Pioglitazone: Indian perspective

Pioglitazone was approved in 1999 as an adjunct to exercise and diet to improve glycemic control in adults with type 2 diabetes mellitus, primarily by reducing insulin resistance. Beyond these effects on glucose metabolism, pioglitazone has positive effects on lipid metabolism, blood pressure, endothelial function, adiponectin, and C-reactive protein levels. These make pioglitazone treatment effective beyond glucose control. Pioglitazone generally has been viewed as a safer option for patients who warrant treatment with a thiazolidinedione-class drug. There has been some recent data on cancer incidence in patients on pioglitazone, which is currently being reviewed by drug regulatory authorities in the United States and in Europe. Given the benefits of pioglitazone, alone and in combination, it would be appropriate to continue judicious use of the drug in patients who may benefit from its use.     

Management of osteoporosis: the Indian perspective

Osteoporosis is a common but neglected problem in India. The major challenges to management are lack of awareness and resource constraints. The management is also hampered by the non-availability of normative data for bone mineral density in Indians. Subclinical vitamin D deficiency is widespread. The drugs available in the country include calcium, vitamin D, hormone replacement therapy, raloxifene, alendronate, risedronate, calcitonin and teriparatide. Bisphosphonates (alendronate) constitute the mainstay of treatment in India. There is a need for evidence based, context specific and resource sensitive guidelines.     

Allergic bronchopulmonary aspergillosis: an Indian perspective

PURPOSE OF REVIEW: Allergic bronchopulmonary aspergillosis is an immunologically mediated lung disease that is caused by hypersensitivity to antigens of the genus Aspergillus. This review summarizes the clinical presentation, radiologic profile, lung functions and immunologic studies on allergic bronchopulmonary aspergillosis from India. Data regarding Aspergillus sensitization in asthmatics are presented. The association of allergic bronchopulmonary aspergillosis with allergic Aspergillus sinusitis and aspergilloma is also highlighted. RECENT FINDINGS: Allergic bronchopulmonary aspergillosis is now an emerging disease in India. Sensitization to Aspergillus antigens is not uncommon in our patients with asthma. Although asthma commenced in these subjects in their early 20s, allergic bronchopulmonary aspergillosis was recognized more than a decade later. Allergic bronchopulmonary aspergillosis can also occur in patients without clinical asthma. Radiology is crucial to the diagnosis of allergic bronchopulmonary aspergillosis. The remarkable radiological similarity to pulmonary tuberculosis has important clinical implications in our country as patients with allergic bronchopulmonary aspergillosis often receive antituberculous therapy for a long time. Although oral corticosteroids still remain the cornerstone for management, itraconazole has emerged as an adjunct therapy in appropriate situations. Concomitant occurrence of allergic bronchopulmonary aspergillosis and allergic Aspergillus sinusitis is now being increasingly recognized. SUMMARY: All asthmatic subjects with a positive skin prick test to Aspergillus antigens must be evaluated for allergic bronchopulmonary aspergillosis and allergic Aspergillus sinusitis should be excluded.     

Complicated colonic diverticulosis: surgical perspective from an Indian Centre.

INTRODUCTION: Colonic diverticulosis was previously uncommon in India but its incidence seems to have increased recently. Patients with the disease in developing countries are also underdiagnosed and are therefore more likely to present with complications needing operation. However there is a paucity of surgical data on the condition. METHOD: Between August 1996 and February 2005 we operated on 32 patients (28 males, 4 females mean age 60 years) with colonic diverticulosis and analysed their characteristics from a prospective database. We here with describe our experience. RESULTS: Operations for diverticular disease constituted 3% of all the colorectal operations we performed. The diverticula were in the sigmoid colon in 28 (88%) and also in the descending colon in 4 (12%). Twenty-four patients were symptomatic. Twenty-two patients were diagnosed before surgery, 8 at operation and the rest from resected specimens. Emergency operations were performed in 23 and elective procedures in 9 patients. Ten patients were operated on for perforation and abscess, 8 for obstruction, 8 for colovesical fistula, 3 for peritonitis and 3 for haemorrhage. Emergency procedures were performed in 2 stages (resection plus a proximal diversion) in 20; unless done for bleeding in a stable patient where a primary anastomosis was done. One patient who had had an emergency procedure died of sepsis and ketoacidosis in the post-operative period. The 8 patients with colovesical fistulae were all males, had only sigmoid involvement and had had symptoms for a longer duration than the 24 without fistulae. CONCLUSIONS: Although operations for colonic diverticulosis still form a small proportion of the total number of colorectal operations, the diagnosis is often delayed till complications ensue and thus patients usually require emergency procedures. Males with long standing symptoms and sigmoid diverticula may develop colovesical fistulae.     

Revised National Tuberculosis Control Programme: Indian perspective

The global tuberculosis programme has promoted the revision of National Tuberculosis Programme by strengthening the focus on Directly Observed Treatment Short-course (DOTS). National Tuberculosis Control Programme (NTCP) which was established in 1962 had less than 30 per cent treatment completion. Based on an in-depth review of the programme by a high level committee in 1992, a Revised National Tuberculosis Control Programme (RNTCP) was envisaged with a view to achieve a cure rate of at least 85 per cent amongst newly detected sputum positive cases under DOTS. By December 1999, 130 million of population had been covered in the country under DOTS. However, there are many challenges that are required to be met before RNTCP can become a success story in our country.     

Sudden cardiac death-an Indian perspective

Coronary artery disease (CAD) is by far the commonest cause of sudden cardiac death (SCD), with the prevalence of CAD paralleling the incidence of SCD in epidemiological studies. With the alarming increase in prevalence of CAD, diabetes and hypertension in India, the incidence of SCD is also on the rise, especially in the urban regions. While the mortality of CAD in the West has decreased, it has reached epidemic proportions in India. Consequently, there is a need for implementing preventive cardiovascular health measures to meaningfully reduce the incidence of SCD.     

Japanese encephalitis: a review of the Indian perspective

Japanese encephalitis virus (JEV) causes Japanese encephalitis, which is a leading form of viral encephalitis in Asia, with around 50,000 cases and 10,000 deaths per year in children below 15 years of age. The JEV has shown a tendency to extend to other geographic regions. Case fatality averages 30% and a high percentage of the survivors are left with permanent neuropsychiatric sequelae. Currently, there is no cure for JEV, and treatment is mainly supportive. Patients are not infectious, but should avoid further mosquito bites. A number of antiviral agents have been investigated; however, none of these have convincingly been shown to improve the outcome of JEV. In this review, the current knowledge of the epidemiology and the pathogenesis of this deadly disease have been summarized.