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Kaushal S.,Quantum Solutions India | Singh H.,AIIMS | Thangaraju P.,Central Leprosy Teaching and Research Institute | Singh J.,Government of Punjab
North American Journal of Medical Sciences | Year: 2014

Diabetes Mellitus continues to be a major non- communicable disease with global burden of 366 million at present and projected to increase to 439 to 552 million by 2030, India being the hub of diabetes. Sodium glucose transporter 2 (SGLT2) inhibitors presents a new class of anti-diabetic drugs having an insulin-independent mechanism that offers a considerable advantage of increasing urinary glucose excretion without inducing hypoglycemia and promoting weight loss due to loss of 300 to 400kcal/day, Canaglifl ozin being the 1st successful candidate of this group and became the fi rst SGLT2 inhibitor to be FDA approved on March 29, 2013. In various clinical trials, it has shown promising results in controlling glycemia, causing weight loss, reducing systolic and diastolic BP and cardiovascular risk. There are some safety concerns associated with its use e.g. genital mycotic infections, increased urination, urinary tract infection and hyperkalemia, which need to be carefully addressed while using this drug. Source

Thangaraju P.,Central Leprosy Teaching and Research Institute | Chakrabarti A.,Post Graduate Institute of Medical Education and Research | Banerjee D.,Post Graduate Institute of Medical Education and Research | Hota D.,All India Institute of Medical Sciences | And 3 more authors.
North American Journal of Medical Sciences | Year: 2014

Background: Diabetes mellitus is a real pandemic of the modern world and the incidence of the disease is increasing at a tremendous rate with a number of complications involving major systems of the human body. The renin angiotensin system (RAS) is considered to be involved in most of the pathological processes that result in diabetic nephropathy and retinopathy. Aim: The study was designed to evaluate and compare effects of ramipril (angiotensin-converting enzyme inhibitor-ACEI) and telmisartan (angiotensin II receptor blocker-ARBs) combinations on the progression of retinopathy and nephropathy in the streptozotocin (STZ) induced diabetic model. Materials and Methods: Diabetic state in rats was induced by chemical method using STZ 55 mg/kg intraperitoneally. Diabetic renal tubulopathy and interstitial infl ammatory changes were done. Diabetic retinopathy manifested in the form of vacuolar changes in the inner plexiform and the ganglionic layers of the retina was observed. Results: Treatments with ACEI and ARBs reduced the incidence of the occurrence of cataract. The effect of combinational drugs of ACEI (ramipril) and AT1 receptor blocker (Telmisartan) was evaluated. The drugs used in combinations showed improvement in the histopathological and biochemical changes of the diabetic animals, both for the retina and kidney. Conclusion: The efficacy of the drugs suggests a pivotal role of the local RAS system in the pathogenesis of tubulopathy in the kidney and neuronal damage in the retina of the diabetic animals. © 2014, North American Journal of Medical Sciences. All right reserved. Source

Amudhan S.M.,Sri Ramachandra University | Sekar U.,Sri Ramachandra University | Arunagiri K.,Central Leprosy Teaching and Research Institute | Sekar B.,Pasteur Institute of India
Indian Journal of Medical Microbiology | Year: 2011

Objectives: Acinetobacter baumannii is a significant pathogen in health care settings. In recent years, an increase in carbapenem resistance among A. baumannii due to Ambler class B metallo-betaβ-lactamases or class D OXA carbapenamases has been reported. In this study we detected the presence of OXA carbapenamases and coproduction of metallo-betaβ-lactamases (bla VIM and blaIMP ) by phenotypic and genotypic methods in carbapenem resistant clinical isolates of Acinetobacter baumannii. Materials and Methods: A total of 116 consecutive, non-duplicate carbapenem resistant A. baumannii isolated from various clinical specimens were included in the study. The modified Hodge test and inhibitor potentiated disk diffusion tests were done for the screening of carbapenamase and metallo-betaβ-lactamase production, respectively. Polymerase chain reaction (PCR) was performed for the detection of OXA (blaOXA 23 like, blaOXA 24 like, bla OXA-51 like and blaOXA-58 like genes) and metallo-betaβ-lactamases (blaVIM and blaIMP ) genes. Gene sequencing was performed for representative isolates. Results: Among 116 A. baumannii, OXA genes were detected in 106 isolates. BlaOXA 51 like (n = 99) and blaOXA -23 like (n = 95) were the most common and they coexisted in 89 isolates. blaOXA-24 like gene was detected in two isolates of which one also carried blaOXA-51 like and bla OXA-58 like genes. The modified Hodge test was positive in 113 isolates. The metallo-betaβ-lactamase screening test was positive in 92 isolates. blavim was detected in 54 isolates of which 1 also carried the blaIMP gene. Conclusions: blaOXA-23 like and bla OXA 51 like genes are the most common types of OXA carbapenamases while the blaVIM type is the most common type of metallo-betaβ- lactamase contributing to carbapenem resistance in clinical isolates of A. baumannii. The coproduction of OXA and metallo-betaβ-lactamases is not an uncommon phenomenon in A. baumannii. Source

Shanthi Amudhan M.,Sri Ramachandra Medical College and Research Institute | Sekar U.,Sri Ramachandra Medical College and Research Institute | Kamalanathan A.,Central Leprosy Teaching and Research Institute | Balaraman S.,Central Leprosy Teaching and Research Institute
Journal of Infection in Developing Countries | Year: 2012

Introduction: The emergence and rapid spread of blaIMP and blaVIMmetallo-beta-lactamase (MBL) producing Gram-negative bacteria causing nosocomial infections are of concern worldwide due to limited treatment options. Methodology: A total of 179 nonreplicate, consecutive, carbapenem resistant Pseudomonas aeruginosa (61), Acinetobacter baumannii (116), Acinetobacter lwoffii (1) and Pseudomonas stutzeri (1) isolated from patients hospitalized for 48 hours or more were included in the study. The minimum inhibitory concentrations (MIC) to imipenem and meropenem were determined and interpreted according to Clinical Laboratory Standards Institute guidelines. The Modified Hodge Test (MHT) and inhibitor potentiated disk diffusion tests with ethylenediaminetetraacetic acid (EDTA) were used for screening of carbapenamases and MBL production respectively. Polymerase chain reaction (PCR) was performed for the detection of MBL (blaVIM and blaIMP) genes. Gene sequencing was performed for representative isolates. Results: MHT was positive in 94.4% (n = 169). MBL screening with EDTA was positive in 80.4% (n = 144). MBL genes blaVIM and blaIMP were detected in 92 (51.4%) isolates. BlaVIM alone was detected in 89 isolates while two isolates had blaIMP alone. One isolate had both blaVIM and blaIMP. Among the P. aeruginosa, 36 carried the MBL gene. In A. baumannii, 54 carried the MBL gene. BlaVIM was found in P. stutzeri and A. lwoffii isolates. Conclusion: Carbapenem resistance in P. aeruginosa and A. baumannii is chiefly mediated by MBL production. The common MBL gene is the blaVIM. © 2012 Amudhan et al. Source

Singh H.,AIIMS | Thangaraju P.,Central Leprosy Teaching and Research Institute | Kumar S.,Nallur PHC | Aravindan U.,AIIMS | And 2 more authors.
Journal of Clinical and Diagnostic Research | Year: 2014

Background: The management of Diabetes Mellitus and its important complication Diabetic Ketoacidosis is very crucial in today's world where the prevalence of Diabetes is very high. Medical students are the pillars of our future healthcare system and it is important to evaluate and update their knowledge and awareness regarding these both conditions. Materials and Methods: This study was a cross-sectional; Questionnaire based observational study conducted in a tertiary care hospital. The respondents were final year MBBS students of that college. Study instrument was a self developed, pre-validated, semi-structured questionnaire. Results: A total of 73 questionnaires were considered for analysis, giving a response rate of 90.12% with 43.83% and 56.16% were male and female respondents respectively. About 81.25% and 90.24% of male and female respondents gave correct answer to question related to the best indicator of glycemic control. Lack of knowledge was seen regarding the world Diabetes day. Approximately 37% of the respondent's parents were diabetic. Only 12 out of 73 respondents were aware about the factors leading to DKA.8 out of 73 were aware about investigations to be done in DKA. Around 43.84% of responders knew regarding the proper screening duration in person with risk of diabetes. Conclusion: From the study it was concluded that most of the students have basic knowledge regarding diabetes mellitus, its clinical features and management etc but only 50 % of the respondent were aware about DKA and further teaching and post teaching evaluation are needed in future direction. Source

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