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Among the various post-COVID sequelae, thyroid function impairment stands as a significant concern. COVID-19-related primary hypothyroidism has been documented in the literature. This study aimed to determine the number of cases with subclinical hypothyroidism and a history of moderate COVID-19 pneumonia who progressed to clinically overt hypothyroidism at six months. A prospective casecontrol study enrolled adult patients with known subclinical hypothyroidism and a history of moderate COVID-19 pneumonia as cases. Detailed medical history and physical examinations were conducted for all participants. Thyroid profiles, including free T4 and TSH, were measured at baseline and again at six months for all cases. The results revealed that 20% of cases with a history of moderate COVID-19 exhibited low free T4 levels at six months following infection, indicating progression from subclinical to clinical hypothyroidism. The mean TSH level at baseline was 7.29 mU/L, which increased to 8.76 mU/L at six months. New-onset symptoms were more prevalent in these cases compared to the controls. Furthermore, the mean baseline TSH level for cases progressing to clinical hypothyroidism was significantly higher (9.17 ± 0.63 mU/L) compared to those who did not progress (6.82 ± 1.16 mU/L; p<0.001). These findings suggest that patients with subclinical hypothyroidism and a history of moderate to severe COVID-19 pneumonia should undergo periodic monitoring to ensure timely treatment initiation if overt hypothyroidism develops. [ABSTRACT FROM AUTHOR]

Background: Neuropathy is one of the most common long-standing complications of diabetes, affecting over 50% of the diabetic individuals. Managing DPN and its complications involves comprehensive care and a multidisciplinary approach. Besides pharmacological treatments, botanicals and dietary supplements that have also been found to improve symptoms of DPN without affecting glucose control. The possible role of vitamin E in the management of DPN have been postulated in various studies. The present study thus aimed to prospectively assess whether add-on treatment with vitamin E can improve treatment outcomes in diabetic peripheral neuropathy. Methods: The study included newly diagnosed patients with diabetic peripheral neuropathy for a period of initial two months. Patients were randomly allocated to either standard treatment Group (Group A) or the intervention Group (Group B). As a part of intervention, patients received vitamin E 400mg once daily in addition to the standard of care. Efficacy Parameters measured at baseline, 6 months and 12 months included changes in visual analog scoring, mean pain score, brief pain inventory and patient’s global impression of change. Treatment safety, quality of life and treatment adherence was assessed. Data was statistically analysed. Result: The study included a total of 100 patients, 50 patients in each Group. Significantly higher decrease of glycaemic measures was noted for Group B compared to Group A in terms of PPPG and serum creatinine, however, there was comparable change in HbA1c and FPG for both Groups. There was comparable significant reduction in mean VAS scoring at 6 and 12 months for Group B. Considering all the efficacy measures, there was highest reduction for the pain interference in the intervention arm (Group B), in comparison to Group A. (p<0.001). Quality of life measures and mean adherence scoring significantly increased for treatment group B as compared to A at both 6 months and 12 months of study assessments. No major safety concerns were reported during the study period. Conclusion: Our study noted that addition of vitamin E as an added supplementation to the standard of care showed benefits in terms of patient reported reduced pain interference and pain perception, which also significantly improved overall quality of life in these patients. [ABSTRACT FROM AUTHOR]

Background: Non-alcoholic fatty liver disease (NAFLD) is an influential cause of liver disease burden. However, there is no evidence-based standard of care. Considering that oxidative stress and diet deficiency of choline plays a role in the pathophysiology of hepatic damage, natural compounds such as silymarin, choline, and ursodeoxycholic acid (UDCA) represent popular therapeutic options. Aims and Objectives: The present study aimed to compare the efficacy, safety, and adherence of the silymarin-choline combination and UDCA in patients with NAFLD. Materials and Methods: A double-blind parallel arm study where 88 NAFLDdiagnosed patients were randomized to receive either silymarin-choline bitartrate or UDCA for 6 months, along with lifestyle modification recommendations. Weight, body mass index, liver enzyme levels, lipid profile parameters, homeostatic model assessment of insulin resistance, liver stiffness measurement, and liver biopsy were monitored at baseline and 6 months. Adverse events and adherence were monitored. Results: A total of 39 patients received a tablet of silymarin-choline bitartrate, while 40 received UDCA. A significant improvement was observed in aspartate aminotransferase (U/L) levels from 54.18 (17.02) to 37.23 (9.94) (P=0.000), NAFLD activity score from 6.5 (0.37) to 2.7 (1.26) (P=0.000), and transient elastography (kilopascal) scores, more in patients receiving the silymarincholine combination, whereas for those receiving UDCA, a significant improvement was observed in total cholesterol (mg/dL) from 187.88 (27.49) to 171.45 (28.47) (P=0.000) and low-density lipoprotein levels. No major safety issues were observed in both groups. Conclusion: NAFLD is currently treated by treating associated comorbidities, which cannot always stop its progression. Silymarin-choline bitartrate can be used as a better alternative to UDCA for the treatment of NAFLD. [ABSTRACT FROM AUTHOR]

This article discusses a case of disseminated tuberculosis in a patient with beta-thalassaemia major and uncontrolled type 1 diabetes mellitus. Beta-thalassaemia is a genetic blood disorder that can lead to iron overload in various organs, including the pancreas, which can result in abnormal glucose metabolism and diabetes. The patient in this case was a 31-year-old woman with beta-thalassaemia major and type 1 diabetes who presented with fever, cough, and sputum production. Laboratory tests confirmed the diagnosis of tuberculosis, and the patient was treated with anti-TB medication. The article highlights the rare association between beta-thalassaemia major, type 1 diabetes, and disseminated TB. [Extracted from the article]

Introduction: Diabetic autonomic neuropathy (DAN), a serious complication of diabetes, is a significant contributor to increased morbidity and mortality. Although DAN often coexists with different peripheral neuropathies and other complications, it may also present in isolation. The present study aimed to understand the DAN status of a cohort of ambulatory type 2 diabetics in a tertiary care setting. Methods: A single-arm prospective observational study was carried out, where enrolled patients were interviewed for basic demographics and comorbidities, screened for symptoms of autonomic dysregulation, and other risk factors such as smoking and alcoholism. Based on the presence of overt symptoms, they were divided into two groups with or without any overt symptoms of autonomic neuropathy. Both groups were subjected to a battery of autonomic neuropathy tests, and their DAN status was characterized based on the observed scores. Results: The overall prevalence of DAN, as observed in our study, was 36%. Of 108 patients, 97 presented with one or more symptoms of autonomic dysregulation, whereas the rest, 10.1%, were without any symptoms. Among heart rate-based tests, a significant (P < 0.001) decrease followed by an increase in the Valsalva ratio was observed in 6 months and 12 months, respectively. A significant decrease (P < 0.001) in deep breathing test (E: I) values was observed in the 12th month. Most of the DAN patients presented with moderate autonomic dysfunction, followed by mild and severe, respectively. However, no significant change in DAN severity was noted with time. Conclusion: Using simple cardiovascular tests, DAN can be detected during the asymptomatic phase of the disease. [ABSTRACT FROM AUTHOR]

Background: Several studies have proved the advantages of second-generation insulin analogs in lowering intra-individual variability in plasma insulin levels, flexibility in dosing, a sustained glucose-lowering effect, and decreasing the risk of hypoglycemia. Glargine 300 is one of the newer second-generation basal insulin analogs to have been approved for both type 1 and 2 diabetes. The present study aims to assess the real-world clinical effectiveness and safety of Glargine U300 (Toujeo®) initiation after oral antidiabetic drug failure in insulin-naïve patients with T2DM. Methods: A prospective, observational study was conducted where participants were interviewed regarding their basic demographics, body weight, and treatment details. Glycemic parameters (HbA1C%, Fasting Plasma Glucose, and Post Prandial Blood Glucose) were observed in the initial 6 months, and changes were noted and compared. Any hypoglycemic events or other complications were also noted. Data collected were statistically analyzed. Results: The study included a total of 188 patients. Treatment with glargine 300 significantly reduced the mean HbA1C level from 9.78% at baseline to 7.90% at the end of 6 months of treatment (p < 0.001). 10.60% of patients achieved the glycemic target of ≤7.0% by the end of 6 months, while only 6.90% were within the target range at baseline. Similarly, significant reduction in FPG was observed at the end of 6 months treatment period with Glargine U300. A significant increase in dose requirement was observed throughout the study phase (p < 0.001). Incidence of hypoglycemia was noted in 2.12% of subjects. Conclusion: The lower incidence statistics of hypoglycemia coupled with sustained positive glycemic effects, stands out to be a prominent advantage of Glargine U300 over its other congeners. [ABSTRACT FROM AUTHOR]

Background: Branded generics offer comparable therapeutic benefits at a lower cost, making them essential in healthcare systems worldwide. Vildagliptin, a widely prescribed antidiabetic medication, is available in various branded generic forms. However, limited research has been conducted to assess the availability of these branded generics, particularly in a real-world setting. Methods: A crosssectional observational study evaluated the availability of branded generics of vildagliptin over 3-month period post 6 months of offpatenting of vildagliptin. Additionally, the switching patterns among patients prescribed branded generic vildagliptin were investigated, shedding light on potential challenges and implications for patient care. Results: Each prescription for branded generic vildagliptin resulted in an average of 2.29 pharmacy visits, highlighting potential challenges in ensuring consistent availability of specific branded generics. Reflecting on switching patterns, due to the unavailability of the prescribed branded generic vildagliptin at the pharmacy store, 28% of patients switched to the innovator brand, 41% switched to other branded generics, and only 31% received the prescribed branded generic. These switching patterns suggest a significant proportion of patients who deviate from the initially prescribed branded generic, potentially impacting treatment adherence and outcomes. Conclusion: Strategies aimed at improving availability and promoting appropriate use of branded generics can enhance the overall quality of care for patients requiring vildagliptin treatment. Further research and interventions should be undertaken to improve coordination between healthcare providers, pharmaceutical companies, and pharmacy stores, aiming to enhance the availability and accessibility of affordable generics without compromising patient care. [ABSTRACT FROM AUTHOR]

An increasing body of research implies that emergency department (ED) physicians fail to identify drug-related ED visits due to the department's hectic workflow. In cases of poisoning or drug intoxications, the offending agent(s) may not be identified during the acute and possibly critical period of the exposure. For cases of suicidal incidents, laboratory assistances in identifying the offending chemical are not promptly available. The diagnosis of "toxidromes" is, therefore, an acceptable clinical diagnostic method that has been pioneered by clinical toxicologists. The present case has emphasized the need for applying clinical pharmacology principles in the early detection of drug-induced ED visits. [ABSTRACT FROM AUTHOR]

Introduction: Fixed-dose combination containing triple antihypertensive agents (Angiotensin-Converting Enzyme Inhibitor (ACE-I)/Angiotensin Receptor Blocker (ARB), diuretic and Calcium Channel Blocker (CCB)) is recommended to achieve target Blood-Pressure (BP). However, none of the study has compared ACE-I based and ARB-based triple fixed dose combinations. Aim: To evaluate the effectiveness and safety of fixed-dose combination of Perindopril (Per)/Amlodipine (Aml)/Indapamide (Ind) and Telmisartan (Tel)/Aml/Chlorthalidone (Chl) in grade-2 hypertensive patients at high Cardiovascular (CV) risk. Materials and Methods: This retrospective, observational, single-centre study enrolled treatment-naïve grade-2 hypertensive patients who were at high CV risk and were treated with ACE-I based (Per/Aml/Ind; Per/Aml/Ind group) or ARB-based (Tel/Aml/Chl; Tel/Aml/Chl group) triple fixeddose combination for atleast one-month at the study centre. Office Blood Pressure (BP) at one-month follow-up was used as a parameter to measure treatment effectiveness. Safety was assessed based on the occurrence of Adverse Events (AEs). Results: A total of 69 patients (n=32 in Per/Aml/Ind group and n=37 in Tel/Aml/Chl group) were included. Office Systolic BP (SBP)/Diastolic BP (DBP) were 181.44±8.52/95.19±7.25 mmHg and 183.32±6.65/94.81±7.14 mmHg in patients belonging to Per/Aml/Ind and Tel/Aml/Chl groups, respectively. There was a significant reduction in office SBP/DBP at one-month follow-up (Per/Aml/Ind: 129.31±6.44/75.06±4.85 mmHg and Tel/Aml/Chl: 129.10±5.90/75.00±4.82 mmHg; p-value=0.0001). Between-group comparisons did not showed any significant difference in terms of reducing office BP. Both groups exhibited identical safety profile. Conclusion: The study demonstrated comparable treatment effectiveness and safety profile with triple fixed dose combinations containing Per/Aml/Ind and Tel/Aml/Chl in a real-world setting. [ABSTRACT FROM AUTHOR]

Byline: Sukalyan. Roy, Shatavisa. Mukherjee, Nikhil. Era, Mala. Mukherjee Cyclooxygenase inhibitors were developed in the quest of enhanced analgesic efficacy devoid of gastric side effects. High usage of etoricoxib by [...]