Evaluation of efficacy and safety of fixed dose combination of glimepiride 2 mg pluspioglitazone 15 mg plus metformin SR 500 mg in the management of patients with type-2 diabetes mellitus

An estimated 25 million Indians currently have diabetes and the projections indicate Indians would be the largest group by the year 2025 AD. An open, phase III, multicentric study was conducted to determine the efficacy and tolerability of the triple drug combination glimepiride 2 mg plus pioglitazone hydrochloride 15 mg plus metformin SR 500 mg for 8 weeks in 101 Indian patients with type 2 diabetes mellitus. The study revealed that the triple drug combination could achieve the recommended goals, recommended by American Diabetic Association, for fasting blood glucose < or = 140 mg/dl and glycosylated haemoglobin (HbA1c) of < or = 8%. After 8 weeks, the mean fasting blood glucose (baseline 189.61) was reduced to 111.68 (41% reduction); the mean glycosylated haemoglobin (baseline 10.32) was significantly reduced to 7.54 (26% reduction). The triple drug combination significantly reduced the levels of triglyceride, low density lipoproteins and total cholesterol. These significant levels were achieved within 8 weeks and all patients tolerated the drug well with no reported case of serious adverse events including hypoglycaemia. There were also no reported drug interactions in the study. Since the decrease in HbA1c was continuous and throughout the study, a further decrease in the HbA1c levels would have been noted since the present trial was designed for a period of 8 weeks. Thus, the present study confirms the efficacy and safety of FDC of the triple drug combination in patients with type 2 diabetes.     

Evaluation of Fungal Flora and Mycotoxin Contamination in Whole Dried Apricots (<Emphasis Type="Italic">Prunus</Emphasis><Emphasis Type="Italic">armeniaca</Emphasis> L.) from J&amp;K,India

The present study evaluated the presence of micro-fungi and mycotoxins in fifty six market samples of dried apricots. Twenty two fungal species belonging to ten genera were isolated using standard methods. Aspergillus niger showed the highest frequency percentage. Assessment of mycobial load of dried apricots showed the presence of many such fungal species that are widely acknowledged as the most important mycotoxin producers. Mycotoxins were assessed by high performance liquid chromatography. 12.5 % of dried apricot samples tested positive for total aflatoxins (AFs) at a mean value of 35 ± 0.006 ng/g and 19.64 % samples contained patulin (PAT) (1025 ± 0.01 ng/g). Ochratoxin A (OTA) was quantified in 28.57 % of positive samples at a mean value of 194 ± 0.001 ng/g. Mycotoxin co-occurrence was recorded in low frequency. The co-occurrence of AFs–OTA, OTA–PAT and AFs–OTA–PAT has been detected in 3.57, 12.5 and 3.57 % samples respectively. To the best of author’s knowledge, this is the first report on the natural occurrence of mycoflora and mycotoxins in dried apricots from India but no literature is available on co-occurrence of AFs, OTA and PAT in dried apricots.     

An informatics approach to assess pediatric pharmacotherapy: design and implementation of a hospital drug utilization system

Drug utilization in the inpatient setting can provide a mechanism to assess drug prescribing trends, efficiency, and cost-effectiveness of hospital formularies and examine subpopulations for which prescribing habits may be different. Such data can be used to correlate trends with time-dependent or seasonal changes in clinical event rates or the introduction of new pharmaceuticals. It is now possible to provide a robust, dynamic analysis of drug utilization in a large pediatric inpatient setting through the creation of a Web-based hospital drug utilization system that retrieves source data from our accounting database. The production implementation provides a dynamic and historical account of drug utilization at the authors' institution. The existing application can easily be extended to accommodate a multi-institution environment. The creation of a national or even global drug utilization network would facilitate the examination of geographical and/or socioeconomic influences in drug utilization and prescribing practices in general.     

Primary bone metastasis as initial presentation of endometrial cancer (stage IVb)

Introduction

Endometrial cancer is the most common malignancy among females in developed countries. Abnormal uterine bleeding is the leading symptom in approximately 90 % of cases. The incidence of stage IV disease is approximately 5–10 % with a 5-year overall survival of less than 10 %.

Materials and methods

A rare case presented with femoral pathological fracture and underlying endometrial cancer. We discuss the diagnosis, management and literature review for this extremely rare entity which can be present even in the absence of vaginal bleeding.

Results

Literature search revealed 28 cases with primary bone metastasis and all were symptomatic at the time of diagnosis. Eighty percent of them had tumour on the lower limb and the majority did not have vaginal bleeding. The predominant histopathological type was endometrioid (72.4 %) and grade 1–2 (59 %). Treatment had been individualised and 57 % of the cases underwent surgery with removal of uterus and adnexa and only three patients (10.7 %) received pelvic radiotherapy. Bone tumour was treated with radiotherapy in 80 % of the cases, alone (28 %), or combined with primary surgery (12 %) or chemotherapy (40 %). Overall, 54 % of patients received chemotherapy and 46 % received hormone therapy. The mean survival of patients who presented with single-bone metastasis was significantly better than those with multiple extrauterine metastatic sites: mean 85.7 months (SE: 9.2) versus 22.9 months (SE: 5.2), p < 0.003, CI 95 %. These two different survival patterns are more likely to reflect two different biological disease behaviours. Those with advanced local and widespread disease progress quicker, in contrast to those with a single-bone extrauterine metastatic site and local disease limited to the uterus, which continues to behave as early stage endometrial cancer.

Conclusions

Although extremely rare, endometrial cancer can present as initial bone pathology. Endometrial biopsy should be included in the patient’s workup when investigating for metastatic bone adenocarcinoma of unknown origin, even when gynaecological symptoms are lacking, as this rare presentation of stage IVb endometrial cancer appears to have good survival outcomes.     

丙肝：诊断与治疗

文章论述了丙型病毒性肝炎的易患因素、诊断、治疗及前沿研究。     

A comparative permeation/release study of different testosterone gel formulations

The major indication for testosterone (T) treatment is male hypogonadism that is characterized by low serum T concentrations. Although a recently developed hydroalcoholic gel, Androgel®, containing 1% T addresses many of the problems associated with the more conventional formulations, the bioavailability of T is only 10% requiring 5 to 10 g of gel to be applied daily. The present study was performed to investigate the effect of isopropyl alcohol (IPA) content as a penetration enhancer based on its ability to prevent skin dryness and in turn to increase T permeation from hydroalcoholic gels. Five different hydroalcoholic gel formulations, containing 1% T and carbopol as the gel-forming polymer, were formulated by varying the amount of IPA. The release of T from each gel, including Androgel®, was studied in vitro on Franz diffusion cells using cellulose ester and Celgard® 2400 as synthetic membranes and hairless guinea pig skin as a natural membrane. The amount of drug released from the gels was analyzed using an HPLC-UV method. The results of release/permeation studies on guinea pig skin showed that all the gels were similar to Androgel®, indicating that the addition of IPA does not affect the release of T from hydroalcoholic gels. Although no statistical significant difference was seen, the release profiles of the gels showed a trend of increasing release of T with increasing concentration of IPA. Thus, IPA does have a potential to increase the bioavailability of T from hydroalcoholic gels.     

Photoacoustic image reconstruction in an attenuating medium using singular-value decomposition

Attenuation effects can be significant in photoacoustic tomography since the generated pressure signals are broadband, and ignoring them may lead to image artifacts and blurring. La Rivie?re et al. [Opt. Lett. 31(6), pp. 781-783, (2006)] had previously derived a method for modeling the attenuation effect and correcting for it in the image reconstruction. This was done by relating the ideal, unattenuated pressure signals to the attenuated pressure signals via an integral operator. We derive an integral operator relating the attenuated pressure signals to the absorbed optical energy for a planar measurement geometry. The matrix operator relating the two quantities is a function of the temporal frequency, attenuation coefficient and the two-dimensional spatial frequency. We perform singular-value decomposition (SVD) of this integral operator to study the problem further. We find that the smallest singular values correspond to wavelet-like eigenvectors in which most of the energy is concentrated at times corresponding to greater depths in tissue. This allows us to characterize the ill-posedness of recovering the absorbed optical energy distribution at different depths in an attenuating medium. This integral equation can be inverted using standard SVD methods, and the initial pressure distribution can be recovered. We conduct simulations and derive an algorithm for image reconstruction using SVD for a planar measurement geometry. We also study the noise and resolution properties of this image-reconstruction method.     

Optimizing wavelength choice for quantitative optoacoustic imaging using the Cramer-Rao lower bound

Several papers have recently addressed the issue of estimating chromophore concentration in optoacoustic imaging (OAI) using multiple wavelengths. The choice of wavelengths obviously affects the accuracy and precision of the estimates. One might assume that the wavelengths that maximize the extinction coefficients of the chromophores would be the most suitable. However, this may not always be the case since the distribution of light intensity in the medium is also wavelength dependent. In this paper, we explore a method for optimizing the choice of wavelengths based on the Cramer-Rao lower bound (CRLB) on the variance of the chromophore concentration. This lower bound on variance can be evaluated numerically for different wavelengths using the variation of the extinction coefficients and scattering coefficients with wavelength. The wavelengths that give the smallest variance will be considered optimal for multi-wavelength OAI to estimate the chromophore concentrations. The expression for the CRLB has been derived analytically for estimating the concentration of multiple chromophores for several simple phantom models for the case when the optoacoustic signal is proportional to the product of the optical absorption and the illumination function. This approach could be easily extended to other geometries.