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Background: Unsafe patient events not only entail a clinical impact but also lead to economic burden in terms of prolonged hospitalization or unintended harm and delay in care delivery. Monitoring and time‐bound investigation of patient safety events (PSEs) is of paramount importance in a healthcare set‐up. Objectives: To explore the safety incident reporting behaviour and the barriers in a hospital set‐up. Methods: The study had two sections: (a) Retrospective assessment of all safety incidents in the past 1 year, and (b) Understanding the barriers of safety reporting by interviewing the major stakeholders in patient safety reporting framework. Further root cause analysis and failure mode effect analysis were performed for the situation observed. Results were statistically analyzed. Results: Of the total of 106 PSEs reported voluntarily to the system, the highest reporting functional group was that of nurses (40.57%), followed by physicians (18.87%) and pharmacists (17.92%). Among the various factors identified as barriers in safety incident reporting, fear of litigation was the most observed component. The most commonly observed event was those pertaining to medication management, followed by diagnostic delay. Glitches in healthcare delivery accounted for 8.73% of the total reported PSEs, followed by 5.72% of events occurring due to inter‐stakeholder communication errors. 4.22% of the PSEs were attributed to organizational managerial dysfunctionalities. Majority of medication‐related PSE has moderate risk prioritization gradation. Conclusion: Effective training and sensitization regarding the need to report the patient unsafe incidents or near misses to the healthcare system can help avert many untoward experiences. The notion of 'No Blame No Shame' should be well inculcated within the minds of each hospital unit such that even if an error occurs, its prompt reporting does not get harmed. [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]

Prescribing cascades entail misinterpreting drug-related adverse events as new medical problems, resulting in unnecessary prescriptions and potential harm, especially in the elderly, leading to adverse outcomes like falls, cognitive defects, and increased health-care costs. For geriatric patients with complex medical histories, the intricacies of symptom differentiation and polypharmacy poses further challenges. This report focuses on managing a geriatric patient with multiple conditions, highlighting the risks and complexities of prescribing cascades. [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]

The aging population is of growing concern all across the globe as well as in India. Polypharmacy has been defined as the simultaneous use of multiple medications by an individual and the clinical suitability of such use. Polypharmacy is found more frequently in the geriatric population. Researches in India have also reiterated the fact. Polypharmacy in the geriatric population leads to many negative consequences such as increased adverse drug reactions, falls, frailty, and even increased mortality. Moreover, it leads to increased out-of-pocket expenditure. Polypharmacy also poses risk of poor treatment adherence and missed dose in the geriatric population. Mitigation measures in this regard may include increased awareness among physicians, improved medication management and adherence, efforts to reduce self-medication, and improper crosspathy. [ABSTRACT FROM AUTHOR]

The recent pandemic outbreak of coronavirus disease 2019 (COVID-19) has left everyone baffled. The exponential rise in deaths worldwide, with such an extensive rapid spread, has made it a public health emergency. While the scientists at the frontier are untiringly putting their utmost efforts to come up with evidence-based pharmacological interventions, attempts have also been made to demystify the disease link with associated comorbidities and further risk prognostication. The presence of comorbidities has been documented to be associated with increased risk of developing acute respiratory diseases. Older hypertensives have been posed to be at greater risk of being affected, with associated complications and severity in grade. Diabetic and obese individuals have also been shown to be in increased risk of infections and other complications. Cytokine storm, a major complication of this disease, has also led to adverse renal outcomes. The present review aimed to probe the possible link between COVID-19 and various comorbidities. [ABSTRACT FROM AUTHOR]

BACKGROUND: Obesity has been an increasing problem globally, and attempts have been made to identify the best anthropometric predictor of chronic diseases in various populations. Owing to increased cost and methodological complexities, imaging diagnostics has been a challenge in resource constraint settings. Thus, anthropometric markers have been assumed to be a better predictor in this regard. Addressing the dearth of research in this arena from this part of the country, the present study was conducted in regular footballers who were assessed for their anthropometric parameters as a probable risk indicator for type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: This cross-sectional study involved 136 athletes, who were screened for risk factors and assessed for their measures such as height, weight, body circumferences, fat level, skeletal muscle, and skinfold thickness. Baseline laboratory investigations of serum glutamic-oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase, fasting glucose, and insulin were done. Homeostatic model assessment of insulin resistance (HOMA-IR) was assessed for all the participants. A 3-day dietary recall history was obtained from all respondents for calculation of total nutrient intake. RESULTS: The mean age of respondents was 13.96 ± 1.91 years. While body mass index was recorded in normal range for 41 participants, 94 were in the "under" range and 1 was overweight. The mean waist, hip, and mid-thigh circumferences were 65.8 cm, 72.15 cm, and 43.86 cm, respectively. HOMA-IR derangement was noted in 11 participants. Increased fasting glucose and SGOT levels were noted in 9 participants, respectively. CONCLUSION: Anthropometric measures may serve as an easy and inexpensive marker for T2DM prediction. However, assessment of its utility across genders and various subgroup populations mandates further research. [ABSTRACT FROM AUTHOR]

Cyclooxygenase inhibitors were developed in the quest of enhanced analgesic efficacy devoid of gastric side effects. High usage of etoricoxib by prescription as well as self-administered routes has led to increasing reports of side effects and adverse reactions including dermatologic reactions in 0.1%-0.3% of cases. The present report enumerates a case of toxic epidermal necrolysis induced by etoricoxib. [ABSTRACT FROM AUTHOR]

Introduction The COVID-19 pandemic had challenged every sphere of humankind, with research conduct being no exception. Methods An online survey-based observational study was conducted among ethics committee members pan India, who were connected through telephone/WhatsApp/email and requested to answer the survey questions. [Extracted from the article]

BACKGROUND: Besides unparalleled benefits, highly active antiretroviral therapy is also associated with wide range of potential adverse drug reactions (ADRs), which hinders treatment adherence. The present study was thus designed to monitor and explore the pattern of occurrence of ADRs to various antiretroviral therapy (ART) regimens in a tertiary care ART setup. MATERIALS AND METHODS: A prospective, observational clinical study was carried out in the outpatient setting of nodal ART center of Eastern India. A total of 610 patients on various ART regimens were studied for suspected ADRs over 12 months. Adverse event history, medication history, and other relevant details were captured. Causality and severity of each reported ADR were duly assessed. RESULTS: 32.45% patients of total study participants presented with a total of 330 ADRs. Patients from zidovudine-based regimens presented with majority of ADRs such as anemia (up to 36%), central nervous system (CNS), and gastrointestinal (GI) side effects. Tenofovir-based regimens were, however, found to be mildly safer. The combination with Efavirenz was associated with majorly CNS side effects while that of nevirapine was associated with rash and pigmentation of nails. Atazanavir boosted second-line regimens were notably associated with increased serum lipid levels followed by other GI and CNS adverse effects. Increased liver enzymes were found in atazanavir-based second-line ART. CONCLUSION: The study enables to obtain information on the incidence and pattern of ADRs associated with various antiretroviral regimens, thereby reducing its occurrence and protecting the patient population from avoidable harm. Need of intensive monitoring for ADRs in ARTs thus seems to be a mandate. [ABSTRACT FROM AUTHOR]

Leukocytoclastic vasculitis (LCV) may be secondary to drugs, underlying infection, collagen vascular disorders, or malignancy. Drug-induced vasculitis contributes to 10% of vasculitic skin lesions cases usually developing within 7-21 days of treatment initiation. The present case highlights a report of LCV in a 59-year-old male with a history of paranoid schizophrenia on clozapine therapy. The report upsurges the need to promote awareness and expedite diagnosis and treatment of drug-induced LCVs. [ABSTRACT FROM AUTHOR]

The recent upsurge of Zika virus infection has alarmed public health officials because of its possible association with thousands of suspected cases of microcephaly, thereby sparking a public health emergency. This mosquito-borne arboviral disease majorly remains asymptomatic. Unavailability of specific prophylaxis or vaccines or treatment necessitates the need to advocate preventive personal measures to get protected from these daytime bitters. Prevention and control measures should be aimed at reducing the vector density and minimizing the vector-patient contact. [ABSTRACT FROM AUTHOR]

Aim: Despite having better tolerability and a wide range of clinical applications over other antidepressants, selective serotonin reuptake inhibitors (SSRIs) are also known to be associated with serious adverse effects like suicidal ideation on chronic use. The present study had explored the impact of the chronic use of sertraline, an SSRI, on the behavioral changes in Wistar albino rats. Materials and Methods: The study was conducted on 30 Wistar albino rats of either sex; divided into ive groups. Four groups were subjected to chronic mild stress induced by using various stressors randomly scheduled in a week and continued for a period of 3 weeks. The stressed rodents were subjected to sertraline treatment for 9 weeks in different human therapeutic doses extrapolated to animal doses. Behavioral changes were monitored, assessed, and evaluated throughout the treatment phase with the help of tests such as locomotor activity test, forced swim test, tail suspension test, antianxiety test, and sucrose preference test (SPT). Results: All tests except SPT, demonstrated significant (P < 0.05) reduction in depressive-like activity in the stressed rodents by the mid-treatment phase, followed by an abrupt onset of the depressive state by the end of the treatment phase. SPT showed a signiicant (P < 0.05) increase in sucrose consumption throughout the treatment phase. Conclusion: Behavioral changes following chronic sertraline administration conferred gradual remission of depression state on initial treatment phase, followed by a reversal of effect on chronic use. [ABSTRACT FROM AUTHOR]

Aim: Despite having better tolerability and a wide range of clinical applications over other antidepressants, selective serotonin reuptake inhibitors (SSRIs) are also known to be associated with serious adverse effects like suicidal ideation on chronic use. The present study had explored the impact of the chronic use of sertraline, an SSRI, on the behavioral changes in Wistar albino rats. Materials and Methods: The study was conducted on 30 Wistar albino rats of either sex; divided into five groups. Four groups were subjected to chronic mild stress induced by using various stressors randomly scheduled in a week and continued for a period of 3 weeks. The stressed rodents were subjected to sertraline treatment for 9 weeks in different human therapeutic doses extrapolated to animal doses. Behavioral changes were monitored, assessed, and evaluated throughout the treatment phase with the help of tests such as locomotor activity test, forced swim test, tail suspension test, antianxiety test, and sucrose preference test (SPT). Results: All tests except SPT, demonstrated significant (P < 0.05) reduction in depressive-like activity in the stressed rodents by the mid-treatment phase, followed by an abrupt onset of the depressive state by the end of the treatment phase. SPT showed a significant (P < 0.05) increase in sucrose consumption throughout the treatment phase. Conclusion: Behavioral changes following chronic sertraline administration conferred gradual remission of depression state on initial treatment phase, followed by a reversal of effect on chronic use. [ABSTRACT FROM AUTHOR]

In its strongest resurgence since the pandemic of 2009, the influenza type A virus, known as H1N1, has broken out in different parts of India with deaths surpassing 1000 mark and number of affected cases exceeding 18,000 by the end of February 2015. Swine influenza spreads from person to person, either by inhaling the virus or by touching surfaces contaminated with the virus, then touching the mouth or nose. Symptoms occurring in infected human by H1N1 are like any other flu symptoms. Treatment is largely supportive and consists of bed rest, increased fluid consumption, cough suppressants, antipyretics and analgesics for fever and myalgias. Management largely includes the potential use of antiviral agents for patients presenting with illness due to influenza virus infection. If the illness is known or suspected to be due to a zoonotic influenza A virus, oseltamivir or zanamivir are treatment options. For known or suspected infection with avian influenza H5N1 virus, antiviral treatment should follow the World Health Organization (WHO) rapid advice guidelines on pharmacological management of humans infected with highly pathogenic avian influenza A (H5N1) virus. WHO also recommends vaccination of the high-risk group with seasonal influenza vaccine. Vaccination is recommended for health care workers working in close proximity to influenza patients are at higher risk of acquiring the disease. Since swine flu can directly be transmitted from one person to another through air droplets, people who fail to follow proper hygiene, especially in crowded places are at a high risk of contracting the virus. Proper preventive and control measures thus must be ensured. We have only limited treatment options, so rational use of the antiviral agent is very essential to avoid resistance and future complications. Health education and awareness among citizens should be transferred by proper mechanism. [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: The search for a protective antibody titer level to prevent coronavirus disease 2019 (COVID-19) infection, progression, and death is far from over. To date, no specific cut-off values have been established for these protective antibodies or neutralizing antibody (NAb) titers. NAb titers inhibit viral replication. Aim: To find out the prevailing NAb titre which might give protection from COVID-19 infection, or complication arising out of it. Material and methods: The data of COVID-19 patients with NAb titers who underwent reverse transcription polymerase chain reaction and presented with mild symptoms within 3 days after receiving the results were analyzed. The data were obtained from the clinic’s electronic database. Of the recruited patients, 63 were included in the final analysis. All statistical analyses were performed using SPSS v. 21. Results and discussion: A highly significant correlation (negative) existed between circulating NAb titer and duration of fever (P < 0.001); a positive significant correlation existed between the period from the 1st vaccine dose to the period of infection and the NAb titer level (P < 0.001). The NAb titer was significantly higher in the group that received both doses (P = 0.00016). Death and admission due to progression to moderate COVID-19 occurred in the group with a NAb titer of less than 10 U/L. Conclusions: The risk of complications and death due to COVID-19 may increase if the protective antibody level remains less than 10 U/L. The sample size used in this study was relatively small; therefore, this finding cannot be generalized. Hence, more robust studies should be performed to determine the appropriate protective NAb titer levels. [ABSTRACT FROM AUTHOR]

This study describes a patient diagnosed as a case of bipolar affective disorder complaining of bothersome incidence of pedal edema 1 month after the initiation of atypical antipsychotic regimen with risperidone and quetiapine. All hematological and biochemical profiles were found to be normal. On discontinuation of risperidone, the condition remained unresolved even after 2 weeks, and the edema progressed reaching her calves. On tapering the dose of quetiapine, she started showing gradual improvement in edematous condition. Quetiapine was slowly discontinued. No further recurrence of edema occurred, and hence, no further medication changes were implemented. Pedal edema was found to be resolved within weeks of dechallenge of the regimen. Naranjo adverse drug reaction probability scale gave a score of 7 which denotes "probable" adverse drug reaction with quetiapine. [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]

Background: Considering enterococci as an emerging important cause of nosocomial infections, and antibiotic resistance by Enterococcus as a major obstacle for treatment, determination of the prevalence of various Enterococcus species and their antibiotic resistance pattern among urinary isolates is very crucial and need of the hour. The present study tried to identify the burden of urinary tract infections (UTIs) caused by Enterococcus species and analyze the current antibiotic susceptibility patterns of the uropathogenic isolates and evaluate the risk factors. Methods: A cross-sectional study included all clinico-microbiologically diagnosed cases of admitted UTI cases. Hospital records were analyzed for the clinical background of the UTI cases, and urine sample was collected and processed for antibiotic susceptibility testing. Data were statistically analyzed. Results: Out of the 372 urine samples, Enterococcus spp. was identified in 13.44% of isolates as the causal uropathogen. Enterococcus faecalis was the predominant species identified, followed by Enterococcus faecium. Cases were mostly observed in clinical settings of sepsis followed by pyelonephritis and cystitis. Antimicrobial susceptibility profile showed that resistance was most frequently observed with norfloxacin followed by levofloxacin, ciprofloxacin, ampicillin, and high-level gentamicin. Linezolid showed maximum sensitivity, followed by vancomycin, nitrofurantoin, and others. Conclusion: The rise of multidrug-resistant (MDR) Enterococcus species is of particular concern in terms of antibiotic therapy. Speciation along with routine culture and sensitivity is essential to gather knowledge about the available antibiotics in MDR uropathogenic Enterococcus species, particularly oral choices. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus (GDM), a common medical condition affecting a high number of pregnant women worldwide, is characterized by high blood glucose levels that develop during pregnancy, usually in the second or third trimester, in women with no prior history of diabetes. While GDM usually resolves after delivery, it can have significant short-term and long-term adverse effects on both the mother and the fetus. Though insulin therapy is the recommended primary treatment, there exists limited evidence comparing the safety and effectiveness of different long-acting insulin analogues, including glargine U-100 and detemir insulin.The study aimed to compare the effectiveness and safety of long-acting insulin analogs, glargine U-100 and detemir insulin, in hyperglycemic pregnancy.This record-based observational study involved 64 subjects, with data collected from medical records. The study assessed demographic data, glycaemic parameters, incidence of hypoglycemia, and neonatal outcomes.The results showed that both insulins were effective in reducing glycaemic levels, but glargine U-100 was associated with better glycemic control, fewer hypoglycemic episodes and less need for dose intensification. The results showed that both insulins were safe when considering infants’ health assessed at 6 months.The study concluded that glargine U-100 may be a preferred treatment option for hyperglycemic pregnancy. Further studies are needed for optimizing treatment strategies in hyperglycemic pregnancies.Objective: Gestational diabetes mellitus (GDM), a common medical condition affecting a high number of pregnant women worldwide, is characterized by high blood glucose levels that develop during pregnancy, usually in the second or third trimester, in women with no prior history of diabetes. While GDM usually resolves after delivery, it can have significant short-term and long-term adverse effects on both the mother and the fetus. Though insulin therapy is the recommended primary treatment, there exists limited evidence comparing the safety and effectiveness of different long-acting insulin analogues, including glargine U-100 and detemir insulin.The study aimed to compare the effectiveness and safety of long-acting insulin analogs, glargine U-100 and detemir insulin, in hyperglycemic pregnancy.This record-based observational study involved 64 subjects, with data collected from medical records. The study assessed demographic data, glycaemic parameters, incidence of hypoglycemia, and neonatal outcomes.The results showed that both insulins were effective in reducing glycaemic levels, but glargine U-100 was associated with better glycemic control, fewer hypoglycemic episodes and less need for dose intensification. The results showed that both insulins were safe when considering infants’ health assessed at 6 months.The study concluded that glargine U-100 may be a preferred treatment option for hyperglycemic pregnancy. Further studies are needed for optimizing treatment strategies in hyperglycemic pregnancies.Methods: Gestational diabetes mellitus (GDM), a common medical condition affecting a high number of pregnant women worldwide, is characterized by high blood glucose levels that develop during pregnancy, usually in the second or third trimester, in women with no prior history of diabetes. While GDM usually resolves after delivery, it can have significant short-term and long-term adverse effects on both the mother and the fetus. Though insulin therapy is the recommended primary treatment, there exists limited evidence comparing the safety and effectiveness of different long-acting insulin analogues, including glargine U-100 and detemir insulin.The study aimed to compare the effectiveness and safety of long-acting insulin analogs, glargine U-100 and detemir insulin, in hyperglycemic pregnancy.This record-based observational study involved 64 subjects, with data collected from medical records. The study assessed demographic data, glycaemic parameters, incidence of hypoglycemia, and neonatal outcomes.The results showed that both insulins were effective in reducing glycaemic levels, but glargine U-100 was associated with better glycemic control, fewer hypoglycemic episodes and less need for dose intensification. The results showed that both insulins were safe when considering infants’ health assessed at 6 months.The study concluded that glargine U-100 may be a preferred treatment option for hyperglycemic pregnancy. Further studies are needed for optimizing treatment strategies in hyperglycemic pregnancies.Results: Gestational diabetes mellitus (GDM), a common medical condition affecting a high number of pregnant women worldwide, is characterized by high blood glucose levels that develop during pregnancy, usually in the second or third trimester, in women with no prior history of diabetes. While GDM usually resolves after delivery, it can have significant short-term and long-term adverse effects on both the mother and the fetus. Though insulin therapy is the recommended primary treatment, there exists limited evidence comparing the safety and effectiveness of different long-acting insulin analogues, including glargine U-100 and detemir insulin.The study aimed to compare the effectiveness and safety of long-acting insulin analogs, glargine U-100 and detemir insulin, in hyperglycemic pregnancy.This record-based observational study involved 64 subjects, with data collected from medical records. The study assessed demographic data, glycaemic parameters, incidence of hypoglycemia, and neonatal outcomes.The results showed that both insulins were effective in reducing glycaemic levels, but glargine U-100 was associated with better glycemic control, fewer hypoglycemic episodes and less need for dose intensification. The results showed that both insulins were safe when considering infants’ health assessed at 6 months.The study concluded that glargine U-100 may be a preferred treatment option for hyperglycemic pregnancy. Further studies are needed for optimizing treatment strategies in hyperglycemic pregnancies.Conclusion: Gestational diabetes mellitus (GDM), a common medical condition affecting a high number of pregnant women worldwide, is characterized by high blood glucose levels that develop during pregnancy, usually in the second or third trimester, in women with no prior history of diabetes. While GDM usually resolves after delivery, it can have significant short-term and long-term adverse effects on both the mother and the fetus. Though insulin therapy is the recommended primary treatment, there exists limited evidence comparing the safety and effectiveness of different long-acting insulin analogues, including glargine U-100 and detemir insulin.The study aimed to compare the effectiveness and safety of long-acting insulin analogs, glargine U-100 and detemir insulin, in hyperglycemic pregnancy.This record-based observational study involved 64 subjects, with data collected from medical records. The study assessed demographic data, glycaemic parameters, incidence of hypoglycemia, and neonatal outcomes.The results showed that both insulins were effective in reducing glycaemic levels, but glargine U-100 was associated with better glycemic control, fewer hypoglycemic episodes and less need for dose intensification. The results showed that both insulins were safe when considering infants’ health assessed at 6 months.The study concluded that glargine U-100 may be a preferred treatment option for hyperglycemic pregnancy. Further studies are needed for optimizing treatment strategies in hyperglycemic pregnancies. [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 and Objective: The emergence of resistance to drugs used to treat tuberculosis (TB), and particularly multidrug-resistant TB, has become a significant public health problem globally. In spite newer modalities for diagnosis and treatment of TB, unfortunately, millions of people are still suffering and dying from the disease. The present study was aimed to study the prevalence of initial drug resistance and the treatment outcome at the end of 6 months in TB patients attending a dedicated TB outpatient department (OPD) in North India. Materials and Methods: A cross-sectional, observational study was carried out on 100 patients of newly diagnosed pulmonary TB with or without glandular involvement attending TB OPD of a tertiary care hospital over a period of 6 months. Results: Culture positivity was encountered in 82% of the cases, while 14% were smear positive though culture negative. Out of all culture positive patients, 56.1% were susceptible to all antitubercular drugs, while 43.9% were resistant to one or other antitubercular drugs (isoniazid, rifampicin, streptomycin or ethambutol). Of the 46 drug-susceptible cases, 93.48% got cured, while 2.2% defaulted and 2.2% had treatment failure. About 86.1% of the 36 initial drug resistant were cured with 2RHZE/4RH, while 5.6% (n = 2) defaulted treatment and 8.3% were treatment failures. Conclusion: Treatment outcomes of this small group of drug-resistant pulmonary TB patients treated with the standardized regimen was encouraging in this setting. Close attention needs to be paid to ensure early identification of drug-resistant cases; good laboratory methodology and quality control measures; regular supply of quality antitubercular drugs; adherence to the prescribed regimen; effective patient education and counseling; and to the timely recognition and treatment of adverse drug reactions for better treatment outcome. [ABSTRACT FROM AUTHOR]

The sign and symptoms of coronavirus disease 2019 (COVID-19) and infectious disease caused by severe acute respiratory syndrome coronavirus 2 are not only restricted to the respiratory system but includes a myriad of clinical manifestations involving various systems. There are various sequelae of COVID-19 reported. Here, we report a series of three cases of tuberculosis along with new onset of diabetes mellitus and hypertension in previously euglycemic, normotensive patients following recovery from COVID-19. [ABSTRACT FROM AUTHOR]

Background: Granulomatous disorders of the skin are commonly encountered and pose a diagnostic challenge due to its diverse etiology with several histological patterns. Granulomatous diseases of skin comprise a large family sharing the common histological finding as of granuloma formation. The various histological types of granulomas can be identified on the basis of the constituent cells and other changes within the granulomas. However, significant overlap exists in histopathological findings of different granulomatous reactions. Thus, morphology alone is seldom specific and cannot be used as a diagnostic tool for the identification of specific diseases. A keen understanding of the manifestations, workup, and subsequent treatment of both infectious and noninfectious cutaneous granulomatous lesion is essential for every practicing clinician and dermatopathologist. Materials and Methods: A 2-year retrospective study involved all the skin biopsies. Detailed clinical and histopathological features were analyzed and were categorized according to the type of granuloma. Special stains were used in few cases for diagnostic purposes. Cases were reviewed and analyzed. Results: In histopathological subtyping, tuberculoid granuloma was the most common type and the most common etiology was leprosy. Others were cutaneous tuberculosis, foreign body granulomas, fungal lesions, cutaneous leishmaniasis, and granuloma annulare. Conclusion: Histopathology when combined with special stain can serve as a gold standard investigation for diagnosis, categorization, and clinicopathological correlation in such cases. [ABSTRACT FROM AUTHOR]