Mithal
- Endocrinology and Diabetology, Max Healthcare Hospital, Gurgaon, India
| | - Shashank R Joshi
- Joshi Clinic, Lilavati Hospital, Apollo Sugar Clinic and Bhatia Hospital, Mumbai, India
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34
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Nandi A, Wadhwani N, Randhir K, Wagh G, Joshi SR. Association of vitamin D with fatty acids in pregnancy. Prostaglandins Leukot Essent Fatty Acids 2020; 157:102030. [PMID: 31753523 DOI: 10.1016/j.plefa.2019.102030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 11/05/2019] [Indexed: 12/24/2022]
Abstract
Preeclampsia is a pregnancy complication, associated with an increased risk of maternal and neonatal morbidity and mortality. The etiology of preeclampsia is not yet fully understood, although the current literature indicates an up regulation of inflammatory mediators. Vitamin D is known to have anti-inflammatory properties and influence vascular function. Fatty acids are also known to regulate inflammation in pregnancy. This study was carried out to explore the association of maternal vitamin D and fatty acids in pregnancy. The present study includes 69 normotensive control (NC) and 50 women with preeclampsia (PE). Maternal and cord serum 25-hydroxyvitamin D [25(OH)D] levels were lower (p<0.01for both) in women with PE compared to NC women. Maternal plasma total polyunsaturated fatty acids (PUFA) levels were lower (p<0.05) while levels of total saturated fatty acids (SFA) and total monounsaturated fatty acids (MUFA) were higher (p<0.05 for both) in women with PE. Cord erythrocyte PUFA levels were higher (p<0.01) in PE women. Maternal 25(OH)D levels were negatively associated with maternal systolic and diastolic BP (p<0.01 for both). Maternal 25(OH)D levels were positively associated with maternal total PUFA (p<0.01) and negatively associated with maternal total SFA (p<0.05), total MUFA (p<0.01). This study for the first time demonstrates an association of maternal vitamin D with fatty acid levels in pregnancy. Our results suggest that vitamin D and fatty acids may work in concert to regulate fetal growth.
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Affiliation(s)
- A Nandi
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, Maharashtra 411043, India
| | - N Wadhwani
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, Maharashtra 411043, India
| | - K Randhir
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, Maharashtra 411043, India
| | - G Wagh
- Department of Obstetrics and Gynaecology, Bharati Medical College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, Maharashtra 411043, India
| | - S R Joshi
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, Maharashtra 411043, India.
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Arulrhaj S, Joshi SR, Shah SN, Tiwaskar M, Nadkar M, Vora A. API Guidelines on Immunizations during COVID 19 Pandemic. J Assoc Physicians India 2020; 68:58-60. [PMID: 32610881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- S Arulrhaj
- President, The Association of Physicians of India
| | | | | | - Mangesh Tiwaskar
- Honorary General Secretary, The Association of Physicians of India
| | - Milind Nadkar
- Honorary Editor Journal of The Association of Physicians of India
| | - Agam Vora
- Member of Governing Body, The Association of Physicians of India
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Udwadia ZF, Malu KN, Rana D, Joshi SR. Hydroxychloroquine for COVID-19: What is our Current State of Knowledge? J Assoc Physicians India 2020; 68:48-52. [PMID: 32610879] [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: 06/11/2023]
Abstract
Chloroquine and Hydroxychloroquine are drugs which have been widely used in malaria and rheumatoid arthritis respectively for over 50 years. There was anecdotal evidence of their efficacy in the earlier SARS outbreak in 2003. This prompted physicians from across the world to use them in the present SARS-CoV- 2 pandemic that is currently sweeping the globe, with 5 million people already infected to date. These drugs are already in widespread use for the treatment of COVID-19 in India, mainly because they are cheap and easily available, and because of the absence of any readily available alternative therapy. This timely review discusses the pre-clinical evidence, and data from the eight available clinical trials. We emphasise that careful monitoring for cardiac toxicity is required when these drugs are used. Finally, we conclude that current data does not allow us to recommend for or against the use of these drugs. Results of two large RCTs, one from the NIH and the other from WHO (Solidarity) are eagerly awaited before the role of these drugs in COVID-19 can be definitively established.
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Affiliation(s)
- Zarir F Udwadia
- Consultant Pulmonologist, PD Hinduja National Hos-pital and Medical Research Centre, Mumbai, Maharashtra
| | - Ketan N Malu
- DNB Pulmonary Medicine Trainee, PD Hinduja National Hos-pital and Medical Research Centre, Mumbai, Maharashtra
| | - Divyanshi Rana
- DNB Pulmonary Medicine Trainee, PD Hinduja National Hos-pital and Medical Research Centre, Mumbai, Maharashtra
| | - Shashank R Joshi
- Dean, Indian College of Physicians; Consultant Endocrinologist, Lilavati and Bhatia Hospital, Mumbai, Maharashtra
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Joshi SR. Indian COVID-19 Risk Score, Comorbidities and Mortality. J Assoc Physicians India 2020; 68:11-12. [PMID: 32610858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Shashank R Joshi
- Dean, Indian College of Physicians; Consultant Endocrinologist, Lilawati Hospital, Bhatia Hospital, Apollo Sugar Clinic, Mumbai, Maharashtra
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Joshi SR, Tiwaskar MH, Shah SN. COVID 19: Diabetes and Obesity API-ICP Recommendations. J Assoc Physicians India 2020; 68:42-44. [PMID: 32610865] [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: 06/11/2023]
Abstract
Diabetes and Obesity are major risk factors which confer vulnerability to Covid 19 . Diabetes has immune defects which makes the individual susceptible to infections and covid 19 is no exception . Also covid 19 can cause pancreatic damage as well as stress hyperglycaemia in hospitals which may need Insulin . Among diabetes male gender,elderly,hypertension ,heart disease and chronic renal disease are more vulbwdvale to covid 19 and need strict supervision . Diabetes management in hospitalised situation merits early diabetes specific nutrition with Insulin. Adherence to lifestyle with self monitoring of blood glucose and adequate supply of Insulin and Oral antidiabetic agents is encouraged.
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Affiliation(s)
- Shashank R Joshi
- Dean, Indian College of Physicians; Consultant Endocrinologist, Lilawati Hospital, Bhatia Hospital, Apollo Sugar Clinic, Mumbai, Maharashtra
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Sharma U, Joshi SR, Ghosh A. Physician Burnout: Cause and Prevention Strategies. J Assoc Physicians India 2020; 68:60-63. [PMID: 32610849] [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: 06/11/2023]
Abstract
Ongoing evolution in healthcare places physicians under an ever-increasing pressure to consistently perform at a higher level, leading to a significant number of physicians including those in training feeling "burnt-out". Burnout is a result of interplay between personal charateristics and environmental factors. Unadressed physician burnout negatively affects the individual, work environment and most importantly patient care. Individual and environmenal changes are needed to assess and effectively manage burnout. Stigma and fear of professional consequences, especially among regional doctors appears to be an important barrier to access services and address burnout. There is an ever increasing need to expand the Triple Aim (enhancing patient experience, improving population health, and reducing costs) to a Quadruple Aim that goal of improving the work life of health care providers, including clinicians and staff.
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Affiliation(s)
- Umesh Sharma
- Community Division of Hospital Medicine, Mayo Clinic Health System, Rochester, MN 55902
| | | | - Amit Ghosh
- Professor of Medicine, Mayo Clinic, Rochester, MN 55902
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Ingti B, Upadhyay S, Hazarika M, Khyriem AB, Paul D, Bhattacharya P, Joshi SR, Bora D, Dhar D, Bhattacharjee A. Distribution of carbapenem resistant Acinetobacter baumannii with bla ADC-30 and induction of ADC-30 in response to beta-lactam antibiotics. Res Microbiol 2020; 171:128-133. [PMID: 31988011 DOI: 10.1016/j.resmic.2020.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 11/09/2019] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
Abstract
A wide range of intrinsic Acinetobacter-derived cephalosporinases (ADC) along with other carbapenemases has now been detected in Acinetobacter baumannii leaving clinicians with few treatment options. The present study reports the spread of ADC-30 co-producing KPC-2 along with other β-lactamases among carbapenem resistant A. baumannii strains obtained from ICU patients in two Indian hospitals. Primer extension analysis revealed higher transcript level of the ADC gene when induced with cefoxitin at 8 μg/ml (170 fold), ceftriaxone at 8 μg/ml (136 fold), ceftazidime at 4 μg/ml (65 fold), cefepime at 8 μg/ml (77 fold) and aztreonam at 8 μg/ml (21 fold) when compared with the basal level without antibiotic pressure. Slight increase in expression of blaADC-30 when induced with imipenem and meropenem at 0.25 μg/ml (3 and 6 fold) was observed and may help in conferring resistance to carbapenem. MLST analysis revealed the circulation of A. baumannii sequence types ST188, ST386, ST583 and ST390 in these hospitals.
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Affiliation(s)
- Birson Ingti
- Department of Microbiology, Assam University, Silchar, 788011, India; Department of Microbiology, Royal Global University, Guwahati, 781035, India
| | - Supriya Upadhyay
- Department of Biotechnology & Bioinformatics, North Eastern Hill University, Shillong, 793022, Meghalaya, India
| | | | - Annie Bakorlin Khyriem
- Department of Microbiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Deepjyoti Paul
- Department of Microbiology, Assam University, Silchar, 788011, India
| | - Prithwis Bhattacharya
- Department of Anesthesiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - S R Joshi
- Department of Biotechnology & Bioinformatics, North Eastern Hill University, Shillong, 793022, Meghalaya, India.
| | - Debajyoti Bora
- Department of Statistics, Dibrugarh University, Dibrugarh, India
| | - Debadatta Dhar
- Department of Microbiology, Silchar Medical College and Hospital, Silchar, India
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Gurung AB, Pamay P, Tripathy D, Biswas K, Chatterjee A, Joshi SR, Bhattacharjee A. Bioprospection of anti-inflammatory phytochemicals suggests rutaecarpine and quinine as promising 15-lipoxygenase inhibitors. J Cell Biochem 2019; 120:13598-13613. [PMID: 30937959 DOI: 10.1002/jcb.28634] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/29/2019] [Accepted: 02/04/2019] [Indexed: 01/31/2023]
Abstract
15-Lipoxygenase (15-LOX) belongs to the family of nonheme iron containing enzymes that catalyzes the peroxidation of polyunsaturated fatty acids (PUFAs) to generate eicosanoids that play an important role in signaling pathways. The role of 15-LOX has been demonstrated in atherosclerosis as well as other inflammatory diseases. In the present study, drug-like compounds were first screened from a set of anti-inflammatory phytochemicals based on Lipinski's rule of five (ROF) and in silico toxicity filters. Two lead compounds-quinine (QUIN) and rutaecarpine (RUT) were shortlisted by analyzing molecular interactions and binding energies of the filtered compounds with the target using molecular docking. Molecular dynamics simulation studies indicate stable trajectories of apo_15-LOX and docked complexes (15-LOX_QUIN and 15-LOX_RUT). In vitro 15-LOX inhibition studies shows that both QUIN and RUT have lower inhibitory concentration (IC50 ) value than the control (quercetin). Both QUIN and RUT exhibit moderate antioxidant activities. The cell viability study of these compounds suggests no significant toxicity in HEK-293 cell lines. Further, QUIN and RUT both did not show any inhibition against selected Gram-positive and Gram-negative bacterial species. Thus, based on our present findings, rutaecarpine and quinine may be suggested as promising 15-LOX inhibitor for the prevention of the atherosclerosis development.
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Affiliation(s)
- Arun Bahadur Gurung
- Computational Biology Laboratory, Department of Biotechnology and Bioinformatics, North-Eastern Hill University, Shillong, Meghalaya, India
| | - Pezaiwi Pamay
- Computational Biology Laboratory, Department of Biotechnology and Bioinformatics, North-Eastern Hill University, Shillong, Meghalaya, India
| | - Debabrata Tripathy
- Genetics and Molecular biology Laboratory, Department of Biotechnology and Bioinformatics, North-Eastern Hill University, Shillong, Meghalaya, India
| | - Koel Biswas
- Microbiology Laboratory, Department of Biotechnology and Bioinformatics, North-Eastern Hill University, Shillong, Meghalaya, India
| | - Anupam Chatterjee
- Genetics and Molecular biology Laboratory, Department of Biotechnology and Bioinformatics, North-Eastern Hill University, Shillong, Meghalaya, India
| | - S R Joshi
- Microbiology Laboratory, Department of Biotechnology and Bioinformatics, North-Eastern Hill University, Shillong, Meghalaya, India
| | - Atanu Bhattacharjee
- Computational Biology Laboratory, Department of Biotechnology and Bioinformatics, North-Eastern Hill University, Shillong, Meghalaya, India.,Bioinformatics Centre, North-Eastern Hill University, Shillong, Meghalaya, India
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Banerjee S, Kamila B, Barman S, Joshi SR, Mandal T, Halder G. Interlining Cr(VI) remediation mechanism by a novel bacterium Pseudomonas brenneri isolated from coalmine wastewater. J Environ Manage 2019; 233:271-282. [PMID: 30583101 DOI: 10.1016/j.jenvman.2018.12.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 12/08/2018] [Accepted: 12/16/2018] [Indexed: 06/09/2023]
Abstract
A bioremedial approach was investigated on the removal of Cr(VI) from aqueous solution using a novel chromium reducing bacteria isolated from coalmine wastewater. Cr(VI) removal efficacy of the bacterium was determined in a series of batch studies under the influence of various parameters viz., pH (1-7), temperature (20-40 °C), initial metal concentration (1-150 mg/L), agitation speed (80-150 rpm) and substrate concentration (1-5 mg/L). Oxygen involvement in the removal process was determined by different incubation conditions. Substrate consumption and its resultant biomass generation were considered for determining the viability of the microbe under varied metal concentration. The microbial isolate survived in Cr(VI) tainted solution with initial concentration of 1-140 mg/L, among which maximum remediation was found in 60 mg/L Cr(VI) loaded solution. The bacterial species also survived in other metal solution viz., Fe(II), As(V), Cu(II), Pb(II), Zn(II), Mg(II), Mn(II) apart from Cr(VI). Multiple approaches were tested to facilitate understanding of the bacterial Cr(VI) removal mechanism. The bacteria accumulated metal ions in the exponential growth phase both on and within the cell. Underlying latent factors which governed the bacterial growth and its removal activity was determined with the classical Monod equation. The isolated bacterium also survived in the bimetallic solutions with significant removal of Cr(VI). The microbial species isolated from mining area was identified as Pseudomonas brenneri by 16s rRNA molecular characterization. Hence, the isolated novel bacterium illustrated promising involvement towards bio-treatment of Cr(VI) laden wastewater.
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Affiliation(s)
- Soumya Banerjee
- Department of Chemical Engg, National Institute of Technology Durgapur, West Bengal, India
| | - Biswajit Kamila
- Department of Chemical Engg, Calcutta University, West Bengal, India
| | | | - S R Joshi
- Department of Biotechnology and Bioinformatics, North-Eastern Hill University, Shillong, India
| | - Tamal Mandal
- Department of Chemical Engg, National Institute of Technology Durgapur, West Bengal, India
| | - Gopinath Halder
- Department of Chemical Engg, National Institute of Technology Durgapur, West Bengal, India.
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Nandi A, Wadhwani N, Joshi SR. Vitamin D deficiency influences fatty acid metabolism. Prostaglandins Leukot Essent Fatty Acids 2019; 140:57-63. [PMID: 30553405 DOI: 10.1016/j.plefa.2018.11.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/28/2018] [Accepted: 11/28/2018] [Indexed: 12/20/2022]
Abstract
Reports indicate that maternal vitamin D deficiency may be associated with increased inflammation. Long chain polyunsaturated fatty acids (LCPUFAs); omega-3 and omega-6 fatty acids are known to have anti-inflammatory and pro-inflammatory properties respectively. The present study examines the effect of vitamin D deficiency on fatty acid composition and metabolism in a rat model. Female Wistar rats were randomly divided into two groups (n = 8/group) as follows; control and vitamin D deficient (VDD). Diets (control: 1000 IU D3/kg diet; VDD: 0 IU D3/kg diet) were given from weaning and continued throughout pregnancy. Pregnant female rats were dissected on gestational day 20 to collect blood, liver and placenta. The VDD diet reduced maternal serum 25-hydroxyviatmin D3 levels (p < 0.001) as compared to control. Maternal vitamin D deficiency resulted in lower total weight gain and placental weight (p < 0.05 for both) during pregnancy. Animals from VDD group demonstrated higher arachidonic acid (AA) levels in both the liver and plasma (p < 0.05 for both) as compared to control. Liver, plasma and placental monounsaturated fatty acid levels (MUFA) were lower (p < 0.01 for all) while plasma total saturated fatty acids (SFA) (p = 0.05) were higher in the VDD group. Animals from the VDD group demonstrated lower ∆9-desaturase activity index (p < 0.01 for all) in the liver, plasma and placenta. The plasma ∆5-desaturase activity index (p < 0.05) was higher although no change was observed in the ∆6-desaturase activity index. However, the mRNA levels of liver ∆6-desaturase was lower (p < 0.05) in the VDD group. Our findings indicate that maternal vitamin D deficiency influences fatty acid desaturase activity and expression and therefore alters maternal fatty acid metabolism.
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Affiliation(s)
- A Nandi
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune411043, India
| | - N Wadhwani
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune411043, India
| | - S R Joshi
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune411043, India.
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Panikar V, Joshi SR, Deogaonkar N, Vadgama J, Nasikkar N, Kamat T, Sheikh S, Jain CC, Wagle T. Efficacy of SGLT2 Inhibitors as the Fifth Drug in the Management of Type 2 Diabetes Mellitus in Asian Indians not Controlled with at least 4 Oral Antidiabetic Drugs. J Assoc Physicians India 2018; 66:46-49. [PMID: 31315325] [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
AIM To evaluate the efficacy of SGLT2 inhibitors as an add-on therapy along with stricter lifestyle modification in Asian Indian type 2 diabetes mellitus (T2DM) patients with inadequate glycemic control despite receiving an optimum dose of at least 4 oral antidiabetic drugs (OADs). METHODOLOGY A retrospective analysis of data of 808 T2DM patients being treated with an SGLT2 inhibitor (Dapagliflozin, Empagliflozin or Canagliflozin) as an add-on drug in patients with inadequate glycemic control despite receiving optimum doses of at least any four OADs(metformin, sulphonylureas, pioglitazone, DPP4 Inhibitors, alpha-Glucosidase Inhibitors) and who preferred not to initiate insulin. RESULTS The average age of the patients included was 51.63 years (SD ± 9.88). 57.7% were males. Average weight was 81.95±16.08 kg. Mean duration of diabetes was 34.08±39.04 months. The mean baseline fasting plasma glucose was 198.21 ± 38.21 mg/dl and mean post prandial plasma glucose was 264.22 ± 45.22 mg/ dl. The baseline HbA1c was 8.92 ± 1.47 %. Total 87.4 % of the cases responded to addition of SGLT2 inhibitors during a mean follow-up period of 6 months. The fasting plasma glucose (FBS) was reduced by -63.65 ± 19.93 mg/dl to a mean FBS of 134.57 ± 33.65 mg/dl (P=0.001). The post prandial plasma glucose (PPBS) was reduced by -79.28 ± 23.57 mg/dl to a mean PPBS of 184.94 ± 38.34 mg/dl (P=0.001). The mean HbA1c reduced significantly by -1.63 ± 0.99 % (P= 0.001). The mean weight reduction at 6 months of therapy was -3.03± 01.84 kg that is 3.8 % decrease from baseline (p=0.001).The response in age group < 55 years was 90.9 %, whereas in ≥55 years, it was 82.2% (p=0.001). The males responded more (91.0%) compared to females (82.5%) (p=0.001). Those with BMI < 23.5 kg/ m2 had marginally higher but insignificant response of 93.0% as compared to 87.1% in patients with high a BMI (≥23.5 kg/m2) (p=0.253). Patients with < 5years duration of diabetes responded better (91.8%) as compared to patients with a ≥ 5 years of diabetes (85.4%). CONCLUSION SGLT2 inhibitors are effective in achieving desired glycemic goals even when used as a fifth add-on drug along with strict lifestyle modification in patients with inadequate glycemic control despite receiving an optimum dose of at least 4 oral antidiabetic drugs (OADs). SGLT2 inhibitors can be effectively used at any stage of diabetes.
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Affiliation(s)
- Vijay Panikar
- Consultant, Department of Endocrinology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra
| | - Shashank R Joshi
- Consultant, Department of Endocrinology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra
| | | | - Jimit Vadgama
- Resident, Lilavati Hospital and Research Centre, Mumbai, Maharashtra,Corresponding Author
| | - Nikhil Nasikkar
- Resident, Lilavati Hospital and Research Centre, Mumbai, Maharashtra
| | - Tejas Kamat
- Resident, Lilavati Hospital and Research Centre, Mumbai, Maharashtra
| | - Saalim Sheikh
- Resident, Lilavati Hospital and Research Centre, Mumbai, Maharashtra
| | - Chandni C Jain
- Resident, Lilavati Hospital and Research Centre, Mumbai, Maharashtra
| | - Tejal Wagle
- Resident, Lilavati Hospital and Research Centre, Mumbai, Maharashtra
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Biswas K, Sharma P, Joshi SR. Co-occurrence of antimicrobial resistance and virulence determinants in enterococci isolated from traditionally fermented fish products. J Glob Antimicrob Resist 2018; 17:79-83. [PMID: 30448521 DOI: 10.1016/j.jgar.2018.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 11/08/2018] [Accepted: 11/08/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Fermented foods frequently consumed in Northeast India can act as a reservoir for disseminating pathogenic organisms. Enterococci are often responsible for contamination of food products. This study investigated the antimicrobial resistance and co-existing virulence determinants of enterococci found in traditionally processed foods in India. METHODS A total of 38 enterococci isolates identified as Enterococcus faecalis isolated from fermented fish samples from retail markets of Northeast India were selected for screening of pathogenic traits. RESULTS Of the 38 isolates, 8 (21%) were able to hydrolyse gelatin and 13 (34%) showed protease activity. Screening for haemolytic activity of the isolates showed no positive test on sheep blood. The presence of virulence genes (gelE, agg, esp, cpd, efaAfs and cylA) was investigated by PCR. gelE, agg and esp were present in 17, 13 and 4 isolates, respectively. cpd and efaAfs were found in all isolates, whereas cylA was not detected. High resistance percentages to various antibiotics included kanamycin (63%), vancomycin and gentamicin (58%), tetracycline (53%) and rifampicin (50%). The vanA genotype was confirmed in 15 multidrug- and vancomycin-resistant strains. CONCLUSION The simultaneous occurrence of virulence determinants and antimicrobial resistance in enterococci prevalent in the fermented fish products studied poses a potential threat of transmission to humans through the food chain. This study highlights the importance of E. faecalis as a reservoir of antimicrobial resistance and virulence factors and their potential transfer to humans. The findings reopen the issue of food safety regarding enterococci prevalent in traditionally processed fish products in the region.
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Affiliation(s)
- Koel Biswas
- Microbiology Laboratory, Department of Biotechnology & Bioinformatics, North-Eastern Hill University, Shillong, Meghalaya, India
| | - Puja Sharma
- Microbiology Laboratory, Department of Biotechnology & Bioinformatics, North-Eastern Hill University, Shillong, Meghalaya, India
| | - S R Joshi
- Microbiology Laboratory, Department of Biotechnology & Bioinformatics, North-Eastern Hill University, Shillong, Meghalaya, India.
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Abstract
Yoga originated in India more than 5,000 years ago and is a means of balancing and harmonizing the body, mind, and emotions. Yoga practice is useful in the management of various lifestyle diseases, including type 2 diabetes. Psycho-neuro-endocrine and immune mechanisms are involved in the beneficial effects of yoga on diabetes. Incorporation of yoga practice in daily life helps to attain glycaemic control and reduces the risk of complications in people with diabetes. In this review, we briefly describe the role of various yoga practices in the management of diabetes based on evidence from various clinical studies.
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Affiliation(s)
- Arkiath Veettil Raveendran
- Department of General Medicine, Government Medical College, Kozhikode, India
- Department of Internal Medicine, Badr Al Samaa Hospital, Barka, Oman.
| | - Anjali Deshpandae
- Padma Yog Sadhana, A Unit of Terna Public Charitable Trust, Navi Mumbai, India
| | - Shashank R Joshi
- Joshi Clinic, Lilavati Hospital and Bhatia Hospital, Mumbai, India
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Joshi SR. Thyro-weight: Unlocking the Link between Thyroid Disorders and Weight. J Assoc Physicians India 2018; 66:75-78. [PMID: 30341874] [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: 06/08/2023]
Abstract
Thyroid hormone is an important determinant of energy expenditure and contributes to appetite regulation, while hormones and cytokines from the adipose tissue act on the CNS to inform on the quantity of energy stores. A continuous interaction between the thyroid hormone and regulatory mechanisms localized in adipose tissue and brain is important for human body weight control and maintenance of optimal energy balance. Direct effects on ATP utilization are a result of thyroid hormone's actions on metabolic cycles and increased cell membrane ion permeability. However, the majority of thyroid hormone induced energy expenditure is thought to be a result of indirect effects, which, in turn, increase capacity for energy expenditure. This review discusses the direct actions of thyroid hormone on energy expenditure, and places special emphasis on the indirect actions of thyroid hormone, which include mitochondrial biogenesis and reduced metabolic efficiency through mitochondrial uncoupling mechanisms.
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Affiliation(s)
- Shashank R Joshi
- Department of Endocrinology, Lilavati Hospital, Mumbai, Maharashtra
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Abstract
BACKGROUND Diabetes has become a major health care problem in India with an estimated 66.8 million people suffering from the condition, representing the largest number of any country in the world. OBJECTIVE The rising burden of diabetes has greatly affected the health care sector and economy in India. The goal of health care experts in India is to transform India into a diabetes care capital in the world. METHODS An expert detailed review of the medical literature with an Asian Indian context was performed. FINDINGS Recent epidemiologic studies from India point to a great burden from diabetes. Diabetes control in India is far from ideal with a mean hemoglobin A1c of 9.0%-at least 2.0% higher than suggested by international bodies. Nearly half of people with diabetes remain undetected, accounting for complications at the time of diagnosis. Screening can differentiate an asymptomatic individual at high risk from one at low risk for diabetes. Despite the large number of people with diabetes in India, awareness is low and needs to be addressed. Other challenges include balancing the need for glycemic control with risk reduction due to overly tight control, especially in high-risk groups and taking into account health care professional expertise, attitudes, and perceptions. Pharmacologic care should be individualized with early consideration of combination therapy. Regular exercise, yoga, mindful eating, and stress management form a cornerstone in the management of diabetes. CONCLUSIONS Considering the high cost incurred at various steps of screening, diagnosis, monitoring, and management, it is important to realize the cost-effective measures of diabetes care that are necessary to implement. Result-oriented organized programs involving patient education, as well as updating the medical fraternity on various developments in the management of diabetes, are required to combat the current diabetes epidemic in India.
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49
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Kumar A, Kalmath BC, Abraham G, Christopher J, Kaparthi P, Fischer L, Deshpande N, Mishra NK, Raj P, Javerani R, Goyal R, Dsouza R, Joshi SR. Role and Relevance of Blood Pressure Variability in Hypertension Related Co-morbidities. J Assoc Physicians India 2017; 65:83-92. [PMID: 29327527] [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: 06/07/2023]
Abstract
Despite maintaining mean blood pressure at optimal levels, cardiovascular complications still occur in hypertensive patients. Blood pressure variability (BPV) has been implicated as a prominent factor responsible for incurring this additional risk. In this review we attempted to generate a consensus on the importance of BPV in the hypertension management and to evaluate different therapeutic options available to reduce BPV. Panel comprising of 11 leading experts from India in different areas of clinical practice (including nephrology, diabetes and endocrinology, cardiology, and critical care medicine) was convened. The board reviewed up to date literature on BPV, shared personal experiences from their clinical practice, and debated their opinions on the significance of BPV in hypertension management and also on various therapeutic options available to control it. The reviewers agreed that BPV is frequently observed in hypertensive individuals and it is a critical factor in hypertension management. Blood pressure variability can be measured by ambulatory blood pressure monitoring, home blood pressure monitoring, and office blood pressure monitoring. Members concurred that variations in blood pressure that are 10 standard deviations above the mean blood pressure should be considered as pathologically significant and such variations should be reduced using pharmacological therapies. The board opined that Angiotensin II Receptor Blockers,Calcium Channel Blockers etc such as Olmesartan, Nifedipine can be used to reduce BPV. As a way forward, the panel recommends to bridge the evidence gap that establishes a possible direct relationship between BPV and cardiovascular complications. Blood pressure variability has paramount role in the current hypertension management scenario. To reduce disease burden and increase quality of life of hypertensive individuals, physicians should consider lowering BPV along with physiological BP levels.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Praveen Raj
- Abbott Healthcare Pvt Ltd., Mumbai, Maharashtra
| | | | - Ramesh Goyal
- Gujarat Super Speciality Clinic, Ahmedabad, Gujarat
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50
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Ghosh S, Unnikrishnan AG, Saboo B, Kesavadev J, Aravind SR, Bajaj S, Rajput R, Seshadri K, Verma N, Gupta A, Makkar BM, Saikia M, Kale S, Damodaran S, Dengra A, Eashwar TKM, Maheshwari A, Pendsey S, Phatak SR, Sharma SK, Singh SK, Ramachandran A, Zargar AH, Joshi SR, Sadikot SM. Evidence-based recommendations for insulin intensification strategies after basal insulin in type 2 diabetes. Diabetes Metab Syndr 2017; 11 Suppl 1:S507-S521. [PMID: 28433618 DOI: 10.1016/j.dsx.2017.03.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Indexed: 01/27/2023]
Abstract
Over the time due to progressive nature of diabetes, proactive intensification of the existing insulin therapy becomes imminent as it minimizes patients' exposure to chronic hypo/hyperglycaemia and reduces weight gain while achieving individualized glycaemic targets. This review focuses on the strength of evidence behind various options for intensification, primarily the insulins as also the GLP-1 analogues. The recommendations presented here are meant to serve as a guide for the physician managing type 2 diabetes patients requiring insulin intensification upon failing of basal insulin therapy.
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Affiliation(s)
- Sujoy Ghosh
- Department of Endocrinology and Metabolism, Institute of Post-Graduate Medical Education and Research, Kolkata, India.
| | | | | | | | | | - Sarita Bajaj
- Department of Medicine, Motilal Nehru Medical College, Allahabad, India
| | - Rajesh Rajput
- Department of Endocrinology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Krishna Seshadri
- Department of Endocrinology and Metabolism, Shri Rama Chandra University, Chennai, India
| | | | | | | | | | | | | | - Ashish Dengra
- Mahi Diabetes & Thyroid Care and Research Center, Jabalpur, India
| | | | - Anuj Maheshwari
- Department of Medicine, Babu Banarasi Das University, Lucknow, India
| | | | | | | | - Surya Kumar Singh
- Department of Endocrinology and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | | | - Abdul H Zargar
- Advanced Center for Diabetes and Endocrine Care, Srinagar, India
| | - Shashank R Joshi
- Lilavati and Bhatia Hospital and Grant Medical College, Mumbai, India
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