A Randomised Placebo Controlled Trial of Herbal Medicine (Sugaradik) in the Treatment of Type 2 Diabetes.

To evaluate the safety and effectiveness of polyherbal powder (Sugaradik) in achieving glycaemic control in newly diagnosed type 2 diabetics. Methods: It was a randomised double blind placebo controlled study. Eighty newly diagnosed patients of type 2 diabetes were selected after meeting inclusion and exclusion criteria. Patients were randomly divided into two groups. One group received drug and other group received placebo bearing a distinctive code number. Anthropometric parameters and HbA1c were performed initially as well as after three months of treatment period. Fasting blood sugar and blood pressure were recorded weekly. Student’s ‘t’ test was applied as statistical tool. Results: After three months of treatment of polyherbal powder (Sugaradik) there was a significant improvement in systolic blood pressure (136.05±3.30 to 126.42±1.51 mmHg) and fasting blood sugar (233.03±8.81 to 136.16±4.96 mg/dl; p less than 0.001). There was a significant reduction in HbA1c (8.39±0.30 to 6.37±0.10 percent; p less than 0.001). No adverse effects were observed in this trial. Conclusion: Polyherbal preparation of ten classic herbs appears to be effective in controlling glycemia. Sugaradik seems to be a safe drug and an effective oral agent in the management of type 2 diabetes.

Short Term Visual Prognosis After Retinal Laser Photocoagulation for Diabetic Retinopathy.

To assess the outcome of laser photocoagulation treatment for diabetic retinopathy in relation to various risk factors. Method: The change in visual acuity shortly after laser photocoagulation for diabetic retinopathy was assessed in 50 eyes of 25 patients and was compared to the age of onset of diabetes, type of retinopathy, pre treatment duration of diabetes, hypertension, microalbuminuria, smoking, dyslipedemia, associated complications of diabetes and type of treatment of diabetes. Results: Visual improvement was good in young diabetics, short duration of diabetes and parents having mild diabetic retinopathy. Factors having adverse effect on prognosis were longer duration of diabetes, hypertension, dyslipedemia, nephropathy and severe diabetic retinopathy. There was no significant influence of smoking, glycemic control, type of treatment, age of onset and sex of patients on visual outcome. Conclusion: Early diagnosis of retinopathy and initiation of specific treatment by laser photocoagulation at earlier stages with proper control of risk factors viz hypertension, dyslipidemia and nephropathy lead to a favourable visual outcome.

Serum magnesium: an early predictor of course and complications of diabetes mellitus.

The aim of this study was to evaluate relationship between serum magnesium and course of diabetes mellitus and also to find out, if there is any relation between serum magnesium and various complications of diabetes mellitus. A cross-sectional study was conducted to examine the relationship between serum magnesium in 50 type 1 and type 2 diabetic patients with or without complications and 40 normal healthy persons. Serum magneisum estimation was done using calmagite dye method using autoanalyser (Beckman DU clin systems). Serum magnesium levels in diabetic population was significantly low (1.93 +/- 0.282 meq/l) in comparison to control (2.25 +/- 0.429 meq/l). It was statistically significant (+3.84; p < 0.005). Serum magnesium was significantly low in diabetes with complication than without complications (p < 0.001). Duration of diabetes and serum magnesium were inversely related. Poor glycaemic control was associated with hypomagnesaemia (-2.623; p < 0.05). There was strong association between hypomagnesaemia and retinopathy (1.76 +/- 0.26), obesity (1.878 +/- 0.326) and hypertension (1.75 +/- 0.071) and it was statistically significantly (p < 0.005, 0.042, 0.000 respectively). Hence it is concluded that the change in serum magnesium level may have a bearing on the complication and morbidity in patients of diabetes mellitus.

A comparative study of regression of jaundice in patients of malaria and acute viral hepatitis.

BACKGROUND & OBJECTIVES: Jaundice is one of the common manifestations of severe malaria in adults. The purpose of this study is to compare the pattern of clinical and biochemical parameters such as serum bilirubin and liver enzyme levels in patients of malaria with jaundice and acute viral hepatitis. METHODOLOGY: The present study was conducted on 34 patients of malaria with jaundice and 15 patients of acute viral hepatitis. Estimation of serum bilirubin, aspartate amino transferase (AST), alanine amino transferase (ALT) and alkaline phosphatase was done daily using standard procedures in malaria patients and weekly in acute viral hepatitis patients. RESULTS: Mean level of serum bilirubin on first day in malaria and acute viral hepatitis patients was 7.07 +/- 3.94 and 10.38 +/- 7.87 mg%, whereas on Day 8 it was 1.19 +/- 1.43 and 7.88 +/- 7.02 mg% respectively. Mean level of AST on Day 1 in malaria and acute viral hepatitis patients was 158.47 +/- 120.35 and 1418.6 +/- 834.11 IU/L, whereas on Day 8 it was 41 +/- 28.33 and 775.3 +/- 399.01 IU/L respectively. Mean level of ALT on Day 1 in malaria and acute viral hepatitis patients was 220.14 +/- 145.61 and 1666.67 +/- 1112.77 IU/L, whereas on Day 8 it was 50.85 +/- 37.31 and 823.8 +/- 475.06 IU/L respectively. Mean level of serum alkaline phosphatase on Day 1 in malaria and acute viral hepatitis patients was 394.74 +/- 267.78 and 513.4 +/- 324.7 IU/L, whereas on Day 8 it was 84.76 +/- 68.50 and 369.27 +/- 207.75 IU/L respectively. INTERPRETATION & CONCLUSION: We observed that resolution of jaundice in malaria took 1-2 weeks in contrast 6 to 8 weeks in viral hepatitis. This difference in duration was statistically significant. Thus, jaundice not resolving in 1-2 weeks time in a patient of malaria requires serious consideration for presence of other concomitant diseases including viral hepatitis.

The changing spectrum of severe falciparum malaria: a clinical study from Bikaner (northwest India).

BACKGROUND & OBJECTIVES: Recently there were reports from all over India about changing spectrum of clinical presentation of severe malaria. The present study was planned to study the same in the northwest India. METHODS: This prospective study was conducted on patients of severe malaria admitted in a classified malaria ward of a tertiary care hospital in Bikaner, Rajasthan (northwest India) during 1994 and 2001. It included adult patients of both sexes belonging to all age groups. The diagnosis of Plasmodium falciparum was confirmed by demonstrating asexual form of parasites in peripheral blood smear. All patients were treated with i.v./oral quinine. The specific complications were treated by standard WHO protocol. The data for individual complications for both the years were analysed by applying chi-square test. RESULTS: In a prospective study in 1994 the spectrum of complication was dominated by cerebral malaria (25.75%) followed by jaundice (11.47%), bleeding tendencies (9.59%), severe anaemia (5.83%), shock (5.26%), Acute respiratory distress syndrome-ARDS (3.01%), renal failure (2.07%) and hypoglycemia (2.07%) whereas in 2001 it was dominated by jaundice (58.85%) followed by severe anaemia (26.04%), bleeding tendencies (25.52%), shock (10.94%), cerebral malaria (10.94%), renal failure (6.25%), ARDS (2.08%) and hypoglycemia (1.56%). The sharp difference for presence of jaundice and severe anaemia in 2001 and cerebral malaria in 1994 was statistically significant. Similarly, the important cause of mortality in 2001 was multiple organ dysfunction syndrome (71.10%) with predominant presentation of jaundice and renal failure, whereas in 1994, it was cerebral malaria (77.96%). INTERPRETATION & CONCLUSION: The observation of changing spectrum of severe malaria in this study and a significant increase in presentation with jaundice as an important manifestation is highly essential for primary, secondary and tertiary level health care providers for proper diagnosis and management.

A randomized placebo controlled trial of Inolter (herbal product) in the treatment of type 2 diabetes.

OBJECTIVE: To evaluate the safety and effectiveness of Inolter in achieving glycemic control and changes in lipid profile of newly diagnosed type 2 diabetics. MATERIAL AND METHODS: Study design: A randomized, placebo-controlled double blind. Sixty newly diagnosed patients of type-2 diabetes were randomized. Of these, 30 were put on Inolter monotherapy and 30 patients on placebo. Efficacy of Inolter was determined by observing glycemic control by estimating glycosylated haemoglobin (HbA1c) and fasting blood sugar (FBS), alteration of lipid profile by serum cholesterol, LDL, VLDL, HDL and triglycerides. STATISTICAL METHODS: Student's unpaired 't' test. RESULTS: Patients compliance was satisfactory and no adverse effects were observed. Better hypoglycemic effect was observed with Inolter both respect to fasting blood sugar (mean 65.4 +/- 63.72 mg/dl) compared to placebo (mean 26.45 +/- 38.3 mg/dl) (p < 0.001). The mean change, with Inolter, in serum cholesterol (21.33 +/- 26.05 mg/dl), serum triglyceride (30.36 +/- 32.62 mg/dl), VLDL (8.85 +/- 3.25 mg/dl), LDL (10.00 +/- 4.48 mg/dl) and HDL (-2.33 +/- 5.66 mg/dl) was also significantly different (p < 0.001) from those given placebo, where it was 15.7 +/- 20.14 mg/dl, 8.70 +/- 13.24, 0.10 +/- 4.10 mg/dl, -0.70 +/- 4.58 mg/dl and 0.65 +/- 0.00 mg/dl, respectively. CONCLUSION: Inolter appears to be an useful adjunctive therapy to exercise and diet control in newly diagnosed type 2 diabetes mellitus.

Ventilatory pulmonary function tests in type 1 diabetes mellitus.

OBJECTIVE: To study the ventilatory pulmonary function tests (VPFT) in type one diabetes mellitus and to correlate it with duration, meticulous metabolic control and various complications of diabetes. METHODOLOGY: Spirometric evaluation of 50 young (15-30 years of age) type one diabetes mellitus patients was done under the case control longitudinal study. After recording baseline parameters patients were subjected to PFT. OBSERVATIONS: Degree of derangement in VPFTs was directly related to duration and metabolic control of diabetes. VPFT parameters such as FVC, FEV1, PEFR, MEF 75% and MEF 25% showed significant reduction (p = 0.009, = 0.001, = 0.001, = 0.05 respectively). Similarly patients with HbA1c > 10% showed significant reduction in FVC, FEV1, PEFR and MEF 75% (p = 0.001 for each). Diabetic patients with complications particularly peripheral neuropathy and nephropathy had significant reduction in FVC, FEV1 and PEFR (p = 0.001). CONCLUSION: Spirometric evaluation in type one diabetes mellitus showed varying derangements in the different parameters of VPFTs, suggestive of dominantly restrictive with some obstructive pattern as indicated by significant decline in FVC, PEFR and MEF 75%.